Youth Lacrosse coaches - University of Kansas Medical Center

Youth lacrosse & Concussions
December 2013
Increase in Sports Concussions?"
Keeping Your Head in the Game
n = 509,640!
e-mail: jradel@kumc.edu!
Meehan W, et al "High school concussions in the 2008-2009
academic year: mechanism, symptoms, and management" Am J
Sports Med 2010; 38: 2405-2409. !
Kansas Intellectual & Developmental "
Disabilities Research Center"
http://www.nationwidechildrens.org/cirp-rio"
KU Medical Center"
Departments of"
Occupational Therapy Education"
Molecular & Integrative Physiology"
Ophthalmology"
n = 287,710!
17%"
Jeff Radel, PhD "
Center for"
Concussion Management"
47%"
10%"
11%"
15%"
strain/sprain"
contusion"
fracture"
concusssion"
other"
37%"
22%"
12%" 14%"
15%"
19%"
Concussions"
excluded:"
19%"
52%"
contusion"
13%"
fracture"
other"
n = 456,344!
47%"
strain/sprain"
16%"
15%"
18%"
n = 224,414!
2"
Concussions are Common, and the Consequences
can be Serious!"
Concussion rates among boysʼ
high school sports"(2008-09)"
Rate per 3000 athlete-encounters"
Hours"
Football"
Ice Hockey"
Lacrosse"
Wrestling"
Soccer"
Basketball"
Baseball"
Football injuries"
2011-2012"
Football injuries"
2005-2006"
Sport-Related Concussions
and Young Athletes"
Headache"
Dizziness"
“Foggy” or “confused”"
Injury"
… and 80% of concussions "
are not reported"
0.5"
1.0"
KCYLL Spring 2012:"
• 1050 registered players"
• Typically 2 practices/week & 1 game/week"
• 8-week season"
= 25200 athlete-encounters"
1.5"
• A concussion can happen on the field, but also at home, play, or school!"
9 concussions expected"
1 concussion reported"
4"
Concussion Signs & Symptoms"
Diagnosis"
• 
• 
• 
• 
• 
•  How does a physician know it is a concussion?"
•  Asks about symptoms!
•  Parents & friends may report changes:"
•  Thinking & attention problems?"
•  Sleep problems?"
• 
•  What about CT or MRI?"
• 
• 
• Not sensitive to concussion injuries"
"
•  Best person to see symptoms?"
!
à Other players & friends!"
• 
• 
• 
5"
jradel@kumc.edu
Confusion
Appears dazed or stunned
Feels “foggy” or “not right”
Answers questions slowly
Concentration or memory
problems
Is confused about position
assignment
Forgets plays
Is unsure of game, score, or
opponent
Seeks solitude on sideline after
injury
Can’t recall events prior to incident
Can’t recall events after incident
 
 
 
 
 
 
 
 
 
Headache or “pressure” in
head "
Balance problems or dizziness"
Sensitivity to light or noise"
Nausea or vomiting"
Loses consciousness (even
briefly)"
Double or blurry vision"
Moves clumsily"
Shows changes in behavior or
personality"
Sleep disturbances – sleeps
too much, or sleeps too little "
6"
1
Youth lacrosse & Concussions
December 2013
Concussions are Common, and the Consequences
can be Serious!"
Concussion Signs & Symptoms"
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
Confusion
Appears dazed or stunned
Feels “foggy” or “not right”
Answers questions slowly
Concentration or memory
problems
Is confused about position
assignment
Forgets plays
Is unsure of game, score, or
opponent
Seeks solitude on sideline after
injury
Can’t recall events prior to incident
Can’t recall events after incident
 
 
 
 
 
 
 
 
 
