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…


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


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

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

Coalition for Concussion Treatment #C4CT

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

Concussion Research on the Slopes

There are many places we can mine data to put the pieces of the concussion puzzle together.  Often it is focused on the gridiron, naturally because of the nature of the sport.  The other obvious place to conduct live testing is hockey and rugby, but those are not the only places where valuable research can be done.

In fact, there may be a conglomerate of athletes that can and do sustain a high number of brain injuries; we have highlighted this section of athletics before.  Even the Olympic version of action sports has its issues with concussions, ask Lindsey Vonn.

There is a team of athletic training students and professors from Weber State that are devoting their time not only to treat the mundane injuries of broken legs and arms but also gain experience and insight into concussions; Continue reading

Lingering Effects Of A Concussion: Girls Soccer Case

If you have read the blog enough you know that concussions not only have an immediate and short-term consequences, but lasting effects.  With any injury this is the case, however the sequelae of each injury is far less known.  What is becoming more apparent is that bashing your brain around can cause not only physical issues (balance, dizziness, etc.) and cognitive impairments, but emotional/social changes that are much more difficult to define.

As we all remember growing up, and if you have kids of certain age, adolescents seem to go through personality changes as the hormones begin to set in and the transition to adulthood begins.  It would be fairly easy to dismiss subtle changes in a person and chalk it up as “teenagers”.  However, there are cases that can be attributed to the mismanagement of concussions; not allowing for the proper recovery of the injury. Continue reading

Vonn Now Doing The Right Thing

We have been following Lindsey Vonn’s injury from the onset (2/4/11), through her saying all the right things (2/10/11) and now with her pulling out of the rest of the World Championships (via Yahoo! Sports);

No longer willing to risk further injury as she copes with the aftereffects of a mild concussion, the Olympic downhill champion has decided to withdraw from her remaining events at the world championships.

That Vonn was cleared to ski when still reporting such symptoms drew a wave of criticism. If a second impact occurs before someone completely gets over an initial concussion it can have life-altering effects.

Vonn had a head scan the day after her crash but was never banned from skiing by the U.S. team. She passed a series of concussion protocol exams multiple times each day during the championships.

That information did not slip one of the foremost writers on this injury, Alan Schwarz Continue reading

Vonn Now Saying Right Things

As we discussed last Friday, Lindsey Vonn had suffered a concussion in a training run leading up to the Finals of the World Cup.  We were concerned with how her and her team were handling the issue, however the tune has changed, for the better.  Vonn is now saying what all professional athletes should be;

“The second I have a headache or focus problems, I’m going to stop,” Vonn said. “I want to be really careful from here on out. It’s a pretty bad sign that I had symptoms again after the super-G, which means that I’m not recovered yet, so I’m not going to take any chances.

“This is a dangerous downhill, and if I don’t feel like I can focus then I’m not going to do it.””The second I have a headache or focus problems, I’m going to stop,” Vonn said. “I want to be really careful from here on out. It’s a pretty bad sign that I had symptoms again after the super-G, which means that I’m not recovered yet, so I’m not going to take any chances.

“This is a dangerous downhill, and if I don’t feel like I can focus then I’m not going to do it.”

Another good sign is US Woman’s ski team doctor, William Sterret, is also saying all the right things and making her recovery very transparent for all to see;

“If there are positive symptoms – things like nausea or headache or feeling like you’re in a fog – any of those things, then you’re shut down for sure,” Sterett told The AP. “Once these symptoms become negative, then we go onto more cognitive testing – balance, memory, repetition – things that are easily defined and measured.

“Again, if you don’t pass that then you’re done again. Once you pass that, then we take a step backwards to the subjective test list and try to slowly increase the stress or exertion on an athlete.”

Hey HOCKEY, get a clue!!!


Skiing And Concussions

It’s a sport/activity that has great risk involved with it.  At the professional level skiers will “fly” down the hill at perilous speeds on what appears to be snow.  However most courses are basically a sheet of ice allowing for higher speeds, but the unforgiving surface can wreak havoc on anyone that falls.  This is also true of the recreational ski resorts, not so much the ice, but the hard surface that skiers ski on.

Helmets are mandated at the highest level and extremely encouraged for all skiers, but as we know helmets cannot prevent concussions, they are on the heads of the individual to prevent skull fractures.  However it is of this author’s opinion that many people strike their head on the snow often to produce concussions.  One of my many concussions that has led me to this point occurred on the slopes of Copper Mountain in Colorado.  I believe I was 12 at the time (hardly remember the incident, in fact my mother had to remind me of it after the article in the New Yorker came out), what I do remember is getting my skis crossed on a “double black” run and trying to save it, next thing I remember was being in a sled, freezing and unaware of what happened, exactly.  Mom, dad and brother were all witness to my efforts to save the mistake, but I fell forward down the hill and hit my head, then (thankfully) my skis ended up downhill as I went over a drop off, my brother claims it was a cliff, and came to rest unconscious. Continue reading

Hand-held Device To Test For Concussions?

It was only a matter of time (there are a lot of VERY SMART people and with money on the line) before the new technology of using blood to test for a brain injury was made available to those that need it.  As we posted in October, research found it possible that identifying certain proteins and markers in blood was linked to identifying a brain injury.

Now this information has led researchers at the Greensboro Joint School of Nanoscience and Nanoengineering in North Carolina to produce a hand held device for the testing.  ESPN.com action sports writer Cameron Walker broke this story yesterday.

Sandros and her team are developing a device that would use a blood, saliva, or urine sample from a person with a suspected head injury. A chip will sense the presence of compounds in the body that the brain releases when it’s injured — a test that could be done quickly on the scene of an accident, whether on the hill or on the football field, and by anyone from military medics to first responders at an accident.

Although this is exciting news for those of us on “the concussion front” during a daily basis, it will be a few (more like five) years before it is available.  Taking the subjective nature of the injury and making it more objective will not only make identifying the injury easier, but it will make the injury more “real”.  This is important to the injured (because some are skeptical of an athletic trainer’s diagnosis) and doctors that are unsure how to diagnose and treat this very serious injury.

The researchers hope their device might be as widely available as automated external defibrillators (AEDs), which were once found only in hospitals but now have a place in many ski patrollers’ first aid kids.