Trek-Segafredo rolls out HeadCheck concussion care

Improved concussion care for riders

Trek-Segafredo proudly announces a partnership with HeadCheck Health, Inc. The company’s unique concussion assessment tool, HeadCheck, fortifies head injury management for riders using evidence-based science, cycling-specific modifications, and smartphone technology. This new tool enables Trek-Segafredo medical staff to rapidly and accurately assess concussions as well as track rider recovery.

In October at the Trek-Segafredo team camp at Trek’s global headquarters in Waterloo, WI, four medical professionals used HeadCheck to assess all Trek-Segafredo riders, providing baseline data for comparison against a post-injury assessment. If a suspected head injury occurs during a race or in training, Trek-Segafredo staff can respond immediately by accessing HeadCheck from their phones and assessing a rider’s response levels and immediately compare results to the baseline data.

“This is a very powerful tool,” said Trek-Segafredo Head Doctor Nino Daniele. “Now we can easily and accurately measure when it is safe for an athlete to continue riding after a concussion.”

"This is a very powerful tool," said Trek-Segafredo Head Doctor Nino Daniele.

Road riders compete at extreme speeds which can result in dangerous crashes. A 2018 study published in The Journal of Sports Medicine and Physical Fitness showed that more than one in five cyclists experience a sports-related concussion. Trek-Segafredo believes athletes deserve top-level protection for their health which is why they are now using HeadCheck for their men’s and women’s teams.

HeadCheck also assists in a rider’s safe recovery after a crash. In addition to assessments by medical staff, riders can track and self-report any symptoms from their mobile devices. HeadCheck has found that cyclists are some of the most active athletes in self-reporting through the tool.

"Trek continues to demonstrate great leadership in the cycling community by taking a proactive approach to the health and wellness of their riders," said HeadCheck Health CEO Harrison Brown.

A wide range of professional and amateur teams in sports such as football, rugby, hockey, and soccer use HeadCheck for concussion assessment and management. Trek worked with HeadCheck Health to understand how to adapt the tool to cycling sports. Trek-Segafredo’s partnership with HeadCheck Health is an expansion of Trek’s relationship with the company which already provides Trek Factory Racing Downhill, Cross-Country, and Enduro teams with their tools and support. HeadCheck’s smartphone technology and offline capabilities are crucial for rugged off-road trail competitors.

“Trek continues to demonstrate great leadership in the cycling community by taking a proactive approach to the health and wellness of their riders,” said HeadCheck Health CEO Harrison Brown. “The addition of the Trek-Segafredo road cycling team to HeadCheck is an important step in working together to advance concussion management practices in the sport.”


Concussion in Road Cycling: A Call to Action

The authors of an April 2019 paper that systematically reviewed all literature on concussion and concussion management in road cycling call for a cycling-specific concussion protocol. They call upon the Union Cycliste Internationale (UCI) to hold a consensus meeting with road cycling medical teams to develop this cycling-specific concussion protocol.

The Need for a Cycling-Specific Concussion Protocol

Cycling reportedly accounts for almost 20% of concussion cases in the U.S -- the highest percentage of any sport

Cycling reportedly accounts for almost 20% of concussion cases in the U.S -- the highest percentage of any sport (1). In an analysis of Tour de France races between 2010-2017, concussions accounted for just over 2% of the injuries suffered by professional cyclists (2). More generally, concussions account for 1.3-9.1% of all injuries in cycling events and this rate is increasing (3-6). Concussions in cycling not only place the injured athlete at risk of short and long term harms, but an undetected injured athlete may also cause an accident (for example, due to a lack of balance which is a common side-effect of concussion), thereby potentially harming other cyclists (7).

Current Cycling Guidelines

Unfortunately, there is no internationally agreed-upon protocol for concussion in cycling.

Given the prevalence and consequences of concussion in cycling, it would thus be expected that there are cycling-specific concussion diagnosis and management protocols, yet this is not the case. Unfortunately, there is no internationally agreed-upon protocol for concussion in cycling (8). The UCI and the American Cycling Association (ACA) recommend using the SCAT5 and SCAT2 respectively to diagnose concussion in road cycling. These recommendations are problematic (9). The SCAT2 is out-of-date (having been created in 2008) and the ACA guidelines are largely meant for education and providing a means in which a team can put in place SRC diagnosis and management processes that are “a bottom line of best practice on which team medical staff can build on.” While the SCAT5 is the latest concussion tool published by the Concussion in Sport Group in 2016, this UCI recommendation remains problematic because the SCAT5 requires modifications in order to be relevant and effective in cycling.

Further Cause for a Cycling-Specific Protocol

There are specific challenges that come with assessing concussion in cycling more generally, such as: the fast pace of the sport and the “remote nature of medical monitoring for cyclists” given that sometimes cyclists are in one country and the medical team is in another (10,11). Ultimately, simply using generic concussion tools is not adequate because they do not address the unique qualities of road cycling.

How to Move Forward

Very few studies have examined this issue and the two studies that were reviewed for this paper’s systematic review make broad statements that are not helpful in further developing a cycling-specific protocol (9,12,13).  Some specific recommended developments/changes that the authors of this paper have suggested are to:

  • Use real-time and replayed television images to create a concussion spotting system;
  • “Motor-pace” a cyclist back into position after they are assessed for concussion to reduce the negative impact a concussion assessment may have on the individual/team’s performance and position;
  • Change the Maddocks questions to include cycling-specific questions such as: what is the name of the race, how many kilometers are left in the race, who is the road captain, what was your last race, and what is your coach’s name; and
  • Create a central injury database to understand patterns of injuries which will, therefore, help develop methods to reduce concussion incidences in cycling.

Other changes that could be made are:

  • Adopt the saying ‘if in doubt, sit them out’ as per many other sports worldwide;
  • Provide the cycling concussion guidelines in multiple languages to reflect the internationality of the cycling community; and
  • Potentially consider an independent evaluation to ensure adherence to the concussion protocol (14).

Considerations also need to be made for both medical and non-medical roles -- such as neutral mechanics who may be the first responder at the scene of a concussion-inducing incident.

Any adaptations also need to be evidence-based which means more research must be done specifically on concussion in cycling and what changes will make: 1) the sport safer and 2) concussion diagnosis and management effective in the cycling environment.

The paper can be found here: https://bmjopensem.bmj.com/content/5/1/e000525.

About The Author

Rebecca Babcock is a recent graduate of the University of Otago in New Zealand, completing a Master’s in Bioethics and Health Law. Her thesis examined the ethical and legal issues surrounding concussion management. She currently spends her time working for the Concussion Legacy Foundation – Canada as a programming coordinator and at Sunnybrook Hospital investigating concussion prevention, management, and education services. Her dream is to be a clinical ethicist at a hospital which she is starting to fulfill by volunteering as a bioethics assistant at Humber River Hospital in Toronto.

