Jan 29, 2015
Bulletin Board

Concussions continue to be a hot topic in the athletic training room, on the field, and in the media. Prevention methods, keys to recognition, and long-term effects associated with the injury are getting more attention than ever before. For this issue’s Bulletin Board, we are zeroing in on the latest and most compelling concussion news.

A Common Return-To-Play Policy

The Ivy League’s decision in August to reduce the number of full contact practices for its football teams generated plenty of headlines, but other aspects of the conference’s plan to address concussion in the sport were overshadowed. In addition to rules designed to reduce players’ exposure to concussive and repeated subconcussive hits, the league adopted common return-to-play guidelines that all eight teams will follow.

Margot Putukian, MD, Team Physician at Princeton University and a member of the ad hoc Football Concussion Committee that recommended the rules changes, says the guidelines start with the best practices spelled out in the NCAA Concussion Management Plan and recommendations from the Third International Conference on Concussion in Sport. Before a player is allowed to return to play, he must be symptom-free at rest and with exertion, and have completed a normal cognitive evaluation when compared to a baseline, normal neuropsychological testing (if performed), and normal balance evaluation.

The return to activity must be based on a gradual increase in exertion. Sports medicine personnel are required to individualize return-to-play-guidelines to account for factors such as a player’s medical history, including previous concussions.

The League also looked beyond the athletic department and asked its schools’ deans to recognize the importance of cognitive rest in concussion recovery. It directed schools to develop plans that would accommodate the need for some athletes to limit their cognitive activities following a concussion.

League officials say they will next conduct studies of men’s and women’s ice hockey, lacrosse, and soccer (in that order). As a result, similar return-to-play guidelines and practice restrictions could be implemented in those sports as well.

To download the Ivy League Concussion Committee report, go to: bit.ly/IvyFBReport.

High-Tech Equipment Help

Since a concussion doesn’t always present with obvious symptoms, equipment manufacturers are working on other ways for coaches and athletic trainers to be alerted that an athlete may have suffered a hit that could cause a brain injury. To date, much of the work has focused on telemetry in football helmets, but technology is now spreading to another piece of equipment.

A Nebraska company has developed a chin strap that contains multiple accelerometers that measure G-forces and the duration of a hit. A light on the strap changes color if any impact exceeds a preset level based on the Wayne State Head Injury Criterion scale. Other companies, including the Cleveland Clinic, are working on a similar system for mouthguards that would send information on dangerous hits to a sideline computer.

Some skeptics, though, worry that these systems will result in false positives and they question whether such devices are useful in identifying concussions. “There’s no doubt [the chin strap] is measuring some aspect of force to the head and body,” Michael Bergeron, Director of Sanford Health’s National Institute for Athletic Health & Performance in Sioux Falls, S.D., told the Chicago Tribune. “However, whether that measured force is clinically meaningful or not, or relates at all to some theoretical concussion threshold, is another story.”

Chris Circo, CEO of Battle Sports Science, makers of the Impact Indicator chin strap, is confident measuring impact to the chin will help identify possible concussion, “especially when you employ technology and software that has actually been correlated to head sensors in the lab,” he told the Tribune. “This is actually what our product does.”

Gender Differences Revealed

A recent study of high school athletes suggests that concussion symptoms may vary by gender. As the number of girls who participate in sports continues to rise, knowing that female athletes may exhibit different symptoms is important for concussion detection.

The study, which was funded by the Centers for Disease Control and appeared in the February issue of the Journal of Athletic Training, looked at reports of 812 concussions from the 2005-06 and 2006-07 school years. Researchers found that while headache was the most commonly reported concussion symptom for both boys and girls, boys were more likely to report amnesia and confusion or disorientation, while girls were more likely to report drowsiness and noise sensitivity.

By knowing what to look for based on whether they are assessing a male or female athlete, athletic trainers may be able to diagnose a concussion more accurately–and quickly–than before. “Some symptoms, especially in the neurobehavioral category, are often overlooked on a sideline or initial assessment,” the study’s authors wrote in their report. “Because high school girls are more likely to display these symptoms, [athletic trainers] should initially associate those types of symptoms with a potential concussion.”

To view the study titled “Sex Differences in Concussion Symptoms of High School Athletes,” click on the Journal of Athletic Training link at: www.nata.org and choose Vol. 46, Number 1 from the list of issues.

Treatments Coming?

One of the frustrating aspects of concussions for athletes, parents, coaches, and athletic trainers alike is the lack of effective treatment. Usually, athletes are told they can do little else but rest until their symptoms subside. However, a pair of new studies hold the possibility of treatment options in the future.

In one study of 38 subjects with traumatic brain injury (TBI) as the result of a concussion, acupressure was found to improve cognitive performance compared to subjects who did not use acupressure. Acupressure involves using the fingertips to apply pressure to specific points on a subject’s body, similar to acupuncture.

“We found that the study subjects with mild traumatic brain injury who were treated with acupressure showed improved cognitive function, scoring significantly better on tests of working memory when compared to the TBI subjects in the placebo control group,” Theresa Hernandez, PhD, Associate Professor in Behavior Neuroscience at the University of Colorado and lead author of the study, told ScienceDaily.com. “This suggests to us that acupressure could be an effective adjunct therapy for those suffering from TBI.”

An unrelated study of mice suggests that antidepressants, which are sometimes prescribed to help people handle the emotional effects of a TBI, may also help brain cells survive and grow after such an injury. In the study, injured mice who were given imipramine had 70 percent more brain cells after four weeks than mice who did not receive the drug. The treated mice also showed significantly improved memory skills through behavioral tests compared to untreated mice although there was no observable difference in motor function recovery.

Jason Huang, PhD, Associate Professor of Neurosurgery at the University of Rochester Medical Center and the study’s corresponding author, told myhealthnewsdaily.com that more research in humans is needed before the Food and Drug Administration would consider using antidpressants to help humans recover from TBI. Because imipramine is an FDA-approved drug for treating depression, approval could be obtained quicker than normal.

To view the study “Acupressure as a Non-Pharmalogical Intervention for Traumatic Brain Injury (TBI)” go to: bit.ly/TCTBIlink1. To view the study titled “Imipramine Treatment Improves Cognitive Outcome Associated with Enhanced Hippocampal Neurogenesis after Traumatic Brain Injury in Mice” go to: bit.ly/TCTBIlink2. Both studies are from the Journal of Neurotrauma.


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