University of Montreal Study

1 Mar

Reported on Tuesday in Science Codex was the findings of a study done in Canada about the effects of concussions on children, adolescents and adults.  Not surprising the study to be published in Brain Injury, showed that all three groups are equally afflicted by the concussion injury.  This is new information because it was thought that with the younger brain after the initial effects of the injury they (children) could recover quicker.  This is mainly due to the ratio of white and gray matter in the brain itself.  Even more peculiar is the difference in sensitivity; adolescent brains more sensitive than the other two.

Principle investigator Dave Ellemberg used both standard neurocognitive testing procedures as well as electrophysiological measurements to determine the overall impact and sensitivity of concussed individuals;

These kinds of injuries mostly affect their working memory – the brain function that enables us to process and store short-term information and that is essential for activities such as reading and mental calculation. “The frontal regions of the brain are more vulnerable to concussions. These areas oversee executive functions responsible for planning, organizing and managing information. During adolescence, these functions are developing rapidly which makes them more fragile to stress and trauma,” explained Dr. Ellemberg, who is a professor at the university’s Department of Kinesiology.

Nevertheless, the research also shows that a first concussion will result in six months to a year of neurophysiological side effects for adolescents, adults and children alike. In addition to the working memory, the ability to sustain attention and focus is also affected.

SIX MONTHS TO ONE YEAR!!!  This is much longer than most have been saying and furthers Dr. Bennet Omalu’s statements that a concussed individual should be shelved for at least three months.  As with all studies we have reported here, there are some questions regarding control, and repeatability.  However, this information is coming from an independent group, therefore should be looked at with a bit more keen eye.

One thing not to do is overreact to this information, as with most current research it is just finding its way to the surface.  Further investigation is always warranted;

According to the Professor, these results force us to re-evaluate our understanding of sport-related concussions. “The situation is more serious than we think,” says Ellemberg. “Contrarily to professional athletes, youngsters don’t have a medical doctor and a protocol in place for becoming active again. However, for me, their brain is more important than the brain of a famous football player. It needs to be protected with the right diagnostic tools and an adapted framework. Obviously, concussions are a part of sport, but we can reduce their occurrence by limiting dangerous situations. Youngsters must pursue their activities in a secure environment where people know how to treat concussions.”

Amen!

 

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13 Responses to “University of Montreal Study”

  1. John Doherty March 1, 2012 at 15:44 #

    If we routinely sideline athletes with concussion for a minimum of three months, there will be no self-reported concussions.

    • Dustin Fink March 1, 2012 at 16:43 #

      Very valid and astute comment…

      • Since a primary goal of medicine is to do no harm…

        … why not ‘err’ on the side of caution…and assist in protecting the brains of our youths…

        From my perspective, as more expansive and global brain sensitive tests are developed that thoroughly address ALL 3 major brain functions…cognitive, emotional and physiological…the more we will realize that concussed brains remain symptomatic longer than previously realized… and that the previously determined ‘recovered’ brain from a concussion will be found to be inaccurately assessed and still symptomatic.

        Support for this perspective is found in research pertaining to visual impairments, abnormalities in metabolic balance, and auditory infomation processing delays found in concussed athletes

  2. Michael Hopper March 1, 2012 at 18:57 #

    Agreed. There was another group who was pushing for similar restrictions about this time last year. I don’t remember offhand, but I believe the doctor was out of West Virginia maybe? Dustin, do you remember?

    I thought the same thing then. If it gets too tight like that, then we will be set back years because the athletes will disregard it in order to avoid sitting…

    • Joe Bloggs March 1, 2012 at 20:54 #

      Does anyone know the validity, reliability, sensitivity, precision and accuracy MEP? Both Montreal and KU are using this technology but it is unclear to me, its quality.

      Both teams obtained readings but what is the standard of measurement and concurrent validity. Without those answers, it is unwise to jump to conclusions.

      Nonetheless, I do agree we should be conservative but based on hard results.

  3. Jake Benford March 1, 2012 at 23:46 #

    I second Joe’s thoughts. I am eager to read both articles. I am all for proceeding with caution, but I also would like to know more about the MEP testing, and how it relates to the healing process.

    Very interesting week. We have gone from re-testing with ImPact at 2 days to shelving an athlete for 3-6 mo after one concussion.

    Right now it feels like we have a lot of research being done on ideas, and not a lot of science to back it up.

