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Back to Basics: Current Concussion Management

9 Jul

What follows below are recommendations that have been on this blog for many years.  I came up with them when it started in 2010 and not much has happened to change what was written.  In fact, more and more these ideas have been accepted, showing that it was ahead of its time in 2010.

AS ALWAYS: PLEASE CONSULT A MEDICAL PROFESSIONAL FOR A CONCUSSION, USING THIS BLOG ALONE FOR TREATMENT OF A BRAIN INJURY IS NOT RECOMMENDED.

We can discuss rehabilitation from a concussion at a later time, but the theory of this being a spontaneous and passive recovery for a vast majority of incidences continues.  It has been my experience that the “less is more approach” is best with concussions, initially.  Being, that after injury the less you do to stimulate the brain and rattle the brain the better and faster the outcomes will be.  When the injury lingers on beyond 10-14 days (usually due to too much activity in the initial phases) that is where rehab and a more dynamic approach to recovery is needed.

Please enjoy and remember that back in 2010 this was not mainstream nor widely accepted.  I hope that four years later this is commonplace.

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Sport-Related Concussion, Don and Flo Brady (NASP Communique)

INITIAL STEPS

After an initial concussion the individual should subscribe to REST, not just physical rest, but COMPLETE and UTTER rest.

  • NO TV
  • NO Texting
  • NO Computers
  • NO Radio
  • NO Bright Lights
  • NO Loud Noises
  • NO Reading

COMPLETE brain rest, in other words, SLEEP!  This should be adhered to for at least 24 hours or when the medical professional that you seek (and you should) tells you otherwise.

SCHOOL AGED INDIVIDUALS

Rest should be continued until all signs and symptoms have resolved.  Rest in this demographic should Continue reading

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This is Interesting. Share Your Thoughts

6 Mar

I just saw this on Twitter from @NSAFitness, Time to Re-think the Zürich Guidelines? appearing as an editorial in the Clinical Journal of Sports Medicine March, 2014 issue.

I can think of many reasons to re-think Zurich; the two biggest is no inclusion of return-to-learn/work and the obvious lack of coalition in concussions.  It may be a “consensus” but really its a compromise, AT BEST.  Here are some excerpts;

The problems with the guidelines include a lack of diagnostic specificity, management strategies that are not evidence based, and rehabilitation goals that are not attainable. Given these problems, the Zürich Guidelines cannot be endorsed.

Don’t know why we have to be more specific, rather more global would make sense: ANY DISRUPTION OF NORMAL BRAIN FUNCTION AFTER AN UNNATURAL TRAUMATIC FORCE IS APPLIED TO THE PATIENT, would fit just fine.  I will defend the non-evidence based management strategies; how can they be evidence based if we are just now getting to this part of the puzzle (SPOILER ALERT: the concussion problem is due to the Continue reading

University of Oregon Novel Study

22 Jan

I found a very interesting email about research being done at the University of Oregon.  It was so well written I thought I would just place it on the blog…

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In what may be the first study of its kind, the University of Oregon’s Motion Analysis Laboratory released a fascinating and chilling new video that illustrates the dramatic effect a concussion can have on high school athletes’ ability to control balance while walking.

Using computer generated images from reflective markers worn by the subjects, the video shows the gaits of two high school students – one a healthy subject and the other a victim of a concussion from a helmet-to-helmet collision in football practice two days prior – to emphasize the poor control and balance of the concussed athlete.

The full study included 40 high school athletes – 20 who were diagnosed with a concussion from sports including football, soccer, volleyball and wrestling, and 20 similar healthy athletes – who were tested over a two-month period. The results showed that the concussed athletes had trouble maintaining balance and walking speed while also responding to auditory cues as long as two months following the concussion.

Research on concussion recovery time, like what is being done at the University of Oregon, may help improve safety and better pinpoint when it is safe for to return to field or court.

Return To Learn Conference

16 Jan

TINY FINALTime is running short for this conference as well, but I thought I would provide another opportunity for people to gain valuable information in the dynamic concussion issue.  A friend of the blog, Katherine Snedaker, is putting on a novel conference; based around the return to learn aspect of concussions.

NORWALK, JAN. 12, 2013 – Katherine Snedaker, MSW and Founder of Pink Concussions, an international social media organization focused on research and resources for female concussions from sports, accidents or military service, and SportsCAPP, a Concussion Education, Advocacy and Policy Group, has announced the dates for The Concussion Conference: Connecticut: Return to School THEN Return to Learn.

The Conference will take place on Thursday January 30th, 2014 at Chelsea Piers Connecticut in Stamford, and then repeat with the same format on Friday, January 31, 2014, at Quinnipiac  University School of Medicine in North Haven, CT.

To register, see http://www.TheConcussionConference.com and to follow on Twitter use #CTBrain.

The Concussion Conference will provide training sessions for school nurses, school staff, pediatricians, athletic trainers, and parents on how best to help children return to school and continue  to heal after concussions.

