Post Concussion Syndrome

EIM Concussion Management: Half Way

Dustin Fink9 Comments

Sure, this is the fifth post of 2016 – and its July – however there is a good reason for it. I continue to be an on the field athletic trainer, I continue to educate on concussion, I continue to be active on Twitter but more importantly I am concentrating more on being a father and husband. Blogging ain’t easy, folks; let’s be honest the coverage of concussion has blossomed well since 2009 when this blog started.

All of that being said, I am also in the process of gaining further education in concussion. This is not your typical education about the injury but right were my mantra for the past six years has been:

The injury of concussion is not the true problem; it is the mismanagement of this brain injury that is the real issue.

As noted in March I began the Evidence in Motion Concussion Management Course. This is a 34 week program that was designed to bring collaboration and current information to those that can impact the real problem of this injury, the clinicians.

We have arrived at the half way point in the program, marked by the weekend intensive course – which met in Chicago this past weekend. Many have wanted to know has it been worth it. The answer is unequivocally, YES.

Before I get to the hands on of the weekend let me recap the first half of the program. One word cannot do it justice but in our search for snippets of information and quick reaction, that one word could be “trailblazing”.

Previously I wrote about how the program was basically going in terms of mechanics and what we were doing at the time. Since then I have read more research (current), discussed, and most importantly learned how to better help those that have been concussed.

We finished the Therapeutic Neuroscience Education and moved into the specifics of the concussion and its management. We spent a week on each of the following parts of the concussion continuum:

  • Emergency Department – evolution and how they view the injury
  • Orthopedics – how concussion relates to bones and muscles (neck)
  • Vestibular Rehab – not only the vestib system but really focusing on the eyes
  • Adult/Migraines – a previously unthought of link/predisposition for concussion
  • Vision Rehab – what I feel will be the next area of focus for recovery from concussion
  • Neuropsych/Return to Learn – how we all fit together in these areas as clinicians
  • Speech Language Pathology – unknown to me how these professionals can and will help

Those seven weeks, plus the last week of summary were probably the most challenging Continue reading →

#pinkTBI Summit 2016: A recap

Dustin Fink4 Comments

pinktbiThe meeting at Georgetown University this past weekend was more than fruitful for this athletic trainer. I went in trying to get two things done: one, provide info to you the follower as best as possible and move along the discussion on female concussion and two, to learn something that is applicable to me as a “boot on the ground” athletic trainer.

The first was probably painfully obvious that I accomplished if you follow on Twitter and didn’t mute me and were not interested in this event (you should have been interested). The second objective I did meet by learning some techniques when working with females, not only at incident but with recovery, education and overall attitude.

Certainly I could write 4000 words on this event but that would be boring to you and I am still recovering from the weekend the the docs there asked that I “rest” my fingers. That being said I will give quick synopsis’s of each speaker, info that I took away as an athletic trainer and advocate for education about mTBI/concussion. It is entirely possible that I misrepresented some thoughts and missed some very valuable info for some out there; don’t worry speakers and audience this was done the best possible.

Lets begin, and this will be in chronological order of the event with presenters last name, in bullet form. My hope is that you will use this as furthering your info about the female sequale and in some cases change how you treat.

  • Kerr:
    • The concussion rate is higher in females in males in college and high school sports, particularly in basketball, soccer, and softball/baseball.
    • Research suggests differences in symptoms reported as well as RTP.
    • More research needed at the youth level.
  • Covassin:
    • Showed that neck strength is a confounding effect on possible injury.
    • MOI is different in the sexes: males contact with player while female is contact with ground/equipment.
  • Lincoln:
    • Exposed us to the lacrosse injury and problems that exist, which is important because this is an emerging sport.
    • No head gear in woman’s lacrosse.
  • Casswell:
    • Impact sensors and injury and how it may relate to injury.
    • Different types of injury for females vs. males (building on Covassin).
  • Colantonio:
    • Logitudial study showed about 24% of female pop has had mTBI.
    • Females seek and get less care overall.
    • Reproductive impact after a mTBI need to be understood.
  • Gioa:
    • Static and dynamic symptoms are different in female vs. males – needs research.
    • Academic performance shows no difference between sexes.  Continue reading →

International Summit on Female Concussions and TBI

Dustin Fink3 Comments

I am very excited to inform you and implore you to attend this first of its kind conference. Katherine Snedaker – a good friend and ally – along with her planning committee have done a wonderful job of creating a great place to discuss a subset of this head injury issue.

