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The Journal of Law, Medicine and Ethics Issue Worth Bookmarking

24 Sep

Twitter is such a wonderful thing!  You can get so much information is such a short time; sure there is a ton of unsolicited information that one may have to weed through, but the benefits outweigh the bad – at least for us here at The Concussion Blog.

Such an instance was getting a tweet at me about a journal and a particular issue.  The Journal of Law, Medicine and Ethics, Volume 42:3 to be exact.  In this volume all of the pages are filled with concussion related issues, after all it was titled: Concussion and Sports.

I cannot speak to the “prestige” or “reach” of this particular journal, however I can post the link here (above) for you to bookmark for some reading on where the tone of med-legal is going in relations to concussion and sport.

Topics include:

  • Youth Concussion Laws
  • Requiring receipt of concussion related materials (a study)
  • Coach Support
  • Informed Consent

At the link you can download, free, the journal and its articles.  It might be worth some time to investigate and look into what we may be facing.

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California First on Football Hitting Legislation

22 Jul

I received this email late last night:

Friends….

Assemblyman Cooley’s office just phoned to say that Gov. Brown has signed Ca. AB 2127, making California the first state to legislate reduced contact on high school practice fields.  As you know, other states have taken similar action via their governing bodies of high school athletics but, after failed attempts in Texas, Illinois and Connecticut, Ca. is the first state to pass legislation and have it signed into law.  Public announcement will be made shortly.  Thanks to Warren Moon, Oliver Luck, Patrick Larimore, Leigh Steinberg, Dr. Chris Giza and others who made it happen.

Reading further on SF Gate:

The law limits full-contact practices to two 90-minute sessions per week during the season and preseason, and prohibits full-contact practices during the offseason. Currently, coaches can hold full-contact practices daily. The law also forces schools to bench players for at least a week if they suffer a concussion. Current rules allow players to return within a day.

The last part of the above paragraph has me very excited about this legislation – AT LEAST one week down time!

Good on CA for taking this to the next step, honestly I don’t think we need more legislation, however if you don’t want to listen this may be the route it has to go…

NOW CALIFORNIA GET YOUR BUTT IN GEAR AND LICENSE THE ATHLETIC TRAINERS IN YOUR STATE!  THEY MUST BE RECOGNIZED FOR WHAT THEY ARE: ALLIED HEALTH CARE PROFESSIONALS.

Filed Claim: Arland Bruce III v. CFL Entities

16 Jul

Bruce

The Filed Claim in its entirety can be found HERE.

You will notice the very wide scope and various Defendants.  Certainly it will have to go through the process up in Canada however, it will definitely get some attention:

Like this from The Toronto Sun.

Or this from Twitter:

I would also like to add the follow video of the Commissioner;

Make of this what you will…

Have To Keep Educating & Holding People Accountable

6 Feb

The education of concussions is great, the legislation is in the right place but there is absolutely no accountability for instances where athletes are “failed”.  Before I go on, I am not perfect, I have and will continue to miss some things here and there (I missed an ACL in football which bothers me).  In fact, looking at the pressure I put on myself and hoping the world puts on my chosen profession of athletic training it may be a bumpy road.  However, missing obvious problems of health and welfare of athletes when one is an athletic trainer is inexcusable.  I implore anyone out there that feels I have missed something to call my ass to the carpet as well.

This brings me to something that I found in my inbox recently and it made me sick and should be handled.  This particular incident occurred in a state that has similar mechanisms for concussions as here in Illinois.  To create the back story on the “mechanisms” in play you should understand the state legislation and high school association concussion education;

  • Players, parents and coaches all have been given information regarding concussions
  • Officials have been given authority to remove player for concussion signs or suspicion including mechanism of injury (MOI)
  • Once removed they cannot return unless cleared by approved medical professional (IL is ATC, MD, or DO only)

With that information here is the email from a fellow athletic trainer – emphasis added is mine – (obviously stripped of identifying information);

Still have a long road ahead of education.