Works Cited

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  • McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5 th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017;12.
  • Echemendia RJ, Meeuwisse W, McCrory P, et al. The sport concussion assessment tool 5th edition (SCAT5): background and rationale. Br J Sport Med 2017;51:848–50.
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Equestrian Helmets May Be Too Stiff to Reduce Risk of TBI

Even in the Equestrian World, Helmets Do Not Prevent Concussions…But They Are Not Even Designed to Try

A recent study, published in Sports Medicine – Open in May 2019, retrospectively found that 70% (139/189) of reported equestrian fall accidents (seemingly focused on horse racing and jockeys’ injuries specifically) resulted in a head injury – 91% of which were concussions. Other head injuries included: skull fractures (4%); diffuse axonal injury (3.6%); subdural hematoma (1%); and cerebral edema (0.7%).

The Study

216 helmets were collected via a damaged helmet return scheme in the UK and USA. Of the 216, 189 accident report forms were provided by the rider or their doctor. These reports were not standardized and the details provided varied. In saying that, associated injuries from the fall were recorded. These helmets also were visually examined to identify damage (or lack thereof) as well as disassembled to inspect any internal damage; all of the helmets were certified.

More to the Story

Little has changed with helmet testing over the last 30 years despite an increased understanding of impact biomechanics

Out of the 139 helmets that also had a report of head injury, 75 (54%) of the helmets showed damage whereas 64 helmets (46%) showed no damage. In fact, the more stringent the certification (i.e. – the stiffer the helmet), the more likely the helmet was to show no damage.

On the one hand, helmets that are very stiff will very likely help protect against skull fracture, more serious brain injury, and death. On the other hand, the researchers of this study suggest that stiffer helmets may be less effective for lower-severity impacts. They argue that this is specifically the case because equestrian helmet certification tests currently do not test helmets under the conditions that falls in equestrian sport occur.

There is a tendency for equestrian falls to occur on softer, uneven surfaces which will ultimately create oblique hits with rotational acceleration and current tests focus on linear acceleration (1-3). In fact, little has changed with helmet testing over the last 30 years despite an increased understanding of impact biomechanics (4).

Finally, the researchers suggest that if helmet testing were to consider these components and helmets were designed with these factors in mind, equestrian helmets may be better suited at reducing incidences of concussion/head injury in low-severity impacts.

Further Considerations Need to Be Made Prior to These Claims

The researchers of this study strongly state that new helmets need to be created by examining detailed accident reconstruction, clinical outcome data, and the needs of helmet users

Yet, in concussion literature, it is widely stated that helmets do not prevent concussion but rather, protect the head against more serious injury. Certainly, ensuring that helmets are designed with the sport in mind is important as is ensuring that helmets are diffusing as much energy from the impact as possible so that they are most effective at preventing these more serious brain or structural injuries. The fact that the researchers of this study strongly state that new helmets need to be created by examining detailed accident reconstruction, clinical outcome data, and the needs of helmet users in a collaborative environment with engineers, clinicians, riders, and equestrian regulatory authorities is reasonable. Certainly, these conditions are vital to achieve this goal of creating a safer equestrian helmet. It may be unreasonable however, given that there is no threshold force to sustain a concussion and that concussion is not prevented in other sports with helmets, to suggest that improving helmets in this way will reduce incidences of concussion.

How to Move Forward

Equestrian sports are incredibly high risk with higher reported rates of concussion and mild traumatic brain injury (mTBI) than American football or boxing

In saying that, equestrian sports are incredibly high risk with higher reported rates of concussion and mild traumatic brain injury (mTBI) than American football or boxing and it is important to start exploring ways to reduce incidences of concussion (5-12). Perhaps exploring the circumstances in which head injuries are arising may lead to changes to the sport/environment/rules/etc. that will help reduce concussion.

About The Author

Rebecca Babcock is a recent graduate of the University of Otago in New Zealand, completing a Master’s in Bioethics and Health Law. Her thesis examined the ethical and legal issues surrounding concussion management. She currently spends her time working for the Concussion Legacy Foundation – Canada as a programming coordinator and at Sunnybrook Hospital investigating concussion prevention, management, and education services. Her dream is to be a clinical ethicist at a hospital which she is starting to fulfill by volunteering as a bioethics assistant at Humber River Hospital in Toronto.

Works Cited

  • Bourdet N, Deck C, Serre T, et al. In-depth real-world bicycle accident reconstructions. Int J Crashworthiness. 2014;19:222–32.
  • Depreitere B, Van Lierde C, Maene S, et al. Bicycle-related head injury: a study of 86 cases. Accid Anal Prev. 2004;36:561–7.
  • Kleiven S. Predictors for traumatic brain injuries evaluated through accident reconstructions. Stapp Car Crash J. 2007;51:81–114.
  • Gilchrist MD, editor. IUTAM symposium on impact biomechanics: from fundamental insights to applications. Dordrecht: Springer; 2005.
  • Abu-Zidan FM, Rao S. Factors affecting the severity of horse-related injuries. Injury. 2003;34:897–900.
  • Ball CG, Ball JE, Kirkpatrick AW, et al. Equestrian injuries: incidence, injury patterns, and risk factors for 10 years of major traumatic injuries. Am J Surg. 2007;193:636–40.
  • DeBenedette V. People and horses: the risks of riding. Phys Sportsmed. 1989;17:250–4.
  • Balendra G, Turner M, McCrory P, et al. Injuries in amateur horse racing (point to point racing) in Great Britain and Ireland during 1993–2006. Br J Sports Med. 2007;41:162.
  • Balendra G, Turner M, McCrory P. Career-ending injuries to professional jockeys in British horse racing (1991–2005). Br J Sports Med. 2008;42:22.
  • McCrory P, Turner M, LeMasson B, et al. An analysis of injuries resulting from professional horse racing in France during 1991–2001: a comparison with injuries resulting from professional horse racing in Great Britain during 1992–2001. Br J Sports Med. 2006;40:614.
  • Turner M, McCrory P, Halley W. Injuries in professional horse racing in Great Britain and the Republic of Ireland during 1992–2000. Br J Sports Med. 2002;36:403.
  • Rueda MAF, Halley WL, Gilchrist MD. Fall and injury incidence rates of jockeys while racing in Ireland, France and Britain. Injury. 2010;41:533–9.

