Prevention of concussions

Prevention of mild traumatic brain injury involves taking general measures to prevent traumatic brain injury, such as wearing seat belts and using airbags in cars.[1] Older people are encouraged to try to prevent falls, for example by keeping floors free of clutter and wearing thin, flat, shoes with hard soles that do not interfere with balance.[2]

Unfortunately, to date, there is no data to support the claim that any particular type of helmet or protective equipment reduces the risk of sports-related concussion.[3] Improvements in the design of protective athletic gear such as helmets may decrease the number and severity of such injuries.[4] New "Head Impact Telemetry System" technology is being placed in helmets to study injury mechanisms and potentially help reduce the risk of concussions among American Football players. Changes to the rules or the practices of enforcing existing rules in sports, such as those against "head-down tackling", or "spearing", which is associated with a high injury rate, may also prevent concussions.[3]

In sports

Prevention of undiagnosed and repeat injury is of importance in sports-related concussions.[5] Every three minutes, a child in the United States is treated for a sports-related concussion.[6] Between 2010 and 2014, sports-related concussions experienced a 500% uptick.[7] Rapid sideline testing using short neuropsychological tests that assess attention and memory function have been proven useful and accurate. The Maddocks questions[8][9] and the Standardized Assessment of Concussion (SAC)[10][11][12] are examples of validated sideline evaluation tools. The Return To Play (RTP) protocol aims to decrease repeat concussions within a short time frame to minimize second impact syndrome.[5] It assures players who experience a concussion have complete cognitive and clinical recovery before returning to play.[5] Best practices of RTP involve graduated activity intensification with each step taking at least 24 hours to assure full rehabilitation within one week (includes asymptomatic at rest and during exercise).[5] In cases in which resources (i.e. neuropsychologists, neuroimaging) are available on-site, RTP may be more rapid.[5] Baseline assessments, performed before concussion occurs, provide a comparison from which to measure severity of post-concussive symptoms. However, they have not been shown to decrease risk of injury.[13] The U.S. based nonprofit National Safety Council included state-by-state concussion prevention efforts for youth-sports related concussions in its 2017 State of Safety report.[14]

Unfortunately, to date, there is no data to support the claim that any particular type of helmet or protective equipment reduces the risk of sports-related concussion.[3] Improvements in the design of protective athletic gear such as helmets may decrease the number and severity of such injuries.[15] New "Head Impact Telemetry System" technology is being placed in helmets to study injury mechanisms and potentially help reduce the risk of concussions among American Football players. Wearing a helmet is associated with a decreased risk of head injury for skiers and snowboarders.[16]

Changes to the rules or the practices of enforcing existing rules in sports, such as those against "head-down tackling", or "spearing", which is associated with a high injury rate, may also prevent concussions.[3] The National Football League (NFL) implemented the sideline concussion assessment protocol in 2011 which oversees the treatment of any possible concussions and ensures that the medical staff on each sideline are following proper league protocol and testing for any head trauma.[17] In 2011 the NFL enforced a kickoff rule change which moved football kickoffs five yards forward, resulting in reduced concussion incidence by 50%.[18] Rules aimed at promoting fair play, while minimizing outwardly aggressive behavior, should be encouraged in all sports.[5]

Prevention could be helped by professional sports such as the National Hockey League pushing towards making hockey safer. Concussions have become a more common injury in hockey today and are being critiqued under a microscope for both their immediate and long-lasting effects. Concussion symptoms can last for an undetermined amount of time depending on the player and the severity of the concussion. There is also the potential of post-concussion syndrome, which can last for months after the concussion. Concussions damage the brain of a person and the brain controls everything in the body so to limit this severe injury to the highest percentage possible would be in everybody’s best interest. National Hockey League Commissioners have been pushing towards stricter rules and longer suspensions to crack down on concussions. There have been great strides taken in changing the rules to help concussion prevention but officials still have to continue to look into this considering the game is evolving at an extremely fast pace. Players also need to make it a responsibility within themselves to protect each other and not take runs at each other with a player with their head down. Taking all these things into consideration, this could help the prevention of concussions in the National Hockey League considerably.[19]

