Rugby Concussion Discussion

23 May

Part of the email I received about the AFL injuries were some papers written about the concussion issue in the National Rugby League (NRL), Rugby Union and of course Footy.  The first article was written by Fredric Gilbert, PhD and Bradley J. Partridge titled The need to tackle concussion in Australian football codes.  The gist of the article was about the still hidden injury of concussion, relating to reporting and return to play.  The authors wanted to point out that the cumulative effects of concussions are just now surfacing and that “all contact sports should adopt and evaluate the effects of precautionary policies that require concussed players to leave the field.”

What I really appreciated was the section devoted to youth sports;

Reducing the risk of concussive and subconcussive impacts is even more critical at the non-professional level, where there is a large population of vulnerable young players to whom a significant duty of care is owed.6 Most reported cases of second-impact syndrome (when a brain that has not healed from a previous injury suffers an additional trauma) that led to death or severe disability have occurred in young athletes.19 Yet most amateur teams do not have qualified health professionals or other staff who are trained to detect and assess concussion. At this level of sport, many concussions likely go unrecognised and incorrectly managed.20,21 However, if players and sporting organisations at the elite level change their approach to head injury and concussion, it is hoped that those at amateur levels will do likewise.

Although the state of athletic trainers – physios in Australia – is currently unknown to me it seems that the push is again for correct oversight for the youth.  Gilbert and Partridge seem to be addressing the same issue we have been here about youth concussions, which is great to see.  If the top-level of sport addresses the issue head on then it will trickle down.  Just like those players sloughing off the concussions to play – and the young players trying to emulate – management can work the same way.

The article above did prompt an editorial reply from some heavy hitters in the continent of Australia, Dr. Andrew Kaye and Dr. Paul McCrory (the primary author of the Zurich Statement).  The article was released May 14th and is titled Does football cause brain damage?

In the article Kaye and McCrory review the case of CTE and other anecdotal evidence that has been used against the collision sports, it is a great review and one that all should read.  The parting two paragraphs caught my eye (as they should); the first was the information regarding head-gear the last was about the caution of media and using science to hammer out the issue;

There is no good clinical evidence that currently available protective equipment (especially soft-shell helmets) will prevent football-related concussion. Two randomised controlled trials have demonstrated the lack of efficacy of helmets in preventing concussion in rugby and Australian football, and extensive laboratory studies have shown that current helmets have little or no protective capability in this regard.16 The use of any protective equipment in contact sport is problematic, as players may adjust their play and take more risks. It has been recognised that hard helmets can be used as “weapons” by American footballers and may increase a tendency to engage in a more aggressive manner of play.1,2,17

At this stage, the available evidence suggests that current conservative management guidelines for acute concussion, if followed, are safe and appropriate.15 Sideline assessment tools for concussion have been developed for both lay and medical use and are freely available online or as apps for smartphones or tablet computers. The engagement of mainstream neuroscience in this area is important but, rather than driving the debate through the media, the issues raised need to be tested in the cold light of scientific peer review. We must remember that the plural of anecdote is not data.

 

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3 Responses to “Rugby Concussion Discussion”

  1. A Concerned Mom May 23, 2012 at 13:01 #

    It’s true that “the plural of anecdote is not data.” However, what do we do while waiting for appropriate scientific studies to be conducted? And, who wants to sign their child up for one of these studies? I still want my children to participate in youth sports, but as far as I’m concerned, there’s enough information available for me to tell them to avoid any sport that results in multiple hits to the head while their brains are still developing. Go ahead and play soccer, but avoid heading the ball and don’t be overly aggressive or too passive … perhaps they won’t be considered “good” players, but hopefully they won’t be cut off from engaging in sports before they finish high school either.

  2. Don Brady, PhD, PsyD, NCSP, Licensed Psychologist May 25, 2012 at 00:25 #

    Definition of ANECDOTE..Online Merriam Webster

    a usually short narrative of an interesting, amusing, or biographical incident

    ———————————————————————————————————————————————————————————————————————————-

    Current research methods emphasize and support the value and use of both quantitative and qualitative data.