Hope on the Horizon: Progressing to a Better Concussion Assessment

Study shows concussion assessments comprising of multiple tools is the best method to assess concussion

It is well known that assessment tools are required to identify concussion. Most organizations promote the use of multiple tools to evaluate several domains known to be impacted by concussion (1-4). Yet few studies have examined which tool individually or which tools in combination best assess and most accurately identify concussion. A recent study -- which examined 22,057 player seasons collected during 2014-2017 for multiple sports from various NCAA and military schools -- has found that concussion assessments comprising of multiple tools, including a subjective symptom tool, is the best method to assess concussion.

One Assessment Tool to Rule Them All?

In the study, all “full models” -- meaning concussion assessments comprised of multiple tools -- outperformed all individual tools

Unfortunately, no singular tool that assesses concussion is more effective than a combination of tools. In the study, all “full models” -- meaning concussion assessments comprised of multiple tools -- outperformed all individual tools, suggesting that testing batteries are more effective at identifying the effects of concussion (5-9). Interestingly, removing the SCAT total symptoms from the full model resulted in the greatest reduction in a model’s performance. On the other hand, removing the BESS minimally impacted the model’s performance, highlighting the BESS assessment’s possible lack of utility in assessing concussion. Ultimately, these results suggest that symptoms better indicate concussion than neurological status and balance assessments. These results differ from other studies that suggest neurological assessment has the highest sensitivity, but this difference may be attributed to methodology and sample size (5,6,8-10).

Are Baseline Tests Necessary or Useful?

Completing baseline testing is becoming more common, but the presumed problem arises when the baseline data is not available to the medical professional assessing the concussed individual.

Some assessment tools use baseline tests to examine the difference between an athlete’s performance before and after the concussive injury. Completing baseline testing is becoming more common, but the presumed problem arises when the baseline data is not available to the medical professional assessing the concussed individual. Even when the data is available, the usefulness of this data remains questionable (11-13). The study found that while there is utility in baseline test scores for the SAC and SCAT (but not the BESS), it is still possible to adequately assess concussion without baseline tests and therefore baseline results may not be clinically valuable (7,10,12,13). In saying that, since this study examined only the assessment of acute concussion, it is possible that baseline information may be useful beyond this acute stage but research is needed to explore this train of thought.

Subjective vs. Objective Data

The underreporting of symptoms (at a rate as high as 50%) may greatly impact how effective concussion assessments are

Since the study showed that symptom scores have a higher sensitivity and specificity than objective measures, the underreporting of symptoms (at a rate as high as 50%) may greatly impact how effective concussion assessments are -- many concussions could go unidentified (14). Unfortunately, all objective assessment tools were outperformed. This raises the importance for developing better objective means in which to diagnose concussion. In saying that, it is possible that the objective tools play an important role once symptoms resolve; examining the utility of objective assessment tools beyond the acute stage is important.

Potential Areas of Improvement

The simultaneous use and interpretation of multiple tools with multiple domains is challenging especially when it does not have a method to combine the results into a single measure

The findings of this study provide some direction as to how to improve concussion assessments. For instance, since the BESS does not provide much value, it may be worth considering removing the tool from assessments; removing the tool would also reduce the time it takes to assess concussion. Furthermore, since this study combined risk modifiers and standard assessments into one score which can be gathered within the time constraints of most sports, there is potential for this to be applied to sideline concussion assessment/management. Indeed, the simultaneous use and interpretation of multiple tools with multiple domains is challenging especially when it does not have a method to combine the results into a single measure (1,3,4,15).

Finally, while the study did not find significant relationships in terms of age, sex, or previous numbers of concussion, it still may be important to incorporate modifying factors (the ones mentioned above as well as numerous others not examined in this study) into acute concussion assessments. Indeed, they can be important factors to consider. For instance, this study found that males were found to have an increased risk of acute concussion (25, 51-53). At first, it looks like this result is contradictory to many other studies that have found females experience more symptoms and a worse cognitive decline (24,26,50,53,54). However, this study’s finding seems to suggest that male athletes may still be concussed despite having fewer symptoms and closer-to-normal neurocognitive deficits compared with female athletes. This fact/trend would be worth knowing and considering when assessing concussion and should be built into the assessment.

Areas to Explore

While this study did find concrete ways in which to improve concussion assessment, it also highlighted areas that are certainly lacking in information and require more research.

  • First, similar research is needed for high school, recreational, and professional athletes to examine whether these findings are similar across all categories of athletes.
  • Second, this study has limitations in the fact that it only looked at specific concussion assessments -- examining both individual components of each assessment, as well as other assessments, will be important.
  • Third, as mentioned above, research on the usefulness of these tools, baseline scores, and objective data beyond the acute stage is required.

Finally, this study does highlight the need for research on other clinical measures that can be used when certain objective data is either unavailable or not as clinically valuable and self-reported symptoms are unreliable.

The study can be found here: https://www.ncbi.nlm.nih.gov/pubmed/29488165

About The Author

Rebecca Babcock is a recent graduate of the University of Otago in New Zealand, completing a Master’s in Bioethics and Health Law. Her thesis examined the ethical and legal issues surrounding concussion management. She currently spends her time working for the Concussion Legacy Foundation – Canada as a programming coordinator and at Sunnybrook Hospital investigating concussion prevention, management, and education services. Her dream is to be a clinical ethicist at a hospital which she is starting to fulfill by volunteering as a bioethics assistant at Humber River Hospital in Toronto.

