Concussions – What you need to know.

Concussions – What you need to know.


My name is Mark Seeley and I’m an
Athletic Trainer with Crossing Rivers Health. I’ve been an athletic trainer for
about 28 years. I’ve been here at Crossing Rivers Health for 20 of those years. I’m here to talk to you today a little bit about concussions. So, 20 years back we used to actually call those bell ringers and we don’t really refer to
that anymore and so now what we want to really relate that information to is
that it’s a traumatic brain injury. It’s actually an injury to the brain and
we don’t want to dismiss those injuries or make them seem like they’re small.
They’re very significant injuries and we want to make sure that we take care
of them correctly. Typically, concussions or traumatic brain
injuries happen when we get a sudden jarring to the head or to the
brain and this could occur from direct contact – like helmet to helmet
contact in football, maybe a student athlete getting hit in the head with a
with a volleyball, or potentially it could even just be a sudden jarring
motion where we get a twisting mechanism of the head. So, somebody gets hit from
the side and the head wobbles back and forth and we can cause an injury to the
brain, as well. There are significant reasons why this happens more with
adolescents than we see in adults is that the adolescent brain is
still developing and it’s not the same as an adult brain. So, we have to take
that a little bit more seriously. Typically, we see that adolescents tend
to be a little bit weaker. Their neck, especially in our female athletes, our
neck structure is a little bit weaker and it doesn’t stabilize the head
and the neck or the brain as well as adult athletes. So, there’s a little
bit of difference between the adult and and the adolescent athlete.
Typically, when we have a head injury, it happens in essentially four areas of
function that are affected. First is physical. We’ll see physical effects on the body. They may seem dazed, confused,
tired, and have trouble with doing simple functions and balance coordination,
things like that. Another area of function is the
cognitive function. So, a lot of times we’ll see people will have problems with
their thinking and processing or being able to pay attention or recalling
information. They may forget ideas and information, as well. Number three is an
emotional area. Sometimes athletes will feel, after a concussion,
they may feel depressed. They may have problems dealing with their emotions and
those can affect how they interact in a daily activity either at school or
with their athletes, with their friends, and certainly at home, as well. And then
sometimes we’ll also see sleep disturbances. They may need more sleep,
they may sleep a little bit less, they may have interrupted patterns of sleep. So,
those are the four areas of function that typically we see that go along with head injuries. Let’s talk a little bit about if an athlete
actually had a head injury. So, say we’ve got a football player, basketball player,
somebody gets hit during practice and what typically is going to take place
during that. We don’t expect coaches, athletes, parents, or staff to be able to
diagnose a concussion but we do expect that they’re able to recognize those
signs and symptoms. So, if somebody – an athlete – presents with an injury, we are expecting
our coaches to be able to immediately remove that athlete from play and
they’re not able to return back to activity or return back to play until
they’ve been cleared by a health care provider. And the reason why we do this is because a lot of times athletes are very
poor itself reporting those injuries. They don’t want to tell you that they’re
hurt, they don’t want to sit out for a game, they don’t want to miss that
playing time, so we have to have, essentially, people that are going to be
able to recognize the signs and symptoms and then do the right thing for that
athlete. Sometimes, athletes either they can’t or they won’t admit that they’re
hurt and that may be because the injury or just because like most
people, they don’t want to miss those opportunities, they don’t want to let
their teammates down, they don’t want to let their friends down, or they don’t
want to disappoint the coach and that they’re hurt and they can’t play in the
big game. So, we expect though that those parents, those coaches, our staff, athletic
trainers, everyone involved with sports is able to recognize those signs and
symptoms of a concussion and be able to remove that athlete at play from play
immediately. So, what are the signs of a concussion? Well, first of all, signs are
what we observe when somebody is injured. So, it could be that they’re dazed, maybe
they’re confused, we may have some different levels of consciousness, they
may actually become unconscious. Someone being unconscious doesn’t necessarily
mean that they have a concussion or vice versa. Concussion isn’t always accompanied by somebody going unconscious, as well. They may have balance issues, maybe coordination issues, feeling slowed down, and being forgetful. So, those are some of the signs of a
concussion. Symptoms – symptoms are a little bit different. Symptoms are what
the athlete feels and these are going to be things like the athlete is going to
have a headache, maybe they’re nauseated, a little bit dizzy, sometimes bright
lights or noise will affect them, as well. Sometimes they’re agitated or maybe even
a little more emotional, some explained crying, or things like that. You’ve seen
it on the sidelines of games before where they just don’t handle that
traumatic experience well and we’ll see that happen as well. We’ve had a state
law in place since 2012 and that state law indicates that whenever we have somebody that presents with signs and symptoms of a concussion or they are suspected of being injured that we have immediate removal from play and
that’s the number one thing there is that we don’t want to allow somebody
that you suspect may have a concussion – again, you don’t have to diagnose it, we
just have to be suspicious of that – that we’re gonna remove them from play and make sure they’re safe. The reason why we do that is because of something that’s
called the second impact syndrome. The second impact syndrome occurs when an athlete who’s already sustained a head injury continues to play and then they
get hit another time or two again and what happens is they can have a
catastrophic brain bleed, which then can relate to severe, very severe,
long-term consequences and potentially even death. And those are the stories
that you hear on the ESPN 30 for 30 or 60 minute sort of stories
where we see athletes who go down the path of potentially harming
themselves or also just end up not being able to function in society. So, we want
to make sure that we remove those athletes from play immediately. So, what happens on the sidelines? Say an athlete then has a severe concussion. So,
somebody is a little dazed, confused, maybe they start going unconscious, maybe they start vomiting, maybe they start being really uncoordinated, or we see deteriorating signs and symptoms of those concussion symptoms. Well,
