2014 Concussion Connection

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3 Concussion Connection is an online resource that strives to provide education and awareness about concussions while being a support for athletes as they recover from one or more concussions. Concussion Connection was founded in August of 2013 by Lauren Long and Samantha Sanderson whose paths crossed after years of recovery for Lauren and after Samantha endured multiple concussions. Concussion Connection was born out of the desire to create a culture of awareness around this invisible injury. Concussion Connection provides a way for athletes to share their journeys as they recover, and educate athletes, parents, coaches, and the general public about risk and prevention of concussions. Concussion Connection strives to keep the public up to date on information and research in the concussion field by assembling an Expert Panel that includes multiple disciplines. The management of concussions is complex and requires cooperation across various fields. Concussion Connection s Expert Panel includes areas of Sports Medicine, Sport Psychology, Athletic Training, and Professional Athlete. The Expert Panel will continue to grow with the intricacies of concussions. Concussion Connection uses a platform for athletes called Share Your Story that allows athletes to write their concussion journey in their own words and include their picture so there is a face with the story. A feature is provided once a week and the athlete can choose to receive messages from visitors through a contact box for encouragement and support. There are numerous athletes who have unique concussion journeys to share. Telling their stories in their own words not only serves as an outlet for the athlete, but as an opportunity for athletes to know they are not alone and receive support from others who understand the concussion journey. Concussion Connection makes every effort to keep the public up to date on recent news and stories surrounding concussions. Reviews are provided on recent research to bring information to the forefront that otherwise may be overlooked or inaccessible. Concussion Connection provides a space for athletes to connect with other athletes through a support forum where various topics of concussions are covered. The support forum will adapt in order to best serve athletes as we come to better understand how peer support aids in the recovery process.

4 This PocketGuide should be used as an educational resource only. Always consult a licensed health care professional who is trained in the evaluation and management of concussion. Photographs by Lauren Long Content by Samantha Sanderson 2014 Concussion Connection

Concussion 1 A concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces.

5 Concussion 1 A concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. A concussion can be caused by a direct blow to the head or other part of the body that causes a force to be transmitted to the head. The onset of symptoms may be rapid or take hours to manifest. Acute symptoms of a concussion reflect a functional change in the brain rather than a structural change which results in no evidence of injury on neuroimaging scans. A concussion results in a set of symptoms that resolve in a sequential manner depending on the individual. Symptoms may or may not include loss of consciousness. McCrory, et al. (2013)

2 Signs & Symptoms Physical (Somatic) Headache, nausea/ vomiting, balance problems, dizziness, fuzzy/blurry vision, low energy/fatigue, light/ noise sensitivity.

6 2 Signs & Symptoms Physical (Somatic) Headache, nausea/ vomiting, balance problems, dizziness, fuzzy/blurry vision, low energy/fatigue, light/ noise sensitivity. Psychological More emotional (emotional lability), sadness, anger, irritability. Cognitive Memory dysfunction, attention problems, mental fogginess, cognitive slowing, fatigue. Sleep Disturbance Difficult falling asleep, sleeping more than usual. **Loss of consciousness is not required to diagnose an athlete with a concussion** Echemendia (2013)

Assessment 3 ALL concussions need to be assessed by a medical doctor as soon as possible after injury. Immediate Sideline evaluation should be administered such as SCAT-3 or SAC.

7 Assessment 3 ALL concussions need to be assessed by a medical doctor as soon as possible after injury. Immediate Sideline evaluation should be administered such as SCAT-3 or SAC. Orientation questions like time, place, and person are unreliable compared to memory tests. Concussions are considered an evolving injury as symptoms may take hours to appear. Follow-Up Athlete should be examined by a medical professional. Undergo thorough cognitive evaluation and determine if symptoms have improved or worsened. Neuropsychological assessment aids in determining the level of cognitive functioning following a concussion. Determine if neuroimaging is needed. McCrory, et al. (2013)

benefits of light exercise is currently unknown.

8 4 Management Physical and cognitive rest are important for the first few days. Those with prolonged symptoms may benefit from low levels of exercise, but the ideal timeframe for benefits of light exercise is currently unknown. Pharmacological treatment may be appropriate for prolonged symptoms. Psychological treatment may be appropriate as depression and anxiety are common in traumatic brain injuries. McCrory, et al. (2013)

Return to Play 5 ALL CONCUSSIONS NEED TO BE CLEARED BY A MEDICAL PROFESSIONAL BEFORE ATHLETE RETURNS TO PLAY AN ATHLETE SHOULD NEVER RETURN TO PLAY THE

Each step requires 24 hours without symptoms before moving to next step 1. No activity. 2. Light aerobic exercise - No resistance, <70% max heart rate.