Works Cited

  1. McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport: the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51:838–47.
  1. Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TSD, Gioia GA, et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80:2250–7.
  2. Broglio SP, Cantu RC, Gioia GA, Guskiewicz KM, Kutcher J, Palm M, et al. National Athletic Trainers’ Association position statement: management of sport concussion. J Athl Train. 2014;49:245–65.
  3. Harmon KG, Drezner JA, Gammons M, Guskiewicz KM, Halstead M, Herring SA, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 2013;47:15–26.
  4. Broglio SP, Macciocchi SN, Ferrara MS. Sensitivity of the concussion assessment battery. Neurosurgery. 2007;60:1050–7.
  5. McCrea M, Barr WB, Guskiewicz K, Randolph C, Marshall SW, Cantu R, et al. Standard regression-based methods for measuring recovery after sport-related concussion. J Int Neuropsychol Soc.2005;11:58–69.
  6. Putukian M, Echemendia R, Dettwiler-Danspeckgruber A, Duliba T, Bruce J, Furtado JL, et al. Prospective clinical assessment using sideline concussion assessment tool-2 testing in the evaluation of sport-related concussion in college athletes. Clin J Sport Med. 2015;25:36–42.
  7. Register-Mihalik JK, Guskiewicz KM, Mihalik JP, Schmidt JD, Kerr ZY, McCrea MA. Reliable change, sensitivity, and speci ficity of a multidimensional concussion assessment battery. J Head Trauma Rehabil. 2013;28:274–83.
  8. Resch JE, Brown CN, Schmidt J, Macciocchi SN, Blueitt D, Cullum CM, et al. The sensitivity and specificity of clinical measures of sport concussion: three tests are better than one. BMJ Open Sport Exerc Med. 2016;2:e000012.
  9. Chin EY, Nelson LD, Barr WB, McCrory P, McCrea MA. Reliability and validity of the sport concussion assessment tool-3 (SCAT3) in high school and collegiate athletes. Am J Sports Med. 2016;44:2276–85.
  10. Randolph C. Baseline neuropsychological testing in managing sport-related concussion. Curr Sports Med Rep. 2011;10:21–6.
  11. Schmidt JD, Register-Mihalik JK, Mihalik JP, Kerr ZY, Guskiewicz KM. Identifying impairments after concussion: normative data versus individualized baselines. Med Sci Sports Exerc. 2012;44:1621–8.
  12. Echemendia RJ, Bruce JM, Bailey CM, Sanders JF, Arnett P, Vargas G. The utility of post-concussion neuropsychological data in identifying cognitive change following sports-related MTBI in the absence of baseline data. Clin Neuropsychol. 2012;26:1077–91.
  13. Williamson IJS, Goodman D. Converging evidence for the underreporting of concussions in youth ice hockey. Br J Sports Med. 2006;40:128–32.
  14. Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, et al. The sport concussion assessment tool 5th Edition (SCAT5). Br J Sports Med. 2017;5:1–3.

AFHL all-in on concussion safety with HeadCheck Health

RED DEER - The Alberta Female Hockey League (AFHL) today announced a new agreement with HeadCheck Health, Inc. (HeadCheck) to supply all teams with mobile and web-based technology to follow the league’s concussion protocol and record and share vital information on suspected concussions with medical professionals.

“We’re very pleased to be teaming up with HeadCheck to help solve some of our biggest challenges in concussion safety,” said Kendall Newell, Manager of the AFHL. “Their tech simplifies what’s normally a complicated process and provides our medical professionals with the information they want to make the most informed decisions possible on the welfare of our players.”

“It shows an incredible commitment to player safety on the part of the AFHL to kick off this agreement by bringing all three levels of play onto HeadCheck,” said Harrison Brown, CEO of HeadCheck Health, Inc. “This is just the first step in providing the league with unparalleled visibility into exactly where they can best allocate resources for concussion safety.”

As part of the agreement, all Bantam Elite, Midget Elite, and Midget AAA teams will be able to use HeadCheck beginning with the upcoming season. Team trainers, athletic therapists, and safety personnel can use HeadCheck’s mobile app to document suspected concussions, perform concussion assessments per what is appropriate for their qualifications and transfer the information collected to medical professionals and partner clinics to safely return players to the ice. The platform allows a player’s concussion history to transfer with them from team-to-team or level-to-level for more informed care.

Additionally, HeadCheck is customized to the league’s concussion protocol and provides administrators governance tools and the ability to monitor compliance in real-time. Where needed, HeadCheck will supply teams within the league with contracted athletic therapists to support team staff. HeadCheck is a secure system that meets all top line health privacy standards in Canada and the United States.

About HeadCheck Health, Inc.
HeadCheck is an innovative mobile and web-based platform that gives medical and non-medical personnel the appropriate tools to follow any concussion protocol, integrates all individuals involved in concussion care, and allows the data collected to be analyzed for health and safety improvements. Hundreds of teams across the world from minor through professional sports have adopted the HeadCheck platform including: the CFL, CJHL, BC Hockey, Trek Factory Racing, Volleyball Canada, UBC Athletics, BC Rugby, Eastern Washington University, Rugby Ontario, Western Lacrosse Association, Rugby Quebec, and more. For more information visit https://www.headcheckhealth.com

Media Contacts

Kari Kylo - kari@somaworks.com
604.889.8057


What Is Known About the Psychological and Social Impacts of Sports-Related Concussion in Youth

It is well-known that sports-related concussion (SRC) can produce a variety of physical, cognitive, and emotional symptoms (1-3). In comparison to neurocognitive outcomes of concussion, however, far less is known about the psychological and social consequences of SRC in youth athletes.

The Particular Importance of Understanding This Area for Youth

This is an incredibly important area to explore as youth typically have longer lasting symptoms – 14-20% of youth experience symptoms beyond 3 months and 12% beyond 12 months – which has a direct impact on multiple aspects of daily life including academic and social areas (4-7).

The Current State of Literature is Underwhelming

A review of the current state of literature on the social and psychological impacts of SRC in youth found 6 main domains that youth’s issues and struggles fall under: emotional and social dysfunction, behavioural problems, academic difficulties, sleep disturbance, headache, and quality of life (QoL). Unfortunately, as explored below, the amount of information specific to SRC is underwhelming. Oftentimes, the authors of this study had to extrapolate conclusions based on studies about general mild Traumatic Brain Injury (mTBI) (i.e. not sport-specific mTBI), but even that research leave questions unanswered.

The Six Domains Impacted by SRC

Emotional and Social Dysfunction: Changes in mood are well associated with SRC and it is hypothesized that the biochemical changes that occur after SRC may directly impact mood (8). Yet, there are other factors that also can compound or produce emotional or social disturbances, such as symptoms of SRC (concentration, headaches, sleep disturbance, etc.) and potential frustration or stress-inducing restrictions in sport (9).

Highlighting the prevalence of emotional and social impacts of SRC, one study found that 50% of children with SRC experience emotional symptoms (10). In the same study, poorer psychiatric outcomes was associated with symptom burden at the time of injury as well as post-concussive syndrome (PCS), highlighting the importance of properly managing symptoms right from the start (10). A concerning statistic in this study is that a new or worsening psychiatric disorder occurred in 10% of the group with 25% of those children being left untreated (10). Another interesting find is that in comparison to other injuries, youth with SRC had more pronounced maladaptive coping (11).

Depression: In regards to depression, no SRC-specific studies have examined depression in youth. In saying that, depressive symptoms appear in youth with mTBI but often are at the subclinical level meaning that the child would not be diagnosed with depression. In one study, criteria for major depressive disorder were met by 4-6% of patients with uncomplicated mTBI (12). In another study, youth were 9x more likely to have a new mood diagnosis at 6 months (13). A third study found that youth with mTBI experience greater mood swings and withdrawal – but not necessarily clinical depression – 2 years after concussion (14). These statistics may highlight the fact that healthcare professionals managing concussion cases should be aware of the possibility that depression and other mood disorders may arise – potentially at the subclinical level – and regardless, should be addressed. One reason youth may experience depressive symptoms is that other symptoms and academic or QoL outcomes may produce or exacerbate low mood, suggesting that addressing these areas may help manage or resolve depressive symptoms (15).

