Dr. Koutures Publishes on Dancers and Concussion in Journal of Physical Education, Recreation and Dance

Dancers are “artistic athletes.” They must possess the strength, agility, power and flexibility of any athlete and perform with perfect musicality and emotion, demonstrating the artistry of the dance. As an art form dance continues to push the physical boundaries of the human body, increasing the inherent risks to the dancers. Most injuries are readily acknowledged as a possible outcome of being a performing artist; however, the possibility of a concussion continues to receive little attention by leaders involved in dance education. The majority of dance and physical education instructors continue to be oblivious to the prevalence, diagnostic procedures, symptoms and appropriate reintegration into the dance environment after a concussion. Adapting the existing knowledge regarding concussion and sports, this article provides fundamental information to support the recovery and return to performance of a dancer with a concussion.

Click here to read the remainder of this important article to learn about:

• Evaluation of concussion symptoms and severity
• Treatment protocols for dancers
• Dancer reintegration after concussion

4 Points that Matter about Post-Concussion Return to Learn

Completely enjoyed learning from Brenda Eagen-Brown- one of the true passionate authorities on post-concussion return to learn, and wanted to share some key "take-away" points from her awesome presentation.

All pictures are from her slides, and comments afterward are mine.

Make sure there is consistent agreement on terms describing what assistance students may receive after a concussion.

Absolutely essential to have all providers ask about these key historical aspects that can and often will impact concussion recovery. If a patient appears to have a more prolonged or difficult post-concussion course, very likely one or more of these items will be a factor. Don't hesitate to ask at multiple encounters as many patients won't initially offer or give sufficient details about pertinent past history.

Great summery of changes that not only teachers should be assessing but also provide the framework for medical providers and families to address classroom difficulties. One of Brenda's key points- recall issues after concussion tend to be difficulties with information retrieval ("on the tip of my tongue") than true memory deficits.

Many benefits to a standing protocol for initial return to learn that doesn't need medical clearance that immediately addresses student need. Extra emphasis on the scheduled rest breaks as waiting until symptoms erupt only slows the recovery process. These efforts attempt to reduce over-stimulation or emotional flooding that more readily occurs during post-concussion recovery as the brain's "filters" are not functioning properly. 

August 27th is Date for 2016 OC Concussion Return to Learn Seminar

 

We are pleased to have the renown educator and speaker Brenda Eagen-Brown, MEd, CBIS return to the OC to review practical recommendations for post-concussion Return to Learn protocols and management.

We encourage school and district-based teams to bring Return to Learn protocols, success stories, and challenging cases to create an interactive opportunity for professional growth and collaboration.

Location: CHOC Childrens Hospital Wade Center (455 S. Main, Orange, CA 92868)

Date: Saturday, August 27th

Save the Date, Share with Colleagues and Stay Tuned for Cost, Times, and Registration Links

Objectives: Participants will have a firm understanding of:

1. Concussion impact on classroom performance

2. Strategies and accommodations to reduce student symptom severity

3. Collaborating with other interdisciplinary professionals (medical/rehab/athletic) for

optimum student concussion management

4. Why schools should identify professionals at the school building level to monitor

symptoms and academics through recovery

5. Identifying key barriers to treatment for minority or underrepresented populations.

(per American Academy of Pediatrics cultural diversity requirement)

Who would benefit from attending?

• Classroom Educators
• School Nurses
• Special Education Instructors
• School Psychologists
• Principals and Assistant Principals
• Guidance Counselors
• Speech and Language Therapy Specialists
• Athletic Trainers
• Community Pediatric Health Care Professionals
• Mental Health Specialists
• Neuropsychologists
• Physical Therapists
• Neuro-Optometrists
• Strongly recommend forming school-based teams to attend and maximize the learning experience

Click here for information on the 2015 OC Concussion Return to Learn Seminar

Should Soccer Goalkeepers Wear Helmets?

Received an email from a colleague asking my opinion on her 9 year-old son wearing a helmet when playing goalkeeper in soccer.

When it comes to soccer helmets and preventing concussions, my usual response is that there is inadequate science to support risk reduction. I am also concerned that some players wearing a helmet may be over aggressive, or that opponents may target a player wearing a helmet.

However, these thoughts are mostly for field players.

When it comes to goalkeepers, there are some similar and yet different thoughts.

Decent evidence that soft helmet use could reduce lacerations, bruising, and potentially skull fractures that may result from the diving actions or contact with the goalposts.

However, we do not have sufficient evidence documenting helmet use can lead to less rotational injury to the brain after close-range impact.

