Management of Management of ConcussionConcussion

For AdministratorsFor Administratorsin in

High School AthleticsHigh School Athletics

MICHELE C. BENZ, ATC, LAT, CSCS, HFSMICHELE C. BENZ, ATC, LAT, CSCS, HFS

1. What are the new guidelines on treatment and 1. What are the new guidelines on treatment and management management of concussion of concussion 2. how can we develop a second impact syndrome 2. how can we develop a second impact syndrome prevention prevention program?program?

Treatment, Management Treatment, Management & Prevention of SIS & Prevention of SIS

Helmet Fitting Performed by ATCViewing of Concussion Video Prior to Play

Baseline Testing (ImPACT) Use Concussion Evaluation Form

(SCAT/SAC) Return To Play Guidelines, Zurich 2008

What Do I Need To Know?

What Is A Concussion?What Is A Concussion? Complex pathophysiological process that affects the

brain, induced by traumatic biomechanical forces.-Zurich Concussion Conference, 2008

Blow to the head resulting inBlow to the head resulting in Concussion=BRAIN DAMAGE!!!Concussion=BRAIN DAMAGE!!!

Facts About ConcussionFacts About Concussion1.2 Million Youth Concussions Per Year50% FB Players Have Sustained A Concussion 35% Suffered Multiple Concussions80% Symptoms Worsen Over Weeks 50% Return To Play Too Soon70% Would RTP Concussed41% Would Not Leave A Game50 H.S. Football Players Have Died Since 97

“It’s not dangerous to play with a concussion,” said Kelby Jasmon, a senior two-way player for his high school in Springfield, Ill., who has had three concussions. “You’ve got to sacrifice for the sake of the team.

The only way I come out is on a stretcher.”

Recognizing A Recognizing A ConcussionConcussion

1. Know the cognitive level of the student2. Learn to recognize the signs and symptoms

Signs:•Athlete stumbles after play•Shakes head in attempt to “shake it off”•Goes to wrong huddle or in wrong direction•Takes a knee/bent over•Runs the wrong play •Eyes don’t focus/follow

Symptoms•Headache•Nausea•Sensitivity to Light•Lethargic•Personality Changes

Baseline Testing and Baseline Testing and Videos Videos

Online 20 minute test Inexpensive Printed test score Tests

– Reaction time

– Working & Design memory

– Attention span

– Non-verbal problem solving

– Visual processing speed

– Impulse control

– Response inhibition

Testing

Videos Heads Up CDC/NFHS Youth Concussion ESPN’s

– E:60 (5.4.10)

– Outside The Lines (11.4.07)

Example Evaluation FormExample Evaluation Form

TreatmentTreatmentNational Federation of State High Schools: February, 2010

– Removal from participation, even if symptoms clear within 15 minutes.– In absence of medical staffing, officials now charged with removal from

participation without LOC.

1)1) SCAT evaluationSCAT evaluation2)2) Parental/guardian Parental/guardian

contactcontact3)3) Dialogue with Dialogue with

coach/athletecoach/athlete4)4) Referral/Diagnostic Referral/Diagnostic

testing*testing*5)5) Post-Injury ImPACT Post-Injury ImPACT

testtest6)6) Graduated RTPGraduated RTP7)7) Head Injury Reporting Head Injury Reporting

FormForm

*Referral based upon results of evaluation.Diagnostic testing diagnoses structural abnormality, not concussion.

Return To PlayReturn To PlayNew guidelines (Zurich Conference, 2008) recommend a graduated RTP

“Step-Wise Return to Play Protocol”

1) Complete physical and cognitive rest2) Light aerobic activity 3) Sport specific exercise4) Non-contact training drills5) Full contact practice6) Return to game play

Athletes should also be back to baseline and depending on grade of Athletes should also be back to baseline and depending on grade of concussion, be cleared by a neurologist and/or neuropsychologist.concussion, be cleared by a neurologist and/or neuropsychologist.

The NFL changed their RTP guidelines on Dec. 3rd, 2009 stating: “Any player suffering signs/symptoms of a concussion should not return to play the same day and should be checked out by proper medical staff.”

Non-Athletic Injured Students

•Physical Education Physical Education Classes Classes •Fighting or other Fighting or other accidentaccident*Have a plan in place prior to the school year*

1.1. Do not move the studentDo not move the student2.2. Have an administrator decide whether or not Have an administrator decide whether or not

EMS is neededEMS is needed3.3. Contact the parent or guardianContact the parent or guardian4.4. If transport is not necessary-advise the parent to If transport is not necessary-advise the parent to

have the student checked out by their doctor.have the student checked out by their doctor.5.5. Fill out accident reportFill out accident report

Second Impact Syndrome Second Impact Syndrome (SIS)(SIS)

Second concussion before previous concussion has completely resolved

Metabolic volcano within the brain Athletes under 23 at greatest risk Catastrophic brain injury or Death

Second Impact Syndrome is Second Impact Syndrome is PREVENTABLEPREVENTABLE

Before & After SISBefore & After SIS

Prevention Prevention Miami Palmetto SIS Prevention Miami Palmetto SIS Prevention

ProgramProgram1) Coaches are on board with program

2) Baseline testing-ImPACT

3) Concussion awareness videos

4) Parent/Athlete Information Sheet

5) Equipment fit by ATC

6) Use of Sideline Evaluation Test

7) Responsibility Clause –Physical form

8) Referral for diagnostic testing via

Sports Medicine team.

SIS is SIS is PREVENTABLEPREVENTABLE

ESPN’sESPN’s E:60 E:60

Questions?