WSBIP

ConcussioninWinter Sports: 

Concussion in Winter Sports A part of the Winter Sports Brain Injury Program

Slide2: 

Purpose To provide first responders and consumers with information regarding the assessment and management of mild traumatic brain injury in winter sports/recreational activities To include risks, causes, mechanisms, assessment, and recommendations The WSBIP promotes collaboration of IBIA with NSAA to emphasize safety in winter sports across all levels Winter Sports Brain Injury Program Concussion in Winter Sport Update

Winter Sports Brain Injury ProgramA Concussion Awareness & Prevention Campaign: 

Winter Sports Brain Injury Program A Concussion Awareness & Prevention Campaign Why? Prompt assessment and appropriate recommendations for injured athletes and recreational consumers is crucial to preventing further brain injury and cumulative neuropsychological deficits. Current research demonstrates that MTBI is not without consequences as previously thought and repeated minor injuries can lead to severe damage Dissemination of this education program through the National Ski Area Associations, ski patrols, and ski instructors provides a critical secondary prevention tool

Content of the Program: 

Content of the Program Information presented includes the following: Mild Brain Injury in Winter Sports (Epidemiology) Anatomy and Mechanism of Injury Signs and Symptoms Second Impact Syndrome Slopeside Evaluation Concussion Grading Scales Return to Activity Guidelines

Epidemiology of Brain Injury: 

Epidemiology of Brain Injury http://www.biausa.org/preventi.htm

Epidemiology-Winter Sports: 

Epidemiology-Winter Sports Current estimates suggest that sports related brain injury accounts for close to 300,000 injuries each year, with winter sports such as skiing and ice-skating accounting for close to 20,000 brain injuries. [1]   [1] Thurman DJ, Branche CM, Sniezek JE. The Epidemiology of Sports-Related Brain Injuries in the United States: Recent Developments. Journal of Head Trauma Rehabilitation 1988; 13 (2), 1-8. http://www.skinet.com/gallery/

Epidemiology-Winter Sports: 

Epidemiology-Winter Sports Study conducted by the Alberta Children’s Hospital, Calgary: investigated downhill skiing accidents- concluded that falls were also the most frequent cause of injury. However, the most severe injuries occurred as a result of collisions with trees. Variables that significantly impacted the likelihood of injury were reckless skiing, the design of the ski run, and man-made snow. [1]   [1] Myles ST, Mohtadi NG, Schnittker J. Injuries to the nervous system and spine in downhill skiing. Canadian Journal of Surgery 1992; 35 (6), 643-8. http://www.skinet.com/gallery/chew/

Epidemiology-Winter Sports: 

Epidemiology-Winter Sports O’Neil et al: Revealed that first-time snowboarders had a higher incidence of emergent injuries, such as a mild brain injury, than did first-time skiers. [1]   Another study conducted in Japan identified that falling during jumping and falling backward were frequent causes of brain injuries in snowboarding. Snowboarders were also more likely to have a mild brain injury associated with the occipital area of the head. [2] [1] O’ Neill DF, McGlone MR. Injury risk in first-time snowboarders versus first-time skiers. American Journal of Sports Medicine 1999; 27 (1), 94-7. [2] Nakaguvhi H, Fujimaki T, Ueki K, Takahashi M, Yoshia H, Kirino T. Snowboard head injury: prospective study in Chino, Nagano, for two seasons from 1995 to 1997. Journal of Trauma-Injury Infection & Critical Care 1999; 46 (6), 1066-9.

Epidemiology-Winter Sports: 

Epidemiology-Winter Sports Macrab and Cadman: Canadian study, injury rates for skiing were identified to be highest among children ages 7-12 and in teens ages 13-17, with 39% of the injuries representing injuries to the head and face. Additionally, 22% of the head and face injuries were accompanied by a loss of consciousness or other clinical signs of mild brain injury. [1]   In Denmark, injuries were followed at an ice skating rink over the course of one year. Results showed that 25% of injuries were sustained to the head or face, with 64% of injuries being incurred by persons 10-19 years of age. [2]   [1] Macnab AJ, Cadman R. Demographics of alpine skiing and snowboarding injury: lessons for prevention programs. Injury Prevention 1996; 2 (4), 286-9. [2] Johannsen HG, Mikkelsen JB, Fricke A. [Skating injuries. A study of an injury sample in a Danish community skating rink]. [Danish] Nordisk Medicin 1997; 112 (2), 61-2.

