Intro

Pathophysiology of Concussions

Neurometabolic Cascade

Youth at Increased Risk

Diagnosing a Concussion

Signs & Symptoms

On Field Response

In the Health Care Setting

Management of Concussions

Monitoring Concussions

Returning to School

Returning to Play

Managing Persistent Symptom Concussion

Preventing Concussions

Pre-Season Planning

Protective Equipment

Review and Quiz

Resources

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Excluding moderate and severe TBI, what may cause concussion symptoms?

A
Neuron disruption in the cerebral cortex

B
Neurometabolic cascade and axonal dysfunction

C
Interruption between Broca's area in the cerebrum and Wernicke's area

D
Hippocampus injury and limbic system impairment

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Why are kids and teens at increased risk for concussion?

A
Susceptibility to chemical and metabolic changes

B
Axons not as myelinated or insulated

C
Less developed cervical and shoulder musculature

D
A and C only

E
All the above

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According to the concussion in Sports Group, concussion will show abnormality on standard structural neuroimaging studies?

A
True

B
False

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What are the four categories of concussion symptoms?

A
Somatic, Cognitive, Affective, Sleep

B
Cognitive, Affective, Effective, Peripheral

C
Cognitive, Affective, Consciousness, Balance

D
Mild, Moderate, Severe, Profound

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Which of the following should prompt immediate transport of an athlete with a concussion for emergency evaluation?

A
Increase in severity of signs and symptoms that may indicate neurological deterioration

B
Decreasing level of consciousness

C
Persistent focal neurologic deficit

D
All of the above

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What 4 components should your concussion plan cover?

A
Pre-Injury, Injury, Post-Injury, Lifelong impairment

B
Sport, Season, Gender, Geographic Area

C
Exertion, Contact, Rest, Symptom Checklist

D
Pre-Season Planning, On-field Exam, Sideline Evaluation, Removal from Play

Submit

How often does a concussion result in loss of consciousness?

A
Often - 85% or more of the time

B
Moderately - 50% of the time

C
Mildly - 25% of the time

D
Seldom - 10% of the time

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A prior personal and/or family history of diagnosis of which of the following may lead to protracted recovery or complicate the recovery process?

A
Depression/mood disorder or anxiety

B
Learning disabilities

C
Developmental disorders

D
B and C only

E
All of the above

Submit

Appropriate management of concussion injury can help:

A
Speed of recovery

B
Prevent further injury

C
Safely return an athlete to play sooner

D
All the above

Submit

When should you refer to a concussion specialist?

A
When an athlete's symptoms have not gone away after 10-14 days

B
When an athlete does not match their baseline after 3 days

C
When an athlete fails to be asymptomatic during Step 3 of the 5-Step return to play process

D
All the above

Submit

The younger the athlete, the more conservative the treatment.

A
True

B
False

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What happens when an athlete's symptoms return after they've initiated the 5-Step return to play process?

A
The athlete should progress to the next level so long as they do not lose consciousness

B
The athlete should drop back to the previous asymptomatic level and try to progress agin after a further 24-hour period of rest has passed and they are again asymptomatic.

C
The athlete should repeat the 5-Step process, starting at Step 1

D
The athlete should rest for 15 days

Submit

An athlete with a suspected concussion can return to play the same day if his or her symptoms that are present at 5 minutes post injury, but are no longer present at 15 and 20 minutes post injury.

A
True

B
False

Submit

What activities might an athlete returning to school need to limit or avoid to achieve cognitive rest?

A
Academic activities (reading, homework, studying at pre-injury levels, etc)

B
Technological activities (using computers, phones, etc)

C
Entertainment activities (television, video games, etc)

D
All the above

Submit

Tolerance for cognitive activity increases as the student recovers, but the rate my vary from one student to another.

A
True

B
False

Submit

Research suggests that Post concussive syndrome occurs in approximately:?

