Managing concussion in sport: a guide for Coaches and Athletic Directors.Includes: How to implement an important new tool in the management of concussion concussion Period of nervous-function impairment that results from relatively mild brain injury, often with no bleeding in the cerebral cortex. It causes brief unconsciousness, followed by mental confusion and physical difficulties. for the athletes in your care. [ILLUSTRATION OMITTED] [ILLUSTRATION OMITTED] [ILLUSTRATION OMITTED] [ILLUSTRATION OMITTED] FREE CONCUSSION TESTING OFFER PROUDLY SPONSORED BY SCHUTT SPORTS Are you prepared for concussions? Do you coach or direct a sport with a high risk of concussion, like football or hockey, or a contact sport like soccer? Then you may have concussions among the athletes in your care each year. [ILLUSTRATION OMITTED] Do you know of an athlete who had multiple concussions and has never been the same? You may even have heard of an athlete who has died. There are few treatments for concussion other than rest, so the most important decision is when should the athlete return to play? It's a tough balance between being overly cautious, and risking permanent harm to the athlete by having them return to play too soon. But now there's a tool which makes these decisions much easier it's called Concussion Sentinel. It's a quick, simple computer test which helps doctors make confident return-to-play decisions. You need to know about it because to use it, all athletes must take a "baseline" test before they get concussed--preferably before the season begins. Completely free for high schools and colleges This year, Schutt Sports is sponsoring completely FREE Sentinel testing for all US high schools and colleges. Julie Nimmons, President of Schutt, explains, "We believe this is an important addition to athletic programs which will help everyone involved." All the details you need to take advantage of this offer are in this supplement. How does it work? While healthy, your athletes take a computerized Sentinel test that looks just like a very simple card game. Any athlete who gets a concussion or suspected concussion takes another Sentinel test once their symptoms have cleared. The athlete's regular doctor (the family physician) or the team doctor can interpret the results to tell whether the athlete's cognitive function cognitive function Neurology Any mental process that involves symbolic operations–eg, perception, memory, creation of imagery, and thinking; CFs encompasses awareness and capacity for judgment has recovered to its baseline level. In some cases a report may need to be interpreted by a specialist. Concussion guidelines guidelines, n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. Sentinel is a key part of concussion management, but it is not the whole story. In this supplement are additional guidelines covering the 4 basic stages of managing concussion: 1. Pre-season baseline testing baseline test Clinical practice Any test than measures current or pre-treatment parameters, including chemistries, cell counts, enzyme levels and so on, against which response(s) to therapy, if any, is evaluated 2. On-field assessment (first aid) 3. Sideline sideline See on the sidelines. assessment (for physicians) 4. Managing return to play (for physicians) What do the experts say? "Appropriate management of concussion requires individual assessment incorporating objective neuropsychological testing. Neuropsychological testing is one of the cornerstones of concussion evaluation and contributes significantly to ... management of the individual." --Concussion management guidelines, agreed at the First International Symposium on Concussion in Sport, 2001 "In the past we would have to do a six-hour neuropsychological test. Now we can do a Sentinel* test in fifteen minutes, anywhere in the world." --Dr. Preston Wiley, Sports Physician, University of Calgary "The University of Notre Dame has used Sentinel* in concussion management for the past 4 years. We have found computerized neuropsychological evaluation of concussed athletes to be an indispensable tool in making return to play decisions. Sentinel's ease of use, rapid turn around time and consistent reproducibility of results has been a reassuring aid in our management of athletes suspected of sustaining concussion ..." --Dr. James Moriarity, Head Team Physician, University of Notre Dame "Computerized neuropsych testing can be done quickly and efficiently from anywhere in the US. A program of preseason baseline and post injury neuropsych testing adds another dimension to the evaluation and safety profile for athletes with concussion." --William O Roberts MD, Dept. of Family Medicine, University of Minnesota Medical School * Comments originally made about CogSport, the technology which powers Sentinel. For more information, please visit www.concussionsentinel.com. 4 basic stages of Concussion Management In Vienna in November 2001, the First International Symposium on Concussion in Sport