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Category: Concussions in sports
Concussions: The neurosurgeon’s role and the current scientific evidence and management strategies.
Posted 10 February 2013 by prehab
Neurosurgeons often manage patients with extracranial injuries that have concomitant concussions. In these cases, neurosurgeons are often the only “concussion experts” that patients encounter.
In recent decades, concussions have received unprecedented attention from the scientific community. The definition of the term has become more refined, and epidemiological data have revealed how remarkably common the injury is.
A neurosurgeon’s intimate knowledge of various head injuries from similar mechanisms gives a distinct advantage in the ability to educate athletes about the possible consequences of their injury. In the past, involvement in concussion management has been less than that of trainers, sports medicine physicians, rehabilitation specialists or other primary care providers. This is mostly attributable to the limited supply of neurosurgeons and the mostly non-surgical pathology of concussions.
Neurosurgeons are limited in number but critical in their knowledge when complication arises. They can provide a solid foundation for those that do provide “frontline” care and be willing to provide assistance and insight whenever consulted. A few neurosurgeons however, have already taken the initiative and are getting more and more involved such as Dr. Tanvir Choudhri, MD or some one like Dr.Robert Cantu, MD who already leads on the frontline role of dealing with concussions. Read more about the role of Neurosurgeons in this, in-depth, study published by Surgical Neurology International.
Sports Concussions Detectable by Changes in Cerebral Blood flow.
Posted 9 February 2013 by prehab
Pediatric SRC (sports related concussions) is primarily a physiologic injury, affecting CBF significantly without evidence of measurable structural, metabolic neuronal or axonal injury.
In a recent study investigating changes in intracranial blood concluded that blood flow decreased post injury and improvements toward control values occurred in only 27% of the participants at 14 days and 64% at .30 days after SRC. The significance of this finding may help healthcare providers closer to finding more accurate testing methods for concussions, quantifiable information to detect severity, speed of recovery and safety. Something Harvard may want to get the hands into with the recent 100Mil NFL donation for their research purposes. See full Study. GE is also working on devices that may assist on improving imaging that may be sensitive to concussions.
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
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
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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