Tag Archives: recovery

Canadian Concussion Collaborative Identifies Characteristics of Good Concussion Clinics

The Canadian Concussion Collaborative (CCC) released today a guide to help parents and their children choose a good concussion clinic.

Signs or symptoms of a concussion can include headaches, blurred vision, dizziness, nausea or vomiting, and sensitivity to light or noise. For about nine in 10 people with concussions, symptoms heal gradually after seven to 10 days, but those with continuing symptoms may need a personalized care plan.

Finding a good concussion clinic that offers management and treatment can be confusing.

4 Characteristics of a Good Concussion Clinic suggests the questions to ask a clinic to make sure you’re receiving high-quality care that is supported by current guidelines.

“The guide provides important questions to ask and outlines the best approach to concussion care and management,” says Dr. Pierre Frémont, Chair of the CCC and professor at the department of rehabilitation in sports medicine general practice at Université Laval.

The four key characteristics to keep in mind when selecting a concussion clinic are:

  1. Medical doctor: Clinics should have timely access to physicians with experience in treating concussions who can do the initial assessment, direct care and provide final medical clearance.
  2. Team of licensed health care professionals: Clinics should have access to licensed professionals from several health care disciplines. They can provide complimentary expertise and work with the medical doctor to design a personalized treatment plan.
  3. Adhere to the most up-to-date standards of care: Recommended standards of care are updated every few years by groups of experts and are shared via documents like the international Consensus statement on concussion in sport.
  4. Tools, tests and recommendations used: Clinics should perform tests recommended in the most current international Consensus statement on concussion in sport to evaluate different components such as symptoms, mental functions and balance. Pre-season baseline testing is not recommended for children and adolescents.

“Good care and treatment is essential to a positive recovery from a concussion. Being able to identify a good concussion clinic that follows best practices provided by licensed health professionals is an important first step,” said Dr. Frémont.

About the Canadian Concussion Collaborative

The mission of the CCC is to create synergy between health organizations concerned with concussions in order to improve both the education about concussions, and the implementation of best practices for their prevention and management.

The CCC is composed of members from the following organizations:

  • Canadian Academy of Sport and Exercise Medicine
  • Canadian Association of Emergency Physicians
  • Canadian Association of Occupational Therapists
  • Canadian Athletic Therapists Association
  • Canadian Centre for Ethics in Sport
  • Canadian Chiropractic Association
  • Canadian Medical Association
  • Canadian Neurosurgical Society
  • Canadian Paediatric Society
  • Canadian Physiotherapy Association
  • Canadian Psychological Association
  • College of Family Physicians of Canada
  • National Emergency Nurses Association
  • Ontario Medical Association Sport & Exercise Medicine Section
  • Ontario Neurotrauma Foundation
  • Parachute
  • Royal College of Chiropractic Sports Sciences (Canada)

For more information, please visit http://casem-acmse.org/education/ccc/

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Case Reports Suggest Mechanisms for Resolving Concussion Symptoms through Osteopathic Manipulative Treatment

Two case reports published in The Journal of the American Osteopathic Association document improvements in concussion-related symptoms following an initial session of osteopathic manipulative treatment (OMT), according to the American Osteopathic Association.

“OMT has long been an instrumental tool in treating athletes,” said Dr. Naresh Rao, an osteopathic sports medicine physician who will be the team physician for USA Water Polo in Rio de Janeiro for the 2016 Summer Olympics. “With manual techniques including craniosacral therapy, we as osteopathic physicians have the ability to help the body restore the flow of cerebrospinal fluid through the central nervous system to promote healing and get our athletes with concussion-related symptoms back to their normal activities.”

In the first case report, a 27-year-old man was treated three days after a snowboarding accident, in which the patient fell and wasn’t wearing a helmet. He suffered from headache, nausea, dizziness and tinnitus during the days after the fall. After one 25-minute OMT session, the patient reported the dizziness, tinnitus and nausea had resolved and his scores on the Sensory Organization Test (SOT), a computerized measure of balance, improved from 76 before treatment to 81 after treatment.

The second case involved a 16-year old girl with a history of three head injuries, the most recent involving a head-to-head collision. Three weeks after that injury, she reported headache, fatigue, mood swings as well as memory and concentration problems that limited her ability to participate in school and band.

