Dhiren J. Naidu MD FRCPC Dip. Sport Med.

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1 Dhiren J. Naidu MD FRCPC Dip. Sport Med. Associate Professor, Division of Physical Medicine & Rehabilitation Faculty of Medicine & Dentistry Varsity Health, University of Alberta Team Physician - Oilers, Eskimos, Golden Bears Football Presenter: Dhiren J. Naidu Relationships that may introduce potential bias and/or conflict of interest: Grants/Research Support: Ongoing research in concussion at University of Alberta Speakers Bureau/Honoraria: Dhiren J. Naidu has received a speaker fee and expense support from the Alberta College of Family Physicians. Consulting Fees: N/A Other: N/A 1

2 This program is presented by the Alberta College of Family Physicians (ACFP) without any commercial or in-kind support. The ACFP provides a speaker fee and expense support for presenting at the Practical Evidence for Informed Practice. 2

3 1. What is a Concussion (SRC) 2. What to do when you have symptoms 3. Sport Concussion Assessment Tool (SCAT5) 4. Post injury advice 5. CTE 6. Concussion Recognition Tool 3

4 Trauma need an force! Force NOT necessarily a blow to the head Don t need to hit your head Symptoms what you feel May be delayed (24 hours later) Signs What we see Balance, slow to get up not in all players Normal CT/MRI Kids are different Longer to recover 4

5 Headache Pressure in head Balance problems Nausea or vomiting Drowsiness Dizziness Blurred Vision Sensitivity to light Sensitivity to noise Fatigue or low energy Don t feel right More irritable Sadness Nervous or anxious Neck pain Difficulty concentrating Difficulty remembering Feeling slowed down Feeling in a fog Physical Headache, neck pain Balance/Vestibular Dizziness, vertigo (room spinning), unsteadiness Cognitive (Brain) Feeling in a fog, slowed down, can t multitask Can t concentrate, memory problems Mood Irritable, emotional, anger, depressed, anxious 5

Lying motionless on the playing surface Slow to get up after a direct or indirect hit to the head Disorientation or confusion or an inability to respond

6 Lying motionless on the playing surface Slow to get up after a direct or indirect hit to the head Disorientation or confusion or an inability to respond appropriately to questions Blank or vacant look Balance, gait difficulties, motor incoordination, stumbling, slow laboured movements Facial injury after head trauma 6

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conciouness, etc. 3. Evaluated by a physician or other licensed healthcare provider 4.

9 1. Removed from play or practice 2. If first aid issues are present refer to EMS or Physician if present Neck pain, n/tingling of arms/legs, loss of conciouness, etc. 3. Evaluated by a physician or other licensed healthcare provider 4. When a player is diagnosed with a concussion they should NOT be allowed to return to play on the day of injury 5. Player should NOT be left alone and should be re-evaluated for a few hours after the initial injury 9

10 WHAT IS THE SCAT5? The SCAT5 is a standardized tool for evaluating concussions designed for use by physicians and licensed healthcare professionals 1. The SCAT5 cannot be performed correctly in less than 10 minutes. 10

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14 To EMERGENCY IF: Change in behaviour Vomiting Worsening headache Double vision Excessive drowsiness Initially limit activities to routine daily activities Limit screen time, school, work to a level that does not increase symptoms Avoid Alcohol Avoid Sleeping tablets Do NOT use anti-inflammatories, aspirin, narcotics Do NOT drive until cleared by healthcare professional 14

15 WHEN CAN I GET BACK DOC? 15

Neurodegenerative disease punch drunk or dementia pugilistica from boxing early 1900 s Currently, the neuropathology is better understood than

16 Neurodegenerative disease punch drunk or dementia pugilistica from boxing early 1900 s Currently, the neuropathology is better understood than the clinical presentation or course TAU protein deposition in Neurofibrillary tangles 20 other neurologic conditions associated with abnormal TAU 16

otherwise clinically symptomatic with cognitive symptoms.