The Conference daytime training sessions will feature multiple national speakers including Brenda Eagan Brown who is co-author the new 2013 CDC Resource: Helping Students Recover from a Concussion: Classroom Tips for Teachers. Also presenting is Dr. Mike Lee, co-author of the newly issued American Academy of Pediatrics’ report, Returning to Learning Following a Concussion.

You can find the remainder of the Full Press Release HERE.

This event will be on the heels of the Brewer Sports International #C4CT Concussion Summit in NYC.  I wanted to be there as a presenter and as a friend, alas my duty as an athletic trainer will not allow me to do so.  I encourage people and press who have the time to make the Connecticut events as this is a new angle that Katherine is attempting.

In addition to Brenda Eagan Brown, attendees can listen to addresses from Alan Goldberger and TJ Quinn among others, you can find the speaker list HERE.

You can register for the conference HERE.

 

TCB Mail Bag

26 Dec

I trust everyone has had a wonderful Christmas experience (or Hanukkah or Kwanzaa or going to have a good Boxing Day), with that I would like to wish everyone continued successes in whatever endeavor they choose.  Over the Holiday I have received many an email regarding concussions; apparently the down time has given people opportunity to share frustrations or good news.

Today I am bringing you a specific case in which we all can learn from.  At the least we can read this and prepare for similar situations that may arise – whether as a parent, doctor, coach or athletic trainer.  

As always you can write in and with your permission I will re-post anything you would like (and it may suit the audience).  It can be attributed to you or anonymously.  Keep it between 500-2000 words and omit any personal identifying factors if it involves patient care or sensitive information.

Here is our post today – by Anonymous:

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Obviously today is Christmas Eve and in most regions of the country kids are not in school for at least the next two weeks. Maybe less, maybe more. All in all it is a great time to rest up that brain and recharge your body. As athletic trainers we also know that sports do not stop for the holidays. For the most part at least. If you remember last year I read an op-ed article that you put on your blog titled “Parental Decisions Can Undercut Good Concussion Laws” or something of that nature. Well, it’s happened again (as it has many times between that time and now but this one is a little more ridiculous than the last) and I’m nauseous!

To be as brief as I can on this without boring you this is the case of a female soccer player who sustained a nasal fracture as well as a concussion when fighting for a header in the air with an opposing player almost a month ago. To be clear, she actually suffered a deviated septum. Anyway, after our AT did a beautiful job of getting this athlete “entered” into our concussion protocol (which Mom still couldn’t get over the fact that she indeed had a concussion; whoda’ thunk it, right?) we all sat in our physician’s office (Mom, AT, myself, physician, athlete) and witnessed the concussion as well as the nasal issue being addressed. The athlete was clearly concussed (clinical exam, balance assessment, and symptom reporting were all abnormal but ImPACT scores remained at baseline) and the athlete was sent for an MRI and referred to an ENT for further evaluation of the nasal issue. Pretty simple. These folks were given the “red carpet” treatment as all of our athletes/parents are and everyone left happy. The consensus was to see the ENT and address that issue then to follow back up with our physician for the resumption of the concussion issue. The athlete ended up having surgery about a week later. She was out for about a week after that. The ENT cleared her to resume play and actually said that there was no concussion. Wow! OK!

Fast forward to last week during exams and the athlete did not follow-up with the AT during exams like she was instructed to do. She THEN shows up to a game on Saturday with a face shield and tries to plead her case to enter the game. The AT did her job and did not allow the athlete to play. Mom was irate. Athlete conceded. Coach was with the AT. So athlete did not go through the GRTP process and as of today the mother refuses to follow-up with our physician for final clearance after all of the objective information is noted. She is choosing to Continue reading

HS Class Uses Blog to Educate

10 May

One of the more gratifying things about this blog is the chance to educate anyone about concussions and the athletic training profession.  I truly enjoy going out to speak and even debate this hot topic.  I understand that my thought process is not like everyone else, nor do I expect everyone to see it the way I do; however I do want people to become more educated and understand what we are facing with this problem.

As I was wrapping up my interview for a local TV station about the new IHSA Heat Acclimatization Policy, I received and email from a school here in Illinois that used my blog to become better aware of the concussion issue.  Honestly, nothing makes me smile more than to provide that to teachers and kids.  The email ended with some questions regarding concussions, I will answer them here (not only for everyone to see but to give a little pub to the students and teachers of Cuba High School).

My current events class has been debating and conducting research about concussions. I have had them use your blog for resources and it is very informative. We also just finished watching “Head Games” documentary and had further discussions. Many of my students are athletes and have raised interesting questions specifically towards how our small rural high school can best prevent head injuries. I know you’re a busy guy so we cut our questions to just 3. Any chance of a response would be greatly appreciated. Continue reading

Zurich 2012 In Writing

12 Mar

If you all recall I went to Zurich in November to attend the “Concussion Conference”; mainly as an observer, but there was enough time and opportunity to impart my questions/knowledge as a practicing athletic trainer.  Here are the links to DAY 1 and DAY 2 of my live blogging.  By the way, the live blogging was WELL received and continues to provide great insight into what went on.  I hope that I am asked back for the next conference, or any other conference that wouldn’t mind my attendance.