concluded that there were no scientifically validated return to play guidelines available. [ILLUSTRATION OMITTED] [ILLUSTRATION OMITTED] [ILLUSTRATION OMITTED] [ILLUSTRATION OMITTED] They recommended that the management of concussed athletes should include assessment of injury recovery followed by step-wise return to activity. The guidelines summarized here are based on both these 'Vienna guidelines', and the Canadian Academy of Sport Medicine (CASM CASM Cost per Available Seat Mile CASM Communities and Small-scale Mining CASM Canadian Academy of Sports Medicine CASM Certificate of Advanced Study in Mathematics (Univeristy of Cambridge, UK) CASM Coherent Adaptive Subcarrier Modulation ) guidelines. You can find more details at www.concussionsentinel.com. Diagnosis of concussion and return to play decisions should be made by licensed physicians only. First aid should only be administered by trained individuals. Stage 1: Pre-season baseline testing Baseline or pre-season evaluation is an essential part of the concussion management process. Concussion Sentinel is designed for use by non-specialists and may be administered by people with minimal training. Reports must be interpreted by a physician, but in most cases that physician does not need to have neuropsychological neu·ro·psy·chol·o·gy n. The branch of psychology that deals with the relationship between the nervous system, especially the brain, and cerebral or mental functions such as language, memory, and perception. expertise. Sentinel provides the two key components of pre-season preparation: 1. A concussion history taken while the athlete is healthy provides important information in the event of a concussion. Where an athlete has a history of previous concussions, physicians should proceed with extra caution when making return to play decisions. 2. Concussion causes subtle changes in the speed and accuracy of cognition cognition Act or process of knowing. Cognition includes every mental process that may be described as an experience of knowing (including perceiving, recognizing, conceiving, and reasoning), as distinguished from an experience of feeling or of willing. (thinking). These changes are usually the last symptoms to go away after a concussion. But, they are very slight and so it is very difficult to detect them without a computer test which compares an individual to themselves when they were 'normal'. This means that testing before any injury occurs is essential. Analysis of baseline neuropsychological data is important to help ensure that the athlete's baseline performance is optimal, and not adversely affected by disease, drugs, practice effects or the athlete 'faking bad'. Every Sentinel baseline test is analyzed to look for performance that falls outside normal ranges. In such cases athletes must be re-tested to obtain a valid baseline. Ensure you have received a baseline report for each athlete and follow up on any actions suggested in the reports. Signs of Concussion * Headache * Dizziness dizziness: see vertigo. * Unsteadiness/loss of balance * Confusion * Unaware of period, opponent, score of game * Feeling stunned stun tr.v. stunned, stun·ning, stuns 1. To daze or render senseless, by or as if by a blow. 2. To overwhelm or daze with a loud noise. 3. or dazed daze tr.v. dazed, daz·ing, daz·es 1. To stun, as with a heavy blow or shock; stupefy. 2. To dazzle, as with strong light. n. A stunned or bewildered condition. * Seeing stars or flashing lights Flashing Light is a rhythmic light in which the total duration of the light in each period is clearly shorter than the total duration of the darkness and in which the flashes of light are all of equal duration. * Ringing in the ears * Double vision * Loss of consciousness/impaired conscious state * Concussive con·cus·sion n. 1. A violent jarring; a shock. See Synonyms at collision. 2. An injury to an organ, especially the brain, produced by a violent blow and followed by a temporary or prolonged loss of function. convulsion/impact seizure Forcible possession; a grasping, snatching, or putting in possession. In Criminal Law, a seizure is the forcible taking of property by a government law enforcement official from a person who is suspected of violating, or is known to have violated, the law. * Slow to answer questions or follow directions * Easily distracted, poor concentration * Displaying unusual or inappropriate emotions * Nausea/vomiting * Vacant stare/glassy eyed * Slurred slur tr.v. slurred, slur·ring, slurs 1. To pronounce indistinctly. 2. To talk about disparagingly or insultingly. 