By Balraj Ougra

The inaugural Sports Concussion Forum was recently (November 10th, 2017) hosted at Arc Centre of Excellence in Cognition and Its Disorders (CCD), at Macquarie Universities state of the art facility, Australian Hearing Hub.

Organised by the Department of Cognitive Science, Macquarie University, the event brought together experts from sports medicine, psychology, law and neuroscience as well as sports professionals. An overarching aim was to develop a strategic focus that leads a concussion research group. Sports Concussion is always a hot topic. Even more so since the release of the discussions from the 5th International Conference on Concussion in Sport, held in Berlin (Consensus OPEN ACCESS and available here:  http://bjsm.bmj.com/content/51/11/838) and the release of the 5^th edition Sport Concussion Assessment Tool (SCAT5 – OPEN ACCESS and available here: http://bjsm.bmj.com/content/51/11/851).

The forum highlighted that in Australia; AFL, rugby union, rugby league and other contact sports are currently re-examining the way in which head injuries are monitored and treated, with AFL leading the way. Assoc Prof Paul Sowman stated the research community has an important role to play in this and will be heavily involved in the development and refinement of objective methodologies for determining return to play protocols and developing evidence-based concussion management guidelines. Concussion in contact sport is notably becoming more visible and at times an emotive issue in the general media, the time for rigorous and open examination of the issues surrounding concussion has arrived.

Featured Topic’s & Speakers

• Neurotrauma: A Histortical, Clinical and Surgical Perspective. Associate Professor Antonio Di Leva, Neurosurgeon, Department of Clinical Medicine, Macquarie University
• Neuroscience Nursing & Concussion: 2017. Vicki Evans, Clinical Nurse Consultant, Royal North Shore Hospital
• The Future of Concussion Research at Macquarie University. Dr Bianca De Wit, Deputy Learning and Teaching Director, Department of Cognitive Science, Macquarie University and Associate Professor Paul Sowman, Department of Cognitive Science, Macquarie University
• Diagnosing Concussion with Visual Evoked Potentials. Daryl Fong, Biomedical Engineering, The University of Sydney
• Sports Related Concussions: A Rugby Perspective. Dr Nicole Sly, Sydney Rays
• Vestibular and Cervicogenic Management in Post Concussion Syndrome from a Physiotherapy Perspective. Chris Wynne, Lead Physiotherapist, Outpatient Services, MQ Health Physiotherapy
• Long Term Health Outcomes Following Concussion: From Epidemiology to Policy. Dr Reidar Lystad, AIHI, Macquarie
• Issues of Legal Liability Associated with Concussion and CTE. David Thorpe, Law, University of Technology

Highlights

• Assoc Prof Antonio Di Leva discussed concussions from a surgical point of view: sharing cases of when symptoms progress from a suspected concussion are more than what we see on the surface. He noted CT Scans are an appropriate initial tool to investigate internal vascular damage associated with the head trauma.
• Neuroscience Nurse Vickie Evans followed from an acute hospital setting, stating concussion testing needs to become more mainstream with pre season (Baseline), mid season and end season testing to be implemented across sporting codes.  Further to this she emphasised recovery for adolescents needs to begin with a return to learn protocol first. Easing the adolescent into school and having a modified/reduced cognitive learning program, then progressing them into a return to sport protocol when symptoms improve.
• Assoc Prof Paul Sowman/Dr Bianca de Wit & Daryl Fong discussed the current research they are involved in with respect to Magnetoencephalography (MEG) Imaging and portable ‘Neurogaming’ technology. These technologies can help pick up concussions in a timely manner as the devices identify functional connectivity network disruptions of the brain. More research and collaboration is required.
• Dr Nicole Sly from Sydney Rays, discussed the current return to play requirements in Rugby Union, with diagnosis of concussions becoming simpler at the elite level with live video footage. Rugby Union has adopted an independent doctor appraisal, who overlooks and can overrule team doctor diagnosis to provide an unbiased and objective prognosis. With Rugby Union Concussions rates being high in sport, Dr Nicole Sly mentioned that rule changes have an important role to play in making sports safer and to reduce incidence rates of Traumatic Brain Injuries (TBI).
• Physiotherapist Chris Wyne discussed a multimodal approach is required in post-concussion recovery, with vestibular training and cervicogenic management being important factors to incorporate.

Interesting fact!

Dr Reidar Lystad, Sports Epidemiologist and Chiropractor highlighted full contact combat sports such as MMA have injury incidence rates up to 275 injuries per 1,000 athletes. Interesting enough only < 1%, of these are ever classed as concussions, considering on average 30% of fights end in KO or TKO.

Why More Education and Advocacy is required to sporting codes.

(Below is an example of current concussion criteria used by World Taekwondo Concussion)

When called upon by the referee, the doctor will check the following:

1. Is the athlete aware or confused? Can he/she answer a simple question? 

2. Has the athlete his/her balance? 

3. Are the athlete’s pupils reactive and symmetrical with lighting? 

4. Is the athlete pale? With a lot of sweat? 

5. Does the athlete seem weak? 


The above example simply doesn’t have the depth to diagnose or manage an athlete suffering from a concussion. All the speakers at the Forum, strongly agreed that the SCAT5 still remains the gold standard concussion protocol endorsed by the Berlin Consensus Statement on Concussions in Sport. This valuable tool needs to be adopted widely by all sporting codes effectively manage sporting concussions.

Thank you to CCD and Macquarie University for hosting an outstanding event and BJSM for allowing me to share my highlights. The main take home point from this event is that the long term health outcomes of concussions need to be researched and monitored further, coupled with education for two main reasons:

1) To make informed decisions surrounding policy and

2) To address issues of legal liability associated with Concussions and CTE.

Recommended Follow up reads:

Cervicovestibular rehabilitation following sport-related concussion

Kathryn J Schneider, Willem H Meeuwisse, Karen M Barlow, Carolyn A Emery. Br J Sports Med Nov 2017 (URL – http://bjsm.bmj.com/content/early/2017/11/09/bjsports-2017-098667)

Tackling concussion in professional rugby union: a case–control study of tackle-based risk factors and recommendations for primary prevention

Matthew J Cross, Ross Tucker, Martin Raftery, Ben Hester, Sean Williams, Keith A Stokes, Craig Ranson, Prav Mathema, Simon Kemp

Br J Sports Med Oct 2017, bjsports-2017-097912; DOI: 10.1136/bjsports-2017-097912 (URL – http://bjsm.bmj.com/content/early/2017/10/11/bjsports-2017-097912)

‘Don’t let kids play football’: a killer idea

James MacDonald, Gregory D Myer

Br J Sports Med Oct 2017, 51 (20) 1448-1449; DOI: 10.1136/bjsports-2016-096833 (URL – http://bjsm.bmj.com/content/51/20/1448)

Pocket Concussion Recognition Tool. Link: URL –

http://bjsm.bmj.com/content/bjsports/47/5/267.full.pdf

World Rugby Concussion Management. Link: http://playerwelfare.worldrugby.org/concussion

******************

For more information on CCD visit https://www.ccd.edu.au/

Thank you also to Nash Anderson @sportmednews for his assistance on this blog.

About Balraj

Balraj Ougra is a Sports Chiropractor in Sydney, Australia. He has been working with the Australian Volleyball League and is looking forward to being a part of the Beach Volleyball World Tour medical team in Sydney in November 2017. Balraj has started a sports based clinic, Back Space Chiropractic in Sydney. He has a special interest in sports injuries and sports performance. You can follow him on Instagram @backspace.chiro