Update on Concussions in Soccer

Transcription

1 Update n Cncussins in Sccer Ricard E. Clberg, M.D., RMSK Andrews Sprts Medicine & Orthpedic Center American Sprts Medicine Institute Hw many here have had a cncussin?

2 Definitins Signs & symptms Management Cmplicatins Preventin Overview

3 Epidemilgy

4 What is a Cncussin? Definitin Brain irritatin secndary t a Direct blw r indirect frce transmitted t the head Manifesting with neurlgic signs r symptms. Lss f cnsciusness may nt happen. Usually heals within tw weeks f the injury.

5 Assessment f the injured athlete Lss f cnsciusness Immbilize the neck Cnsider CPR Call EMS Injured athlete N lss f cnsciusness Sideline evaluatin Refer t a physician

6 Sideline evaluatin Anyne with symptms f a cncussin needs t be remved frm play and seek medical evaluatin. If in dubt, sit them ut. N return t play n same day. Symptms culd arise ver the first 48 hurs. The athlete may sleep but shuld nt be left alne. The athlete must g t the E.R. at nce if they: -- Have signs r symptms f a strke -- Have persistent lss f cnsciusness -- Have seizures (arms and legs jerk uncntrllably) -- Have weakness f arms and legs Remember, it is always better t be safe than srry.

7 Signs and symptms Hw many here have had a cncussin?

8 Grading Scales are n lnger used Scales d nt predict severity f the injury American Academy f Neurlgy, Clrad Medical Sciety, etc. ANY NEUROLOGIC DEFICIT AFTER A HEAD INJURY IS A CONCUSSION I gt my bells rung Dizzy Headache I am seeing stars Cnfusin Etc.

9 Caches 4-step actin plan The CDC recmmends a 4-step actin plan t manage sprts-related cncussin: 1. Remve the athlete frm play. 2. Refer the athlete t a physician experienced in evaluating cncussins. 3. Infrm the parents abut the pssible cncussin and give them the CDC fact sheet n cncussin. 4. Keep the athlete ut f play until a physician gives a written clearance.

10 Radigraphic imaging Cnventinal imaging is typically nrmal in cncussin MRI r CT scan is nt rutinely rdered fr the average cncussin Wh d we image with CT scan r MRI? Athletes with: Suspicin f skull fracture, brain bleed, r spinal crd injury Seizures Persistent uncnsciusness

11 Cgnitive Testing Tls SCAT 3 The GOLD STANDARD fr an acute cncussin evaluatin Cmputerized Testing ImPACT, CRI, CgSprt, ANAM Valid nly if tested prir t start f seasn s there is a baseline t cmpare t It measure multiple aspects f cgnitive functin and cncentratin Neurpsychlgic Testing Frmal pencil/paper testing Best reserved fr patients with prlnged cgnitive symptms that need reasnable accmmdatin at schl

12 Management REST, Rest, rest... Cgnitive Limited schl activity N TV, mvies, texting, cmputer use May nt attend r watch practices/games N driving Physical N sprts r exercise until symptm-free fr 24 hurs and have physician clearance Headache r neck pain Offer nly Acetaminphen (e.g. Tylenl). D nt use aspirin r anti-inflammatry medicatin.

13 Return t Play Guidelines They must be symptm-free fr 24 hurs t start this Prtcl

14 Cmplicatins Pst-cncussin syndrme Persistent symptms lasting >3 mnths Secnd impact syndrme Catastrphic cerebral swelling that may lead t death Usually ccurs when there is still residual inflammatin in the brain and the athlete returns t play and sustains a secnd head injury.

15 Cmplicatins Chrnic Traumatic Encephalpathy Prgressive degenerative brain disease frm repetitive impact Atrphy f the brain Psychiatric disrders (i.e. depressin, suicidal thughts) Diagnsis is dne with cadaver bipsy Initial signs and symptms may nt manifest fr decades Patrick Grange was the first sccer player t be diagnsed with CTE.

16 Alabama HB 108-6/9/2011 Legislatin "Any player wh shws signs, symptms r behavirs assciated with a cncussin must be remved frm the game and shall nt return t play until a medical release is issued by a medical dctr. Caches, parents, and student athletes must attend annual training prgrams n cncussins

17 Additinal Resurces CDC- "Heads Up" Vides, guides and nline training fr caches, psters, fact sheets fr parents and athletes -

18 Cmmn questins Are there mre cncussins nw than befre? Yes. A study reviewed hundreds f hurs f videtape and fund that Referees have, ver time, allwed mre rugh play. This has led t mre aggressive style f play, mre cllisins, and mre cncussins. Are girls mre likely t suffer cncussins? Maybe. A 2013 Institute f Medicine study pints t bys strnger necks, yet anther study shwed that neck strengthening exercises in female athletes have nt decreased the rate f cncussins. Anther study shwed that girls are mre hnest and likely t reprt an injury than bys. Are children mre likely t get a cncussin? Yes. The neck muscles are smaller in relatinship t the head and cannt absrb the impact apprpriately (ex. Bbbleheads) In additin, they are mre likely t head the ball with the wrng technique. Finally, the child s brain swells mre easily after an injury than in adults.

19 Cmmn questins D helmets/head gear prevent cncussins? N. Studies have shwn that head gear decrease laceratins but d nt decrease the frce transmitted t the brain and d nt decrease the rate f cncussins. In fact, head gear give a false sense f prtectin that leads t mre aggressive play and an increase risk f cncussins. As a cach, can I prevent a cncussin? YES! Teach athletes prper heading technique, fster gd sprtsmanship, d nt tlerate and permit aggressive behavir frm players, and encurage athletes t be hnest and pen abut reprting symptms f a cncussin.

20 It is always better t miss ne game than a lifetime f seasns Questins?