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Sports Concussion PowerPoint - S

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									Sports Concussions:
Where are we headed?
    Michael C. Koester, MD, ATC
         January 4th, 2010
  Chair, NFHS Sports Medicine Advisory Committee
      Director, Slocum Sports Concussion Program
  Slocum Center for Orthopedics and Sports Medicine
                      Eugene, OR
Disclosures

   I am a paid consultant for the Oregon Center
    for Applied Science, Inc. (ORCAS). They are
    developing concussion education programs
    for youth programs and high schools.

   I have no financial relationship with the
    developers/owners of ImPACT, Inc., CRI, or
    CogSport
What is a Concussion?

   A concussion is a mild
    traumatic brain injury
    that interferes with normal
    function of the brain
   Evolving knowledge
        “dings” and “bell ringers”
        are serious brain injuries
       Do not have to have loss of
        conciousness
   Young athletes are at
    increased risk for serious
    problems
The Problems in the Medical Field
   There is much variation in
    the knowledge of health
    care providers managing
    concussed athletes
       Physicians (MD/DO)
       Physician assistants
       Nurse practitioners
       Chiropractors
       Athletic trainers
       School nurses

   New and emerging
    research and technologies
    will lead to a continuing
    evolution of care
Problems for Athletes-
Post-Concussion Syndrome
   85-90% of concussed
    young athletes will
    recover within 1 to 2
    weeks
   The remainder may
    have symptoms lasting
    from weeks to months
    interfering with school
    and daily life
   Subtle deficits may
    persist a lifetime
Problems for Administrators: Just a
few mouse clicks away……
 “At Burg, Simpson, Eldredge, Hersh, & Jardine, P.C., our
 brain injury lawyers represent brain injury victims caused
 during high school sports in Colorado, Wyoming and
 nationwide. We have the resources and experience with
 complex brain injury lawsuits to fully assess your injuries
 and take your case to a jury. If you or your loved one
 has suffered a brain injury while playing high school
 sports, please email or call us today.”
Extent of the Problem
   Professional athletes get a
    great deal of attention
       1600 NFL players
   Much more common in
    high school than any other
    level- due to large number
    of participants
     HS Sports Participants

           Football- 1.14 million
           Boys Soccer- 384,000
           Girls Soccer- 345,000
           Boys Hoops- 545,000
           Girls Hoops- 444,000
                  NFHS 2008-09
Extent of the Problem



                     19.3% of all FB injuries
                      in 2009!!!

                     Likely at least 100,000
                      concussions in HS
                      athletes yearly based
                      on CDC estimates
Not Just a Football Problem
    Injury rate per 100,000
    player games in high
    school athletes

   Football                47
   Girls soccer            36
   Boys soccer             22
   Girls basketball        21
   Wrestling               18
   Boys basketball         7
   Softball                7

   Data from HS RIO
               JAT, 2007
What has happened to make this such a
big deal?
   Increasing awareness
    and incidence
       Number of high profile
        athletes over the past
        20 years
         Steve Young, Troy
           Aikman, Eric
           Lindros, etc
       Bigger and faster kids,
        increased opportunities
What has happened to make this such a
big deal?
   High profile cases
       Second Impact
        Syndrome
           Death or devastating
            brain damage when
            having a second injury
            when not healed from
            the first
       Long-term effects
           Possible long-term
            effects- dementia,
            depression
    Chronic Traumatic Encephalopathy
   CTE- progressive
    degenerative disease
    of the brain found in
    athletes (and others)
    with a history of
    repetitive brain trauma
       Tau protein
   Examples-
       Normal brain
       45 yo former NFL
        player
       73 yo boxer
Chronic Traumatic Encephalopathy

   18 yo HS athlete
       2 documented
        concussions in football
       Multi-sport athlete
       Early CTE changes on
        autopsy
   Isolated case or
    harbinger of huge
    ramifications for contact
    sports?
NFL making changes
   Commissioner before
    Congressional Sub-
    committee in Oct
   NFL’s response since
    that time:
       Resignation of
        concussion committee
        co-chairs
       Hiring of “independent”
        neurologists to make
        RTP decision
       No RTP same game in
        most cases
NCAA Follows NFL lead

   December 2009
       NCAA now making
        changes in
        response to what
        NFL has done
           No return to play
            same day of
            concussion
Sea Change?

