Category Archives: Outside U.S.
(The Editor’s Note: The following excerpt comes from an article written by Michael J. Perrotti, Ph.D., a concussion expert and frequent contributor to Concussion Litigation Reporter. The full article, as well as several other relevant articles (http://concussionpolicyandthelaw.com/2013/02/01/february-issue-of-concussion-litigation-reporter/), appears in the February issue of the Reporter.)
Recently the examination of the brain of Junior Seau revealed the diagnosis of chronic traumatic encephalopathy, or CTE. This diagnosis underlines the seriousness not only of repetitive brain trauma in professional sports and in military populations, but also raises continuing serious questions about the management and prevention of CTE in sports.
Introduction to Concepts: CTE, originally termed dementia pugilistica, is associated with memory disturbance, neurobehavioral disturbance, parkinsonism, and motor and speech abnormalities.
There has been increasing attention to neurological sequelae of concussive injuries in sports. While one has heard frequently of individuals having a “concussion” and then returning to play after the “concussion,” what is not realized is that players, as McKee et al. (2009) note, may experience thousands of subconcussive hits over the course of a single season. These are cumulative, and repetitive head trauma is applicable to athletes and military veterans.
Clinical Pathology: CTE was first introduced by Martland in 1928, who introduced the term “punch drunk” to a symptom complex related to repeated blows to the head. Symptoms of CTE are firstly deteriorations in functions of attention, concentration, and mnemic functions as well as disorientation and confusion occasionally accompanied by dizziness and headaches. Junior Seau frequently complained of headaches to peers. With progressive deterioration, additional symptoms, such as lack of insight, poor judgment, and dementia, become manifest. Severe cases are related to progressive slowing of muscular movements, gait disturbance, and speech disturbance. Corsellis et al. describe three stages of clinical deterioration. The first stage is characterized by affective disturbance and psychotic symptoms. Social instability, erratic behavior, memory loss, and initial symptoms of Parkinson’s appear during the second stage. The third stage consists of general cognitive dysfunction progressing to dementia and often accompanied by full-blown parkinsonism as well as speech and gait abnormalities.
Incidence: It is estimated that, in cases of repetitive concussion, there is mild traumatic brain injury (MTBI). At least 17% of these individuals develop CTE. Moreover, 1.6 to 3.8 million sports-related concussions occur annually in the U.S.
Prevention and Treatment: Of course, the most direct way to manage CTE and decrease incidents is to decrease the number of concussions or mild traumatic brain injuries by limiting exposure to trauma. The NFL is making some attempts at this, such as a second look at run backs after kickoffs as well as prescriptions against, or mandates against, helmet-to-helmet contact. However, from the players’ point of view, they are vocal in asking for independent medical personnel or independent health-care providers on the sidelines to make decisions about “concussions.”
Asymptomatic individuals have been shown to have persistent decreases in P300 amplitudes in response to an auditory stimulus at least five weeks after a concussion thereby casting doubt on the validity of the absence of symptoms as a guidepost. Neuropsychological tests have also helped provide estimates as to the appropriate time for athletes to return to play.
McKee et al. (2009) note that PET (positron emission tomography),,DTI (diffusion tensor imaging), and MRI (magnetic resonance imaging) studies have all shown abnormalities in concussed athletes or non-athletes with TBI lasting for two to four weeks. Thus, these studies indicate safe return-to-play guidelines might require at least four to six weeks to facilitate more complex recovery and protect from reinjury as a second concussion occurs much more frequently in the immediate period after a concussion. Animal studies note that there is expansion of brain injury and inhibition of functional recovery if the animal is subjected to overactivity within the first week.
(To read more, click http://concussionpolicyandthelaw.com/concussion-litigation-reporter/)
Concussion Compliance Hosts National Symposium on Concussion Management to Tackle Transferring Today’s Expert Guidelines into Clinical Practice
Concussion Compliance announced today that it will hold a national symposium called “Bridging the Gap on Best-Practices in Concussion Management” on March 2, 2013 at the Norris Conference Center in Austin.
This event, sponsored by St. David’s HealthCare, will bring together leading medical experts and practitioners to discuss the issues dominating today’s best-practice concussion management and how to incorporate the guidelines as well as the use of several tools into clinical practice.
“Communication and education that crosses traditional boundaries are key factors to providing good concussion treatment for our young athletes,” said Theodore Spinks, M.D., chair of the symposium program planning committee. Dr. Spinks is a board certified neurosurgeon seeing patients in Austin, Round Rock, and Georgetown, Texas. He currently serves on the CDC Expert Panel for Pediatric Mild Traumatic Brain Injury. Dr. Spinks also served on the Texas Medical Association Committee on Concussions in Athletes during the last session of the Texas Legislature.