  4. A Concerned Mom March 2, 2012 at 08:13 #

    I may have a skewed opinion from reading concussion horror stories for the past five months, but based on what has been discovered so far, it seems like it’s time to inform parents, players, and coaches of the possible long term risks as well as the possible need for longer recovery periods. More research is necessary. There’s no need to shut down youth sports (but some may need to be modified sooner rather than later). It just may be time to re-evaluate what youth sports are doing to kids (I know more parents who’ve hired personal coaches for their kids than have hired academic tutors … sports are viewed by many as the best way to get a free ride through college, even though those opportunities are obviously limited to the best of the best … and by pushing, some kids actually get sport ending injuries).

    My goal as a parent is to raise well rounded healthly kids. All I want is to be given the information I need to make informed decisions. I don’t believe parents are currently being provided with that information, and that is a shame (and possible future liability). Episode 27 of the Dr. David Geier (drdavidgeier.com) touches on some of these issues … call for more research and awareness.

    • joe bloggs March 2, 2012 at 09:56 #

      I, like Robert Cantu, that collision sports should be curtailed before 14 and perhaps as late as 16. Let’s face it, coaching, equipment, and medical care is often lacking even at the high school level so we are placing children in risky situation by design.

      There is no evidence that contact makes better players before 14 and there are many risks that are either not understood or have never been investigated. Coaches, parents and players should be developing skills, coordination, speed and fitness that will all be beneficial when contact begins. It also will screen out those less skilled and more vulnerable.

      As far as the science from Montreal and KU, Hovda (mice) and Barth’s (humans) work suggested a recovery of between 3 and 10 days. Brosek showed a longer interval of recovery in females. I am concerned the wide variation reported may be noise not functionally significant. Just because one sees a measurement move it does not mean it tells you anything, it can simply be within the natural variation of the instrument.

      Caution is fine, spin is dangerous. We need to exercise reason after years of shlock largely produced with the support of the NFL.

      • A Concerned Mom March 2, 2012 at 12:00 #

        I recognize I don’t have the background to review these studies. I didn’t intend to disagree with your comments about the need to examine the technology used. Based on what I’ve read about concussions the past few months, it seems like we may have reached the point where parents should at least be informed that there are some questions about how long it may actually take to recover and safely return to sports. No one really seems to know why some kids experience a reinjury within six months to a year. No one seems to know why a certain percentage experience post concussion syndrome (and some disagree that post concussion syndrome even exists). As a parent, I just can’t help but question what’s going on when I read about a 16 year-old cheerleader suffering from a 6th concussion (maybe there is no magic cut off number, but 6 by 16 can’t be a good thing).

        As for spin, I’ve already seen some questionable conclusions drawn from the studies in main steam articles so I can really see your point.

      • Dustin Fink March 2, 2012 at 12:06 #

        To this comment and Joe’s… I put my own spin on things and I truly hope the reader can develop their own conclusions… However, I welcome anyone to question my opinions and call me out… I try to remain as neutral as possible…

        Thanks for the comments…

      • joe bloggs March 2, 2012 at 12:49 #

        Concerned Mom, remain concerned. Feel free to question any statement I make.

        You are reaching logical conclusions. The only way to avoid a brain injury is not to play – even non-contact sports generate accidents. This has many trade-offs that are negative like children becoming more overweight and sedentary opening a path to Type II diabetes.

        On the other hand, Kevin Guskiewicz’s work in football players, while flawed, suggests three concussions has consequences. In my experience one concussion can be enough in some players and some seem largely resistant to multiple events. We don’t know why. Since concussions have only now been cataloged and the long-term effects often manifest themselves decades after the injury, it will take time to establish the types of outcomes one should expect. We do know the consequences in professional players NFL, NHL and Boxing include early onset dementia, CTE, loss of impulse control, depression and so on. Note: these professionals have often played decades at very high levels of competition exposed to the most extreme forces.

        As far as female athletes, research has been neglected and a big help would be supporting researchers like Donna Broshek at UVa who did pioneering work but funding did not follow. Female athletes have serious injuries that are less understood than males.

    • Scooby Axson March 2, 2012 at 14:13 #

      Hi, “A Concerned Mom”..I am doing a story for the Columbia Journalism School on concussion and would like to talk to you because it seems you have some good opinions. If you are interested please feel free to reach me at tma2125@columbia.edu. Thank you..

      • Dustin Fink March 2, 2012 at 15:06 #

        Scooby just interviewed me, good journalist and questions…

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