HB 2038 Coaches Training

July 2012

Objectives

• Definition

• Natasha’s Law (HB 2038)

• Concussion Oversight Team

• Sign/Symptoms of Concussion

• Return to Play

• Coaching/Administration Role

Coaches Concussion Training

• HB 2038~Natasha’s Law

• Named after Natasha Helmick, a soccer player who sustained at least 5 concussions

• Signed into law September 1, 2011

• Goal is to reduce injuries from second impact syndrome

• Allen, TX

The Law

• The new law applies to all interscholastic athletic activity, including practice and competition sponsored or sanctioned by the UIL

• All schools are required to take a training course in the subject of concussions-must be completed no later that September 1, 2012

What the law does!

• Concussion Management Team

• Removal from Play

• Waiver and Graded Protocol to Return to Play

• Specific Education/Training for all HCP’s

• State Wide Tracking/Logging of Concussions

What is the Concussion Oversight Team

• The governing body of each school district and open-enrollment charter school with students enrolled who participate in an interscholastic athletic activity shall appoint or approve a concussion oversight team.

• Who is the COT-at least one member, a Texas licensed physician, Texas licensed athletic trainer or Texas licensed health care professional.• Steve Jones MD-Required to take additional

training• Tom Lewis-Required to take additional training

Concussion Oversite Team

Each concussion oversight team shall establish a return-to-play protocol, based on peer-reviewed scientific evidence, for a student's return to interscholastic athletics practice or competition following the force or impact believed to have caused a concussion.’

Additional Information: Required!

• Each student athlete and their parent/guardian will be required to sign, for that school year, a form acknowledging that both the student athlete and guardian have received and read written information that explains concussion prevention, symptoms, treatment, and oversight and that includes guidelines for safely resuming participation in an athletic activity following a concussion.

What do you know about concussions?

Concussion Quiz

•You have to be knocked out to have a concussion.

•True

•False

False

•Most kids who have a concussion are never

knocked out.

What is a concussion?

• A complex pathophysiological process affecting the brain, induced by traumatic biomechanical force or “An injury to the brain that effects function.

• Usually no damage to brain anatomy

-as far as we can tell

• Disturbance in brain metabolism

• Common features: Direct blow to the head or body Loss of consciousness not necessary Rapid onset of symptoms (usually) Traditional medical test usually normal (CT/MRI)• .

CONCUSSIONS

It’s a Chemical Thing!

It’s a Chemical Thing !Phone Disconnect

You don’t have to be knocked out to get a

concussion

Concussion Quiz

•Concussions are only a problem for boys, and girls don’t need to worry about

it.

•True

•False

False

•Girls have concussions at least as often as boys

Here’s the Problem

The Facts

• A concussion is a brain injury

• All concussions are serious

• Concussions can occur without loss of consciousness or other obvious signs

• Concussions can occur from blows to the body as well as to the head

• Concussions can occur in any sport

• Recognition and proper response to concussion when they first occur can help prevent further injury or death

• Athletes may not report their symptoms for fear of losing playing time

• Athletes can still get a concussion even if they are wearing a helmet

• Data from the NCAA injury surveillance system suggest that concussion represent 5 to 18 percent of all reported injuries, depending on the sport

The Facts

• A concussion can occur in any sport and all concussions are serious.

• 10% of all contact sports sustain concussions

• 63% of all concussions occur in football.

• Girls soccer report second highest # of concussions.

The Facts

• An athlete who sustains a concussion is 4-6 times more likely to sustain a 2nd concussion.

• “Bell ringers” account for 75% of all concussive injuries.

• Effects of concussions are cumulative in athletes who return to play prior to complete recovery.

The Facts

• 80% of all concussions get better in one week; 20% usually takes 3 weeks or longer to recover.

• Repeat concussions can result in brain swelling, permanent brain damage, and even death.

Can you which kid has a concussion?

Does Age Matter?

• Children may be less prepared for a blow to the head

• Parents may be inclined to believe child is “fine” due to negative imagining and the “he looks fine to me” factor.

• Other concerns may override safety issues, and often youth sports may not have a protocol in place for dealing with concussion

• Children may underreport symptoms to go back to play sooner for fear of appearing weak, losing position, feeling invulnerable

• Concussion MAY be 10-20 X more prevalent in children

• Children are more at risk for second impact syndrome

Concussion Quiz

•A concussion can make school work harder.

•True

•False

True

•After have a concussion, kids often can’t

concentrate as well and reading and doing math can cause headaches.

Recovery of the Young Athlete

• Kids are not the same as PROS

• The brain of athletes under the age of 18 heals at a slower rate than older athletes following a concussion

Prevention

• Helmets decrease risk of skull fractures and intracranial hemorrhage.

• Mouthguards decrease dental and oral trauma.

