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Sport-Related Concussions

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B Sprad

on 1 March 2013

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Transcript of Sport-Related Concussions

Sport-Related Concussions Concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.

The Center for Disease Control and Prevention (CDC) estimates that up to 3.8 million concussions occur in sports-related activities in the United States annually.

Much of the focus on concussions has come from the realization that concussions are brain injuries.

Often referred to as mild traumatic brain injuries...
Introduces Rugby union as a popular contact sport played on all sport levels
Mentions the risks associated with collision sports, specifically Rugby
Zones into the main focus of the article, which is the occurrence of concussion or mild traumatic brain injuries (MTBI) in sport
Interestingly, prior studies report a relatively low incidence rate of concussion in rugby CONCUSSIONS AUTHORS INTRODUCTION METHODS Education DISCUSSION RESULTS By: Brandon Spradley Education Doug King, PhD Sport Performance Research Institute in New Zealand
Lead Clinical Nurse Specialist
Works in the Emergency Dept
Thesis- Injuries in rugby league: Incidence, dominance, influences and return to play decisions Matt Brughelli, PhD Lecturer in Exercise Science
External reviewer for multiple journals
Research Areas: Injury prevention in sport, acute and chronic effects of eccentric exercise, mechanics of sprinting Patria Hume, PhD Professor in Human Movement
Leading expert in sports injury prevention and sports performance biomechanics
Research areas: Sports injury biomechanics, equipment testing, sports technology Conor Gissane, PhD Completed PhD at Brunel University
Research Areas: Injury in sport, statistics, statistics education, research design
Design of research studies to investigate sport rehabilitation practices St Mary's
University College,
School of Sport, Health
and Applied Science Programme
Director Introduction: Review and Critique Introduction: Review and Critique Introduces the Sport Concussion Assessment Tool (SCAT); developed in 2004
Updated to the SCAT2, developed in 2009 at the international conference on Concussion in Sport (CIS)
The SCAT2 is an improvement of the original SCAT and requires approximately 20 minutes to complete
Authors state that the SCAT2 is more of a training room assessment rather than sideline assessment Introduction: Review and Critique The King-Devick (KD) test is introduced as a concussion sideline screening tool.
Originally developed as a reading tool to assess the relationship between poor oculomotor functions and learning disabilities.
Poor oculomotor function has been reported as a determinant for the identification of a MTBI.
The KD test uses a series of charts of numbers that progressively become more difficult to read. Introduction: Review and Critique Introduces a pilot study that utilized the KD test in a representative rugby league.
KD test and SCAT2 identified players with sport-related concussions. Purpose of the study The purpose of this study was to use the KD test and SCAT2 in amateur rugby union players to identify witnessed and unrecognized episodes of concussion that occurred from match participation. Methods: Review and Critique Prospective observational cohort study was conducted on a premier club level amateur rugby union during 2012 in New Zealand.

All matches were played under the rules and regulations of the New Zealand Rugby Football Union.

The study received Institutional Review Board (IRB) approval from The Auckland University of Technology Ethics Committee.

All players gave informed consent to participate in the study.

All players provided a written record of their concussion history, which included number of concussions, residual symptoms, and medical clearance to return to competition. King-Devick (KD) Test Saccadic test measuring the speed of rapid-number naming

Utilizes three test cards with a series of single-digit numbers that are read aloud from left to right

The baseline assessment required less than 2 minutes to administer per player

The KD tests utilized were v2.2.0 and completed on an IPAD2 Sport Concussion Assessment Tool 2 Consists of both subjective and evaluative components consisting of the cognitive assessment, neurological screening, Post-Concussion Symptom Scale (PCSS), and modified Maddock's questions

The cognitive assessment includes: five word immediate and delayed recall assessment, reciting the months of the year in reverse order, and repeated single digits in reverse order

Assessments were completed on an IPAD2 Methods: Review and Critique All concussion match injuries were recorded by the team sports medic, who was a registered comprehensive nurse with tertiary sports medicine qualifications.

Definition of concussion used for the study:

Any disturbance in brain function caused by a direct or indirect force to the head.
It results in a variety of non-specific symptoms and often does not involve loss of consciousness.
Concussion should be suspected in the presence of any one or more of the following signs: (a) symptoms (e.g. headache), (b) physical signs (e.g. unsteadiness), (c) impaired brain function (e.g. confusion), or (d) abnormal behavior Testing Procedures Each player completed a pre-competition questionnaire on concussion history, a baseline PCSS and two trials of the KD test.
The fastest time of the KD with no errors was recorded as the baseline scores.
During matches, players observed to have received a direct blow to the head, were slow to rise, or appeared unsteady following a collision, were assessed on-field.
Any signs of delayed answering, incorrect answers to questions, or if the player appeared to be impaired in any way, resulted in the athlete being removed from competition.
Players who reported any sign(s) of a concussion or who were suspected to have incurred a concussion as a result of match participation were removed from the match and assessed with the KD test and SCAT2. Modified repeat high intensity endurance test The modified repeat high intensity endurance test was a secondary objective for the research study and completed by all members of the rugby team.

