Month: January 2013

Va. House panel rejects youth sports concussions bill

Posted 28 January 2013 by prehab

Under the proposal, Del. Rich Anderson, R-Prince William County, coaches and employees would have had to complete annual training on concussions. School divisions and youth sports organizations also would have had to provide concussion information to parents and develop procedures for recognizing concussion symptoms and ensuring athletes who suffer those head injuries receiving medical clearance before returning to the field. HB1719

In the current law, passed in 2010 requires the Board of Education to develop guidelines for “concussion education, awareness, and management” for public school athletes and expanded the code to include sports groups that use public property.

Read the proposal

 

 

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“Asymptomatic”; Subjective but key to safety post concussion.

Posted 20 January 2013 by prehab

“Asymptomatic; is a state that concussed athletes need to demonstrate before they are accepted back to competitive play”, According to Dr. Alex Gometz, DPT, CIC, who discussed the issue with concerned  pediatricians at Park Avenue Pediatrics in NYC, last week. In order to prevent exposure to catastrophic injury, there should be a clear medical team agreement on the athlete safety before he is exposed to the possibility of another injury. There has been hundreds of examples of “concussions gone wrong”, on TV ads and YouTube videos in the past few years that has hit to close to home.

As echoed in a recent statement by the American Medical Society for Sports Medicine (AMSSM), an athlete with a concussion should not return to practice or competitive play until all symptoms have resolved. The statement was published in the January issue of the Clinical Journal of Sport Medicine and headed by Dr. Kimberly Harmon, MD. The report provides an evidence-based, best practices summary to assist physicians with the evaluation and management of sports concussion.

To ensure safety, Dr. Gometz advises that the developing brain has to return to a pre-injury state of homeostasis demonstrated at rest during a thorough review with their pediatrician. Secondly athletes should follow a carefully tailored exertion-infused rehabilitation program by Concussion Management of New York. There is a proven period of increased vulnerability, post injury. No game is worth risking the catastrophic consequences of repeated trauma in a poor state of metabolic ability to sustain injury.

The state of concussions in the country has now alarmed the stablished sports dominant institutions but prompted government to investigate methods of standardization of assessment and treatment. Recently, the Institute of Medicine (IOM) has formed a committee to study sports-related concussion in youth from elementary school through young adulthood. The committee held its first meeting on January 7.

According to the IOM Web site, the committee will review the available literature on concussions, in the context of developmental neurobiology, in terms of their causes, relationships to hits to the head or body during sports, and the effectiveness of protective devices and equipment. You can read the full statement by the AMSSM here.

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Correlation between nonuse of bicycle helmets and risk of fatal head injury

Posted 17 January 2013 by prehab

Not wearing a helmet while cycling is associated with an increased risk of sustaining a fatal head injury. Policy changes and educational programs that increase the use of helmets while cycling may prevent deaths.

Policies and campaigns that promote helmet use may decrease cycling mortality, which contributes substantially to mortality among young adults worldwide. Concomitant educational programs and public awareness campaigns may account for some of the positive effects of enacting helmet legislation. Cyclists less than 18 years of age are required by law to wear a helmet in Ontario. That 88% of decedents in our study were older than 18 years (and 18% were > 60 yr) suggests a gap in public policy. Full study report published in CAMJ

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Poor Reliability of Concussion History in Athletes

Posted 15 January 2013 by prehab

Recent research has explored the long-term neurodegenerative effects associated with recurrent concussion in athletes. Findings from a number of former professional football players found that the number of concussions sustained during their professional careers was associated with the rate of diagnosed clinical depression and late-life cognitive impairment. A limitation of these studies was the use of a self-reported history of concussion.

Imperfect recall can generate bias in studies when the proportion of events recalled is associated with the health end points of interest (such as neurodementia or depression). Associations observed in these studies may be inaccurate if athletes differ in their knowledge and recognition of concussion symptomatology in a manner that is associated with the health outcome of interest. Taking depression as an example, if depressed athletes tend to overreport their concussions (or if nondepressed athletes tend to underreport their concussions), then the association between concussion and depression observed in these studies might be due to bias. Without data about the reliability of concussion self-report, there will always be a concern that the observed association between concussion and neurodementia/depression could be due to differential recall bias. Here is a copy of the abstract published in Med Sci Sports Exercise in 2012

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Concussed athletes may require extended recuperation time before full recovery, study finds.

Posted 12 January 2013 by prehab

Young athletes may need a longer period of time to recover well after a concussion than previously believed, according to a study recently published in Medicine & Science in Sports & Exercise. Researches from the University of Oregon Department of Human Physiology examined the attention and executive function of 20 athletes measured against  a 20 person control group. Among their findings, concussed participants showed significant impairment on executive function 2 months after injury. The conclusions suggest that athletes should be evaluated for executive function post injury before returned to sports. Dr. Alex Gometz, DPT at Concussion management of NY suggests constant supervision and constant periodical neurocognitive testing before returning to sports and an exertion program. New data available suggests athletes are returning to sports before they are completely safe and should be allowed extended periods of rest for proper healing.  Read complete study details. 

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Escalating trend in sports concussions

Posted 8 January 2013 by prehab

Escalating trend in documented concussions due to improvements in the detection and clinical management of concussion says the NCAA. Concussion rates in football had been escalating over a 21-year period beginning in the early 1980s. But the trend stabilized in recent years, becoming relatively flat from 2004-12. NCAA Director of Health and Safety David Klossner said the reasons for the previous escalating trend are not well documented but could be due to multiple factors, including improvements in the detection and clinical management of concussion. Read the full article.

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CT scans at the ER may triple the risk of leukemia in children.

Posted 7 January 2013 by prehab

New research indicates that CT scans pose potential cancer risks to children. The study was funded by the U.S. National Cancer Institute and the U.K. Department of Health, was published online in the Lancet today. CT scans pose potential cancer risks from associated ionizing radiation, especially if he or she had a previous scan.

Researchers said the use of CT scans in children to deliver cumulative doses of about 50 mGy might almost triple the risk of leukemia, and doses of about 60 mGy might triple the risk of brain cancer. Because these cancers are relatively rare, the cumulative absolute risks are small: In the 10 years after the first scan for patients younger than age 10, one excess case of leukemia and one excess case of brain tumor per 10,000 head CT scans is estimated to occur. Clinical benefits should outweigh the small absolute risks, but radiation doses from CT scans ought to be kept as low as possible, and alternative procedures that do not involve ionizing radiation should be considered.

For information about certified baseline concussion testing for young athletes contact us at Concussion Management of New York. At: baseline@cmofny.com

Read the publication by Lancet and more details about the study.

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The use of general anti-inflammatory drugs will not serve as a “magic bullet” for this silent epidemic.

Posted 1 January 2013 by prehab

There is no “magic bullet” when it comes to treating concussions with anti-inflammatory medication. Medications are not the first line of treatment for concussions. Even though a good option when complications expected or in the case of protracted recovery, not all cases respond well and like with any other injury, every patient responds differently. Rather, it seems that a tailored array of pro- and anti-inflammatory compounds given at particular temporal intervals will likely be implemented given the complexity of the inflammatory response to concussion. Treatments will likely differ based on severity of brain injury, age of the patient, and previous history of brain injury. Read the full article published on Frontiers in Cellular Neuroscience. Understanding the neuroinflammatory response following concussion to develop treatment strategies

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