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on 30 November 2013

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Transcript of Concussion

Under the surface
Post-Concussion Syndrome
Highly Debated

Concussion symptoms last "longer than expected"
- >3 months post-injury - some argue less, some more (few weeks or >6 months)

Diagnostic and Statistical Manual for Mental Disorders (DSM-IV):
1) Problems with attention and memory

2) 3 (+) symptoms of a concussions

3) Lasting at least 3 months
Second Impact Syndrome
Involves 2 events:

1) Post concussive symptoms following an initial head injury

2) A second head injury prior to the first one healing (same day to weeks following initial, if initial injury was not fully healed)

Diffuse cerebral swelling, brain herniated, and death can occur
Cumulative Effects of Concussion
cumulative effects poorly understood and difficult to demonstrate but over time:
SINGLE CONCUSSION: causes cell damage to a number of cells
MULTIPLE: damage to previously inured cells decreases ability to recover
REINJURY: if happens before recovery - sustained damage

3+ concussions = "memory problems" + "taking longer to think" + worse outcomes

other research:
increased future risk for concussions + longer recovery
increased and prolonged symptoms
What is a concussion?
How does it happen?
What does it look like?
Signs and Symptoms
Considerations as ATHLETES
What happens if I get one?
Why do I CARE?
COMPLEX pathophysiological process affecting the brain

Cause: trauma or biomechanical forces

Involves a rapid onset of impairments to functioning

Functional disturbances rather than structural damage

Associated with several symptoms (of which we will discuss further)

1) Direct blow to head, face, neck, or elsewhere
2) Blow to elsewhere on body - forces are transmitted up to head

Acceleration/Deceleration Coup OR Contre-coup

Torsion/Rotation Lower Jaw Impact
Athlete A
14 years old

Suffered head injury - continued playing for 25 mins before suffering another head injury

Coach and referee were unaware of the head injury

Cause of death: cerebral edema and subdural haemorrhage due to SECOND IMPACT SYNDROME
Athlete B
21 years old

diagnosed with second impact syndrome after being forced to play

lost function to the right half of his body
now lives in a Selkirk Rehabilitation Center
Filing 7.5 million dollar lawsuit against Bishop's University
Different for everyone
Can still be concussed without losing consciousness

Special Considerations for Athletes
- Adolescent athletes = younger than 18 years old
- 100, 000+ concussions in 2010 reported for high school football
- Less common in wrestling, but still happen.

- Potential for delayed onset of symptoms

- Age can affect recovery, but compliance is most important.

- Recovery time is longer (adult vs. college vs. high school)

- ***Increased academic strains from school***
In the Event of a Concussion
Return to Play
NO same day return to play

Stepwise process

Each step can take approx. 24 hrs

Only proceed to next step once asymptomatic

If symptoms reoccur -> drop back a step

1. No activity
Physical and cognitive rest

2. Light aerobic exercise
Walking, swimming, cycling

3. Sport-specific exercise
Running drills

4. Non-contact training drills
More complex training drills
Passing, catching
May start progressive weight training

5. Full contact practice
All normal training activities following medical clearance




- you MUST be assessed
find your therapist or a doctor
- if you have one:
DO NOT return to play
stay with people
see your doctor if symptoms increase
take a break: physically AND mentally
- full concussion assessment after reporting of symptoms
- notify coaches of NO RETURN TO PLAY
- home instructions for you AND your parents
- doctor clearance before return to play
- step-wise return to play process

1) Accessed 9/27/13
2) Accessed 9/27/13 http://www.gaylord.org/our-services/rehabilitation/center-for-concussion-care.aspx
3) Accessed 10/3/13 http://www.gaylord.org/our-services/rehabilitation/center-for-concussion-care.aspx
4) Accessed 10/3/13
5) Accessed 10/5/13 http://www.macisaacandcompany.com/injuries/head_injuries.php
6) Accessed 9/28/13 http://www.macisaacandcompany.com/injuries/head_injuries.php
7) Accessed 9/23/13 http://www.dailymail.co.uk/news/article-2410391/Rugby-player-14--died-second-impact-syndrome-playing-rugby-25-minutes-heavy-collision-player.html
8) Accessed 9/23/13 http://ca.sports.yahoo.com/blogs/cfl-55-yard-line/kevin-kwasny-brain-damage-lawsuit-against-bishop-could-213547781.html
9) Accessed 10/5/13 http://www.scientificamerican.com/article.cfm?id=unschooled-in-hard-knocks
10) Accessed 10/5/13 http://goldcoastphysicaltherapy.wordpress.com/2012/10/17/gold-coast-physical-therapy-and-immediate-post-concussion-assessment-for-high-school-athletes-in-palm-beach-county/
11) Accessed 10/5/13 http://www.npr.org/blogs/health/2013/03/18/174638083/doctors-bench-athletes-at-first-concussion-sign
12) Accessed 10/5/13 http://www.npr.org/blogs/health/2013/03/18/174638083/doctors-bench-athletes-at-first-concussion-sign
13) Accessed 10/5/13 http://www.sacramentovalleyconcussion.com/
14) Accessed 10/5/13 http://www.nytimes.com/2013/05/12/sports/safety-advocates-focus-on-hidden-threats-to-young-athletes.html?pagewanted=all&_r=0
15) Accessed 10/5/13 http://www.nugget.ca/2013/09/18/lakers-gearing-up-to-hit-the-ice
Bey, T., & Ostick, B. (2009). Second Impact Syndrome. West J Emerg Med. 10(1) 6-10. Retrieved September 23, 2013 from PubMed. PMC2672291 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672291/
Grady, F. M. (2010). Concussion in the Adolescent Athlete. Current Problems in Pediatric and Adolescent Health Care. 40:154-169. DOI: 10.1016/j.pmrj.2011.07.015
Karlin, M. A. (2011). Concussion in the Pediatric and Adolescent Population: “Different Population, Different Concerns”. American Academy of Physical Medicine and Rehabilitation. 3(10S2) S369-S379. doi:10.1016/j.cppeds.2010.06.002
Logan, K. (2010). Recognition and management of post-
concussion syndrome. Athletic Therapy Today, 15(3), 4-7.
McCrory, P. et al. (2012). Consensus Statement on Concussion in Sport. Br J Sports Med. 47(5) 250-25. doi:10.1136/bjsports-2013-092313
McCrory, P., Meeuwisse, W., Johnston, K., Dvorak, J., Aubry, M,. Molloy, M., Cantu, R. (2009). Consensus Statement on Concussion in Sport – the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. South African Journal of Sports Medicine. 21 (2) 36-46.
Metcalf, E. (2011, November 3). After a concussion: What to do. Retrieved September 28, 2013, from WebMD website: http://teens.webmd.com/features/teen-concussion-recovery-what-to-do
Purcell, L. K. (2012). Evaluation and management of children and adolescents with sports-related concussion. Paediatrics & Child Health, 17(1), 31-32.
Su, J. K., & Ramirez, J. F. (2012). Management of the athlete with concussion. The Permanente Journal, 16(2), 54-56.

Jake Deitchler

Flagged by experts as future olympic medalist

Retired Jan. 2008 because of second impact syndrome from approximately 12 concussions
Forced to Retire at 22.
Concussions in Wrestling
Potential risks with tournaments?

Full transcript