Barry Jordan, MD

Proper medical surveillance is one of the best tools for preventing and managing concussion. As neurologists, we play a key role in this aspect of concussion prevention and recovery, with the ultimate responsibility of protecting the health and safety of athletes.

That said, there are several instances in which neurologists and sports doctors could face ethical quagmires as they strive toward this goal. One of them is determining when athletes can return to play, if at all, as repetitive injuries are more likely to cause serious brain injury. Those players who have had previous concussions are also at a higher risk for sustaining another one, with football players having a four to six times higher risk than do others with prior concussions. Additionally, those who go back to play too soon are vulnerable to sustaining a second concussion, typically within 10 days of the prior one.

©Fred Hall/iStockphoto.com

Therefore, much care and consideration must be taken into account when assessing a concussed athlete’s condition. And not all neurologists will be qualified to perform the necessary evaluations, treatment recommendations, and postconcussion follow-up. It is the ethical responsibility of the licensed health care professional to ensure that whoever is treating the concussed athlete is experienced and knowledgeable about treating this type of trauma, including sending the athlete to a different neurologist if necessary.

There’s also a 2013 study that began to take a look at two particular genetic polymorphisms, an amino acid switch in exon 6 of the MAPT (microtubule-associated protein tau) gene and in the promoter region of the APOE (apolipoprotein E) gene, and their relation to postconcussion neurocognitive function/reaction time and outcome in a group of college athletes comprising men’s football and men’s and women’s soccer players. The goal of the study is to determine whether an athlete’s genetic makeup determines the severity of postconcussive brain function. The outcome of the study could potentially add another wrinkle to the question of whether to let players go back to the game or not.

A similar ethical question arises when considering whether to let athletes with certain genetic dispositions play at all. Evidence has been found that boxers with the APOE epsilon-4 allele were more likely to suffer from the effects of chronic traumatic brain injury as their careers went on than did those who did not have the genotype (JAMA 1997;278:136-140). This genotype has also been linked with Alzheimer’s disease (Arch. Neurol. 1995;52:1074-9).

Knowledge of an athlete’s genetic vulnerability to brain injury creates an ethical grey area because the misuse of the information could harm his or her career. Like other HIPAA-protected information, this type of information should be kept confidential. However, sports doctor always needs to keep the athlete’s safety in mind, and if confronted with an athlete who has a genetic predisposition to concussion or poor recovery from concussion, they need to advise the athletes to get regular brain scans to ensure there’s no damage but not necessarily to stop them from playing.

There are other factors at play beyond genetic disposition, and more studies need to be done to get a better understanding of this public health risk. Until then, neurologists need to make careful judgments when dealing with concussions.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He also serves as the assistant medical director there. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

Proper medical surveillance is one of the best tools for preventing and managing concussion. As neurologists, we play a key role in this aspect of concussion prevention and recovery, with the ultimate responsibility of protecting the health and safety of athletes.

That said, there are several instances in which neurologists and sports doctors could face ethical quagmires as they strive toward this goal. One of them is determining when athletes can return to play, if at all, as repetitive injuries are more likely to cause serious brain injury. Those players who have had previous concussions are also at a higher risk for sustaining another one, with football players having a four to six times higher risk than do others with prior concussions. Additionally, those who go back to play too soon are vulnerable to sustaining a second concussion, typically within 10 days of the prior one.

©Fred Hall/iStockphoto.com

Therefore, much care and consideration must be taken into account when assessing a concussed athlete’s condition. And not all neurologists will be qualified to perform the necessary evaluations, treatment recommendations, and postconcussion follow-up. It is the ethical responsibility of the licensed health care professional to ensure that whoever is treating the concussed athlete is experienced and knowledgeable about treating this type of trauma, including sending the athlete to a different neurologist if necessary.

There’s also a 2013 study that began to take a look at two particular genetic polymorphisms, an amino acid switch in exon 6 of the MAPT (microtubule-associated protein tau) gene and in the promoter region of the APOE (apolipoprotein E) gene, and their relation to postconcussion neurocognitive function/reaction time and outcome in a group of college athletes comprising men’s football and men’s and women’s soccer players. The goal of the study is to determine whether an athlete’s genetic makeup determines the severity of postconcussive brain function. The outcome of the study could potentially add another wrinkle to the question of whether to let players go back to the game or not.

