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North Alabama Concussion Coalition

North Alabama Concussion Coalition. Debbie Neighbors Managing Director. North Alabama Concussion Coalition. Volunteer Organization Sports are an integral part of development Help coaches, parents, and athletes participate in sports without risking avoidable long-term injury from concussions.

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North Alabama Concussion Coalition

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  1. North Alabama Concussion Coalition Debbie Neighbors Managing Director

  2. North Alabama Concussion Coalition • Volunteer Organization • Sports are an integral part of development • Help coaches, parents, and athletes participate in sports without risking avoidable long-term injury from concussions.

  3. Concussions • Traumatic brain injury (TBI) • Occurs from direct blow or shaking (whiplash). • Cerebral (memory) or vestibular (balance) • Does not show up on scans. CT, MRI, EEG are not helpful in detection, because a TBI causes changes to the way the brain works but does not effect the structure.

  4. Concussion Statistics • The risk of athletes is higher, with estimates as high as 19% of all athletes receiving a concussion in a given year. • Football players are estimated to have as high of a risk as 50%.

  5. Dangers of Concussions • Post Concussion Syndrome • When symptoms of a concussion last for more than 3 months. • There is no reliable data for percentages of concussions that linger, but most are believed to heal within 5-7 days. • Most reliable gauge of severity is amnesia. • Second Impact Syndrome • Results from returning to play before a prior concussion has healed. • Severe, permanent brain injury and death can occur. • Implicated in 30-40 deaths in the last ten years.

  6. Concussion Protocol • When a player has sure signs of a concussion, they are out of the game and practice until cleared by a licensed healthcare provider: • Loss of consciousness • Awkward motion • Confusion • Neurological Signs (pupils, etc) • Nausea, vomiting • Sudden onset headache • Amnesia*

  7. Concussion Protocol • If a player, coach, trainer, parent, or official suspects a concussion, but the player isn’t demonstrating sure signs, administer the NFL Sideline Concussion Assessment Test (SCAT). • NFL SCAT • Tests balance and memory compared to a baseline test administered pre-season. • Players who fail the SCAT are out for the game/practice and require physician’s signature to return to play. • The athlete and parents will receive information about concussions, the Weekend Concussion Clinic, and red flags. • Failing the SCAT does NOT mean that the player has a concussion. It means that a concussion is suspected.

  8. Concussion Protocol • Players who display sure signs of a concussion or players who failed the SCAT and a concussion is suspected will be held out of games and practice until a doctor clears them for practice. • ImPACT software can be used to determine neurocognitive abilities compared to a baseline test taken in the pre-season.

  9. Concussion Protocol • If a concussion has been sustained, the Acute Concussion Evaluation (ACE) Plan of Care will be explained and used as gradual return to play/school guidelines.

  10. Recovery • Many concussions recover on their own within a few days. • Those who don’t may be evaluated by a neuropsychologist or may enroll in a local research project that is safe and very promising to help recovery from concussions and post concussion syndrome.

  11. Concussion Laws Paul Sanford Alabama State Senator

  12. Concussion Laws • HB 108 was passed by the state legislture on June 11, 2012 and signed into law by Governor Bentley in July, 2012.

  13. Lystedt Laws • The bill is similar to laws now adopted in 44 states commonly refered to as the Lystedt Law. • ZackeryLystedt suffered a permanent disabling brain injury as a result of returning to a middle school football game after suffering a concussion.

  14. HB 108, Section 2 (a) Mandates • Inform parents of the nature of the risk – which this program does through the “Know your Concussion ABC’s” information sheet for parents. • This sheet must be signed and returned by a parent or guardian.

  15. HB 108, Section 2(b) Mandates • Coaches must receive annual training on how to recognize the symptoms of a concussion and what to do to seek proper medical care. • This program will focus largely on these matters.

  16. HB 108, Section 2(d) • An athlete suspected of sustaining a concussion shall be immediately removed from participation and may not return to play until cleared by a licensed healthcare professional. • The same procedures are used for practices or games.

  17. HB 108, Section 2(d) • Under this program, a player is suspected of sustaining a concussion, and will require medical clearance, when: • There is loss of consciousness, • confusion, • Sudden onset of symptom, such as headache, nausea • Neurological signs, such as pupils dilated unevenly • altered gait, or • failed the SCAT 2 sideline test.

  18. Identifying a Concussion and Emergency Situations

  19. Physical Signs and Symptoms • Headache • Nausea/Vomiting • Balance Problems • Visual Problems • Fatigue • Sensitivity to Light/Noise • Numbness/Tingling

  20. Cognitive Signs and Symptoms • Mentally Foggy • Feeling “slowed down” • Difficulty Concentrating • Difficulty Remembering • Loss of memory*

  21. Emotional Signs and Symptoms • Irritability • Sadness • More emotional • Nervousness

  22. Sleep • Drowsiness • Sleeping less than usual • Sleeping more than usual • Trouble falling asleep

  23. Worse With Exertion • On the sidelines the symptoms may abate. • Ascertain if the symptoms are worse/occur when on the field.

