Sports Concussions Assignment

Concussion Assignment
Natasha Pena
Pima Medical Institute

Sports related concussions are the most common head injuries occurring with sports participation. The Center for Disease Control (CDC) estimates 1.6-3.8 million reported concussions occur each year. Concussions are unseen injuries and hard to manage but if mismanaged or undiagnosed can be devastating and have potentially deadly consequences. Common sports in which athletes are most at risk for a sport-related concussion include football, soccer, baseball, boxing, hockey, lacrosse, rugby, equestrian events, and snow skiing or snowboarding. Understanding the epidemiology and pathophysiology as well as guidelines related to sports concussions is crucially important when working with athletes. Identifying and managing concussions in youth athletes requires a team approach involving all parties including athlete, parents, coaches, teaches and healthcare professionals.
Typically in sports, a concussion is a result of a hit from an opponent such as during football when a player is tackled by the opponent. During such contact a concussion can result from either helmet to helmet contact, head to body contact, head to ground contact and/or simply from the whipping effect resulting from such contact. According to a study by Daniel H. Daneshvar et al, of all the sports played in the U.S., American football has the greatest number of participants as well as the greatest number of traunatic brain injuries. The same study goes on

to state that tackling or being tackled resulted in approcimately 67.6 % of concussiones observed in football players (Daniel H. Daneshvar, 2011, Jan 30(1)). In sports such as soccer, a concussion can be the result of a player heading the ball due to the force of the ball. In soccer it is estimated that for men, 64.1% of reported concussions and 36.7% reported by women were a result of heading the ball. Other sports such as cheerleading, hockey, baseball, as well as many others are just as likely, though generally less so, to result in concussive injuries amongst athletes. Overall the CDC estimates that approximately 5-10% of all athletes will experience a concussion in a given season (Concussion Facts, n.d.).
So, what exactly is a concussion and why are they hard to identify? Well, a concussion is in essence a traumatic brain injury (TBI) resulting from a direct or indirect force to the head, face, neck or body which is transmitted to the head, causing neurological impairments. The human brain sits inside the skull surrounded by a small amount of fluid called cerebral spinal fluid, which acts as a buffer or shock absorber for mild movement of the brain. During a substantial direct or indirect force, as seen with many contact sports, the impact is rapid thus causing the brain to strike the inner skull (usually the front first) at an accelerated rate. During deceleration of the force motion, the brain then moves in the opposite direction striking the opposite (back) side. The type of concussion resulting from this type of impact is known as a contrecoup concussion, simply meaning that the injury resulted in damage to the front and back of the brain due to the directional force. Another type of concussion is the rotational concussion which results in the head rapidly rotating from one side to another causing a shearing effect, straining the brain tissue. Symptoms of concussions usually are representative of a functional disturbance in the brain and can present as headaches or nausea, difficulty with memory or concentration, irritability and sadness and/or changes in energy, appetite or sleep.
Although concussions are serious and potentially dangerous, misidentifying a concussion can lead to a player continuing to play which might result in second impact syndrome, a rarer result yet the outcome is usually deadly. Second impact syndrome develops as a result of an athlete receiving a second concussion before fully recovering from the previous one. Second impact syndrome symptoms typically appear quickly and include athlete appearing dazed and confused followed shortly by collapsing with dialed pupils, loss of eye movement and breathing difficulty or failure. So why are they so hard to identify? According to the CDC it is estimated that approximately 47% of athletes do not report feeling any symptoms after a concussive blow, and fewer than 10% result in a loss of consciousness, or visual disturbance. This frequency in concussions being under-reported make diagnoses difficult. Recently, approximately 31 states and the District of Columbia have passed some form of youth sports concussion law. However according to the CDC, even those states with a concussion in sports law in place, coaches still may receive limited information on the prevention, recognition, and management of sports-related concussion. For that reason it is crucial that all parties involved understand and work together to minimize the risk as well as identify and seek appropriate treatment as soon as possible (Tracey Covassin, 2005). In an interview with PT in Motion, Anne Mucha stated “Because concussions create so many medical issues, no single discipline can treat them. Concussion patients need a core medical team that includes a vestibular or exertional physical therapist, a neuropsychologist, a physician with concussion training, and an athletic trainer. They also need the support of an academic team, including teachers, coaches, and counselors; and help from parents and family” (Concussion Management Should).
In 2013, the American Academy of Neurology (AAN) released evidence-based guidelines for evaluating and managing athletes with concussions which replaced the 1997 guidelines. According to the guidelines, a licensed health professional should look for ongoing symptoms such as headache and fogginess, and obtain history of concussions (PT Resource: AAN Issues New Guidelines for Evaluating, 2013). In recent years the American Physical Therapy Association (APTA) has advocated for the inclusion of physical therapists as “an integral part of the multidisciplinary team” that diagnoses concussions. In an article written by Kia Boriboon, she quotes APTA spokesperson and ESPN injury analyst Stephanie Bell, PT, OCS, CSCS as stating the following in regards to the role of Physical Therapist as part of the concussion treatment team:
“Physical therapists are an integral part of the health care professional team that evaluates and manages not only athletes with concussions, but also members of the military, workers who sustain head injuries on the job, and anyone who might suffer a concussion such as from a whiplash injury or a fall. With their extensive education and training, physical therapists provide a unique contribution. The effects of sports-related concussions can last for decades. Physical therapists can play an important role in concussion detection and intervention. In addition to concussion diagnosis, physical therapists also have a role to play in concussion prevention and management” (Boriboon, 2013).
According to Ann Mucha, for sports-related concussions athletes are usually assessed by a team of medical experts including a neuropsychologist, physician, and vestibular physical therapist. Once a medical professional or team diagnoses a concussion, the team must develop a treatment plan to manage concussion symptoms. Kia Boriboon writes that, Vestibular physical therapists can create customized treatments for dizziness and balance dysfunction associated with concussion (Boriboon, 2013). Furthermore, in addition to treatments for dizziness and balance dysfunctions, physical therapist can provide individualized exercise and training plans to restore balance and stability. Treatment plans may include a wide arrange of interventions such as vestibular rehabilitation, manual therapy, balance retraining, and aerobic exercise, which can also help athletes reduce pain, increase mobility and motion, and gradually return to physical activity (Boriboon, 2013). As health care providers treating and managing patients with concussive symptoms it is important to remember not all patients present the same. Along with the typical symptoms previously describe, other common abnormalities found following concussions include space and motion discomfort, impaired postural control, Ocular Motor dysfunction, and Cervicogenic Dizziness. Physical Therapist need to understand as well as be able to identify these abnormalities, and treat accordingly. Some of these abnormalities have to potential to become chronic issues, thus patients need to be educated on these abnormalities and proper identification of triggers and how to manage them before being cleared for a safe return to play, if possible for them to do so. Following treatment of concussion symptoms according to the International Conference of Concussion in Sports, gradual return to play program should be implemented once the following conditions are satisfied. First athlete must be symptom free at rest. Secondly they must be symptom free with physical and/or cognitive exertion. Third, athlete must have intact neurocognitive functioning, and lastly they must be off medication that might potentially mask or modify symptoms.
Sports related concussion are often unseen and miss identified leading to potential dangerous and deadly outcomes.

