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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

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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.

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1. What is a Concussion (SRC)2. What to do when you have symptoms3. Sport Concussion Assessment Tool

(SCAT5)4. Post injury advice5. CTE6. Concussion Recognition Tool

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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

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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

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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

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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

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WHAT IS THE SCAT5?

The SCAT5 is a standardized tool for evaluating concussionsdesigned for use by physicians and licensed healthcareprofessionals1. The SCAT5 cannot be performed correctlyin less than 10 minutes.

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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

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WHEN CAN I GET BACK DOC?

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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

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“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”.

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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 NORMALat rest, with exercise and at school BEFOREreturning to sport

CONCUSSION RECOGNITION TOOL 5 ©

To help identify concussion in children, adolescents and adults

© Concussion in Sport Group 2017© Concussion in Sport Group 2017

RECOGNISE & REMOVE

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

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

Supported by

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.

If there are no Red Flags, identification of possible concussion should proceed to the following steps:

STEP 2: OBSERVABLE SIGNS

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 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

STEP 3: SYMPTOMS

• 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 emotional

• More Irritable

• Sadness

• Nervous or anxious

• Neck Pain

• Difficulty concentrating

• Difficulty remembering

• Feeling slowed down

• Feeling like “in a fog“

STEP 4: MEMORY ASSESSMENT (IN ATHLETES OLDER THAN 12 YEARS)

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?”

• “What team did you play last week/game?”

• “Did your team win the last game?”

Athletes with suspected concussion should:

• Not be left alone initially (at least for the first 1-2 hours).

• 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.

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.

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

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