Behavior or signs observed indicative of a possible concussion
- Loss of consciousness
- Appears dazed or stunned
- Appears confused
- Forgets plays
- Unsure of game, score, or opponent
- Moves clumsily
- Answers questions slowly
- Shows behavior or personality changes
- Can’t recall events prior to or after the injury
Symptoms reported by a player indicative of a possible concussion
- Headache
- Nausea
- Balance problems or dizziness
- Double or fuzzy vision
- Sensitivity to light or noise
- Feeling sluggish
- Feeling foggy or groggy
- Concentration or memory problems
- Confusion
A concussion is a brain injury that disrupts normal brain function. To have a concussion, an athlete does not need to be unconscious (be “knocked out”). Indicators of a possible concussion.
- Concussion is a common injury with about __% of all student athletes in contact sports suffering a concussion during their season.
• 2%
• 6%
• 10%
• 20% - It is recommended that student athletes have a baseline test of neurocognitive functioning because:
• The test will tell the parents which sports the child should play
• The test provides a baseline so that if a concussion occurs, there is something to compare brain function after the injury.
• The test will look for abnormalities that may interfere with the child’s ability to play sports. - True or False: Amnesia is a rare side effect of a concussion.
True
False - If you compared it to a food, your brain has the consistency of:
• Hamburger
• Cooking oil
• Gelatin - True or False: A concussion can only be caused by a blow to the head.
True
False - True or False: Children who have suffered a concussion should rest mentally as well as physically.
True
False - If the symptoms of a concussion last for weeks, this is called:
• Post-concussion syndrome
• Concussive edema
• Concussion complication disorder
• Reflexive concussion - Which of the following is not a significant risk factor for the problem outlined in question 7
• Being older
• Being female
• Having a sports-related concussion - Which of the following is not a symptom of a concussion?
nausea or vomiting
slurred speech
feeling anxious or irritable
feeling happy
“seeing stars” - Which of the following is not a common reason that high school sports injuries occur?
improper training
drinking too much water during the game
wearing the wrong type of shoes
lack of safety equipment - Which is a good way to heal from a concussion?
Physical and mental rest
Exercise and problem-solving video games
Brain transplant - True or false: If you don’t lose consciousness, you don’t have a concussion.
True
False - When it comes to a head injury in sports, the best thing to remember is:
“No pain, no gain!”
“When in doubt, sit out!”
incidences of concussions
-30% of all concussions in individuals between 5 to 19 are sports related
-highest sports : football, wrestling, girls/boys soccer and girls basketball
-game concussion are higher than practice
-highest sports : football, wrestling, girls/boys soccer and girls basketball
-game concussion are higher than practice
definition of concussion
-a complex pathophysiological process affecting the brain induced by traumatic biomechanical forces
-concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury
-concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury
external forces may include any of the following events:
-the head being struck by an object
-the head striking an object, the brain undergoing an acceleration/deceleration movement without direct external trauma to the head
-a foreign body penetrating the brain, forces generated from events such as a blast or explosion, or other force yet to be defined
-the head striking an object, the brain undergoing an acceleration/deceleration movement without direct external trauma to the head
-a foreign body penetrating the brain, forces generated from events such as a blast or explosion, or other force yet to be defined
concussions occur when
linear and/or rotational forces are transmitted to the brain causing the “neurometabolic cascade”
neurometabolic cascade
-release of excitatory neurotransmitters
-increase in amounts of ATP
-increase in glucose metabolism
-decrease in cerebral blood flow
-decrease in oxygen metabolism
-spike in potassium causes the dulling effect and that takes time to regulate
-increase in amounts of ATP
-increase in glucose metabolism
-decrease in cerebral blood flow
-decrease in oxygen metabolism
-spike in potassium causes the dulling effect and that takes time to regulate
diffuse axonal injury
most frequent head injury
-occurs from shearing, stretching or traction on small nerves leading to poor axonal transport, focal swelling and possible axonal disconnection
-occurs from shearing, stretching or traction on small nerves leading to poor axonal transport, focal swelling and possible axonal disconnection
head injuries
-diffuse axonal injury (most common)
-contusion
-subdural hemorrhage
-contusion
-subdural hemorrhage
second impact syndrome
-rare condition
-onset of second concussion before completely healing from the initial
-rapid swelling of brain tissue
-signs/symptoms: dilated pupils, loss of eye movement, respiratory failure, death
-onset of second concussion before completely healing from the initial
-rapid swelling of brain tissue
-signs/symptoms: dilated pupils, loss of eye movement, respiratory failure, death
age recovery rates change
prof athlete = 1 day
college = 7 days
high school = 10-26 days
youth = 30 days `
college = 7 days
high school = 10-26 days
youth = 30 days `
post concussion protocol
there is none, individualized approach
PA law with concussion
must be removed from play, cleared by medical professional, and educated prior to return to play