Now the information gathered at the conference has been hashed and rehashed and now appears as the 4th Consensus Statement (tweeted previously).

As part of the initiative the Standardized Concussion Assessment Tool (SCAT) was looked at and changes were made to the 2nd version from 2008.  You can now find the new version by clicking SCAT3.

A new wrinkle was an assessment tool for the younger ages, the group decided on the “Child” version of the new SCAT3, that can also be found by clicking Child SCAT3.

Also included in the addendum of the Consensus Statement was a recognition pocket card, found by clicking Recognition Pocket Card.

All of the above is free and intended to be used as a resource for better concussion assessment and even early management of concussion.  Please read the Statement regarding best practices.  As always this blog is NEVER to be used to diagnose or treat a concussion.  There is a lot to be absorbed and read; one thing is for sure we as athletic trainers and concerned/educated individuals now have the most recent information at our fingertips.  I guess this blog is actually doing some good work :)  A side note; how about this appearing during National Athletic Trainers Month?  It might be a coincidence, but I find it serendipitous.

Quick Hits on a Cold Thursday

31 Jan

American Medical Society of  Sports Medicine Position Statement…

I had seen this but caught it again in a below article, the AMSSM released its position statement on concussions recently.  Most of those involved in writing this were in Zurich last November and this comes out about two months before the consensus statement is released in the British Journal of Medicine.  (pssssst – it is also going to have a release in Australia, in conjunction with the AFL Concussion Conference and first round of games and I am still looking for a sponsor)

I found one piece of this position statement very encouraging and made me smile for all the hard work others have done;

Return to Class

* Students will require cognitive rest and may require academic accommodations such as reduced workload and extended time for tests while recovering from concussion.

The rest of the statement is not really “Earth shattering” but there are interesting points in there;

* In sports with similar playing rules, the reported incidence of concussion is higher in females than males.

* Certain sports, positions, and individual playing styles have a greater risk of concussion.

* Youth athletes may have a more prolonged recovery and are more susceptible to a concussion accompanied by a catastrophic injury.

* Balance disturbance is a specific indicator of concussion but is not very sensitive. Balance testing on the sideline may be substantially different than baseline tests because of differences in shoe/cleat type or surface, use of ankle tape or braces, or the presence of other lower extremity injury.

* Most concussions can be managed appropriately without the use of neuropsychological testing.

* There is increasing concern that head impact exposure and recurrent concussions contribute to long-term neurological sequelae.

* Some studies have suggested an association between prior concussions and chronic cognitive dysfunction. Large-scale, epidemiological studies are needed to more clearly define risk factors and causation of any long-term neurological impairment.

* Primary prevention of some injuries may be possible with modification and enforcement of the rules and fair play.

* Helmets, both hard (football, lacrosse, and hockey), and soft (soccer, rugby), are best suited to prevent impact injuries (fracture, bleeding, laceration, etc) but have not been shown to reduce the incidence and severity of concussions.

* There is no current evidence that mouth guards can reduce the severity of or prevent concussions.

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X-Games, D on coverage…

Anyone catch the X-Games this past weekend?  Action sports are on the rise and the X-Games Continue reading

Matt Chaney – Tireless Worker

18 Jan

SpringGame1984Sideline
If you have been around enough you have seen the stylings of Matt Chaney on this blog, he is someone I call a friend.  In some circles that discounts me as a professional, which is both stupid and dumb.  I don’t always agree with Matt, heck him and I have been known to battle via electronic and phone communications.  However, his opinion is a valuable one – often his work is based in so much fact it makes your head spin as to why some of its missed.  Regardless, Matt has published two recent articles on his blog, for all to consume, here are some excerpts.

Part 1, published January 7th;

Historic football excuses thrive in modern debate over brutality

Lawsuits, criticism explode and officials project blame onto individuals

Old talking points of football apology resonate yet as officials tout anti-concussion measures like trainers along sidelines, new rules for safer play, injury reduction and expert consultation—same type of promises heard from gridiron leaders during the Victorian Era

American football gets lambasted in public for maiming and killing, denounced by an influential movement of critics, and game officials pledge safer play based on their new concepts of prevention, including:

*Qualified trainers and doctors will patrol sidelines.

*State-of-art medical response will treat the rare severe casualties.

*Limits will govern length of practices.

*Injury tracking will cut rates already on decline.

*Coaches will properly train players.

*Every player will undergo medical prescreening.

*Experts will lead safety reform in rulemaking and research.

*Referees and coaches will enforce new rules of experts.

*Players will follow new rules of experts.

Sounds familiar, these steps, a practical recitation of talking points for contemporary “safer football” promoted by the NFL and commissioner Roger Goodell, in face of lawsuit frenzy against the league and sport in general, along with festering disgust in the public.

