2. Purpose
• To raise awareness on the seriousness of sport
concussions.
• To decrease the number of sport related
concussions.
• To provide insight into the newest information
on concussion management and prevention.
3. Concussion
•
Definition of a Concussion
…a complex pathophysiological process affecting
the brain, induced by traumatic biomechanical
forces.
• Several common features that incorporate
clinical, pathologic, and biomechanical injury
constructs that may be utilized in defining the
nature of the concussive head injury include:
4.
5. SYMPTOMS
Early Symptoms Late Symptoms
• Headache • Low-grade headaches
• Lightheadedness
• Dizziness
• Poor attention and concentration
• Lack of awareness of
• Memory dysfunction
surroundings
• Easy fatigability
• Nausea or vomiting • Irritability and low frustration
tolerance
• Intolerance of bright lights or
difficulty focusing vision
• Intolerance of loud noises
• Anxiety or depressed mood
• Sleep disturbance
American Academy of Neurology
7. How Often Do Concussions Occur?
• On average, 3-5% of all sport and recreational
injuries are head injuries.
• The majority of sport related head injuries are
mild.
• The most common cause of sport related head
injuries are falls.
7
8. How Often Do Concussions Occur?
• Patients younger than 20 years old are more
likely to suffer a sports related head injury.
• Males are more frequently injured. These
statistics are changing as more females engage
in contact sports.
• Very few head injuries are hospitalized.
8
9. Recognition of Concussions
• It is common for athletes to underreport the
incidence of sport concussions.
• Often athletes do not associate their
symptoms with those of a concussion.
9
10. Athletic Trainers Report
• Athletic Trainers from Canada and the United
States identified head injuries as 5% of their
total sports injuries.
• X Top sports?
10
11. Top Causes of Concussions
Female Male
• Soccer • Ice Hockey
• Horseback Riding • Cycling
• Cycling • Football
• Ice Hockey • Soccer
• Snowboarding • Snowboarding
11
12. Sport Specific Rates
Hockey: • Hockey
High School: 17.6/1000 hours – Professional (Europe):
Peewee: 23.1/1000 hours 14.3% of all injuries;
Bantam: 10.7/1000 hours 0.16/1000 hours
Peewee:
Children under age 6 had twice – College (Canadian
Intercollegiate): 7.5% of
the head injuries as older injuries; 1.5/1000 hours
children.
– High School (US):
18.7/1000 hours
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13. Peewee Hockey
N = 125 (86% response rate)
• Average age: 11.5 years-old with 5.6 years of playing experience
• No. of players with concussion: 11 (incidence rate = 9.87%) 16 total
• 7 players with 1 concussion
• 3 with 2 concussions
• 1 with 3 concussions (1 non hockey related)
• Mechanism of Injury: player contact (n = 10)
• hits from behind (n = 4)
• fall (n = 1)
• collision into boards (n = 1)
• Avg # of practices missed: 3.25 (range 0 – 6)
• Avg #. of games missed: 2.00 (range 0 – 4)
• Avg duration of symptoms: 7.03 days (range 1 - 21 days)
• No. subjects with ED visit: n = 1
• No. with previous concussion: n = 2
13
16. Mouth Guards
• Mouth Guards have not been proven to
prevent concussions.
• Mouth Guards are required by many Athletic
Associations because they reduce trauma of
jaw, facial and dental injuries.
16
17. Helmets
• Helmets are known to reduce the risk of
intracranial injury however, there is no helmet
that can prevent all head injuries.
• An athlete should wear the correctly sized
helmet and one specific to the activity
(hockey, football, snowboard, bike).
