Do you understand BEST practice when it comes to concussion management?

We think we do.

That’s why we’ve come up with our BEST practice model of concussion care.

Baseline screening

We have removed time and cost limitations by designing fast and cost-effective multimodal screens that focus on key measures monitored and compared at an individual level to inform best care following a concussion.

Education

We have developed a world class programme of three critical courses for anyone involved in concussion management. From parents and teachers through to medical practitioners wanting evidence-based updates. Knowing the most up to date developments saves lives.

Support

We facilitate support by providing opportunities for global networking within our custom designed online community of experts. Knowledge around concussion continues to evolve rapidly from the fields of neurology, vestibular, musculoskeletal and sports rehabilitation. Collaboration and sharing are key to innovation and best practice moving forward.

Technology

We are at leading the way in the selective use of the very best technological advances. From specific software, apps, virtual reality, eye-tracking, balance, movement, heart rate and cognitive testing devices, we know what people need and when.

For the eagle eyed amongst you, you’ll have spotted why we call it BEST practice. If you didn’t, have another read. It’ll be good fodder for your brain.

BEST practice. It’s not something enough people know about when it comes to concussion management.

Odd really, given that ignorance isn’t bliss, it costs lives.

Ten years is a long time.

When it comes to both the landscape relating to the management of concussion and the advancing role of the Athletic Trainer within sporting organisations in the United States a lot has happened.

As such, it was great to read the latest position statement from the National Athletic Trainers’ Association (NATA) on the management of concussion.

One that provides an excellent update that bridges the condition and the profession.

One that considers the last decade of clinical evidence.

One that, if we reflect that the last position statement from the NATA was offered in 2014, is something that is overdue.

It is an essential read for all Athletic Trainers who want to consider an alignment between recent advances and current practice.

We have summarised the key points below.

Biopsychosocial Model:

The paper emphasizes a holistic approach to concussion management.

Beyond physical aspects, consider psychosocial factors (e.g., mental health, social support).

Personalized care is crucial.

 

Education and Prevention:

From athletes, to coaches, to parents improving education in this area is essential.

The paper underscores the authority of licensed medical professionals in decision-making.

Preventive measures, such as proper technique and equipment, play a vital role.

 

Assessment Advances:

The assessment process has evolved, including an update on the optimal value of baseline screening measures.

A comprehensive evaluation includes symptom assessment, cognitive testing, balance assessment, vestibular-ocular and mental health screening.

Athletic trainers should be proficient in these areas.

 

Prognostic Recovery Indicators:

Factors affecting recovery post-concussion are explored.

Initial symptom severity, early care seeking, and other individual characteristics influence outcomes.

Monitoring these indicators can inform key management decisions.

 

Mental Health Considerations:

Pre- and post-injury mental health are critical.

Screening for mental health conditions is recommended.

Establish referral networks for athletes with mental health needs.

 

Return to Academics:

Returning to school after a concussion requires careful planning.

Individualized support, academic adjustments, and communication with educators are essential.

Monitor academic progress during recovery.

 

Physical Activity and Rehabilitation:

Early controlled aerobic exercise benefits recovery.

Targeted rehabilitation interventions address persistent symptoms, including vestibular and cervicovestibular rehab protocols.

Gradual return to physical activity is part of the process.

 

Return to Sport:

Updated return-to-sport guidelines emphasize a stepwise approach.

Clinically directed aerobic exercise is part of treatment.

Individualized decisions consider the athlete’s well-being.

The above points can be quite daunting for some, when considering the complex and challenging nature of concussion and potential serious health implications.

The authors encourage Athletic Trainers to:

‘engage with domain-specific stakeholders who have expertise beyond the scope of AT clinical practice when feasible. Despite the updates provided herein, concussion science and care will continue to evolve, including in the areas of diagnostic and treatment capabilities. To best facilitate a successful outcome for their patients, ATs are encouraged to stay abreast of scientific advances and thoughtfully modify clinical policies within their scope of practice to provide evidence-based care whenever possible.’

And Your Brain Health is here to help Athletic Trainers!

We provide education with our specific level courses in addition to clinical support and networking through our Community Platform.

If you are an Athletic Trainer who works in this area please do reach out.

Knowledge around concussion and brain injury recovery and rehabilitation is making promising progress; however, challenges remain in driving progress and innovation in clinical practice.

Every field of clinical practice faces the challenges of keeping up to date with the latest clinical evidence and implementation of a change in practice usually takes a frustratingly long time! Concussion research and practice is also further challenged by the complex nature of brain impairments that involve many clinical specialities from the areas of neurology, neuropsychology, sport, and vestibular clinical practice, just to name a few. If rehabilitation is to progress, these clinical specialities will need to communicate and collaborate effectively. That is no easy task, with differences in terminology, experience, locations, and expertise making collaborative work very challenging.

