What we know
- Repetitive concussions may have serious consequences over a lifetime
- Consecutive concussions prior to resolution of previous concussion may have detrimental long-term effects
- Called Secondary Impact Syndrome
- Most Concussions do not involve loss of consciousness
- Many concussions go unreported, increasing the risk of repeated traumas
- Youth injuries (5-14) are most often sports/bicycle accidents
- Children and adults experience the same post-concussive symptoms (DeMatteo, 2015)
Symptoms-Headache (71%), Distractible (57%), Memory Dysfunction, Dizziness (55%), Fogginess (53%), Sensitivity to light, Fatigue (50%), Blurred vision.
Youth Legislation
- H.R. 469 (2011) protects student athletes from concussions.
- Each state required to develop a standard plan for concussion safety
- All states have sports concussion laws as of 2014
Return to Play Protocol-Zurich Method
- Student athlete needs to return to the classroom first!
- One stage per day minimum without recurrence of symptoms
Stage 1-Cognitive rest-No TV, texting, computer. Resting stage until symptoms are free (at least 1 week.)
Stage 2-Stationary bike, TM (10-15 mins), low level activity
Stage 3-Mod exertion, more running drills. Sport specific activity.
Stage 4-At least 30 mins continuously, more cognitive load. Weight training.
Stage 5-Allowed contact in practice for the first time.
Stage 6-Has to be cleared by the physician before returning to game activity.
Current Multiple-Concussion Return to Play Guidelines
- Positive neuroimaging for 2 or more concussions= 3 months off contact sport
- 2 concussions in 3 months= 6 months off contact sport (From latest injury)
- 3+ concussions in 1 year=1 year off sport and retirement consideration
References
- www.Vestibular.org
- https://www.congress.gov/bill/112th-congress/house-bill/469
- Field, M, Collins, MW, Lovell, MR, Maroon, J. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J Pediatric. 2003;142:546-553.
- Toledo, E, Lebel, A, Bercerra, L. The young brain and concussion: imaging as a biomarker for diagnosis and prognosis. Neurosci Behav Rev. 2012;36:1510-1531
- DeMatteo, Carol et al. Development of a Conservative Protocol to Return Children and Youth to Activity Following Concussive Injury. Clinical Pediatrics. 2015 54(2) 152-163.
- Leddy J et al. A Preliminary Study of Sub symptomatic Threshold Exercise Training for Refractory Post-Concussion Syndrome. Clinical J of Sport Med 2010
- Burke, C. Stony Brook Neuro Concussion Assessment, 2017