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.
X-Games, D on coverage…
Anyone catch the X-Games this past weekend? Action sports are on the rise and the X-Games represent the most “public” exposure for these sports, via ESPN. Normally I watch the X Games, if for nothing else, to observe unusual injuries – mechanism of injuries to be more specific. I happened to miss most of the action this year, but I was forwarded an account of an injury; Caleb Moore.
Moore was completing a backflip when he came up short and the skis on his sled slammed into the landing, causing the 450-pound machine to flip end-over-end.
Moore went over the handlebars of the snowmobile and it came crashing down on top of him. He tumbled down the slope for several feet before coming to a stop at the bottom, where he lay on the ground for a few minutes.
Moore eventually got up and walked off the course with help, but he was rushed to Aspen Valley Hospital with a concussion, according to an X Games Medical report.
This young man is now fighting for his life as bleeding was found around the heart which has created a “secondary brain injury”. I don’t exactly know what that is, perhaps a stroke or embolism from the bleeding? The criticism of this event is on the announcers of the accident; where after Moore got up they stated “he just had his bell rung”. If I am going to be critical of football announcers, then X Games announcers deserve the same prodding. If you are going to show and commentary on a sport that has a pretty good risk of concussion it would be good to brush up on the information.
Call for Abstracts…
The Brain Injury Association of Canada is hosting their annual conference in September, 25-27 to be exact, up in Kingston, Ontario. Now is the time they are calling for abstracts, if you are interested in presenting or have interesting material look at the BIAC Call for Abstracts.
Predictors of Length…
A research group in Washington released information regarding symptoms and their possible effect on prognosis of concussion. It has long been understood that anterograde amnesia was a predictor of lengthy sequelae – amnesia of any kind really. D.r Sara P.D. Chrisman was the head of this study and came up with this;
Researchers found that athletes who have four or more symptoms at initial injury were more likely to have persistent concussive symptoms. Drowsiness, concentration difficulties, nausea and sensitivity to light and noise were also associated with longer-lasting concussive symptoms. Because concussions tend to be a common occurrence in football, researchers compared data from football players to other sports, and found that risk factors were different for football and non-football-related concussion.
The results of this study could change how long high school athletes are kept from returning to play after a concussion.
I don’t want to discount the work at Washington University, however here is a novel idea… Lets assume that all concussion are going to have some residual symptoms lasting longer than a week. Who are we harming if we take that approach on concussions? Wait, what, no one, we are doing no harm in assuming symptoms will last longer than a week.
Seriously, when are we going to just “sack it up” and take the stance that concussions are no longer and should not be accepted to be something that is recovered from in less than a week. In my humble opinion this is a MINIMUM 12 day injury, and that is the absolute best case. I bet if we all started treating concussions this way we would see far less long-term issues, call that my working hypothesis.
Larry King and Concussions…
On the Larry King Now show, the topic was “Head Trauma in the NFL”. Here is the link to the video, take a look.