Parental Decisions Can Undercut Good Concussion Laws

We are beginning a new program here at TCB.  This one is called “Outreach”; the purpose is to publicize the good (we hope the vast majority) and sometimes the not so good of concussion management across this vast planet.  One thing I realized real quick in Zurich is that the stories of the bad are relatively the same, but unheard.  Meanwhile the stories of good are different and helpful and not heard at all.  I am asking our readers to send in stories of your cases (please be mindful identifying specifics) so we can share.  There are vast stories in the comment section but I would like to bring forward as many as possible.

The stipulations are simple: 500-2000 words with specific situations that we all can learn from and benefit from, email them to us at theconcussionblog@comcast.net and consent to possible editing as I see fit.  It would be nice if you included a bio or frame of reference, but if you would like to remain anonymous that is fine to (however, it would be good if you included something like “licensed doctor in _____ (state)” or coach, athletic trainer, mom, dad, etc.

As Dr. Kissick stated in Zurich it is high time we start sharing as much information as possible.  I will do my best to weed through the “complaints” and “uninformed” from the group; be a “gate-keeper” if you will.  Trust me (as you have witnessed on this blog) I will get information out!

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By Tommy Dean, ATC, LAT

You can’t turn on the TV today or open the newspaper without hearing about concussions. It seems like over the last few years there have been more superstar athletes who have suffered this injury, especially from those who played “back in the day” and are now coming forward and bringing their multitude of recent struggles to the forefront that have been caused by multiple concussions.

But the problem doesn’t start in the NFL. It starts at the youth level. It starts at home.

Every Saturday and Sunday families gather to watch collegiate and NFL games, bringing society together on common ground for a day or two. In a way, however, this culture can also tear us apart. When kids and parents see elite athletes take punishing hits and stumble off the field only to be returned by the medical staff just minutes later it raises questions and causes confusion about concussions.

What must be understood is that there is not one of these injuries that will be treated the same. Your son or daughter at home is NOT the same as RGIII or Melissa Gilbert (Dancing with the Stars). We are talking about the adult, or fully developed brain of an elite athlete who gets paid to do what they do versus the still developing brain of an adolescent who may not yet be legal to drive a vehicle. This is in no stretch of the imagination an apples-to-apples comparison.

What’s disconcerting to me as a certified athletic trainer and a father of two Continue reading

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NBA Head Coach – Clueless on Concussions

While traveling abroad you tend to miss a few things in American sports.  Take for example I missed all college football games and only caught snip-its of NFL action yesterday.  Even more easily missed are stories that are not “front page” news, take for example a professional basketball coach opening mouth and inserting foot;

“When you’re dealing with the brain, I guess what’s happening in football has impacted everybody,” Williams said before the game. “He got touched up a little bit last night. That happens a lot in basketball. It’s just that now they treat everybody like they have white gloves and pink drawers and it’s getting old. It’s just the way the league is now.”

“It’s a man’s game,” Williams said. “They’re treating these guys like they’re 5 years old. He desperately wanted to come, but he couldn’t make it.”

Anthony Davis was hit in the head via friendly fire as teammate Austin Rivers delivered a blow.  Actually if you look at the anecdotal evidence if the NBA players were treated like 5 year old’s he would have been right back on the court.  The NBA and the professional level is trying to set precedence for the youth to follow.

Maybe Monty Williams had a few too many hits to the head?  Perhaps Coach Williams didn’t get the memo Continue reading

Zurich Day 2… And We Are Live

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

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

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

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

Conference set to begin in 20 minutes…

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1408

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

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END OF DAY ONE RECAP

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

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

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