The International Summit on Female Concussions and TBI will be held a month from now at Georgetown University in Washington, DC. This summit is unique because this will only be about sex and gender-based research on females, from pediatrics to the elderly.

As much as we think we know about head injuries and concussions we don’t know squat, globally. Let alone in one gender over the other; females have been painfully overlooked/lack of attention because most of the noise and spotlight is on male dominated sports. Although, females choose to play many of the collision sports (rugby, hockey, lacrosse) there are other issues we know that impact females differently.

The summit is over two days and will eventually culminate in a consensus statement about female issues surrounding and within the concussion paradigm. This is also going to be a first of its kind, and appreciated at least from me.

The Topics (briefly summarized):

  • Menstrual Phase and its impact
  • Age and Sex and its impact on symptoms
  • Domestic Violence
  • Female Soldiers
  • Pediatrics
  • Female Sport Concussions
  • Concussion Recovery male vs. female
  • Female RIO Data
  • Clinical Spectroscopy of Female brain
  • Return to School
  • Social Interactions
  • Ice Skaters
  • Psychology of Concussoin
  • And more

Here are the presenters, moderators and planning committee members (as of this post):  Continue reading →

Time to Heal: Tracy Yatsko’s Story (3/22/11)

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Last June, I had the pleasure of speaking at a press conference at Lincoln Financial Field in support of Pennsylvania State Representative Tim Briggs’ proposed concussion management legislation.  I was an eighteen-year old who had been researching concussions in sports for nearly ten months at that point—a task that I engaged in to further educate myself and others on the subject at hand; a project that would essentially close many doors in my past that had been left open for too long.  But as I situated myself beside the podium at this press conference, I had no idea what kind of story the young woman sitting to my left had to say.  Of course, throughout my research, I understood that others have been through worse—much worse—than what I had experienced, but never did I think I would meet someone I could relate to.  It was even more than just relating to, for this individual shared a heartbreaking story to the public.  She was at the press conference for the same reason as myself, and that was to promote the need for concussion legislation in our state, but she did more than that.  Her words were more than the cover to a bill.  Her words were the voice of the sports concussion crisis.

Today, Tracy Yatsko, a twenty-three-year old woman from Tamaqua, Pennsylvania, is still fighting the repercussions of an injury that ended her high school athletic career.  Six years removed from the moment of her last concussion, Yatsko represents the qualities of strength and motivation, for her battle has not been one that has been easy.  Sure, I have heard of stories in which athletes have sustained decisively fatal blows to the head.  But when I talk to this woman, and when I think about her story, the only words that I can describe how I have perceived her story is hell on earth.  Why did this situation in which Yatsko found herself within come to be?

2005 was a year, with regards to concussion awareness, that was still present in the sports’ ‘Era of Good Feelings.’  There was not much to worry about, and though there were stories creeping out of the media regarding concussions in football, there was not much of a worry in other athletic activities.  There really wasn’t much consideration as to what a concussion was.  It was merely an injury that was ignorantly summarized as a headache; a distraction; a joke.  And with such stigma comes tides of the familiar phrase that claims pain to be weakness leaving the body.  Only did we, or rather, do we, come to open our eyes to what a concussion is until the moment of a tragedy personally affects ourselves or those who we consider to be close to us. Continue reading →

#tbt: Eye Opener from 2012: Was it overlooked?

