Wednesday, January 30, 2013


New information on concussions is published on an almost daily basis.  So much information is available sometimes that even I’m overwhelmed when trying to understand where we are with this “crisis” and making progress in its prevention, recognition and management.  The following paragraphs simply highlight what I believe to be some of the most interesting developments and stories regarding concussion in the last month.

The AFC Championship game brought us another example of the fencing response.  It is minimally a clinical sign of brain trauma, often more specifically a concussion.  Dustin Fink on the Concussion Blog who sites THIS study from Medicine & Science in Sport and Exercise (2009) provides the best definition.  Briefly, it is an unnatural position of the arms following an impact to the head that result from forces applied to the brain stem.  Stevan Ridley clearly demonstrates the fencing response in this video.  While most statements regarding concussion recognition do not list the fencing response as a specific sign of concussion there seems to be a growing number of examples of athletes who demonstrated this response and were ultimately diagnosed with a concussion.  It is important to note that the fencing response can be an important part of the puzzle, but you can still be diagnosed with a concussion without demonstrating the fencing response.

Dave Siebert through the Bleacher Report posted an interesting analysis of the Stevan Ridley hit, click HERE to check it out.

Earlier this month the Institute of Medicine (part of the National Academies) announced the launch of a comprehensive study of youth concussions in the United States.  According to information available on their website, the Committee on Sports-Related Concussion in Youth will consider the following topics/questions among others:
  • the acute, subacute and chronic effects of single and repeated concussions
  • risk factors for concussion, post concussive syndrome (PCS) and CTE
  • physical and biological triggers and threshold for injury
  • the effectiveness of protective equipment
The study will include elementary school age children through young adulthood, including those who serve in the military and their dependents.  The study hopes to publish its results along with recommendations to key organizations by the end of 2013.

If you would like to keep pace with the status of this project you can sign up for the project list serve through the IOM’s Committee on Sports-Related Concussion in Youth website.  For inquires you can send emails to

According to a recent study from the University of Oregon, concussion recovery time may be longer than expected for adolescents.  Previous research on the cognitive recovery from concussions has focused on neuropsychological testing.  Lead researcher David Howell attempted to measure attention and executive function using laboratory based measures following concussion.  Executive function is simply the umbrella term for all those cognitive processes that help us problem solve, focus, switch between tasks, and control our inhibitions.  The study followed concussed adolescents for two months and demonstrated additional recovery time may be required for full recovery.  There is also hope that these laboratory tests may be helpful as part of the complement of follow up testing options after a concussion.  The study, published in Medicine and Science in Sport and Exercise, can be found HERE.  For the University Oregon announcement discussing the study results and the researchers, click HERE.

Based on current research it appears that the concussion education for coaches is beginning to have a positive effect.  According to a study published in Athletic Training & Sports Health Care (Jan./Feb. 2013) participants correctly identified more concussion-related symptoms and subscribed to fewer concussion misconceptions than did that those previously studied.  While qualified healthcare professionals should always make medical decisions, until athletic trainers (or other qualified healthcare providers) are available in all high schools coaches must continue to be educated on recognizing and referring athletes who suffer from concussions.  Coaches must also understand that following appropriate return to play guidelines is critical.  To read the full article:

Submitted by Heather L. Clemons, MS, MBA, ATC

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