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Coach  -­‐  Case  Study  Tool  

Introduction  

Concussions  are  a  major  public  health  concern  that  can  be  followed  by  severe  consequences.    Concussion  and  their  impact  can  be  prevented,  and  while  there  is  still  more  to  learn  about  concussion,  it  is  clear  that  at  a  youth  level,  this  is  a  concern.    This  is  why  education  and  awareness  of  concussion  is  of  such  importance.  

As  a  coach,  informing  your  athletes  and  parents/caregivers  about  concussion  is  important.    One  way  you  can  do  this  is  to  provide  education  and  information  before,  during  and  after  the  game  season.    Getting  your  athletes  and  their  parents  together  before  or  during  practice,  or  holding  an  education  session  that  is  part  of  training  camp,  for  example,  are  some  ways  you  can  connect  with  these  individuals  in  a  group  setting.    Discussing  concussion-­‐specific  case  studies  is  one  way  to  educate  and  this  tool  kit  provides  you  with  two  sample  case  studies  plus  discussion  questions.  The  sample  case  studies  are  hockey  specific,  but  can  be  modified  to  suit  your  sport  and  the  needs  of  your  athletes  and  parents.    Note  that  answers  for  the  discussion  questions  are  embedded  within  the  3E's  tool  kit,  and  proper  links  will  be  provided  for  each  question,  where  appropriate.  

Case  Study  Objectives  

a) Enhance  concussion  education  and  awareness  of  athletes  and  parents/caregivers  through  the  discussion  of  concussion  case  studies  

b) Help  athletes  and  parents/caregivers  to  identify  and  understand  key  concussion  concepts  such  as  recognizing  a  concussion,  signs  and  symptoms,  when  to  seek  help  and  how  to  get  better    

c) Encourage  reporting  of  concussion  in  sport  

d) Provide  athletes  and  parents/caregivers  with  knowledge  they  need  to  make  well  informed  decisions  about  concussion  

Remember...inform  your  audience  that  education  involves  many  such  as  athletes  and  their  parents/caregivers,  coaches  and  trainers,  teachers,  healthcare  professionals  and  sport  organizations.    Injury  prevention  organizations  such  as  Parachute  also  play  an  important  role  in  concussion  education,  awareness  and  prevention.    Encourage  your  target  audience  to  visit  Parachute’s  website.  

 

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Preamble  

A  concussion  is  a  brain  injury  caused  by  a  jarring  motion  or  blow  to  the  head  or  part  of  the  body,  resulting  in  a  disturbance  of  the  brain  and  its  functioning.    Concussions  may  occur  as  a  result  of  a  fall  or  impact.    Concussions  often  result  from  a  sports  injury  where  another  player  or  an  inanimate  object  has  struck  the  athlete.        

To  help  us  understand  concussion  better,  we  will  be  growing  through  some  case  studies  that  talk  about  concussion.    The  cases  of  twin  boys  who  each,  at  various  stages  of  their  hockey  career,  suffered  a  concussion  will  be  discussed.    Both  boys  played  minor  hockey  on  an  Ontario  rep  team.    We  will  talk  about  the  way  that  each  concussion  was  handled  and  how  education  of  coaches,  trainers  and  parents  positively  impacted  the  management  of  concussions.      

Case  1:    

Part  A  

Twin  AK  is  playing  in  an  Atom  rep  hockey  provincial  semi-­‐final  playoff  game.    While  skating  around  the  back  of  the  net,  he  is  body  checked  into  the  boards  by  an  opponent,  and  hits  his  head  on  the  upper  rim  of  the  boards.      AK  falls  to  the  ground,  but  slowly  manages  to  get  up  and  with  wobbly  legs,  skates  to  the  bench  unassisted.    He  is  crying  and  holding  his  head,  and  keeps  shaking  his  head  to  try  to  "clear  himself."    The  trainer  who  is  managing  the  bench  door  for  the  team  seems  disinterested  in  assessing  the  player.    AK’s  mother,  a  neuro-­‐trauma  intensive  care  nurse,  approaches  the  bench  and  is  quickly  told  to  leave  by  the  head  coach.    The  assistant  coach  (a  first  time,  young  17  year  old)  is  now  dealing  with  the  player.    He  sits  him  down  and  was  gives  him  water,  trying  to  comfort  him.      The  period  ends  5  minutes  later  and  AK  follows  his  teammates  into  the  dressing  room  for  a  15-­‐minute  intermission.      Following  the  intermission  he  returns  to  the  bench  with  his  team  mates  and  plays  the  rest  of  the  game.    AK’s  parents  see  that  his  performance  is  off  and  that  he  seems  distracted  from  the  game.      

Discussion  

1. What  was  the  cause  of  AK's  concussion?  

2. Did  the  coach  manage  the  player  properly?  

3. Should  the  athlete  have  returned  to  play?    (Why?  Why  not?)  

4. As  an  athlete,  do  you  feel  pressure  to  return  to  play  in  situations  like  this?  (If  applicable)  

5. As  a  parent/caregiver,  do  you  feel  there  is  pressure  from  your  son/daughter,  teammates  or  others  for  your  son/daughter  to  return  to  play?  (If  applicable)  

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Part  B  

AK’s  parents  see  him  when  he  gets  on  the  bus  to  go  home  from  the  game.    He  is  complaining  of  a  headache,  nausea  and  dizziness.    He  sleeps  on  the  bus  ride  home.    When  home,  AK  notes  that  his  headache  is  better,  but  feels  really  tired  and  goes  to  sleep.    The  next  day,  AK  is  complaining  of  a  headache  and  feeling  tired.    He  goes  to  the  doctor  and  is  told  that  he  suffered  a  concussion.    AK  is  sent  home  with  no  follow-­‐up  information  and  is  told  to  take  a  couple  of  days  off  from  hockey  and  that  he  should  be  OK  to  play  by  the  end  of  the  week.  Fortunately,  as  this  is  the  playoff  and  AK’s  team  is  eliminated,  the  season  is  finished  with  the  exception  of  a  few  remaining  on  ice  practices.    AK  recovers  from  the  concussion  with  no  long-­‐term  deficits.    He  has  some  cognitive  issues  at  school  for  two  years  after  the  concussion,  which  cannot  be  directly  linked  to  his  injury.    

