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Concussions in young athletes : myths and reality
Christopher NEWMAN
Friday, Sept. 22, 2017 · 10:52 a.m. · 23m 16s
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thanks a lot for the introduction i'm what i'm going to do over the next twenty minutes is
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to invite you to fall we knew if this young lad um on what seems to be
00:00:13
it sure ready back trajectory towards the ice rink
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which might ultimately you you tune to a
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concussion oh yeah this works perfect so i'm i'm going to be
00:00:25
talking not concussions in young athletes uh and try to dispel
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a couple of minutes that are still pretty prevalent not only in the general
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population but also i'd say i'm i'm on a i'm certain number doctors
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errors uh uh not people who work around these these young people
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um so i used well as as it has been said i'm working
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trial rehabilitation uh um majority virtual nice yeah after she guy had
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severe traumatic brain injury but i do follow up a few june who had had milder forms
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especially those with post concussion syndrome which i will be a touch you on a bit later on
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now what are the myths of i'm going to try to dispel uh
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the first one is this one concussions are always been online
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i wouldn't be here if that was the case uh giving you a twenty minute talk on the subject
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um but it still is i see pretty problems believe that in the general population at least
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the second is is a very symptomatic that is to say uh yeah basically you
00:01:27
have a concussion when you faint i'll three then that is not true
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uh and the third one and that's probably the one that is the
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most strongly anchored not only in the general population but also in
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our field is that can cost children actually do better than adults to
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and that as i will show you is also completely falls
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i'm just a bit of the definitions so what is a concussion the concussions be really
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basically a an acute brain disorder which is in use by external by mechanical forces
00:01:57
and which will uh basically create a certain number of neurological symptoms that
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i mean one being that there are going to be a well effects on consciousness but without
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complete loss of consciousness in the majority of cases uh so we're basically in the spectrum what we called mile
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traumatic brain injury in there is a big overlap between what we call concoction and mild t. i.
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i don't think you have to well note about this in the definition is that it's more of a functional issue
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then a structural issue that is if you do brain injury only standard green
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m. r. i. is ensuring with concussions these images will usually be normal
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um so then the fisher pathology of concussions um there is as
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i said a buyout mechanical aspect notions and those are basically
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the forces that are going to be applied onto the skull
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and the brain at the are then secondarily going to
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leads to neural biological disorder which is going to give you the symptoms of concussion
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so by mechanically what you basically have or a linear forces are going to
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basically go on to the spell and affect the brain with what we call the crew and complete cool
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um but more importantly and we often forget about was there a important rotational forces
00:03:16
which are going to lead to lots of shearing throughout the brain
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and these are probably the most damaging forces during the concussion
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uh and so as i said this is secondarily
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going to be two very acute disruption
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all green function what basically is happens is that you're gonna have a massive released
00:03:36
of pollution made into the green which made is a strong excite radio to excited to read
00:03:41
and i mean last it in your transmitter this is going to lead to
00:03:45
basically an electrical storm within the brain massive construction of blue pools
00:03:51
and or uh the span of a few minutes actually you're going to have a break down of the whole system
00:03:56
and your bloopers metabolism is going to drop strongly you have the
00:04:00
creation free are radicals and this is basically going to affect
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brain function for several hours several days and sometimes even a few weeks
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there is also i did say it wasn't a structural issue but actually you look at microstructure
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what you can see here uh who is yeah well you can see here is that on
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them like for structural level there is actually disruption of the actions which are basically
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uh the connections from one euro on to another and that also does
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take archie several days to a few weeks to actually repair
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so going on to one of the myths i was talking about like all this
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stuff monkeys in children uh and it's the what we call the cannot principle
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in neuroscience is like our principal was basically developed by margaret can are choosing you
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all the just worked in the early thirties absolute forties and united states
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and to date experiences on b. b. um
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monkeys basically cutting off their mortar
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areas on what she was able to demonstrate on these baby monkeys
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it was that despite completely disconnection their motor areas they
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where able to recover quite a good more function
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from that she basically postulate should that children's brains are highly plastic and that they are
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able to recover much better than adults through from diff well a brain injury
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the thing about mark enters experiences first monkeys on through the human shoulder and
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uh the second thing is that these are very artificial and focal lesions
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in traumatic brain injury and also in concussion what you basically have to diffuse injury