“I had my bell rung”: 

“I had my bell rung” Concussion Defined: Concussion is an alteration in mental status that may or may not involve a loss of consciousness.1 Many people still believe that you must be “knocked out” in order to sustain a concussion. Repeated concussions can cause cumulative brain injury in an individual over months or years. 2 1 Kelly, JP, Rosenberg, JH. Diagnosis and management of concussion in sports. Neurology 1997; 48:575-580. 2 Lewis-ICF. The Cost of Disorders of the Brain. Washington DC: The National Foundation for the Brain. 1992.

Anatomy of a Concussion: 

Anatomy of a Concussion The brain floats in cerebrospinal fluid and is protected by the skull. However, the skull alone does cannot prevent the brain from incurring forces of an impact. The brain will rotate and twist inside the skull , with both localized and diffuse damage possible.

Immediate Signs of Concussion(occurring within seconds to minutes): 

Immediate Signs of Concussion (occurring within seconds to minutes) Vacant stare Delayed verbal and motor responses Confusion and inability to focus Disorientation Slurred or incoherent speech Gross coordination abnormalities Emotional reactions out of proportion Memory deficits Any loss of consciousness

Later Signs of Concussion(occurring within hours to days): 

Later Signs of Concussion (occurring within hours to days) Persistent headache Dizziness/vertigo Poor attention and concentration Memory dysfunction Nausea or vomiting Fatigue easily Irritability Intolerance of bright lights Intolerance of loud noises Anxiety and/or depression Sleep disturbances

Second Impact Syndrome-What is it?: 

Second Impact Syndrome-What is it? Second brain injury occurs while the symptoms from the first impact have not resolved. Impact can be separated by minutes, days, and, perhaps weeks. Loss of consciousness not required Rapid loss of circulatory regulation within the brain causes intracranial pressure to rise quickly. http://www.ditto.com

Slopeside Evaluation for Concussion(to be administered by Health Care Providers only, but can be used to identify consumers at risk): 

Slopeside Evaluation for Concussion (to be administered by Health Care Providers only, but can be used to identify consumers at risk) Neurological symptoms headaches, nausea, sensitivity to light, emotional distress, dizziness, unsteadiness, blurred vision, ringing in ears Neurological Testing strength, coordination and agility, sensation Mental status testing Orientation, concentration, memory Exertional provocative tests 5 squats, 5 sit-ups NOTE: History of recent concussion should be considered equivalent to multiple concussions and merits consideration for additional evaluation and monitoring.

Grade 1 Concussion: 

Grade 1 Concussion Transient confusion (inattention, inability to maintain a coherent stream of thought and carry out goal directed movements) NO loss of consciousness Symptoms or mental status abnormalities on examination resolve in less than 15 minutes Quality Standards Subcommittee of the American Academy of Neurology. The Management of Concussion in Sports {practice parameter}. Neurology 1997; 48:581-585.

Grade 2 Concussion: 

Grade 2 Concussion Transient confusion NO loss of consciousness Concussion symptoms or mental status abnormalities (including amnesia) on examination last more than 15 minutes Quality Standards Subcommittee of the American Academy of Neurology. The Management of Concussion in Sports {practice parameter}. Neurology 1997; 48:581-585.

Grade 3 Concussion: 

Grade 3 Concussion Any loss of consciousness, either brief (seconds) or prolonged (minutes). Quality Standards Subcommittee of the American Academy of Neurology. The Management of Concussion in Sports {practice parameter}. Neurology 1997; 48:581-585.

Return to Activity Guidelines (For Use By Health Care Professionals Only): 

Return to Activity Guidelines (For Use By Health Care Professionals Only) Grade of concussion After being asymptomatic with normal neurologic assessment at rest and with exercise and evaluation by qualified Health Care Professional (Time to Return to Activity). Grade 1 Concussion May return to activity same day if mental status abnormalities or post- concussive symptoms clear within 15 minutes. Multiple grade 1 1 week Grade 2 1 week Multiple grade 2 2 weeks Grade 3 With brief loss of consciousness 1week w/prolonged loss of consciousness 2 weeks Multiple grade 3 1 month or longer, based on decision of evaluating physician

Slide20: 

Winter Sports Brain Injury Program International Brain Injury Association