Anxiety: Similarly, anxiety-related symptoms have not been explored in pediatric SRC. One study in pediatric mTBI literature suggests that around 10% of youth with mTBI develop “a new anxiety disorder within a year” and another study found that concussed children were “4x more likely to have a new anxiety diagnosis within 6 months” (16, 17). Fortunately in the latter study, in comparison with orthopaedic controls, the anxiety symptoms in mTBI youth were comparable 1 and 2 years later (18,19).

Social Functioning: There is a void of information in this area regarding pediatric SRC. The authors of this literature review suggest “it could be” that an extended disruption in a concussed child’s integration back into school and sports may “temporarily interfere with social relationships at a critical time in personal development.” One study examined uninjured, moderate/severe TBI, and mTBI children, finding that the mTBI group had the poorest social competence (20). These difficulties emerged after 2 years and are likely representative of the fact that children with mTBI receive less support because mTBI is an invisible, and not as severe, head injury in comparison to other traumatic brain injuries (19,21). Social support after traumatic brain injury aids in improving physical health and overall QoL and any negative impacts on social functioning due to concussion should be adequately addressed, but more information is required (22).

Behavioural Problems: Following the trend, there is very little research investigating behavioural disorders following pediatric concussion, sport-related or otherwise. In a New Zealand study, children with a history of mTBI during preschool years were at a greater risk of “attention-deficit/hyperactivity, conduct, or oppositional defiant disorder during adolescence” (23). Once again, this may be as a result of a disruption in the child acquiring behaviour skills during a “critical development period” (23, 24). In saying that, in one study, behavioural problems were either an issue or not present depending on who was asked about child conduct (parent vs. teacher) (25). Regardless, more research on this topic specific to SRC and mTBI generally is necessary.

Academic Difficulties: It is well-known that the symptoms of concussion can have negative impacts in the school environment, such as challenges with learning new material or difficulties concentrating, especially if one returns to school too soon which exacerbates symptoms (26). One study found that 45% of concussed students returned to school too early and suffered from worse symptoms (27, 28). Cognitive rest and slowly returning to school via a step-by-step program is important. Yet, it is important to find a balance between mental rest and activity as cognitive stimulation is important in recovery and there is a concern that the student may suffer from social isolation if withdrawn from school for too long (29).

Sleep Disturbance: Much like cognitive stimulation, it is important to find a balance between too much and too little sleep. Sleeping patterns often change immediately after a concussion -- 33% of concussed youth claimed they slept too much or had troubles sleeping (30, 31). Excessive sleep – identified in one study as longer than 9 hours – was associated with “reduced visual memory, visual motor speed, and reaction time” and prolonged symptoms (32,33). On the other end of the spectrum, sleep difficulties are associated with poorer functional, social, and emotional outcomes ( but these difficulties are not necessarily associated to concussion) (34,35). Sleep is an important restorative measure for the brain after concussive injury and these side-effects should be acknowledged and addressed for the most effective recovery (31, 32, 36, 37).

Headache: Chronic headaches are a common symptom after concussion, reported in more than 90% of high school concussions (31). The prevalence of chronic headache in youth 3 months after injury range from 8%-31% depending on the study (38, 39). Headaches, and pain in general, can have a negative impact on daily activities, mental health, sleep, and personal relationships (40). Interestingly, in one study that looked at post-injury headache in mTBI compared to arm fractures, more concussed females suffered from headache, highlighting that there are differences in concussion symptomatology and severity between males and females (41). More research is required in this area, particularly to understand the prevalence and duration of chronic headache in youth suffering from SRC as well as to understand the transition of acute post-concussion headache to chronic headache pain.

Quality of Life (QoL): The impact concussion has on overall QoL is up for debate. Some studies have found that athletes with greater post concussive symptoms or longer recovery had reduced QoL (42, 43) One study even found that QoL remained “significantly below normative levels even after symptom resolution” in 11% of children at 3 months and 13% at 12 months (44-47). This may be an important finding because it reinforces the idea that just because concussion symptoms are resolved does not mean all of concussion’s effects are resolved. This fact ultimately should have an impact on return to play (RTP) and treatment decisions. On the other hand, there are studies that also have mixed findings (48). Ultimately, QoL impairments seem to be minimal, with symptom burden likely being the cause of a lower QoL (46).

Final Conclusions

Ultimately, more information is required on these topics to fully understand what psychological and social components youth with SRC suffer from as well as to understand how to address these side-effects to most effectively manage concussion and promote recovery. Regardless, for the time being, it could be suggested that medical professionals managing concussion cases consider these 6 areas as potential areas that may be impacting the youth’s recovery.

The original review can be found here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383087/

About The Author

Rebecca Babcock is a recent graduate of the University of Otago in New Zealand, completing a Master’s in Bioethics and Health Law. Her thesis examined the ethical and legal issues surrounding concussion management. She currently spends her time working for the Concussion Legacy Foundation – Canada as a programming coordinator and at Sunnybrook Hospital investigating concussion prevention, management, and education services. Her dream is to be a clinical ethicist at a hospital which she is starting to fulfill by volunteering as a bioethics assistant at Humber River Hospital in Toronto.

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Volleyball Canada becomes first national program to adopt HeadCheck concussion protocol platform

Volleyball Canada becomes first national program to adopt HeadCheck concussion protocol platform

New partnership with HeadCheck Health aims to advance player safety standards across all programs

May 28, 2019 – Volleyball Canada is proud to announce a new partnership with HeadCheck Health, Inc. to bring all national team programs onto an innovative concussion protocol platform. The mobile and web-based technology gives team medical staff tools for following protocols, integrates all those involved in a player’s concussion, and allows the data collected to be analyzed for potential player safety improvements.

"Concussions are a major concern in sport these days and volleyball is no exception. As a national sport organisation, it is important that we are leading in best practices when it comes to the health and safety of our players," said Kerry MacDonald, Director of Sport Science, Sport Medicine & Innovation at Volleyball Canada. "And this partnership with HeadCheck ensures we’re at the forefront of player safety when it relates to concussion."

The partnership will see the Canadian women’s and men’s national indoor, beach and sitting teams use HeadCheck with the platform customized to Volleyball Canada’s concussion protocol. Team medical staff have been trained how to use HeadCheck’s mobile app for baseline and post-injury concussion assessments and have access to comparable data to assist in their clinical judgment. All information collected will be made instantly available to medical professionals to facilitate more informed care programs for the players. Additionally, HeadCheck will regularly provide reporting and meet with Volleyball Canada to review protocols and identify areas for player health and safety improvements.