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so the miss miss here is basically the child greener covers better than an adult screen does
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but the truth actually is that when you do have diffuse injury which are basically
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going to affect the networks that which are necessary for learning from memory
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then a child's brain is is especially vulnerable because he is at this
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stage of his life where you use developing and he is learning
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so it's really just say that's a among all of the complications that i'm
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now going to go into and the long term symptoms of concussion
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yeah actually tend to be more severe and more frequent in
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june nineteen years than what you would encounter in adults
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so it it affected immunology well of course all sports and basically reach concussion and
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also non scores activity what you basically need is a hit to the head
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uh but there are certain sports that are go at high risk now which into fuels
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a chicken altogether represents a bit less than ten percent of all childhood
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sports injuries and i showed you the incidence uh incidences here
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in terms of properly and also in terms of number exporters what we do know is that competition is
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actually a high risk activities in training isn't that's
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pretty well demonstrated tramp a series of studies
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not one just our numbers specific sports not to say that they're on the only you orders
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all of concussions one that probably has been
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mess best um studied is american football
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um what we do know about american football and that has
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been studied using excel or meters on the helmets of
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a football or is it that's the advantage in this type sports that you can equip the helmet um
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for high school athlete should american football they have anywhere between two hundred in two
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thousand head impacts in one season and on each one of these impacts
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big celebration which is imparted up on this call is between twenty and a hundred
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times earth's gravity with maximal values that have been recorded three hundred g.'s
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usually beyond three hundred jeez you die uh that is the this is sub lethal
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uh uh this is basically study that was done over
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two season in standard high school athletic american football
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um now rugby of course european counterpart uh as well maybe
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not that surprisingly the fact that they don't wear helmets
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is actually slightly protective in terms of brain injury uh because
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people who don't wear helmets are probably but more careful and take less risks
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uh so actually is an interesting facts and i'll come back to that when i talk about prevention
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um i saw k. a. helmets again high speed
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high velocities lots of acceleration done the celebrations
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soccer or well european football um it doesn't seem very much race but
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what's the special thing that football is that sometimes use your head
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uh and and they're actually now a series of studies thus far in the
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eighties but have gone through to contemporary football's well we sure that
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i'm heading is actually a trace of concussion all symptoms and post concoction
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will syndrome um what has been very well shown is that
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put bowers who's there had a lot tend to have slightly lower cognitive but abilities and slightly
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laura memory than their counterparts who don't use their head as much
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uh what we know is that a cumulative number of eighteen hundred heads significantly these two or
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memory even too long when compared to standard populations so again an at risk sport
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um your sports which you might not think about cheerleading becoming more more
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athletic more more risky has led to basically a small academic
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all i'm compassion and traumatic brain injury on long a young
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athletes in united states and to finish of course
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combat sports well look this isn't something that we see too much uh i'd say at least
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in europe a prism thailand's competitive type boxing you can start around ten years old
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and you can more in national polls seeing this picture the rotational
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forces which are important on this young man's skull and brain
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not to go on to the symptoms and complaints that children who have had concussions actually do we have
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as i said one of missus the conscious contest means that you lose consciousness that you think that is not true
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loss of consciousness is actually only found in around ten percent of
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cases and a big majority of the troll no actually had
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this type of sin from which are basically the lower part
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of the iceberg doesn't feel site signs and completes
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in terms of signs that some consumed days they can get confused basic unseen from g. n. have upper bounds
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all these signs if you actually work on the field side must over choose to the
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fact that something is happening and you should withdraw these children immediately from the field
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likewise if the child or teenager comes to with the following complaints that is i
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have a headache i'm feeling nulls yes i'm annoyed by basically lighten sound
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like i'm not able to focus on the game rules again these
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are all milder signs that the child has been can