I was at a basketball game Friday night as a spectator and watched a player bounce [their] head off the floor.  Opponent had set a screen and athlete ran right into [defender], bounced off and landed on floor bouncing head off the floor.  The player then rolled around on the floor grabbing head and could tell [athlete] was in pain.  Time was called by the officials to attend to the player.   MOI would strongly Continue reading

“League of Denial” (Part 2)

8 Oct

Coming to a bookstore and TV near you today is “League of Denial” a book and documentary about one of the dirty little secrets the NFL has been avoiding for some time.  Fortunately, I have been provided with advance copies of both; the Frontline film was easy to digest, as for reading a book, well we can just say I am trying to read as fast as possible.

I was reminded quickly, yesterday via Twitter, that I may lack valuable perspective when it comes to concussion information (and that I am not normal – this is not breaking news).  Will Carroll of Bleacher Report let me know that this information will be new to a lot of people out there.  He is exactly right, not only that, this documentary will be easily digestible for the fan of football.  For any person just wading into this, when you tune into PBS tonight to view “League of Denial” you will be absolutely hooked from the start.

The sounds of the crowd, visuals of big hits grab your football part of the brain IMMEDIATELY, over those sounds you will quickly discover the problem NFL players have faced with brain injuries playing their sport.  Harry Carson saying “and then they are gone” when talking about former players.  A bold statement that the level of denial was “just profound.”  An NFL lawyer saying “we strongly deny those allegations that we withheld information or misled the players.”  And more video and sound of punishing hits that used to fill the highlight reel bring the opening curtain of this very important documentary.

This problem is real – it’s not just real for the professionals – and from the get go Frontline makes you understand, vividly and personally, why this is.  After listening to old radio calls of the Steel Curtain it all begins with the story of Mike Webster and the forensic pathologist who studied his brain, Bennet Omalu.

The discovery of a possible reason one of the most respected and lauded players in Pittsburgh sports pantheon fell from grace and eventually found and early demise.  If the football portion of your brain does not connect to what is being presented then I would haphazardly guess that you are not ingrained within the fabric of football.

As Harry Carson explains how the game was played and to some extent how it’s still played you can begin to understand the issue at hand.  This is hammered home when Robert Stern, PhD tells the audience blows to the brain are at forces 20 times greater than the force of gravity (20 G’s); or as he so eloquently put it “driving into a brick wall at 35mph”, 1,000 times or more in a season.

In the first 11 minutes of this 2 hour presentation you are at full attention and want to understand the “whats”, “whys” and “whos”.  If you are not engaged and ready for further explanation I can only say that you don’t care or want to bury your head in the sand.

Contributions in the film include Continue reading

False/Misleading Advertising Targeted

23 May

If there is one thing in the concussion issue that really draws my ire its the false and sometimes fraudulent advertising of some companies claiming they can prevent concussions with a product.  There has been a good effort to reduce this, however now there may be some serious teeth behind the problem.  A press release;

For Immediate Release
May 22, 2013
Contacts:
Tom Udall Press Office / 202.228.6870 / news@tomudall.senate.gov 
Kevin McAlister (Rockefeller) 202.224.8374 / kevin_mcalister@commerce.senate.gov 
 
 
Udall, Rockefeller Introduce Bill to Help Protect Young Athletes from Sports-Related Traumatic Brain Injuries
 
 
WASHINGTON – To mark National Physical Fitness and Sports Month, U.S. Senators Tom Udall (D-N.M.) and John D. “Jay” Rockefeller IV (D-W.Va.), Chairman of the Senate Committee on Commerce, Science, and Transportation, today introduced legislation that seeks to protect youth athletes from the dangers of sports-related traumatic brain injuries by improving equipment safety standards and curbing false advertising claims.
 