Dustin FinkLeave a comment

Originally titled “Bombshell Found in Sports Illustrated Vault” this post appeared on July 4, 2012…  To this day, it may be one of the most poignant articles I have written about the road we have been down.  I believe that this post still rings true, two years later, in regards to all the information we knew that we didn’t know…  

Considering where – 2014 – and what has transpired – League of Denial – this article may have been glossed over and was WAY AHEAD OF ITS TIME from SI.  I often find myself wondering why we are not learning from the past to make proactive measures going forward…

Enjoy the read from the past (excellent RT @protectthebrain);

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Thanks to @ConcernedMom9 I was sent an article from Sports Illustrated written by Michael Farber.  Before I tell you the year and provide the link I want so share some quotes from it;

“People are missing the boat on brain injuries,” says Dr. James P. Kelly, director of the brain-injury program at the Rehabilitation Institute of Chicago and an assistant professor of neurology at Northwestern University Medical School. “It isn’t just cataclysmic injury or death from brain injuries that should concern people. The core of the person can change from repeated blows to the head.

“I get furious every time I watch a game and hear the announcers say, ‘Wow, he really got his bell rung on that play.’ It’s almost like, ‘Yuk, yuk, yuk,’ as if they’re joking. Concussions are no joke.”

That sounds very similar to what we are discussing now in 2012.

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•Of the 1.5 million high school football players in the U.S., 250,000 suffer a concussion in any given season, according to a survey conducted for The American Journal of Public Health.

•A player who has already suffered a concussion is four times more likely to get one than a player who has been concussion-free. Quarterbacks, running backs, receivers and defensive backs are most vulnerable, […] that special teams players were at the highest risk per minute spent on the field.

•Concussions are underreported at all levels of football. This is partly because of the subtlety of a mild concussion (unless a player is as woozy as a wino, the injury might go undetected by a busy trainer or coach) but primarily because players have bought into football’s rub-dirt-on-it ethos. “If we get knocked in the head, it’s embarrassing to come to the sideline and say, ‘Hey, my head’s feeling funny,’ ” says San Francisco 49er quarterback Steve Young, who has suffered at least a half dozen concussions. “So I’m sure we’re denying it.”

•Football’s guidelines for players returning after concussions are sometimes more lenient than boxing’s. The New Jersey Boxing Commission requires a fighter who is knocked out to wait 60 days and submit to an electroencephalogram (EEG) before being allowed back into the ring.

•According to Ken Kutner, a New Jersey neuropsychologist, postconcussion syndrome is far more widespread than the NFL or even those suffering from the syndrome would lead us to believe. […] Kutner says that the players fear that admitting to postconcussion syndrome might cost them a job after retirement from football.

Hmmm, we all thought this was information new to us – new being 2008.

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That, however, doesn’t console Lawrence and Irene Guitterez of Monte Vista, Colo. “He just thought it was something trivial,” Irene says of her son, Adrian, who was a running back on the Monte Vista High team three years ago. “He had a headache and was sore, but it seemed like cold symptoms. He wasn’t one to complain. He wouldn’t say anything to anybody. He wanted to play in the Alamosa game.”

He did play. At halftime Guitterez, who had suffered a concussion in a game two weeks before and had not yet shaken the symptoms, begged teammates not to tell the coaches how woozy he felt. When he was tackled early in the third quarter, he got up disoriented and then collapsed. Five days later he died.

Years later another Colorado high school football player, Jake Snakenberg, would unfortunately repeat history; leading to the concussion legislation passed in that state.

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Do you have a guess on the year… Continue reading →

Nick Mercer: Adjustment/Accomplishment

Nick Mercer1 Comment

Nick wrote two quick takes on his experiences with TBI recovery and where he stands, currently.  Here they are presented in one post.  We would like to thank Nick for continuing to post from a unique perspective and appreciate the work he has done for us.

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Adjusting is not quitting.

I finished my Pilates teacher training in Toronto last Sunday – thank you Body Harmonics! I’m feeling great and have confidence that I will be a good and effective teacher. It’s due to the outstanding instruction I’ve gotten from Sarah Stoker at Pony Locale here in St. John’s and the amazing teacher training from Larisa Makuch and Margot McKinnon at Body Harmonics. The excellence of the instruction I’ve received notwithstanding, I’m happy and confident because Pilates suits me. It fits well with my personality and where I am currently; in life, location, and in the time since my brain injury. Pilates wasn’t even in my mind 5 years ago and if you had asked me about taking on Pilates before my brain injury, I wouldn’t have been interested. I am now though. Very interested. And happy and confident too.

