Monday, August 2, 2010

ATSNJ Concussion Summit

Kudos once again to Eric Nussbaum ATC for once again putting together a great seminar.  These are notes from Dr. Rober Cantu's presentation, and the roundtable discussion which followed:

-VERY important the athlete is permitted appropriate time for healing to take place.
-There is no set number of concussions that is a disqualification for further participation in contact sports.
-2 man wedge tackling, blindside hits rule changes in American football are in order.
-No way to predict CTE in a live person; lawyers should not be driving decision making.
-Concussion accounts for 6-10% of all athletic injuries.  The reported ones are just the tip of the iceberg.  Subconcussive blows and their effect is an unknown factor.
-Loss of consciousness is not a good indicator of degree of brain injury.
-You don't need to grade a concussion to manage them efficiently.
-Time to recovery is a good indicator for risk in subsequent concussions.
-When a player shows any symptoms of concussion, they should discontinue participation at least for that day.
-The cornerstone of concussion management is physical and cognitive rest until symptoms resolve.
-Prolonged post concussion syndrome (1m+) is usually associated with playing with a pevious head injury prior to the concussion.
-Concussion Research- Journal of Neural Trauma:
-Many concussions occur at lower force, 60G's and below.  The new NFL helmet recommendations are suspect because they involved testing at higher G's.  Head and spine biomechanist specialists were not used in the study.
-Since every concussion is different, is legislating concussion guidelines a good idea?


KP said...

The only positive about concussion legislation is that is bringing the issue to the forefront of the discussion around youth sports.

Jonathan said...

Although not useful in our day to day assessment and management of concussions but my favorites from the day were the talks with Dr. Barry Jordan and how the ApoE e4 gene leaves you more susceptible to CTE and Dr. Anne McKee's stuff on tau protein buildup and brain malformations in autopsied football players...

Joe Przytula said...

Yeah, those were cool presentations. Could genetic therapy in post concussion TX be the future??

JH said...

Very eye opening story if you haven't already seen it.

Joe Przytula said...

What I'm wondering is, with the new guidelines, will athletes fail to report headaches because they don't want to be removed from the game, because they automatically are out for one week?

JH said...

Athletes have been fudging their symptoms for years. May only get worse from here. If they see something like the ESPN clip I posted, I think they may be more willing to be honest. But their lies a bigger issue doesn't it? Where are they learning about honesty? If we could change the way kids think about being honest then we wouldn't have to have this discussion.

drcieslak said...

Hi Joe,

I was unable to attend the summit, but it looks like it provided some great info. My question is this: Am I correct in that the 7 day rule is not an absolute, but just a guideline recommendation that can be adjusted by the athletes own MD if needed. And what was the opinion of ATSNJ on whether all MTBI's need to be evaluated by an MD/DO prior to any RTP? Thanks for your reply in advance.

Joe Przytula said...

I specifically asked Eric Nussbaum at the conference. It is an absolute minimum. Not certain if all need to be cleared by MD before R2play. NCAA the same

drcieslak said...

Hi Joe,

Thanks for the reply. I am in the process of setting up our concussion policy, and have read the NJSIAA guidelines, and find them to be ambiguous on clearance for RTP. Do you use IMPACT or similiar program yet at EHS? If so, who reads them to determine RTP clearance? While I agree the issue of concussion needed to be seriously addressed, I feel this new policy is an "overreaction" to an area that previously had an "underreaction". It should be interesting this year... especially with the Football coaches!


Joe Przytula said...

Dr. Ken- I use Impact here at EHS. We don't have a team MD; most of our athletes don't have private MD's. I interpret the results myself and use it with exertional testing to come to my conclusion. I already explained the new guidelines to our FB staff. From what I understand, the NJSIAA wanted to stanadarize the guidelines in the absence of an ATC.

sal m said...

I think concussion legistlation will prevent some kids from reporting symptoms. I've already seen how over-protective ATs keep kids out of the training room -right or wrong - this is just teenage human nature.

enuss said...

Thanks for the kind remarks on the Summit. It was a great day of discussion. Some clips from the summit can be found at:

I personally think the NJSIAA mandate (though not called a mandate but rather a recommendation) has to be viewed as such. After speaking with a medical legal attorney, his response was that you need to consider the recommendation and also think about "worst case scenario" What if your school adopts a more liberal policy and a kid is symptom free, passes their neurocognitive testing, exercise protocol and returns in 7 days...they then suffer another concussion that leaves them like Preston would probably be liable or at least subject to scrutiny!

The panel was pretty much in consensus. Treatment needs to be individualized and ALL the variables need to be considered. You can't mandate care as concussions should not be cared for using a "cookie cutter" approach (Cantu quote). Brolinson stated his concern that legislating care would drive the concussion under the table. All valid opinions.

My gutt feeling is that the NJSIAA has created issues for EVERY party involved w/ the concussed athlete. The schools: created a legal nightmare if you adopt a more liberal approach then NJSIAA, AT: I think you've increased the likelihood that care could be based on personal bias vs clinical evaluation...some may delay evaluation of the better players w/ subtle symptoms to save their eligibility or you send every kid with any symptoms similar to concussion to the MD for evaluation of a concussion just to protect your butt. net result is less reliance on clinical findings and more on bias. Coach: come on, do they need any more excuses not to refer a concussed kid to the AT? Athlete: true, athletes aren't always open and forthright with their symptoms, but now throw in a mandatory 12 days out and my fear will be more witholding vs more being more open.

Wait till existing legislation in Trenton passes and concussion care falls under the department of education! All the NJSIAA guidelines could be a mute point next year! But wait...should the Department of education be mandating concussion care either???

It's a very popular topic that has received a lot of media attention.
That's a good and bad thing.

I don't know that there is a simple and straight forward answer w/ these recommendations and legislation! I think the discussion of current research had the same much as we know, we don't know!

Good discussion though!

enuss said...

I spoke w/ Dr. Jordan after his talk about the possibility of screening. He felt it was too much of a hot potatoe to see it widely looked for in current athletics.

Personally, I think the first place you'll see screening for genetic factors will be at the professional level. They look for everything else at the combine. Why wouldn't they screen for genetic factors that could predispose injury? Would it be any different then sickel cell or HIV? When making a monetary investment on a player, it only makes sense to minimize your variables.......???

I think you'll hear more about this in the near future.