Discussion  

1. What  signs  and  symptoms  did  AK  suffer?  

2. Did  the  physician  manage  and  treat  AK's  concussion  properly?    (Why?  Why  not?)  

3. As  a  parent/caregiver,  what  steps  would  you  take  to  help  educate  other  athletes,  parents/caregivers  and  athletic  personnel/staff?  

Case  2:    

Part  A  

Three  years  after  AK’s  concussion,  his  twin  brother  BK  is  involved  in  an  illegal  hit  from  behind  during  a  regular  season  game.    BK  is  thrusted  forward  into  the  boards,  hitting  the  front  of  his  head.    He  lays  on  the  ice,  dazed  by  the  unexpected  hit.    His  father,  the  team  trainer,  is  educated  about  concussion  and  recognizes  that  BK  is  not  himself.    He  is  complaining  of  headache  and  dizziness,  and  his  balance  is  affected.  BK  is  removed  from  the  game  and  taken  to  the  dressing  room  for  assessment.    He  is  then  taken  to  the  ER  and  assessed  by  a  medical  doctor.    He  is  complaining  of  headache  and  dizziness.    The  ER  physician  diagnoses  him  with  a  concussion  and  discusses  with  BK  and  his  mother  the  importance  of  rest  and  identifies  a  return  to  play  protocol.    BK  is  instructed  to  rest  and  seek  medical  follow-­‐up  from  his  family  doctor  when  symptom  free,  before  starting  the  return  to  play  protocol.      

 BK  is  symptom  free  one  week  later  and  sees  his  family  doctor  who  gives  him  clearance  to  start  the  return  to  play  process.    Already  informed  about  the  return  to  play  protocol,  BK’s  coach  and  trainers  start  him  through  the  steps  and  monitor  him  for  return  of  symptoms.    BK  goes  through  all  stages  and  does  well  with  no  return  of  symptoms.  He  is  returned  to  game  play.        His  coach  

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and  trainers  are  aware  that  BK  is  high  risk  for  a  repeat  concussion  and  monitor  him  closely  in  the  following  months  of  play.    BK  had  no  further  concussion  like  events  during  the  remainder  of  the  season.    BK  did  have  cognitive  issues  at  school  for  6  months  following  his  concussion,  but  this  cannot  be  proven  to  be  a  direct  result  of  the  concussion.      

Discussion  

1. What  was  the  cause  of  BK's  concussion?  

2. What  signs  and  symptoms  did  BK  suffer?  

3. Did  the  physician  manage  and  treat  BK's  concussion  properly?    (Why?    Why  not?)  

4. Are  you  familiar  with  the  return  to  play  protocol  and  if  so,  can  you  describe  some  of  the  steps?  

5. Why  is  BK  at  high  risk  for  a  second  concussion?  

Additional  Discussion  Questions  

1. Where  did  the  two  cases  of  concussion  differ  amongst  the  twins?    

• AK’s  coaching  staff  had  no  knowledge  of  concussions  or  how  to  recognize  symptoms.    AK  was  returned  to  play  during  a  game  when  a  concussion  should  have  been  suspected  given  the  symptoms  that  AK  was  exhibiting.  AK  did  get  the  diagnosis  of  concussion,  but  no  management  of  concussion  was  explained  to  AK  and  his  parents.    He  received  no  follow-­‐up  information  from  his  family  doctor.    AK  likely  would  have  been  back  on  the  ice  playing  hockey  within  a  few  days  had  their  season  not  been  completed.      

• BK’s  case  was  handled  differently.    Knowledgeable  coaching  staff  and  trainers  aware  of  concussion  signs  and  symptoms,  dealt  with  BK’s  concussion  like  symptoms  immediately.    He  was  removed  from  the  game  and  sent  for  emergency  evaluation.    The  ER  physician  was  knowledgeable  about  the  signs  and  symptoms  of  concussion  and  made  a  diagnosis  quickly  based  on  information  from  the  athlete.    The  ER  physician  knew  about  the  return  to  play  protocol  and  explained  the  follow-­‐up  management  of  concussions.    BK  and  the  trainers  followed  the  return  to  play  protocol  and  watched  for  return  of  symptoms  while  going  through  the  steps.  Enforcement  of  rules  was  also  a  factor  in  BK’s  case.      

2. What  recommendations  would  there  be  for  the  first  case  to  have  a  more  positive  outcome?      

• Provide  education  to  parents,  trainers,  coaches  and  physicians  involved.    

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• Rules  and  their  reinforcement  is  key.  Changes  to  body  checking  rules  changed  after  AK’s  year  in  Atom  hockey.    Body  checking  was  removed  in  Ontario  at  the  Atom  division.    Perhaps  removal  of  body  checking  in  minor  hockey  all  together  would  positively  reduce  the  number  of  concussions.    Both  boys  received  concussions  as  a  result  of  a  body  check  into  the  boards.