The Youth Sports Concussion Act will help ensure that safety standards for sports equipment are up to date and informed by the latest science. The bill will also increase potential penalties for using false injury prevention claims to sell youth sports equipment.
 
“We want our children to be active and participate in sports, but we must take every precaution to protect them from traumatic head injuries,” said Udall. “There will always be some risk, but athletes, coaches and parents need to be aware of Continue reading

Ohio’s New Concussion Law FAQ’s

17 May

I was forwarded an information sheet on the newly enacted Ohio Return to Play Law.  It appears as a Frequently Asked Questions form, here are some highlights;

  • Guidelines for both interscholastic and youth sports
  • Who can clear the athlete
  • Specific definition of required training for coaches, referees and officials of youth sports
  • Resources for parents and athletes

This “fact sheet/FAQ” is probably the best written resource I have seen regarding the new return to play legislative actions by states.  It is good that each state is doing something, but in my honest opinion these laws are just a start.

Unfortunately it took actions by legislature to make it perfectly clear that those with concussions, show signs of concussion or report concussion symptoms shall not return on the same day and must be evaluated by a health care professional.  This is something we have known for a few years now.  Each state piece is great for raising awareness.

What we need to advance is the true problem of this concussion “crisis”, that is the proper management and overall treatment of the brain injury.  Concussions will occur, it is an inherent part of all sports – essentially something we cannot “control” – however we can certainly control how the after effects of each concussion are handled.

Head Football Coach ‘X’: How to take a stand on player safety

26 Mar

Working on a cause is difficult, especially if you are trying to swim upriver. When the cause is in direct conflict with the juggernaut that is football it becomes even more difficult – even at the high school level. I received and provided counsel to this individual as he fights a good fight in regards to player safety, most notably concussions. I applaud this individuals effort, attention to detail, player first mentality, and his willingness to sacrifice his job. What we have below is a microcosm of the issues we face with concussions; detailed and beyond sufficient for action – that is not being taken except against this author.

This information was obtained mainly through email strings – all identifiable properties have been painstakingly scrubbed to the best of my knowledge. It has been understood and agreed upon by the author that publication of this information may identify him and place him in further jeopardy. He is willing to take that chance and I am willing to provide him a platform. Unless otherwise noted in the post with breaks all of this is his and his alone. We shall begin;

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A Little Context:

At the start of my advocacy for safer measures to be applied to the competitive arena in high school football, I involved many people who I trusted and cared for in helping find my voice. Those people usually ended conversations with the same question:

“Are you willing to Get Fired for this?”

I laughed at the question considering the fact that I am advocating on behalf of measures that enhance Student Athlete Safety. At no point was my advocacy meant to be an argument, so the extent in which there has been resistance to proactive thinking has been quite a disappointing surprise to me.

The last 3 months of my professional career have been a whirlwind as I have gone from Advocate to Agitator. When the time for action came to blaze a trail for the future, and promote all that can be good on behalf of our student athletes, we collectively passed as a school system, even though a safer future for the thousands of kids who choose to play football within it is still very attainable.

Through my advocacy I have felt empowered by the leading researchers in the field of sports injury supporting these ideas. Support from the actual people who could make these changes has been “Hot & Cold” in a way that led to me presenting to the Athletic Administration of our entire school system and then being handed a letter of reprimand. At the current time I am labeled as a “Demanding” Coach and a person “Searching for a Cause”.

What follows is a chronological story of advocacy on behalf of player safety at the high school level as well as an example of how far away we actually are from a safer future for the student athletes who choose to play the sport of football.

Authors Note:

Some of the Main Points of Resistance in this philosophy have been diffused by simple logic when it comes to providing a safer arena for competition.

