In this issue. Risk Factors for Concussion. Concussion Awareness for Provincial Women s Softball Association

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Lilian Skinner
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In this issue Overview of Concussions Concussion is Suspected Concussion Assessment & Treatment Baseline Testing Return to Play Return to Learn Contact Information Risk Factors for Concussion

Association What is a Concussion? A concussion is a disturbance in brain function caused by sheer stress to the brain tissue.

4% concussion the most common injury reported Steenstrup et al, Br J Sports Med, 2014 Rate of concussions per year in general population: 6 per 1000 people (1.

1 In this issue Overview of Concussions Concussion is Suspected Concussion Assessment & Treatment Baseline Testing Return to Play Return to Learn Contact Information Risk Factors for Concussion Previous concussions Females Age Higher risk sports/ activities Pre-injury learning disability (ADHD, ADD, dyslexia) Mood disorders Migraines Concussion Awareness for Provincial Women s Softball Association What is a Concussion? A concussion is a disturbance in brain function caused by sheer stress to the brain tissue. Statistics Rate of head injury at FIS World Cup Level: reported range between 10% and 13.4% concussion the most common injury reported Steenstrup et al, Br J Sports Med, 2014 Rate of concussions per year in general population: 6 per 1000 people (1.6%) Many more go unrecognized & unreported. We Need to Take Concussions Seriously Some can be fatal (Second impact syndrome) Post-concussion syndrome (persisting headaches, dizziness, forgetfulness and mood changes) Permanent brain impairment (e.g. Punch drunk boxers; hockey and football players) Mechanisms of Concussion Direct blow to the head face or neck Transmitted force to the head from an injury elsewhere in the body Twisting or rotational forces LOSS OF CONSCIOUSNESS OCCURS INFREQUENTLY The Brain After a Concussion Impairment of neurologic function due to a cascade of brain neurochemical changes The disturbance is functional, not structural (Xray and brain scans are normal) Usually resolves spontaneously: 80 to 90% are better in 7 to 10 days Common Symptoms Headaches Nausea Sleep Disturbance Difficulty Concentrating Foggy Feeling Light Sensitivity Poor Balance Poor Memory Slowed Reaction Times Crying

Proportion of Concussion and Mild Head Injury by Type of Sport and Helmet Use, 0-19 years old, BC CHIRPP, 2001-2009 How do we know if an

May be unconscious Call 911 and ski patrol Do not move or remove helmet Use basic CPR Preventative Measures Head gear & helmets: No

reduction prevent oral injury Minimize risk of injury Safe course set up and good snow conditions Discourage risky behaviour Encourage

Seizure or convulsion Tingling or burning in arms/legs Deteriorating consciousness Loss of consciousness Unusual behaviour change Double

day, date, venue, event?? unbalanced or unsteady? behaving inappropriately? irritable or emotional?

2 Proportion of Concussion and Mild Head Injury by Type of Sport and Helmet Use, 0-19 years old, BC CHIRPP, How do we know if an injured skier has a concussion? May be unconscious Call 911 and ski patrol Do not move or remove helmet Use basic CPR Preventative Measures Head gear & helmets: No evidence of concussion reduction They do reduce biomechanical forces and head and facial injury Mouth guards no evidence of concussion reduction prevent oral injury Minimize risk of injury Safe course set up and good snow conditions Discourage risky behaviour Encourage sportsmanship Red Flags - Call 911 Severe neck pain Severe or increasing headache Increased confusion or irritability Repeated vomiting Seizure or convulsion Tingling or burning in arms/legs Deteriorating consciousness Loss of consciousness Unusual behaviour change Double vision Weakness in arms/legs If skier is conscious and able to get up: Screen for concussion symptoms confused, dazed? day, date, venue, event?? unbalanced or unsteady? behaving inappropriately? irritable or emotional? CAN USE IMPACT or SCAT3 APP If even mild concussion is suspected: Skier should not continue skiing Skier should be assessed that day Emergency Room, or physician s office. Should not be left alone following the injury Should be monitored for deterioration over the initial few hours following injury

3 You Should Know Concussions are often NOT managed well. You CANNOT diagnose a concussion on x-ray or CT scan, as there is no obvious structural damage... no visible signs. There is still controversy over how to best manage a concussion. The Brain is Under Construction Cognitive Rest no activities that require concentration. This includes no smart phones, video games, TV, playing music or reading! Physical Rest no activities that increase your heart rate or make you break a sweat Emotional Changes are very real after a concussion It is normal to be anxious, angry or depressed after sustaining a concussion Research Recent research indicates that recovery takes more than just sitting in a dark room with no stimulation waiting to feel better. Research has shown that having physiotherapy treatment from a concussion trained therapist increases your chance of returning to activity earlier. Kathryn Schneider et at. BJSM June 2014 Practical Recovery Tips Power down to speed up your recovery Rest at night & during day Don t drink alcohol or take recreational drugs Write things down to help your memory Avoid driving for 24 hrs after injury or longer if needed, as it is cognitively demanding Consult with family members or friends if you have to make important decisions The LifeMark Model Active Recovery Accurately Assess the systems that are having problems Treat the deficits or Refer to others for more testing or treatment Get Active with a safe & individualized graduated reentry strategies for their school, sports & work Education throughout the healing process Autonomic Nervous System Vestibular Cognitive Function ASSESSMENT & TREATMENT Visual Psychological & Emotional Support Neck Sleep Dysfunction

and Supportive This is not a no pain, no gain scenario! Sideline or Coach s Assessment Tools Might include ImPACT Sideline evaluation app SCAT 3 and child SCAT When in doubt Sit them out!