The symposium program provides an overview of the current best practices and consensus statements on concussion management, the latest scientific research, an update on tools available to practitioners, and perspectives from experts in concussion management.
Featured Topics include: The Physician’s Perspective; An Athletic Trainer’s Perspective; Head to Head: Cognitive Testing; Beyond Cognition: Balance Testing; A Look Into the Future: Vision Testing; Neurosurgical Management of Head Injuries and Concussion; and Implementation of Best Practices Into Clinical Practice
The keynote speaker will be Dr. Steven Erickson, who will present on the latest best practices in concussion management. Dr. Erickson is a medical consultant for Major League Baseball and serves on the MLB Medical Advisory Committee and the MLB Mild Traumatic Brain Injury Committee.
Additional speakers include: Tina Bonci, MS, ATC, LAT; Mark Burnett, MD; Jason Clopton, OD, FCOVD; Steven Erickson, MD; Douglas Fox, MD; Derek Hamilton, OD; James Kemper, MD; Louann Kuntz, ATC, PT, DPT, MEd; Mike Lamb; Ken Locker, ATC; Mary McMains, OD, MEd, FCOVD; Shane Miller, MD; Anne Mucha, PT, DPT; Rachel Mundy, RN; Andrea Pana, MD; Martha Pyron, MD; Michael Reardon, MD; Paul Saenz, DO; Jamie Schlueter, MD; Emily Schottman, OD, FCOVD; Bucky Taylor, ATC; Richard Temple, PhD; Bridgett Wallace, PT, DPT; and Rod Walters, DA, ATC.
“There’s no limit to what we can accomplish when we work together,” said Bridgett Wallace, owner and co-founder of Concussion Compliance and its sister company, Concussion Health. Wallace, PT, DPT, is also the president of 360 Balance, a specialty clinic in Austin. “It’s in the best interest of the injured athlete to have a broad, knowledgeable care team that may include their family, coaches, athletic trainers, team physician, school nurse and other allied healthcare providers.”
The intended audience includes athletic trainers, school nurses, allied healthcare professionals and physicians with an interest in sports medicine and concussion management.
“Each year, more than 300,000 people suffer from sport- related concussions in the US. The Texas Brain Injury Alliance is committed to providing support to those in need through education, awareness and resource referral statewide for concussion health,” said Penny Phillips, president, Texas Brain Injury Alliance. “We are proud to be a sponsor of the 2013 National Symposium which will provide a full day of education from highly educated professionals in the concussion world.”
St. David’s HealthCare is the presenting sponsor of the national symposium. To date, other sponsors include ReBuild Products, Natus Medical, Balance and Mobility, Balance Engineering, Concussion Health, Wells Fargo Insurance’s Play It Safe Concussion Care, 360 Balance, CORE Health Care, Texas Brain Injury Alliance, Stars in Your Eyes, Neuro Resource Group, NeuroImpact, Biodex Medical Systems, and Dell Children’s Medical Center of Central Texas.
Concussion Compliance is a community outreach project by Concussion Health, which offers school superintendents, coaches, athletic trainers, primary care physicians, and parents a free online resource to increase the safety and care of student athletes while complying with state concussion laws. To learn more about the free compliance program and to view educational videos, go to concussioncompliance.com
For more info on the symposium, visit https://concussioncompliance.com/static/uploads/symposium_brochure_012613.pdf
Photo by Tim Hipps
Researchers Zero in on Risk Factors for Prolonged Sports Concussion Symptoms; Impact Seen of Return to Play Guidelines
Researchers at the University of Washington have found clear, identifiable factors that signal whether an athlete will experience concussive symptoms beyond one week.
The researchers sought to identify risk factors for prolonged concussion symptoms by examining a large national database of high school athletes’ injuries.
Previous concussion studies were limited in scope, focusing only on male football players. The information from this study applies to male and female athletes from a number of different sports.
Researchers found that athletes who have four or more symptoms at initial injury were more likely to have persistent concussive symptoms. Drowsiness, concentration difficulties, nausea and sensitivity to light and noise were also associated with longer-lasting concussive symptoms.
The results of this study could change how long high school athletes are kept from returning to play after a concussion. Previously, athletes who lost consciousness were held out from playing longer than those who did not lose consciousness, but the study found little correlation between loss of consciousness and persistent symptoms.
Dr. Sara P. D. Chrisman, an adolescent medicine fellow in the University of Washington Department of Pediatrics, headed the study.
“The medical community is becoming more aware that concussions may not be a minor injury and may result in prolonged symptoms,” she said. “This is a step towards developing evidence-based return to play guidelines.”