Except the football rhetoric is 119 years old, from 1894, a packaged response during the game’s initial siege against formidable opposition seeking abolishment. Continue reading

Coach & AD Magazine Cover Story

17 Jan

cover picIn January’s edition of Coach and Athletic Director Editor-in-Chief, Michael Austin wrote the cover story on concussions; titled “What you’re missing when it comes to brain injuries”.  A very well researched and written article on concussion issues at the high school level.  Austin looked at the changing protocols, safety issues and legal concerns that will be facing the sports of our community schools now and in the future.  Here are some excerpts;

This isn’t just a football problem.  Media coverage focuses on the gridiron, but any time a player’s head is placed in harm’s way, a brain injury is a potential result.  “From what I see, football leads the pack by far but we’re also seeing more girls and boys soccer players sustaining concussions,” says Dr. Michael C. Koester, MD, ATC, who is the director of the Slocum Sports Concussion Program within the Slocum Center for Orthopedics and Sports Medicine in Eugene, Ore. “Interestingly this year, and this could just be a statistical blip, but it’s worth noting we are seeing more girls volleyball players as well.”

That comment struck me as in the fall I saw more junior high school volleyball concussion (5) than high school football concussions (4), I have no idea what that means.

In the area of classification, Austin does a good job of trying to put ‘mild’ to rest with concussions;

Dr. Gerard Gioia, the director of the Pediatric Neuropsychology Program at Children’s National Medical Center and the director of the hospital’s Safe Concussion Outcome, Recovery & Education (SCORE) Program, says the medical community has “dropped the grading system” when it comes to concussions.  He adds a common misnomer is the
suggestion you must have loss of consciousness to sustain a concussion, which is not true.  “You can’t call a concussion
‘mild’ just because someone isn’t knocked out for 10 minutes. Most concussions do not involve a loss of consciousness,” Gioia says.

Regarding the state legislation and protocols;

“The No. 1 goal is to get the student-athlete back to school without symptoms or ramifications before even thinking about a return to the sport,” Fink says. For coaches anxious to have the player return to the field, Fink tells them every athlete Continue reading

Another Upcoming Concussion Symposium – January 25th

16 Jan

Time is short on this, I understand, but I just was dropped a note about this symposium being held in Chicago.  Once again yours truly has “commitments”, this time it is a wrestling dual tournament – where my services are needed more.  Regardless, when I looked at the faculty list and the speaking topics my interest was piqued.  BIG NOTE here it is only $25 for athletic trainers to attend ($60 for physicians).

The lecture is going to be directed by Julian Bailes, MD and David Firm, MD, PhD, both unheralded leaders in the field of brain injury.  What is more interesting than that is the fact that two relative “quiet” doctors will be presenting their information.  Both of these men are “controversial”; one is seen as an extreme outsider by the NFL and the powers that be in their corner – Dr. Bennett Omalu the other has had his share of issues, mainly in the press (see Irv Muchnick), for previous perceived mishandling of concussions in the NFL and WWE – Dr. Joseph Maroon.

Unlike the symposium I posted about yesterday, there are no athletic trainers on the speaking panel, to me that is a shame as the athletic trainer is the front lines on concussions in sports (mainly HS up).  Here are the topics, Continue reading

Matthew Gfeller Neurotrauma Symposium

12 Dec

Loudermilk_picsIn Zurich I had the chance to speak to many people; I enjoyed my brief time speaking with Jason Mihalik – fellow athletic trainer.  He reminded me of the previous Symposium in North Carolina and the upcoming second version.  I asked him to send along an email and I would put it up on the blog.  Here it is, and he is right, make sure you register NOW, it fills fast.

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It is with great excitement that my colleagues and I will be hosting the Second Matthew Gfeller Neurotrauma Symposium at the University of North Carolina at Chapel Hill on March 8-9, 2013. We have lined up another great list of local, regional, and national speakers. For additional information regarding a schedule of topics, invited faculty, and links to negotiated hotel rates, please visit us at http://tbicenter.unc.edu, and click on “TBI Symposium” in the header. A direct link to register for the symposium is as follows: http://tinyurl.com/c576kdu.

Our first symposium sold out 2 months prior to the scheduled event, so register early! Current Early Bird rates in effect until January 8, 2013 are as follows:   Continue reading

Zurich Day 2… And We Are Live

2 Nov

I have figured out the power situation so I will be trying to update the blog ASAP after each session…  For the time being make sure to follow on Twitter…

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1030 CST: Session 7, final session: The Sharp End

First debate between Dr. Cantu (yes) and Dr. Herring (no): is no RTP same day the best management paradigm?  Is keeping a player out one week long enough and is the graduated RTP protocol sufficient…

THERE WILL BE NO RTP on same day in the new statement!!!

Change of direction on Session 7, questions with panel answers, pro-con (if available)

Do 3 concussions end your career?

