Book review by Dr. Michael Turner
Sports-Related Concussion in Youth- Improving the Science, Changing the Culture (336 pages)
This is essentially the 2012 Zurich Concussion Consensus process applied to research in youth sport – a great summary of the topic but not an easy read.
For anyone versed in concussion the themes will be familiar:
- A very high profile topic
- Very few good quality articles published in the recent literature relating to concussion in youth sport
- Epidemiology data non-existent for grass roots sport
- The culture in youth sport is to play down concussion and avoid letting the team down
- A single definition of concussion is not universally applied so data gathering is a mess
- Little research has taken place on the molecular changes that occur in the young brain when a concussion occurs
- Mixed findings on the long term effects of repetitive concussions and sub-concussive episodes
- Risk factors for post-concussion syndrome and CTE have not been identified
- No studies on the pre-high school group have tracked the post-concussion changes found in the following activities – physical, cognitive, emotional or sleep
- There is no data to establish a threshold for concussion in young athletes
- The is no equipment that can mitigate or prevent concussion, despite the manufacturers claims to the contrary
- There is currently inadequate information to establish what combination of tests is best to identify and monitor concussion in youth sport (using hospital based or non-hospital based assessment tools)
- Despite the consensus agreement that concussion should be treated with physical and cognitive, there is little empirical evidence to establish what is the optimal degree and duration of physical rest and if cognitive rest is necessary
The authors explore these problem areas and offer a detailed review of the published literature:
- Neuroscience, biomechanics and risks of concussion in the developing brain
- Concussion recognition, diagnosis and acute management
- Treatment and management of prolonged symptoms and post-concussion syndrome
- Consequences of repetitive head impacts and multiple concussions
- Protection and prevention strategies
- Conclusions and recommendations
The authors make 6 recommendations:
- Surveillance – establish a national surveillance program for children aged 5-21
- Evidence based guidelines for concussion diagnosis and management – should be established and research supported
- Short and long term consequences of concussion and repetitive head impact – should be evaluated using a controlled, longitudinal, large scale study
- Age appropriate rules and playing standards – should be rigorously evaluated by sports associations, schools and national governing bodies of sport
- Biomechanics, protective equipment and safety standards – should be evaluated by research funded by the National Institutes of Health and the Department of Defence
- Culture change – the NCAA and other organisations should develop, implement and evaluate the effectiveness of the large scale efforts to increase knowledge about concussion and change the culture surrounding concussion (among elementary school through college-age youth, their parents, coaches, sports officials, educators, athletic trainers and health care professionals)
The book costs just US$64-00; the recommended research will cost a great deal more
Sports-Related Concussion in Youth – Improving the Science, Changing the Culture (336 pages)
Institute of Medicine and National Research Council of the National Academies
ISBN – 13: 978-0-309-28800-2
ISBN – 10: 0-309-28800-2
http://0-www.ncbi.nlm.nih.gov.elis.tmu.edu.tw/books/NBK169016/
http://www.nap.edu/catalog.php?record_id=18377
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Dr. Michael Turner, MB BS, FFSEM is the Chief Medical Adviser for the Lawn Tennis Association, London
Listen HERE to the BJSM podcast interview about his time as chief medical adviser of the Lawn Tennis Association, including the medical scandals that have cropped up and the advances he’s seen in the game’s sports medicine.