A similar ethical question arises when considering whether to let athletes with certain genetic dispositions play at all. Evidence has been found that boxers with the APOE epsilon-4 allele were more likely to suffer from the effects of chronic traumatic brain injury as their careers went on than did those who did not have the genotype (JAMA 1997;278:136-140). This genotype has also been linked with Alzheimer’s disease (Arch. Neurol. 1995;52:1074-9).

Knowledge of an athlete’s genetic vulnerability to brain injury creates an ethical grey area because the misuse of the information could harm his or her career. Like other HIPAA-protected information, this type of information should be kept confidential. However, sports doctor always needs to keep the athlete’s safety in mind, and if confronted with an athlete who has a genetic predisposition to concussion or poor recovery from concussion, they need to advise the athletes to get regular brain scans to ensure there’s no damage but not necessarily to stop them from playing.

There are other factors at play beyond genetic disposition, and more studies need to be done to get a better understanding of this public health risk. Until then, neurologists need to make careful judgments when dealing with concussions.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He also serves as the assistant medical director there. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

Proper medical surveillance is one of the best tools for preventing and managing concussion. As neurologists, we play a key role in this aspect of concussion prevention and recovery, with the ultimate responsibility of protecting the health and safety of athletes.

That said, there are several instances in which neurologists and sports doctors could face ethical quagmires as they strive toward this goal. One of them is determining when athletes can return to play, if at all, as repetitive injuries are more likely to cause serious brain injury. Those players who have had previous concussions are also at a higher risk for sustaining another one, with football players having a four to six times higher risk than do others with prior concussions. Additionally, those who go back to play too soon are vulnerable to sustaining a second concussion, typically within 10 days of the prior one.

©Fred Hall/iStockphoto.com

Therefore, much care and consideration must be taken into account when assessing a concussed athlete’s condition. And not all neurologists will be qualified to perform the necessary evaluations, treatment recommendations, and postconcussion follow-up. It is the ethical responsibility of the licensed health care professional to ensure that whoever is treating the concussed athlete is experienced and knowledgeable about treating this type of trauma, including sending the athlete to a different neurologist if necessary.

There’s also a 2013 study that began to take a look at two particular genetic polymorphisms, an amino acid switch in exon 6 of the MAPT (microtubule-associated protein tau) gene and in the promoter region of the APOE (apolipoprotein E) gene, and their relation to postconcussion neurocognitive function/reaction time and outcome in a group of college athletes comprising men’s football and men’s and women’s soccer players. The goal of the study is to determine whether an athlete’s genetic makeup determines the severity of postconcussive brain function. The outcome of the study could potentially add another wrinkle to the question of whether to let players go back to the game or not.

A similar ethical question arises when considering whether to let athletes with certain genetic dispositions play at all. Evidence has been found that boxers with the APOE epsilon-4 allele were more likely to suffer from the effects of chronic traumatic brain injury as their careers went on than did those who did not have the genotype (JAMA 1997;278:136-140). This genotype has also been linked with Alzheimer’s disease (Arch. Neurol. 1995;52:1074-9).

Knowledge of an athlete’s genetic vulnerability to brain injury creates an ethical grey area because the misuse of the information could harm his or her career. Like other HIPAA-protected information, this type of information should be kept confidential. However, sports doctor always needs to keep the athlete’s safety in mind, and if confronted with an athlete who has a genetic predisposition to concussion or poor recovery from concussion, they need to advise the athletes to get regular brain scans to ensure there’s no damage but not necessarily to stop them from playing.

There are other factors at play beyond genetic disposition, and more studies need to be done to get a better understanding of this public health risk. Until then, neurologists need to make careful judgments when dealing with concussions.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He also serves as the assistant medical director there. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

This summer, amateur, elite male boxers are back to competing without headgear after nearly 3 decades of being required to wear it during competition. The headgear rule was put in place by the International Boxing Association (AIBA) before the 1984 Olympics, but now elite, male boxers are beginning to compete in much more professional style.

So what will this mean for concussion rates and concussion risk?

At first glance, it may seem to put boxers at greater risk; however, clinical evidence has shown that headgear does not necessarily reduce the incidence of concussion. The advantage of headgear is that it protects the face and decreases eye injuries, nose injuries, and facial lacerations. It does not stop the head from spinning, the primary cause of concussion in boxers.

