Have you read the Consensus Statement on Concussion in Sport? After all, it was required reading! In honor of Brain Injury Awareness Month, I reread it. Here are some of the key points that jumped out at me, concerning sports-related concussion (SRC).
Don’t miss #11!
The last item on this list says that vision therapy may reduce the incidence of SRC! This is based on the work of Dr. Joseph Clark and his team at the University of Cincinnati, and was published in Optometry and Visual Performance. Read on for the other ten items in the 11 Rs of SRC: Recognize; Remove; Re-evaluate; Rest; Rehabilitation; Refer; Recover; Return to sport; Reconsider; Residual effects; Risk reduction
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SRC may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.
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SRC typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms
evolve over a number of minutes to hours.
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SRC may result in neuropathological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no
abnormality is seen on standard structural neuroimaging studies.
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SRC results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged.
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A key concept in sideline assessment is the rapid screening for a suspected SRC, rather than the definitive diagnosis of head injury.
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Clinically, there is a need for diagnostic biomarkers as a more objective means to assess the presence/severity of SRC in athletes. Beyond the potential diagnostic utility, there is also keen interest in the development of prognostic biomarkers of recovery after SRC. Imaging and fluid biomarkers that reliably reflect the extent of neuronal, axonal and glial damage and/or microscopic pathology could conceivably diagnose and predict clinical recovery outcome and/or determine risk of potential cumulative impairments after SRC.
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‘Persistent symptoms’ does not reflect a single pathophysiological entity, but describes a constellation of non-specific post-traumatic symptoms that may be linked to coexisting and/ or confounding factors, which do not necessarily reflect ongoing physiological injury to the brain.
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Treatment should be individualised and target-specific medical, physical and psychosocial factors identified on assessment.
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Very little research to date has been carried out on children under the age of 13. There is some evidence that the teenage years, particularly the high-school years, might be the most vulnerable time period for having persistent symptoms—with greater risk for girls than boys.
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Schools are encouraged to have an SRC policy that includes education on SRC prevention and management for teachers, staff, students and parents, and should offer appropriate academic accommodation and support to students recovering from SRC.
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There is some promise that vision training in collegiate American football players may reduce SRC.
So what’s the bottom line? Yes, developmental optometrists have a role, not only in the treatment of the symptoms of SRC, but also in potentially reducing its incidence. But don’t miss out on the bigger picture. This consensus statement brought together experts from both the research and clinical sides of the house. They concluded that the study of the “11 Rs of SRC” is an evolving science. “Athletes, referees, administrators, parents, coaches and healthcare providers must be educated regarding the detection of SRC, its clinical features, assessment techniques, and principles of safe return to play.” It’s Brain Injury Awareness Month; the perfect time to commit to educating yourself and others!
The perfect place to educate yourself is next month’s Annual Meeting in Bellevue, Washington! Join us for a variety of courses on sports- and concussion-related topics, plus so much more!
Mindsight 