3. To pass over lightly or carelessly; treat without due consideration. speech * Personality changes * Inappropriate playing behavior * Significantly decreased playing ability * Poor coordination or balance All completed baseline tests should be e-mailed to Sentinel for analysis within 2 weeks of the test date. Tests submitted later than this will not be processed, and the athlete will need to take another baseline test. Yearly baseline testing of all athletes participating in contact sport is required. Once analyzed, Sentinel baseline tests are valid for 12 months. Stage 2: On-field assessment (First Aid) It is essential that all individuals who have an on-field injury management role in their sport have formal training and certification in both first aid and Advanced Trauma Life Support Advanced Trauma Life Support is a training program in the management of acute trauma cases (requiring surgical emergency care), run by the American College of Surgeons. The program has been adopted worldwide in over 30 countries; its goal is to teach a simplified and standardized (ATLS ATLS Advanced Trauma Life Support ATLS Aerial Target Launch Ship ), Trauma Evaluation and Management (TEAM) or equivalent. The immediate priorities are the basic principles of first aid: Danger, Response, Airway airway /air·way/ (-wa) 1. the passage by which air enters and leaves the lungs. 2. a device for securing unobstructed respiration. , Breathing & Circulation. Once the athlete is stabilized, he or she should be removed from the field. Before moving, careful assessment for the presence of a cervical spine cervical spine Clinical anatomy The region of the vertebral column encompassing C1 through C7 or other injury is necessary. If the athlete is unconscious, then a cervical injury should be assumed until proven otherwise. In alert athletes, neck bracing bracing, n a resistance to the horizontal components of masticatory force. and transport on a suitable spinal frame is required if the athlete complains of neck pain, has evidence of neck tenderness or deformity Deformity See also Lameness. Calmady, Sir Richard born without lower legs. [Br. Lit.: Sir Richard Calmady, Walsh Modern, 84] Carey, Philip embittered young man with club foot seeks fulfillment. [Br. Lit. or has neurological neurological, neurologic pertaining to or emanating from the nervous system or from neurology. neurological assessment evaluation of the health status of a patient with a nervous system disorder or dysfunction. signs that suggest a spinal injury. Removal of helmets or other head protectors For the 1970s television series made by Gerry Anderson, see The Protectors Protectors was a team of fictional superheroes that starred in the eponymous title published by Malibu Comics. should only be performed by individuals with appropriate training. Stage 3: Sideline assessment (for physicians) A full medical and neurological exam should be undertaken. If any of the concussion symptoms or signs listed in the box Signs of Concussion are present, a head injury should be suspected. A patient does not need to have lost consciousness to suffer a concussion. There are two validated systems by which a physician can make a rapid diagnosis of concussion. These are known as the Maddocks Questions and the Standardized standardized pertaining to data that have been submitted to standardization procedures. standardized morbidity rate see morbidity rate. standardized mortality rate see mortality rate. Assessment of Concussion (SAC Sac: see Sac and Fox. SAC - 1. An early system on the Datatron 200 series. [Listed in CACM 2(5):16 (May 1959)]. ). These are designed for rapid concussion diagnosis on the sidelines On the sidelines An investor who decides not to invest due to market uncertainty. on the sidelines Of or relating to investors who, having assessed the market, have decided to avoid committing their funds. , and are not meant to replace comprehensive neurological and neuropsychological testing Neuropsychological testing Tests used to evaluate patients who have experienced a traumatic brain injury, brain damage, or organic neurological problems (e.g., dementia). , which may detect subtle deficits that can persist beyond the acute episode. Further, although such tools may be used by non-medically trained individuals to suspect a diagnosis of concussion, a medical examination should follow this provisional diagnosis as soon as possible. Maddocks Questions What field are we at? * Which team are we playing today? * Who is your opponent at present? * Which half/period is it? * How far into the half/period is it? * Which side scored the last touch-down/goal/point? * Which team did we play last week? * Did we win last week? If athlete answers incorrectly or cannot answer any question, concussion should be strongly suspected. The Maddocks Questions combine scientific validity with a quick simple and practical tool which can be administered either on-field or on the sidelines. Further post-injury assessment is best performed in a quiet medical room rather than in the middle of a football field. The major priorities at this stage are to establish an accurate diagnosis and exclude a catastrophic brain injury. Thus a full neurological examination The neurological examination is the physical examination of the nervous system. It attempts to identify or exclude signs of nervous system disease, and - if these