There are four ways that boxers can get brain injury, but none of them can be prevented by wearing headgear. These mechanisms include:

• Rotational acceleration. This occurs when the head twists/spins – usually from a blow to the side of the jaw, cheek, or chin – and the brain follows, resulting in the stretching and tearing of axons. (This is why knockouts usually come from a severe blow to the chin.)

• Linear acceleration. This happens when the brain moves forward/backward – usually from a direct blow to the face – and strikes the skull, resulting in the stretching or tearing of neurons in the brain and brain stem.

• Injury to the carotid arteries. This occurs after a sudden flexion of the neck – usually from a direct blow to it – resulting in tears in one or both carotid arteries, causing a stroke.

• Impact deceleration. This is the rapid slowing of the brain inside the skull and is usually caused by hitting an immovable object like the ring floor, resulting in cerebral contusions.

In fact, there is a new, still unpublished AIBA study that suggests the removal of headgear would decrease head injuries, such as concussions. According to the study spearheaded by AIBA medical commission chairman Dr. Charles Butler, the rate of concussion was 0.38% in 7,352 rounds for boxers wearing headgear, compared with 0.17% in 7,545 rounds for those without headgear.

On the other hand, another recent study by the Cleveland Clinic found that headgear can help decrease linear acceleration and the potential for injury from it.

Clearly, there is still much debate on this issue. As amateur boxers start this new phase of competition, experts will be better able to observe changes in concussion rates, if any, and hopefully come to a definitive conclusion as to whether headgear use has any impact at all.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

This summer, amateur, elite male boxers are back to competing without headgear after nearly 3 decades of being required to wear it during competition. The headgear rule was put in place by the International Boxing Association (AIBA) before the 1984 Olympics, but now elite, male boxers are beginning to compete in much more professional style.

So what will this mean for concussion rates and concussion risk?

At first glance, it may seem to put boxers at greater risk; however, clinical evidence has shown that headgear does not necessarily reduce the incidence of concussion. The advantage of headgear is that it protects the face and decreases eye injuries, nose injuries, and facial lacerations. It does not stop the head from spinning, the primary cause of concussion in boxers.

There are four ways that boxers can get brain injury, but none of them can be prevented by wearing headgear. These mechanisms include:

• Rotational acceleration. This occurs when the head twists/spins – usually from a blow to the side of the jaw, cheek, or chin – and the brain follows, resulting in the stretching and tearing of axons. (This is why knockouts usually come from a severe blow to the chin.)

• Linear acceleration. This happens when the brain moves forward/backward – usually from a direct blow to the face – and strikes the skull, resulting in the stretching or tearing of neurons in the brain and brain stem.

• Injury to the carotid arteries. This occurs after a sudden flexion of the neck – usually from a direct blow to it – resulting in tears in one or both carotid arteries, causing a stroke.

• Impact deceleration. This is the rapid slowing of the brain inside the skull and is usually caused by hitting an immovable object like the ring floor, resulting in cerebral contusions.

In fact, there is a new, still unpublished AIBA study that suggests the removal of headgear would decrease head injuries, such as concussions. According to the study spearheaded by AIBA medical commission chairman Dr. Charles Butler, the rate of concussion was 0.38% in 7,352 rounds for boxers wearing headgear, compared with 0.17% in 7,545 rounds for those without headgear.

On the other hand, another recent study by the Cleveland Clinic found that headgear can help decrease linear acceleration and the potential for injury from it.

Clearly, there is still much debate on this issue. As amateur boxers start this new phase of competition, experts will be better able to observe changes in concussion rates, if any, and hopefully come to a definitive conclusion as to whether headgear use has any impact at all.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

This summer, amateur, elite male boxers are back to competing without headgear after nearly 3 decades of being required to wear it during competition. The headgear rule was put in place by the International Boxing Association (AIBA) before the 1984 Olympics, but now elite, male boxers are beginning to compete in much more professional style.

So what will this mean for concussion rates and concussion risk?

At first glance, it may seem to put boxers at greater risk; however, clinical evidence has shown that headgear does not necessarily reduce the incidence of concussion. The advantage of headgear is that it protects the face and decreases eye injuries, nose injuries, and facial lacerations. It does not stop the head from spinning, the primary cause of concussion in boxers.