4 Coaches and Parents... Provide reassurance about prognosis but stress importance of taking it seriously Review what to restrict and what to allow/encourage Be alert to new symptoms or deteriorating condition Be Patient and Supportive This is not a no pain, no gain scenario! Sideline or Coach s Assessment Tools Might include ImPACT Sideline evaluation app SCAT 3 and child SCAT When in doubt Sit them out! Baseline Testing A computerized test conducted pre-season by a trained health care professional to measure an individual athlete s brain function Objectively Measures, Collects & Records: Learning and memory skills Ability to pay attention or concentrate Reaction time in problem solving Balance reactions Visual input and abilities Supports Safe Return-to-Play Decisions Why We Use ImPACT It is the gold standard in Concussion Management for neurocognitive testing Test results are safely stored in central database More accurate than paper version (SCAT) Used by leagues such as the NFL, MLB, NHL and MLS School before Sport: A focus on return to learn first has been shown to lead to a quicker return to sport This it the only sports injury that DIRECTLY impacts one s ability to learn Gradual Return to Activity STAGE No Activity Light Aerobic Sport-Specific Non-Contact Training Drills Full Contact Practice Chalk talk sessions Review signs & plays Light jogging/ stretching No throwing or swings Dry run without balls Fielding prep drills Dry swings Pitch tracking drills Hitting softies/wiffles Catch and throw ball Grounder/fly ball drills Full practice with team ACTIVITY SUGGESTIONS Progress to Next Level if No Symptoms No Activity Light Aerobic Activity Sport-Specific Exercise Non-Contact Training Drills Full-Contact Practice Return to Play

REPORT When in doubt, sit them out. Athletes are not always the best judge of their symptoms. RECOVER Persistent symptoms need to be assessed and addressed so that you can get active.

Online Resources Parachute injury prevention www.parachutecanada.org ImPACT Testing www.impacttest.com Centre for Disease Control www.cdc.gov/concussion ONF mtbi Guidelines www.

.. Help Us Build Awareness lifemarkconcussion.blogspot.ca/ twitter.com/lmconcussion facebook.com/pages/lifemark- Concussion/642260432519014?

Meadowvale Sunday, April 19 th LifeMark Physiotherapy - London Register Online at: http://www.centrichealth.ca/healthfairs/ Event ID: Concussion2015 (it is not case sensitive) Cost?

Jessica Mancini, MScPT Registered Physiotherapist & Vestibular Therapist Ontario Clinical Leader of Concussion Management for LifeMark Centric Health Ontario Softball Team Trainer for

5 REPORT When in doubt, sit them out. Athletes are not always the best judge of their symptoms. RECOVER Persistent symptoms need to be assessed and addressed so that you can get active. Doing nothing is no longer good enough. RETURN A gradual return to school and sports needs to be clearly communicated to minimize the risk of returning too soon. Online Resources Parachute injury prevention ImPACT Testing Centre for Disease Control ONF mtbi Guidelines Concussion Awareness Training Tool CanChild Brain Injury Research PWSA Baseline Testing Days Join us on Social Media... Help Us Build Awareness lifemarkconcussion.blogspot.ca/ twitter.com/lmconcussion facebook.com/pages/lifemark- Concussion/ ?ref=hl Clear & Consistent Communication Athletes Parents Healthcare Coaches Schools Sunday, April 12 th LifeMark Physiotherapy - Oshawa Saturday, April 18 th LifeMark Physiotherapy - Meadowvale Sunday, April 19 th LifeMark Physiotherapy - London Register Online at: Event ID: Concussion2015 (it is not case sensitive) Cost? $30 + tax per athlete (takes approx. 30 min) If tested on one of the above dates; *$5 from every baseline test administered will be given back in! Jessica Mancini, MScPT Registered Physiotherapist & Vestibular Therapist Ontario Clinical Leader of Concussion Management for LifeMark Centric Health Ontario Softball Team Trainer for the 2013 Summer Games Joy Brooks-DesBarres, BSc.PT, RPT Registered Physiotherapist & Clinic Director LifeMark Physiotherapy Oshawa Team Physiotherapist Canadian s Men s Softball 1999 Pan American Games/ 2000 World Softball Championships Lead Medical Practitioner Softball 2015 Pan American Games/ Ajax Pan Am Ballpark

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