signs are present - to produce a likely anatomical or physiological explanation that can be tested through medical should be conducted. The treating physician must also determine who should be referred to a hospital emergency department or neurosurgical center. There are a number of urgent indications for hospital referral. Never return a patient with a confirmed or suspected concussion to the field of play on the day of the injury. For concussed adult patients, referral to an Emergency Department depends on the experience, ability and competency COMPETENCY, evidence. The legal fitness or ability of a witness to be heard on the trial of a cause. This term is also applied to written or other evidence which may be legally given on such trial, as, depositions, letters, account-books, and the like. 2. of the individual physician. Some patients may be discharged home under the care of a responsible adult. The patient and this responsible adult should both be given a 'head injury' card upon discharge. There is a suitable card on the back cover of this supplement. Refer to hospital urgently for ... * All children with head injuries * Fractured skull * Penetrating skull trauma * Deterioration de·te·ri·o·ra·tion n. The process or condition of becoming worse. in conscious state following injury * Focal neurological signs * Confusion or impairment Impairment 1. A reduction in a company's stated capital. 2. The total capital that is less than the par value of the company's capital stock. Notes: 1. This is usually reduced because of poorly estimated losses or gains. 2. of consciousness > 30 minutes * Loss of consciousness > 5 minutes * Persistent vomiting vomiting, ejection of food and other matter from the stomach through the mouth, often preceded by nausea. The process is initiated by stimulation of the vomiting center of the brain by nerve impulses from the gastrointestinal tract or other part of the body. or increasing headache post injury * Any convulsive con·vul·sive adj. 1. Characterized by or having the nature of convulsions. 2. Having or producing convulsions. convulsive pertaining to, characterized by, or of the nature of a convulsion. movements * More than one episode of concussive injury in a game or training session * Where there is assessment difficulty (eg: an intoxicated in·tox·i·cate v. in·tox·i·cat·ed, in·tox·i·cat·ing, in·tox·i·cates v.tr. 1. To stupefy or excite by the action of a chemical substance such as alcohol. 2. patient) * High risk patients (eg: hemophilia hemophilia (hē'məfĭl`ēə,–fēl`yə), genetic disease in which the clotting ability of the blood is impaired and excessive bleeding results. , anticoagulant anticoagulant (ăn'tēkōăg`yələnt), any of several substances that inhibit blood clot formation (see blood clotting). use) * Inadequate post injury supervision * High risk injury mechanism (eg: high velocity impact, missile injury) When in doubt, refer to hospital. Stage 4. Managing return to play (for physicians) The vast majority of concussions recover over 3-7 days, although some patients will take longer to recover. Referral to a neurologist Neurologist A doctor who specializes in disorders of the brain and central nervous system. Mentioned in: Cervical Disk Disease neurologist a specialist in neurology. or neurosurgeon neurosurgeon a physician who specializes in neurosurgery. neurosurgeon A surgeon specialized in managing diseases of the brain, spine and peripheral nerves Meat & potatoes diseases Brain tumors, spinal cord disease Salary $245K + 15% bonus. with expertise in concussive injury is recommended for patients who exhibit persistent neurological or cognitive symptoms for longer than this. For the majority of patients who recover within a week of concussion, return to play decisions are based on repeated evaluation in the days following the injury. There are three basic steps in the return-to-play decision making process: 1. Ensure symptoms have resolved. 2. Ensure cognition has recovered. 3. Rehabilitation rehabilitation: see physical therapy. and graded return to exercise. It is important to emphasize that a qualified physician must supervise the management of a concussion and determine the timing of return to play. Patients should be evaluated until their symptoms have resolved. The evaluation should include specific reference to these symptoms and the patient should not proceed to the next step until he/she reports that he/she is symptom free. The consensus of the First International Symposium on Concussion in Sport was that "neuropsychological testing is one of the cornerstones of concussion evaluation". Medical evidence suggests that recovery proceeds in a step-wise process for most patients, with symptom resolution occurring before cognitive resolution. The next step in the process is therefore a formal cognitive evaluation. At this stage the patient should perform an 'after injury' Sentinel test, and the report should be e-mailed to Sentinel for analysis. Sentinel also includes a