Future studies need to include women's hockey
Simon Fraser University researchers are learning more about how the scenarios for head impacts in hockey—from player clashes to contact with the boards or glass—affect impact severity. Their findings, reported in the journal Scientific Reports, should help to inform improvements in injury prevention.
In a follow-up to their previous study on how hockey head impacts occur, researchers returned to a Burnaby rink to follow 43 university men’s hockey players over another three seasons (2016-2019).
This time they compared video evidence—gleaned from cameras strategically placed around the rink to capture head impacts during play—with data from helmet-mounted sensors, or GForceTrackers, which measured head linear accelerations and rotational velocities. In all, 234 head impact incidents were recorded.
The head impact videos were analyzed with a validated questionnaire that probed situational factors before, during, and after impact to the head. Videos were then paired with corresponding helmet sensor data.
“We found that players with visible signs of concussion—such as clutching the head or slow to get up after the impact—experienced greater head rotational velocities than those without signs,” says Olivia Aguiar, a PhD student in SFU’s Department of Biomedical Physiology and Kinesiology (BPK). “Regardless of whether a hit to the head appears to be big or small, any athlete with visible signs of concussion must be removed from play and assessed by a medical professional.”
Researchers also found that while shoulder-to-head impacts occurred more frequently than hand or elbow contact, glass-to-head impacts were nearly four times more common—and just as severe—as board-to-head impacts.
And while the most severe head impacts resulted in penalties, researchers say rules that focus on “primary targeting of the head” offer a limited solution. “The head was the initial site of contact in 24 per cent of cases, of which only four per cent were penalized,” says Aguiar. “More often we saw some degree of player contact prior to the head being struck and found that these head impacts were just as severe. We suggest that prevention strategies aim to reduce any contact to the head, not just instances where the head is targeted.”
Despite growing evidence of repeated sub-concussive impacts, which are more prevalent than concussions in hockey and associated with structural changes to the brain, including symptoms of depression and cognitive impairment, the researchers say a lack of understanding on the most common and severe types of head impacts prevails.
“This is a barrier to the design and development of strategies for better protecting the brain, such as rule changes, skills training, and improvements to protective equipment as well as rink design,” says Aguiar.
“We’re hopeful that adding to the evidence on head impacts in hockey will lead to better ways to create a safer game and preserve brain health.”
Hockey head impact research highlights need to improve injury prevention
Read more: https://www.sfu.ca/sfunews/stories/2023 ... ry-pr.html
To our knowledge, our study is the first to combine helmet-sensor measures with video footage to classify and examine how head impact severity depended on the circumstances of head impacts in men’s university ice hockey. We collected 234 head impact events and examined observable situational factors before, during and after the collision.
We found that the most severe head impacts tended to result in penalties. Player-on-player collisions resulting in “major infractions” (penalties of longer than two minutes in the box) generated 2.0-fold higher head rotational velocities than cases involving “no infraction.” Similarly, Mihalik et al. (2010b) found that, in male youth hockey, penalized impacts resulted in higher linear accelerations. At the same time, we found multiple lines of evidence to support the notion that rules that focus on primary targeting of the head (e.g., Head Contact Rule 7.6 by Hockey Canada47), while important and in need of improved enforcement, offer a limited solution. First, direct targeting of the head rarely resulted in a penalty, indicating the challenge of reinforcing the rule. Only 4% of events where the head was the initial site of contact were penalized (n = 2 of 54). Second, when compare to primary head impacts, secondary impact to the head was far more common. Of the 234 head impacts we examined, the head was the initial site of contact in only 24% of cases. Finally, the severity of impacts did not depend on whether the head was the initial site of contact. Clearly, strategies are required to reduce the frequency and severity of both primary and secondary contacts to the head.
We found that players who exhibited visible signs of concussion (versus no signs) experienced impacts that produced 1.3-fold greater peak head rotational velocities. This finding casts doubt on the controversial question of whether players tend to purposefully exhibit visible signs of concussion for competitive advantage. The most common signs were “slow to get up” and “clutching of head.” Echemendia et al. (2018) and Bruce et al. (2018) examined the use of visible signs to predict subsequent concussion diagnosis in professional ice hockey. They found that, despite being observed frequently, “slow to get up” and “clutching of head” were poor predictors of diagnosed concussions. Bruce et al. (2018) speculated these signs, rather than reflecting concussive injury, may reflect an attempt to draw a penalty or lesser forces experienced at the head. Although injury diagnosis in the current study was unknown, our finding that players with visible signs experienced greater head impact severity support the notion that any player exhibiting visible sign of concussion should be removed from play and receive appropriate medical attention.