—–

ORIGINAL LETTER TO RAISE CONCERNS & TO START MY ADVOCACY
January 8th 2013
To: (School System) Director of Athletics ————————
CC: (School) Principal —————–, (School) Athletic Director ———————, (School) Assistant Athletic Director ——————

Subject: Public Health Issue regarding (School System) Cross-District Scheduling of Football Competition

I am writing to make you aware of a safety issue that our county has unknowingly placed many of our student athletes in through our recent scheduling for football. (School System) Athletics cross district scheduling policy for teams in the newly formed ——– District, while making sense from a convenience and perhaps even a cost basis, exposes athletes at certain smaller schools to a greater risk of serious injury. I share these concerns with other Head Football Coaches within (School System) as was voiced at the —————- 2012 All-District meeting.

(School System) scheduling policy requires each (Small School) District football team, which is made up of schools that have been classified at the 3A and 4A level in the (State League) to compete with three schools at the 5A classification from the (Big School) District for the 2013-2014 scheduling cycle. The 2013-2014 scheduling cycle determines opponents for each school’s next two (2) seasons. ——————— High School (——) is a 3A school that, based upon the recent scheduling for the 2013/14 seasons, is expected to compete with schools classified at the 5A level on six (6) separate occasions, schools at the 4A level 12 times, and similarly sized 3A classified schools 2 times in our next 20 scheduled games.

A schools classification is predicated upon the (State Association) account for each school’s student enrollment. That enrollment produces the available population to field athletic teams. (State Association) has outlined parameters identifying like-sized enrolled schools to view as competition throughout the state. (School System) scheduling policy has ignored these guidelines in which the (State Association) believes our schools can equitably, and safely, compete in the sport of football.

Current scheduling policy lacks the awareness of a significant and measurable increased risk of injury to the players at (School) and similar sized schools. What is alarming, and requires immediate awareness, are the findings of the most recent and advanced studies related to head injuries. These studies strongly suggest that (School System) scheduling policy as currently constituted, subjects student-athletes of the smaller schools, not only to a greater risk of injury but to a greater risk of serious head trauma 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.

Moorad Sports Law Symposium: Concussion Conundrum

12 Mar

The concussion issue has permeated every facet of life and sport.  Now policies, products, rules and law are starting to address the issue head on (pun intended), and one of the most renowned groups is taking a look at this issue as well;

The 2013 Jeffrey S. Moorad Sports Law Journal Symposium—Concussion Conundrum—explores, debates, and informs on the key issues facing players, teams, leagues, doctors, and lawyers regarding head injuries and brain trauma in sports.

Panels include commentary from well-known retired professional athletes about concussion awareness and prevention amongst players; an examination of both sides of the NFL Concussion Injury Litigation—the concussion injury class action suit brought by former NFL players against the league; an exploration of the science and concussion-related liability facing professional and amateur sports; and a look at where we are and where we are going with media personalities commenting on the state of sports and concussions.

Andrew Brandt, Director of the Jeffrey S. Moorad Center for the Study of Sports Law and NFL Business Analyst, has covered the concussion issue for ESPN and moderates all panels.

The Symposium takes place on Friday, March 15, from 9 a.m. to 12 p.m., in the Arthur M. Goldberg Commons at Villanova University School of Law. This program is approved by the Pennsylvania Continuing Legal Education Board for 2 substantive CLE credits. The event is free for non-CLE attendees.

The panel and the topics are top notch; this event should be on the “to-do” list of  anyone interested in sports law.  Below is the topics and panels (check the website for more deets – also notice our partners at stopconcussions.com (Keith Primeau) and our good friend Paul Anderson);

  • Panel 1: Framing the Issue
    • Keith Primeau
    • Jim Nelson
    • Taylor Twellman
    • Brian Westbrook
  • Panel 2: Building the Case — A Legal and Medical Background of Concussions  Continue reading

Watch This: Enough Said

31 Jan

This is Ry Koopman, a 7th grader from Georgia…

The kids are now talking about it, the feeder system of all sports.  If the kids are talking the parents are talking.  Awareness is setting in!