9 Return to Play 5 ALL CONCUSSIONS NEED TO BE CLEARED BY A MEDICAL PROFESSIONAL BEFORE ATHLETE RETURNS TO PLAY AN ATHLETE SHOULD NEVER RETURN TO PLAY THE SAME DAY OF INJURY AS SYMPTOM ONSET CAN BE DELAYED RTP protocol contains 6 steps. Each step requires 24 hours without symptoms before moving to next step 1. No activity. 2. Light aerobic exercise - No resistance, <70% max heart rate. 3. Sport-specific exercise - No head impact acitivities. 4. Non-contact training drills - Can start progressive resistance training. 5. Full-contact practice. 6. Return to Play - Normal game play. McCrory, et al. (2013)

6 Post Concussion Syndrome American Medical Society for Sports Medicine defines post concussion syndrome (PCS) as symptoms and signs of a concussion that persist for weeks to months after the

10 6 Post Concussion Syndrome American Medical Society for Sports Medicine defines post concussion syndrome (PCS) as symptoms and signs of a concussion that persist for weeks to months after the incident. PCS is not well defined at this time and there is no way to predict who will develop it. PCS management hinges on time, recovery can be a long and slow process. Frustration often arises from being unable to participate in regular activities. Management should include a comprehensive neuropsychological evaluation, cognitive therapy, integrated neurorehabilitation programs, and supervised progressive exercise programs that advance slowly as symptoms permit. Academic and workplace accommodations may be needed to modify cognitive workload. Treating mood and sleep disturbance may also be beneficial. Harmon, et al. (2013)

Risk Factors 7 Females report higher concussion incidences.

11 Risk Factors 7 Females report higher concussion incidences. Youth athletes may experience prolonged recovery and are at a risk of a catastrophic injury. A history of concussions is associated with a higher risk of sustaining additional concussions. Greater number, severity, and duration of symptoms predict longer recovery time. Mood disorders, learning disorders, ADD/ ADHD, and migraines that existed before injury may complicate concussion diagnosis and management. Harmon, et al. (2013)

8 Psychological Effects and Support People with PCS also have a high rate of depression and anxiety. Social support serves to decrease depression, especially related to brain injury (concussion).

12 8 Psychological Effects and Support People with PCS also have a high rate of depression and anxiety. Social support serves to decrease depression, especially related to brain injury (concussion). People with PCS report having few people they can count on for support. Peer-to-peer interaction throughout concussion recovery may be a key aspect to education about concussions. FOR SUPPORT, PLEASE VISIT: McCauley, et al. (2001) Ahmed, et al. (2010)

Prevention 9 Increasing education about signs and symptoms, assessment techniques, and principles of safe return

$Hard and soft helmets like those used in football and soccer are best used to prevent fractures, bleeding,$ Mouthguards are best suited for dental and orofacial injuries.

Mouthguards are best suited for dental and orofacial injuries.

13 Prevention 9 Increasing education about signs and symptoms, assessment techniques, and principles of safe return to play protocol aids in preventing concussions. Hard and soft helmets like those used in football and soccer are best used to prevent fractures, bleeding, lacerations, etc. Hard and soft helmets have not been shown to reduce the amount or severity of concussions. Mouthguards are best suited for dental and orofacial injuries. Using proper return to play management helps to reduce occurrence of secondary impact. Modification and enforcement of rules as well as encouraging fair play may help in prevention of concussions. McCrory, et al. (2013) Harmon, et al. (2013

14 Ahmed, O. H., Sullivan, S. J., Schneiders, A. G., & McCrory, P. (2010). isupport: do social networking sites have a role to play in concussion awareness? Disability and Rehabilitation, 32(22), Echemendia, R. J. (2012). Cerebral concussion in sport: An overview. Journal of Clinical Sport Psychology, 6, Harmon K. G., Drezner J. A, Gammons M, Guskiewicz, K.M., Halstead, M., Herring, S.A., Kutcher, J.S., Pana, A., Putukian, M., & Roberts, W. O. (2012). American Medical Society for Sports Medicine position statement: Concussion in sport. British Journal of Sports Medicine, 47, McCauley, S.R., Boake, C., Levin, H.S., Contant, C.F., & Song, J.X. (2001). Postconcussional disorder following mild to moderate traumatic brain injury: Anxiety, depression, and social support as risk factors and comorbidity. Journal of Clinical and Experimental Neuropsychology, 23(6), McCrory P, Meeuwisse W, Aubry M, Cantu RC, Dvorak J, Echemendia R, Engebretsen L, Johnston K, Ktcher J, Raftery M, Sills, A, Benson B, Davis, G, Ellenbogen R, Guskeiwicz K, Herring SA, Iverson G, Jordan B, Kissick J, McCrea M, McIntosh A, Maddocks D, Makdissi M, Purcell L, Putukian M, Schneider K, Tator C, Turner M. Consensus Statement On Concussion In Sport The 4th International Conference On Concussion In Sport Held In Zurich, November Br J Sports Med 2013; 47:

15 CONNECT WITH

Dr Mark Fulcher Sports and Exercise Medicine Physician Axis Sports Medicine Specialists

Dr Mark Fulcher Sports and Exercise Medicine Physician Axis Sports Medicine Specialists 16:30-17:25 WS #163: ACC Sports Concussion Guidelines 17:35-18:30 WS #175: ACC Sports Concussion Guidelines (Repeated)