I didn’t write this post to talk about Pilates, but about change, about adjustment after, in my case, a very serious brain injury. It’s about having an open mind and knowing that just because adjustment is tough, especially at a challenging point in your life, it doesn’t mean trying something new is a waste of time. Just the opposite actually. While having an unwanted challenge thrown at you can be tough, a challenge you give yourself can be exhilarating! It doesn’t even have to mean a drastic change in your mindset, just a different activity. Before my brain injury, playing water polo and cycling were activities from which I got a lot of enjoyment. I would still love to play a game of water polo like I used to. I would still love to hop on a bike and just ride all day. That doesn’t happen anymore, but, after finally listening to my sister, with encouragement from physios, I decided to try something that keeps me motivated, interested, and looking to improve. Maybe it was something you used to do, but ‘life got in the way’ and you stopped. Maybe it’s something you do every day and would like to know more about. Or maybe it’s something that has never even crossed your mind.

There are aggravating and depressing times while recovering, but those times don’t need to last forever. Instead of refusing yourself of any happiness until you recover all of the abilities you think you have lost, embrace the opportunity to try something different. Whatever that is.

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I’ve received some very nice and intriguing comments about my last post and they led me to write more about the idea of adjusting.

In essence, it’s life. Life is one long adjustment, with a bunch of intermittent adjustments thrown in. I wrote my last post, initially with the idea of talking to brain injury survivors. The more I wrote and gave my views, the more I realized that it applied to everyone who has had to deal with an unintentional life-changing event. Then, after my post (post-post), some comments got me thinking of who else may be able to relate and then thought “everyone”.

Graduation (from high school, college, or university) is an adjustment. A new job is an adjustment. Having kids is an adjustment. Retiring is an adjustment. These are simply easy ones to name, “big” ones. They all get more challenging the less prepared you are for it. For example, graduation is an event you see coming and it’s achieved with intention. It’s viewed as a good thing. An accomplishment. All of those events, when approached with intention and preparation are what we view as accomplishments. Intention and preparation.

Those two important elements are generally lacking when an accident happens and we’re forced to make an adjustment. Although making adjustments are what life’s all about, and although life is viewed as a good thing, ‘adjustment’ has a negative connotation. People are “forced to make adjustments” and even when given a positive spin, it’s with a qualifier – “a good adjustment”, “the correct adjustment”.

Since adjustments are such an essential and ever-present part of life, viewing them negatively goes against the whole notion of life being good. Embracing the idea of adjustment, that adjustment makes life more interesting (whether due to a “good” or “bad” event), gives a new look to challenges.

It’s not about ‘making the best of a bad situation’, it’s simply about adjusting.

Sylvia Mackey – Video

Dustin Fink3 Comments

In a follow-up, and what I believe to be the same presentation that Elanor Profetto’s video is from a very strong and wonderful woman, Sylvia Mackey, “Mrs. 88” gives a talk about brain injury.  She also has intimate and troubling experience with what brain injury/disease can do as she took care of the great John Mackey in is twilight.

Keep on learning and listening!

#C4CT Concussion Summit 2014

Dustin Fink2 Comments

In a little over three weeks, Brewer Sports International (BSI) along with #C4CT (Coalition for Concussion Treatment) founding partner Amarantus BioScience will be hosting their 2nd Concussion Summit in New York, at the United Nations.  There have been many press releases on this event, and I have mentioned it a time or two on Twitter (and will continue).

Sure, there are many “summits” around concussions and head trauma – which is great as it keeps the dialog going – but few are populated by people with ideas on going forward.  Often, we find ourselves sitting, listening to bright people talk about what was done and can’t be done; rarely do we find the same bright people addressing the issues going forward.  Whether that be with tactical changes or with management or even the possibility of intervention with traumatic brain injury.

