Zurich Live…. Sort Of… UPDATE End of Day 1

1 Nov

It almost all fell into place…  I just don’t have the battery power as my converter is not converting the electricity to what is needed for my computer…

However, I will post re-caps as time and battery warrant, for the time being you can follow on Twitter as I will do my best, until that battery goes gone as well…
I can say nice conference room and a lot of the “who’s who” in attendance, Steve Broglio and Chris Nowinski amongst the first to say hi to me…

Conference set to begin in 20 minutes…

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1408

wow,  good start…  So much to tell!  Lunch was awesome, met some good people with same frustrations…

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END OF DAY ONE RECAP

It all began with the usual welcomes and introduction as well as the process and thoughts/history behind the Consensus Statements.  As it began in 2001 at Vienna with International Ice Hockey Federation (IIHF), International Olympic Committee (IOC) and FIFA it has since expanded to include everyone on panel today.  There are North American interests from NHL, NFL in attendance, didn’t notice the MLB, NBA or NASCAR overtly.  The theme is that is is much bigger than sports but we are here for the sport aspect and this is an international problem, hence all of us here.

The format is to address 12 questions regarding the previous 2008 statement and how things can be improved/changed.  This is a living statement/guidelines as you will see with the complete action of no same day return to play (RTP) for any sport – if you remember in the 2008 version they excluded some professional and collegiate American Football players (no longer the case).

The next part of the presentation was what were the responses to the 2008 Statement;

  • NFL (Dr. Richard Ellenbogen)
    • Education with posters and meetings with players and team physicians
    • Contact days reduced to 14/year
    • Sideline test (adapted SCAT2)
    • Rule changes
    • Observer (athletic trainer eye in the sky) – side note on this: all presenters today acknowledged that observers at games, be it in NFL or Aussie Rules or Hockey or Soccer all had good reliability with identifying possible injuries – kind of like what I do when watching other games.
      • This observer sends information and video to sideline personnel for review of injury
    • Increased research and money for research
  • FIFA (Dr. Jiri Dvorak)
    • Moved to prevention with rule changes
    • Strict rule enforcement with red cards
    • Discovered many more concussions in female footballers than male
  • IIHF (Dr. Mike Stuart)
    • 2010 Mayo clinic Ice Hockey Summit
    • Introduced injury reporting system
    • Solidified rules on contact to head (was way ahead of the game on this one)
  • NHL (Dr. Ruben Eschemendina)
    • Baseline testing with computer and paper and pencil
    • Complete list of objective signs (see picture)
    • Neuropsych for each team answers to league not team for decisions
    • New RTP protocol
  • IRB (Dr. Martin Raftery)
    • IRB is more governance than setting policies
    • The 3 week removal was found to be a detriment for finding concussions/honesty from players
    • New regulation in 2011
    • Law change for temporary substitution for concussion evaluation
  • Australian Rules Football (Dr. Paul McCrory)
    • Reviewed 30+ years of research
    • Rule changes – more continuous play and decreasing impact speeds
    • Culture of change in sport with avoiding head contact
    • Adapted SCAT2
    • No RTP on same day
    • Side note on AFL: they produce a PUBLIC injury database on injuries after the season is complete.  Also in a side conversation with Dr. McCrory the league medical office reviews all incidences and those found by observers and questions the medical officers of the team.  If there was some inappropriate behavior then they must “explain themselves” to the league and if they erred then the team is punished.
  • FEI (Equestrian) (Dr. Allen Sills)
    • Database
    • Cutting edge information/help for TBI
    • Rule changes – helmets and frangible fences
    • Baseline testing

—–

Next topic was with media and legislation, presented by Dr. Stan Herring, and he was very good.  He began the presentation with a “personal” touch as he showed us the Zackery Lystedt injury and interviews.  It got our attention for sure.  He went on to discuss the good work by the CDC, I concur.

As for legislation it is catching on and is a good start, and the design is for each piece to be living and have the ability to change as warranted.  Before Zack Lystedt there were 7 laws, currently there are 40.  He discussed legislation versus education and noted there has to be both in order for no one to ignore this issue.  Education must be consistent, but is creates rules that are different, here is the need for legislation to attempt to get everyone on the same page.  The education and legislation after the Lystedt laws have affected change in the NFL, ACSM and nationally.

—–

Dr. Bob Cantu was next about the implementation of said consensus statements, legislation and education.  He pointed to the fact that the NFL and NCAA changed the thought on RTP same day after Zurich 2008, so it has some effect.  He feels that what is working in the United States in the education from places like the CDC, because of its access (free) and co-branding from other entities.  He also discussed how the media has played a role in the implementation of the consensus statement and educations, citing Teddy Johnson from the New England Patriots.

—–

During a quick Q&A session Dr. Prestorious (sp) from South Africa made a good point about education of colleagues (other doctors) about concussions and management of concussions – AWESOME POINT!