There are four ways that boxers can get brain injury, but none of them can be prevented by wearing headgear. These mechanisms include:

• Rotational acceleration. This occurs when the head twists/spins – usually from a blow to the side of the jaw, cheek, or chin – and the brain follows, resulting in the stretching and tearing of axons. (This is why knockouts usually come from a severe blow to the chin.)

• Linear acceleration. This happens when the brain moves forward/backward – usually from a direct blow to the face – and strikes the skull, resulting in the stretching or tearing of neurons in the brain and brain stem.

• Injury to the carotid arteries. This occurs after a sudden flexion of the neck – usually from a direct blow to it – resulting in tears in one or both carotid arteries, causing a stroke.

• Impact deceleration. This is the rapid slowing of the brain inside the skull and is usually caused by hitting an immovable object like the ring floor, resulting in cerebral contusions.

In fact, there is a new, still unpublished AIBA study that suggests the removal of headgear would decrease head injuries, such as concussions. According to the study spearheaded by AIBA medical commission chairman Dr. Charles Butler, the rate of concussion was 0.38% in 7,352 rounds for boxers wearing headgear, compared with 0.17% in 7,545 rounds for those without headgear.

On the other hand, another recent study by the Cleveland Clinic found that headgear can help decrease linear acceleration and the potential for injury from it.

Clearly, there is still much debate on this issue. As amateur boxers start this new phase of competition, experts will be better able to observe changes in concussion rates, if any, and hopefully come to a definitive conclusion as to whether headgear use has any impact at all.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

Concussions have been under-diagnosed and under-treated for many years despite being one of the most common sports-related injuries, but we have made progress in recent years with public education efforts and standard of care treatment guidelines. I am encouraged by the findings and promise of continued work on concussions that were on display at the fourth and most recent International Consensus Conference on Concussion in Sport, which took place in November of last year in Zurich.

The conference addressed the currently controversial issue regarding chronic traumatic encephalopathy (CTE) that has been found in National Hockey League and National Football League players from posthumous brain biopsies. In 2000, with funding from the NFL players’ union, Dr. Julian Bailes, co-director of the NorthShore Neurological Institute, and I surveyed 1,090 retired pro football players, most of whom had at least one concussion during their careers. We found that players who had concussions showed significantly more CTE-like symptoms of permanent brain damage, such as confusion, memory loss, and speech problems, than did players without concussions.

But, by the time of the most recent conference, there was still not enough proof that concussions can cause CTE. The international consensus agreed, however, that more information is needed and more research must be done on the matter. In the future, I plan on following former professional boxers to determine the effects of repeated concussions and their role in CTE later in life.

The conference also revealed contradictions to some widespread beliefs about protections against concussion. The consensus found no evidence that helmets or mouth guards protect against concussion because concussions are caused by acceleration/deceleration of the head, although they do have their place in protecting people from other types of brain injuries.

There were also new findings on the treatment of concussion. From 4 years ago until the latest conference, bed rest has been recommended for treating concussion. The new consensus readdressed this issue and determined that perhaps relative rest, not bed rest, would be a better solution, along with some low-level activity and therapy before symptoms have completely disappeared. One month after the trauma, patients are also now advised to take part in more low-level activities and physiotherapy and have a neuropsychological consult.

The Sport Concussion Assessment Tool (SCAT2), which gives us a standardized method for evaluating athletes aged 10 years and older for concussions, will also be refined and a SCAT3 will be created in 2013.The new SCAT would exclude neck injuries from the assessment, among other changes.

What won’t be changed are the present guidelines regarding the age of youth athletes to begin practicing skills such as heading in soccer, tackling in football, and body checking in ice hockey. However, there needs to be continued research, on the types and magnitudes of head forces for specific ages and sports to better understand the threshold of concussion.

While the official new consensus statement won’t be published until this month or next, here are some other key points the conference panel agreed upon:

• No return to play on the same day.

• Potentially revising the pocket SCAT for non–health care personnel.

• Creating a Child SCAT for children less than 10 years old.

• Removing baseline testing from the postconcussion evaluation of patients.

• Conducting computerized neuropsychological testing only for those athletes whose concussions persist.

