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CRANIUMConcussion Recognition And Neurological Intervention United Management

What is a Concussion Mayo defines a concussion as:

“Traumatic brain injury that alters the way your brain functions”

http://www.mayoclinic.org/diseases-conditions/concussion/basics/definition/CON-20019272

CDC defines a concussion as: “Type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth”

http://www.cdc.gov/headsup/basics/concussion_whatis.html

Traumatic Brain Injuries (TBI) 75% of all TBI’s result from concussions or other forms of mild

TBI’s TBI’s can cause:

Epilepsy Parkinson's Alzheimer's

Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal

Chronic Traumatic Encephalopathy Newly identified disease associated with repeated concussions Release of a protein called TAU slowly kills brain cells Once started it appears to progress without further incident Only diagnosed after death

http://www.cdc.gov/HeadsUp/ http://concussionfoundation.org/learning-center/what-is-cte

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Concussion Prevalence Estimated 1.7-4.0 million occur each year 60-80% resolve in 7-10 days Up to 33% of individuals will have post

concussion syndrome Up to 30% of individuals will demonstrate

post concussion symptoms 6 months post injury

Kozlowski, K. F., Graham, J., Leddy, J. J., Devinney-Boymel, L., & Willer, B. S. (2013). Exercise intolerance in individuals with postconcussion syndrome. Journal of Athletic Training, 48(5), 627-635. doi:10.4085/1062-6050-48.5.02

Possibility of Becoming a Star 8 million student athletes compete at the high

school level 480,000 athletes compete at the collegiate level Less than 2% of college athletes play professional

sports http://www.ncaa.org/about/resources/research/estimated-probability-competing-college-athletics http://work.chron.com/likelihood-someone-becoming-professional-sports-player-26110.html

Signs & Symptoms Confusion Amnesia Headache Loss of consciousness Balance problems Blurry Vision Concentration/

memory problems

Sensitivity to light/noise

Nausea Feeling foggy, tired Feeling irritable Slowed reaction

time

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Concussion Management Protocol1. Athlete suspected of concussion is

immediately removed from field of play2. Athlete assessed by qualified health care

provider3. Referral to Physical Therapist or Athletic

Trainer4. Return to play progression completed5. Athlete referred to health care provider for

clearance to return to practice and then competition

Three Is Better Than One Sport Concussion Assessment Tool-3rd

Edition Vestibular Ocular Motor Screening Balke Treadmill Test

Sports Concussion Assessment Tool 3rd

Includes: Symptom evaluation, Cognitive & physical evaluation, Balance, Coordination, Recall, Memory Balance Error Scoring System

Broadly Normal: Score 1-4 Below Average: Score ≥ 5

Self reported symptom score of 24.91/122 compared to 6.53/122

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Vestibular Ocular Motor Screening (VOMS) Quick 5-10 minute test Provocation testing of the vestibular and

ocular motor systems Symptom changes are rated by patient 2014 American Journal of Sports Medicine

Scores ≥ 2 total symptoms after any VOMS item (96%) or a Near Point Convergence distance of ≥ 5 cm (84%) resulted in high rates of concussion identification.

Balke Treadmill Test Standardized treadmill protocol Test terminated due to fatigue or

production of concussion symptoms 2013 Journal of Athletic Training:

100% of patients with concussion stopped the test due to return of concussion symptoms.

Median exercise duration was 40% of the control group, 9 minutes or less compared to 18

Sensitivity 99% and Specificity 89%

Return to Play Protocol Consists of 5 phases each adding a plane

of movement and intensity Athletes 12 years old or younger- 72 hours

symptom free before progressions Athletes 13 years old and older- 24 hours

symptom free before progression http://www.cdc.gov/headsup/providers/return_to_activities.html

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Return to Play Phases Phase #1- No Activity

Complete physical and cognitive rest Symptom free x 24 hours progress to phase 2

Phase #2- Light Aerobic Exercise 20 min of cardiovascular exercise at less than 70% heart

rate max

Phase #3- Sport Specific Exercise 45min of cardiovascular less than 80% heart rate max

