Improving Concussion Awareness and Care in your Community

IMPROVING CONCUSSION AWARENESS AND CARE IN YOUR Dr. Wyatt J.COMMUNITY LaVigne, PT, DPT, ATC Physical Therapist and Athletic Trainer Director, Therapy & Wellness

Rainy Lake Medical Center International Falls, MN OBJECTIVES To share my experience of developing a Concussion Management Program in a rural setting.

To provide a template to others in underserved communities on how they can initiate or improve their own Concussion Management Program. To offer suggestions to others on how they can educate their own community about concussions.

DISCLOSURE S I have no financial disclosures. MY COMMUNITY HEALTH CARE IN I. FALLS CONCUSSION PREVALENCE

Very common as many as 3.8 million concussions each year in the U.S. Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006 Sep-Oct;21(5):375378 Very commonly undiagnosed Meehan WP, Mannix RC, O'Brien MJ, Collins MW. The Prevalence of Undiagnosed Concussions in Athletes. Clin J Sports Med

2013;0:1-4 (epub ahead of print) MY STORY High School and College Hockey ATC PT CONCUSSION STORIES IN I.

FALLS Hockey Coaches Football Coach Physician MY COMMUNITY = UNDERSERVED Obvious lack of training for coaches and parents

Medical system that struggled to care for athletes with concussion HOW CAN I IMPROVE CONCUSSION MANAGEMENT IN MY COMMUNITY? Two goals: Educate community

Especially coaches, parents, other health care providers Improve quality of local concussion care EDUCATING THE COMMUNITY Evidence-based message

Concussions happen frequently and are frequently undiagnosed. We need to take concussions seriously. Trying to play through concussion symptoms is a bad idea Can lead to PCS or other long-term problems Helmets and mouthguards have minimal effect on concussion risk Helmets and Mouth Guards: The Role of Personal Equipment in Preventing Sport-Related Concussions. Clin

Sports Med. 2011 Jan; 30(1): 145163. doi: 10.1016/j.csm.2010.09.006 MOST IMPORTANTLY When in doubt, sit them out, and get them checked out. EDUCATING COMMUNITY Concussion Education Night Meet with AD, coaches, parents

Meet with other health care providers EMT training Education at local youth athletic events Providing sideline coverage as an athletic trainer Social media articles on Facebook, RLMC website Concussion articles in local paper Advertisement radio, newspaper, etc. Local Television station

RLMC CONCUSSION MANAGEMENT PROGRAM Founded in International Falls in 2012. Falls High School athletes Junior high and recreational athletes Expanded to include Littlefork-Big Falls High School in 2013.

Expanded to include Fort Frances Lakers of the SIJHL in 2015. CONCUSSION PROGRAM STAFF BENEFITS OF A SMALL STAFF More consistency in the care thats being provided

Players see the same health care provider throughout the process Improved therapeutic alliance Build meaningful relationships with coaches, athletic director, teachers, parents, etc. CONCUSSION MANAGEMENT

PROGRAM: OVERVIEW All players in contact sports get baseline tested during pre-season with ImPACT Football, hockey, basketball, diving in our town

Non-contact sports can still be treated using normative data Coaches are educated: When in doubt, sit them out, get them checked out Following possible concussion, evaluation in 1-3 days by PT/ATC History and physical examination Re-take ImPACT test Plan recovery

BENEFITS OF IMPACT TEST Increases compliance among players, coaches, parents Baseline session is a great opportunity to provide additional education Gives you additional objective data to go along with subjective Harder to hide symptoms Note: It is only one piece of a concussion evaluation. CONCUSSION CARE

Relative rest Return to learn Gradual return to sport protocol MSHSL guidelines 1. American Academy of Pediatrics. (2016, April 30). Complete rest until symptom-free after concussion may not be best for

recovery: New study found that youth who exercised within seven days of head injury had nearly half the rate of persistent post-concussive symptoms a month later. ScienceDaily. Retrieved March 23, 2017 from www.sciencedaily.com/releases/2016/04/160430100401.htm 2. Returning to Learning Following a Concussion. Mark E. Halstead, Karen McAvoy, Cynthia D. Devore, Rebecca Carl, Michael Lee, Kelsey Logan, Council on Sports Medicine and Fitness, Council on School Health. Pediatrics Nov 2013, 132 (5) 948-957; DOI: 10.1542/peds.2013-2867 3. https://www.cdc.gov/headsup/providers/return_to_activities.html 4. http://www.mshsl.org/mshsl/news/ConcussionInfo.pdf

RELATIVE REST VS RETURN TO LEARN American Academy of Pediatrics Guidelines 30 minutes of concentration

days progressing to full days Accommodations Gym Music class Breaks Testing environment Etc.

GRADUAL RETURN TO SPORTS PROTOCOL 1. No activity, rest until all symptoms have resolved. Once asymptomatic, proceed to level 2. 2. Light aerobic exercise such as walking or stationary cycling, no

resistance training. 3. Sport specific exercisefor example, skating in hockey, running in soccer; progressive addition of resistance training at steps 3 or 4. 4. Non-contact training drills. 5. Full contact training.

6. Game play. COMMUNICATION IS KEY! Conversation, text, e-mail, phone calls between: Athletes Parents Coaches Teachers

Doctors Etc. POST-CONCUSSION SYNDROME PCS Sub-symptom aerobic exercise

Leddy JJ, Kozlowski K, Donnelly JP, Pendergast DR, Epstein LH, Willer B. A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clin J Sport Med. 2010;20(1):21-27 [PubMed] Vestibular therapy

Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. cervico-vestibular physiotherapy in the treatment of individuals with persistent symptoms following sport related concussion: a randomised controlled trial. Br J Sports Med 2013;47:e1. http://www.sportsconcussion.co.za/Research/Pharmacological%20Treatment/Vestibular-Rehabilitation-Dizziness-Balance.pdf Education

Referral Time UNPUBLISHED OUTCOMES Approximately 95% of patients have successfully RTS within 2-4 weeks without subsequent concussion in short or intermediate term

Approximately 3% have suffered second concussion within 1 month of return Approximately 2% have suffered Post-Concussion Syndrome KEYS TO SUCCESS (IMHO) Trying to be as evidence-based as possible

Stay as current as you can Adapt with evidence Strong therapeutic alliance through compassion, communication, and building relationships YOUR COMMUNITY

FIRST STEP Assessment: Whats existing in your community? Education? Care? WHAT IS NEEDED TO PROVIDE CONCUSSION

EDUCATION? A passionate and persistent individual, even if youre not a health care provider A simple, concise message A creative and pragmatic approach

Networking If your message can reach one person, its worth it RESOURCES https://www.cdc.gov/headsup/index.html MSHSL concussion Impacttest.com

USA Hockey Concussion NETWORKING School districts are typically eager to support this kind of program Start by talking with AD Coaches Parents Players

Health care facilities Local newspaper, radio, etc. NEEDS FOR CONCUSSION MANAGEMENT PROGRAM A Health Care Provider to coordinate it If you use neurocognitive testing:

Training (impacttest.com) A little $$$ (subscription for our school is~$600/year). A computer lab to perform baseline testing A quiet room with a computer for health care provider to do follow-up appointments Sideline coverage at games is very valuable

Education to coaches, parents, players about when to refer IF FUNDING IS NEEDED School district Health care facilities Booster clubs Old Timers tournaments Local businesses

IMPROVING CONCUSSION CARE Questions, help, ideas, etc. Dr. Wyatt LaVigne, PT, DPT, ATC [email protected] (218)283-5444

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