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

Concussion Symposium March 2nd

15 Jan

I received the following press release about a Concussion Symposium coming up in March.  The faculty is not your “usual suspects” rather some very good and known people in the medical field.  If you get the chance to head down to Texas for that Saturday I believe you will not be wasting your time or resources.  I would love to make it, however I have a prior commitment; that being said someone take good notes for me.

I would also like to add that having athletic trainers on the program list legitimizes this symposium in my mind.  Here is the presser;

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Austin, Texas (PRWEB) January 10, 2013

Concussion Compliance presents “Bridging the Gap on Best-Practices in Concussion Management.” This day-long exchange, sponsored by St. David’s HealthCare, brings together leading medical experts and practitioners to discuss the issues dominating today’s best-practice concussion management and how to incorporate the guidelines as well as the use of several tools into clinical practice.

The national symposium will be held March 2, 2013, at the Norris Conference Center, Austin. Registration is now open

“Communication and education that crosses traditional boundaries are key factors to providing good concussion treatment for our young athletes,” said Theodore Spinks, M.D., chair of the symposium program planning committee. He is a board certified neurosurgeon seeing patients in Austin, Round Rock, and Georgetown, Texas. Dr. Spinks currently serves on the CDC Expert Panel for Pediatric Mild Traumatic Brain Injury. He also served on the Texas Medical Association Committee on Concussions in Athletes during the last session of the Texas Legislature.

The symposium program provides an overview of the current best practices and consensus statements on concussion management, the latest scientific research, an update on tools available to practitioners, and perspectives from experts in concussion management.

  •     Featured Topics – The Physician’s Perspective; An Athletic Trainer’s Perspective; Head to Head: Cognitive Testing; Beyond Cognition: Balance Testing; A Look Into the Future: Vision Testing; Neurosurgical Management of Head Injuries and Concussion; Implementation of Best Practices Into Clinical Practice
  •     Keynote Speaker – Dr. Steven Erickson will present on the latest best practices in concussion management. Dr. Erickson is the medical consultant for Major League Baseball caring for the umpires and serves on the Major League Baseball Medical Advisory Committee and the Major League Baseball Mild Traumatic Brain Injury Committee.
  •     Reading of Proclamation from Governor Perry’s Office – March Concussion Awareness Month in Texas
  •     Exhibit Hall – Featuring the newest in technology, practice services, practice information, and pharmaceuticals

In addition, Governor Perry has Continue reading

National Concussion Awareness Tour

18 Dec

It is an idea that can catch on, real quick, it has the basic tenet of education/awareness at its core, with the right promotion and teaching/tools I am in agreement this will do some good.  The plan is to have a national concussion awareness month, September, and along with that have a tour across the United States.  Instead of me trying to explain it, here is a promotional video, geared to finding sponsors for this event;

I do not endorse the Shockwave System, I am only endorsing the idea of an awareness tour….  Heck I don’t even know about baseline and/or neurcognitive testing…  However the idea to inform everyone is sound…

NFL Concussion Litigation – The Science of Sport

18 Dec

That is the title given to the upcoming webinar/teleconference sponsored by Perrin Conferences.  These events are mainly geared toward attorneys/lawyers and offer continuing education credits (CLE) for attending.  Below is the press release;

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Experts in NFL Concussion Suits join together to tackle industry trends, litigation challenges, and the science in sports injuries on Jan. 8.

Berwyn, PA – Perrin Conferences‘ teleconference series presents “NFL Concussion Litigation – The Science of Sport,”  a program bringing together leading attorneys, doctors and other experts to discuss the issues dominating the headlines of the concussion cases against the NFL, NCAA and equipment manufacturers.  The teleconference will be hosted on Jan. 8 at 2:00 p.m.- 4:00 p.m. EST.

