Tag Archives: treatment

Researchers Identify Concussion Treatment for Persistent Cases in Children

Researchers at Seattle Children’s Research Institute published a study in the journal Pediatrics showing a new intervention for adolescents with persistent post-concussive symptoms that improved health and wellness outcomes significantly. The approach combines cognitive behavioral therapy and coordinated care among providers, schools, patients and families.

“We were pleased to find that using an approach that adds a psychological care component to treating concussions and providing coordination of care in areas of the patient’s life significantly improved outcomes,” said Dr. Cari McCarty, a psychologist and researcher at Seattle Children’s Research Institute who led the study. “This new approach aims to improve the quality of life for patients who were otherwise left to deal with unrelenting concussion symptoms.”

A fall off a horse causes a persistent concussion

Carmen Einmo, 16, loves to ride horses. In November 2014, she fell off her horse and broke her arm. At first, she didn’t complain of typical concussion symptoms, but after a few weeks it became clear something was amiss.

“I developed really bad headaches and became very sensitive to light,” Carmen said. “I started having memory issues and would forget words in the middle of a conversation.”

As her symptoms persisted over a couple months, Carmen’s doctor at Seattle Children’s, Dr. Elaine Tsao, suggested she sign up for McCarty’s study. The family was excited to have found another treatment option to pursue.

“A lot of Carmen’s schoolwork had to be done on an iPad, and spending long amounts of time on it hurt her eyes and head,” said Diana Einmo, Carmen’s mom. “Some of the teachers didn’t understand that Carmen couldn’t spend a lot of time on an iPad, and they didn’t know what to make of how long her symptoms had been going on.”

Carmen’s grades had started to slip and she worried about how the persistent symptoms got in the way of schoolwork.

“I entered my second year of high school ready to start off strong, but the concussion set me back,” she said. “My PE class was especially challenging because I couldn’t run, so I would walk, and I got penalized for it in my grade.”

A coordinated approach to concussion care

As a participant in the study, Carmen got support from a research team member that created a coordinated care plan for her. The researcher worked with the school and family on a plan that would allow Carmen to continue school with accommodations as she recovered. The plan included a homework priority list, allowing her more time to finish work and access to another room if she became tired from light and sound in class.

In addition, Carmen received cognitive behavioral therapy that involved her parents and sister.

“Cognitive behavioral therapy involves changing both behaviors and thinking patterns,” McCarty said. “In our study that included relaxation techniques, teaching coping skills and offering pain management. We found that incorporating a psychological care component improved health outcomes and quality of life for these kids.”

Only 13% of patients who received the coordinated care and psychological intervention in the study reported high levels of post-concussive symptoms after six months, compared to 42% of patients who received standard concussion care. In addition, 78% of patients who received the specialized care reported reduction in depression symptoms, compared to just 46% of patients who received standard care.

Getting back in the saddle

Carmen is feeling more like herself now and has been cleared to ride horses again. She and her mom say one of the most important things they learned during this experience was to take concussions seriously, especially because the effects and symptoms might not be apparent right away.

“It’s especially challenging when a teenager gets a concussion because it’s hard to tell if a change in behavior is because of a concussion, or because a teenager is going through a growth and development phase,” Einmo said. “We found the therapy to be especially helpful in figuring some of this out.”

Carmen adds that having a plan and realistic expectations with school helped immensely.

“I would tell young people struggling with a concussion to stick up for yourself and what you need,” she said. “Take it one day at a time and do your best, and ask for the help you need.”

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Canadian Soccer Organizations Team Up With Health Care Provider on Concussion Awareness and Soccer Safety

The Ontario Soccer Association, Toronto Soccer Association and Toronto Football Club have each teamed up with Holland Bloorview Kids Rehabilitation Hospital’s Concussion Centre in collaborations focused on increasing the safety of youth soccer players.

“These collaborations are a commitment to ensuring a safer game for kids to play,” says Dr. Nick Reed, co-director and clinician scientist in Holland Bloorview’s concussion centre and assistant professor at the University of Toronto. “Youth athletes, both at professional and amateur levels, need to be informed about concussion prevention, identification, and recovery strategies. We’re thrilled to work together on this important initiative with three leading soccer organizations for kids at all levels of sport.” Video link

It is estimated that one in five sport-related injuries are concussions. About 200,000 concussions are reported each year in Canada but the true number is likely much higher, as concussions are largely underreported.