Phase #4 Non-Contact Training Drills 60min of complex training less than 90% of heart rate

max

Phase #5- Full Contact/Practice

Medical Clearance Between Stage 4 & 5:

Balke Treadmill Testing Normal SCAT-3 Normal VOMS

Medical Clearance to Return to Full Contact Practice Only

Symptom Free x 24 hours Clearance to Return to Competition

Medical Coverage MHSAA Insurance Benefit

Suspected concussion Grades 7-12 Receive prompt and professional attention

for head injuries Requires referral to Physical Therapy

services from qualified health care professional

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How to Improve the Health and Vitality of Your Community

Patrick Sustrich, MSChief Integration Officer/

Executive Director of AL!VE

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Old Mission

To provide personalized and affordable quality healthcare…

New MissionTo enhance the overall health and vitality of the 

people and communities we serve.

Phase 1 - HUD Project Cost: $ 9.6 millionPhase 1 – non-HUD Project Cost: $ 2.7 millionPhase 2 Project Cost: $ 3.2 millionTotal Project Costs: $15.5 million

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Guiding Principles

Collaboration

vs.

Competition

Collaborators

8,000+ ProgramsPer Year!!

Local Collaborators

Charlotte Public Schools Eaton RESA

Charlotte Time Bank CrossFit Fade

CAN DO!/ Step by Step Charlotte Chamber

Eaton Area Senior Center Barry Eaton District Health Dept.

Charlotte Aquatic Center Linn Products

Gavel Restaurant Team One Chevrolet

Spartan Motors Eaton County Offices

Peckham Eaton Federal Bank

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Regional Collaborators

The Big Salad Michigan State University

Fenner Nature Center Sparrow Hospital

Impression 5 Science Center GLCVB

Eaton Conservation District Capital Area Health Alliance

LEAP BC/BS Michigan

Boy Scouts of America Community Partners in Health

Lansing Chamber YMCA

American Heart Association American Kidney Foundation

Olivet College PNC Bank

Guiding Principles

Accessible to ALL

Accessible to ALL

• 16,000+ L!NK Cardholders…

200,000+ Visits/ Year!!

In a community of 9,500 people…

coming from over 240 different zip codes!

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Fitness Membership Data

14%

L!NK Cardholder Data

38%

Guiding Principles

Regional Impact

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Regional Impact

• MHA Ludwig Community Benefit Award

• Lansing Regional Growth Award

• CAHA Health Advancement Award

• Alvin Whitfield Community Service Award

• GLCVB Be a Tourist Passport Participant

• PNC Grow-Up Great Grant

• Nature-A-Bounds Grant

• Joe D. Pentecost Grant

• BC/BS Winter Warm-Up Grant

• Generation E Grant

• Capital Regional Community Foundation Grants

Video Links

• Creative Well-Being: https://vimeo.com/105239043

• The Business Case: https://vimeo.com/105243154

• Design Experience: https://vimeo.com/105239042

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How to Improve the Health and Vitality of Your

Community

How to Improve the Health and Vitality of Your

Community

Questions

Guiding PrinciplesReturn on Investment

• By year 3, AL!VE should generate positive EBIDA

• After year 3, AL!VE operations should also contribute to debt obligation

• Long‐term payback of investment

AL!VE Financials

FY11 FY12 FY13 FY14 FY15 FY16

Net Revenue $3,152,408 $3,319,372 $3,944,678 $4,464,112 $4,839,142 $5,151,436

Expense $1,756,945 $2,440,432 $3,299,867 $3,418,825 $3,107,119 $3,210,953

Net Income $1,395,463 $878,940 $644,811 $1,045,286 $1,732,023 $1,940,483

EBIDA $1,466,815 $967,646 $803,265 $1,257,068 $1,968,119 $2,205,094

Incremental EBIDA

($499,169) ($663,550) ($209,747) $501,304 $738,279

33% AL!VE Phase 1

100% AL!VEPhase 1; 

33% Phase 2

100% AL!VE Phase 1 & 2

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EBIDA

EBIDA