Headache or “pressure” in
head "
Balance problems or
dizziness"
Sensitivity to light or noise"
Nausea or vomiting"
Loses consciousness (even
briefly)"
Double or blurry vision"
Moves clumsily"
Shows changes in behavior
or personality"
Sleep disturbances – sleeps
too much, or sleeps too little "
Immediate"
Headache, dizziness, etc."
Associated biomechanical injuries"
Risk to self & others if driving vehicle"
Injury"
Short-term"
Risk of second impact syndrome (rare in adults)!
Unrecognized post-concussion syndrome "
Social consequences of behavior & impaired judgment"
Academic challenges"
7"
8"
Concussions are Common, and the Consequences
can be Serious!"
Your brain isnʼt a thumb"
Immediate"
="
Headache, dizziness, etc."
Associated biomechanical injuries"
Risk to self & others if driving vehicle"
Injury"
Short-term"
Long-term"
Nathan Stiles!
1992 - 2010!
Risk of second impact syndrome"
Unrecognized post-concussion syndrome!
Social consequences of behavior & impaired judgment"
Academic challenges"
Accumulation of impairment after successive injuries"
Changes in speech, behavior, control of movements"
Memory problems, possibly dementia"
Depression, possibly suicide"
Chronic Traumatic Encephalopathy"
That difference usually is good…!
9"
10"
Concussion Management"
Recognition of signs & symptoms!"
•  Education of players, parents & coaches"
•  Identify risky situations"
" Caswell, et al., Mason University S.M.A.R.T Laboratory 2010"
Studied 5000 High School players, 50 teams in Virginia (2008-2009 season)"
Boysʼ lacrosse: (32 concussions)!
90% = body check while contesting a loose ball!
25% of plays yielding concussions resulted in penalties!
!
!Girlsʼ lacrosse: (14 concussions)!
36% = stick to head; unintentional!
21% = stick to head; intentional!
14% of plays yielding concussions resulted in penalties"
11"
jradel@kumc.edu
http://dsc.discovery.com/tv/mythbusters/"
#1
• A concussion is a type of traumatic brain injury"
• Loss of consciousness is not required for it to be a concussion!!
• Injured athletes seldom acknowledge concussion signs or symptoms"
12"
2
Collins, M. (2010). Retrieved from http://www.neurosurgery.pitt.edu/trauma/concussion.html"
Youth lacrosse & Concussions
December 2013
Mythbusters …"
Mythbusters …."
Youth concussions ≠ Adult concussions!
•  Adolescent brains are more likely to have:"
Abolishing Football will eliminate concussions"
•  Prolonged brain swelling"
•  Slower recovery"
•  Greater potential for lingering problems with learning, memory,
judgment, and social behavior"
•  Challenges related to other high school activities – academic,
social, etc."
•  An “adult” pattern of brain connections doesnʼt mature
until 18-24 years of age"
•  Disordered brain activity impairs learning, memory, judgment, & reasoning"
•  Potential for disordered pattern to become permanent, with long-term consequences"
October 2012"
Dover, New Hampshire"
13"
14"
Mythbusters …."
Mythbusters …."
Girlsʼ concussions ≠ Boysʼ concussions!!
Abolishing Football will eliminate concussions"
Complied from RIO database (2008-2009 data)"
Rate per 3000 athlete-encounters"
15"
Lacrosse"
Soccer"
Girls" Basketball"
Field Hockey"
Softball"
Cheerleading"
Boys"
A higher rate"
than boys"
Football"
Ice Hockey"
Lacrosse"
Wrestling"
Soccer"
Basketball"
Baseball"
0.5"
1.0"
1.5"
Does gear make a difference?"
Mythbusters …"
Better helmets will prevent concussions"
Yes, but only to a point …!
Leatherheads
George Clooney
Renée Zellweger
Universal Pictures
(2008)
… and consider
teenaged behaviors!
Football helmets were developed to prevent skull fractures, not concussions
17"
jradel@kumc.edu
18"
3
Youth lacrosse & Concussions
December 2013
… and what about sports with no
helmets?"
A related issue…"
Players should wear properly-fitted protective gear!
19"
Relying on concussion
detection devices is risky"
Riddell HITS system
helmet accelerometers
What can I do?"
mouth guard accelerometers
Biometrics
X2 Impact
BattleSport
chinstrap accelerometer
Shockbox
helmet sensor
CheckLight
skullcap accelerometers
20"
•  Student Athlete"
•  “Brain Rest” - no reading, video games, texting, TV, loud music …"
•  Gradual return to sports & school activities; no school = no sports!!
•  Let adults know about other players who “arenʼt right” after a hit"
•  Teachers"
•  Accept that “Brain Rest” means no homework – at first!"
•  More time needed for assignments, exams? "
!(Required by ADA AA & section 504, and maybe by IDEA if symptoms persist)!
•  Coaches"
•  Communicate with parents, athlete, teachers, officials, other coaches"
•  Good hydration & frequent rest periods"
•  Listen to sideline & post-game chatter"
•  Parents"
•  Monitor player for sleep disturbances, headaches, memory
problems, or changed behavior (4 weeks?)"
•  Read the research evidence; donʼt rely only on news or internet!"
•  Advocate for safety, awareness, and evidence-based education!"
Full 90° soccer helmet!
21"
22"
Thank you!!
Tel:
(913) 588-7195"
e-mail: jradel@kumc.edu!
jradel@kumc.edu
4
Concussion Resources - Education
http://www.cdc.gov/concussion/sports/
http://www.kansasconcussion.org/
http://www.uslacrosse.org/
http://www.nfhslearn.com/
http://www.kshsaa.org/
http://www.mshsaa.org/SportsMedicine/
1 Concussion Resources - Care • 24/7 Call Center: (913) 588-1227
for non-emergency appointments
• email: concussionreferrals@kumc.edu
• mention this is an evaluation for youth sports
concussion and the player will be seen within 24 hours
• main campus (39th & Rainbow)
• Indian Creek Campus (107th & Nall),
• Arrowhead sports medicine clinic
Other options for concussion care:
2