Monday, March 29, 2010
Opening Day is Here!
Sunday, March 28, 2010
A Little More on Concussions
A colleague of mine reminded me of a story that she told me recently after reading my blog and thought it might be worth adding to this story.
This colleage asked me a couple of months ago about return to play standards after a concussion. The story told to me second hand a few months ago, so some of the details I may be a little fuzzy on. Her nephew was playing hockey when he sustained a very significant concussion. If I recall correctly, this was actually the second concussion he had suffered this season. The treating physician, a neurosurgeon, gave the athlete strict instructions to remain at home for a period of about 5-7 days. During this time he was to minimize stimulation as much as possible. This included no TV, video gaming, reading, and to minimize interactions with others. (This is being prescribed more often by physcians as a means to give the brain time to heal after the injury.) While a lot of research is continuing into this practice, on the surface, it makes sense that the brain would need time to heal.
Now for the disturbing part of the story. The teachers at his school, while reluctant to accept this plan of care, went along with it since they didn't want to cross a doctor's orders. However, the hockey coach was beside himself and was ready to throw this young man off the team when he didn't show up to support his teammates later in the week at another hockey game. Somehow, I guess he didn't think that being a spectator in a game that the young man cared greatly about was any kind of siginificant stimulation. It required parental intervention with the coach's supervisors to get the coach to back away from his threats.
This situation, I think, just reinforces the need for Athletic Trainers to be present and helping to inform coaches of just what is going on in with their althetes. I think that a lot of the headache in this case (no pun intended,) could have been averted with the right amount of education to all of the parties involved.
This colleage asked me a couple of months ago about return to play standards after a concussion. The story told to me second hand a few months ago, so some of the details I may be a little fuzzy on. Her nephew was playing hockey when he sustained a very significant concussion. If I recall correctly, this was actually the second concussion he had suffered this season. The treating physician, a neurosurgeon, gave the athlete strict instructions to remain at home for a period of about 5-7 days. During this time he was to minimize stimulation as much as possible. This included no TV, video gaming, reading, and to minimize interactions with others. (This is being prescribed more often by physcians as a means to give the brain time to heal after the injury.) While a lot of research is continuing into this practice, on the surface, it makes sense that the brain would need time to heal.
Now for the disturbing part of the story. The teachers at his school, while reluctant to accept this plan of care, went along with it since they didn't want to cross a doctor's orders. However, the hockey coach was beside himself and was ready to throw this young man off the team when he didn't show up to support his teammates later in the week at another hockey game. Somehow, I guess he didn't think that being a spectator in a game that the young man cared greatly about was any kind of siginificant stimulation. It required parental intervention with the coach's supervisors to get the coach to back away from his threats.
This situation, I think, just reinforces the need for Athletic Trainers to be present and helping to inform coaches of just what is going on in with their althetes. I think that a lot of the headache in this case (no pun intended,) could have been averted with the right amount of education to all of the parties involved.
Saturday, March 27, 2010
Cold Weather Softball/Baseball
Oh how much I am looking forward to being outside again for these two sports. I am not ready to freeze while doing it though.
Wednesday, March 24, 2010
Concussion Management in High School
With all of the attention that the NFL has finally given to the issue of concussions, it is not a suprise that the NFHS has begun to reexamine their rules as they relate to concussions as well. The first place to start is obvious, in football. The reasons to start here is first, the timing of the season, since rules changes for football for the succeeding season are usually approved in February. It is also one of the sports with the highest risk. However, I have not heard if the same rule was instituted in soccer. I would hope so, since now is the time to make changes there as well.
I also understand that since the official is the one person that is closest to the athletes that are at risk of injury during the course of the game, that they are given more authority to remove a student athlete from the game than they previously had. (Previously, they could only send an athlete out of the game if they suspected that the athlete was rendered unconcious.) The new rule allows the official to send an athlete out of the game for any suspected concussion symptom.
Now this is where it gets complicated. The previous rule allowed for an athlete to return to the game only with a written clearance from a physician. This was not a bad way to do it. However, now the official, who more than likely has no medical background whatsoever, can send an athlete out for any symptom including a headache. The problem here is that an athlete may complain to a teammate of a headache caused by skipping lunch or having a small, relatively benign, muscle pull in their neck during the game. If an official overhears this, he should send the athlete out of the game to be looked at. The problem is that there is not always a physician on the sidelines of a game. This is especially true at the sub-varsity levels. Under the old rule, there was no way to return an athlete if this was the scenario.
