Concussions

ConcussionsInformation, Statistics, Issues and Next Steps

International Concussion Summit – Presenters

Dr. Scott Delaney Assistant Professor of Sports Medicine, McGill University, and Montreal Alouettes team Physician

Dr. Blaine Hoshizaki Neurotrauma Impact Research Laboratory, University of Ottawa

Dr. Charles Tator Chair of Neurosurgery, at the University of Toronto

Dr. Michael Hutchison Director, Concussion Program, University of Toronto

Chris Nowinski Sports Legacy Institute (SLI)

Dr James Carson Assistant Professor, Department of Family and Community Medicine and the Department of Surgery at the

University of Toronto

OBIA, OPHEA, Brock University, Sunnybrook Health Sciences Centre

Simple facts of Concussions

Immediate and temporary alteration of mental functioning due to traumaNot necessarily caused by direct impact to the head, but due to whiplash effect on the brainWant to avoid the term mTBI - as Concussion issues are not so mildExact mechanism is still unknownContinuous concussions cause brain degeneration

Canadian Statistics25% of Hockey, 50% of Football players with average age 18yrs concussed each year.20% School aged children concussed in 12mth period, 6/10 suffer a ABI1/2 of all trauma deaths due to TBI, 30% pediatric injuries - ABI500 000 people in Ontario living with a brain injuryBrain injury #1 cause of death and disability <45yrsIncidence of Brain Injury 15x more prevalent than Breast CancerCosts $19.8 Billion/year

Global Stats85% direct trauma to the head<5-7% include LOC15-20% Pre/Post AmnesiaTBI – kills >5mill a year, 9% of global mortalitySport injuries statistically small, yet on the rise and the focus has been one of acceptance.

Movement of the Brain

Linear

Rotational and Angular

Mechanism of InjuryTends to vary for females and males (female – ice, boards, balls. Male – elbows, fists, shoulders15msec impact can cause 100-190 G’s of force. Longer the impact, more effect on brain (puck vs soccer ball)

What we are dealing with.

Falls create the biggest Linear impact

Punches lead to the biggest angular impacts

Issues and Recovery

Recovery rates amongst teens is much greater than those more physically developed

First ConcussionAdult 7-14 daysChild up to 1 month

Blue – Professional AthletesRed – College AthletesGreen – High School Students

Issues and RecoveryShowing longer healing rates in females than males.

Some evidence to indicate susceptibility and effects have a genetic link

5-15% symptoms >6mths.

C a novel experience and don’t have skills to deal with it.

Rest is a foreign concept, hard to get students to rest.

Delay of treatment can greatly effect recovery times.

Issues we are facingHiding concussions – Individuals and Staff

WWE Trainers reported 5%, Survey shows 50%

CT/MRI DO NOT show any indicators of concussionsContinued impacts are causing degenerative brain conditions – CTE Chronic traumatic encephalopathy

Frontal and Medial Temporal lobe inhibition (path of destruction for CTE – reasoning and memory)Doctor’s not up to scratch with current and evolving information.

Issues in the schoolHeavy focus on R2P, need more focus on R2LNO universal R2P, R2L protocolNeed “Point Person” in each schoolResentment and lack of success implementing strategies in IEP’s for recovery (ABI brain has changed, LD is a brain that has always been that way)

ABI/TBI symptoms can overlap with existing LD conditions

Baseline testing flawed – easy to misinterpret Concerns that no Dr. signature required on C3 formsDoctors charging up to $80 for a concussion assessment.

What can be implemented in the class for sufferers?ID ABI/TBI in the classroom (BC/NFLD only provinces)Avoid the labeling of behaviourTreat as ABI, not LD even if they present the sameTarget organization/planning problems.Focus on initiation for “lazy” aspectStructure and RoutineMonitor learning on their capabilities NOW, not from beforeAllow opportunities for successProvide alternatives for frustration.Time to talk

Recommended R2L Procedures

Recommended R2P Procedures

RDSB Schools

Hockey Flag Football Basketball Football Wrestling Hallway Community Total Cases Concussions

School                  

Confederation 1 - - 1 - - - 2 2

Chelmsford n/a n/a - n/a - - - 0 0

Sudbury Sec  - -  -  -  - -  -  0 0 

Lively 1 1 - 2 - - 4 8 8

LoEllen - 1 1 1 - - 1 4 4

Lockerby - - - 4 - 1 3 8 8

Lasalle 2 2 7 2 1 2 7 23 14

Espanola                  

Manitoulin                  

Where do we go now?Continual implementation of “Prevention” and removing “accidents”Comprehensive and consistent message to all stakeholdersPoint Person + Time to manageAcademic Support needs a bigger focus during recoveryProcedure to monitor progression and development of ILPAnnual concussion education for staff and students

WILLINGNESS TO CHANGE