Overview of ConcussionsConcussion is Suspected

Concussion Assessment & TreatmentBaseline Testing

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What is a Concussion?A concussion is a disturbance in brain function caused by sheer stress to the brain tissue.

Statistics Rate of head injury at FIS World Cup Level: •reported range between 10%

and 13.4%•concussion the most

common injury reportedSteenstrup et al, Br J Sports

Med, 2014Rate of concussions per year in general population: 6 per 1000 people (1.6%)Many more go unrecognized & unreported.

We Need to Take Concussions Seriously•Some can be fatal (Second

impact syndrome)•Post-concussion syndrome

(persisting headaches, dizziness, forgetfulness and mood changes)

•Permanent brain impairment (e.g. “Punch drunk” boxers; hockey and football players)

Mechanisms of Concussion•Directblow to the head face

or neck•Transmittedforce to the

head from an injury elsewhere in the body

•Twisting or rotational forces •LOSS OF CONSCIOUSNESS

OCCURS INFREQUENTLY

The Brain After a Concussion•Impairmentofneurologicfunctiondue to a cascade of brain neurochemical changes

•The disturbance is functional,notstructural(Xray and brain scans are normal)

•Usually resolvesspontaneously: 80 to 90% are better in 7 to 10 days

Common Symptoms •Headaches•Nausea•Sleep Disturbance•DifficultyConcentrating•Foggy Feeling•Light Sensitivity•Poor Balance•Poor Memory•Slowed Reaction Times•Crying

Concussion Awareness forProvincial Women’s Softball Association

Risk Factors for Concussion•Previous concussions •Females •Age •Higher risk sports/

activities•Pre-injury learning

disability (ADHD, ADD, dyslexia)

•Mood disorders•Migraines

Proportion of Concussion and Mild Head Injury by Type of Sport and Helmet

Use, 0-19 years old, BC CHIRPP, 2001-2009

How do we know if an injured skier has a concussion?•May be unconscious•Call 911 and ski patrol•Do not move or remove helmet•Use basic CPR

If skier is conscious and able to get up:•Screen for concussion

symptoms •confused, dazed?•day, date, venue, event??

•unbalanced or unsteady?•behaving inappropriately?• irritable or emotional?•CAN USE IMPACT or

SCAT3 APP

If even mild concussion is suspected:•Skier should not continue

skiing •Skier should be assessed that

day •Emergency Room, or physician’soffice.

•Should not be left alone following the injury

•Should be monitored for deterioration over the initial few hours following injury

Red Flags - Call 911•Severe neck pain •Severe or increasing

headache •Increased confusion or

irritability •Repeated vomiting •Seizure or convulsion •Tingling or burning in

arms/legs •Deteriorating consciousness •Loss of consciousness •Unusual behaviour change •Double vision•Weakness in arms/legs

Preventative Measures •Headgear&helmets:•No evidence of

concussion reduction•They do reduce

biomechanical forces and head and facial injury

•Mouthguards•no evidence of

concussion reduction•prevent oral injury

•Minimizeriskofinjury•Safe course set up and

good snow conditions•Discourage risky

behaviour •Encourage sportsmanship

You Should Know•Concussions are often

NOT managed well.•You CANNOT diagnose a

concussion on x-ray or CT scan, as there is no obvious structural damage ... no visible signs.

•There is still controversy over how to best manage a concussion.

The Brain is Under ConstructionCognitiveRest•no activities that require

concentration. This includes … no smart phones, video games, TV, playing music or reading!

PhysicalRest•no activities that increase

your heart rate or make you break a sweat

EmotionalChanges •are very real after a

concussion•It is normal to be anxious,

angry or depressed after sustaining a concussion

ResearchRecent research indicates that recovery takes more than just sitting in a dark room with no stimulation waiting to feel better.Research has shown that having physiotherapy treatment from a concussion trained therapist increases your chance of returning to activity earlier.