This edition of the #C4CT Summit on January 29, 2014 will hear from some people in many fields – you can see the current line-up HERE – focusing on the burgeoning topics of chronic traumatic encephalopathy (CTE), general neuroscience, pharmacology among other topics.

Interestingly enough, yours truly, was invited to sit on a panel and discuss how all of this information has been translated to the high school level – as an athletic trainer.  I was not only surprised by the invitation but feel it is VERY OPPORTUNISTIC for a “boot on the ground” athletic trainer to provide input.  I feel that not only have athletic trainers seemed to be seen and not heard, the vast majority of us practice in the high school setting, where the adolescents are playing sports.  I can assure you I will do my very best to be a quality representative of not only athletic training (it appears I am on the only AT in a speaking role) but those of us working with the most kids/athletes.

Anyhow the cast of speakers/presenters is indeed “star-studded” and even has some opposing view points on where we should be headed; which should make for some quality discussion.  If I can get my technology working and to NYC I will attempt to live blog/tweet the event for those that cannot make it.

Speaking of that, I know that time is short but I encourage anyone who is going to be in NYC during Super Bowl Week try to attend this event.  If there are scribes out there I am sure the wonderful support staff at BSI can arrange for you to cover and meet the star of the show – me, of course – hahahahaha, I kid.  Seriously, you can register HERE and if you have questions feel free to contact them.

I hope to see you all there!

What About Return-to-Learn?

Dustin Fink9 Comments

Two important groups released information about concussions and youth recently.  The Institute of Medicine recently released its Sports-Related Concussions in Youth: Improving the Science, Changing the Culture, addressing concussions for the youth (obviously by the title).  This was on the heels of the American Academy of Pediatrics release of their second report on concussions, addressing the return-to-learn aspect.  I offered some opinions on both of the reports via Twitter, but was really underwhelmed by the information in both documents.  It seems to me that even though the car is pointed in the right direction the gas pedal is being confused with the brake pedal.  At best I feel the community is driving though the rear-view mirror.

A loyal follower and some time contributor, Dorothy Bedford, a self-described “parent activist in concussion education, awareness and advocacy, and newly retired school board member in Princeton NJ,” has penned the following post regarding return-to-learn and the AAP paper.  This is not your typical parent; “I come by the interest in return-to-learn honestly, both from my daughters’ concussion and from the point of view of a school board member – with the opportunity to help protect the brains of all students.”

With all of that said, below is her post.  Thank you, Dorothy.  As a reminder, the inbox is always open to contributors.

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The Pediatricians Weigh In on Returning-to-Learning – A Mixed Review

The American Academy of Pediatrics has released its second major clinical report on concussions. It’s a good first step which will help many pediatricians begin to address the second most important issue in concussion management (after “remove from play,” and before “return to play”).  On the other hand, ten pages limits the territory it can cover; there’s little new for the ATC who takes a broad view of concussion recovery; the report wildly underplays the complementary role of the neuropsych, and omits any discussion of some important symptoms. I think the most important contribution this report makes will be nudging school administrators to action, especially those who have been inattentive or resistant to dealing with concussions in the classroom and gradual return to learn. It’s hard to ignore the AAP.  I will confess, since its release my reaction has swung up and down with each re-reading. Five days later, I hope this will be a balanced review. I like to keep the conversation open.

“Returning to Learning Following a Concussion” was published on October 27 (full report here: http://pediatrics.aappublications.org/content/early/2013/10/23/peds.2013-2867.full.pdf+html)  complementing AAP’s 2010 clinical report on “Sport-Related Concussions in Children and Adolescents”. The lead author on both reports is Dr. Mark Halstead, a specialist in non-operative sports medicine at Washington University in St. Louis. Neuropsychologist Dr. Gerald Gioia of National Children’s Medical Center was a consultant. Dr Gioia is a co-author of the CDC’s Physician’s ACE Return to School form, which should be in the hands of every student athlete and their parents for any concussion-related visit to a doctor (http://www.cdc.gov/concussion/headsup/pdf/ACE_care_plan_school_version_a.pdf ). Six other professional societies have endorsed this report.