  • its comedy hour
  • Aubrey – treat each athlete individually
  • Dvorak – it has to be based on timing and complexity of each recovery – case-by-case basis
  • Putukian – if we can’t agree on dx how can we agree on a number
  • Overall theme is it is individualized, not all concussions are the same (Cantu)

Who is best qualified to make the sideline decision?

  • Cantu – multiple members working under a physician can make the call
  • Herring – concerning to him that some information is intrinsic to doctors so need to be careful
  • better question is who best qualified – person with most experience
  • Dvorak – looking at spectrum of games played, doctors are best qualified in most instances, but are they there in all matches?  We should aim all this to the “grass roots” as the professional level there is more than adequate coverage.
    • comedy about football versus american football
  • Ellenbogen – those that know the athletes should be making the decision, maybe a parent in youth sports, or athletic trainers, understanding the patients baseline is important
  • Putukian – balancing act, in a perfect world its a team approach (Athletic Trainer mention), and she says in the US the athletic trainer should be making the decisions on the sidelines…
  • Aubrey – Hockey Canada has a safety person (volunteer) in lieu of an athletic trainer
  • Cantu – brings up possibly training school teachers in concussion
  • Herring – if you are team physician do you need someone else to make the decision if you are on the sideline?  Panel – no

Is there a role for grading concussions?

  • Cantu – not perfect, but informing patient is important about severity and duration of recovery, after the fact
  • McCrory – we have moved from grading, look at the recovery – perhaps look at the SCAT/serial testing
  • Putukian – looking at history is more important than arbitrary “grade”
  • Herring – may help with continual care from one place to another, but again important to understand history

Should we be returning on the same day of concussion?

  • Aubrey – what about the NHL player in the playoffs (rhetorical question)
  • Cantu – no once recognized
  • McCrory – what about the players that clear the SCAT, so no concussion, but you know something is amiss?
  • Putukian – example of hockey player with delayed symptoms
  • McCrory – concussion is often an evolving injury
  • Ellenbogen – it is a traumatic brain injury, is the game worth it?  No.
  • Panel – consensus is NO RTP same day
  • McCrory to Aubrey about playoff example – what about a regular season, and Aubrey is being very honest, and he feels the player push back is greater
  • Ken Dryden from the audience – why are we treating professional athletes different from the youth or non-elite athlete
    • We are starting to move away from that, all athletes should be treated the same

Should there be helmets in woman’s lacrosse and field hockey?

  • Cantu – yes, because of stick and ball causation of concussion
  • Putukian – no, change nature of the game, no reports of intercranial bleeds in women’s lacrosse, weary of unintended consequences (BTW, probably has the most experience with this)
  • Cantu and Putukian discussing this topic
  • Change gears – what about football?
    • Dvorak not in FIFA’s plans to recommend, many reasons including the false security of wearing head gear
  • Audience Q: should we discourage the use of the head bands/head gear
    • Dvorak – your own prerogative but data does not support the use of them as recommendation (Czech goalie wears one)
    • McIntosh – Rules are more important at this time

Should there be age restriction on tackling in American football, heading in soccer and checking in ice hockey?

  • Cantu – his words speak for themselves, youth sports needs to look at how the game is played because of the differences between older
  • McCrory – in Australia you cannot get to the gladiatorial aspect of Aussie Rules until they are “of age” (13 if I heard correctly)
  • Ellenbogen – risk of activity, most concussions via CDC information is from wheeled sports and recreation, does not make sense at this time to him, advise accordingly
  • Cantu – youth sports don’t have the good data, personally he does not believe learning a sport at age 5 will make you elite, it is a genetic disposition in his opinion
  • Putukian – it makes sense to decrease exposure, US Lacrosse has put age 13 on checking, her take on soccer is that there is no data to support this when using proper sized ball and equipment
  • Dvorak – young soccer players learn sport first, and fundamentals of “football” its not “headball”, studies done on heading ball and with study there was no increase in biomarkers they were looking at it.  They don’t force kids to head ball until skills are sufficient.
  • Herring – false warranty?  Arbitrary age is concerning, take head out of the game rather then taking the game away from youth athletes.  The limit to exposure is accurate, but complete removal of the sport may not be necessary.
  • Cantu – sport needs to be safer for younger athletes
  • Aubrey – ice hockey has set limits on age for body checking, research is very important, it will help make decisions

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Dr. Jamie Kissick speaking on “From Consensus to Action”

  • Knowledge is power
  • “There is an app for that”
  • Knowledge Translation (KT) Concepts Continue reading

Finally Addressing Adcademic Concerns of Concussions

3 Aug

This one is a very good seminar for anyone who deals with school aged children and once again it is free.  This event will be put on by the CDC and the most poignant part is the academic and return to school concerns when dealing with the brain injury known as concussion.  It has been my opinion that not only have the parents and schools underplayed the seriousness of returning to school with a brain injury, the medical community has been behind as well.  Brain health will need to be though of as physical health going forward.  Not only is stressing the cognitive parts of the brain while injured a problem, the most overlooked portion of school is something Don Brady has been the champion of, the emotional wellness of the brain/individual.