risk factors – migraine Hx & current complaints
-no association has been shown between pre existing migraine and prolonged course
-however, post “migraine symptom complex” had a longer recovery
-however, post “migraine symptom complex” had a longer recovery
risk factors – prior concussions
2-5.8 times higher risk of sustaining another concussion, conflicting evidence on recovery course
risk factors – number, severity, and recovery length
increases in any of these are predictors for a prolonged recovery
-*dizziness sideline is a predictor of recovery greater than 21 days
-*dizziness sideline is a predictor of recovery greater than 21 days
risk factors – mood disorders
pre-exisiting or result will complicate diagnosis and management
-17 to 46% oh high school and college athletes have symptoms of anxiety, depression, or irritability
– no evidence that pre existing mood disorders predispose athletes to concussion
-anxiety, depression, and other psychological impairments may affect NP testing
-17 to 46% oh high school and college athletes have symptoms of anxiety, depression, or irritability
– no evidence that pre existing mood disorders predispose athletes to concussion
-anxiety, depression, and other psychological impairments may affect NP testing
risk factors – learning ability
-preinjury ADD/ADHD may be associated with increased cognitive dysfunction and prolonged recovery
-baseline score are lower in this population
-baseline score are lower in this population
risk factors – age
developing brains with less cognitive reserve, recovery times are longer
concussion symptoms
-headache (most common)
-feeling slow
-difficulty concentrating
-dizziness (2nd most common)
-fogginess
-fatigue
-visual blurring
-light sensitivity
-memory issues
-balance problems
-feeling slow
-difficulty concentrating
-dizziness (2nd most common)
-fogginess
-fatigue
-visual blurring
-light sensitivity
-memory issues
-balance problems
pre-participation exam
-concussion related questions (number, frequency, severity, and recovery)
-presence of mood, learning, attention, or migraine disorders
-baseline testing – impact remains unclear
-presence of mood, learning, attention, or migraine disorders
-baseline testing – impact remains unclear
impact testing
immediate post concussion
-assessment and cognitive testing
-assessment and cognitive testing
SCAT2
sports concussion assessment tool 2
-sideline test included 22 item
-sideline test included 22 item
king devick test
-can look at eye movement, attention, and language skills
-PTs are using this for baseline measurement during initial eval
-PTs are using this for baseline measurement during initial eval
on field management of a collapsed athlete
-check airway, breathing and heart function
-physical exam including c/s and brain injury
–immobilize spine if c spine can not be cleared and transfer to E
–brain injury – mental status, unequal pupil reaction and worsening symptoms
-physical exam including c/s and brain injury
–immobilize spine if c spine can not be cleared and transfer to E
–brain injury – mental status, unequal pupil reaction and worsening symptoms
sideline assessment of concussion
-immediate stop from play and assessment from a healthcare provider
-standardized assessment tool
-a player should be continually monitored if kept sideline for deteriorating mental status
-if a concussion is thought to have not occurred, the player may not return to the game with serial evaluation
-standardized assessment tool
-a player should be continually monitored if kept sideline for deteriorating mental status
-if a concussion is thought to have not occurred, the player may not return to the game with serial evaluation
most common symptoms to use medications for
sleeping, depression, and headache
current medical management
physical and cognitive rest until symptoms improve or resolve followed by graded program of actvity
differences between concussion managment and vestibular
-altered cognitive fxn, HA
-observe C/spine and vision
-observe C/spine and vision
impairments with concussion
-postural control (c spine)
-dizziness, peripher vs. central
-visual/ocular motor
-dizziness, peripher vs. central
-visual/ocular motor
balance error scoring system
-3 positions with firm/foam surface eyes closed
-double leg stance, SLS, tandem
– pt is timed for 20 seconds and the number
– errors include: hands off iliac crest, opening eyes, step/fall, moving hips >30 degrees abduction, lifting forefoot or heel
-double leg stance, SLS, tandem
– pt is timed for 20 seconds and the number
– errors include: hands off iliac crest, opening eyes, step/fall, moving hips >30 degrees abduction, lifting forefoot or heel
impaired postural control
-perform sensory integration exercises
-SLS eyes open and closed
-squats with Bosu
-SLS eyes open and closed
-squats with Bosu
oculomotor training
-monitor for Sx the entire time
-convergence training
-saccade training and visual pursuit
-perform task, rest let Sx decrease, then repeat
-convergence training
-saccade training and visual pursuit
-perform task, rest let Sx decrease, then repeat
dual tasking training
incorporating high level cognitive task with static and dynamic balance activities
vestibular therapy
dizziness, balance, headaches
manual therapy
headaches, neck pain, and nay impaired strength
progressive aerobic activity
deconditioning
return to play stages
-no activity
-light aerobic exercise <70% max HR
-sport-specific exercise
-non contact drills
-full contact drills
-return to play
-light aerobic exercise <70% max HR
-sport-specific exercise
-non contact drills
-full contact drills
-return to play
Was this helpful?
Let us know if this was helpful. That’s the only way we can improve.
