AAN Concussion Guidelines – One Stop Post

19 Mar

Here is the presser for the updated AAN Sports Concussion Guidelines; their guidelines are simple and to the point, via YouTube;

  • No Grading System of concussion
  • 10 day rest period – “key” – Dr. Jeffrey Kutcher
  • Greater risk if you have had a concussion
  • Addressing of youth and recovery
  • Helmets are not the full answer
  • Licensed Health Care Providers should be clearing
  • Repetitive head injuries are bad
  • The discovery and annotation of “Chronic Cognitive Impairment”
  • No single test, CLINICAL assessment
  • “Kids are not little adults.” – Dr. Christopher Giza

Here is the LINK to the Updated Guidelines (can someone give me permission to post it here?)

Here is the LINK to the Sports Concussion Toolkit from AAN

Here is the LINK to the Concussion Quick Check from AAN

==========

What does this mean in comparison to the Zurich Statement?  That is a great question; both groups used “consensus” however this group is much more centered on American practices.  Both have similar approaches, both advise nearly the same thing; but which one carries more weight.  I have been told the AAN will be much more “powerful”, respected and learned than Zurich.

This is a good debate, regardless, there is ample evidence to sit kids and any concussed individual.  This statement also continues the wave of information that cumulative and repetitive trauma to the brain (still figuring out thresholds) is not good.  Based on this and the Zurich statement the only way that we can collectively abate concussions at this point is exposure limitation.  No where in that last sentence does it state “stop playing sports,” or “get rid of football”.

When dealing with the brain and the injury of the brain less is better, which is ironically simple and a “no brainer”.

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5 Responses to “AAN Concussion Guidelines – One Stop Post”

  1. joe bloggs March 19, 2013 at 18:38 #

    I am sure there was much rejoicing by the NFL legal team after the Sunday Massacre of Bob Cantu. Yesterday AAN piled on and beat BU/SLI some more.

    I have been very critical of the CTE panic induced by incomplete and poorly designed studies promoted by both Anne McKee and Ben Omalu. McKee really irritated the motorneuro community (ALS) by publishing pronouncements Chris Nowinski’s mindless self promotion coupled with poor science opened the door for both AAN and Zurich to call into question the notion that every player will develop CTE. In fact, the BU/SLI release of case data sealed there fate. The NFL bought SLI for pennies on the dollar. SLI thought its was going to be the anointed with the NFLPA and DoD research money. It does some very dubious press (Ann McKee rock star crap) and the NFL waits to let the scientific community go medieval on them.

    The real scientific community shares the following observation:

    1) CTE exists and results from repeated blows to the head;
    2) There is a likely genetic component; and
    3) the incidence is unknown but unlikely for the NFL rate to approach the rates experienced in boxing.

    It is sad to see Cantu ripped as his contributions to the field have been enormous. On the hand, he needed to put a leash on these people and it got away from him.

    Now for the downside of AAN:

    1) Neurobehavioral/Neurocognitive pathologies acknowledged in professional football (nfl legal team just rolled over and tossed its lunch);
    2) Chronic traumatic brain injury now is the key long-term description (Jordan’s thesis of over a decade ago built by examining NFL players AAN reported nothing new);
    3) The claim that helmets mitigate concussions is unsupported – so AAN should be more explicit;
    4) 10 day wait period (NFL docs need to go back to mass misclassification of injuries instead just misclassification of injuries because too many players will be off the field) – for the NCAA it will just be business as usual;
    5) Every brain injury is unique;
    6) Children are not little adults (USA football just coughed up its lunch);
    7) Someone forget Kutcher’s check because his NHL statements showed he was off the reservation and on the team;
    8) Diagnosis and treatment are multidisciplinary; and
    9) Concussions are compounding and cumulative (known for some time but no stated).

    Chris Giza deserves an A for not letting all the idiots with conflicts totally water down the guidelines. Zurich was filled with NFL, NCAA, FIFA, NHL and various other professional hacks so it was not nearly as focused as AAN.

    If the leagues are not happy now, I would expect American Family Practitioners and the AMA itself to promote more stringent guidelines. CDC and NIH will throw DoD and the NFL under the bus because science is science.

    Finally, GE and NFL might want to reconsider the phony research plan they promoted last week. The NFLPA should get its money back from Harvard as both now look rather foolish.

    • A Concerned Mom March 19, 2013 at 20:22 #

      “3) the incidence is unknown but unlikely for the NFL rate to approach the rates experienced in boxing”

      Why is the incidence expected to be lower in NFL than boxing? (Was rate between 10 to 20% for boxing at one time? Not sure if new rules expected to lower rate in boxers going forward.)

      • joe bloggs March 20, 2013 at 05:34 #

        If you examine the number of retirees in boxing and compare then to NFL football retirees, one does not see numbers consistent with boxing’s rate of incidence. In fact, if you add up all NFL documented dementias, it does not approach a count consistent with boxing’s rate of CTE.

      • A Concerned Mom March 20, 2013 at 06:54 #

        Thanks,

        Guess I didn’t realize we had good info on the number of documented cases of dementia for football players.

        I suspect PCS/some level of impairment is a more widespread problem than CTE among high contact/collision sport athletes. Through google searches, I come across a number of articles about young athletes suffering from PCS or memory/other impairment after sustaining multiple injuries (high school/college – with injuries going back to grade school for some – often athlete/parent/coaches & 1st set of doctors unaware of potential long-term consequences). Curious as to what the actual incidence might be (assume they are part of the 10% who don’t recover quickly), and wonder if new laws/educational initiatives/guidelines will help prevent these situations going forward (seems like there are still great discrepancies at high school level and below with training/coaching/access to ATs-medical professionals/concussion identification & management).

        Hope more schools start tracking concussions in students so we can get a better idea about what’s going on at the youth level.

  2. joe bloggs March 20, 2013 at 08:20 #

    The data is not very good or terribly reliable for football. It is just shear numbers that fail to resolve. Keep in mind if one lives long enough the probability of being diagnosed with dementia approaches 50%. 1/3 of all US deaths involves dementia. Don’t worry the NFL will be using this as a defense even though it is hollow.

    The diagnosis for PCD/PCS will become more refined with chronic types being characterized.

    Most PCS/PCD resolves in less than a year with careful management, however, we have little information about the incidence of chronic PCS/PCD. This will be a central question in the next few years of research.

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