Mild Traumatic Brain Injury: Concussion in Youth Soccer

Transcription

1 Mild Traumatic Brain Injury: Concussion in Youth Soccer Stephanie Arlis-Mayor, MD Center for Orthopaedics Director, Center for Sports Concussion May 1, 2015

2 What is a Concussion Concussions can occur in any sport and all concussions are serious Concussions can occur without loss of consciousness Repeat concussions can result in brain

3 Who gets injured

4 Who gets injured Injuries 4x more likely in games than practices Advanced level players more likely to get injured More injuries in older players (over age 13)

5 Prevention

6 Pre-Season Evaluation Baseline evaluations Prior History Communication Athletes, Parents, Coaches, Teachers Equipment

7 Pre-Season Evaluation Baselines SAC SCAT3 BESS Neuropsychological Testing

8 Pre-Season Evaluation Baselines SCAT3: Sport Concussion Assessment Tool 3 Standardized for ages 10 and up 8 sections: Total potential score 100 Symptom evaluation Physical signs Glasgow coma scale Maddocks score: sideline assessment Cognitive assessment Balance examination Coordination examination Cognitive assessment of delayed recall

9 Pre-Season Evaluation Baselines Balance Error Scoring System BESS o Three 20 sec. tests repeated on 2 surfaces: firm/foam o Trials: Double leg Single leg Heel toe tandem

10 Pre-Season Evaluation Baselines Neuropsychological Testing ANAM: Automated Neuropsychological Assessment Metrics Sports Medicine Battery CogState Sport/Axon Sport ImPACT: Immediate Postconcussion Assessment and Cognitive Testing

11 Pre-Season Evaluation Baselines Neuropsychological Testing Always starts with normative comparison Helps control for individual factors such as Learning disabilities, ADHD, Medications Can be done in large groups with educational seminars Orients athletes to concussion information, risks and procedures at start of season

12 Pre-Season Evaluation Prior History Number of prior incidents of mtbi Severity of symptoms Duration of symptoms

13 Pre-Season Evaluation Uniform and equipment Make sure it fits! Field safety with regular and frequent inspections Properly trained referees New Developments Reinforce correct Technique Proper heading technique Fitness training in women Increase neck and upper back strength

14 Pre-Season Evaluation Communication Opportunity to educate Estimate that 50% of concussions are not reported Unaware of symptoms Not wanting to be withheld from competition Did not think injury was serious Not wanting to let teammates down.

15 Pre-Season Evaluation Communication Educate parents, coaches and athletes It s better to miss one game than the whole season

16 Evaluation of Head Injury Always assume a neck injury Remove player from the game for observation Always inform the player s parents about any injury, even if it is minor If you think your athlete has sustained a concussion take him/her out of play, and seek the advice of a health care professional experienced in evaluating for concussion.

17 Symptoms and Signs of Acute concussion Somatic or Physical Behavioral changes Cognitive impairment Sleep disturbance

18 Signs and Symptoms: Observed Appears dazed or stunned Confused about assignment Forgets plays Unsure of game, score, or opponent Moves clumsily Answers questions slowly Loss of consciousness Shows behavior or personality changes Can t recall events prior to hit Can t recall events after hit

19 Signs and Symptoms Reported by Athletes Headache Nausea Balance problems or dizziness Fuzzy Vision Sensitivity to Light or Noise Feeling Sluggish Feeling Foggy or Groggy Concentration or memory problems Confusion

20 Signs and Symptoms can be delayed Athletes sidelined during a game should be checked often when suspected of having a concussion Athletes should be checked on during the night by their parents if they are suspected of having a concussion The athletes should be transported to the hospital if there are ANY worsening of signs or symptoms

21 Treating Concussion The cornerstone of concussion management is physical and cognitive rest until symptoms resolve

22 Why REST? ANY activity that increases blood flow to the brain will cause symptoms, and should be avoided!

23 Recovery from concussion All concussions are different Concussion treatment should be individualized Everyone recovers in a different time frame Studies have shown that adolescent and preadolescent athletes take longer to recover from concussion than adults.

24 Comprehensive Team Approach Behavioral therapy Neuro radiology Physical Medicine and Rehab Exertional Physical Therapy PCP; Primary Care Sports Medicine; Neuropsych ology Vestibular Therapy Orthopedic Neuro surgery Neuro ophthalmo logy

25 Management and Return to Classroom Excused absences from class Rest periods during the school day Extensions of assignment deadlines Postponement or staggering of tests Excuse from certain tests Extended time on timed tests Accommodate oversensitivity to light/noise Excuse for physical education activities Use of tape recorded test or a test reader

26 Management and Return to Classroom Opportunity to take verbal tests rather than written tests Smaller quieter exam rooms to decrease stimulation Preferential classroom seating Temporary assistance with tutor to help with organizing and prioritizing school work Hall pass Elevator pass Lunch room accommodations

27 Management and Return to Play Graduated Return to Play Protocol: Athlete can continue to proceed to the next level if asymptomatic at the current level. Generally each step should take 24 hours so the athlete would take approximately one week to rehab. If symptoms occur in one step, then patient should drop back to the previous asymptomatic level and try to progress after a further 24 hour period.

28 Management and Return to Play No activity Complete physical and cognitive rest Light aerobic exercise Walking, swimming, intensity <70% MPHR, no resistance training Sport- specific exercise Skating drills, running drills, no head impact activities Non contact training drills Progression to more involved complex training drills, may start progressive resistance training Full contact practice Following medical evaluation, and fully asymptomatic participate in all training activities Return to play Normal game play

29 Risks of Returning to Participation Too Soon Someone who is not fully recovered from a concussion is much more likely to sustain another concussion The second concussion often causes worse symptoms that will last longer.

30 Complications of Concussion: Second Impact Syndrome: Severe, debilitating traumatic brain injury occurring from second concussion occurring before brain has healed from prior concussion Sudden death Post-Concussive Syndrome: Symptoms lasting more that one month after injury Sleep issues, fatigue Headaches and vertigo Concentration and Memory issues Depression or other psychiatric problems

31 Complications of Concussions Chronic Traumatic Encephalopathy or CTE

32 When Can I Go Back to Play? As determined by a medical professional No symptoms at rest and with everyday activities No symptoms with exertion (cognitive and physical) No symptoms with gradual return to play guidelines Neuro-cognitive testing can be a useful tool in demonstrating neuro-

33 The 5 R s of Concussions Recognize that a concussion has occurred Remove the person immediately from activity Refer the individual for medical care Rest (physical and cognitive) is the treatment Return to activity after full recovery

34 THANK YOU Center for Sports Concussion Management Branford, Hamden, Orange, Norwalk