  24. Sure Signs of Concussion • Loss of Consciousness • “arms up” position • This is not a seizure.

  25. Sure Signs of Concussion

  26. Sure Signs of Concussion • Loss of Consciousness • “Arms up” position • No attempt to soften landing.

  27. Sure Signs of Concussion

  28. Sure Signs of Concussion • Uncoordinated Movement.

  29. Sure Signs of Concussion

  30. Sure Signs of Concussion • Amnesia. • Obvious signs that the athlete is not thinking right. • Going to the wrong sideline. • Not understanding directions or game situation.

  31. Importance of Baseline Testing

  32. Importance of Baseline Testing • If we only saw him exit the ring, he would have been pulled out of competition. • Seeing how he entered the ring is the equivalent of a baseline test. • If a person can’t keep balanced when closing their eyes under normal circumstances, they won’t do well on the NFL SCAT. • If you don’t have a good baseline test, you would be sitting out a healthy player.

  33. Baseline Risk Factors for Prolonged Recovery • Concussion History • History of Headaches • Learning Disabilities • ADHD • Dyslexia • Anxiety • Depression • Sleep Disorders

  34. Red Flags May Indicate Emergency • Headaches that worsen • Seizures • A quick contraction may be normal and not be a seizure. • Focal Neurological Signs • An injury to brain, spinal cord, or nerve tissue. • Tremors/Uncoordinated • increased/decreased muscle tone, drooping of an eyelid • Speech/language disturbance. • Numbness in a particular area

  35. Red Flags (continued) • Looks drowsy/Can’t be awakened • Repeated vomiting • Slurred speech • Can’t recognize people/places • Increasing confusion or irritability

  36. Red Flags (Cont) • Weakness/numbness in arms and legs • Neck pain • Unusual behavioral change • Change in state of consciousness

  37. A Hard Hit to the Upper Body:What would you do? • If the player is down on the field, to be cautious, have him do the NFL SCAT even if he seems perfectly normal. • If the player lingers on the ground, then gets up, instruct the player to go to a knee so he can be evaluated. If he seems OK, do the NFL SCAT. • If the player pops up and shows no sign of LOC, confusion, or uncoordinated motion: • Send in a substitute to get him off the field, see if he seems ok. Do the NFL SCAT even if he is OK. • You taught him to come off if he got his bell rung. Ask him if he’s OK as he goes back to the huddle, trust his answer but pay attention.

  38. What would you do?

  39. Prevention of Concussions Dallas Terrell Strength and Conditioning Coach Personal Trainer

  40. Concussions are Deceleration Injuries

  41. Roots of Modern Training • Training began as a method of practicing attack. • The techniques come largely from martial arts, boxing, and grappling. • These exercises are largely concentric (the muscle goes from long to short). • Though helpful, these methods do not help protect players who are forced to absorb a hit. • In a collision, the reaction is eccentric (the muscle goes from short to long)

  42. Strengthen Resistance to Impact • Eccentric exercises. • Isometric (a muscle contraction with no movement). • Multi-angle training. • Unloaded range of motion. • End-position assistance stretching.

  43. Other Methods • Training the neck stabilizers in proprioceptive spontaneous environments. • Emphasize proper head position and postural alignment while exercising, warming up, stretching, and conditioning.

  44. Additional Help • Through membership in the North Alabama Concussion Coalition, Dallas Terrell works with coaches and their staff to develop and teach proper tackling technique while fresh or fatigued and using film study to promote safe and effective tackling.

  45. NFL Sideline Concussion Assessment Tool (NFL SCAT)

  46. NFL SCAT • When a concussion is possible, but symptoms are not obvious, the NFL SCAT is administered and compared to the player’s baseline scores. • A player who doesn’t pass the NFL SCAT is out of action and will need a doctor’s note to get back to practice. • A player who doesn’t pass the NFL SCAT should take the ImPACT test.

  47. NFL SCAT • Tests Short-Term, Long-Term Memory, and concentration (Cerebral Concussions) • Tests Balance (Vestibular Concussion) • Assesses symptoms • This test does NOT diagnose a concussion, it is not sensitive or specific enough. • Sometimes it takes 24-72 hours for concussion symptoms to present. • This test will NOT be as anything other than an acute assessment tool.

  48. NFL SCAT • Has separate baseline and post-injury tests. • Baseline data must be collected pre-season and be available at practices and games. • Baseline Test assesses risk factors.

  49. Part 1: No Go Questions ANY OF THE FOLLOWING ARE OBVIOUS SIGNS OF DISQUALIFICATION (i.e. "No Go"): 1) LOC or unresponsiveness? (for any period of time) If so, how long? ______________ Y N 2) Confusion? (any disorientation or inability to respond appropriately to questions) Y N 3) Amnesia (retrograde / anterograde)? If so, how long? ____________ Y N 4) New and/or persistent symptoms: see checklist? (e.g. headache, nausea, dizziness) Y N 5) Abnormal neurological finding? (any motor, sensory, cranial nerve, balance issues, seizures) or Y N 6) Progressive, persistent or worsening symptoms? If so, consider cervical spine and/or a more serious brain injury (See box below) Y N Other __________________________ Total Physical Signs Score: (total above Yes scores) of 6 = _____

  50. Test Cranial Nerves

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