The Good:

For pediatricians in areas with thin or no sports medicine/neuropsych coverage, this report is going to be very important,  Continue reading →

“League of Denial” (Part 2)

Dustin Fink9 Comments

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 →

Nick Mercer: Impromptu Expectations

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The thing about expectations is that they presume a certain course of events. In July 2003, I assumed that I would start my co-op job in Ottawa in September and I based my expectations for the coming years on that presumption – my previous post, Finding yourself after a brain injury. First step: Recon. Brain injuries themselves are unexpected, so you don’t know what presumptions to make that will allow you to generate expectations. You’re already starting off on the wrong foot. It’s not so much the issue of living up to, not meeting, or exceeding expectations, it’s more about the expectations themselves that I will write about.

After considering a patient’s health/medical history, age, other essential factors and the severity of most injuries, conditions, or diseases, doctors can only base their ultimate prognosis on probabilities. This is where expectations begin to go awry. Not to get into statistics or anything, but if the probability of surviving a coma of a certain length and severity is low, it’s because it hasn’t happened very much, therefore there will be few cases upon which to build expectations. The fewer cases, the fewer reliable prognoses can be made, hence few, if any expectations.

Those are for others to make. The most important expectations are the ones you make for yourself. I had been making those ever since
I can remember. When I was a kid and used to catch insects, I had Continue reading →

Concussion Conglomeration “Road Marker” (UPDATED FREE ARTICLE LINK)

Dustin Fink3 Comments

A paramount review of concussions and their “long-term” effects has been published (or soon will) in Nature Reviews Neurology that I certainly hope does not slip past the masses.  Not only is the information somewhat of a “where we stand”-moment of clarity, it is authored by a very underrated and proficient researcher; Dr. Barry D. Jordan.

Jordan, B. D. Nat. Rev. Neurol. advance online publication 12 March 2013; doi:10.1038/nrneurol.2013.33 (note you need a log in).  Here is the FREE DOWNLOAD LINK

Acute and chronic sports-related traumatic brain injuries (TBIs) are a substantial public health concern. Various types of acute TBI can occur in sport, but detection and management of cerebral concussion is of greatest importance as mismanagement of this syndrome can lead to persistent or chronic postconcussion syndrome (CPCS) or diffuse cerebral swelling. Chronic TBI encompasses a spectrum of disorders that are associated with long-term consequences of brain injury, including chronic traumatic encephalopathy (CTE), dementia pugilistica, post-traumatic parkinsonism, post-traumatic dementia and CPCS.

Dr. Jordan also discussed CTE in further detail including the limitations of possible antemortem detection; including imaging and categorization.

In this Review, the spectrum of acute and chronic sport-related TBI is discussed, highlighting how examination of athletes involved in high-impact sports has advanced our understanding of pathology of brain injury and enabled improvements in detection and diagnosis of sport-related TBI.

The overriding theme I gathered from this review article is one that I have been hammering home for a very long time: the mismanagement of the original sequale may be the largest factor in discussion the multiple faces of “chronic TBI” that result from concussion.  This paper is also very succinct in demonstrating the massive amount of work that still needs to be done.

I urge you to find a copy or pay for a subscription for this article, it should be one that we look back on in 5 years as the “where have we come from” moment in this issue, regarding chronic issues from sports related concussion.

Zurich 2012 In Writing

Dustin Fink15 Comments

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.

Team Gleason PSA – Hey NFLPA Please Read

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I received this from an anonymous source and was asked to spread this news, hopefully it will reach those it is intended for…  How bout you watch the video first then go to the Team Gleason website;
Subject: PSA release: NFL Players and Coaches stand together to cure ALS
Hi everyone…I hope this email finds you well…
Just wanted to let you know that beginning today, we at Team Gleason are rolling out a new ALS awareness campaign to be introduced this week in New Orleans for the Super Bowl.
Here’s a link to the video, which takes viewers directly to the Team Gleason website:
This is important, please spread if you get the chance…  This is NOT JUST A FOOTBALL PROBLEM, this is a problem for everyone!