Get yourself registered, set a reminder on your phone (just tell Siri) and take notes; parents especially.

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CDC Heads Up to Schools Webinar for Schools Professionals

Tuesday, August 7, 2012 at 2:00 – 3:00 PM EST.

Click below to register for a FREE CDC webinar on concussion in schools (K-12): https://attendee.gotowebinar.com/register/3354303556335213312

This webinar will help you:  

  • Learn the signs, symptoms and effects of a concussion on students K-12.
  • Know how to prevent and respond to concussions in school.
  • Explore school-wide approaches to addressing concussion.
  • Learn ways to support individual students returning to school after a concussion.

Invited presenters include:

 

Julie Haarbauer-Krupa, Ph.D.

B.R.A.I.N. Program Coordinator

Children’s Health Care of Atlanta

 

Karen McAvoy, Psy.D

Director of the R.E.A.P Program

Rocky Mountain Hospital for Children

 

CDC is dedicated to improving the lives of Americans and keeping them safe from injury. Through the Heads Up program, CDC provides information on preventing, recognizing, and responding to concussion, and more serious brain injuries.

For more information, visit www.cdc.gov/Concussion.

States Listening

27 Jun

We have stated on here that legislation is only a small step in the way of stemming the concussion issue.  Awareness is the of the highest priority for the general public (and partly for the medical providers) and both Maryland and Indiana reported some good news today.

In Maryland the State Board of Education discussed the information that Parent Advocate Tom Hearn presented in May.  The Baltimore Sun has the report;

Thomas Hearn, a Montgomery County parent whose son received a concussion playing football at Walt Whitman High School, has testified before the state school board and Montgomery County school board, asking members to consider requiring parents to get more training in recognizing the signs of concussions and limiting the number of contact practices. He said the new state law doesn’t go far enough.

High school students can still have contact practices twice a day and five days a week, Hearn said. While there are no reliable statistics on how many of the 115,000 athletes in public schools in the state suffer concussions while playing sports, he suggested that if you extrapolate from the experience of Virginia school systems that have kept careful records, there may be as many as 6,000 a year in Maryland.

Between now and the start of football season in August, you need to consider why you shouldn’t at least adopt the NFL and Ivy League limits for Maryland high school football,” Hearn said in his testimony before the board last month.

In 2011, the NFL limited practices with contact to about one a week. While the NCAA does not have the limits, the Ivy League adopted rules last July that permitted no more than two practices with contact a week.

The limits are intended to reduce the number of concussive hits players experience. Tackles or hits also can produce subconcussive injuries that do not have symptoms but over time have been shown to increase the risk of long-term health issues.

State school board members said they Continue reading

More Confirmation of Age/Sex Differences

18 May

The difference between male and females has been known for a little while as the females tend to show more cognitive issues and in research have shown to be slower at recovering.  Also known but for some reason discounted is the age aspect; it would be logical to expect a developing brain to struggle more with brain trauma.  Reuters wrote up an article about the recent research;

Female and high school athletes may need more time to recover from a concussion than their male or college counterparts, according to a U.S. study that comes amid rising concern about concussions in young athletes.

Researchers, whose report appeared in the American Journal of Sports medicine, found that of 222 young athletes who suffered a concussion, female athletes tended to have more symptoms than males. They also scored lower on tests of “visual memory” – the ability to recall information about something they’d seen.

Meanwhile, high school athletes fared worse on memory tests than college players, and typically took longer to improve.

For parents, coaches and athletes, the key message is to have patience with concussion recovery, said lead researcher Tracey Covassin, an assistant professor at Michigan State University in East Lansing.

Research like this will now begin to be shown to the world, as the research and money has ramped up over the past 3-4 years making longevity and high volume studies available.  The simple moral of the story is; take plenty of time to recover before returning.  One or two games is better than a semester or year.

 

Parent Urges School Board to Take a Look

14 May

In Maryland, Montgomery County to be specific, the school board is taking – at the minimum – a look at what they can possibly do to help with the safety of the kids they are in charge of.  Lisa Gartner of The Examiner wrote a brief column on it;

Montgomery County school officials are weighing efforts to screen high school athletes for concussions and similar head injuries linked to Alzheimer’s-like disease and suicide.

Superintendent Joshua Starr said Tuesday that his staff is drafting a memo on concussions, while school board member Patricia O’Neill asked for a report on the cost and implementation of baseline screening, which would allow doctors to compare athletes’ brain activity before and after injuries.

“I know our budget doesn’t have an inch to spare,” O’Neill said, “but our students’ health obviously has to be paramount.”

As the board mentioned there is not much money there, so why are they entertaining the thought of using baseline tests?  It is just a tool that is often highly criticized for its results.  I feel that if baselines are needed then deals should be made with local doctors that use the tool and are trained to use the tool.  By deals I mean the baselines be given away or at a significantly high discount, then the doctors are in control.  Perhaps if the schools have outsourced athletic trainers the place of employment of the AT’s can defer or absorb the cost.

