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Max Strauss

on 14 December 2013

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Transcript of Concussions

3.8 million sports related concussions occur
each year

In U.S. high schools, concussions make up
9% of all injuries

7.5 million students participating in high
school sports

The incidence of concussions in high school
athletes had increased 4.2-fold over the 11 year period ending in 2008.
Conscious state compromised

disorientation, confusion, look dazed,
slowed reaction time, slowed verbal responses, anterograde/retrograde

seizure, off-balance, coordination/gait

emotional, sad, moody
Sport Specific
Onset & Symptoms / M.O.I. (Mechanism of Injury)
How It Occurs?
Direct blow to the head:
-Punch to the skull,
-Helmet-to-helmet hit
Indirect blow to body
-Whiplash, violent moving
Age of Onset
-Can occur at any age
-Children and young adults are more
-Thinner skull
-Weaker neck muscles
-Decreased amount of myelination
-Underdeveloped auto-regulatory

Males vs. Females
• Females are more susceptible to concussions due to
weaker neck musculature.

Activity Restriction
Athlete absolutely cannot play any sport
while symptomatic

Should refrain from all activity that
requires exertion
ex. running, biking, weight lifting etc.

Should refrain from watching TV, playing
video games, being in crowds, going to sports events
Academic Assistance
"Post concussive symptoms often interfere with a student-athlete's ability to do academic work, participate in the classroom setting, and function interpersonally with peers and parents. Fatigue and sleep disruption may leave the student-athlete without the mental energy participate in a full day of class work and evening studies."
Duration until
Return to Activity

Lauren Baker
Anthony Chickillo
Dane Pollack
Beau Sandland
Max Strauss

Basic Anatomy
Brain consists of tissue with a jello-like consistency.

It is surrounded by three meninges:
Dura mater
Arachnoid layer
Pia mater

Outside of the meninges is the bony skull
Bony skull is surrounded by strong muscles

1. Educate Coaches, Parents, and Athletes.
2. Remove Athlete from Play.
3. Obtain Permission to Return to Play.
Since 2009, 49 states have passed legislature:
MRI, CT, and X-Ray will be negative
Exceptions: Hemorrhaging / Fracture
25 minute computerized test
Baseline score before season
Retested within 72 hours of injury for comparison
Measures symptoms, reaction times, verbal and
visual memory, and processing speed
Special Tests
Sideline evaluation
Assesses impaired eye movements, language,
concentration, and neurological functions
PCSI by ImPACT: subpart of ImPACT
Measure symptom severity
22 symptoms measured on scale 1-6
Standardized sideline evaluation tool
8 sub-parts: Glascow Coma Scale,
Maddock's score, symptom evaluation
cognitive assessment, neck exam,
BESS coordination exam
and SAC delayed recall test
Any athlete with suspected concussion:
Must be taken out of the game or out of practice immediately.
Must be cleared by a licensed medical
Varies by state
UConcussion RTS

Headache, nausea, vomiting, dizziness or
‘‘wooziness’’, vertigo, imbalance, changes in vision or hearing, tinnitus, photophobia, phonophobia, fatigue

Unclear or ‘‘foggy’’ thinking, difficulty
concentrating or remembering, hallucinations

Sadness, depression, moodyness
Concussion is a sudden-onset, transient alteration of consciousness due to a combination of functional and structural brain disturbances following a physical impact transmitted to the brain.
Describe the Injury
Can occur in any sport but is especially prevalent in contact sports

Highest concussion incidence are
football (40.5%) and girls’ soccer (21.5%).

Football: Lineman are the most vulnerable. They sustain:
-1000 or more impacts per season
-An average of 70 impacts per week in high school.
Zackery Lystedt Law
Requires medical clearance before returning to play.
Any athlete taken out of play for a suspected
concussion must be cleared by an licensed medical professional before returning to play.

Protocols vary between school, clinic, physician etc.
for return to play, however most recognize that once the athlete is asymptomatic, they must be returned to play in a gradual fashion.

Typically, 50-60% of symptoms resolve within 7 to
10 days after injury
Gradual Return to Play
Athlete needs to complete GRTP
without having any symptoms

Can last from 3 to 5 days

UHealth Concussion Clinic GRTP:
Education Programs

Associated Risks
Second Impact Syndrome (SIS): Sustaining an
impact before brain heals from previous injury
Can be fatal
Only reported in athletes less than 25 years old

Chronic Traumatic Encephalopathy (CTE): thought to
be caused by repetitive concussive events and head injuries.
Results memory deficits, depression, disorientation,
confusion, aggression, violence, suicidal
behavior, and eventually dementia.
90% in athletes with repetitive head trauma

Khurana, V. & Kaye, A. An overview of concussion in sport. Journal of Clinical Neuroscience. 2012; 19:1-11.
Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. The Journal of Head Trauma Rehabilitation. 2006; 21(5): 375-378.
Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among United States high school and collegiate athletes. Journal of Athletic Training. 2007; 42(4): 495-503;
2011-2012 high school athletics participation survey. National Federation of State High School Associations. Available at: http://www.nfhs.org/content.aspx?id=3282. Accessed November 5, 2012
Lincoln, A.E. et al. Trends in concussion incidence in high school sports: A prospective 11-year study. The American Journal of Sports Medicine. 2011; 39: 958. DOI: 10.1177/0363546510392326
Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among United States high school and collegiate athletes. Journal of Athletic Training. 2007; 42(4): 495-503).
Broglio et al. Estimation of head impact exposure in high school football: A biomechanical assessment. American Journal of Sports Medicine)
Meehan WP, Bachur RG. Sport-related concussion. Pediatrics. 2009; 123:114–23.
Chrisman, S.P., Quitiquit, C., Rivara, F.P. Qualitative study of barriers to concussive symptoms reporting in high school athletics. Journal of Adolescent Health. 2012; 52:330-335, McCrea, M., Hammeke, T., Olsen, G., Leo, P. Guskiewicz, K. Unreported concussion in high school football players: Implications for prevention. Clinical Journal of Sports Medicine. 2004; 14(1): 13-17., Williamson, I.J.S., Goodman, D. Converging evidence for the under-reporting of concussions in youth ice hockey. British Journal of Sports Medicine. 2006; 40:128-132. doi: 10.1136/bjsm.2005.021832
McGrath, N. Supporting the student-athlete’s return to the classroom after a sport-related concussion. Journal of Athletic Training. 2010; 45(5): 492-498.
McCrea. Acute effects and recovery time following concussion . 2003.
retrieved from http://www.cdc.gov/concussion/pdf/a_fathers_story-a.pdf
Bagley, A.F. et al. Effectiveness of the SLICE Program for youth concussion education. Clinical Journal of Sports Medicine. 2012; 22(5):385-389.

Largely underreported
Want to keep playing, didn't think it was
a concussion, expected to play,
embarrassing, don't want to let
team down
Rotational or angular forces cause neuronal
Acceleration and deceleration
Full transcript