• Role of protective equipment in prevention of concussion not established

Recovery and Return to Play-Grades and Guidelines

• Are not scientifically based

• Assumes standard use for gender and age groups

• Poor job distinguishing “mild” concussion

• Assigns too much importance in LOC

• Did not provide useful prognostic information

• Did no account for risk factors/individuals factors

Commonly Reported Symptoms

• High School & College athletes – within 3 days of injury

1. Headache 71%

2. Feeling slowed down 58%

3. Difficulty concentrating 57%

4. Dizziness 55%

5. Fogginess 53%

6. Fatigue 50%

7. Visual blurring/double vision 49%

8. Light sensitivity 47%

9. Memory dysfunction 43%

10.Balance problems 43%

Factor Analysis, post-concussion symptom scale (Pardini et al 2004) N=327 High school and

University Athletics witin 7 Days of Concussion

Emotionality- More emotional

- Sadness- Nervousness- Irritability

Cognitive symptoms- Attention

problems- Memory dysfunction

- “fogginess”- Fatigue

- Cognitive slowing

Somatic Symptoms

-Visual problems-Dizziness-Balance

difficulties-Headaches

-Light sensitivity-Nausea

Sleep Disturbance-Difficulty falling

asleep-Sleeping less than

usual

Symptom Evaluation

Concussion SignsAppears dazedConfused about playMoves clumsilyAnswers questions

slowlyPersonality/behavior

changeForgets plays prior to

hitAnterograde amnesia

Loses consciousness

• Concussion symptoms• Headache• Nausea• Balance problems• Double vision• Photosensitivity• Feeling sluggish• Feeling foggy• Change in sleep pattern• Cognitive changes

Concussion Quiz

•If I feel ok right after a hit, it means I am fine and do

not have a concussion

•True

•False

False

•Many athletes don’t have a headache or other

symptoms for hours after a concussion.

Later Signs of Concussion Post-Concussion Syndrome

• Decreased Processing Speed

• Short-term Memory Impairment

• Concentration Deficit

• Irritability/Depression

• Fatigue/Sleep Disturbance

• General Feeling of “fogginess”

• Academic Difficulties

Relative Impacts •

vid

eo

Second Impact Syndrome

Occurs in athletes with prior concussion following often relatively minor second impactAthlete returns to competition before resolution

of symptoms

Catastrophic increase in intracranial pressurevasomotor paralysis, edema, massive swelling,

herniation, deathNeuro-chemical processes appear to differ in

developing brain

Second Impact

• 2nd IMPACT USUALLY OCCURS WITHIN 14 DAYS OF THE FIRST CONCUSSION AND UNDER AGE 21

On field assessment cardSigns and symptoms

evaluationSigns observed by staff:

Appears to be dazed or stunned

Unsure of game score or opponent

Lack of coordinationPoor reaction timeLosses consciousness

(even temporarily)Shows behavior, mod or

personality changeForgets events prior to

injury (retrograde)Unequal or dilated pupilsBleeding or clear fluid

coming from nose or ears

• Symptoms reported by athlete:• Headache• Nausea or vomiting• Balance problems or

dizziness• Double or fuzzy vision• Sensitivity to light or

noise• Feeling sluggish• Feeling foggy• Change in sleep pattern• Concentration or

memory problems• Lightheadedness• Easily fatigued• confusion

Symptoms may worsen with exertion.

Athlete should not return to play until symptom-free

On-field Cognitive testing Orientation

Ask the athlete the following questions: What stadium is this? What city is this? Who is the opposing team? What month is it? What day is it?

Anterograde amnesia Ask the athlete to remember the following words:

Girl, dog, green

Retrograde amnesia Ask the athlete the following questions:

What happened in the prior quarter/period? What do you remember just prior to the hit? What was the score of the game prior to the hit?

Concentration Ask the athlete to do the following:

Repeat the days of the week backwards Repeat these numbers backwards: 63 (36 is correct): 419 (914 is correct)

Word list memory Ask the athlete to repeat the three words from earlier

SCAT II

• SCAT II Form

Concussion Management

• Rule out more serious intracranial pathology• CT, MRI, neurologic examination primary

diagnostic test

• Prevent second impact syndrome

• Prevent presence of post-concussion syndrome (Home Program)• Avoid video games• Text messages• Watching tv• Playing or doing homework on computer• Long periods of reading

Return to Play Protocol

• Exercise Progressions

Return To Classroom Protocol

• Classroom Progressions

What do we need to do as football coaches

• Teach proper technique-UIL requires that all football coaches teach there athlete about

“Heads UP in Football”

• Before-Mid-season

• Heads-Up in Football Video

Home with a Concussion

• A person with a concussion may: • Use acetaminophen (Tylenol) for headaches• Use ice pack on head and neck as needed for

comfort• Eat a light diet• Go to sleep• Rest (no strenuous activity or sports)

Home Care

• There is no need to: • Wake up every hour• Test reflexes• Stay in bed

• Observe and monitor athlete. If there is a decline in symptoms, see physician

Home Care

Do not:Drink alcoholDrive while symptomaticExercise or lift weightsUse a computer or test messageWatch TV for long periods of timeTake Ibuprofen, aspirin, naproxen or other non-steroidal anti-inflammatory medications

ImPACT

• ImPact Test

• ImPact Test Modules

High School vs Pros

Long Term Research

Long Term

Long Term Research

Concussion Quiz

•The brain needs to rest after a concussion.

•True

•False

True

• The Brain needs a lot of rest after a concussion and you may need to sleep more than usual. You should not play video games, read a lot, or do other things to make your brain work hard. If you rest, you will be able to return to normal activities quicker! If you try to go back playing a sport too soon, your concussion could take longer to get better.

Most Important Take Away

•Improved awareness and increase in concussion recognition!

Questions?

Reminders

• The Rules Compliance Program (RCP) is required for coaches of grades 7-12. See UIL

web page.

• CPR Refresher GISD web site. Go to my web page.

• Email me once you have gone over the refresher.