Matt Chaney – Tireless Worker

Dustin Fink9 Comments

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

Dustin FinkLeave a comment

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

Dustin Fink1 Comment

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 →

Matthew Gfeller Neurotrauma Symposium

Dustin FinkLeave a comment

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.

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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

Dustin Fink16 Comments

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 →

Call it what you want, just don’t panic

Nick Mercer1 Comment

Confidence, arrogance, or indifference. It doesn’t matter which term you use, as long as you understand what it means to show any  of those characteristics. The popular conception is that confidence encapsulates valuing yourself, being proud of what you’ve accomplished and ‘standing up for yourself’. The unfortunate circumstance is that the word ‘confidence’ (as used in the phrase, ‘Have confidence in yourself’) appears to have been corrupted and used to connote an arrogant, narcissistic attitude. People who have been affected by brain injury, or any other health condition that has had detrimental effects on self esteem, are encouraged to  show confidence, with the hope that they will feel good about themselves when they go out into society. This is well-meaning, but perhaps, not the best way to go about instilling true confidence.

Confidence is defined by the Oxford Dictionary as: the feeling or belief that one can have faith in or rely on someone or something; the state of feeling certain about the truth of something; a feeling of self-assurance arising from an appreciation of one’s own abilities or qualities.

That is what confidence means. What’s often impressed on people – recovering from brain injury or not – is that Continue reading →

Why do I write?

Nick Mercer1 Comment

Nick Mercers provides some insight into why he chooses to write for us and his blog.

Because, as much as it lets others ask questions, it encourages me to ask questions of myself.

Granted, I have always questioned myself, I’m hyper-self-critical. In general, it’s not necessarily a good thing. I hesitate or stop completely. I waste opportunities. I’ll pass up a good chance (with a woman, for a job,…) for a safer, if not longer, chance. However, in writing, my exhaustive self-analysis, is probably beneficial. It means I take longer to write, because I’m always correcting what I wrote and how I wrote it. There aren’t many sentences in this post that haven’t been ‘renovated’ in some way. That’s not to say there aren’t mistakes, or that I catch-all of those errors on the first, second, or even third read. I’m cognizant, but maybe not enough, of the propensity of my self-criticism to take the emotive punch out of what I write. So I try to guard against that. I try to be open, and I hope that shows through, but since this personality trait has been with me my whole life, it’s not completely natural for me to silence it. It is at constant odds with the my ‘newly’ acquired (9 years ago) impulsive nature.

My impulsive side has not completely balanced out my patient and measured side (or vice versa), but it has made some headway. That said, I’m certainly calmer and less anxious than I was before my brain injury, which could have more to do with the severity of my brain injury than with the injury itself, however I don’t know, I’m just speculating, and I don’t have any medical information to back up such a claim. See that? That was Continue reading →

Book Review: Concussions and Our Kids – Dr. Robert Cantu

Dustin Fink6 Comments

Due out tomorrow, Tuesday, September 18th, is Dr. Robert Cantu’s most recent writing on brain trauma; more specifically the concussion and how it relates to the ‘kids’.  Dr. Cantu is THE expert when it comes to concussions, heck his CV is so expansive it would take up like 7 pages on here.  The man knows his stuff; collaborating with Mark Hyman I believe he has written a book that is worth the read for everyone interested in this topic.  By writing this book they not only address the concussion issue but the “iceberg below the surface” the youth athletes and their care.  Obviously the millions that partake in sport and recreation are not privy to the top of the line medical staffs that the professional and high college athletes have at their disposal.

With Dr. Cantu’s wealth of knowledge there was a chance this book could have been written above the audience – so to speak – but after reading it twice I have found it to be perfectly succinct and to the point.  There is no beating around the bushes and you definitely get the feeling of where Dr. Cantu stands on this pressing issue.  All of that being said there are some points that I disagree with, but remember my favorite Japanese Proverb: “None of us is as smart as all of us.”