The point is that a Walt Whitman HS parent by the name of Continue reading

Innovative Concussion Care Concept

18 Apr

It seems that I often am applauding the efforts north of the border in Canada, it really seems that they have put a concerted COMBINED effort to seek out and implement innovative ideas.  I don’t think it says much about the United States other than we are all trying to do our best in our own little areas.  There is little consortium or conglomeration of effort, rather “‘A’ has found this”, “‘B’ has discovered this”, “‘C’ is saying this”, etc, etc, etc…

It may be the same up north but with the population centers mainly in fewer areas in Canada it seems that the Toronto, Ottawa, Montreal, and Vancouver areas seem to all be on the same page.  This could also be because of the overall influence of the Brain Injury Association of Canada and its influence on such things.

This idea is not from the BIAC, but it has some solid foundations none the less, including our partner in concussion awareness stopconcussions.com with Kerry Goulet and Keith Priemeau at the lead.  They have created a vision and group of like-minded individuals to create what they are calling Sports Concussion Care Clinic.  Here it is in a press-release; Continue reading

Revisited: Academic Accommodations

29 Mar

Some of the most important posts will be re-published from time to time.  This one was published in October of 2010.

In the most recent Journal of Athletic Training, Neal McGrath was published about the accommodations that may need to be made for concussed students.  This topic is one that is commonly overlooked by those that care for the student-athlete that has a concussion.  The every day tasks of walking in a hallway at a high school can be very difficult.

Below are the accommodations that were suggested, if you jump to the article you will see the rationale for each.

  • Excused Absence
  • Rest Periods During Day
  • Extension of Assignments
  • Postponement or Staggering of Tests
  • Excuse from Specific Tests
  • Extended Testing Time
  • Accommodations to Sensitivity to Noise/Light
  • Excuse from PE/Sports
  • Avoid other Physical Exertion
  • Use of Reader for Tests/Assignments
  • Use of Note Taker/Scribe
  • Use of Smaller/Quieter Testing Room
  • Preferential Classroom Seating
  • Use of Tutor

Drew is ready for College

5 Mar

Drew Fernandez is the son of Tracey Mayer – one of our Parent Advocates – and like John Gonoude a person that has overcome the stigma of concussion.  Not only is it a real brain injury, not treating it correctly can have life long effects for more people than we care to admit.  As Drew finds time he will send us updates, we hope this avenue will help him as well.

Over the past week, two really great things happened in regard to my upcoming freshman year in college at Illinois State University.  The first was having my request for formal academic accommodations approved, based on my medical condition of suffering from migraines, as a result of a severe concussion.  My parents and I were overjoyed with receiving the email notifying us with such amazing news.

Secondly, based on my outstanding academics, I received a letter from Illinois State University inviting me to compete for the University scholarship, one of the most prestigious scholarships available to new freshmen at ISU.  It is designed for academically talented, new freshmen from traditionally underrepresented groups or first generation college students who have overcome hardship in achieving their academic goals.  I did not receive this scholarship, however when you don’t receive one scholarship, they put your entry in the run for other potential scholarships.  Catching me by surprise, I was awarded a Redbird Academic Scholarship, renewable for up to four years.

Both of these things are especially significant because ISU acknowledged that what I have gone through is real.  Having them validate it is really important, not only for me, but for all other student athletes who suffer from post-concussive issues.

This is what I had written for my scholarship entry; Continue reading

Clincal Utility of ImPACT: Mayers & Redick

19 Dec

A new article on the review of ImPACT and it utility of use in determining return-to-play status of a post concussed individual has been published in the Journal of Clinical and Experimental Psychology.  (Lester B. Mayers & Thomas S. Redick (2011): Clinical utility of ImPACT assessment for postconcussion return-to-play counseling: Psychometric issues, Journal of Clinical and Experimental Neuropsychology, DOI:10.1080/13803395.2011.630655)

The abstract reads; Computerized neuropsychological testing is commonly utilized in the management of sport-related concussion. In particular, the Immediate Postconcussion Assessment and Cognitive Testing 2.0 program (ImPACT) is widely used to assess the cognitive functioning of athletes before and after a concussion.We review the evidence for the clinical utility of this program in terms of validity, reliability, and use in return-to-play decisions. We conclude that the empirical evidence does not support the use of ImPACT testing for determining the time of postconcussion return to play.

The authors mention the other used computer tests, but chose to focus on ImPACT because of its wide use; from professional sports all the way down to youth sports.  The over all impression is that the current studies from independent sources Continue reading

School Policy Update: Tracey Mayer

15 Dec

Parent Advocate, Tracey Mayer will be offering up her writings to The Concussion Blog as a resource to the readers, especially the parents out there.  As time allows she will be submitting posts for you to read.  I truly hope that everyone gets a chance to read about concussions from yet another perspective.  Thank you Tracey!

