Neuroimaging May Predict Recovery After Mild TBI

Neuroimaging May Predict Recovery After Mild TBI

Taking a Stand on the Silent Epidemic.

The Silent Epidemic
Concussion and its risks are poorly understood by athletes, parents, doctors, and sports organizations because it is a "silent epidemic". Silent and Epidemic are strong words but are accurate.
Unfortunately, athletes across the spectrum of sports are victims of sport-related concussion (SRC) and going unrecognized and being returned to play too early.
Why the confusion when the evidence is out there? Why ignore the warnings? What will it take to make us take a concussion seriously?
Surprisingly the first move to create a protocol was made in 2001 (Vienna), 2nd in 2004 (Prague) 3rd in 2008 (Zurich), the 4th in November 2012 (Zurich), and 5th and latest in April 2017 (Berlin)by the International Consensus Conferences on Concussion in Sport.

Silent Ones
Regrettably the fact that athletes are silent about their experiences is particularly worrisome. A silence that is driven by many factors which include being told that they cannot return to play, or play anymore, or be seen to be weak by fellow athletes, their families, and even suffer reprisal from the coach and all the way up to the top of the sports organizations they are involved with.

Derek Boogaard, a hockey player from Saskatchewan, Canada is one of the many who is silent to rest of the world, but not to his family and team-mates.
Derek died at age 28 of an overdose, but on autopsy was found to have CTE, (Chronic Traumatic Encephalopathy), previously known as dementia pugilistica. During his hockey career as a defenseman, he had sustained multiple concussions.
Had Derek lived he could have developed some or even all of the classical symptoms of CTE such as confusion, headaches, memory loss, aggression, and depression but these can take years to develop. This makes it more difficult to grasp the association of head injuries or concussions and CTE. But then it is too late.
His problems with alcohol and drug addiction do muddy the waters and though it is not clear what played the greatest role we do know that the concussions played a significant role.

Non-Silent Ones

Sidney Crosbie's experience with a concussion, Sidney Crosbie diagnosed with a concussion,

certainly drew attention to this condition, although sadly due to his celebrity but if that is what it takes then so be it. He diligently took sufficient time to recover before returning to play, which cost him almost a full year of absence from the team and playing but it was important to him.

The National Association of School Psychologists is taking a stand. Their published article Research-based-Practice on Sport-related-Concussions expertly expresses the concerns and shared views.

The Coaching Association of Canada has accepted to follow a protocol of proper Concussion Management.

The movie Concussion about Dr. Bennet Omalu, a renowned pathologist in Pittsburgh, documents his non-silence but also the consequences of his actions and the imposing reaction from sports organizations.

Eric Lindros is taking a stand. (Eric Lindros hits back at sports concussions).

Rowan Stringer died taking a stand, which led to Rowans law ( Bill 149, Rowan's Law Advisory Committee Act, 2016)

What can we do in the meantime?
See Guidelines for Concussion / Mild Traumatic Brain Injury & Persistent Symptoms
Thanks to the Ontario Neurotrauma Foundation.

Denial and fear are still rampant and until this is overturned, athletes will not feel safe to express their symptoms, their suffering and so unmanaged and untreated they will be lost to us all in silence.

When will we all stop the silence?

A prospective study of concussions....

A prospective study of concussions among National Hockey League Players during regular season games: the NHL-NHLPA Concussion Program

See

Concussion Resources in Canada

Concussion Resources

• Parachute Canada, also see Resources

• Canadian Concussion Collaborative

• Think First Canada

• Brain Injury Canada

• Hockey Canada Concussions

• Health.gov.on. Concussions

The Coaching Association of Canada Supports Jury’s Recommendations for Concussion Education Guidelines

Concussion Awareness can increase when sports organizations get involved creating protocols and plans to deal with concussion in a systematic way.

This was posted June 6, 2015, by the Coaching Association of Canada

"Coaching Association of Canada - OTTAWA (June 5, 2015) – The Coaching Association of Canada (CAC) supports the education-driven recommendations made by the jury serving on the inquest into the death of Rowan Stringer highlighting the important role an educated coach plays in the prevention, identification, and management of sport-related concussions and return to play for participants.

“The Coaching Association of Canada and its partners recognize the importance of concussion awareness and preparedness as an essential part of coach training,” said Lorraine Lafrenière, Chief Executive Officer of the CAC. “Through the National Coaching Certification Program, we help our partners implement strategies to ensure safe environments for athletes in all sports. We are proud to continue to provide coaches with concussion awareness resources and education that are in line with many of the jury’s recommendations.”

The CAC partners with more than 500 Canadian sports organizations in the development and delivery of coach training as part of its flagship program, the National Coaching Certification Program (NCCP).

The NCCP, identified as a world-leader in coach education, has a long-standing recognition of the value of the role of the coach in all matters of safety in sports. Core components of NCCP coach training at all levels include ethical decision-making, the safety of participants, and emergency action plan development.

Rugby Canada is an NCCP partner that continuously demonstrates their commitment to athlete safety. Rugby Canada’s NCCP programs are fully integrated with World Rugby’s international standards for concussion protocols and management.

“Rugby Canada is thoroughly reviewing the recommendations made by the jury serving on the inquest into the death of Rowan Stringer and supports any steps that make the game safer for its players,” said Jim Dixon, Rugby Canada General Manager, Rugby Operations and Performance. “We will continue to work with our partners such as the CAC and World Rugby, to ensure players, coaches, referees, and volunteers have the tools and education to prevent, identify, and manage concussions.”

“Player safety is and will continue to be a priority for Rugby Canada. All registered Rugby Canada coaches must meet minimum NCCP and World Rugby coach education requirements including Make Ethical Decisions and World Rugby’s Concussion Management program and Rugby Ready module.”