To best minimize the outcomes a team approach to identification and management is most effective. New research, evidence and guidelines are being published to help reduce the number or concussion injuries and improve management of concussions. As part of the concussion treatment and management team, physical therapist play a critical role in identification and

management.

References
Boriboon, K. (2013). Concussion Management in Football: Don't Shake it Off. PT in Motion, 18-25. Retrieved from PT in Motion: http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=ed53de9c-da31-4105-b777-edfb19f219a1%40sessionmgr114&vid=1&hid=109
Concussion Facts. (n.d.). Retrieved from Sports Concussion Institute: http://www.concussiontreatment.com/concussionfacts.html
Concussion Management Should. (n.d.). Retrieved from PT in Motion: http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=8fa6df9d-2ae8-4305-973b-75b2d337b242%40sessionmgr115&vid=1&hid=109
Daniel H. Daneshvar, M. M. (2011, Jan 30(1)). The Epidemiology of Sports-Related Concussions. Clin Sports Med, 1-17. Retrieved from NCBI: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2987636/
Kathy Aligenea, a. E. (2013). Vestibular and balance treatment of the concussed athlete. NeuroRehabilitation, http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=ab5040e6-9a47-49de-b402-4624f0e48be9%40sessionmgr112&vid=1&hid=109.
Marc Goldman, M. (n.d.). Sports-Related Concussions. Retrieved from Hughston Health Alert: http://www.hughston.com/hha/a_12_2_3.htm
PT Resource: AAN Issues New Guidelines for Evaluating. (2013, June ). Retrieved from PT in Motion: http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=04024e96-ea83-4b08-b0b5-1ec66cc06bc3%40sessionmgr110&vid=1&hid=109
TRACEY COVASSIN, P. A. (2005). Educating Coaches About Concussion in Sports: Evaluation of CDC's "Head Up: Concussion in Youth Sports" Initative. Journal of School Health, 233-238.