We found no evidence to indicate that the severity of head impacts depended on the playing zone where the hit occurred. More head impacts occurred in the offensive zone, but there were no differences in head impact severity between playing zones. Previous studies have reporting conflicting evidence on whether the severity depends on playing zone. Swenson et al. (2022) reported that male youth athletes reached higher speeds in the neutral zone resulting in greater head linear accelerations and rotational velocities at impact48. However, Hutchison et al. (2015b) found that concussive impacts in male professional hockey most often occurred in the injured player’s defensive zone (45%), followed by the offensive (34%) and neutral (21%) zones. Further investigation is required on whether hits tend to be more severe in specific playing zones at different levels of play.
We also found no evidence that head impact severity depended on the object striking the head. Collectively, over 80% of head impacts involved the head being struck by an opponent’s upper limb (44% of all cases) or the head striking the boards or glass (36% of cases). There were no differences in the severity of impacts to the head from being struck by an opponent’s “shoulder/upper arm,” “elbow/forearm,” or “hand.” Potvin et al. (2019) examined the severity and duration of linear and rotational head accelerations when players delivered padded shoulder-, elbow-, and hand-to-head impacts “as hard as they were comfortable in delivering” to an instrumented kickboxing dummy. They found that mean peak linear and rotational head accelerations were up to 2.1-fold greater for the hand and 1.9-fold greater for the elbow than shoulder. Our current results suggest that, during real-life game play in men’s university hockey, impacts delivered by the shoulder, elbow, and hand create similar peak head accelerations and rotational velocities. Head-to-glass collisions were just as severe, and much more common, than head-to-board collisions. Tuominen et al. (2017) and Schmitt et al. (2018) showed that modifications to the rink may reduce impact severity and injury risk. Our findings suggest that additional studies are required to evaluate the stiffness of the glass/boards and its effect on head accelerations. Previous studies which found differences in head impact severity either (1) reported small differences in mean magnitudes (< 2 g or < 200 rad/s2), where the clinical significance is unclear, or (2) examined factors at high impact magnitudes (e.g., > 20 g threshold or at the 95th percentile), excluding common low-magnitude impact events.
We found no association between head impact severity and anticipation of the collision. Mihalik et al. (2010a) also reported no differences in mean head accelerations between anticipated and unanticipated head impacts in youth hockey (aged 14). Furthermore, Eliason et al. (2022) found that more experience in delivering and receiving body checks did not protect minor hockey players (aged 15–17) against injury, including concussion53. Future research is required to evaluate the protective value of anticipatory responses and player training in reducing the frequency and severity of head impacts and injury in hockey.
Our study has several strengths. While previous studies had examined male youth hockey, ours is the first to combine head kinematics from helmet sensors with video footage to identify the most common and severe head impact scenarios in men’s university ice hockey. We also extend previous research by examining how impact severity depended on the specific object that impacts the head, puck possession, and visible signs of concussion. We recorded game play with a five-camera system, whereas most studies have used only one camera, and we used the video footage to verify that every case we examined involved a direct impact to the head.
Our study also has important limitations. First, we only analyzed data from the home games of a single men’s university ice hockey team. Therefore, results from this study may not apply to other contexts (e.g., practices; women’s ice hockey; other teams, leagues, and levels of play). Second, we observed substantial to perfect inter-rater reliability (kn > 0.60) for most questionnaire items used in our analysis. However, caution should be used when interpreting “looking in the direction of the collision,” as only fair agreement was achieved (TPA = 67%, kn = 0.31). Third, we included only the portion of head impacts having verified matches between video and sensor data. However, we have no reason to believe that the head impacts analyzed in the current study are not representative of all head impacts in the games we studied. Fourth, we reported peak head kinematics as proxy measures for head impact severity and consequently the degree of brain trauma. Future research should consider estimating brain tissue strain, using finite element models, which has been shown to have the closest association with brain injury. Fifth, we only included head impacts observed by six research assistants who watched the game from different angles around the rink, and it is likely some head impacts were missed by the observers. However, our approach ensured that we only included direct head impact events in our analysis. We did not review all sensor-recorded events using the video footage, since previous research has shown that sensor-recorded events often do not correspond to a direct head impact. For example, Wilcox et al. (2014b) used helmet-mounted sensors (HITS) and recorded 1965 impact events across 12 home games in a single season, yet only 270 head impacts were verified on video. Finally, the accuracy of helmet-mounted sensors in reflecting head accelerations and velocities may be affected by factors such as helmet fit, sensor location, and vibration of the helmet shell. To minimize these effects, we standardized the helmet model and sensor placement. Future studies should consider using instrumented mouthguard sensors, which are less error prone and are associated with improved skull coupling.