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cost that these brain function is not normal and that again
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you should remove him in egypt we from the field
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you really have to know about the symptoms focus on them and be able to react them adequately
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you see that if you don't it can have quite dramatic uh consequences
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in terms of problem moses once a child or teenager has had a concussion what basically happens well
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yeah as i said concussions are considered benign and luckily in a vast majority pieces they are and
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it is true that following caution in the majority of children or teenagers within a week
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the symptoms will result and around ninety percent of defected keener zeros
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within two weeks we'll have a complete resolution of their simpsons
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sometimes can be in the field of basically cognitive issues but they can also have a
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certain number of physical issues uh typically the headaches that i was talking about
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funerals yes street can also be quite strongly affected and these are all domains which you have to systematically
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explore when you do meet these shown when in the fall a lot of their of their concussion
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no portion control syndrome which i briefly uh i'm touched upon a bit earlier
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on what is it basically to make it easy post confessional syndrome is
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the persistence all the simpsons that i've just shown you beyond usual resolution and
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other uh is uh that it all started disagreement on the threshold
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some people say it's beyond two weeks others be on the mount basically if it goes beyond a couple of
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weeks you are within uh i'd say the the the span of what we call post concussion syndrome
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um so if you look at the figure actually before that's ninety percent resolution
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within two weeks that leaves you with ten percent of all these kids
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to basically will still have symptoms be on that and you will need a certain type
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receive medical follow up to try to help them a result in improved those symptoms
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now there are some parents are numbered risk factors for post
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concussion syndrome for so then is the severity of the
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mile t. v. i of course if they did lose consciousness it was probably a higher impacts to the brain
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an easy uh again is probably a stronger sign of that you bring this function
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and shown it had repeated concussions i'll be coming back to that
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are clearly at much higher risk of course confessional syndrome
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um now if you go beyond the simpsons and the traditional signs if
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you actually do test these children in terms of their cognitive
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and mental abilities you are able to demonstrate that
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it did you actually have objective this functions
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typically the effect what we call executed functions executed functions are
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basically our mental functions which allow us to face novelty
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to please mental flexibility the ability to organise on top patterns to plan a
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phi and this can be pretty strongly affected within post concussion syndrome
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concentration attention of course memory which i've already talked about especially short term memory which of
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course is very annoying when you have to be learning in school and also
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full speed which can be pretty strongly affected in each one with post concussion syndrome
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um so be on post concussion syndrome there are a certain number of
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more severe complications uh and and this basically demonstrates one of they
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is uh which is uh what was initially call is uh
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well dementia put really stick yeah uh which still has that name when it is referred to in terms of combat sports
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which is basically a subgroup of what we call chronic chronic traumatic and careful coffee
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people who have been submitted to repeated concussions throughout their training maybe
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starting in childhood and teenage years and then going into adulthood
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uh and in the long run a run into basically patterns where they will develop dementia
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parkinson isn't a and one of the most famous offers of
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that is used was mohamed are the two uh
00:15:09
in it is well very well known developed an inch separately sticker and that's probably the best known case
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but there are several cases which have been published size uh
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since standard especially in american football over last decade
00:15:22
the pair depression suicide is also be instrument to be significantly increased
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the population a battery to have been submitted to repeated concussions
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a second impact syndrome this is probably the most dramatic complication of concussion
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what second impact syndrome if you have a teenager or child on the field who has had a concussion
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seems pretty okay and then he continues to play doh play over the next few hours
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in a certain number of cases if he has a second concussion what will happen
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even if the concussion didn't seem more severe you have massive brain swelling
00:15:55
and bring it in a and actually in a very high proportion that is
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up to sit up to sixty percent these cases can be fatal
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it's extremely rare luckily we don't see many of these cases i probably so one
00:16:07
over the last decade but when they do happen of course they're absolutely tragic
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um multiple scroll this uh there's a bit of data for over the last decade and there's
00:16:17
actually one paper which can happen annals of urology just two weeks ago which shows that
00:16:23
teenagers that had one to cash concussion during their teenage years
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i have a twenty percent increase and the risk of having multiple scroll as as as adults