Fortunately, the rules comittee was willing to expand their interpretation of who could allow the athlete to return. However, this still poses yet another problem. The NFHS is a national boady and cannot make the rules too specific to govern who is qualified for all 50 states. Therefore, they chose to use vague language in the rule and settled for "appropriate medical personnel." I believe that it was understood to be left to each state athletic governing body to define this rule more specifically for each state. This is necessary because of differing state practice laws for many the diverse medical professionals that may be present at games. I can assume that the rules committee wanted to include Certified Athletic Trainers (that can also be licensed or registered depending upon the state.) I am also fairly certain that the intent was not to expand the list too greatly so as to prevent any individual from simply walking out of the stands and saying "I can do this." This can place far too many people and organizations at risk of litigations.
I am also aware of that the Ohio High School Athletic Association (OHSAA) is looking into defining this terminology as we speak. They have contacted other professional organizations in the state of Ohio asking for their input into this matter. This includes the Ohio Athletic Trainer's Association (OATA.) It is my hope that every ATC that received the invitation to the survey participates. The OATA has brought up some interesting arguements about whom to exclude from the list for various reasons.
The survey also asks about the possible use of neurological baseline testing requirements for all athletes at a local hospital or clinic. While I think this would be ideal, I question some of the logistics of getting this done. The locally popular software program has been advertised widely as a premier program for this assessment. I have had some experience using it in the past, and I agree that it is a high quality product. However, when it became cost prohibitive to the high school I work for, we had to discontinue the annual subscription. The hospital system that I am employed by has looked into becoming a provider of this program as well. However, this has run into a serious roadblock since larger, globally recognized hospital system that is in our market area already has a contract with the software program. The software company will not even return our phone calls due to their contractual commitments to this other system.
Video Links:
ESPN commentary on YouTube
Time Magazine article on long term effects of concussions
If anyone else has thoughts on this topic, please feel free to comment.
I also understand that since the official is the one person that is closest to the athletes that are at risk of injury during the course of the game, that they are given more authority to remove a student athlete from the game than they previously had. (Previously, they could only send an athlete out of the game if they suspected that the athlete was rendered unconcious.) The new rule allows the official to send an athlete out of the game for any suspected concussion symptom.
Now this is where it gets complicated. The previous rule allowed for an athlete to return to the game only with a written clearance from a physician. This was not a bad way to do it. However, now the official, who more than likely has no medical background whatsoever, can send an athlete out for any symptom including a headache. The problem here is that an athlete may complain to a teammate of a headache caused by skipping lunch or having a small, relatively benign, muscle pull in their neck during the game. If an official overhears this, he should send the athlete out of the game to be looked at. The problem is that there is not always a physician on the sidelines of a game. This is especially true at the sub-varsity levels. Under the old rule, there was no way to return an athlete if this was the scenario.
Fortunately, the rules comittee was willing to expand their interpretation of who could allow the athlete to return. However, this still poses yet another problem. The NFHS is a national boady and cannot make the rules too specific to govern who is qualified for all 50 states. Therefore, they chose to use vague language in the rule and settled for "appropriate medical personnel." I believe that it was understood to be left to each state athletic governing body to define this rule more specifically for each state. This is necessary because of differing state practice laws for many the diverse medical professionals that may be present at games. I can assume that the rules committee wanted to include Certified Athletic Trainers (that can also be licensed or registered depending upon the state.) I am also fairly certain that the intent was not to expand the list too greatly so as to prevent any individual from simply walking out of the stands and saying "I can do this." This can place far too many people and organizations at risk of litigations.
I am also aware of that the Ohio High School Athletic Association (OHSAA) is looking into defining this terminology as we speak. They have contacted other professional organizations in the state of Ohio asking for their input into this matter. This includes the Ohio Athletic Trainer's Association (OATA.) It is my hope that every ATC that received the invitation to the survey participates. The OATA has brought up some interesting arguements about whom to exclude from the list for various reasons.
The survey also asks about the possible use of neurological baseline testing requirements for all athletes at a local hospital or clinic. While I think this would be ideal, I question some of the logistics of getting this done. The locally popular software program has been advertised widely as a premier program for this assessment. I have had some experience using it in the past, and I agree that it is a high quality product. However, when it became cost prohibitive to the high school I work for, we had to discontinue the annual subscription. The hospital system that I am employed by has looked into becoming a provider of this program as well. However, this has run into a serious roadblock since larger, globally recognized hospital system that is in our market area already has a contract with the software program. The software company will not even return our phone calls due to their contractual commitments to this other system.
Video Links:
ESPN commentary on YouTube
Time Magazine article on long term effects of concussions
If anyone else has thoughts on this topic, please feel free to comment.
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