Associations between the circumstances and severity of head impacts in men’s university ice hockey
Read the study: https://www.nature.com/articles/s41598-023-43785-5
concussions
Moderators: Mitch Hawker, east hockey, karl(east)
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greybeard58
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greybeard58
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Canadian researcher helps define new standards for diagnosing concussions
Canadian researcher helps define new standards for diagnosing concussions
Remembering what happened after she hit her head on the ice while playing hockey is tough for Meg Kerekes, but she knows how that particular headache felt -- "like a one-pound weight on the spot that got hit.”
"I forget if they took me out or if I finished the rest of the game. I think I might have finished the game," she said of the suspected concussion in September 2018 when she was playing amateur hockey during her high school years in Vancouver.
Her coach, who doubled as the person in charge of safety, suggested she stop playing and mentioned she may have a concussion."I didn't go to a doctor or anything. They just didn't let me play for two weeks," said Kerekes, who suffered another hit to the head five months later when an opposing player slammed into her.
Her mother took her to hospital after the second incident on the coach's orders, where a suspected concussion was confirmed and Kerekes was out of school for 10 days. She returned to "light" hockey practice, but no games, three weeks later.
Coaches and other volunteers in amateur sports need to be more aware of concussion risks, said Kerekes, who still gets a slight headache sometimes from just shaking her head while listening to music.
Recognizing and properly diagnosing concussions has also been an issue in clinical settings. A Canadian researcher hopes that will change with a new diagnostic standard he helped develop.
Noah Silverberg, associate psychology professor at the University of British Columbia, co-led an international panel's efforts to replace "wildly inconsistent" definitions of concussion. The North American, European and Australian experts included clinician scientists such as emergency room doctors, neurosurgeons, pediatricians and those specializing in rehabilitation and sports medicine.
Silverberg's paper outlining the new standardized criteria, co-authored by neuropsychologist Grant Iverson of the Harvard University-affiliated Spaulding Rehabilitation Hospital on behalf of the American Congress of Rehabilitation Medicine (ACRM), was published last week in Archives of Physical Medicine and Rehabilitation.
Silverberg said concussion has historically been minimized as a minor injury that does not need medical attention and is believed to get better on its own.
That often means people don't seek medical treatment immediately, or at all, so a potential mild traumatic brain injury goes undetected, said Silverberg, who focuses on concussion recovery and treatment.
However, a concussion may not get diagnosed in an emergency room, where the focus is typically on ruling out catastrophic injuries rather than diagnosing a condition that could involve persistent symptoms and disability, he said. There is also a long-standing concern about family doctors missing the signs and symptoms of a concussion because of little training in a field that has advanced quickly over the last few decades. There are inconsistencies in how the condition is diagnosed in specialty concussion clinics as well, Silverberg said.
A definition of mild traumatic brain injury published by the ACRM in 1993 is outdated, he said, and whether a patient is diagnosed with the condition depends on the particular criteria being used.
He said diagnosing concussions is tricky because symptoms can overlap with other conditions so health-care providers should determine how someone was injured, for example by being hit on the head while participating in a sport or in a crash.
Two or more symptoms, such as a headache and dizziness, would meet the criteria for diagnosing concussion but clinicians should also rely more heavily on observational signs such as a patient responding slowly to questions, being off balance or not knowing where they are, Silverberg said.
A clinical exam that tests for balance, memory, concentration and vision is also part of the new criteria, he said, adding a brain scan could also be ordered but does not always show signs of injury.
He pointed to a 2008 study in Australia that applied multiple sets of criteria for 12,000 children aged three to 16 and found the proportion of those diagnosed with a mild concussion ranged from seven per cent to 99 per cent. Silverberg said such a wide range means there's a huge barrier to harmonizing findings from studies that compare "apples and oranges.”
"I think there has been widespread discontent with the existing criteria among health-care providers of all kinds. Different settings all stand to benefit from getting on board with this unified, evidence-based, consensus-based criteria.”
The new criteria also emphasize the need for awareness about intimate partner violence.