post-concussion questionnaire that summarizes the patient's symptoms at the time of testing, and also other useful information (time since injury, whether loss of consciousness occurred etc.). The patient should not proceed to the next step until their cognition has recovered. The patient must be completely symptom free and have normal neurological and cognitive results before starting the rehabilitation program Noun 1. rehabilitation program - a program for restoring someone to good health program, programme - a system of projects or services intended to meet a public need; "he proposed an elaborate program of public works"; "working mothers rely on the day care . This program includes a stepwise stepwise incremental; additional information is added at each step. stepwise multiple regression used when a large number of possible explanatory variables are available and there is difficulty interpreting the partial regression return to exercise, with gradual increases in exercise duration and intensity. The program is described in the box Return to Play Protocol. With this stepwise progression, the patient should proceed to the next level only if symptom free at the current level. If any post concussion symptoms occur, the patient should drop back to the previous symptom free level and try to progress again after 24 hours. Although each step may take a minimum of one day, depending on the duration or recurrence recurrence /re·cur·rence/ (-ker´ens) the return of symptoms after a remission.recur´rent re·cur·rence n. 1. of symptoms, proceeding through each step may take longer in some patients. Return to Play Protocol 1. No activity, complete rest. Once symptom free and cognitive recovery is demonstrated, proceed to level 2. 2. Light aerobic exercise aerobic exercise, n sustained repetitive physical activity, such as walking, dancing, cycling, and swimming, that elevates the heart rate and increases oxygen consumption resulting in improved functioning of cardio-vascular and respiratory systems. such as walking or stationary cycling. 3. Sport specific training (eg. running drills, ball handling skills). 4. Non-contact training drills. 5. Full contact training after medical clearance. 6. Game play. See www.concussionsentinel.com for more information about: Using Concussion Sentinel tests * What happens when athletes perform consistently below normal ranges in a Sentinel baseline test * How to do the baseline testing, and why it is important for athletes to practice the test first * Why athletes have to take a test every year * The SAC test * The value of brain imaging in managing concussion * Exit medical examinations when an athlete leaves a team or institution. Starting your Concussion Sentinel Program FREE Sentinel testing sponsored by Schutt Sports Schutt Sports is sponsoring up to $20 million worth of free Sentinel testing to US high schools and colleges, for the 2004-2005 season. * There are no charges at all--including afterinjury test reports * There are no contracts to sign * There is no ongoing commitment To take advantage of this offer, go to www.concussionsentinel.com and use the promotion code printed on the back of this supplement. All baseline and after-injury tests are free and include testing of up to 300 athletes per school for the 2004-2005 season. Julie Nimmons, President of Schutt comments, "Schutt Sports is pleased to help bring Concussion Sentinel to athletes. Physicians involved in caring for concussed patients will appreciate this innovative tool." Everything you need to begin using Concussion Sentinel can be found at www.concussionsentinel.com. [ILLUSTRATION OMITTED] * Download the free software from the website. * Install the software in your computer lab, or on laptop/s and have your athletes take a baseline test. Testing takes approximately 15 minutes and can be administered to multiple athletes at one time. * Use the software to send the test over the Internet to Sentinel for analysis. To do this you need to set up a free, no obligation account on the Concussion Sentinel website. * You will get baseline reports for each athlete emailed back to you. Check to ensure you have received a baseline report for each athlete and follow-up on any actions suggested in the reports. * Have those athletes whose initial results were outside normal ranges take another test, and check the report which comes back.