"We are extremely excited by the opportunity to partner with a national program like Volleyball Canada and show what’s possible when an entire program adopts HeadCheck,” said Harrison Brown, CEO of HeadCheck Health. "We are hopeful this will lead to a wide scale adoption across the country and raise the standard for concussion care at all levels of the sport."

Research that was conducted by Volleyball Canada and presented at the 5th international conference on concussion in sport has shown that over 7% of youth volleyball players sustain a concussion over the course of one season.  57.1% of concussions in volleyball occur from a player getting struck in the head by a ball, while 46.5% of concussions occur during practice. In addition to games and tournaments, Volleyball Canada medical staff will have HeadCheck available on their mobile devices during practices to help log all suspected concussion events.

About Volleyball Canada
Volleyball Canada is the National Sport Organization for volleyball, and has approximately 77,000 registered participants. Volleyball Canada fosters the growth and development of the sport in Canada, and oversees the national programs for indoor, beach and sitting volleyball.  For more information, see www.volleyball.ca

About HeadCheck Health, Inc.
HeadCheck has developed innovative software and services for sports organizations, teams, clinics, and individual practitioners to improve their concussion identification, assessment and management capabilities. The software can be customized to fit the requirements of any concussion policy or protocol. Over 400 teams and organizations deploy HeadCheck as their primary tool for concussion management, including the CJHL, BC Hockey, UBC, Edmonton Oil Kings, BC Rugby, Eastern Washington University, Rugby Ontario, Trek Factory Racing, Shawnigan Lake School, Rugby Quebec and more. For more information visit https://www.headcheckhealth.com

Media Contact:
Kari Kylo - kari@somaworks.com
604.889.8057

Volleyball Canada media contact:
Jackie Skender jskender@volleyball.ca
Mobile: 613-794-7676

Communiqué

Volleyball Canada devient le premier programme national à adopter la plateforme de gestion des commotions cérébrales HeadCheck 

Le nouveau partenariat avec HeadCheck Health vise à améliorer les normes de sécurité pour les joueurs dans tous les programmes.

Volleyball Canada est fière d’annoncer un nouveau partenariat avec HeadCheck Health, Inc. qui permettra à tous les programmes de l’équipe nationale d’accéder à une plateforme novatrice en ce qui concerne les protocoles de soins dans les cas de commotion cérébrale. La technologie mobile et basée sur Internet offre au personnel médical les outils nécessaires pour suivre des protocoles, intégrer toutes les personnes impliquées dans la gestion des commotions cérébrales chez un joueur et permettre la collecte des données à analyser pour améliorer la sécurité des joueurs.

« Les commotions constituent une préoccupation majeure dans le sport ces jours-ci, et le volleyball ne fait pas exception à la règle. À titre d’organisme national de sport, il est important pour nous d’être un chef de file en matière de pratiques exemplaires lorsqu’il s’agit de la santé et de la sécurité de nos joueurs », déclare Kerry MacDonald, directeur, Science et médecine du sport et Innovation de Volleyball Canada. Et ce partenariat avec HeadCheck nous placera à l’avant-garde de la sécurité des joueurs en ce qui concerne les commotions cérébrales. »

Ce partenariat verra les équipes canadiennes féminines et masculines de volleyball intérieur, de volleyball de plage et de volleyball assis utiliser la plateforme HeadCheck adaptée aux protocoles de gestion des commotions cérébrales de Volleyball Canada. Le personnel médical de l’équipe a été formé à l’utilisation de l’application mobile de HeadCheck pour l’évaluation initiale des commotions, ainsi que l’évaluation après une blessure et aura accès à des données comparables pour l’aider dans son jugement clinique. Toute l’information collectée sera mise immédiatement à la disposition des professionnels de la santé afin de favoriser l’élaboration de programmes de soins beaucoup plus informés pour les joueurs. De plus, HeadCheck communiquera régulièrement des rapports à Volleyball Canada en plus de participer à des rencontres avec l’organisation pour passer en revue les protocoles et déterminer les éléments à améliorer en ce qui a trait à la santé et la sécurité des joueurs.

« Nous sommes ravis de l’occasion qui nous est offerte de travailler en partenariat avec un programme national comme Volleyball Canada et de montrer ce qu’il est possible de réaliser lorsqu’un programme adopte HeadCheck », ajoute Harrison Brown, chef de la direction de HeadCheck Health. « Nous espérons que ce partenariat débouchera sur une adoption à grande échelle de la plateforme, partout au pays, et contribuera à élever les normes en matière de traitement des commotions cérébrales à tous les niveaux du sport. »

La recherche qui a été menée par Volleyball Canada et présentée à la 5e conférence internationale sur les commotions cérébrales dans le sport a démontré que plus de 7 % de jeunes joueurs de volleyball subissaient une commotion au cours d’une saison. Dans le volleyball, 57,1 % des commotions sont causées lorsque le ballon frappe les joueurs à la tête, tandis que 46,5 % des concussions surviennent pendant les entraînements. En plus des matchs et des tournois, les membres du personnel médical de Volleyball Canada auront accès à HeadCheck sur leurs appareils mobiles pendant les pratiques afin d’aider à enregistrer tous les cas suspectés de commotion cérébrale.

À propos de Volleyball Canada
Volleyball Canada est l’organisme national de sport responsable du volleyball avec environ 77 000 participants inscrits. Volleyball Canada sou tient la croissance et le développement du sport au Canada et supervise les programmes nationaux de volleyball intérieur, de volleyball de plage et de volleyball assis. Pour de plus amples renseignements, consultez www.volleyball.ca

À propos de HeadCheck Health, Inc.
HeadCheck a développé un logiciel et des services novateurs pour les organismes de sport, les équipes, les cliniques et les praticiens pour les aider à améliorer leurs capacités en matière d’identification, d’évaluation et de gestion des commotions cérébrales. Le logiciel peut être adapté pour répondre aux exigences de toute politique et de tout protocole.  Plus de 400 équipes et organisations ont fait le choix de HeadCheck en tant que principal outil de gestion des commotions cérébrales, y compris la CJHL, BC Hockey, l’UBC, les Oil Kings d’Edmonton, BC Rugby, l’Université Eastern Washington, Rugby Ontario, Trek Factory Racing, la Shawnigan Lake School, Rugby Québec pour ne citer que ceux-là. Pour plus d’information, visitez le https://www.headcheckhealth.com

Personne-ressource pour les médias :
Kari Kylo - kari@somaworks.com
604.889.8057

Volleyball Canada
Jackie Skender
jskender@volleyball.ca
Cell. : 613-794-7676


Moving to 7-Day Disabled List Improves Major League Baseball Concussion Reporting

Major League Baseball’s (MLB) change from a concussion-specific mandatory 15-day disabled list (DL) rule to a 7-day DL rule in 2011 seemingly has improved concussion reporting amongst the league’s athletes.

