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CONCUSSION! What Do I Do?

Calgary Represented on World Stage in Concussion Research

When your brain is on the line – an interview on concussion with Drs. Winne Meeuwisse and Cory Wowk of Innovative Sport Medicine and Kathryn Schneider, PT, PhD of Evidence Sport and Spine

We see concussion in the news almost daily.  Gone are the days of hockey with no helmets, or kids skating at school in just a toque. The Government of Canada is in talks to create a Canadian concussion action plan and organized sports are implementing formal concussion protocols.

It may seem like this is all new and just happening now, but in fact, experts from around the world met in 2001 under the umbrella of the International Ice Hockey Federation with a clear goal in mind – to “create a simple, clear message and tools that will equip the practitioner to diagnose and manage concussion in sport”.  Ambitious…

Fifteen years of planning, scientific process development, the review of 60,000 research articles, 12 separate manuscripts, 33 experts, 420 participants from 24 countries and inclusion from all the major sports organizations the world over led to the release of the most recent Berlin Consensus Statement on Concussion in Sport in 2017.

The Calgary connection to the work of the consensus is closer than you know.  Of the six Canadians on the expert panel, three are Calgarians, two of them are within our clinical network and we connected with them both.

We caught up with Dr. Meeuwisse (WM) and Kathryn Schneider (KS) to ask about their experience creating the consensus and how it is used to implement the most up to date protocols on concussion rehabilitation.  Dr. Wowk (CW) also brought his clinical perspective to the interview.

First, we have to recognize a critical question on concussion care:

Why is concussion in sport more important than concussion from a slip and fall or a motor vehicle collision?

WM: “Simply put, it isn’t! A brain is a brain and the injury due to concussion is relatively similar in all cases.  The biggest difference is that players in sports may get hit again. No one wants another car crash and we often take fewer risks if we have had one collision, for example.  In sport, athletes want to be back on the field. Our aim is to ensure they do so as safely as possible”.

Besides being an injury to the brain, how does concussion differ from a muscle or bone injury?

CW: “We treat most injuries with the same principles - early recognition and appropriate management.  This results in reduced risk of further damage and less short, medium or long term complications. That being said, for a knee injury such as a meniscal tear, there may be a surgical option if an individual ends up with unresolved symptoms. Concussion and the brain have no such alternatives.  You have one brain. Early management with recognition of complicating factors is a key to keeping that brain healthy.”

Speaking of managing concussions, what tools did the Consensus give practitioners to help prevent and treat concussions?

KS: “I’m so glad you asked because it was a lot of work to create those tools! At the end of the four day conference in Berlin, we were able to provide three key tools.  The Concussion Recognition Tool 5, SCAT 5 and child SCAT5.  The first helps identify concussion in children, adolescents and adults and is used by FIFA, World Rugby and by groups such as Parachute Canada.  The other tools are used by medical professionals to assess concussion in adult and child athletes”

Can anyone get these tools?

CW: “Yes and no. The Recognition tool is readily available and can and should be used by the public; whether players, parents or coaches. Understanding the professional tools and how and when they are used to guide management requires medical experience and expertise. Furthermore, the medical tools should be used in conjunction with medical knowledge and training in conjunction with up to date research”

What are the 11 R’s?

WM: “We developed the 11 R’s at the Conference as a way of presenting the Consensus Statement in a step-by-step format: Recognise, Remove, Re-Evaluate, Rest, Rehabilitation, Refer, Recovery, Return to Sport, Reconsider, Residual effects and Risk Reduction.

The first two steps are the most important – Recognise and Remove. Any athlete with a suspected concussion should be immediately removed from practice or play and should not return to activity until assessed medically, even if the symptoms resolve.”

CW: “There are also some ‘Red Flags’ when parents or coaches should know to call an ambulance if no medical assessment is available.  These include neck pain, double vision, weakness or tingling in arms or legs, severe or increasing headache, seizure or convulsion, loss of consciousness, deteriorating conscious state, vomiting or increasingly restless agitated or combative behaviour.”

Can anyone come see you for concussion management?

CW: “We have a lot of expertise, and we have created a Rapid Access clinic (YYCsportinjury.com) at Innovative Sport Medicine that has a focus on sport-related concussions.”

KS: “Evidence Sport and Spine and Momentum Health have physiotherapists who have been introduced to some resources and protocols I’ve developed.  Concussions due to an MVA or other mechanisms of injury are best suited to see these trained physiotherapists. Our colleagues at Momentum Health can also see WCB cases.”

When are concussions different?

WM: “The principles and milestones are the same in children and young adults, but recovery normally takes longer in younger athletes.

Are concussions really as prevalent it would seem from the media?

CW: “It's not clear if there is an increase in the number of concussions, or an increase in the recognition of this injury.  The World Health Organization estimates that concussion is the 9th highest reason for disability-adjusted-life-years or DALY. In simpler terms, it is the #9 reason our work, activity and lifestyle is interrupted by injury.”  

Are you involved with some of the legislation happening in Ottawa?

KS: “Yes,  I’ve had the great opportunity to speak to parliament with some fascinating and inspirational people.  For example, Gordon Stringer is the father of Rowan Stringer, the reason for Ontario’s “Rowan’s Law”. Rowan Stringer died from a head injury in Rugby and the “Law” is being implemented to help with concussion recognition and management.  The work we do is critical for concussion management but is also crucial for developing intelligent policies that allow athletes to perform safely without compromising the integrity of the games they participate in.”

We are so privileged to work with these and other experts in the field of medicine. Call, click or come in to any of our nine locations to be connected with the right practitioner for your injury rehabilitation or prevention needs.

For rapid access, click

http://www.YYCsportinjury.com

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