References
  1. Kushner D (1998). "Mild Traumatic brain injury: Toward understanding manifestations and treatment". Archives of Internal Medicine. 158 (15): 1617–1624. doi:10.1001/archinte.158.15.1617. PMID 9701095.
  2. Mayo Clinic Staff (2007). "Concussio". Mayo Clinic. Retrieved 2008-01-10.
  3. McGuine TA, Hetzel S, McCrea M, Brooks MA (2014). "Protective equipment and player characteristics associated with the incidence of sport-related concussion in high school football players: a multifactorial prospective study". The American Journal of Sports Medicine. 42 (10): 2470–8. doi:10.1177/0363546514541926. PMC 4477806. PMID 25060072.
  4. Levy ML, Ozgur BM, Berry C, Aryan HE, Apuzzo ML (2004). "Birth and evolution of the football helmet". Neurosurgery. 55 (3): 656–61, discussion 661–2. doi:10.1227/01.NEU.0000134599.01917.AA. PMID 15335433.
  5. McCrory, P., Meeuwisse, W., Johnston, K., Dvorak, J., Aubry, M., Molloy, M., & Cantu, R. (2009). Consensus Statement on Concussion in Sport – the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. South African Journal of Sports Medicine, 21(2), 36-46.
  6. Bryan, M. A., Rowhani-Rahbar, A., Comstock, R. D., & Rivara, F. (2016). Sports-and Recreation-Related Concussions in US Youth. Pediatrics, 138(1), e20154635. Access at: http://pediatrics.aappublications.org/content/early/2016/06/16/peds.2015-4635
  7. FAIR Health. (2016). Five Hundred Percent Increase in Youth Concussion Diagnoses since 2010. Access at: http://www.fairhealth.org/servlet/servlet.FileDownload?file=01532000001niFi
  8. Maddocks D, Dicker G. (1989). An objective measure of recovery from concussion in Australian rules footballers. Sport Health, 7(Supplement):6-7.
  9. Maddocks DL, Dicker GD, Saling MM (1995). "The assessment of orientation following concussion in athletes". Clinical Journal of Sport Medicine. 5 (1): 32–5. doi:10.1097/00042752-199501000-00006. PMID 7614078.
  10. McCrea M. (2001). Standardized mental status assessment of sports concussion. Clinical Journal of Sport Medicine. 11(3):176-81.
  11. McCrea M, Kelly JP, Randolph C, Kluge J, Bartolic E, Finn G, Baxter B (1998). "Standardized assessment of concussion (SAC): on-site mental status evaluation of the athlete". The Journal of Head Trauma Rehabilitation. 13 (2): 27–35. doi:10.1097/00001199-199804000-00005. PMID 9575254.
  12. McCrea M, Randolph C, Kelly J. The Standardized Assessment of Concussion(SAC): Manual for Administration, Scoring and Interpretation. 2nd ed. Waukesha, WI 2000.
  13. Randolph, C. (2011). Baseline neuropsychological testing in managing sport-related concussion: does it modify risk? Current Sports Medicine Reports, 10(1):21-6.
  14. National Safety Council (2017). The State of Safety - A State-by-State Report. Itasca, IL. Pg. 32-33. accessed at: http://www.nsc.org/NSCDocuments_Advocacy/State-of-Safety/State-Report.pdf Archived 2017-07-28 at the Wayback Machine
  15. Levy ML, Ozgur BM, Berry C, Aryan HE, Apuzzo ML (2004). "Birth and evolution of the football helmet". Neurosurgery. 55 (3): 656–61, discussion 661–2. doi:10.1227/01.NEU.0000134599.01917.AA. PMID 15335433.
  16. Sulheim S, Holme I, Ekeland A, Bahr R (2006). "Helmet use and risk of head injuries in alpine skiers and snowboarders". JAMA. 295 (8): 919–24. doi:10.1001/jama.295.8.919. PMID 16493105.
  17. National Football League. (2011). NFL announces new sideline concussion assessment protocol. Retrieved from http://www.nfl.com/news/story/09000d5d81e78cc4/printable/nfl-announces-new-sideline-concussion-assessment-protocol-. Retrieved April 8, 2012.
  18. Klemko, R. (2012). NFL: 2011 kickoff rule change cuts concussions in half. USA Today. Retrieved from http://content.usatoday.com/communities/thehuddle/post/2012/02/nfl-2011-kickoff-rule-change-cut-concussions-in-half/1. Retrieved April 8, 2012.
  19. Hutchison, Michael G; Comper, Paul; Meeuwisse, Willem H; Echemendia, Ruben J (2013-06-13). "An observational method to code concussions in the National Hockey League (NHL): the heads-up checklist". British Journal of Sports Medicine. 48 (2): 125–129. doi:10.1136/bjsports-2012-092059. ISSN 0306-3674. PMID 23766437.
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