Study’s Statistics

This study, published in The Orthopaedic Journal of Sports Medicine, examined 112 players between 2005-2016. The average number of concussions increased from 3.7 concussions/year prior to 2011 when the mandatory 15-day DL was enforced to 13.0 concussions/year after the mandatory 7-day DL rule was implemented.

The Importance

There are numerous benefits of this increased reporting of concussion. Most generally, concussion is traditionally underreported and increasing reporting rates is an important improvement in the area of concussion management. More specifically, given the potential harms of inadequately diagnosed and managed concussions, increased reporting and subsequent concussion care benefits the injured player’s health. Specifically to baseball, since a professional baseball player’s career trajectory significantly changes for the worse if a concussion is left unreported, increased reporting and subsequent appropriate concussion care is beneficial for both player and team success.

While concussions are prominent topics in sport leagues such as the National Football League (NFL) and National Hockey League (NHL), baseball is often overlooked. Thus, this study provides valuable insight into concussion identification and management trends in professional baseball. In fact, this study examined which positions had the highest rates of concussion. The top three positions were outfielders (34%), catchers (33%), and infielders (20%) followed by pitchers (8%) and basemen (4%). Pitchers however, had the highest number of days on the DL as well as the highest concussion-associated costs, followed by fielders and catchers.

Financial Benefits

This study also examined the total cost of the player’s injury to the team. The cost per concussed player before 2011 was $1.1 million and that total decreased to $565,000 after the 7-day DL rule change. This decreased cost occurred despite an increase in reported incidents of concussion and an increase in player salaries. This decrease may be partially explained by the decreased average number of days that concussed athletes spend on the DL (from 38.8 days during the 15-day DL rule to 29.2 during the 7-day DL rule) although the study did not speculate as to why the total cost of an injured player to a team decreased by almost 50%.

Cause for Concern

Many studies and concussion protocols, including this one, cite the fact that most concussions typically resolve between 7-10 days [1][2]. The most recent protocols and guidelines however, state that concussions resolve anywhere from 10-14 days to 4 weeks (the latter time period being most relevant for youth) [3][4]. It is thus initially concerning that the MLB reduced the mandatory sit-out period from 15 days to 7 days which may mean players are returning to play too early.

There are two pieces of evidence that may suggest there is no need for worry. First, this study examined average performance metrics between injured players before and after the 2011 rule change – including earned run average, walks plus hits per inning pitched, batting average, and on-base percentage – and found that there were no significant differences. This means that players before and after the 2011 rule were returning to the game at a similar skill level. It would be important and more valuable however, to examine the performance metrics of the specific injured player before and after his concussion to truly assess whether the player is returning at an appropriate time or too early.

Second, the fact that the average number of days an athlete stayed on the DL after a concussion decreased from 38.1 to 29.2 after 2011 but remained around the 4 week mark suggests that players still are taking significant time off to appropriately recover. In short, simply because the rule mandates a 7-day sit-out period does not mean that immediately after 7 days the player is back on the field.

Conclusion

Ultimately, one cannot conclude that the 7-day DL rule increased the reporting rates of concussion amongst MLB athletes as the trend may be attributable to a general increase in awareness and understanding of concussive injuries which positively correlates with increased reporting [5]. However, it can be said that decreasing the mandatory days on the DL from 15-days to 7-days creates an environment where MLB athletes may be more likely to report concussions. This change is beneficial both physically and financially.

The full study can be read here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383093/

About The Author

Rebecca Babcock is a recent graduate of the University of Otago in New Zealand, completing a Master’s in Bioethics and Health Law. Her thesis examined the ethical and legal issues surrounding concussion management. She currently spends her time working for the Concussion Legacy Foundation – Canada as a programming coordinator and at Sunnybrook Hospital investigating concussion prevention, management, and education services. Her dream is to be a clinical ethicist at a hospital which she is starting to fulfill by volunteering as a bioethics assistant at Humber River Hospital in Toronto.

References

  1. Belanger HG, Vanderploeg RD. The neuropsychological impact of sports-related concussion: a meta-analysis. J Int Neuropsychol Soc. 2005;11(4):345-357.
  2. Karr JE, Areshenkoff CN, Garcia-Barrera MA. The neuropsychological outcomes of concussion: a systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury. Neuropsychology. 2014;28(3):321-336.
  3. “Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms.” Ontario Neurotrauma Foundation, 6 July 2018, www.braininjuryguidelines.org/concussion.
  4. McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5thinternational conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017;51:838-847.
  5. Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among United States high school and collegiate athletes. J Athl Train. 2007;42(4):495-503.

 


Increase in Diagnosed Concussions Following Mandated Concussion Policy

Study shows there is still room for improvement in documenting suspected concussions.

A study examining the effect of Ontario’s Policy/Program Memorandum #158 (PPM #158) – a policy requiring each publicly funded school board in the province to create and implement a concussion policy – has found that there has been a 30% increase in diagnosed concussions in school children after policy was implemented.[1]

Comparing Trends

The study, published in the November 2018 issue of BMC Public Health, examined 21,094 head injuries in youth aged 4-18 between 2009-2016 from five hospitals across Ontario. The purpose being to compare trends of the 8,935 diagnosed and 12,159 suspected concussions in youth before and after PPM #158 was established in March 2014.

In the 5 years prior to PPM #158, the average number of diagnosed concussions in school children was 89 concussions/month. That number increased to 117 diagnosed concussions/month after the policy was established. Similarly, there was an “almost twofold” increase in the number of diagnosed concussions where the concussion-inducing incident happened at school. Before March 2014, school-incurred concussions accounted for 28% of all diagnosed concussions. This rate increased to almost 50% in 2016. The most common places of injury at school were the playground (24%), gymnasium (22%), or sports field (20%).

The Gender Equation

Finally, there was also an increase of diagnosed concussions in females, growing from 38% in 2013 to 46% in 2016 after PPM #158. This increase in the number of confirmed concussions in women is important.[2] Some studies have suggested that female head injuries are more often overlooked despite the fact that women may receive more concussions – with longer recoveries – than their male counterparts.[3],[4],[5],[6],[7]

Is the policy truly effective?

