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Concussion Talk

published on 06-17-2011

Concussion Talk, June 2011, Dr England and Dr Priebe

Definition of concussion: A complex pathophysiologic process affecting the brain, induced by traumatic biomechanical forces. It can be caused by either a direct blow to the head, face, neck or elsewhere on the body with an “impulsive” force transmitted to the head

Other names for concussion, “punch drunk”, “bell rung”

Concussion typically results in the rapid onset of short lived impairment of neurologic function that resolves spontaneously

Concussion often is an intra/extra cellular neurologic change and rarely any structural change

Concussions are common >300,000 per year.

Initial Symptoms of concussion: Confusion (answers slowly, forgets plays, dazed), Amnesia, Loss of consciousness, nausea/vomiting, convulsion (rare)

Later Symptoms:
    Cognitive: concentration deficits, “fogginess”, feeling slow
    Emotional: anxiety, sadness, irritable
    Somatic: headache, dizziness, light/sound sensitivity
    Sleep related: hypersomnia, insomnia

Concession specialists have abandoned older guidelines and grading systems, i.e. Dr Cantu

New guidelines are based on the 2008 Guidelines from 3rd International Conference on Concussion in Sport Medicine held in Zurich  (Clinical Journal of Sport Medicine May 2009, Vol 19, Issue 3, pp 185-200)

Majority of concussions (80 to 90%) resolve in a short period (7 to 10 days), however, recovery time may be longer in adolescents, children and repeat injuries
The importance of correct concussion diagnosis and return to play:
    Now high schools have access to neurodiagnostic studies such as IMPACT system, however it is important to have a baseline reading from preseason for comparison to in season injury.  Another test can assess the balance of the athlete prior to being cleared for return.  Lastly the athlete can be cleared with the IMPACT system but may still be symptomatic and it is essential he/she is cleared by a physician who knows current guidelines.

Second impact syndrome, concern for death if adolescent athlete is returned to competition too early, CDC reports 1.5 deaths/yr

Return to play – When athlete has been cleared to return and is asymptomatic, he/she needs to gradually increase activity.  Too many athletes are cleared and instantly return to full activities and this increases risk for recurrent concussions.

Guideline: (advance after 1 to 2 days of being asymptomatic)
    1.Cognitive and physical rest until asymptomatic
    2.Light aerobic exercise, e.g stationary bike
    3.Sport specific exercise
    4.Non contact drills
    5.Full contact drills
    6.Return to competition

Same day return to play – should be okay with adult elite athletes if all symptoms improve within 20 minutes.  Symptoms in youth may clear initially, but often have delayed onset of neurologic symptoms.

Advice to coaches and parents:
    1)Do not leave athlete alone for 24-48 hours
    2)Emphasize problems may arise over 24 hours
    3)Review warning signs for head injury
    4)Emphasize rest (physical and cognitive)
    5)Avoid aspirin and sleeping tablets
    6)No alcohol, driving or other sports

Long term concerns are the cumulative effect of repeated concussions and alzheimers, brain damage, parkinsons

Recommend limiting helmet to helmet hitting in football, minimizing headers in soccer

Lastly each concussion should be treated on an individualized basis

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