Pittsburgh, USA
Friday 25th November 2011

Earlier in the week I was speaking to my good friend & occasional blog contributor, John Geist, regarding some recent updates in the area of concussion.  For those of you that read the blog regularly, you will be aware that John is well read on concussion management & you may even have downloaded one of his presentations on the subject.  John had just spent some time with Dr Michael Collins, one of the creators of the ImPACT programme & I asked him if he wouldn't mind sharing some of his experiences with the blog.  John kindly agreed & here is what he said: 

"Last week myself and my colleague, Jennifer Wuyscik, were invited to spend the morning with Dr. Michael Collins.  Dr. Collins is one of the original creators of the ImPACT program.  He is known worldwide and has recently been appointed Director of the UPMC (University of Pittsburgh Medical Centre) Concussion program.  We have both known Dr. Collins for over 10 years & have had the pleasure of hearing him speak on numerous occasions, but this was the first time we were with him in clinic.  We were able to see some very interesting cases that we would not have normally been exposed to.  Many of the patients he sees have been having concussion symptoms for many months, but some are just recently concussed and only having minor issues.  He sees a majority of athletes, but he also sees people who are laborers, workmanís compensation cases, and people of all ages. 

One aspect of the evaluation that struck both Jen and I, was the thoroughness of Dr. Collinís medical history questions.  I liken it to the cross-examination of a trial lawyer.  Dr. Collinís questions were incredibly detailed and every answer given by the patient generated another question pertaining to the previous answer.  The information he derived from these questions was amazing.

During our observation, we also learned about some of the newer developments being researched with regards to vestibular testing and its link to concussion recovery.   A couple of the tests we observed were the horizontal and vertical saccades test, convergence testing, and gaze stability.  They are currently researching the possibility of incorporating these tests during an on-field examination.

The saccades test involves having the patientís eyes track rapidly both vertically and then horizontally.  The convergence test involves the clinician using an object, such as a pen, and having the patient focus on it.  The clinician will then slowly move the object closer to the patientís nose and the patient is to report when the object becomes blurry or the image distorts.  There are two gaze stability tests.   The first one involves the patient sticking out their thumb directly in front of them with their arm extended.  They then focus on the thumb and move their head horizontally.  The second test involves the thumb and head moving together horizontally as a unit rotating ninety degrees left and right.  In all of the tests, the clinician is looking for quality of eye movement and whether or not concussion symptoms are brought on or increased.  Hopefully, in the near future we will be seeing some of these tests incorporated into our on-field concussion evaluations. 

I asked if they are at the point in their practice where 5 different clinicians seeing the same patient will all have the same opinion as to the patientís assessment and prognosis.  They all answered ďyesĒ.  This shows me that they have developed an excellent standard of care and are able to train their fellows in a consistent manner.  This fact allows for more highly trained clinicians to spread this standard of care across the country.  It also creates a high confidence level in the patients because they can be sure they are getting consistent care regardless of which clinician they are seeing.

Jen and I hope to be able to spend some more time with Dr. Collins and his colleagues in clinic, continuing to expand our knowledge in the area of concussion diagnosis, treatment and management"

Further to John's summary of the time spent with Dr Michael Collins, he also sent a link to two articles written on the research into concussion that fellow athletic trainer & occasional Pittsburgh Steeler contractor, Kevin Guskiewicz has been involved in.  Kevin is based at the University of North Carolina & is the research director of the Center for the Study of Retired Athletes & founding director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center.

The first article, published in USA Today, reviews the work that Kevin has been doing with UNC's football team using accelerometers embedded in the player's helmets to gather data on collision forces.

Brady, E. (2011) "Genius" Concussion Researcher Tries to Make Football Safer.  USA Today 

The second article, also sourced from USA Today, provides background to Kevin's interest in the topic, stemming from his own experience of a traumatic head injury.

Brady, E. (2011) Concussion Researcher Suffered Hard Knocks of His Own.  USA Today

John suggests that the Center for Disease Control concussion resource is also a valuable source of free education in concussion.  Read the following excerpt for further information:

Get a Heads Up on Diagnosing and Managing Concussions

With support from the National Football League and CDC Foundation, the CDC has created a new Free online training to provide health care professionals with an overview of what they need to know about concussion among young athletes. The goal of this course, Heads Up to Clinicians: Addressing Concussion in Sports among Kids and Teens<>, is to prepare health care professionals to diagnose and manage concussions on the sidelines, in their office, training room, or in the emergency department.

In this course health care professionals will:

 *   Examine current research on what may be happening to the brain after a concussion
 *   Understand why young people are at increased risk
 *   Explore acute concussion assessment and individualized management of young athletes to help prepare for diagnosing and managing concussions
 *   Learn about the 5-Step Return to Play progression and helping athletes safely return to school and play
 *   Focus on prevention and preparedness to help keep athletes safe season-to-season
 *   Receive continuing education credits through the American College of Sports Medicine

To view the course or for more information,<>.

Once again, John, thank you for sharing your knowledge & experiences in this important area of emergency medicine.

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