It is important to note that the total number of identified head injuries (comprising of both suspected and diagnosed concussions) did not increase after the policy. Given the trends of under-reporting for concussion, this circumstance raises questions as to whether PPM # 158 was indeed effective at increasing concussion awareness and reporting at schools. In fact, the increase in only diagnosed concussions may suggest that there was an improvement in emergency department doctors’ knowledge and confidence in diagnosing concussion – an increase that would be unrelated to the policy.

More Research and More Policies

The study concludes that “ongoing research into the effectiveness of PPM 158 in terms of prevention of concussions and student, teacher, and parental awareness is required.” This call for research should also extend to examining the effectiveness of the Ontario government’s latest concussion safety bill: Bill 193, Rowan’s Law (Concussion Safety), 2018. Further research will help support the direction of changes made to concussion policy and legislation in Ontario as well as push other provinces to develop and implement effective concussion policy and legislation.

You can read the full study here: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6232-9

About The Author

Rebecca Babcock is a recent graduate of the University of Otago in New Zealand, completing a Master’s in Bioethics and Health Law. Her thesis examined the ethical and legal issues surrounding concussion management. She currently spends her time working for the Concussion Legacy Foundation – Canada as a programming coordinator and at Sunnybrook Hospital investigating concussion prevention, management, and education services. Her dream is to be a clinical ethicist at a hospital which she is starting to fulfill by volunteering as a bioethics assistant at Humber River Hospital in Toronto.

 

Footnotes

[1] Ministry of Education of Ontario. Policy/Program memorandum no. 158. 2014. http://www.edu.gov.on.ca/extra/eng/ppm/158.pdf. Accessed 9 Feb 2017.

[2] Zhang AL, et al. The rise of concussions in the adolescent population. Orthopaedic journal of sports medicine. 2016;4(8):2325967116662458.

[3] Snyder M. Girls Suffer Sports Concussions at a Higher Rate than Boys. Why Is That Overlooked? The Washington Post. 2015. https://www.washingtonpost.com/posteverything/wp/2015/02/10/our-effort-to-reduce-concussions-inyouth-sports-overlooks-the-biggest-victims-girls/?utm_term=.29b684e6a9a9.Accessed 14 Feb 2017.

[4] Abrahams S, et al. Risk factors for sports concussion: an evidence-based systematic review. Br J Sports Med. 2014;48(2):91–7.

[5] Schallmo MS, Joseph AW, Wellington KH. Sport and sex-specific reporting trends in the epidemiology of concussions sustained by high school athletes. JBJS. 2017;99(15):1314–20.

[6]Resch JE, et al. Sport concussion and the female athlete. Clin Sports Med. 2017;36(4):717–39.

[7] Covassin T, Moran R, Elbin RJ. Sex differences in reported concussion injury rates and time loss from participation: an update of the National Collegiate Athletic Association Injury Surveillance Program from 2004–2005 through 2008–2009. J Athl Train. 2016;51(3):189–94.


Faster recovery from concussion following immediate removal from play

Getting off the field is key to getting athletes back in the game

A recent study out of the University of Florida confirmed the importance of immediately removing athletes from play after they have suffered a sports-related concussion.

Shorter symptoms and quicker return to play

The study, which looked at more than 500 athletes across 18 different sports, showed that immediate removal from sport not only reduced the number of days that the athlete experienced symptoms but it also resulted in quicker return to play. According to the report, student-athletes immediately removed from activity experienced symptoms for two days less— and were able to return to play three days earlier— than their peers who experienced a delayed removal from activities.  The data also suggests that immediate removal may lessen the severity of acute symptoms.[i]

These findings echo previous research, adding weight to current management practices that require athletes suspected of having a concussion be immediately removed from play.[ii] For those working with adolescents, immediate removal from play may be even more important—one study showed that adolescents immediately removed from activity returned to play 22 days earlier than their peers who were not.[iii]

The right rest

Multiple studies show that immediate rest is key, but this study suggests that too much rest may not be the best approach. While there is a consensus that 24-48 hours of rest immediately after sustaining a concussion is crucial to a speedy recovery, prolonged rest may increase the risk of an extended recovery. [iv] Instead, properly timed physical activity could improve outcomes. [v] Researchers believe physical activity may encourage better outcomes by increasing the brain’s uptake of proteins associated with healing and neural repair and could speed up a return to homeostasis.[vi]

Catch it when you can

Despite the strong evidence that immediate removal is essential, as many as 50% of athletes are delayed in being removed from sport after sustaining a concussion.[vii] It’s unlikely that all of these delays are simply caused by a failure to report or non-compliance with concussion guidelines. In this study, a high proportion of those who were not immediately removed from sport were people who experienced delayed symptom onset— helping to explain why so many athletes continue to play after the impact responsible for the concussion.

Unfortunately, not every concussion is immediately detectable. Still, as soon as symptoms are noticed, it is time to get off the field immediately. Mounting data shows that removal from play at the time of symptom onset— even if that is after the impact that caused the concussion— gives the best chance of avoiding a prolonged recovery. [viii]

Further to go

There have been great strides in the recognition and reporting of sports-related industries over the last two decades, but there is still a long way to go. Too many athletes are still not immediately removed from play.

This study, like several before it, highlights the importance of educating athletes, coaches, and trainers on how to identify symptoms and the importance of immediate removal from play—it’s what is best for recovery, and the fastest way to get athletes back in the game.

 

 

References

[i] Asken, B. M., Bauer, R. M., Guskiewicz, K. M., McCrea, M. A., Schmidt, J. D., Giza, C. C., ... & Broglio, S. P. (2018). Immediate removal from activity after sport-related concussion is associated with shorter clinical recovery and less severe symptoms in collegiate student-athletes. The American journal of sports medicine46(6), 1465-1474.

[ii] Asken BM, McCrea MA, Clugston JR, Snyder AR, Houck ZM, Bauer RM. “Playing through it”: delayed reporting and removal from athletic activity after concussion predicts prolonged recovery.  J Athi Train. 20016; 51(4):329-335.

[iii] Elbin R. Sufrinko A, Schatz, et al. Removal from play after concussion and recovery time. Pediatrics. 2016; 183(3):e20160910

[iv]  McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016 [published online April 26, 2017]. Br J Sports Med. Doi: 10, 1136/bjsports-2017-097699

[v] Silverberg ND, Iverson GL. Is rest after concussion “the best medicine?” Recommendations for activity resumption following concussion in athletes, civilians, and military service members.  J Head Trauma Rehabil. 2013 28(4) 250-259

[vi] Griesbach GS, Hovda D, Molteni R, Wu A, Gomez-Pinilla F. Voluntary exercise following traumatic brain injury: brain-derived neurotrophic factor upregulation and recovery of function, Neuroscience. 2005; 125(1):129-139.

[vii] Asken (2016).

[viii] Asken (2018).