Kathryn Schneider et at. BJSM June 2014

The LifeMark ModelActive Recovery•Accurately Assess the systems

that are having problems•TreatthedeficitsorRefer

to others for more testing or treatment

•GetActivewith a safe & individualized graduated re-entry strategies for their school, sports & work

•Education throughout the healing process

Autonomic Nervous System

Visual

Vestibular

Neck

Cognitive Function

Psychological & Emotional

Support

Sleep Dysfunction

ASSESSMENT & TREATMENT

Practical Recovery Tips•Power down to speed up

your recovery …•Rest – at night & during day•Don’t drink alcohol or take

recreational drugs•Write things down to help

your memory•Avoid driving for 24 hrs

after injury or longer if needed, as it is cognitively demanding

•Consult with family members or friends if you have to make important decisions

Baseline Testing•A computerized test conducted

pre-season by a trained health care professional to measure an individual athlete’s ‘brain function’

ObjectivelyMeasures,Collects&Records:•Learning and memory skills•Ability to pay attention or concentrate

•Reaction time in problemsolving

•Balancereactions•Visual input and abilities

Supports Safe Return-to-Play Decisions

Coaches and Parents ...•Provide reassurance about

prognosis but stress importance of taking it seriously

•Review what to restrict and what to allow/encourage

•Be alert to new symptoms or deteriorating condition

•Be Patient and Supportive •This is not a “no pain, no gain”

scenario!

Sideline or Coach’s Assessment ToolsMight include …•ImPACT Sideline evaluation app•SCAT 3 and child SCATWhen in doubt … Sit them out!

Why We Use ImPACT•It is the gold standard in

Concussion Management for neurocognitive testing

•Test results are safely stored in central database

•More accurate than paper version (SCAT)

•Used by leagues such as the NFL, MLB, NHL and MLS

SchoolbeforeSport:•Afocusonreturntolearnfirst

has been shown to lead to a quicker return to sport

•This it the only sports injury that DIRECTLY impacts one’s ability to learn

No Activity↓

Light Aerobic Activity↓

Sport-Specific Exercise↓

Non-Contact Training Drills

↓Full-Contact Practice

↓Return to Play

STAGE ACTIVITY SUGGESTIONS

No Activity “Chalk talk” sessions Review signs & plays

Light AerobicLight jogging/ stretching No throwing or swings Dry run without balls

Sport-SpecificFielding prep drillsDry swingsPitch tracking drills

Non-Contact Training Drills

Hitting softies/wifflesCatch and throw ball Grounder/fly ball drills

Full Contact Practice Full practice with team

Progress to Next Level if No Symptoms

Gradual Return to Activity

Clear & Consistent Communication

AthletesParents

HealthcareCoachesSchools

REPORTWhen in doubt, sit them out. Athletes are not always the best judge of their symptoms.

RECOVERPersistent symptoms need to be assessed and addressed so that you can get active. Doing nothing is no longer good enough.

RETURNA gradual return to school and sports needs to be clearly communicated to minimize the risk of returning too soon.

Online ResourcesParachute – injury prevention•www.parachutecanada.org ImPACT Testing•www.impacttest.com Centre for Disease Control•www.cdc.gov/concussion ONF – mTBI Guidelines•www.concussionsontario.org Concussion Awareness Training Tool•www.cattonline.com CanChild Brain Injury Research•www.canchild.ca

Join us on Social Media ... Help Us Build Awarenesslifemarkconcussion.blogspot.ca/ twitter.com/LMConcussion facebook.com/pages/LifeMark-Concussion/642260432519014?ref=hl

Jessica Mancini, MScPT•Registered Physiotherapist & Vestibular Therapist •Ontario Clinical Leader of Concussion Management for

LifeMark Centric Health•Ontario Softball Team Trainer for the 2013 Summer Games

Joy Brooks-DesBarres, BSc.PT, RPT•Registered Physiotherapist & Clinic Director – LifeMark

Physiotherapy – Oshawa•Team Physiotherapist Canadian’s Men’s Softball 1999 Pan

American Games/ 2000 World Softball Championships•Lead Medical Practitioner Softball 2015 Pan American

Games/ Ajax Pan Am Ballpark

PWSA Baseline Testing DaysSunday, April 12th LifeMark Physiotherapy - OshawaSaturday, April 18th LifeMark Physiotherapy - MeadowvaleSunday, April 19th LifeMark Physiotherapy - London

Register Online at: http://www.centrichealth.ca/healthfairs/ Event ID: Concussion2015 (it is not case sensitive)Cost? $30 + tax per athlete (takes approx. 30 min)

If tested on one of the above dates; *$5 from every baseline test administered will be given back in!