   November 2009
       2 Super Bowl QBs report
        that they cannot play in
        upcoming games due to
        persistent headaches
        and/or not feeling that
        they had recovered from
        most recent concussion.
       How important is that
        upcoming HS game this
        week??
What has the NFHS SMAC done?

   Rulebook
       Language change
           Education!!
       Suggested management
   Concussion Brochure
       No RTP same day- Fall
        2008
   Dissemination of
    information
   Where does that
    information come from?
2010 – 2011 NFHS Rule Book Changes
on Concussion
   Any athlete who exhibits signs, symptoms, or behaviors
    consistent with a concussion (such as loss of
    consciousness, headache, dizziness, confusion, or
    balance problems) shall be immediately removed from
    the contest and shall not return to play until cleared by
    an appropriate health care professional. (Please see
    NFHS Suggested Guidelines for Management of
    Concussion).
       Approved by NFHS Sports Medicine Advisory Committee –
        October 2009
       Approved by the NFHS Board of Directors – October 2009
Concussion Management- The Basics

   Coach Education
       Awareness and
        Recognition
       When in doubt, sit
        ‘em out!!
   Policies
       No return to activity on
        the same day of a
        concussion
       No return to activity if
        having symptoms of a
        concussion
Staying Ahead of the Issue

   Need to take initiative
   State SMACs (form one
    if you don’t have one!!)
       Education for coaches
       No same day return to play
   State laws in WA and
    OR in 2009
       What’s happening in your
        state?
       Keep your ear to the ground
The Oregon Experience- 2008

   Any athlete…with a
    concussion…shall not
    be permitted to return…
    on that same day.
   No return until… “no
    longer experiencing
    post-concussive
    symptoms, and a
    medical release form
    signed by an
    appropriate healthcare
    professional”
The Oregon Experience- 2009

   Oregon BIA sponsors “Helmet Law” in honor
    of young Second Impact Syndrome victim
       Mandatory football coach education
       Mandatory helmet “re-conditioning” yearly
       Mandatory helmet retirement after 10 years
   OSAA finds out just before the first public
    hearing
   Testimony by OSAA execs and SMAC Chair
       Result is a significantly better law
“Max’s Law”- The final product

   Mandatory coach education
   Player must be removed
    from play if “exhibits signs,
    symptoms, or behaviors
    consistent with a
    concussion”
   Cannot return to play that
    day
   Cannot return to play until
    asymptomatic and cleared
    to return by a “health care
    professional”
Washington- “Zach’s Law”

   Zach Lystedt- suffered devastating brain
    injury playing with concussion symptoms
   Similar to Oregon Law with additions:
       Applies to youth sports
       Parents and athlete read and sign information
        sheet which details signs, symptoms, and effects
        of a concussion
   Outstanding press state-wide and nationally
   FB player from Spokane died in September
Beyond Education and Policy
   Rules making and
    enforcement
       Leading with helmet
       Rough play
       Limiting contact in practice?
   Can we prevent
    concussions?
   Should there be a
    “mandatory retirement”
    rule?
   What if they just say, “I’m
    fine?”
Neuropsychologic Testing

   Computerized
    programs
       Easily accessed
       Can be done quickly with
        immediate results
       Can obtain “baseline”
        data on all athletes
       Can assess reaction
        times and processing
        speed
Prevention
   “Concussion prevention” has
    become the “holy grail” for sports
    equipment marketers
       Soccer head gear
       Girl’s Lacrosse head
        gear/helmets
       Pole vaulting helmet
   New football helmets, soccer
    head pads, mouth guards- NO
    PROVEN PROTECTION FROM
    CONCUSSION!!
   Multiple flaws in a study looking
    at “Riddell Revolution” helmet
                Neurosurgery, 2006
Conclusions

   Educate
       Everyone dealing with
        young athletes must be
        aware of the signs,
        symptoms, and
        ramifications of
        concussions
   Mandate or Legislate?
       Concussion management
        policies must be in place at
        every level
       If you don’t do it, someone
        will do it for you
         THANK YOU!!!!!!
   Thad Stanford, MD, JD- Salem
   Bill Bowers- Executive Director, OADA
   Tom Welter- Executive Director, OSAA
   Mickey Collins, PhD- Pittsburgh
   Ron Savage, EdD- New Jersey
   Brian Rieger, PhD- New York
   Ann Glang, PhD- Eugene
Feel free to contact me with any questions:
  michael.koester@slocumcenter.com

								
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