    3 pertinent excerpts and perspectives from 3 different professionals found in my 2004 NFL Players’ Knowledge of Concussions Dissertation research pertain to the anecdote comment: “We must remember that the plural of anecdote is not data.”

    The 3 prominent individuals are cited below. In addition to McCrory , the second two authors, Damasio (a respected neurologist) and Patton (an internationally known and distinguished researcher) share perspectives that encourage and support a more expansive view of science than McCrory’s view of science. These 2 authors suggest that the singular AND plural of ‘anecdote’ may be accurate data…

    1- McCrory -2001
    McCrory (2001) dismissed the adverse impact of multiple concussions when he advocated there was no existing scientific evidence to support the tenet that an athlete’s sustaining multiple concussions over his career necessarily results in permanent brain damage.

    He also discounted, as not being scientifically validated, the existing concussion guidelines utilized in making return-to-play decisions. In a personal communication with McCrory during the summer of 2003 this author asked McCrory to define the construct “scientifically validated.” His response and corresponding definition for the term is below:

    scientifically validated concussion symptoms refers to the symptoms validated in prospective studies of this condition. Surprisingly there are few such studies. Also the papers are retrospective or review type papers and list the standard PCS or PTSD type symptoms (and call them “concussion” symptoms) with no evidence for their presence,
    duration or significance (P. McCrory, personal communication, August 12, 2003).

    2- Damasio – 1994

    In addition to utilizing solely traditional research methods to gather information,
    Damasio (1994) acknowledged the value of human wisdom employed within natural settings when he pointed out that our perceptive grandmothers used the powers of deduction to obtain information about the adverse effects of psychological disturbances on the body.

    Despite their acuity, our grandmothers’ observations were often viewed as being “too folksy” or “too soft” by the scientific establishment. Damasio also reminded us that it took a significant period of time for medicine to uncover and scrutinize the claims of our forebears. Damasio’s insights seem to reflect the essence of the Journal of American Medical Association’s primary goal of promoting not only the science, but also the art of medicine.

    3- Patton (1990)

    The notions of science neither being truly objective nor value free have also been enunciated by Patton (1990). Although objectivity has been viewed by many as the cornerstone of scientific investigation, Patton (1990) emphasized the absurdity of the objective versus subjective debate among philosophers and experimentally-based researchers when he clearly and succinctly pointed out

    the ideals of absolute objectivity and value-free science are impossible to obtain in practice and are often of questionable desirability in the first place because they ignore the intrinsically social nature and human purposes of research. Subjectivity…has such negative connotations in the public mind that to openly advocate the value of subjective insight into a research is to undermine the credibility of one’s work (p. 55).

    Patton (1990) urged the avoidance of these constructs in order to bypass useless debates, while at the same time advocating for the investigator to commit to “comprehending the world as it is while simultaneously utilizing credible research strategies which are balanced in reporting both confirming and disconfirming evidence” (p. 55). He emphasized as well the importance of the investigator maintaining a neutral position, and strongly cautioned and reminded the reader that: (a) instrumentation designed by humans is subject to inherent biases of the researcher; and (b) no single research methodology adequately explains away differing causal variables.

    • A Concerned Mom May 25, 2012 at 17:02 #

      It would be nice if you could get quoted in the media to help provide some balance to the ongoing debate over youth football (I doubt if the youngest kids can even tackle and block without some forces being transmitted to their heads – their shoulders are just too small, their heads are huge once they put a helmet on, and they wobble):

      http://www.prweb.com/releases/2012/5/prweb9540432.htm

      “Instead, Dr. Bonnie says players need to be taught to tackle and block with the shoulders and not their head; some feel people playing football in high school or college are more at-risk if they don’t learn these protective skills when they’re very young. So even though some parents may not want their children to play when they’re young, risk for injury could actually increase later on if they don’t play as kids.

      She also believes football remain a part of the American fabric, but that the issues which come along with it are addressed. “The answer is not to get rid of football, but to change it to make it safer. Don’t take it away from young kids – it teaches them how to get along, how to follow rules, to be consistent and how to healthily sublimate aggression and not act it out in a sadistic way.” In a world where bullying has become such a prominent issue, it’s very important for kids to learn how to deal with their anger and aggression in the correct way, says Dr. Bonnie.”

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