Category Archives: Hockey
Sport-related concussion, one of the most complex injuries in sports medicine, is the focus of a new special issue of the Journal of Athletic Training, the scientific publication of the National Athletic Trainers’ Association.
“Over the last 20 years, our understanding of concussion mechanics, injury assessment and management has increased dramatically. We’ve made great strides with regard to education, research and legislation,” says special issue Guest Editor Steven Broglio, PhD, ATC, director, Neurotrauma Research Laboratory, University of Michigan. “Having the right multidisciplinary medical team in place, including the athletic trainer, who plays an important role in injury prevention and treatment, is vital. Our universal goal is to reduce the risk of injury and ensure a gold standard of care should concussion occur.”
Concussions during sport and recreation occur as often as 3.8 million times a year,1 resulting in up to seven injuries per minute every day of the year in the United States. Although each patient requires individual management, 90 percent of concussed athletes recover by day seven after injury.2 Concussive injuries compose 8.9 percent of all high school and 5.8 percent of all college athletic injuries.3
Key points from select studies published in the issue:
- Head-impact sensors have limited applications to concussion diagnosis but may provide sideline staff with estimates of athlete exposure and real-time data to monitor players.
- Given that concussion risk is inﬂuenced by many factors in addition to impact biomechanics, viewing an athlete’s head-impact data may provide context for the clinician working on the sidelines, but impact sensors should not replace clinical judgment.
- Amnesia was the predictor that most inﬂuenced clinical recovery from concussion.
- Loss of consciousness, concussion history and acute symptom group did not substantially affect symptom, cognitive or balance outcomes.
- Most injured athletes recovered within the normal timelines established by the Graded Symptom Checklist, Standardized Assessment of Concussion and Balance Error Scoring System.
- Compared with high school athletes who had access to an athletic trainer, those without such access were less knowledgeable about concussion.
- Access to an athletic trainer was not linked to high school athletes’ concussion-reporting percentages. However, such access was related to 10 reasons for not reporting a concussion.
- The most common reasons for not reporting a concussion were not wanting to lose playing time, not thinking the injury was serious enough to require medical attention and not wanting to let the team down.
- Per 10,000 athlete-exposures, the rates of sport-related concussion were highest in football (9.21), boys’ lacrosse (6.65), and girls’ soccer (6.11).
- Among sex-comparable sports, the rate of sport-related concussion was 56 percent higher in girls than in boys.
- Most athletes with sport-related concussions returned to play after seven days, despite resolution of symptoms in a smaller proportion within one week.
“No sports medicine topic is more polarizing than concussion, and today’s standard of care supersedes where we were just a decade ago,” says Broglio. “With validated measures, more and more of the guesswork is being removed from the process. While many questions persist about more sophisticated diagnostic measures, rehabilitation and long-term effects of injury, we continue to make great progress, remain current on research and new techniques and provide the best possible care for our patients at any level of sport or activity.”
Other suggested articles in the special issue:
- “If You’re Not Measuring, You’re Guessing: The Advent of Objective Concussion Assessments”
- “A Multifactorial Approach to Sport-Related Concussion Prevention and Education: Application of the Socioecological Framework”
- “Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature”
1Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–378.
2McCrea M, Guskiewicz KM, Randolph C, et al. Incidence, clinical course, and predictors of prolonged recovery time following sportrelated concussion in high school and college athletes. J Int Neuropsychol Soc. 2013;19(1):22–33.
3Gessel 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.
From bustling cities to tiny farming communities, the bright lights of the local stadium are common beacons to the Friday night ritual of high school football.
A study from the Peter O’Donnell Jr. Brain Institute and Mayo Clinic shows the technology exists to ease this dilemma: By using a remote-controlled robot, a neurologist sitting hundreds of miles from the field can evaluate athletes for concussion with the same accuracy as on-site physicians.
The study provides preliminary data to support a nascent movement to utilize teleconcussion equipment at all school sporting events where neurologists or other concussion experts aren’t immediately accessible.
“I see teleconcussion being applicable anywhere in the world,” said Dr. Bert Vargas, the study’s lead author, who directs the sports neuroscience and concussion program at the O’Donnell Brain Institute at UT Southwestern Medical Center. “Right now there’s a significant disparity in access to concussion expertise.”
Further, having personnel on hand to quickly identify and remove concussed players from games is an important part of protecting against such long-term injuries, Dr. Vargas said. But across the country – and most notably in rural regions – more than half of public high schools don’t have athletic trainers available to spot such incidents, increasing the chances that a concussion could go unnoticed and perhaps be exacerbated by additional injuries.
“Worst-case scenario, you have nobody at the games who can identify or address potential concussion cases,” said Dr. Vargas, an Associate Professor of Neurology and Neurotherapeutics. “You’re putting the athlete in a position to have a more severe injury with prolonged symptoms and longer recovery time.”
While previous teleconcussion research has focused on diagnosing severe traumatic brain injury (TBI) in the military, Dr. Vargas’ research is the first to measure how accurately telemedicine using standard sideline concussion evaluation tools can help diagnose concussions – a mild form of TBI – at sporting events.
The study, published in Neurology, used a mobile robot that was stationed for two seasons on the sideline and athletic training room of Northern Arizona University’s football games. A neurologist could view the game from the robot’s camera and make evaluations of players who may have been concussed.
Research shows mobile robots controlled by doctors can diagnose sports concussions with the same accuracy as on-site physicians. Researchers say the technology could be a game-changer in rural America, where few doctors or athletic trainers are available to diagnose head injuries during high school athletics.
Using diagnostic tools that measure cognition, balance, and other factors, the remote neurologist made assessments in 11 cases brought to the robot for review. These assessments were later compared with separate face-to-face diagnoses made by sideline medical personnel consisting of Northern Arizona team physicians and athletic trainers. The results matched each time.
The study demonstrates that teleconcussion technology can work, but it doesn’t lessen the need to have trained personnel to help on the sidelines, said Cherisse Kutyreff, Director of Sports Medicine at Northern Arizona, who helped make the on-field assessments during the study.
“If you don’t start with the basics of having an athletic trainer in the schools first, you’re already spinning your wheels,” she said. “Don’t ask the questions if you aren’t prepared to have somebody there to do something with the answers (from the neurologist).”
The findings add scientific backing for the few entities that have already used teleconcussion robots at sporting events. Dr. Vargas sees only a limited future for the technology in college athletics and even less in the professional ranks, where qualified doctors and athletic trainers are already accessible.
His major goal is getting teleconcussion into high school athletics, including soccer, basketball, baseball, and cheerleading. He envisions a scenario where multiple districts could have one concussion specialist on standby for all their games. This person would be accessible when needed through a robot or less expensive interface.
The strategy could be especially beneficial in states such as Texas, which requires concussed high school players to get a physician’s approval before returning to action. In rural corners of the state, finding a doctor to do so often requires a lengthy trek.
“This is a way of bringing physicians into these outlying areas,” Dr. Vargas said. “One person could cover numerous schools. If you’re on-call virtually, you could be anywhere and available as soon as a consult is needed.”
Dr. Vargas’ research was funded by Mayo Clinic Center for Innovation, where he studied brain injury before moving to UT Southwestern. Drs. George Hershey, Northern Arizona’s team physician, and Amaal J. Starling with Mayo Clinic collaborated on the study.
“Removal from play decisions are of utmost importance in the setting of an acute concussion,” said Dr. Starling, a neurologist and concussion expert. “This teleconcussion study demonstrates that a remote concussion neurologist accessible through telemedicine technology can guide sideline personnel to make those decisions in a meaningful and timely manner.”