Posts Tagged ‘concussion management’

A Look into Concussion Protocols

Wednesday, March 15th, 2017

Posted March 15, 2017

Nicole T. Wasylyk
MSEd, LAT, ATC

By Nicole T. Wasylyk, MSEd, LAT, ATC

Preventing, identifying and managing sport-related concussions (SRC) continues to be a challenge for both healthcare professionals and for patients. The complexity in management of SRC may be mitigated by adopting solid policies and procedures to follow for those involved with concussion care. Best practice for concussion management encourages all high schools, colleges, club and professional sports to have policies in place regarding SRCs.

Both the National Hockey League (NHL) and National Football League (NFL) have accepted policies1,2 with the NHL adopting a new mandatory protocol this season. The purpose of the protocols is to educate players and provide guidelines for identifying and managing sports-related concussions. It has been well publicized that both the NHL and NFL face litigation from former players accusing the leagues of failing to protect them from concussions and head injuries. They also allege the withholding of information about long-term effects of concussions.3,4 These new protocols may achieve improved player education, prevention and recognition of concussion.

At their core the protocols are very similar; the NHL and NFL reference the Zurich II Consensus Statement from 2012 to define concussion as a “brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces.”5 The NHL’s protocol specifically states that all players must watch an educational video and received a brochure of the information prior to the first day of training camp. All players are also required to complete baseline concussion testing, a well-adopted best practice for all contact sport athletes. Players complete both the SCAT3 and ImPACT® Test, core components of baseline testing.

The protocols both take into account thoughtful details regarding baseline and follow-up concussion testing. For example, they recognize the importance of an appropriate baseline testing setting.  Baseline testing environment and timing of the test (not immediately after physical exertion) should be considered carefully.  It is crucial for these tests to be completed in an environment where a player has minimal distractions to ensure validity of these tests.

As both protocols describe baseline testing, they also describe recognition of sports-related concussion during game play and on-field management. Signs and symptoms of concussion are mentioned in detail along with the way each league monitors for concussions. During gameplay, the NHL utilizes 2 types of spotters or individuals who monitor game play for potential athletes who may have sustained a head injury.

The first type is a Central League Spotter described as an Athletic Trainer (AT) or athletic therapist who observes the games via multiple live game feeds in the NHL offices. The second is an In-Arena League Spotter described as an Off-Ice Official who observes the game live in the arena. If either spotter suspects a player has sustained a concussion the player is then taken off ice and assessed by the club’s medical personal as described in the protocol. In contrast, the NFL only describes a Booth Athletic Trainer; this individual serves as the spotter similar to the Central League Spotter for the NHL.

If an NFL player is suspected of having a concussion during a game, they are removed from play and assessed as described by the “Madden Rule.” This rule states that the player must be removed from the field and evaluated in the locker room area by medical personal. If medical staff concludes a concussion was sustained that player is not permitted to return to play the same day. If no concussion is suspected, then video of the game play must be reviewed to remove any doubt of head injury prior to allowing the player to return to participation. The NHL describes assessment similar to the NFL’s “Madden Rule.” Return to play progression is also outlined in both protocols and both leagues encourage a multidisciplinary team approach to treatment. The medical teams are comprised of either a neurotrauma consultant or neuropsychologist along with the team medical doctors and ATs.

These concussion protocols serve as a comprehensive approach to education, diagnosis and management of sports related concussions. It is important that a transparent policy is adopted as a part of best practice so players, coaches, medical staff and officials understand not only the actions to take to protect athletes but expectations surrounding concussion recognition, management and return to sport.

References

1.https://images.nflplayers.com/mediaResources/lyris/pdfs/NFL_Diagnosis_Mgmt_Concussion.pdf

2.https://nhl.bamcontent.com/images/assets/binary/282574512/binary-file/file.pdf

3.http://www.cbsnews.com/news/supreme-court-rejects-former-players-challenge-1-billion-nfl-concussion-settlement/

4.https://www.boston.com/sports/boston-bruins/2016/02/06/105-former-nhl-players-are-plaintiffs-in-class-action-concussion-lawsuit-against-league

5.http://bjsm.bmj.com/content/47/5/250.full

 

Resources

https://www.nata.org/sites/default/files/Concussion_Management_Position_Statement.pdf

http://www.bocatc.org/blog/athletic-trainers-in-the-news/concussion-baseline-assessments-what-should-clinicians-capture/

About the Author

Nicole Wasylyk works as an Athletic Trainer in a physician practice at Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, New Hampshire. Prior to DHMC she resided in Madison, Wisconsin and was an Athletic Trainer in a physician practice at Meriter-Unity Point Health. Wasylyk obtained her Bachelor of Science in Athletic Training from Boston University and Masters of Science in Education from Old Dominion University. She has completed a residency program for healthcare providers who extend the services of a physician at UW Health. Wasylyk also obtained her orthopedic technician certification. Her professional interests include injury surveillance and prevention, standardization of best practices and patient reported outcomes collection. 