Additionally, the consensus suggested that all those involved in sports adhere to the following:

• Maximizing rule enforcement and zero tolerance for head checking and unsafe player behavior that puts the head at risk for injury, as well as enforcing and strict penalties for those who do.

• Teaching young athletes the proper techniques and fundamentals for their respective sports.

• Teaching coaches, parents, and athletes concussion recognition and response.

• Reducing unnecessary contact in youth sports.

• Maximizing rule enforcement.

Our role as doctors is just one part of a larger effort to help reach the best outcomes for athletes. The conference highlighted the need for various experts – from health professionals to those on the sidelines to those who make and enforce sporting rules – to come together to find a consensus on the best way to manage and prevent concussion in sport.

We are at an unprecedented time in our ability to prevent, recognize, and manage sports-related head injuries. What we do next can and will affect the lives of the athletes we treat. I look forward to continuing this dialogue with you as the next chapter of treatment for sports concussion and other brain injuries is written.

Dr. Barry Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He currently serves as the chief medical officer of the New York State Athletic Commission, a team physician for U.S.A. Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

Concussions have been under-diagnosed and under-treated for many years despite being one of the most common sports-related injuries, but we have made progress in recent years with public education efforts and standard of care treatment guidelines. I am encouraged by the findings and promise of continued work on concussions that were on display at the fourth and most recent International Consensus Conference on Concussion in Sport, which took place in November of last year in Zurich.

The conference addressed the currently controversial issue regarding chronic traumatic encephalopathy (CTE) that has been found in National Hockey League and National Football League players from posthumous brain biopsies. In 2000, with funding from the NFL players’ union, Dr. Julian Bailes, co-director of the NorthShore Neurological Institute, and I surveyed 1,090 retired pro football players, most of whom had at least one concussion during their careers. We found that players who had concussions showed significantly more CTE-like symptoms of permanent brain damage, such as confusion, memory loss, and speech problems, than did players without concussions.

But, by the time of the most recent conference, there was still not enough proof that concussions can cause CTE. The international consensus agreed, however, that more information is needed and more research must be done on the matter. In the future, I plan on following former professional boxers to determine the effects of repeated concussions and their role in CTE later in life.

The conference also revealed contradictions to some widespread beliefs about protections against concussion. The consensus found no evidence that helmets or mouth guards protect against concussion because concussions are caused by acceleration/deceleration of the head, although they do have their place in protecting people from other types of brain injuries.

There were also new findings on the treatment of concussion. From 4 years ago until the latest conference, bed rest has been recommended for treating concussion. The new consensus readdressed this issue and determined that perhaps relative rest, not bed rest, would be a better solution, along with some low-level activity and therapy before symptoms have completely disappeared. One month after the trauma, patients are also now advised to take part in more low-level activities and physiotherapy and have a neuropsychological consult.

The Sport Concussion Assessment Tool (SCAT2), which gives us a standardized method for evaluating athletes aged 10 years and older for concussions, will also be refined and a SCAT3 will be created in 2013.The new SCAT would exclude neck injuries from the assessment, among other changes.

What won’t be changed are the present guidelines regarding the age of youth athletes to begin practicing skills such as heading in soccer, tackling in football, and body checking in ice hockey. However, there needs to be continued research, on the types and magnitudes of head forces for specific ages and sports to better understand the threshold of concussion.

While the official new consensus statement won’t be published until this month or next, here are some other key points the conference panel agreed upon:

• No return to play on the same day.

• Potentially revising the pocket SCAT for non–health care personnel.

• Creating a Child SCAT for children less than 10 years old.

• Removing baseline testing from the postconcussion evaluation of patients.

• Conducting computerized neuropsychological testing only for those athletes whose concussions persist.

Additionally, the consensus suggested that all those involved in sports adhere to the following:

• Maximizing rule enforcement and zero tolerance for head checking and unsafe player behavior that puts the head at risk for injury, as well as enforcing and strict penalties for those who do.

• Teaching young athletes the proper techniques and fundamentals for their respective sports.

• Teaching coaches, parents, and athletes concussion recognition and response.

• Reducing unnecessary contact in youth sports.

• Maximizing rule enforcement.