17
20. Force to the Head in just 6 milliseconds
A bare head A good helmet
21. Upcoming technology
A pair of football cleats….. 150 dollars
Football pads……………… 250 dollars
Registration in football……. 250 dollars
Protecting your head…….. Priceless
CONCUSSION SYMPTOMS EVOLVE OVER TIME AND MAY TAKE DAYS, WEEKS, OR MONTHS TO RECOVER FROM THE EARLY SYMPTOMS OF A CONCUSSION INCLUDE… HEADACHE DIZZINESS LACK OF AWARENESS OF SURROUNDINGS NAUSEA OR VOMITING THE LATE SYMPTOMS OF A CONCUSSION INCLUDE… LOW-GRADE HEADACHES LIGHTHEADEDNESS POOR ATTENTION AND CONCENTRATION MEMORY DYSFUNCTION EASY FATIGABILITY IRRITABILITY AND LOW FRUSTRATION TOLERANCE INTOLERANCE OF BRIGHT LIGHTS OR DIFFICULTY FOCUSING VISION INTOLERANCE OF LOUD NOISES ANXIETY OR DEPRESSED MOOD SLEEP DISTURBANCE
5 Emergency Departments (ED’s) in Edmonton, AlbertaPatient: all personsin a 1-year period reporting to the ED’s with a Head Injury (HI)HI defined as: IC9 – CM coded skull fracture, loss of consciousness, concussionAll children and adultsThese number include sports, recreational and other accidents. Emergency Department; Children’s Hospital; Calgary, ABPatients: 4 year period (2000-2003), ages 6-16Finland (2001) Head injuries accounted for 9% of all sports/recreation injuries for under 6 year-olds; 13% for children ages 6 to 16. France (2003): Head & neck injuries accounted for 17.25% of all sports/recreation injuries.
Retrospective survey of 289 players in the CFL in 1997 Athletes were asked: 1. whether they had experienced specific symptoms after a blow to the head; 2. whether they had sustained a concussionResults: 44.8% reported the experience of headaches, dizziness, memory difficulties, blurred/abnormal vison, nausea, after a hit.Only 18.8% recognized they’d experienced a concussionSymptoms lasted at least 1 day in > 25% of casesOther evidence of underreporting – Wiliamson (2006) under reporting in hockey in BCProblem with definition Self-reporting vs. interview; report fewer in an interviewGirls report more symptoms
US/Canada Sports & Recreation Injuries identified by athletic trainers
Number of concussion related ED visits 2005 from sport, top 5 causes by age and sex. Note: Based on registrants who live in the Capital Health region and are active on the Alberta Health Care Insurance.
HockeyProfessional (Europe): 14.3% of all injuries; 0.16/1000 hoursCollege (Canadian Intercollegiate): 7.5% of injuries; 1.5/1000 hoursHigh School (US): 18.7/1000 hoursMinor HockeyHigh School: (Canadian); 17.6/1000 hoursPeewee: 23.1/1000 hoursBantam: 10.7/1000 hoursTae kwon Do(tournaments) Concussions accounted for 50/1000 athlete exposuresOther reports 5.1 to 17.1/1000 athlete exposuresSkating (athletes presenting to hospitals; 1993 to 2003)Total Injuries: 1,235,467Hockey: 4.6%; Roller skating (0.6%); Inline skating (0.8%)Children < age 6 had 2X the head injuries as older childrenRugbyPremier League (Europe): 9.05/1000 player hoursHigh School: 10.26/1000 player hoursBoxingProfessionals: 0.8/10 roundsAmateur: 7.9/1000 man minutes
HockeyProfessional (Europe): 14.3% of all injuries; 0.16/1000 hoursCollege (Canadian Intercollegiate): 7.5% of injuries; 1.5/1000 hoursHigh School (US): 18.7/1000 hoursMinor HockeyHigh School: (Canadian); 17.6/1000 hoursPeewee: 23.1/1000 hoursBantam: 10.7/1000 hoursTae kwon Do(tournaments) Concussions accounted for 50/1000 athlete exposuresOther reports 5.1 to 17.1/1000 athlete exposuresSkating (athletes presenting to hospitals; 1993 to 2003)Total Injuries: 1,235,467Hockey: 4.6%; Roller skating (0.6%); Inline skating (0.8%)Children < age 6 had 2X the head injuries as older childrenRugbyPremier League (Europe): 9.05/1000 player hoursHigh School: 10.26/1000 player hoursBoxingProfessionals: 0.8/10 roundsAmateur: 7.9/1000 man minutes
Research regarding the use of mouth guards as preventative equipment is inconclusive (Barbick, 2005).Some studies showing no difference in athletes using mouth guards versus those who don’t (Mihalik, 2007). Use of mouth guards continues to be mandated by Athletic Associations to reduce maxillofacial and dental trauma.