A new review article ‘Concussion Rehabilitation and the Application of Ten Movement Training Principles’ has been recently published and was written by our Co-Director, Associate Professor James McLoughlin. It encourages a common language that can help categorise and review progress in relation to key rehabilitation principles. This article will keep you well up to date in the latest development in concussion rehabilitation and hopefully support future collaborations and innovations for rapid progress. This fits with our motto at Your Brain Health

“Better information leads to better decision making and ultimately better outcomes.”

Movement training principle Factors to consider in concussion rehabilitation
Actual and predicted bodily state Body schema. Spatial cognition. Cervical joint position sense errors
Feedback Visual and vestibular feedback dependence. Sensory reweighting.
Integration and perceptual dysfunction. Overemphasis on symptom reporting
Error-based learning Gaze stability and balance training. Vision training
Reward-based learning Behavioural changes. Motivations and pressures. Managing expectations
Cognitive selection and planning Memory and concentration changes. Executive dysfunction. Cognitive adaptations, loads, and fatigue. Slowed processing speed. Difficulty with increasing complexity
Practice and variability Time for learning and adaptation. Frequency, intensity, and duration of practice to be effective. Variability and integration of different domains into rehabilitation. Autonomic and cardiovascular limitations. Prescribed rests/breaks
Biomechanics Forces for brain damage and cervical whiplash injury. Prevention via protective gear. Prevention via motor skill training. Motor control and muscle compensations. Post-traumatic benign paroxysmal positional vertigo (BPPV)
Physical capacity Detrimental rest. Autonomic dysfunction and postural orthostatic tachycardia syndrome (POTS). Deconditioning. Neck strength and stability
Attentional focus Dual-task challenges. Attention-deficit/hyperactivity disorder (ADHD) and concussion testing. Functional overlay, external focus, and distraction techniques. Overemphasis on symptoms and hypervigilance illness behaviours
Beliefs and self-efficacy Anxiety. Depression. Post-traumatic stress disorder (PTSD).
Psychological flexibility. Negative beliefs and nocebo effects. Community misinformation and messaging

At Your Brain Health, we take concussion in sport very seriously.

As one of the most common injuries in contact sport, it is also potentially one of the most devastating to long term health and quality of life. Your Brain Health has put together this list of facts on concussion you should know following the advice released from the Australian Sports Commission, partly addressing the recommendations from the Australia Parliament Senate inquiry into concussion and repeated head trauma contact sports.

Your Brain Health offers many services to help sporting clubs including education, multimodal baseline screening and clinical support.

Here are some facts about concussion in sport you should know……

13.4 concussions per 1000 hours played Rugby union (1). In Rugby, concussion injury rates are high for both ball carrier and tackler (2).

There are 6 concussions per 1000 hours played in AFL (3,4).

Concussion is also common in sports such as basketball (5) and netball (6).

Incidence of concussion and games missed is on the rise, likely due to improved recognition and early care. For example, concussion without loss of consciousness is more likely to be recognised, and more players are now more likely to be removed from play and assessed.

Concussion increases risk of further musculoskeletal injury (7,8).

Concussion is the most common injury requiring hospitalisation. Concussion is about 1 in 8 injuries in community Australian Rules Football. (Australian Institute of Health and Welfare).

There is a higher incidence of anxiety and depression in those with persistent symptoms following concussion (9).

Adverse mental health and sleep has been found in former rugby players with higher numbers of previous concussions (10).

Concussion is linked to worsening mental health, including depression (11,12).

Slowed reaction times are common after concussion 13 and can lead to increased risk of further head impacts (14,15).

Vestibular-ocular changes can occur in over half of sport related concussions (16).

Vestibular-ocular dysfunction (17), mental health (9) and sleep quality (18) is associated with prolonged recovery and should be included in baseline screening.

Concussion and repeated head impacts are associated with increased risk of developing Chronic Traumatic Encephalography (CTE) (19).

Females are more susceptible to concussion and suffer worse symptoms (20).

Multimodal baseline screens help with interpretation of post-concussion assessments (21).

Early interventions combining vestibular, ocular and neck treatment and sub-threshold exercises improve outcomes with earlier return to play (22–24).

Associate Professor James McLoughlin, Co-Director, Your Brain Health

References

1. Union, R. F. England Professional Rugby Injury Surveillance Project. 2014-15 Season Report. Preprint at (2016).

2. West, S. W. et al. It Takes Two to Tango: High Rates of Injury and Concussion in Ball Carriers and Tacklers in High School Boys’ Rugby. Clin. J. Sport Med. (2023) doi:10.1097/JSM.0000000000001118.

