Writing the next chapter for sports concussion

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.