ST. CHARLES, Ill. | March is National Athletic Training Month and Brain Injury Awareness Month. Perhaps not coincidentally then, the featured presentation at The Great Lakes Athletic Trainers' Association's Annual Meeting last week, here, was on concussion. Neuropsychologist Michael Collins, PhD, of the University of Pittsburgh, led off the William "Pinky" Newell Lecture, named for the Purdue University legend.
Early in his presentation, Collins said, "Concussion is being mismanaged in many communities where athletic trainers are not present." To remedy that situation, the Centers for Disease Control is distributing a tool kit on the diagnosis and management of concussion to every primary care physician in the country this month. Collins is a co-author.
According to Collins, there are as many 3.8 million sports-related concussions per year. Most go undiagnosed. The CDC calls the numbers a "silent epidemic." Therefore usually undiagnosed, victims continue in their chosen sport and are re-injured, which can lead to permanent problems.
To illustrate his point, Collins showed a video of former San Francisco Giant catcher Mike Matheny taking repeated foul tips off his facemask during a four-day period in May of last year. By the fourth day, Matheny could no longer remember which signals were which and had to removed from the game.
Seen by Collins shortly thereafter, he has yet to recover and has retired. Had previous concussions been recognized and managed properly, Matheny would still be playing Collins believes.
"(Proper management) is like hitting the re-set button on the brain and the risk of concussion returns to normal," he said.
Speaking along with Collins was Kevin Guskiewicz, PhD, ATC who co-authored the NATA's position statement on concussion. He echoed much of what Collins had to say.
The Director of the Sports Medicine Research Laboratory at the University of North Carolina started by taking issue with an article in the New England Journal of Medicine, published earlier this year. It offered the following definition: "'Concussion' refers to an immediate and transient loss of consciousness accompanied by a brief period of amnesia after a blow to the head."
Highlighting that particular line on one of his slides, Guskiewicz said, "That's a 1966 definition (and) if you have read it, please don't practice it." To refute that definition, Guskiewicz relied on the CDC's definition which makes no mention of loss of consciousness and instead lists headache, difficulty remembering, constant fatigue, and irritability as symptoms. In fact, according to the CDC, only 10 percent of concussions involve loss of consciousness.
Once less enthusiastic about the computerized neuropsychological testing becoming more and more popular even at the high school level, Guskiewicz advocated its use in his talk. To deal with reluctant coaches and administrators, Guskiewicz urged those attending to share what he had recently found in his research. Athletes evaluated by neuropsychological tests are cleared to play, on average, two days sooner than those who are not.
John Doherty is a certified athletic trainer and licensed physical therapist.
This column reflects solely his opinion. Reach him at ptatcsport@sbcglobal.net.
