1. Sport Concussion
A Publication of
The Sport Medicine Council of Alberta 1

2. The Purpose of this Course
To raise awareness on the seriousness of sport concussions.
To decrease the number of sport related concussions.
To provide insight into the newest information on concussion management and prevention.
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3. Look on the bright side
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For a few seconds you forgot you were a Calgary Flame
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4. Some Humor
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5. The Myths of Concussions
Its not a serious injury
A second hit to the head will make the concussed person feel better
Concussions get better within 7 days
Its only a short-term injury
You have to lose consciousness
Others
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6. The Challenge of Concussions
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7. What is a Concussion?
Section 2
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8. Definition
A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.
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9. Diagnostic Tests
Concussions involve a disruption of brain function rather than structural damage.
The majority of time CT scans or MRI tests show no obvious damage.
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10. Neurometabolic Changes and Concussion
Trauma/Concussion
Diffuse axonal injury
Massive release of K+ ions
Glycolysis for K +pumps
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11. Neurometabolic Changes and Concussion
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12. fMRI
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13. fMRI
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14. Impact Mechanics
A contrecoup injury is a result of axial rotation with acceleration, this causes an injury away from the actual impact site.
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15. Concussion Rates
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16. How Often Do Concussions Occur?
On average, 3-5% of all sport and recreational injuries are head injuries.
The majority of sport related head injuries are mild.
The most common cause of sport related head injuries are falls.
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17. How Often Do Concussions Occur?
Patients younger than 20 years old are more likely to suffer a sports related head injury.
Males are more frequently injured.These statistics are changing as more females engage in contact sports.
Very few head injuries are hospitalized.
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18. Recognition of Concussions
It is common for athletes to underreport the incidence of sport concussions.
Often athletes do not associate their symptoms with those of a concussion.
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19. Athletic Trainers Report
Athletic Trainers from Canada and the United States identified head injuries as 5% of their total sports injuries.
X Top sports?
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20. Top Causes of Concussions
Female
Soccer
Horseback Riding
Cycling
Ice Hockey
Snowboarding
Male
Ice Hockey
Cycling
Football
Soccer
Snowboarding
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21. Sport Specific Rates
Hockey:
High School: 17.6/1000 hours
Peewee: 23.1/1000 hours
Bantam: 10.7/1000 hours
Peewee:
Children under age 6 had twice
the head injuries as older
children.