A
1-3% of patients with concussion

B
5-8% of patients with concussion

C
10-13% of patients with concussion

D
21-24% of patients with concussion

Submit

Which of the following can help reduce the risk for concussion?

A
Good sportsmanship

B
Awareness of coaches, parents, leagues, and schools

C
All the above

Submit

Which of the following is true about concussion?

A
Protective equipment will make you "invincible" to concussion

B
You must lose consciousness to have a concussion

C
Kids and teens are more susceptible to concussion

D
Teaching kids to "shake it off" and keep playing is the right thing to do

Submit

LESSON 5

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Contributors Participating Organizations

© 2011 NFL Enterprises LLC. NFL and the NFL shield design are registered trademarks of the National Football League. Disclaimer

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Lead Contributors:
Stanley A. Herring, MD
Physiatrist and Team Physician
Depts of Rehabilitation Med, Orthopaedics and Sports Med and Neurological Surgery
University of Washington

Kelly Sarmiento, MPH
Director of Communications
Division of Injury Response
Centers for Disease Control and Prevention

External Expert Work Group:
Richard G. Ellenbogen, MD, FACS
Neurosurgeon
Professor and Chairman, Dept of Neurological Surgery
University of Washington School of Medicine

Gerard A. Gioia, PhD
Neuropsychologist
Chief, Division of Pediatric Neuropsychology
Children's National Medical Center

Christopher C. Giza, MD
Adult and Pediatric Neurology
Associate Professor of Pediatric Neurology and Neurosurgery
UCLA Brain Injury Research Center

Andrew JM. Gregory, MD, FAAP, FACSM
Pediatrician Sports Medicine Specialist
Department of Orthopedics and Rehabilitation
Vanderbilt University School of Medicine

Kevin Guskiewicz, PhD, ATC
Director, Matthew Gfeller Sport-Related TBI Research Center
Professor and Chair, Department of Exercise and Sport Science
University of North Carolina at Chapel Hill

Margot Putukian, MD, FACSM
Internal Medicine and Sports Medicine
Director of Athletic Medicine, Head Team Physician
Princeton University

CDC Expert Work Group:
Victor Coronado, MD, MPH
Preventive Medicine Specialist and Medical Epidemiologist
Division of Injury Response
Centers for Disease Control and Prevention

CDR Julie Gilchrist, MD
Pediatrician and Medical Epidemiologist
Division of Unintentional Injury Prevention
Centers for Disease Control and Prevention

Richard C. Hunt, MD, FACEP
Emergency Medicine
Director, Division of Injury Response
Centers for Disease Control and Prevention

Lisa C. McGuire, PhD
Lifespan Cognitive Developmental Psychologist
Research Team Lead, Division of Injury Response
Centers for Disease Control and Prevention

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American Academy of Family Physicians
American Academy of Neurology
American Academy of Pediatrics
American Academy of Physical Medicine and Rehabilitation
American Association of Neurological Surgeons
American College of Emergency Physicians
American College of Sports Medicine
American College of Surgeons Committee on Trauma
American Medical Society for Sports Medicine
American Society of Pediatric Neurological Surgery
Emergency Nurses Association
National Academy of Neuropsychology
National Association of School Nurses
National Athletic Trainers’ Association

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This course provides an overview on select medical issues that are important to health care professionals who are responsible for athletes with concussion. It is not intended as a standard of care, and should not be interpreted as such. This course is only a guide, and as such, is of a general nature, consistent with the reasonable, objective practice of the health care professional. Individual treatment will turn on the specific facts and circumstances presented to the health acre professional. This course will be periodically updated as new research becomes available on this topic.

PROOF OF DISCLOSURE
CDC, our planners, and our presenters wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters.

Presentations will not include any discussion of the unlabeled use of a product or a product under investigational use.

There is no commercial support for the activity.

ACCREDITATION STATEMENTS
The American College of Sports Medicine's Professional Education Committee certifies that the Centers for Disease Control and Prevention meets the criteria for official ACSM Approved Provider status from 2011-2014.

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