Dr. Cantu underscored the need for independent observers where applicable.

A comment from the gallery basically noted that not all doctors are trained or have experience with concussions and this is a problem.

Another comment was about unattended consequences since Zurich 2008; more frivilous injuries or longer out periods without true knowledge of the injury put in place by doctors.

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LUNCH – it was very good in case you were wondering, Dr. Tad Seifert, Dr. Simon Kemp stopped me to say hi!  Also side note Dr. Broglio is highly cited in all the work so far and going forward.  That dude does good work!

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Session 2 – Defining Minimal Concussion/Acute Assessment

Presenters were: Dr. McCrory (minimal concussion threshold), Dr. Michael Makdissi (existing tools are they sensitive/reliable enough), Dr. Michael McCrea (existing computer tools/assessments are they sensitive/reliable enough), Dr. Margot Putukian (best practice for adult sideline eval), Dr. Laura Purcell (best practice for pediatric and differences)

McCrory – concussion is a constellation of symptoms and signs, needs to be a 360 degree assessment, clinical assessment is best practice and is only supported by tools, tools are poor for diagnosis – paraphrased comment “do tools help us make bad decisions sooner?”.  Take home/recommendation:

  • concussion is a default diagnosis (absence of other more severe injury)
  • there is huge tolerance to impacts from one person to the next
  • sideline assessments only aid in concussion diagnosis, that must be made by clinical judgement
  • when in doubt sit them out
  • have a set list of signs (like the picture above)

Makdissi – current tools not reliable on their own (SAC, Maddocks, etc.) but in combination have validity and need to be used in conjunction to gain whole picture.  Take home/recommendations:

  • reaction time component
  • possible EEG (portable being made now)
  • avoid telemetry tools for now
  • sideline video review

McCrea – a giant movement to using these tools, good for mass testing, finding the proper signal detection is important for any CNT, CNT on day of injury does not show reliable when used alone (again must use with other tools), doing research comparing four different CNT’s.  Take home/recommendations;

  • need more advancement on this aspect of assessement

Putukian – elusive injury sometimes delayed symptoms, must have proper preperation (EAP) recognition, tools and disposition to make decisions, there are time limits with sideline assessments, be careful not to miss the extremes of concussions (the person that seems fine, passes tests but to the clinical eye/judgement is off or the possible TBI incidences).  Take home/recommendations;

  • know your athlete – clinical judgement
  • reaction time component
  • maybe King-Devek

Purcell – showed differences between adult/youth, current sideline assessments not applicable for youth, the consensus previous did not go far enough to address the youth athlete, need a return to learn aspect.  Take home/recommendations;

  • youth specific tools
  • understand youth are not autonomous, parent/care giver input necessary for assessment
  • return to school aspect needed

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In Q&A/Comment session we heard from: Dr. Seifert, Dr. Charles Tator, Dr. Jeff Kutcher and Ken Dryden

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Session 3: Updating SCAT2?

Presenters were: Dr. Willem Meeuwisse (Using SCAT in pro sports), Dr. Gavin Davis (Child SCAT), Dr. Kevin Guskewicz (role of balance testing in SCAT), Dr. Ruben Echemendia (do we always need baselines)

Most of that was on twitter so I will send you that way, as it is time for bed!!!  I hope do get information to you tomorrow…
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My take away from today was this:

  • Format is conducive for a consensus from everyone, including people like me, hoping to be a good AT voice over here
  • Solid poster presentations from other groups about stuff coming soon
  • It is really genuine that they are trying to get best practices out to affect as many people as possible
  • This conference is LOADED with knowledge, the collective IQ would rival anywhere at any time, including MENSA meetings
  • The FIFA location is amazing
  • Truly lucky to be here!!!
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3 Responses to “Zurich Live…. Sort Of… UPDATE End of Day 1”

  1. gabriel fife November 1, 2012 at 05:09 #

    hello,

    i just found the concussion in sport site: http://concussion-in-sport.com/2012/ today.

    back in july i had been encouraged to attend by one of the organizers and in an effort to get more info, was unable to find a site at that time with information and in the end did not submit an abstract…

    have you been aware of the above site for a while, or was i just locked in my own google tunnel of search that drifted me away from finding it earlier???

    will be looking for your own take on the meeting as it continues and comes to a close..

    gabe fife, ms, atc
    dong-a university
    assistant prof.
    ATEP

    ps…if you run into steve broglio again…tell him gabe (taekwondo guy) says hello and hopes to be at the next one :))))

  2. Jon November 1, 2012 at 12:37 #

    Keep up the good work Dustin!!

  3. A Concerned Mom November 1, 2012 at 17:47 #

    Thanks for sharing Dustin. Encouraged to see return to learn/return to school being addressed.

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