* * That's it. An athlete's results are considered valid for 12 months. * If an athlete gets concussed, have them take an after-injury test to aid the treating physician in making the return-to-playing decision. *Initial results that fall outside normal ranges for cognitive performance may indicate an undiagnosed medical condition for which treatment may be needed and in such cases the athlete should be seen by a medical professional. Reminder cards Read in conjunction with guidelines on pgs. 5-6 Basic principles of First Aid * Danger. Ensure that there are no immediate environmental dangers which may potentially injure To interfere with the legally protected interest of another or to inflict harm on someone, for which an action may be brought. To damage or impair. The term injure is comprehensive and can apply to an injury to a person or property. Cross-references Tort Law. the patient or treatment team. This may require stopping play in a match. * Response. Is the patient conscious? Can he/she talk? * Airway. Ensure a clear and unobstructed airway. Remove any mouth guard or dental device which may be present. * Breathing. Ensure the patient is breathing adequately. * Circulation. Ensure an adequate circulation. Maddocks Questions What field are we at? * Which team are we playing today? * Who is your opponent at present? * Which half/period is it? * How far into the half/period is it? * Which side scored the last touchdown/goal/point? * Which team did we play last week? * Did we win last week? If athlete answers incorrectly or cannot answer any question, concussion should be strongly suspected. Signs of concussion * Headache * Dizziness * Nausea * Unsteadiness/loss of balance * Confusion * Unaware of period, opponent, score of game * Feeling stunned or dazed * Seeing stars or flashing lights * Ringing in the ears * Double vision * Loss of consciousness/impaired conscious state * Concussive convulsion/impact seizure * Slow to answer questions or follow directions * Easily distracted, poor concentration * Displaying unusual or inappropriate emotions * Nausea/vomiting * Vacant stare/glassy eyed * Slurred speech * Personality changes * Inappropriate playing behavior * Significantly decreased playing ability * Poor coordination or balance Refer to hospital urgently for All children with head injuries * Fractured skull * Penetrating skull trauma * Deterioration in conscious state following injury * Focal neurological signs * Confusion or impairment of consciousness > 30 minutes * Loss of consciousness > 5 minutes * Persistent vomiting or increasing headache post injury * Any convulsive movements * More than one episode of concussive injury in a game or training session * Where there is assessment difficulty (eg: an intoxicated patient) * High risk patients (eg: hemophilia, anticoagulant use) * Inadequate post injury supervision * High risk injury mechanism (eg: high velocity impact, missile injury) When in doubt, refer to hospital. Return to play protocol 1. No activity, complete rest. Once symptom free and cognitive recovery is demonstrated, proceed to level 2.2. Light aerobic exercise such as walking or stationary cycling. 3. Sport specific training (eg. running drills, ball handling skills). 4. Non-contact training drills. 5. Full contact training after medical clearance. 6. Game play. FREE Concussion Sentinel testing for high schools and colleges. Your promotional code: See page 7 of this supplement for details. HHNB-F52YS-YCNK HEAD INJURY This patient has received an injury to the head. A careful medical examination has been carried out and no sign of any serious complications has been found. It is expected that recovery will be rapid, but in such cases it is not possible to be quite certain. If you notice any change in behavior, vomiting, dizziness, headache, double vision or excessive drowsiness drows·i·ness n. A state of impaired awareness associated with a desire or inclination to sleep. Also called hypnesthesia. drowsiness Medtalk Semiconsciousness; grogginess, sleepiness , please telephone the medical clinic or the nearest hospital emergency department immediately. No alcohol * No analgesics Analgesics Definition Analgesics are medicines that relieve pain. Purpose Analgesics are those drugs that mainly provide pain relief. or pain killers * No driving * No physical exertion exertion, n vigorous action, a great effort, a strong influence. * Do not make important decisions Patient's name Date & time of injury Date of medical review Treating physician CLINIC PHONE # IMPORTANT WARNINGS These guidelines are intended for implementation by Athletic Directors Athletic director (commonly, "athletics director") is a position at many American colleges and universities, as well as in larger high schools and middle schools, which oversees the work of the coaches and related staff involved in intercollegiate or interscholastic athletic and Coaches. Diagnosis of concussion and return to play decisions should be made by licensed physicians only. First aid should only be administered by trained individuals. Taking a Concussion Sentinel test does not protect you from head injury. Sentinel reports are intended for interpretation only by licensed medical professionals, and only as an adjunct adjunct (aj´ungkt), n a drug or other substance that serves a supplemental purpose in therapy. adjunct to conventional medical management of sports concussion. Sentinel is a performance test, not a diagnostic test. It should not be used as a method of diagnosis of any medical condition. |
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