I recently met with one of the Vice Principals at Drew’s high school for a non-concussion related matter.  During our conversation, the topic of concussions came up because he is aware of what Drew has gone through, and he was asking how he is doing.  He told me about two female athletes who both suffered fairly significant concussions recently.  He said they were really struggling academically, which was such a perfect opportunity for me to enlighten him about the policies put in place in Prince William County, Virginia.  I sent these policies to the Superintendent Continue reading

ATSNJ Survey

15 Dec

Below is an email from the ATSNJ that I feel needs to be posted to create more dialogue.  New Jersey, the ATSNJ and Eric Nussbaum have done a fine job of leading the way in this issue at the high school level.  Thanks for the note.

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Dustin,

From the Athletic Trainers Society of NJ, completed in November.

NJ was one of the first states to formally pass a concussion law in December of 2010.  Our concussion law accomplished several things.  a) directed our department of Education to develop a model concussion policy and instructed ALL districts to implement a formal concussion policy by September 1, 2011.  b) Mandated concussion education for all licensed athletic trainers in the state.  This makes us the only healthcare profession with mandated continuing education in concussion care, making athletic trainers concussion “experts”.

We had heard that many schools were having some issues formulating/implementing a formal program for their districts.  There were several questions that were not well-defined in the law or model policy put out by the DOE.  Key terms like: “trained in the management of concussion”, “asymptomatic”, “academic accommodations”, specific education and RTP guidelines were all issues that districts needed to consider for their policies.

The ATSNJ put together an online survey and sent it out to our secondary school ATs.  We had 110  secondary schools with an LAT respond to the survey.  (about a 33% return)

We conducted the survey to: a) see how many schools actually were implementing a board approved policy. b) find out if terms were being defined c) find out about consistent issues w/ policies d) determine what source of information schools were using to develop their programs d) determine who was responsible for education, notification, coordination and implementation of actual policy.

The highlights of the results were posted in our release, HERE;

  •     Only 63% of team physicians are “trained in the management of concussions”
  •     9% of respondents do not have a board approved concussion policy.
  •     27% of schools adopted a generic policy.
  •     84% of districts do not define “trained in the management of concussions” in their concussion policy.
  •     51% of districts do not define “asymptomatic” in their concussion policy.
  •     60% of districts do not define specific academic accommodations in their concussion policy.
  •     89% of school policies define “graduated return to play protocol”
  •     100% of districts utilized athletic trainers as the gatekeeper for the concussion management process

We also developed a policy check list that schools and parents could utilize to evaluate each schools policy.  We have posted suggestions for definitions and improving policies on our website, HERE.

We realize that development of a good working policy may take time and a little tweaking.  The ATSNJ wants to be a resource for parents and schools as they develop their individualized policies.

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Feedback is encouraged by commenting below.

The Hardest Part Of My Job

14 Dec

As an athletic trainer there are many difficult situations that arise on the job.  Broken bones, overzealous parents, concussions, weather and a myriad of other things get to you.  However, there is nothing more troubling and depressing than what I just had to do.

Back story is a female basketball player who has sustained multiple concussions over her high school years in various sports/activities.  Each one was handled to the best of our ability and under the concussion policy at this school, even had great conversations with the MD on the case.

After her last concussion, last December, we discussed that because of the number (then at 4) for her the resolution would be longer and possibly met with more difficulties.  We also discussed that if all her care takers; parents, coaches and Continue reading

School Getting Smart

3 Nov

From the Globe and Mail (Canada), St. Micheal’s College School has developed a return to school program from concussions.  As we know return to the classroom and the school environment can be just as harmful as rushing back to sports.

“There’s a lot of focus on the return to play but not on the return to the classroom, where the kids can have a number of difficulties due to their brain injury,” said Corinne Kagan, a program director at the Ontario Neurotrauma Foundation.

The classroom demands that students listen, learn and think, all of which involve brainwork. Some of the symptoms of a concussion, such as headaches, dizziness and trouble concentrating, can make this even more difficult.

What St. Michael’s has developed, Ms. Kagan said, is “a very good thing.”

I have been promoting this from the beginning here on the blog.  In fact the school I work with adopted a policy that deals with this exact thing.  I believe it to be the first of its kind in Illinois.  Simply we educate the athlete and parents about the injury and proper management; with that the school is suggesting and allowing students to be excused for up to three days before seeing a doctor.  Upon return the student will work with the guidance counselor, teachers and myself for a simple graded return to classroom activity.  Since each person is different in recovery there is nothing set in stone for academics.  We do have an understanding that if the student misses quizzes/tests they will not make up more than one a day until full recovery.  Homework is often allowed to be turned in on a “graded return”, and classroom performance is monitored by the teacher.

This is not required of the student or parents, rather a recommendation and not every kid that gets a concussion follows our guidelines.  However my limited sample size shows some serious results (based on concussions from January 2010 to present): Continue reading

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