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NATA PS: Concussions
Transcript of NATA PS: Concussions
-Symptoms include: Dizziness, balance problems, loss of consciousness, memory difficulties, ringing in ears, nausea, confusion etc...
-All athletes should be assessed by there own symptoms and not compared to anyone else's -Coup: to have an injury sustain at the point of impact
-Contracoup: a moving object hitting an unyielding object where injury occurs on the opposite side of cranial impact
-Focal: posttraumatic intracranial mass lesions
Subdural hematoma, epidural hematoma, cerebral contusion, intracranial hemorrhages and hematoma
-Diffuse: widespread or global disruption of neurologic function
Acceleration-deceleration motions Mechanisms of Injury Equipment Use - Recommend to have a baseline before season starts to know athletes "normal".
-Standardized Assessment of concussion
-Balance Error Scoring System
-Computerized tests such as ImPACT Assessment Tools -Athletes should be told to avoid such things as, alcohol, illicit drugs, and other substances that could tamper with their cognitive function.
-They should be recommended to rest and to stay away from all stimulates like music, television, phones, etc.
-Depending on symptoms some athletes may need to be woken up in the middle of the night to be checked on for deteriorating signs and symptoms. Home Care -If the athlete has three or more concussions in one season it is recommended they be disqualified from all contact sports
-If the athlete is still showing signs or symptoms of a concussion When to disqualify the Athlete -The brain of a young athlete is still developing
-Almost all repoted cases of second impact syndrome are in young athletes
-Concussions of athletes under the age of 18 need to be treated mor conservatively than those of mature athletes' -Helmets should meet National Operating Committee of Standards on Athletic Equipment (NOCSAE)
-Athletes must be made aware of consequences if they tamper with equipment
-Helmets do not prevent concussions. But they do protect against against catastrophic head injuries ATC should develop high sensitivity for the many types of TBI
The word "ding" should not be used to describe a concussion as it promotes the idea of an insignificant injury and therefore false information and encouragement
ATC should be able to recognize:
Obvious signs - fluctuation level of consciousness, balance problems, memory and concentration difficulties
Subjective signs - headache, ringing in ears, nausea, etc. Recognizing a
Concussion* Clinical Evaluation* Evaluation Conducted by both ATC and Physician
History, Observation, Palpation, Special tests
Neuropsychological testing and postural stability-testing
Referral options (neurologist, neuropsychologist, etc) Determining Injury Severity* Force of blow to the head, degree of metabolic dysfunction , the tissue damage and duration of time needed to recover, number of previous concussions, and time between concussions are all factors that must be considered
Loss of consciousness and amnesia are two great factors in determining severity but they should not the sole factors. Studies for their usefulness is establishing RTP is scarce.
3 approaches to determining a grade on concussion
grade concussion at time of injury on signs and symptoms
Grade concussion by presence and duration of the symptoms
Focus attention on the athlete's recovery by symptoms, neuropsychological tests, and the postural-stability tests. 7 day waiting period after initial grade 1-2 concussion and first time of having a concussion
Must be clear of symptoms at rest and during some exertional exercises before cleared to practice in sport specific skills
Monitoring of patient in these skills should be done for first few days after asymptomatic Return to Play (RTP)* During restricted practice, patient should be monitored periodically to asses any returning symptoms
Before returning to full contact, patient should participate in neuropsycholigical and postural-stability tests
Once all tests return to baseline or better, patient may return at the discretion of AT and Physician Special Considerations for Young Athletes *Guskiewicz, Kevin M., Scott L. Bruce, Robert C. Cantu, Michael A. Ferrara, James P. Kelly, Michael McCrea, Margot Putukian, and Tamara C. Valovich McLeod. "National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion." Journal of Athletic Training 39.3 (2004): 280-97. Print. Guskiewicz, Kevin M., Scott L. Bruce, Robert C. Cantu, Michael A. Ferrara, James P. Kelly, Michael McCrea, Margot Putukian, and Tamara C. Valovich McLeod. "National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion." Journal of Athletic Training 39.3 (2004): 280-97. Print. *Guskiewicz, Kevin M., Scott L. Bruce, Robert C. Cantu, Michael A. Ferrara, James P. Kelly, Michael McCrea, Margot Putukian, and Tamara C. Valovich McLeod. "National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion." Journal of Athletic Training 39.3 (2004): 280-97. Print. Concussions usually ocurr as a result of direct impact to the brain or thorugh a combination of acceleration/deceleration forces.
There are a variety of ways to determine the severity of a concussion.
It is the athletic trainer's responsibilty to recognize concsussion symptoms and to monitor them.
Return to play decisions must be made with caution since there is concern for second impact syndrome,subdural hematomas,etc. Conclusion