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if you have had more than one concussion then you more than double your risk of multiple sclerosis
00:16:38
so again uh and multiple sclerosis is not frequent but it is not but
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knowing and these are all things that you have to be aware of
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now in terms of management as i said first reaction remove the child from
00:16:51
the field that's really the first thing you have to avoid the second
00:16:54
impact is extremely rare it when it happens it zaps you absolutely tragic
00:16:58
and you have to be able to take match also offer surveillance
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uh if in doubt city not that's basically if there's there's one thing that you
00:17:06
leave with from this room that's it if an ounce of them out
00:17:11
it can be feasible rowdy but it can seek medical advice again
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concussion is not benign it should not be penalise the the
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really do encourage their children to see the rupture within the
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next couple of days to basically event planned follow up
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uh uh and also to determine when uh the child can basically return trees usual activities
00:17:31
because the best treatment for compression is basically physical
00:17:34
and cognitive rest because if you do continue
00:17:39
well making then active physically or cognitively during those first few days after the simpsons
00:17:44
you are going to slow the resolution of the symptoms on your are going to increase their risk
00:17:49
of developing post concussion syndrome some drum so really put them to rest at least for a few days and when
00:17:55
are you going to get them to return to physical activity it's basically when they have no more symptoms
00:18:00
without medication it's good come backs and comes back and says no i don't have my headaches anymore
00:18:05
he's taking power seats mall three times a day then he's not ready to return to play
00:18:10
uh there are certain number return to play protocols bridal have to go and talking to going to actually
00:18:15
you can find them easily on the web a return to cognitive
00:18:18
activity same thing it's basically guided by cognitive symptoms that
00:18:23
difficulty here is basically balancing uh and the risk of putting the channel
00:18:28
back to college inactivity ties back into school or back into
00:18:31
a vocational training against the fact that he might be missing
00:18:35
false isn't missing or missing opportunities for new learning
00:18:40
i'm going to prevention our uh because luckily it is something
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that we can prevent at least to a certain extent
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uh and well as you see it's not all about how that's uh and if it was it
00:18:51
would be well much simpler i see that one of the elements is rules and regulate
00:18:56
is i mean clear rules and that has been quite strenuously in well done i ate
00:19:00
lots of teen games now american football ice
00:19:04
hockey also soccer football more recently
00:19:08
the rules for example for heading in soccer have recently been
00:19:11
adapted by the american uh um soccer of federation
00:19:16
uh saying that children below the age fifty and uh in training and in competition should never hedge
00:19:21
until the age of thirteen should strongly limit the number of headings
00:19:26
education i think that well this is what we're doing today educational professionals but
00:19:30
also education of families and education of children and teenagers around basically concussion
00:19:36
equipment does have a role to play and certainly legislation to a certain extent
00:19:42
now going into equipment and helmets as i said there's a bit
00:19:45
of paradoxical effect especially in teenagers teenagers are risk takers
00:19:50
and if you put a hand on their head yeah actually might be more in fine to taking risks that
00:19:55
uh so sometimes that actually out bounces the mechanical effect of the helmet
00:20:00
how much technology is also improve here you have a quite recent hamlet which not
00:20:04
only will dissipate the a linear exaggerations but also the rotation acceleration is
00:20:10
by the fact that you're basically you have a membrane which can move within the hard part of the helmet
00:20:15
user recent developments in probably are pretty interesting in terms of head injury prevention
00:20:21
um and as i said child education at the h. t. need
00:20:26
a teenage i've meet education this is a canadian canteen
00:20:30
um around well basically uh what i put the print version begin pointed
00:20:34
english versions you doesn't once you buy and not invincible this isn't
00:20:38
an excellent campaign sure basically um censor ties children and their parents around
00:20:44
the risk of concussion what can be done to prevent church
00:20:48
how to react to it and also how to return to the and returned to school after the concussion
00:20:55
um so if you take home message so be on the miss
00:20:59
that i've talked about what is the reality of concussion
00:21:03
um first of all um use as i have
00:21:07
said is a time of learning and development
00:21:10
and this does not make the brain more plastic it makes the brain more fun liberal as i
00:21:15
said to diffuse injury to we have to try to take care all these kids brains
00:21:21
and if the majority of contortions resolve and again this is to the speech a the big picture
00:21:26
home uh you shouldn't keep showing off sports because well i've what i've just told you
00:21:31
um contortions to usually result without long term symptoms but you really do have to be careful
00:21:37
about that minority of children who are going to go into more long term problems
00:21:43
and the where the cumulative effects not only visible concussions but also
00:21:48
stop confessional impacts that is within one season as i've said
00:21:52
uh why should you for uh the the american football or screen not
00:21:56
have more than two thousand basically impacts on their head per season
00:22:01
even if they don't have a can cut visible concussion every time the fact that you repeat those blows to the head
00:22:06
in the long run it while will have an effect on brain biology
00:22:11
um and finally a smart heads are protected heads in protection
00:22:16
is not only about how much is also down to
00:22:18
policies it's down to regulations it's down to education and that is something that we can all do you
00:22:25
uh and now a couple of resources parachute canada an excellent website
00:22:30
uh uh well i'm on which you also find a um
00:22:33
the fires that i showed you earlier on about i'm not invincible a very good side of the
00:22:38
centre for disease control and this is basically uh the whole book which you can find
00:22:42
a freely available online was called scores waited concussions and you was is excellent and very
00:22:47
very comprehensive now maybe coming back to the young man i showed you start with
00:22:52
uh so he's basically a a junior olympic i'm skating
00:22:56
champion and you didn't land with his head
00:22:59
uh on the ice rink use actually in the magic the middle of a very complex figure and he's
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Sept. 22, 2017 · 2:12 p.m.
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Sports specialized training: what are the true effects and is it really all bad ?
Neeru JAYANTHI
Sept. 22, 2017 · 2:29 p.m.
141 views
What is “load” and how does it impact athletes’s risk of injury ?
Torbjorn SOLIGARD
Sept. 22, 2017 · 2:49 p.m.
344 views
Instituting a unique public health approach to ACL injury risk management
Joseph Janoski
Sept. 22, 2017 · 3:47 p.m.
Instituting a unique public health approach to ACL injury risk management - Q&A
Joseph Janoski
Sept. 22, 2017 · 3:54 p.m.
Parents’ Knowledge of Sport Psychology and Nutrition
Dr Camilla J. Knight
Sept. 22, 2017 · 3:57 p.m.
152 views
Injuries and injury risk factors in youth alpine ski racing: A two-season prospective study
Lisa, Müller
Sept. 22, 2017 · 4:09 p.m.
FREE COMMUNICATION AND BEST ABSTRACT PRESENTATION - Q&A
Panel
Sept. 22, 2017 · 4:21 p.m.
610 views
Closing Address
Frederic Koehn, President Young Athletes Forum Foundation
Sept. 22, 2017 · 6:04 p.m.
140 views