 

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Discussion and Research on Concussion Management

Thursday, October 6th, 2016

Posted October 6, 2016

Diane Sartanowicz,
MS, LAT, ATC

By Diane Sartanowicz, MS, LAT, ATC

With the start of the fall athletic season, much has been written about concussions. In the news and media, concussions are referred to as a public health crisis due to the increase in the number of diagnosed cases.  As Athletic Trainers (ATs), we are called upon as experts in the field of concussion management and are driving the research and discussion around this very hot topic. So why are there so many unanswered questions?

Some of it has to do with the definition of a concussion. The term concussion (or commotio cerebri) has been used for centuries to imply “a transient loss or alteration of consciousness without associated structural damage.”1 It is also known as a mild traumatic brain injury (mTBI) and can cause a variety of physical, cognitive and emotional symptoms. In recent years, concussion has been used most frequently in reference to sport-related head trauma.

Along with the struggle to come to a unified definition of concussion, another set of questions relates to the diagnosis of a concussion and the reporting rates. An estimated 1.7 million concussions occur each year in the United States as a result of sport and physical activity, and of those, 80 percent  are seen in an emergency room department. These numbers are staggering when almost half a million visits for mTBI are made annually by children aged 0 to 14 years.2  Many more concussed youth seek treatment through physicians’ offices or not at all.  So are these statistics accurate? We need to understand exactly what we are diagnosing in order to collect and track the data. Education on the signs and symptoms of a concussion is the key to successful outcomes for the athlete.

As a consequence of the multi-faceted issues facing youth sports concussions, programs like the Massachusetts Concussion Management Coalition (MCMC) are being established to address this issue.  MCMC is a group of individual stakeholders who are dedicated to the health and safety of our student-athletes. The broad range of groups like the Massachusetts Interscholastic Athletic Association (MIAA), Massachusetts School Nurse Organization, Athletic Trainers of Massachusetts (ATOM), Department of Public Health and the Brain Injury Center of Boston Children’s Hospital are represented and their top priority is to prevent and manage concussions.

MCMC is a pioneer in concussion research and education outreach bringing everyone together to collaborate on the best way to tackle the many issues surrounding concussions. Due to the generous funding by the NHL Alumni Foundation, MCMC has been able to provide free ImPACT™ neurocognitive testing to all MIAA member schools that enroll in the program. Along with the free testing, MCMC provides secondary schools with concussion education presentations to their communities. It is our goal to ensure tools are readily available for all secondary schools to be knowledgeable in the recognition, management and treatment of concussions. We hope to create a legacy of concussion education in the Commonwealth of Massachusetts which reflects these goals. For more information on our program or how to get involved, please visit our website at www.massconcussion.org.

As I write this blog, we have just completed a successful Concussion Awareness Week in Massachusetts. It is through the collaborative efforts of the Think Taylor Foundation and the MIAA that 86,000 student-athletes have become more engaged in the discussions surrounding concussions. Think Taylor was founded by Taylor Twellman, star forward for the New England Revolution soccer team. His career-ending concussion left him seeking answers and wanting to make an impact on the lives of student-athletes.

During Concussion Awareness Week, all student-athletes were encouraged to turn their school orange, the color of healing, and to take the TT Pledge. This pledge states, “I will become more educated on the signs and symptoms of concussions, I will be honest with my coaches, and Athletic Trainers, parents and teammates, and that I will be supportive of anyone with a concussion.” These 3 words – education, honesty, support – are what ATs embody every day. Our combined efforts lead the way to increased awareness and expanded concussion education across the state. I would encourage each of you to get involved in a movement like ours.

Resources

1 Charles H. Tator. Concussions and their consequences: current diagnosis, management and prevention, CMAJ. 2013 Aug 6; 185(11): 975–979

2 Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.

About the Author 

Diane Sartanowicz, MS, LAT, ATC is the Director of the MCMC.  She was president of ATOM from 2006-2008, past-president of Eastern Athletic Trainers’ Association from 2011-2012 and is currently the NATA District One Treasurer.