The objective was to test whether fatigue had any effect on the results of the KD test.

Players completed a series of 6 x 70 meter sprints, with a 30 second recovery.

Two minutes after exercise, players were asked to rate their perceived exertion using the Borg RPE scale.

Players were also required to complete the KD test on an IPAD2. Statistical Analyses All data were entered into a Microsoft Excel spreadsheet and analyzed with SPSS v19.0.0.

Baseline and post-match KD scores were compared using the Wilcoxon signed-rank test.

The relationships of pre-competition KD scores to the PCSS scores were determined using Spearman rank-correlations.

The differences between the RHIET run tests were assessed using the Wilcoxon signed-rank test.

Statistical significance was set at p<0.05. Results: Review and Critique Results: Review and Critique Discussion: Review and Critique Main Points The KD test rapidly identified players with concussions and provided instant feedback to the coaching and medical staff.

The KD test was able to identify players that had not shown, or reported, any signs or symptoms of a concussion but sustained a head injury.

The KD test is sensitive to neurological changes such as those seen with sports-related concussion. Future Research Future studies involving the KD test as a sideline assessment tool for concussion may need to have more than one KD test available for administration.

Further research is warranted to explore the impacts that occur from participation in rugby union.

Future studies should investigate the implementation of the KD test in specific sport environments. Limitations of the Study Every player was not tested with the KD post-match (some players avoided testing).

Having a team medic on the sideline as a researcher meant that other injuries were required to be tended to other than concussions.

Previous concussion history was most likely under-reported. Doug King, PhD Lecturer in Exercise Science
External reviewer for multiple journals
Research Areas: Injury prevention in sport, acute and chronic effects of eccentric exercise, mechanics of sprinting
Teaching Areas: Human Movement, Strength & Conditioning Sport Performance Institute in New Zealand
Lead Clinical Nurse Specialist
Works in Emergency Dept
Thesis: Injuries in rugby league incidence, dominance, influence, and return to play decisions Matt Brughelli, PhD Programme
Director St Mary's University College
School of Sport,
Health and Applied Science Patria Hume, PhD Professor in Human Movement
Leading expert in sports injury prevention & sports performance biomechanics
Research Areas: Sport injury biomechanics, equipment testing, sports technology Connor Gissane, PhD Completed PhD at Brunel University
Research Areas: Injury in sport, statistics, statistics education, research design
Design studies to investigate sport rehabilitation practices Concussions in amateur rugby union identified with the use of a rapid visual screening tool (2013), Journal of Neurological Sciences Signs & Symptoms Management of Concussion Managing concussions involve primary, secondary, and tertiary strategies.

Primary strategies are those that prevent concussions from happening.

Secondary prevention refers to expert management of a concussion that has already occurred.

Tertiary strategies help prevent the long-term complications that concussions can cause. Sport Psychology Many athletes tend to deny concussion symptoms because the culture of athletics encourages athletes to be tough and play through the pain (Echemendia, 2012).
Athletes are strongly motivated to return to competition following a concussion and often minimize symptoms: therefore a reliable assessment is critical in the evaluation of concussion (Echemendia, 2012).
A significant amount of concussions are not reported to coaches or athletic trainers.
Underreporting symptoms is a common practice at the high school level. Concussion Defined Total number of players: 37
Mean age: 22 +/- 4.0 years
Total games: 5 pre-season games & 19 competition games
Match exposure: 478.8 hours

22 concussive incidents recorded
5 concussive incidents were witnessed
17 unrecognized concussive incidents/identified with KD

Post-Exercise KD Scores
Baseline: 44.9 s (25.4 - 69.2)
Post test 2 min: 43.6 s (25.3 - 68.4)
Significantly different (p<0.001) This section re-introduces the purpose of the study and reports the KD test as a practical sideline screening tool for detecting concussions.

The KD test assesses for impairment of eye movements, attention, language, and other areas that correlate with sub-optimal brain function that may occur following a concussion.

The current study, along with previous investigations support the use of the KD test, as it is designed to complement other assessments.
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