Our role as doctors is just one part of a larger effort to help reach the best outcomes for athletes. The conference highlighted the need for various experts – from health professionals to those on the sidelines to those who make and enforce sporting rules – to come together to find a consensus on the best way to manage and prevent concussion in sport.

We are at an unprecedented time in our ability to prevent, recognize, and manage sports-related head injuries. What we do next can and will affect the lives of the athletes we treat. I look forward to continuing this dialogue with you as the next chapter of treatment for sports concussion and other brain injuries is written.

Dr. Barry Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He currently serves as the chief medical officer of the New York State Athletic Commission, a team physician for U.S.A. Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

Concussions have been under-diagnosed and under-treated for many years despite being one of the most common sports-related injuries, but we have made progress in recent years with public education efforts and standard of care treatment guidelines. I am encouraged by the findings and promise of continued work on concussions that were on display at the fourth and most recent International Consensus Conference on Concussion in Sport, which took place in November of last year in Zurich.

The conference addressed the currently controversial issue regarding chronic traumatic encephalopathy (CTE) that has been found in National Hockey League and National Football League players from posthumous brain biopsies. In 2000, with funding from the NFL players’ union, Dr. Julian Bailes, co-director of the NorthShore Neurological Institute, and I surveyed 1,090 retired pro football players, most of whom had at least one concussion during their careers. We found that players who had concussions showed significantly more CTE-like symptoms of permanent brain damage, such as confusion, memory loss, and speech problems, than did players without concussions.

But, by the time of the most recent conference, there was still not enough proof that concussions can cause CTE. The international consensus agreed, however, that more information is needed and more research must be done on the matter. In the future, I plan on following former professional boxers to determine the effects of repeated concussions and their role in CTE later in life.

The conference also revealed contradictions to some widespread beliefs about protections against concussion. The consensus found no evidence that helmets or mouth guards protect against concussion because concussions are caused by acceleration/deceleration of the head, although they do have their place in protecting people from other types of brain injuries.

There were also new findings on the treatment of concussion. From 4 years ago until the latest conference, bed rest has been recommended for treating concussion. The new consensus readdressed this issue and determined that perhaps relative rest, not bed rest, would be a better solution, along with some low-level activity and therapy before symptoms have completely disappeared. One month after the trauma, patients are also now advised to take part in more low-level activities and physiotherapy and have a neuropsychological consult.

The Sport Concussion Assessment Tool (SCAT2), which gives us a standardized method for evaluating athletes aged 10 years and older for concussions, will also be refined and a SCAT3 will be created in 2013.The new SCAT would exclude neck injuries from the assessment, among other changes.

What won’t be changed are the present guidelines regarding the age of youth athletes to begin practicing skills such as heading in soccer, tackling in football, and body checking in ice hockey. However, there needs to be continued research, on the types and magnitudes of head forces for specific ages and sports to better understand the threshold of concussion.

While the official new consensus statement won’t be published until this month or next, here are some other key points the conference panel agreed upon:

• No return to play on the same day.

• Potentially revising the pocket SCAT for non–health care personnel.

• Creating a Child SCAT for children less than 10 years old.

• Removing baseline testing from the postconcussion evaluation of patients.

• Conducting computerized neuropsychological testing only for those athletes whose concussions persist.

Additionally, the consensus suggested that all those involved in sports adhere to the following:

• Maximizing rule enforcement and zero tolerance for head checking and unsafe player behavior that puts the head at risk for injury, as well as enforcing and strict penalties for those who do.

• Teaching young athletes the proper techniques and fundamentals for their respective sports.

• Teaching coaches, parents, and athletes concussion recognition and response.

• Reducing unnecessary contact in youth sports.

• Maximizing rule enforcement.

Our role as doctors is just one part of a larger effort to help reach the best outcomes for athletes. The conference highlighted the need for various experts – from health professionals to those on the sidelines to those who make and enforce sporting rules – to come together to find a consensus on the best way to manage and prevent concussion in sport.

We are at an unprecedented time in our ability to prevent, recognize, and manage sports-related head injuries. What we do next can and will affect the lives of the athletes we treat. I look forward to continuing this dialogue with you as the next chapter of treatment for sports concussion and other brain injuries is written.

Dr. Barry Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He currently serves as the chief medical officer of the New York State Athletic Commission, a team physician for U.S.A. Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.