Would still be cautious about goalkeepers feeling a false sense of over-confidence using helmets and then putting their heads in risky positions.

Helmet or not, would strongly recommend the following head injury risk reduction techniques for goalkeepers:

• Do recommend going feet first rather than head first into a challenged ground ball situation.
• Raising elbows and knees to protect the head when in challenge situations can also be protective, as long as not done with intent to harm another player.
• Keeping the hands up near the face while in the ready position to anticipate a shot allows quicker reaction of hands protecting the head.
• Using a fist to punch the ball rather than attempt to make a catch in traffic may reduce the risk of either direct contact with other players or limit chance of feet being taken out from below leading to uncontrolled head impact with the ground.
• Officials should enforce a reasonable protective halo distance around diving goalkeepers trying to collect balls to reduce risk of kicks or other direct blows to the head.

If selecting a helmet, I do recommend finding one that doesn't adversely affect peripheral vision and also one that properly fits and continues to fit with use. A recent study indicated that improper football helmet fit may lead to more complicated concussion outcomes. Changes in liner, sweat pattern, and  hairstyle among other things were found to affect helmet fit. While study was done in football, do think it would apply to helmet use of all types.

Click here for more injury prevention tips for soccer goalkeepers

Complete Rest After Concussion May Not Be Best Prescription

Exercise May Actually Help After Concussion? https://t.co/dash57gqAL pic.twitter.com/qrzofSaD0S

— ScienceDaily (@ScienceDaily) April 30, 2016

This report from the 2016 Pediatric Academic Societies meeting adds to a growing body of evidence suggesting that children who get low risk exercise even while still having post-concussion symptoms may actually have shorter recovery periods.

One may rightfully wonder if there is some selection bias in these results- kids who may have felt less burdened by concussion symptoms naturally tried to return to exercise sooner. Further study will have to explore this potential phenomenon.

Overall, I think these findings and the outcomes of similar studies provide support for a more active post-concussion recovery monitored by qualified health care providers and not just predicated on rest and watchful waiting.

The proper time to start such active recovery is not certain and likely will be an individual matter as well.

This does also bring up the fact that many current concussion return to sport policies recommend or even require that athletes must be symptom-free before being allowed to return to any form of exercise.

If continued study indeed adds support to the role of appropriately monitored and prescribed exercise to enhance recovery, then these policies, such as the California Interscholastic Federation return protocol, will need to be amended.

Rather than a "one size fits all" uniform pathway, allowing some measure of flexibility may also provide beneficial when determining starting points and type/amount of exercise.

Otherwise medical experts and school officials are possibly restricted in utilizing exercise to aid in recovery and this limitation may actually be slowing the improvement of concussed athletes.

Dr. Koutures Reviews New Mexico Concussion Return to Play Case

Panel Reviews NM Concussion Case- Pt. 2 by @dockoutures https://t.co/IlYE1Aw2Qq https://t.co/wBQabTAqWX pic.twitter.com/24Topj8fab

— ConcussionConnection (@concussconnect) February 22, 2016

The mere fact that a return to play decision ended up in court is in itself a big shame.

And that shame is definitely rooted in a lack of preparation and breakdowns in communication leading to an oversimplified attempt to make a complex decision.

Practical Recommendations for dealing with a Sports Concussion

CONCUSSION INFORMATION

Listed below are informative blog posts with practical discussions of common sport-related concussion symptoms and concerns with helpful treatment recommendations.                             Please click on each bullet point below to access the particular article

• What is a Concussion?

Concussions do not necessarily require being hit in the head or getting knocked out.  The full definition of a concussion is any fall, blow, or trauma that causes physical, emotion, or mental changes with or without loss of consciousness. 

• Common Visual Problems After Concussion

With formal names like Convergence Insufficiency and Saccadic Dysfunction you might indeed think that this stuff is far too technical to grasp,  but in reality, these issues strike at the very heart of some basic life functions.

• How Many Concussions Are Too Many?

Experts Debate: How Many Concussion are Too Many for an Athlete?

• How to Guide for Reading, Schoolwork, TV, Friends and even Smart Phone and Texting 

In the midst of the usual complexities of recovering from a sports-related concussion, I have found that one simple mantra of "re-start activity in 15-20 minutes blocks" can be an anxiety reducing guideline.

• Tips on Dealing with Post-Concussion Headaches

Given that headaches are the most common symptom after concussion and often the last to fully resolve,  I spend a good amount of time with my patients discussing headache triggers, anticipated healing course, and how to reduce intensity and duration