ESTABLISHING A CONCUSSION MANAGEMENT PATHWAY - Dr Enda Devitt The Medical Centre,Whitehall,Galway - Investnet

ESTABLISHING A
CONCUSSION MANAGEMENT
PATHWAY
Dr Enda Devitt
The Medical Centre,Whitehall,Galway
MRCSI, MICGP, MFSEM, DISORM, CIC, DGM, DME, DPD, DOWH, DCH, CTH

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What is concussion?
A concussion is defined as a mild traumatic brain injury (mTBI) caused by a jolt to
the head or body that disrupts the function of the brain.

This injury can result in physical, cognitive, emotional, and/or sleep-related
symptoms that may or may not involve a loss of consciousness. The symptoms
can last from several minutes, to days, weeks, months, or longer.

DIFFERENT RTP GUIDELINES- WHICH ONE TO
FOLLOW?
GAA

5-18YRS: RTP MINIMUM 14/7

ADULTS: RTP 7 DAYS

Galway GAA Concussion Education &
Management Pathway
What are we trying to achieve?

 ● Remove uncertainty & anxiety around concussion for players,parents,coaches
   & medics
 ● If a concussion occurs that coaches are more confident in identifying the
   signs & removing that player from play & prompts pathway

2011-2014

● MADDOCKS ON FIELD

● SCAT 3

2015
● Introduced baseline SCAT 3 scores including BESS

2016-Present
● Introduced ImPACT and UPMC model of care

Galway Senior Football Concussion Pilot
● Education evening for the squad on concussion - what we are doing & why

● Computerized neurocognitive baseline test:
    ○   Verbal memory
    ○   Visual memory
    ○   Visual motor speed
    ○   Reaction time

Galway Senior Football Concussion Pilot
Post Injury Assessment consisting of:

 ● Repeat computerized neurocognitive test

 ● Clinical Examination and History including Vestibular/Ocular Motor
   Screening(VOMS)

VOMS : The simplest of clinical examinations

Breakdown of Concussion Types

Galway Senior Football Concussion Pilot

Guidance on return to activity/training etc

 ● Dispel some myths about ongoing complete rest for days without
   TV/phone/lying in a dark room
 ● Get them doing something! - maybe just stationary bike or jogging
 ● Signs of vestibulo-ocular concussion - link in with rehab team
 ● Follow up appointments if ongoing signs of incomplete recovery

Player Example

What Next?

● Rolling out to other football squads and hurling squads

Galway GAA Concussion Education &
Management Network
1. Education evening for coaches,players & parents
2. Baseline computerized neurocognitive testing
3. Remove player from play in event of concussion(better identified by coaches
   through education)
4. Seen by doctor/OOH/A&E - any concern or red flags
5. Appointment made with clinical lead for post injury assessment and
   examination
6. Clear guidance on return to activity with clear communication lines

What might you consider doing leaving here
today?
● VOMS
● Modify Maddocks
● Club lead for concussion pathway - clubs come together, pool resources, link
  in with colleagues with an interest- Doctor in the area/Rehab team with
  expertise in treatment/Rehab of concussion
● Link with other colleagues/networks
● Education evenings
● Make connections

Thank You

Concussion Facts
●   A direct blow to the head, face, neck, or elsewhere can cause a concussion if the force of the hit is
    transmitted to the head

●   Concussions can occur even if consciousness is not lost(90%)

●   A person is at risk for a concussion based on numerous factors, like medical history, age, gender

●    An athlete displaying any of the many signs and symptoms of concussion should not be allowed to
    return to the practice or game even if symptoms clear quickly

●   No two people have an identical concussion

Concussion facts
●   There are existing evidence based active treatments, like vision therapy, vestibular therapy, exertion
    therapy, and medications.

●   The best way to prevent a concussion is proper clinical management. Recovering from one
    concussion should not increase risk of another. Some inherent conditions, such as migraine, may
    put the athlete at higher risk.

●   Long term effects from concussion are typically due to poorly managed injuries. No definitive
    conclusions can be made because studies on long term effects of concussion are ongoing.

●    Helmets have been shown to protect against skull fracture and severe traumatic brain injury, but
    there is little evidence that helmets and mouth guards reduce the incidence of concussion.

Concussion Myths
-   The only thing that can cause concussion is a direct blow to the head
-   An athlete only gets a concussion when they lose consciousness
-   The risk of concussion is the same for everyone
-   An athlete can safely return to playing after suffering concussion-related
    symptoms
-   All concussions,treatments,and recoveries are the same for everyone
-   You have to be put in a dark room to recover from concussion
-   Once you have one concussion,you are at higher risk for future concussions
-   You can prevent a concussion with helmets & mouthguards

ON FIELD COGNITIVE TESTING