The program provides an overview of the current allegations and defenses in NFL concussion litigation, an update on the latest scientific studies, and tackles other issues including:

  • The potential legal and economic impact of concussion litigation for players, sports leagues and uniform equipment manufacturers
  • Chronic Traumatic Encephalopathy – what is it and how does the science fit into the current litigation strategies?
  • The history of the dangers of head injuries and the timeline of NFL-sponsored studies/concussion rules
  • Medical monitoring and other potential damages
  • Duty to defend, trigger, occurrence and other insurance issues

Speakers include 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.

———-

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

Concussion Trending Stories

24 Oct

This morning I looked for the trending stories on concussions and the top three are as follows.

Concussions Bring More Scrutiny in Youth Football

  • Naturally this is stemming from the Pop Warner fallout; the game that resulted in five concussions and discipline against the adults that were coaching the game.
  • It brings up the debate of should kids that young be playing collision football.

As evidence mounts that repetitive head injuries can have a cumulative effect, and leagues at all levels take steps to improve player safety, parents said games where one team is physically overmatched should be stopped right away. Football is tough enough when the sides are fair, some parents said.

  • Massive size and skill advantages not with standing is it really a good idea to have our 5-12 year old’s go out there and be put in a situation where head trauma is not only present, but likely?

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Dale Jr. Cleared to Return

  • I have been sort of quiet on this particular concussion; mainly because I feel it was handled correctly.
  • If you follow racing sports you will notice that concussions are relatively low for the amounts of accidents that occur on a track at high-speed.  A couple of theories on that, one and most importantly Continue reading

Let Us Hear From Woods about “Woodsgate”

10 Oct

TCB follow-up to Robert “Woodsgate” and this is not the first time the PAC-12 has been under the microscope here at TCB, if you recall “Lockergate” a few years back.

There are hundreds if not thousands of hits on any given weekend in football that will result in concussions across the football landscape, many go unnoticed, except by the trained medical staff (mainly athletic trainers); certainly we see a very limited number on national TV.  However last week Robert Woods of USC was drilled in the head while blocking that resulted in OVERT signs of brain trauma.  Before we go further we should define what a concussion is, in its simplest terms:

  • A concussion, at the very base level, is a pathological event that results from forces to the brain that cause disruption of normal brain activity.  These “disruptions” can occur immediately or in a delayed response.  Regardless, any disruption of normal physical, cognitive or emotional behavior would fit this criteria.

The new standard of care for concussions across all levels is that if someone exhibits signs of a concussion they should be removed from play for a proper evaluation.  If there is no one there to do a proper evaluation (see youth and HS levels) then that player may not be returned to the game and cannot return to sport without a medical clearance from a physician.

As I have stated many a time most evaluations on the sideline are either a case of detective work – weeding through the subjective nature of the injury – or not needed because of the overt signs and clinical presentation.  I say this as an expert, one who deals with concussions in sport on almost a daily basis.  Observation is the most trusted source for concussion detection; whether it be observation  Continue reading

The Updated Concussion Law in New York

3 Jul

As of July 1st the state of New York’s law on concussions is in full effect.  The key provisions are not un-similar to other states and include: each school coach, athletic trainer, nurse and PE teacher must take a course on concussions, suspected concussions will result in immediate removal, and anyone with a concussion cannot return to activity in less than 24 hours and MUST have a physician clear them.

WSYR of Syracuse, New York had a segment on the topic a couple of days ago, and you might notice the individual interviewed in the piece, non other than Dr. Don Brady – follower and commenter on this blog (click on link to see video);

According to experts like psychologist Dr. Don Brady, as many as 40% of kids prematurely return to play a sport after getting a concussion. “Think of a concussion as a sprained brain,” explained Dr. Brady. “You don’t ask someone who sprains their ankle to go out and see if their ankle’s okay and run around the track a couple of times to see how much better it is. You tell them to rest, period. We don’t do that with concussions.”

Dr. Brady says brain damage occurs when the brain ricochets in the skull after an impact.