3. Orchard, J., Seward, H. & Orchard, J. J. AFL Injury Survey 2014. , Victoria, Australia: AFL Doctors Association, AFL … (2014).

4. League, A. F. AFL Injury Survey 2015. Melbourne, Victoria, Australia: AFL Doctors Association (2015).

5. Patel, B. H. et al. Concussions in the National Basketball Association: Analysis of Incidence, Return to Play, and Performance From 1999 to 2018. Orthop J Sports Med 7, 2325967119854199 (2019).

6. Downs, C., Snodgrass, S. J., Weerasekara, I., Valkenborghs, S. R. & Callister, R. Injuries in Netball-A Systematic Review. Sports Med Open 7, 3 (2021).

7. Howell, D. R., Lynall, R. C., Buckley, T. A. & Herman, D. C. Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A Scoping Review. Sports Med. 48, 1097–1115 (2018).

8. McPherson, A. L., Nagai, T., Webster, K. E. & Hewett, T. E. Musculoskeletal Injury Risk After Sport-Related Concussion: A Systematic Review and Meta-analysis. Am. J. Sports Med. 47, 1754–1762 (2019).

9. Sheldrake, E. et al. Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review. Front. Neurol. 13, 850590 (2022).

10. Hind, K., Konerth, N., Entwistle, I., Hume, P. & Theadom, A. Mental health and wellbeing of retired elite and amateur rugby players and non-contact athletes and associations with sports-related concussion: the UK …. Sports Med. (2021).

11. Rice, S. M. et al. Sport-Related Concussion and Mental Health Outcomes in Elite Athletes: A Systematic Review. Sports Med. 48, 447–465 (2018).

12. Gornall, A., Takagi, M., Morawakage, T., Liu, X. & Anderson, V. Mental health after paediatric concussion: a systematic review and meta-analysis. Br. J. Sports Med. 55, 1048–1058 (2021).

13. Eckner, J. T., Kutcher, J. S., Broglio, S. P. & Richardson, J. K. Effect of sport-related concussion on clinically measured simple reaction time. Br. J. Sports Med. 48, 112–118 (2014).

14. Harpham, J. A., Mihalik, J. P., Littleton, A. C., Frank, B. S. & Guskiewicz, K. M. The effect of visual and sensory performance on head impact biomechanics in college football players. Ann. Biomed. Eng. 42, 1–10 (2014).

15. Mihalik, J. P. et al. Collision type and player anticipation affect head impact severity among youth ice hockey players. Pediatrics 125, e1394-401 (2010).

16. Kaae, C., Cadigan, K., Lai, K. & Theis, J. Vestibulo-ocular dysfunction in mTBI: Utility of the VOMS for evaluation and management – A review. NeuroRehabilitation 50, 279–296 (2022).

17. Whitney, S. L. et al. Association of acute vestibular/ocular motor screening scores to prolonged recovery in collegiate athletes following sport-related concussion. Brain Inj. 34, 840–845 (2020).

18. Magliato, S. N. et al. Sleep Problems After Concussion Are Associated With Poor Balance and Persistent Postconcussion Symptoms. J. Child Neurol. 08830738231170721 (2023).

19. Daneshvar, D. H. et al. Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males. Nat. Commun. 14, 3470 (2023).

20. McGroarty, N. K., Brown, S. M., & Mulcahey, M. K. (2020). Sport-Related Concussion in Female Athletes: A Systematic Review. Orthopaedic Journal of Sports Medicine, 8(7), 2325967120932306.

21. Resch, J. E. et al. The sensitivity and specificity of clinical measures of sport concussion: three tests are better than one. BMJ Open Sport & Exercise Medicine 2, e000012 (2016).

22. Reid, S. A., Farbenblum, J. & McLeod, S. Do physical interventions improve outcomes following concussion: a systematic review and meta-analysis? Br. J. Sports Med. 56, 292–298 (2022).

23. Leddy, J. J., Haider, M. N., Ellis, M. & Willer, B. S. Exercise is Medicine for Concussion. Curr. Sports Med. Rep. 17, 262–270 (2018).

24. Hutchison, M. G. et al. Randomized controlled trial of early aerobic exercise following sport-related concussion: Progressive percentage of age-predicted maximal heart rate versus usual care. PLoS One 17, e0276336 (2022).

Sports injury in Australia, Australian rules football. (2023). Retrieved 4 September 2023, from https://www.aihw.gov.au/reports/sports-injury/sports-injury-in-australia/contents/featured-sports/australian-rules-football.