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KP 424 Medical Case

Sports Concussion
by

James D

on 14 March 2011

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Transcript of KP 424 Medical Case

Symptoms Early Symptoms
Later Symptoms
Gender Differences Early Symptoms Somatic/Vestibular Cerebral Neuropsychiatric Headache
Dizziness
Nausea or vomiting
Tinnitus (rining in the ear)
Reduced eye site
Altered coordination and balance
Drowsiness and/or unconsciousness
Phonophobia (sensitivity to noise)
Photophobia (sensitivity to light) Anterograde Amnesia
Retrograde Amnesia
Attention Impairment
Reduced surroundings awareness
Disorientation
Vacant Stare Personality alternation
Emotional lability
Frustration
Restlessness Gender Differences Male Female Amnesia
Confusion
Disorientation Drowsiness
Sensitivity to noise Similarities Number of symptoms
Symptom resolution time
Return-to-play time More difficult returning to academics Later Symptoms Somatic/Vestibular Neuropsychiatric Persistent or recurrent headache
Light headedness
Visual difficulties
Fatigue Irritability
Anxiety
Depression
Sleep disturbances Cerebral Memory dysfunction
Poor attention and/or concentration Sports Concussions James Dyck
Jenna Franklin
Jenna Jacobson
Katie Mitchell
Mat Mori Closed-head injury resulting from direct trauma causing shearing forces on the brain
Diffuse Axonal Injury (DAI) - not a localized brain injury
Various physiological and behavioural side effects may or may not be present at the time of trauma
Consecutive injury can amplify symptoms and result in post-concussion syndrome
Rehabilitation is sport-specific and progression occurs with the completion of each stage of recovery symptom-free What is a Concussion? Conservative assessment and treatment using SCAT cards and cognitive testing
Only true diagnosis through CT and MRI (fMRI)
Upward rotation in the coronal plane causing shearing forces on the brain What is a Concussion? Mechanisms of injury Assessment Medical Case Jeremy Hacket is an elite soccer goalie for the Wilfrid Laurier Golden Hawks
Prior to starting his second season, he was injured receiving a mild concussion during summer play for London FC.
After taking two months off to recover, he resumed play for the Golden Hawks in the fall.
During practice, he collided with a teammate sustaining a second concussion experiencing moderate concussive symptoms.
He is seeing a specialist to monitor his symptoms. What is a Concussion? What is a Concussion? Action Plan Rehabilitation stages
Analysis Rehabilitation Stage Functional Exercise Objective 1 - No Activity 6 - Return to play 5 - Full contact training drills 4 - Non-contact training drills 3 - Sport-specific exercise 2 - Light aerobic exercise Following medical clcearance, participate in normal training activities Normal game play Simple passing and catching drills. Work on positioning. No head impact activities. Progression to more complex and intense training drills. May start progressive resistance training. No head impact activities Walking, swimming or stationary cycling keeping intensity less than 70% of predicted maximum heart rate Complete physical and cognitive rest Increase heart rate Increase exercise intensity tolerance, improve coordination and cognitive load Add movement Restore confidence, assessment of functional skills by coaching staff Recovery Stepwise Approach Once he is asymptomatic in one stage, he may proceed to the next
Typically, each step should take an individual approximately 24 hours.



Post consussion symptoms = demoted a stage until his symptoms subside Severity of concussion = base progression on the presence or absence of his signs and symptoms Indicates inadequate healing time Consequences Second Impact Syndrome
Post-concussion Syndrome
Basis of Syndrome
Recent Research Second Impact Syndrome (SIS) Occurs when a second concussion is sustained before the first symptoms are relieved
Cerebrovascular congestion and loss of auto-regulation of blood flow in brain results
Cerebral edema can then result in brainstem herniation which can be fatal
Pressure in the brain increases rapidly and can cause death within minutes. After a first concussion, hypermetabolism can occur.
The altered metabolism makes the brain more susceptible to SIS, with the potential for irreversible or fatal damage.
Athletes who do survive suffer from permanent neurological deficits. Post-Concussion Syndrome (PCS) Concussion Symptoms persisting for more than 3 - 6 months.
Different methods with differing criteria to diagnose PCS. International Classification of Disease (ICD-10) History of traumatic brain injury
Presence of 3 or more of: headache
dizziness
fatigue
irritability
insomnia
concentration
memory difficulty
stress intolerance
emotion
alcohol Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) History of traumatic brain injury causing signficaint cerebral concussion, cognitive deficits in atttention and/or memory
Presence of 3 or more of: fatigue
sleep disturbance
headache
dizziness
irritability
affective disturbance
personality change
apathy Basis of Syndrome: Organic vs. Psychological Controversy exists as to which is the cause Organic basis Thought to be responsible for early PCS symptoms but have been present in patients over 1-year post concussion

Cellular damage
Reduced glucose metabolism in certain areas of brain
Metabolic abnormalities
Abnormal cerebral blood flow Psycholgical basis Thought to be responsible for persistant symptoms Recent Research Group of researchers from Buffalo looked at the effects of moderate exercise on post-concussion syndrome
Based on knowledge that post-concussion syndrome is related to a disrupted equilibrium of cerebral blood flow
Had athletes progress through an exercise program of graduated bouts of exercise just below their sub-symptom threshold
Significant gains in exercise tolerance were observed in only a few weeks Bey, T. & Ostick, B. (2008). Second impact syndrome. Western Journal of Emergency Medicine. Retrieved March 1, 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672291/.

Frommer, L. J., Gurka, K. K., Cross, K. M, Ingersoll, C. D., Comstock, R. D., and Saliba, S. A. (2011). Sex differences in concussion symptoms of high school athletes. Journal of Athletic Training. 46 (1). 76-84.

Legome, E. L. (2010). Postconsussive syndrome in emergency medicine. eMedicine. Retrieved March 1, 2011 from http://emedicine.medscape.com/article/828904-overview.

Rindlisbacher, T. (2010). Moderated exercise may ease post-concussion syndrome, new study finds. The National Post. Retrieved March 1, 2011 from http://www.nationalpost.com/life/Moderated+exercise+ease+post+concussion+syndrome+study+finds/2628799/story.html.

Zeigler, T. (2010). Second impact syndrome. Sports MD. Retrieved February 28, 2011 from http://www.sportsmd.com/Articles/id/38.aspx. References Need to pay special attention to his recovery because he has had two concussions in the past 2 months Reasonable Accomodations for the Student-Athlete Recovering from a Concussion Accommodation Rationale Excused absence from class Use of a reader (or recorded books) Monitor backpack weight, stair use Extended testing time Postponement or staggering of tests Extension of assignment deadlines Avoidance of other physcial exertion Lessens visual scanning and concentration demands Mental effort to prepare and then take test may worsen symptoms Information-processing speed may be impeded Information-processing speed and ability to handle full workload may be impeded Several days of complete rest, progressing to limited attendance, may be needed Use of a note taker Temporary assistance of a tutor Preferential classroom seating Use of a smaller, quieter examination room Lessens distraction Assists in organizing and prioritizing assignments Lessens attentional, visual, and concentration demands Lessens stimulation and distraction
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