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Sports Related Concussions: Present and Future
Alyssa Hoot
What is a Concussion?
• Traumatic Brain Injury
• Forceful blow to the head area
• Causes rapid movement of the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head
http://www.umm.edu/imagepages/17143.htm
Brain Function
• Disturbance of brain function
• Brain is literally bouncing within the skull
• Cell and cell membranes in the brain are stretched and torn and are disrupted from their normal functions
• Calcium, potassium, glutamate, and other substances abnormally move in and out of the injured cells
Brain Function
• Blood flow is restricted in the brain’s injured area
• Blood is the brains only source of fuel
• Limited supply for the injured brain cells
• High demand for blood as the brain tries to repair
Signs and Symptoms
• Headache
• Nausea/Vomiting
• Loss of consciousness
• Amnesia
• Balance Problems or Dizziness
• Blurry Vision
• Sensitivity to Light and Noise
• Feeling Sluggish
• Concentration or Memory Problems
• Confusion
• Not Feeling Right or Feeling Down
Chronic Traumatic Encephalopathy
• Progressive degenerative disease of the brain
• Found with history of repetitive brain injury
• Memory loss, depression, aggression, dementia
• Effects the brain tissue
• Build up of tau protein
Tau Protein
• Structural element of tiny tunnels called microtubles in the axon.
• Tau malfunctions and stops working while the tunnels are deteriorating.
• Nothing can get through because the brain function is not functioning correctly.
• Staining the tissue with an antibody turns the tau protein brown abnormal tau protein remains as clumps and strands.
Photo by Ann C McKee, MD, VA Boston/Boston University School of Medicine.Copyright: Ann C McKee, MD, VA Boston/Boston University School of Medicine. (Nowinski, 2013)
Post Concussion Syndrome
• Persists beyond the general time frame of recovery
• Symptoms may include: Attention, memory, headaches, dizziness, sleeping problems, or irritability
• Symptoms can last for weeks to months
Baseline Testing
• Recommended to establish the athlete’s normal pre injury performance
• Evaluates: Brain processing speed, Memory, Reaction time, and Visual motor skills
• A benchmark to measure post injury recovery
SCAT Test
• Standardized tool of evaluating injured athletes
• Sideline evaluation assessment
• Evaluates symptoms, balance, Glasgow coma scale, cognitive assessment, coordination examination, memory, concentration, and delayed recall
Impact Test
• Computerized neurocognitive assessment
• Measures: Attention span, Working memory, Sustained and selective attention time, Response variability, Non-verbal problem solving, and Reaction time
• Guidance in return to play decision
Return to PlayRehabilitation Stage Functional exercise at each
stage of rehabilitation Objective of each stage
1. No Activity Symptom limited physical and cognitive rest Recovery
2. Light Aerobic ExerciseWalking, swimming or stationary
cycling keeping intensity <70% max permitted HR
Increase HR
3. Sport-Specific ExerciseSkating drills in ice hockey, running
drills in soccer. No head impact activities
Add Movement
4. Non-Contact Training DrillsProgression to more complex training drills. May start progressive resistance
training.Exercise, Coordination & cognitive load
5. Full-Contact Practice Following medical clearance participate in normal training activities
Restore confidence & assess functional skills by coaching staff
6. Return to Play Normal game play
Second Impact Syndrome
• Athlete who returns to play while recovering from initial injury and sustain another concussion
• Athlete is more susceptible because of the inherent risk of a second injury
• This could happen days or weeks after initial injury
• Rare, but young athletes are at an increased risk
• Could cause permanent brain damage and can be fatal
Bauer Re-Axt
• Suspend-Tech liner
• Poron XRD Foam
• Vertex Foam
• Adjustment/Lock features
www.bauer.com
Impact Indicator
• Chin strap that detects a blow to the head
• Measures the force and duration of a hit
• Light turns red when a hit is over 240 HIC’s
ShockBoxIce Hockey, Football, Ski/Snowboard, LacrosseIce Hockey, Football, Ski/Snowboard, Lacrosse
• Placed on the helmet
• Collects impact data
• Wirelessly sends impact data to a smartphone (free app)
www.theshockbox.com
X2 Biosystems
• X-Patch
• Located behind the ear
• X-Guard
• Detects a hit to the head
• Collects information and send them wirelessly to an app
What can be improved• Education:
• Coaches go through training seminars - certified
• Family physicians go through training
• Contact sports: proper hitting techniques
• Baseline Testing: Before the regular season starts
• Ages 12 and under: every year
• Ages 13 and up: every 2 years
• Testing is covered by insurance
• Offered by family physician
What can be improved
• Return to Play:
• No same day return
• Graduated return to play steps
• Medical clearance
• Equipment:
• Knowledge of helmets
• Sensor
WHEN IN DOUBT, SIT THEM OUT!