“Basically, the brain is moving in the skull when Continue reading

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

Maryland State Board of Education Meets Tomorrow

25 Jun

Tom Hearn, a parent advocate of Maryland provided initial testimony to the Montgomery County Board of Education earlier this spring.  He had a further opportunity to provide testimony/information to the State Board of Education back on May 22nd.  Due to that testimony (seen below) there has been a discussion item placed on the agenda for tomorrows regularly scheduled meeting.

I must say that Mr. Hearn has been working his tail off and I am very interested to see how his approach is handled, as most states have not involved the BoE.  Mr. Hearn does take up the contact limits in practices; making Maryland and Illinois as the only two states that have been given such a proposal.  Here is the testimony (minus the attachments);

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May 22, 2012
Maryland State Board of Education
Public Comment Testimony of Tom Hearn
Regarding Concussions in High School Football and Other Sports
 
 
Good afternoon, Members of the Maryland State Board or Education and Acting Superintendent Sadusky.  I am Tom Hearn and I am a parent of a student at Walt Whitman High School in Montgomery County, Maryland.
 
I wanted to talk with you about concussions in high school football and other sports.  As discussed further below, I am requesting that the State Board take three actions to improve the safety of Maryland high school sports athletes:
 
1.     Adopt regulations similar to those adopted by the Massachusetts Department of Health for youth sports concussions; in Massachusetts, the Department of Health has gone through extensive notice and comment rulemaking procedures to develop workable policies and procedures to manage the risk to student athletes of sustaining sports concussions.  The result is a set of state-of-the art best practices that are a suitable starting point for the State Board to align with those practices.
 
2.     Impose limits on full contact practices per week in high school football given that the NFL and Ivy League have adopted similar limits in light of emerging medical research; and
 
3.     Reorganize responsibility for sports concussion safety away from the Maryland Public Secondary School Athletic Association, which currently has the lead, to a new department within the Department staffed by a lead public health professional or sports safety professional, such as a certified athletic trainer with experience managing sports health in a large school system, who reports directly to the State Board.
 
Background
 
It may not be highlighted in the job description, but collectively you are the senior safety officers for public high school sports in Maryland, and this may be the most important position that you play.
 
In sports vernacular, collectively you are the Blind Side left tackle for the 15,500 students who play public high school football and the 100,000 or so other high school athletes.
 
No one ever died from a bad academic education, but high school student athletes die Continue reading

Quick Hits

6 Jun

One catcher returns, another goes on the DL for concussion.  Carlos Santana of the Indians is scheduled to return from his stint on the DL for concussion while Angels Bobby Wilson was struck with a foul ball;

Bobby Wilson knew something was wrong when, while catching the second inning against the Seattle Mariners Monday night, he said he “felt like I could fall asleep right there behind home plate.”

Wilson took a foul ball off the facemask in the first and was replaced by John Hester in the bottom of the second. Tuesday, Wilson was put on the seven-day concussion disabled list and replaced on the roster by catcher Hank Conger, who was recalled from triple-A Salt Lake.

“It was the same feeling I had the last time,” said Wilson, who suffered a concussion in a plate collision with Yankees first baseman Mark Teixeira in his first big league start on April 23, 2010. “My face felt like it was on fire. I was drowsy, fatigued, in a fog.”

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NFL running back not thinking about future injury, nor should he.  Javid Best of the Detroit Lions Continue reading

New Hampshire Awaiting Signature

24 May

Governor John Lynch has a bill sitting on his desk that will put New Hampshire in line with the majority of states by enacting concussion legislation;

The bill, which has the support of the New Hampshire Interscholastic Athletic Association and others, would have school districts distribute information on the risk and nature of concussions to coaches, students, athletes and their parents.

Under the bill, a student athlete who shows symptoms of a concussion or who a coach, trainer or other suspects has sustained a concussion must be removed from the game or practice.

The student could return to practice or a game only with the permission of a heath care provider.

At first glance it appears that the bill is similar to that of Illinois, the signature would make New Hampshire the 36th state with legislation.

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