"Being assaulted by your partner is an alarmingly common way to get hurt," Silverberg said. "These are predominately women victims and predominantly not having a single injury but multiple injuries with repeated assaults over months to years. And they've been left out of the conversation around the brain injury research until pretty recently.”
Stacey Ashton, manager of shelter services and affordable housing at YW Calgary, said the facility that offers shelter space to women for 21 days recently started screening for mild traumatic brain injuries that could have occurred because of domestic violence.
"The big piece, too, is going to be around building awareness for women who are experiencing violence, that they could have a potential brain injury. I think that correlation is poorly understood by a lot of people," Ashton said.
New criteria or clinical guidelines typically take several years to be universally adopted as awareness increases but that could happen more quickly in some cases if insurance companies require a verified diagnosis according to the latest definition of a condition before paying for a specific treatment, Silverberg said.
Canadian researcher helps define new standards for diagnosing concussions
Read more: https://www.ctvnews.ca/health/canadian- ... -1.6412466
Remembering what happened after she hit her head on the ice while playing hockey is tough for Meg Kerekes, but she knows how that particular headache felt -- "like a one-pound weight on the spot that got hit.”
"I forget if they took me out or if I finished the rest of the game. I think I might have finished the game," she said of the suspected concussion in September 2018 when she was playing amateur hockey during her high school years in Vancouver.
Her coach, who doubled as the person in charge of safety, suggested she stop playing and mentioned she may have a concussion."I didn't go to a doctor or anything. They just didn't let me play for two weeks," said Kerekes, who suffered another hit to the head five months later when an opposing player slammed into her.
Her mother took her to hospital after the second incident on the coach's orders, where a suspected concussion was confirmed and Kerekes was out of school for 10 days. She returned to "light" hockey practice, but no games, three weeks later.
Coaches and other volunteers in amateur sports need to be more aware of concussion risks, said Kerekes, who still gets a slight headache sometimes from just shaking her head while listening to music.
Recognizing and properly diagnosing concussions has also been an issue in clinical settings. A Canadian researcher hopes that will change with a new diagnostic standard he helped develop.
Noah Silverberg, associate psychology professor at the University of British Columbia, co-led an international panel's efforts to replace "wildly inconsistent" definitions of concussion. The North American, European and Australian experts included clinician scientists such as emergency room doctors, neurosurgeons, pediatricians and those specializing in rehabilitation and sports medicine.
Silverberg's paper outlining the new standardized criteria, co-authored by neuropsychologist Grant Iverson of the Harvard University-affiliated Spaulding Rehabilitation Hospital on behalf of the American Congress of Rehabilitation Medicine (ACRM), was published last week in Archives of Physical Medicine and Rehabilitation.
Silverberg said concussion has historically been minimized as a minor injury that does not need medical attention and is believed to get better on its own.
That often means people don't seek medical treatment immediately, or at all, so a potential mild traumatic brain injury goes undetected, said Silverberg, who focuses on concussion recovery and treatment.
However, a concussion may not get diagnosed in an emergency room, where the focus is typically on ruling out catastrophic injuries rather than diagnosing a condition that could involve persistent symptoms and disability, he said. There is also a long-standing concern about family doctors missing the signs and symptoms of a concussion because of little training in a field that has advanced quickly over the last few decades. There are inconsistencies in how the condition is diagnosed in specialty concussion clinics as well, Silverberg said.
A definition of mild traumatic brain injury published by the ACRM in 1993 is outdated, he said, and whether a patient is diagnosed with the condition depends on the particular criteria being used.
He said diagnosing concussions is tricky because symptoms can overlap with other conditions so health-care providers should determine how someone was injured, for example by being hit on the head while participating in a sport or in a crash.
Two or more symptoms, such as a headache and dizziness, would meet the criteria for diagnosing concussion but clinicians should also rely more heavily on observational signs such as a patient responding slowly to questions, being off balance or not knowing where they are, Silverberg said.
A clinical exam that tests for balance, memory, concentration and vision is also part of the new criteria, he said, adding a brain scan could also be ordered but does not always show signs of injury.
He pointed to a 2008 study in Australia that applied multiple sets of criteria for 12,000 children aged three to 16 and found the proportion of those diagnosed with a mild concussion ranged from seven per cent to 99 per cent. Silverberg said such a wide range means there's a huge barrier to harmonizing findings from studies that compare "apples and oranges.”
