Concussions in High School Athletics. John F. Kosowicz Jr., ATC

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1 Concussions in High School Athletics John F. Kosowicz Jr., ATC

2 What is an Athletic Trainer - Directly responsible for all phases of health care in an athletic environment - Six performance domains established by NATABOC 1. Prevention of athletic injuries 2. Recognition, evaluation, and assessment of injuries 3. Immediate Care of injuries 4. Treatment, rehabilitation, and reconditioning of athletic injuries 5. Health Care Administration 6. Professional development and responsibility - knowledgeable in a variety of specialties encompassed under the "umbrella" of sports medicine.

3 What does this mean? Basically I am there; 1. BEFORE they get injured 2. WHILE they are injured 3. AFTER they are injured ** EVERYTHING in between ** This includes Prevention and Management of Concussions

4 What is a Concussion - most common type of Traumatic Brain Injury known as (MTBI) - a head injury that significantly impacts the way a healthy brain functions resulting in a variety of physical, cognitive, and emotional symptoms - if left untreated, concussions can lead to permanant brain damage or even death

5 Causes of MTBI's Two main causes: 1. Direct blow to head ("coup" and "contrecoup") 2. Rotational or Acceleration force What happens? - if a head or face is struck with enough force it will cause brain to shift and contact skull resulting in brain swelling and intracranial pressure

7 Signs and Symptoms Physical: - Headache (most common) - Dizziness - Nausea/Vomitting - Lack of Motor Control - Balance Difficulty - Light Sens, Blurred/Double Vision - Uneven Pupils - Ringing in Ears - Slurred/Incoherant Speech - Loss of Consciousness Cognitive: - Confusion - Disorientation - Difficulty focusing attention - Amnesia Emotional: - Irritability - Tearfulness - Emotion inappropriate to situation - Restlessness - Lethargy

8 Post Concussion Syndrome - symptoms that do not resolve, following a concussion, for weeks, months, years or in some instances may be permanant - Headaches, Dizziness, Fatigue, Anxiety, Memory and Attention Problems, Sleep Problem, Irritability - No scientifically established treatment --> Rest

Rapid increase of intracranial pressure * Mortality Rate --> approaches 50% * Morbidity

9 Second Impact Syndrome - Medical Emergency! - a second concussion before the intitial has fully healed - Dangerous Brain Swelling and Rapid increase of intracranial pressure * Mortality Rate --> approaches 50% * Morbidity (Disability) --> almost 100% - persistant muscles spasms, emotional instability, hallucinations, epilepsy, mental disorders, paralysis, coma, brain death

include psychiatric disorders and Long-term memory - Clinical Depression, Alzheimers

10 Cumulative Effects of Multiple Concussions - studies have shown the severity of concussions and their symptoms may worsen with each successive injury - Effects may include psychiatric disorders and Long-term memory - Clinical Depression, Alzheimers (study-fivefold), Memory Deficets, Disability (Dave Duerson and Jack Dempsey-DP or boxers dementia)

11 "Concussion Management and Awareness Act" - Signed by Governor into law Sept. 19, Directs Comissioners of Education and Health to adopt rules and regulations for the treatment and monitoring of students with MTBI's * Effective July 1, > WSD has adopted immediate compliance

12 The "Meat and Potatoes" of the Legislation 1. Promulgate, implement, and update rules and regulations 2. Establish an informational pamphlet -signed by parents stating they have recieved and understood- prior to any participation 3. Formation of a District Concussion Management Team - charged with implementaion - Athletic Trainer, School Nurse, AD, Principal, etc *4. When in doubt, it shall be assumed Athlete has sustained a concussion *5. Minimal Guidelines: Return to play (RTP) requires symptom-free for 24hrs and written and signed authorization from a physician

13 Justification for Legislation According to Centers for Disease Control and Prevention: 1. MTBI's are a contributing factor in 1/3 of all injury-related deaths *2. It is estimated that the treatment of sport-related concussions for children age 5-18 is 135,000 yearly According to National Center for Injury Prevention: 1. 47% of all HS Football players recieve a concussion each season 2. Statistically, the risk of future concussions increase significantly with each sucessive concussion *3. Children and teens, in general, are more likely to get a concussion and have longer recovery time than adults.

15 Washingtonville Concussion Management Policy 1. Any Head or Facial Injury that results in any concussion sign or symptom, however minor or brief, requires immediate removal from competition 2. All such incidents require Physician evaluation before RTP 3. Physician will determine and RTP is as follows; A) No Concussion B) Concussion 1. written and signed authorization to RTP with no restrictions 2. No practice for 24hrs

16 * All requirements must be met to RTP RTP for a Concussion 1. Written and signed authorization to RTP without restrictions 2. Minor AND First Concussion - symptom-free + 1 Week Severe OR History of Concussions - symptom-free + 2 Weeks - followed by - 3. "Tiers of Physical Activity" 1. Light Cadio (bike, jog 1 mile) --> evaluate 2. Sport-specific Drills -Non-contact (dribbling, shooting, passing) --> evaluate 3. Sport-specific Drills -Contact (one-one drills, no scrimmage) --> evaluate 4. Full Practice --> evaluate 4. Concussion Management Team clears Athlete to RTP

17 Thank You!

WISD Athletic Department Guidelines for Concussion Management

WISD Athletic Department Guidelines for Concussion Management Introduction Approximately 10 percent of all athletes involved in contact sports suffer a Mild Traumatic Brain Injury (concussion) each season;