In a one-year collaboration, Holland Bloorview’s concussion centre will work with the Toronto Football Club (TFC)’s academy soccer players, to provide a comprehensive baseline testing and follow-up care program that includes the assessment of neurocognitive function, as well as balance, strength and agility. Concussion education and training is another critical part.

Three-year collaborations with the Ontario Soccer Association (OSA) and Toronto Soccer Association (TSA) are also underway, focusing on concussion education, strategies, and awareness campaigns to align players, parents, coaches and trainers on the most up-to-date evidence and resources for concussion prevention, identification and management.

The OSA is the governing body for 21 soccer districts, 13 Associate Members and 26 Non-Club Academies across the province. With over 475,000 annual participants, the OSA is one of largest sporting organizations in Canada.

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Legalization Fears Fade, Giving Hope to the Use of Cannabis to Treat Concussions

By Fernanda Alonso, an associate with the O’Neill Institute for National and Global Health Law at Georgetown University.

A month ago, rumors spread that the DEA was about to reschedule cannabis from a Schedule I to a Schedule II drug in the Controlled Substances Act. Even though this rescheduling would not have many impacts in terms of legalization, it would allow derivatives of cannabis to be made available through medical prescription, if approved by the FDA. Even more importantly, the rescheduling would allow medical and scientific research under more relaxed conditions. pot

While those rumors have collectively been considered a false alert, there was reason to think things were finally starting to move at the federal level. In late 2015, the FDA apparently forwarded a recommendation on a potential rescheduling of cannabis to the DEA, the content of which remains unknown. The DEA, which would effectively be in charge of conducting a rescheduling, has yet to take any action. In a letter to Sen. Elizabeth Warren and seven other Democratic senators, the DEA had stated that a decision would be made within the first half of 2016. One week into the second half of 2016, however, the decision-making process appears to be more controversial than initially thought. In the meantime, lack of federal action leaves the states as the powerhouse for cannabis legalization and its effects.

It has been almost four years since Colorado passed Amendment 64, legalizing cannabis for personal use, and 2 and a half years since the first shops opened. We are no longer completely in the dark about the effects that legalization has had and should start using this state’s example when thinking about further legalization efforts. One of the major arguments used by the opponents of cannabis legalization is that widespread availability will – almost naturally – trigger increased use among the population, especially amongst youth. Looking at available data from Colorado, it would appear this is not the case. The 2015 Healthy Kids Colorado Survey indicates that use among teenagers has hardly changed since the first retail store for recreational cannabis opened in Colorado in January 2014. This is in line with the findings of a previous study conducted shortly after legalization occurred in Colorado.

The Healthy Kids Colorado Survey of 2015 has found that 21.2% of teens have used cannabis in the past month. While this marks a minor increase compared to the data published in 2013, when 19.7% of teens had been using cannabis in the past month, the data shows a clear decrease from 24.8% in 2009, before legalization of non-medical cannabis took place.

The survey further indicates that, in 2015, youth use in Colorado was even below the national average (see bar graph).

From a public health perspective, the biggest concern – the increase in youth consumption – has apparently remained stable. So, can we say that legalization, two and a half years into the project, has been a success in other areas as well? From a financial perspective, it seems so. Colorado imposes a 2.9% sales tax on medical and recreational cannabis as well as an additional 10% sales tax as well as a 15% excise tax on recreational cannabis. According to the latest figures published by the Colorado Department of Revenue:

-In April 2016 alone, the revenue from cannabis taxation, licensing and fees amounted to USD 17,183.162 (of which only USD 1,145.069 was retrieved from the sales of medical cannabis), compared to USD 10,617.311 in April 2015.

-Between April 2015 and April 2016, the state earned USD 142.218,370, compared to USD 91,068,724 during the previous year. This marks an increase of 56.2%.

