2019 Concussion Symposium
Recognizing a Concussion
Thomas Buehler M. Ed., ATC/LAT CHI Health Sports Medicine
Disclosures
No Disclosures No Conflicts
About Me
• Certified AthleticTrainer since 2011
• Millard West athletic trainer since 2014
• Concussion Focus
Group member since 2016
• 11 years of experience observing and
evaluating concussions
• Golf, weight training and home renovations
Sport Related Concussion
• A Sport Related Concussion or SRC may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head. (1)
• SRC’s can present with varying signs and symptoms and may or may not include loss of consciousness (LOC).
• Typically an SRC will not cause structural damage but rather a neuropathological disturbance that can manifest many
different ways depending on the location and severity of the injury along with several other factors
Signs and Symptoms
(1)
• The suspected diagnosis of SRC can include one or more of the following clinical domains:
• Symptoms: somatic (eg, headache), cognitive (eg, feeling like in a fog) and/or emotional
symptoms (eg, lability)
• Physical signs (eg, loss of consciousness, amnesia, neurological deficit)
• Balance impairment (eg, gait unsteadiness)
• Behavioral changes (eg, irritability)
• Cognitive impairment (eg, slowed reaction times)
• Sleep/wake disturbance (eg, somnolence, drowsiness)
Sideline Evaluation - Assessment
• Recognition and understanding of the injury mechanism itself
• Assessment of any symptoms reported by the athlete AND any observable signs demonstrated by the athlete
• Determination of any cognitive, cranial nerve or balance deficits
• Supervision and serial assessments for delayed onset
• Any sign or symptom consistent with a concussion warrants removal of the athlete from participation
• Signs or symptoms simply prompt the inclusion of a concussion but aren’t always diagnostic
Assessment Tools
• SCAT5 - Sport Concussion Assessment Tool
• This Multimodal assessment is currently the gold standard for sideline evaluation
• Many different components including a symptom evaluation, Standardized Assessment of Concussion (SAC), modified Balance Error Scoring System (mBESS), rapid neurological screen,
immediate and delayed memory recall, and concentration
• Should take at least 10 minutes to complete
• For individuals 13+ years old
• Child SCAT can be used for children 5-12 years old
• Should not serve as a stand alone tool for diagnosis OR return to play decisions
• Advanced balance and gait assessment
• Clinical reaction time
• Oculomotor screening
• VOMS
• Video replay analysis
• MOI
• Observable S/S
Subtle
Signs
to Look For
•
THIS
• Highly emotional
• Constantly touching their neck, head or face
• Unwarranted anger • Vacant stare****
• Trying to distance themselves from you
• Refusal to cooperate • Mitigating severity of
symptoms
Emergency Management
(5)
• Immediate referral to nearest emergency room if:
• Neck pain (HCP can evaluate and determine severity of injury)
• Increasing confusion or irritability
• Repeated vomiting
• Seizure or convulsions
• Weakness or tingling/burning in arms or legs
• Deteriorating conscious state
• Severe or increasing headache
• Unusual behavioral change
Emergency Management
• Lucid interval
• Time period that is believed to occur during the formation an extradural hematoma
• The athlete will present with an initial onset of symptoms
• After symptoms resolve the athlete will return to a normalized state • Symptoms come back and worsen
rapidly
• In this situation you should suspect a medical emergency and
Removal from Participation
• LB260(4)
• (2)(a) A student who participates on a school athletic team and is suspected by a coach, an athletic trainer, or a medical professional of sustaining a concussion or brain injury in a practice or game shall be removed from the practice or game at that time. Such student shall not be permitted to participate in any school supervised team athletic activities involving physical exertion, including, but not limited to, practices or games, until the student has been evaluated by a licensed health care professional and has received written clearance to resume participation in athletic
activities from the licensed health care professional.
Removal from Participation
• LB260(4)
• (b) If a student is suspected of sustaining a concussion or brain injury and is removed from an athletic activity under subdivision (2)(a) of this section, the parent or guardian of the student shall be notified by the school of the date, time, and extent of the injury suffered by the student and any actions taken to treat the student.
• Communication following a concussion is possibly the most important aspect of proper management:
• At home care instructions
• Do’s and Do Not’s
Tidbits
• Be the voice of reason
• Be an advocate for your athlete
• Block out the haters
• Keep track of your athlete
• Detach yourself from the situation
• Document
• Know your athletic trainer
• School district policies
• RTP/RTL paperwork
Works Cited
1. McCrory, P., et al. (2017). Consensus statement on concussion in sport – the 5th international conference on concussion in
sport held in Berlin, October 2016. British Journal of Sports Medicine; 0: 1-10.
2. Echemendia, R.J., et al. The Sport Concussion Assessment Tool 5th Edition (SCAT5). British Journal of Sports
Medicine 2017; 51 851-858 Published Online First: 26 Apr
2017. doi: 10.1136/bjsports-2017-097506SCAT5
3. Patricios J, Fuller GW, Ellenbogen R, et al. What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review: British
Works Cited
4. https://nebraskalegislature.gov/FloorDocs/102/PDF/Intro/LB2 60.pdf
5. Elkington, L., et al. Australian Institute of Sport and Australian Medical Association Concussion in Sport Position Statement. November 2017.
6. Ludwig, S.C., Zahir, U. Sports-Related Cervical Spine Injuries: On-Field Assessment and Management. Semin Spine Surg 22:173-180 © 2010 Published by Elsevier Inc.