Hockey

22. Professional (Europe):14.3% of all injuries; 0.16/1000 hours 23. College (Canadian Intercollegiate): 7.5% of injuries; 1.5/1000 hours 24. High School (US): 18.7/1000 hours21
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25. Peewee Hockey
N = 125 (86% response rate)
Average age:11.5 years-old with 5.6 years of playing experience
No. of players with concussion:11 (incidence rate = 9.87%) 16 total
7 players with 1 concussion
3 with 2 concussions
1 with 3 concussions(1 non hockey related)
Mechanism of Injury:player contact (n= 10)
hits from behind (n = 4)
fall (n = 1)
collision into boards (n = 1)
Avg # of practices missed: 3.25 (range 0 6)
Avg #. of games missed:2.00 (range 0 4)
Avg duration of symptoms:7.03 days (range 1 - 21 days)
No.subjects with ED visit:n = 1
No. with previous concussion:n = 2
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26. Common Signs/Symptoms
Section 4
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27. Common Signs/Symptoms
Nausea, vomiting
Dizziness
Confusion
Fatigue
Light headedness
Headaches
Irritability
Disorientation
Seeing bright lights
Feeling of being stunned
Depression
Inappropriate behavior
Decreased work/playing ability
Inability to perform daily activities
Cognitive and memory dysfunction
Sleep disturbances
Vacant stare
Poor balance
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28. Any 1 Symptom
Signs/symptoms may vary for each athlete.
A concussion should be suspected in the presence of any one symptom.
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29. Nausea
Be cautious if nausea is a significant symptom.
Some athletes will suffer a mild cognitive impairment for longer periods of time when nausea is present.
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30. How Do I Manage a Suspected Concussion?
Section 5
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31. Recovery Model
Concussion Recovery Model vs. Orthopedic Recovery Model
Concussions need to be managed differently than orthopedic injuries.
No pain. No gain. Does not apply.
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32. Removing a Player from Play
Remove the player from the current game or practice.
Do not leave the player alone; monitor for signs and symptoms.
Do not administer medication.
Inform coach, parent or guardian about the injury.
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33. Return Within a Game?
Be very cautious
Hockey Canada:If player is asymptomatic after 15 minutes, can return
Not if LOC, NeckInjury, ANY symptom
Must be evaluated by qualified professional
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34. When in Doubt, Sit Them Out!
No athlete with a concussion should continue to play or return to a game after sustaining a concussion.
Center for Disease Control
International Concussion
Guidelines (Zurich, 2009)
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35. Deteriorating Neurological Function
Athletes need to be carefully monitored for the first 24-48 hours.If any of the below symptoms occur refer them to the emergency department.
Headaches that worsen
Seizures
Looks drowsy or cant be awakened
Repeated vomiting
Slurred speech
Cant recognize people or places
Increased confusion, unusual behavioral change, or irritability
Weakness or numbness in arms or legs
Neck pain
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36. Screening/Diagnosis
Section 6
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37. Simple or Complex
Concussions can be classified as either simple or complex.
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38. Simple Concussion
A simple concussion usually resolves without complication in 7-10 days.
This is the most common type of head injuries, accounting for 75% of all concussions.
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39. Complex Concussion
A complex concussion involves persistent symptoms and prolonged cognitive impairment.
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40. Post Concussion Syndrome
Following a concussion, an athlete can suffer from long term sleep disturbances, memory and concentration troubles, depression and even psychiatric problems.
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41. Other Issues
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42. History of Concussion
Athletes with a history of concussion are at an increased risk of:
Future concussions (3 to 5 x more likely)
Worse on-field presentations following their next concussion
Experiencing acute changes in their memory performance and reaction times
Slowed recovery
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43. 3 Concussions
After an athlete has sustained 3 concussions, serious consideration should be given to removal from contact sports.
However, each athlete should be considered on an individual basis.
Athletes with a history of 3 or more concussions have a slower recovery rate than athletes with one prior concussion.
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44. How Many is too Many?
There is no magic number of how many concussions are too many.
This must be evaluated individually.
Return to play decisions should be guided by neuropsychological test results and symptoms reported by the athlete regardless of the number of concussions.
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45. Long Term Consequences
Studies from retired NFL players suggested
Increased incidence
Depression (2 to 4x higher than normal population)
Cognitive Difficulties
Chronic Traumatic Encephalopathy
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46. Does Age Affect Recovery Time?
High school athletes may exhibit slower recovery after sports related concussions compared to collegiate athletes.
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47. Younger Athletes
Younger athletes are more prone to complex concussions than college athletes.
Younger athletes show more signs of mood disturbance (irritability, lower frustration tolerance) than older athletes.
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48. Second Impact Syndrome
It is thought to occur when an athlete suffers a second blow to the head while recovering from an initial concussion.
This can happen up to 14 days post injury.
The result is a catastrophic increase in intracranial pressure which, in rare cases, can lead to death.
It most often occurs in athletes under 21 years of age.
This is very rare and there is still debate on when it occurs.
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49. Return to Activity
Section 8
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51. Medical Doctor Evaluation
An athlete should be evaluated by a medical doctor after any blow to the head.
Hockey Canadas Guidelines
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52. Medication
Only take medications your medical doctor has prescribed only after medical assessment.
Do not drink alcohol or
take non-prescription drugs.
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53. Medical Decision
Return to play is a medical decision that should not be made by a parent, coach, trainer or athlete.
Each case must be handled individually
7 Day rule does not apply
An athlete should complete a sport specific rehabilitation program and cleared by a medical doctor.
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54. Pocket SCAT2
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55. Symptoms in Sports concussion
Everyone feels fine
Always ask:
1.On a scale of 0 to 100%, how do you feel?
2.what makes you not 100%?
3. Checklist SCAT2
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56. 6 Return to Activity Steps
If it is decided that an athlete will return to play a stepwise process must be followed.
(Available in the SCAT-2)
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57. Graded Exertion Protocol

24 hours per step

58. If there is recurrence of symptoms at any stage, return to previous step