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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
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Coalition for Concussion Treatment #C4CT

27 Apr

Yesterday I helped launch the #C4CT cause via the blog and twitter and it was nice to see the interest really begin to peak (thanks @SchuttSports, @the_jockdoc  and many others).  As with most movements or introduction of products getting interest is the first thing; now with official press release in hand it is time to explain and get more of us going here.

The hard work of Jack Brewer and Alex Nennig (and probably others) of Brewer Sports International have created this coalition which I believe to be a “best foot forward” approach in not only raising awareness and education of concussions (our number on goal on The Concussion Blog) but has a possibility to stake a claim in treatment of lasting effects of TBI.  I am honored to be asked to be a primary supporter of this cause, although as it catches wild-fire I am hopeful more important people jump aboard – looking at you NFLPA and NFL.

It is also an honor to be along side a very strong and promising law student in Paul Anderson.  I have had many conversations about creating such a cause, but have yet to find the trailblazing counterparts until this came along.  Please take the time to read the below press release and join along this weekend in using the #C4CT, even promoting questions from others about the hash tag is an opportunity to inform!

Press Release========== Continue reading

Forget Organized Sports For A Second

17 Oct

The concussion and head trauma issue has centered on organized sports, mainly football and hockey in North America.  Granted those are collision sports with a high propensity of traumatic events, but what about the activities that our children partake in on a daily basis.  At parks, streets, parking lots, and private property the youth is exposed to concussion/head trauma risks.  This information was brought to my attention by Sal Marinello, CSCS, CPT in response to the Matt Chaney post, thanks Sal.

In 2008 93 kids under the age of 15 were killed in bicycle accidents while a staggering 13,000 were injured, 62% of the injuries and deaths were due to head injuries.  This has been the reason for wearing helmets, especially for the youth.  These numbers probably don’t take into consideration the accidents that occur where a person may walk away and not seek treatment.  The ol’ bump on the head injury is of particular concern.

Bikes are not the only issue, skateboards and other wheeled activities have a high incidence as well.  According to Continue reading

Remember Chris Horner?

3 Aug

If you recall during the Tour de France there was a couple of bike wrecks that ended cyclists run at the Yellow Jersey.  One in particular involved Chris Horner, he was caught on video after the stage with obvious signs of a head injury/concussion.  Hearing that he wanted to continue was not a surprise, as most athletes will do anything to keep on going, what has since become clear via his own writing/blog is how bad he was;

The first thing I remember following my crash on Stage 7 of the Tour de France was sitting in the hospital bed talking to the team doctor. The only problem was, it was the NEXT morning! I was mid-sentence in my conversation with Dag when I finally became conscious of where I was and what was going on. Before that, whatever conversation we’d had, whether it was after the race, on the way to the hospital, or even in the hospital, I don’t remember having. Who Dag was talking to all that time, I don’t really know, but he said the guy sounded and acted just like me, strangely enough!

As you read through the story you will find that he was hurt Continue reading

Tour de France: 7 Stage Update

9 Jul

I know I have not been on top of the Tour, but honestly as a sports fan I usually try to find time to watch some of each stage (I guess with a third child something has to go, ha).  However, last night I was bombarded by concussion news from the Tour de France from around the world, via email and tweets.  I would like to say thanks to everyone that passed along the information, a special thank you to Bill from Australia.  There has been two high-profile head injuries resulting in very intriguing coverage from international press.  Let me add to this, that the CDC (the statistic gatherer in America), has cycling as the NUMBER ONE activity that causes brain injury for all AGES.

Here is what has happened for those of you that do not follow cycling, it started in Stage 5 when Tom Boonen from Belgium crashed and continued in the stage and race the next day.  However after starting Stage 7 he abandoned the race due to his headache;

Boonen sat down to talk with the press but this clearly wasn’t his usual self. He was pale and talked quietly. Almost at the same moment, Cavendish crossed the line after winning the stage’s final bunch sprint. It didn’t matter much to Boonen.

“I’ve got a huge headache,” said Boonen. “Every kilometre was one too many. I was wondering, ‘who am I pleasing by continuing?’ Not myself, that’s for sure.

“I was a danger for the other riders, too. I think I suffered a concussion. Noise, colours… I couldn’t stand them. A honking car that passed was echoing a thousand times in my head. Yesterday was a dark day – due to the rain – and maybe that’s why it went better.” Continue reading

Live From Lexington

24 Jun

Welcome to the intended live feed from the 2nd Annual Sports Concussion Summit here in Lexington, Kentucky.  We are at Cardinal Hill Rehabilitation Hospital, a beautiful facility.  Attendance looks to be very good, about “60 or so” according to Jonathan Lifshitz, host of the event.  I will be updating this post as we go along with a time, follow @concussionblog on Twitter for updates.

7:05am CST:  Jonathan Lifshitz, PhD opens up the conference, a big “walk-in” group, I still think I may be the only one not from KY here.

7:10am CST: Dr. Lifshitz had a great perspective on announcers and how the terminology of the game regarding head injuries has to slowly begun to change.

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7:50am CST: Dan Han, PsyD “Contemporary Perception on CHI: Multidisciplinary Initiatives

  • 1.7M documented TBI; 52,000 deaths per year, 275,000 Hospitalizations (CDC Numbers)
  • 75% of TBI (1.3M) are concussions/mTBI/mDAI; 300,000 are DOCUMENTED sports concussions
  • 0-4, 15-19 and 65+ y/o’s most likely to sustain a TBI
  • Females have significantly higher odds of poor outcomes
  • Documented TBI (see above) not the real issue; the undocumented TBI is the proverbial iceberg under the water
  • Diffuse Brain Injury
  • Secondary to stretching forces on the axons
  • Moderate DAI = “Classic Concussion” (unconsciousness, possible basal skull fracture)
  • Persistent confusion, retrograde & anterograde amnesia, mood/personality changes
  • Severe DAI = Brainstem Injury (high mortality rate)
  • And TCB Contributor Tracy Yatsko gets some run on a video!!!  Man girl you get around :)!
  • Postconcussional Disorder
    • LOC > 5 min or anterograde amnesia or new onset of seizures within 6 months after CHI
    • Just learned a lot about seizures; many go unnoticed
  • AND attention or memory deficit
  • Plus 3 or more symptoms present for at least 3 months following CHI
  • Significant impairment in social or occupational functioning
  • Academic achievement decline
  • HUGE Multidisciplinary Concussion Program at University of Kentucky, well on the way to being a leader in concussions
  • —–

    8:50am CST: Greg Wheeler, MD “Treatment of Sports-related concussions and return-to-play clearanceContinue reading

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