Concussion Management in 2014, Part One

As 2013 draws to a close and attention moves from football and cheerleading to the winter sports, it is a good time to take a look at trends and progress in concussion care and what to look out for in the months and the year ahead.

This year has seen an explosion in position papers on concussion from many professional organizations including US pediatricians, neurologists, school psychologists and athletic trainers associations as well as the Ontario Neurotrauma Foundation which produced a fine document for those 18 and over. And of course the lawsuit was settled between players and the NFL. My Google Alert box is filled on a daily basis with news about concussion and its management across North America.

So what do we have to look forward to? Here are just a few themes to watch for:

How important is aerobic exercise in the recovery phase of concussion? Some researchers have begun to postulate that a gradual increase in aerobic activity following concussion may be beneficial as opposed to the prolonged rest and inactivity that has become common. There are psychological and physical reasons why some aerobic activity may be the better way to go. Athletes become de-conditioned and depressed when they are not allowed to exercise and participate. In addition there is some evidence that increasing cerebral blood flow may contribute to healing. Watch for more on this.

Research will continue to look for bio-markers of brain injury. Imagine if there were a simple blood test that could tell us whether the brain had actually sustained a blow strong or hard enough to correlate with what we call “concussion.” And even better, imagine if we could track such a blood test to tell us if recovery is moving in the right direction and how quickly. This is a long ways off, but is one of many holy grails in concussion research.

Meanwhile, others are developing head gear that tracks the impacts sustained by players. Watch for more data from these inventors, developers and promoters that correlates g-forces of hits with symptoms. Of course this does little for the thousands who sustain concussions in non-helmet sports or off the playing fields all together.

Watch for the continuing debate on whether kids under 13 should be playing contact sports. Look out, America. This conversation has started among pediatricians and neurologists and a few famous folks as well(NFL players and POTUS himself). If data begins to accumulate showing long term damage or consequences of early head injury (or even “sub-concussive” hits) there could be a sea-change in school-sponsored sports.

At the same time, many are now reinforcing the idea that physical education and sports are a good, healthy and important part of growing up. It would be great to have better data to inform this emotional subject.

Watch for Part 2 of this discussion for more upcoming products, strategies, resources and practices.

Ann Engelland, MD
Adolescent and Young Adult Health
School and College Health