that’s the time that we need to call the emergency medical response. That’s where
we need to have the ambulance come in and we need to immediate transport to
the hospital. Usually, though, we don’t see those very often, but we need to make
sure that we’re treating those athletes in the right way during those times,
though. Now, we’ve got an athlete who’s potentially on the sidelines of a football game and say I’m present or maybe it’s a day or two after the injury and I have that athlete in the office and I’m taking a look at them, I’m gonna do an evaluation and typically what we use is what’s called a SCAT form. SCAT
basically is just a – it’s S-C-A-T – and what it is is a standardized assessment of
concussion and what that test is is that I go through and assess their cognitive
abilities. So, I give them a whole bunch of questions about where they are, their
time, date, place, all those kind of things. We evaluate whether or not they can
remember words and number sequences, basically give them a little mini mental
test and make sure that things are functionally normally and then we can
score that and basically quantify how they’re doing on that test. Then, we can
use that test then to continue to evaluate them over the next couple of
days to make sure that they’re making the right progress. Other things we’ll
check at that time are going to be their balance, we’re gonna do special
tests for the head to see whether or not they may have an injury to the
vestibular system – the vestibular system is the balance and the coordination
system that’s located in the ears, an injury to that can go right along with a
concussion, as well, so we screen for those types of things – and then we also
do what’s called a symptom checklist, where we have the athlete rate their
symptoms and how they’re feeling and then we can keep track of those symptoms
over the course of the and the duration of the injury and what we should see is
that those symptoms gradually decrease over the next two to four weeks or so. So,
our initial treatment after we’ve evaluated that athlete determined yes
they do have a concussion, then our initial treatment is going to be for
that first 24 to 48 hours is really just rest. We want to do physical and
cognitive rest, so we’re gonna remove them from play, we’re not going to have
them out running around, we’re not going to continue to participate in sports, we’re
gonna let them have lots of sleep, we’re going to have them rest, be in an area where they
can get good rest and good sleep, we’re going to draw the shades so that the
bright lights and things like that don’t bother them, and then we’re gonna also
limit their screen time. So, mom, dad, sorry; kids, sorry we’re gonna take away your
phone and we’re gonna take away your laptop and your computers and those
screens. We’re gonna limit that screen time now we don’t want to completely put
them into hibernation, but we want to kind of let that brain reset; give them
time to recover and that’s for the first 24 to 48 hours or so. But, we also don’t
want to do what’s called cocooning meaning that we don’t want to keep them
there for for a long time for those two to four weeks. We want to get them
eventually easing them back into school, back into their daily activities, and
back into the routines and we’ll do that slowly with different accommodations and
modifications in their school day and doing things to to help them get back
into activity. So, things like we may limits again their screen time we’re
going to probably limit a little bit of their physical activity sometimes make
some accommodations to their homework. They may have to have a little less
homework, potentially have somebody take notes for them, limit the number of tests
that they’re taking through that time, and make some different modifications
with their academic schedule if we need to. Allowing them to wear if bright
lights bothering them, maybe allowing them to wear sunglasses to school;
maybe they’re eating lunch in an office away from the loud noise of a
lunchroom, and things like that. So, we’ll make some of those different
accommodations for that athlete throughout the time that they’re still
having those signs and symptoms and then those gradually fall away as they start
feeling better and get them back into a full academic load and back into normal
classroom and testings and things like that. Then, what we do is we follow a
return to play protocol and so once they are signs and symptom-free for 48 hours -so, two full days of they come to me and they say, “Yep, I feel great. I feel
perfectly back to normal. I’m not having any accommodations or need for
those. I really feel back to normal. I’m feeling good.” Then, we’ll do what’s called
the ImPACT test, a computerized neurocognitive test. It’s another evaluation tool that we can use and what we can do is compare the
post-injury tests to their baseline test and make sure that those mash up and
that they’re looking good and when they pass that ImPACT test, then we will
follow a gradual return back to play protocol, which is a stepwise protocol
where we gradually increase their activity from a few minutes of working
out doing cardiovascular work and then another 24 hours and we’ll add in a
little more work and each day we’ll take a little bit more practice,
gradually working into functional activities, gradually working back into
full practice, and then eventually back into full contact practice at the end of
that time and that usually takes about a week to really complete before we get
there. So, once we do that then we can return the athlete back to play. If at
any time during that return to play protocol, they develop signs symptoms
again, we start the clock over and we just proceed with that return to play
protocol from there. What are some of the things that we can do to prevent
concussions? Your coaches are doing a great job with you football players –
learning different tackling techniques, taking the head out of football so we’re
not leading with the head, we’re not directing contact with the head, we’re
hitting with the shoulders, getting the head off the side to the side when we
tackle, and things like that. We’re limiting, the WIAA has limited the
amount of contact time in football practice. With other sports what we can
do are really focus on strengthening the neck and the head
to support that, so if we’re stronger with the muscles in the neck
then we don’t get the head wobbling quite as much and that will limit some
of that head injury as well. So, those are the things that we can do to help
prevent concussions. But, really the number one thing is again recognizing
those signs of symptoms and immediately removing that athlete from play and then
getting them to a proper health care provider to take care of them and make
sure that we’re going down the right path. The number one thing with concussion care is when in doubt, sit them out. Thank you.

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