17 The symptoms described in CTE overlap with those described in concussion, PCS and the neurodegenerative diseases. There is a selection bias for many of the reported cases, some died from violent deaths such as suicide or drug overdose and/or were otherwise clinically symptomatic with cognitive symptoms. There are now an increasing number of reports of cases with multiple concussions but no evidence of CTE at autopsy (Hazrati et al., 2013; McKee et al., 2013). The exact relationship between multiple concussions and CTE is ambiguous. 17

rest, with exercise and at school BEFORE returning to sport CONCUSSION RECOGNITION TOOL 5 STEP 3: SYMPTOMS To help identify concussion in children, adolescents and adults RECOGNISE & REMOVE Supported

18 Let your kids play! Concussions are a good news story! Most improve, but, need time But every concussion is different CTE is scary, but, need context Know a bit about concussion Concussion recognition tool Make sure your son/daughter feels NORMAL at rest, with exercise and at school BEFORE returning to sport CONCUSSION RECOGNITION TOOL 5 STEP 3: SYMPTOMS To help identify concussion in children, adolescents and adults RECOGNISE & REMOVE Supported by Head impacts can be associated with serious and potentially fatal brain injuries. The Concussion Recognition Tool 5 (CRT5) is to be used for the identification of suspected concussion. It is not designed to diagnose concussion. STEP 1: RED FLAGS CALL AN AMBULANCE Headache Pressure in head Sensitivity to light More Irritable Balance problems Nausea or vomiting Drowsiness Dizziness Blurred vision Sensitivity to noise Fatigue or low energy Don t feel right STEP 4: MEMORY ASSESSMENT (IN ATHLETES OLDER THAN 12 YEARS) More emotional Sadness Nervous or anxious Neck Pain Difficulty concentrating Difficulty remembering Feeling slowed down Feeling like in a fog If there is concern after an injury including whether ANY of the following signs are observed or complaints are reported then the player should be safely and immediately removed from play/game/activity. If no licensed healthcare professional is available, call an ambulance for urgent medical assessment: Neck pain or tenderness Double vision Weakness or tingling/ burning in arms or legs Severe or increasing headache Seizure or convulsion Loss of consciousness Deteriorating conscious state Vomiting Increasingly restless, agitated or combative Failure to answer any of these questions (modified appropriately for each sport) correctly may suggest a concussion: What venue are we at today? Which half is it now? Who scored last in this game? Athletes with suspected concussion should: What team did you play last week/game? Did your team win the last game? Not be left alone initially (at least for the first 1-2 hours). Remember: In all cases, the basic principles of first aid (danger, response, airway, breathing, circulation) should be followed. Assessment for a spinal cord injury is critical. Do not attempt to move the player (other than required for airway support) unless trained to so do. Do not remove a helmet or any other equipment unless trained to do so safely. Not drink alcohol. Not use recreational/ prescription drugs. Not be sent home by themselves. They need to be with a responsible adult. Not drive a motor vehicle until cleared to do so by a healthcare professional. If there are no Red Flags, identification of possible concussion should proceed to the following steps: STEP 2: OBSERVABLE SIGNS The CRT5 may be freely copied in its current form for distribution to individuals, teams, groups and organisations. Any revision and any reproduction in a digital form requires approval by the Concussion in Sport Group. It should not be altered in any way, rebranded or sold for commercial gain. Visual clues that suggest possible concussion include: Lying motionless on the playing surface Slow to get up after a direct or indirect hit to the head Disorientation or Balance, gait difficulties, confusion, or an inability motor incoordination, to respond appropriately stumbling, slow to questions laboured movements Blank or vacant look Facial injury after head trauma ANY ATHLETE WITH A SUSPECTED CONCUSSION SHOULD BE IMMEDIATELY REMOVED FROM PRACTICE OR PLAY AND SHOULD NOT RETURN TO ACTIVITY UNTIL ASSESSED MEDICALLY, EVEN IF THE SYMPTOMS RESOLVE Concussion in Sport Group 2017 Concussion in Sport Group

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CONCUSSION RECOGNISING THE SIGNS STARTS WITH YOU. co.nz

CONCUSSION RECOGNISING THE SIGNS STARTS Malcolm.Francis@acc. co.nz WITH YOU. A step-by-step guide to concussion and your role in recognising the signs, removing players from play and referring them to