Legalization has also visibly impacted the crime statistics in Colorado. According to recent statistics, the overall amount of cannabis-related arrests has dropped by 95% since 2010. Additionally, data from the Colorado Court system in 2014, cannabis possession arrests have dropped 84% since 2010 and arrests for cultivating and distributing cannabis have also dropped by more than 90%.

All this said and done, challenges do still remain; the regulation of edibles, the labelling and testing of cannabis products as well as driving under the influence are still issues that have certain glitches. The fear of an increase of driving under (cannabis) influence (DUI) has been major argument of legalization opponents. Colorado State Patrol reported that the number of citations issued for impaired driving from cannabis has fallen slightly since the agency started tracking the numbers two years ago. In 2015, troopers handed out 4,546 citations for driving under the influence of drugs or alcohol, with 665 including cannabis and 347 of them – or 7.6%- involving only this drug. These numbers decreased 1.3% from 2014, where 5,546 citations were given, 647 involving cannabis. More concerning is that through the “Drive High, Get a DUI” campaign, the Colorado Department of Transportation reported that 51% of cannabis ere not aware that driving under the influence of cannabis was prohibited. This survey also showed that about 55% of users drove a vehicle within 2 hours of consuming marijuana.

The current legal limit (both in Colorado and Washington) for THC is 5 nanograms or less per milliliter – which depends very much on the individual. It remains a challenge, however, to determine a valid threshold for cannabis-induced DUI, as apparently, blood tests to determine the THC-level appear to be unreliable, as no direct connection between THC-blood-levels and driving impairment has yet to be scientifically proven. Oregon and Alaska, in contrast to Washington and Colorado, therefore rely on the expertise of trained drug experts and an evaluation of the individual suspected of DUI. Either way, a safe bet is to abstain from cannabis consumption entirely before deciding to drive.

Labeling and dosing of THC-containing products and the regulation of edibles remains another issue that regulators are trying to cope with. By December 2014, edibles made up 45% of Colorado’s cannabis market based on units sold, making any issues with these products a widespread problem. Similarly to the medical cannabis markets in other states, there have been some problems with dosing for edible non-medical cannabis products. In March 2014 and April 2015, the Denver Post conducted studies on some of the largest producers of cannabis-infused edibles in Colorado to analyze whether their product labeling matched the actual THC content. In 2014, they found that none of the products labeled at 100 milligrams of THC actually contained that level, with the majority of products ranging anywhere between 17 and 146 milligrams (and one brand containing less than half a milligram). In 2015, potency claims on the packaging were more accurate, but with differences between 17-30% of the labeled amount. The improvement could be due to the stricter regulations introduced by the Colorado government regarding edibles in February of 2015. A similar study in JAMA in California and Washington showed similar results. A review of dozens of products from marijuana dispensaries in these two states found that 23% of products contained more active chemicals than their labels suggested, while 60% fell short on what was promised.

What’s to come?

Colorado and Washington have been the country’s guinea pigs in terms of cannabis legalization. It has been up to them to identify all the problems, quirks and concerns. Oregon and Alaska have already used these two states’ experiences in designing their own markets and in a couple of years we will have a couple of models to pick and choose from when considering legalization. Alaska for example, is still in the early stages of implementation. The first dispensaries are set to open only at the end of 2016. According to latest news, California will be the next step to follow through a ballot initiative on the legalization in November. Arizona seems to be pushing a similar timeline.

 It has yet to be seen whether the developments observed in Colorado may prove to be a global phenomenon or if they will only be copied in the US. On an international level, despite the fact that Uruguay de facto legalized cannabis for non-medical purposes in December 2013, we still have very little data. Their model, which varies significantly from the Colorado and Washington one could eventually prove to be another option. However, cannabis sales, which, under the law, are only permitted through pharmacies through a government monopoly, still remain unavailable. The government has recently announced that full implementation of the law shall take place later in 2016. For the time being though, it appears that, besides home-grown cannabis, the illicit market remains the predominant source of cannabis supply for Uruguayans. Apart from Uruguay, Canada might be the next country to legalize recreational cannabis, potentially in 2017. However, until any of this happens, the four states in the US will continue to be at the forefront of this development. The developments here will be decisive for how governments will treat cannabis around the globe in years to come – and despite some shortcomings, it looks like they’ve had a pretty good start.

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