The book begins with the most important topic, in my opinion, “what is a concussion?”, delving into the brain and its physiology.  Don’t be scared, it is a well written chapter and explains to the layman how and what we feel determines a concussion.  Highlighting that section is the explanation of linear and rotational acceleration and why one is way more important than the other.  If you have read here enough you will note that the rotational aspect of the traumatic force to the brain bucket is the most troublesome, Cantu agrees.  In this chapter Cantu also discusses the term “rest”, and what we are all trying to convey, especially to the youth.  Rest is both physical AND cognitive, meaning not using your brain.

The next two chapters deal with collision sports Continue reading →

Reflection on the Weekend

Dustin Fink3 Comments

While away on a family vacation I don’t get to the researching/data mining I usually do, inevitability there are events and happenings that occur that get push back in coverage.  The nice thing is that the media and other sources are doing a wonderful job of highlighting the issues that come about.  There are a few instances of concussion related news that I would like to now opine on.

First and most concerning was the Olympic woman’s soccer match between the United States and New Zealand and this;

Not only can you clearly see the keeper get hit in the head and having a violent deceleration, then her head smashes the turf, not only that she was CLEARLY unconscious after this hit, yet she was allowed to continue.  If the governing bodies of sports want to get a handle on the concussion issue then cases like this must be handled with supreme independence and a player should be removed.  Take a look at this picture and tell me she should have continued…

I will be as obnoxious and abrasive as possible with this next statement:

IF ANY PLAYER IS KNOCKED OUT FOR WHAT EVER REASON THEY SHOULD BE REMOVED FROM ACTIVITY, PERIOD.  SCORE AND CIRCUMSTANCES SHOULD NOT HAVE A BEARING ON THIS DECISION.  SAID PLAYER SHOULD NOT RETURN TO ACTIVITY UNTIL CLEARED BY A PHYSICIAN AFTER AT LEAST 24 HOURS.

We are talking about a disruption of the brains activities so “gross” Continue reading →

Multiple Concussions Cause Delay Deficits, says new study

Dustin FinkLeave a comment

The study was done with the mouse model as the human analog, however its results could lead researchers down the path of what most believe about multiple insults to the brain;

We did it in mice. We gave them one mild concussion, so mild that they had no problems with learning or memory afterwards and then did it over and over and over again,” said Meehan, the study’s first author.

The mice were then tested for learning and memory, using what’s called a Morris water maze.

“Under the surface of the water is a hidden platform. And every time the mice find that platform, we reward them,” said Meehan. “The mice that are uninjured, have not been concussed, find that platform within five seconds after they do it several times. But mice that are injured take 20 to 25 seconds.”

And with each concussion, Meehan said it just got worse.

“Once they’ve had three concussions, or five, or 10, they develop profound deficits in their ability to learn and in their memory. And of course, mice don’t use steroids, and they don’t abuse drugs and alcohol,” said Meehan

The study appears in Neurosurgery and highlights not only the compounding effects of multiple traumas but takes out the other “factors” some seem to be grasping at for a reason as to why the brain is suffering.  While we are looking at the text, it seems Continue reading →

Players and Owner Perspectives on Concussions in the NFL

Dustin Fink14 Comments

Time in the summer has seemingly been slipping away from me fast.  Honestly, most of the traffic ’round here tails off in June, July and August.  However I do feel an obligation to make sure y’all keep informed.  Today here are some links from the past few days;

Priest Holmes explains that some of the concussions caused some weird side-effects/symptoms;

In some instances, the concussed can feel very much like he’s on another planet. The sky itself can change to colors the sky shouldn’t be at a particular time.

“This color obviously isn’t going to be blue. It can be a color that can be orange. It can be red. The sky could turn green,” Holmes told Chris Corbellini. “There’s even an episode where you see a clear light, like light at the end of the tunnel.”[…]

“As much as I loved it [football], that same love now has put me in situations that I have to live with,” he said.”The frontal headaches, the migraines. Laying in bed, it’s tough to get out mornings just because of the pain that is setting in with an arthritic condition, it’s things like that that you never would have really thought about.”

Accepted risk by Holmes, no doubt, however not grasping the long-term effects and really just wanting to play a sport he loved has put him in a position that makes it tough.  In related news Stephen Davis, also a former running back, recently made statements about concussions in his time as a player; Continue reading →