Berlin 2016 SRC. Concussion Management: An Update 7/26/2017. Sport related concussion. mtbi often used. Rapid onset, short lived

Transcription

1 Concussion Management: An Update Jeff Sellman, MD, CAQSM Primary Care Sports Medicine Physician Florida Orthopedic Institute July 22, 2017 Berlin th International conference on concussion in sport 60,000 articles screened Management of SRC Offers a guide SRC Sport related concussion mtbi often used Rapid onset, short lived Functional disturbance, not a structural abnormality Direct blow or impulsive force transmitted to the head Large range of signs and symptoms not explained by drug, alcohol or medication use, other injuries with/without LOC 1

2 Diagnosis No perfect diagnostic test nor marker Sideline/immediate assessment SCAT5 (memory and balance) Clinical signs and symptoms Somatic, cognitive, emotional, physical, balance, behavioral Immediate removal if SRC Reassessment in ED or doctor s office Detailed neurological exam, VOMS SRC Clinical Trajectories Vestibular Anxiety/Mood Cervical Ocular Post Traumatic migraine Cognitive/Fatigue Smooth pursuit Saccades Gaze stability Convergence Accommodation Optokinetic stimulation VOMS 2

3 Neuropsychological Assessment ImPACT testing Aid to clinical decision making Not a diagnostic tool Cognitive recovery often lags behind clinical symptom resolution Return to Play Symptom limited activities Daily symptom free activities Light aerobic exercise Walking, stationary bike. No resistance training. Sport specific exercise Running or skating drills Non contact drills Passing drills, running routes, plays Full contact practice Functional assessment by coaches Normal game play Return to Learn Daily home activities symptom free Start with 5 15 minutes, increasing in same increments School activities Homework, reading Part time school Partial day with increased breaks Full time school Gradual return to full academic activities 3

4 Early Movement Cocooning Based on symptoms Therapy 10 15% SRC require treatment Physical Speech and language (cognitive) Occupational Physical Therapy Non contact PT helpful, even with symptoms Balance, coordination, vestibular system, reaction time, multitasking, peripheral awareness and the relationship to symptoms Sport specific strategies 4

5 Sports Specific Walking without looking at your feet (eye foot coordination) Catching a ball without looking at your hand (eye hand coordination) Reacting to objects thrown at different angles Deflecting/catching beach balls quickly and answering math questions at the same time (multitasking) Listening to instructions while taking notes (recovery from interruptions) Cognitive Therapy Speech and language therapy Perception, fine motor skills, handwriting, learning, memory retention, recall, comprehension Adaptation to the school setting Occupational Therapy Visual motor skills Fine motor control 5

6 Visual Therapy Saccades Exercise Vertical and Horizontal 2 sticky notes on wall, 12 inches apart, stand 3 feet in center, keep head still move eyes up and down or left to right quickly for 1 minute, 3 times a day Vestibular Ocular Exercise Head movements up and down, side to side, then diagonal to right and left 5 times, 2 times a day Gaze stabilization, sticky note with capital letter, stand 3 feet from wall, keep eyes on note and move head up and down or side to side for one minute, 3 times a day Eye Head Movements Hold thumb out at comfortable distance, thumbnail in focus, move thumb from side to side and up and down and follow with your eyes and head as a unit, 3 5 reps in each direction Supplemental Help Cognitive/neuronal support Fish oil/omega 3 5,000mg 3 times daily x 10 days 5,000mg 2 times daily x 10 days 5,000mg 1 time daily x 10 days Headache relief Coenzyme Q10 160mg once daily Riboflavin 400mg once daily Magnesium oxide 400mg 1 2 times daily D ribose 4mg once daily Insomnia Melatonin 3 5mg at bedtime Depression/Anxiety St John s Wort 900mg twice daily Turmeric 500mg twice daily Alpha lipoid acid mg twice daily Summary SRC Early and immediate recognition No same day return Neuropsychological testing helpful with management Return to learn and return to play are separate Early movement once symptoms allow Therapy if indicated 6

7 When it comes to concussion, don t believe a word that comes out of my mouth. NFL Athlete,