Concussion 2015 What next for schools Feb 2015

Concussion 2015 What next for schools ? Feb 2015 Michael Webb Medical Director Ulster Rugby Sports Physician Sports Institute N Ireland

RISUS 2014 -15 Preliminary data 20% schoolboy rugby 1 st XV injuries are concussions

Hugely Topical

USA Zack Lystedt

Concussion Awareness

Recognised Removed What next

Neurometabolic “Mismatch” of Concussion (Giza & Hovda, J Athl Train; 36: 228 -235 2001) 500 Calcium % of normal 400 K+ 300 Glucose 200 Glutamate 100 50 0 2 6 Cerebral Blood Flow 12 minutes 20 30 6 24 hours 3 Hovda, et al. UCLA Brain Injury Research Center 6 days 10 10

Post Concussion • Period of vulnerability – For secondary / compounding injury – Rest needed to ensure optimum environment for recovery – Young people need even more rest than adults

Why do young need longer before RTP ? • 3 -6 x as likely to suffer concussions • Clinical recovery takes longer • Clinical recovery takes place before recovery assessed by other means e. g. f. MRI • 80% 2 nd concussions occur in 1 st 10 days • Developing brain -more difficult assessment • Return to study before RTP • Risks of 2 nd Impact syndrome • Solid consistent message that concussion is a brain injury that needs to be taken seriously

Physiological Recovery • Period of time from full resolution of symptoms to when brain function returns to normal / risk of secondary injury returns to baseline • But – How do we do know it’s happened ? ? • Injury • Clinical recovery • Physiological recovery Return to full function

Return to Learn • School Concussion Policy • Care Pathway from injury until return to play

Concussion Care Pathway Injury Rest Return to learn Recognise & remove Until symptoms resolved As per school concussion policy Return to full function GRTP As per Zurich Consensus

1985 • Average weight 76 kg • Average height 1. 79 m