The authors evaluated the girl using the Initial Concussion Symptom Score (CSS), which measures progression of symptoms on a scale of 0 to 144, and the Balanced Error Scoring System (BESS), a 0 to 30 scale measuring vestibular dysfunction. On the day after her first OMT treatment, her CSS decreased from 53 to 22 and her BESS improved from 22 to 17. At the end of six treatments, her CSS was 0 and BESS dropped to 14.

“These cases are consistent with the clinical experiences of osteopathic physicians who use OMT as part of a multidisciplinary approach to concussion,” said Dr. Rao. “While the mechanisms of healing are not well understood with concussion, formal studies measuring OMT’s impact on recovery and quality of life are much needed to demonstrate its efficacy as a viable therapy where there are very limited therapies to date.”

The full case reports are available online:

http://jaoa.org/article.aspx?articleid=2498827

http://jaoa.org/article.aspx?articleid=2498831

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Study Shows Less Physically Mature Ice Hockey Players Have Prolonged Concussion Symptoms

A study led by a Hasbro Children’s Hospital sports medicine physician found that male student ice hockey players in earlier pubertal stages had a significantly increased risk of prolonged symptoms from concussion compared with advanced pubertal and postpubescent players.

Research by Peter Kriz, M.D., found that less physically mature players took on average 54 days – 21 days or nearly 40 percent longer – to recover compared to more physically mature players. Kriz said the findings further highlight the need for student athletes in collision sports to compete with similar-aged players and that there is risk in having younger, more talented athletes “play up” on varsity teams.

“Unlike other contact-collision scholastic sports with a high incidence of concussion, high school ice hockey lacks stratification by age grouping, largely because of prohibitive costs associated with equipment, transportation and ice time incurred with fielding varsity, junior varsity and freshman teams,” said Kriz. “Consequently, it’s not uncommon at the varsity level for younger, less physically mature players to oppose older players with increased strength, power and speed.”

The study, currently published online in The Journal of Pediatrics, assessed disparities in age, size, and physical maturity level among concussed adolescent ice hockey players 13 to18 years of age, and was performed at Hasbro Children’s Hospital, Boston Children’s Hospital, and South Shore Hospital, in Weymouth, Massachusetts. Additionally, the study also found that lighter weight among males and heavier weight among females increased the probability of experiencing prolonged concussion.

Concussion has been reported to be the most common youth ice hockey injury, representing more than 15 percent of all injuries in nine to 16-year-old players and nearly 25 percent of injuries among male high school players.

The study’s results challenge recent opinion, which has suggested that collision sport participation be postponed until freshman year or 14 years of age. “Sixty-five percent of freshman male ice hockey players in our study were in early stages of pubertal development and none were postpubertal,” said Kriz.

The findings also support concerns within the youth athletic community that adolescents might have longer recoveries from concussions than adults.

“Our findings have important implications for policy decisions related to grouping for high school ice hockey players,” explained Kriz. “While economic considerations often dictate whether a school fields ice hockey teams other than varsity, we support, at the very least, the establishment of junior varsity ice hockey by state interscholastic leagues for the purposes of player development and improved safety for undersized, peripubertal male players.”

Additionally, policies pertaining to high school football and boys’ lacrosse — two other collision sports which commonly permit underclassmen to “play up” on varsity teams — may ultimately be impacted by these findings, as lighter, less physically mature players may be at risk of prolonged concussion symptoms.

Kriz recommends that, until further studies determine valid physical maturity indicators, arbitrary age and grade cutoffs should not be used to determine when adolescent athletes are ready to participate in collision sports.

“Until such studies are available, collision-sport high school athletes should play in leagues grouped by relative age,” said Kriz. “Highly-skilled, peripubertal collision sport athletes should also be discouraged from ‘playing up’ at the varsity level with post-pubertal competitors three to four years their senior.”

In accordance with recommendations from the American Academy of Pediatrics, Kriz encourages youth hockey organizations to provide the option of non-checking divisions for players who remain in earlier stages of pubertal development, players who are undersized, players who have significant concussion histories precluding them from participating in collision sport participation or for players 13 years old or younger seeking safer alternatives to body checking leagues.

This study was funded in part by the National Federation of State High School Associations Foundation and the Rhode Island Foundation.

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