The CAC is committed to ensuring all sport organization partners and coaches have access to concussion awareness resources. With funding from the Public Health Agency of Canada’s Active and Safe Initiative, and in collaboration with the Canadian Centre for Ethics in Sport, Hockey Canada, and Parachute Canada, the CAC created the award-winning Making Head Way eLearning series.

The free Making Head Way module educates coaches, parents, athletes, teachers, and officials on concussion prevention, signs and symptoms, management, and internationally recognized the return to play protocol. The Making Head Way series was developed in consultation with medical experts Dr. Jamie Kissick, Dr. Mark Aubry, and Dr. Charles Tator and is available for small or large-scale use immediately via coach.ca. Proof of completion of the module is available publicly through the CAC’s national database upon successful completion.

For more information on the CAC’s concussion awareness tools and resources, including the Making Head Way eLearning Series, please visit coach.ca/concussion.

About the Coaching Association of Canada

The Coaching Association of Canada unites stakeholders and partners in its commitment to raising the skills and stature of coaches, and ultimately expanding their reach and influence. Through its programs, the CAC empowers coaches with knowledge and skills, promotes ethics, fosters positive attitudes, builds competence, and increases the credibility and recognition of coaches.

About Rugby Canada

Rugby Canada is a member of World Rugby (formerly the International Rugby Board) and is also the National Sport Organization (NSO) responsible for administrating the game of Rugby Fifteens and Rugby Sevens in Canada. Rugby Canada’s mandate is to keep Canadian rugby competitive at the highest levels domestically and internationally. For more information, visit www.rugbycanada.ca.

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For more information, contact:

Natalie Rumscheidt
Director, Marketing and Communications
Coaching Association of Canada
613-235-5000, ext. 2051
nrumscheidt@coach.ca

Bryan Kelly
Manager of Communications and Media Relations
Rugby Canada
250-418-8998, ext. 314
bkelly@rugbycanada.ca"

Link between fighting and concussion in NHL Emails

This appeared March 28, 2016, on TSN Link-between-fighting-concussions-personal-tragedies-discussed-in-unsealed-nhl-emails

The evidence is actually available, but it is not being used in practice. Unfortunately, athletes still experiencing symptoms of concussion are returning to their sport and other activities without proper management.

Link between cold weather and an increased risk of concussion

This article was published in the Globe and Mail today, and I'm posting it here as it contains valuable information.

Study finds link between cold weather, increased risk of concussion

ADRIANA BARTON

The Globe and Mail

Published Thursday, Mar. 31, 2016 2:56PM EDT

Last updated Thursday, Mar. 31, 2016 2:59PM EDT

Cold weather during National Football League games doubled the risk of concussion for players in the 2012-13 and 2013-14 seasons, researchers at the University of Toronto have found.

NFL players were also 50 per cent more likely to suffer ankle injuries on game days when the temperature dipped below 10 C than when it was 21 or warmer.

The study is the first to show a link between cold weather and increased risk of injuries in pro football, said Dr. David Lawrence, lead author of the report published Thursday in the Orthopaedic Journal of Sports Medicine.

Nevertheless, he cautioned against concluding that colder weather is hazardous to players, saying it would be premature to set game-day temperature guidelines to prevent injuries.

“Additional research that either replicates or refutes these findings needs to be done before we take that next step,” said Lawrence, a clinical fellow in sports medicine at the University of Toronto and St. Michael’s Hospital.

Pro football is arguably the roughest of all major pro sports. Previous research by Lawrence found the overall risk of injury in the NFL was about three times higher than in professional rugby, and 25 times higher than in the NHL.

In this latest study, Lawrence and colleagues set out to identify risk factors for the five most common locations of injury in NFL players: knee, ankle, hamstring, shoulder and head (concussion).

The impetus for the research was to evaluate how the NFL’s proposal to expand its geographic borders might affect players’ injury risks. Changes in the NFL would require teams to travel greater distances to countries with different climates and altitudes, across a broader range of time zones.

In their analysis, however, the researchers found no relationship between injury risk and a change in time zone prior to a game, distance travelled to a game or how late in the season the game was played. Nor did factors such as the game’s importance, outcome or altitude seem to affect injury risk.

The researchers did find that shoulder injuries increased about 40 percent when teams played on grass instead of synthetic turf. Players may be more likely to lose their footing on grass, which tends to be more uneven, Lawrence said. He added that newer forms of synthetic turf have improved shock-absorbing properties and may help soften direct impacts to shoulders.

The association between cold weather and injuries is more difficult to explain, he said. Lawrence speculated that, in warmer weather, athletes may mistake the symptoms of concussion for heat stroke and fail to report them. In colder weather, athletes may be more likely to use hand-warmers, hot drinks, and warm coats on the sidelines, and, therefore, have more interaction with training staff who recognize symptoms of a concussion. He added that playing surfaces and sports equipment may become less elastic at colder temperatures, increasing the force to the head during impact. “But that hasn’t been proven,” he said.

There may be a physiological explanation for why cold weather may increase the risk of concussions, said Dr. Will Panenka, a neurologist and psychiatrist at the University of British Columbia who specializes in traumatic brain injury. In colder temperatures, “your whole body is more tense and you might not fall the right way,” he said. “Your neck may not be as amenable to stretching, so the impact is more to your head.”

Lawrence and colleagues are conducting a follow-up study using a larger data set over five years to see whether the link between cold weather and increased risk of injury for NFL players remains. “If that does turn out to be a true finding,” he said, the data could be relevant to rugby, soccer or “any outdoor sports that are played in different temperatures.”