"I think there has been widespread discontent with the existing criteria among health-care providers of all kinds. Different settings all stand to benefit from getting on board with this unified, evidence-based, consensus-based criteria.”
The new criteria also emphasize the need for awareness about intimate partner violence.
"Being assaulted by your partner is an alarmingly common way to get hurt," Silverberg said. "These are predominately women victims and predominantly not having a single injury but multiple injuries with repeated assaults over months to years. And they've been left out of the conversation around the brain injury research until pretty recently.”
Stacey Ashton, manager of shelter services and affordable housing at YW Calgary, said the facility that offers shelter space to women for 21 days recently started screening for mild traumatic brain injuries that could have occurred because of domestic violence.
"The big piece, too, is going to be around building awareness for women who are experiencing violence, that they could have a potential brain injury. I think that correlation is poorly understood by a lot of people," Ashton said.
New criteria or clinical guidelines typically take several years to be universally adopted as awareness increases but that could happen more quickly in some cases if insurance companies require a verified diagnosis according to the latest definition of a condition before paying for a specific treatment, Silverberg said.
Canadian researcher helps define new standards for diagnosing concussions
Read more: https://www.ctvnews.ca/health/canadian- ... -1.6412466
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greybeard58
- Posts: 2512
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Susanna Tapani entered concussion protocol
Susanna Tapani entered concussion protocol
Injury Issues Will Impact Season Opener
Some were surprised to see Minnesota sign 14 forward, particularly with Abby Boreen still unsigned, who arguably outperformed a group of already signed players in Minnesota like Clair DeGeorge, Brooke Bryant, and Clair Butorac in camp. But the truth is, Boreen could still find herself under contract in Minnesota with Sydney Brodt, Susanna Tapani, and Grace Zumwinkle all sidelined. It's now been determined that the injury to Brodt, presumed to be an ankle or lower leg injury, will keep her out for months. Zumwinkle looked to injure her shoulder, which if any kind of separation or collarbone injury occurred, could also hold her out through the opening week of the season, and Tapani entered concussion protocol after Blayre Turnbull sent her crashing into the goalpost. She's likely to return in time for the season to begin. Minnesota general manager Natalie Darwitz believes her team has the versatility to manage the injuries, particularly with Sophia Kunin and Tapani, who she believes can also play on the blueline this year. Minnesota was not the only team that was dealing with injuries in camp. Madison Packer, who is expected to sign with PWHL New York, remained out with a shoulder injury, but didn't look too far off from a return in her practice reps. Micah Zandee-Hart will certainly miss the season opener for New York as well, and likely the opening 3-4 weeks of the year, but she also looked sharp on her feet during practice. The final injury of of note is with Montreal's Erin Ambrose, who went down in Canada's last Rivalry Series contest. The injuries mounting, coaches and general managers will wait and watch anxiously as star players depart for the December Rivalry Series games.
PWHL Rumblings read more: https://thehockeynews.com/womens/pwhl/p ... d-injuries
Injury Issues Will Impact Season Opener
Some were surprised to see Minnesota sign 14 forward, particularly with Abby Boreen still unsigned, who arguably outperformed a group of already signed players in Minnesota like Clair DeGeorge, Brooke Bryant, and Clair Butorac in camp. But the truth is, Boreen could still find herself under contract in Minnesota with Sydney Brodt, Susanna Tapani, and Grace Zumwinkle all sidelined. It's now been determined that the injury to Brodt, presumed to be an ankle or lower leg injury, will keep her out for months. Zumwinkle looked to injure her shoulder, which if any kind of separation or collarbone injury occurred, could also hold her out through the opening week of the season, and Tapani entered concussion protocol after Blayre Turnbull sent her crashing into the goalpost. She's likely to return in time for the season to begin. Minnesota general manager Natalie Darwitz believes her team has the versatility to manage the injuries, particularly with Sophia Kunin and Tapani, who she believes can also play on the blueline this year. Minnesota was not the only team that was dealing with injuries in camp. Madison Packer, who is expected to sign with PWHL New York, remained out with a shoulder injury, but didn't look too far off from a return in her practice reps. Micah Zandee-Hart will certainly miss the season opener for New York as well, and likely the opening 3-4 weeks of the year, but she also looked sharp on her feet during practice. The final injury of of note is with Montreal's Erin Ambrose, who went down in Canada's last Rivalry Series contest. The injuries mounting, coaches and general managers will wait and watch anxiously as star players depart for the December Rivalry Series games.
PWHL Rumblings read more: https://thehockeynews.com/womens/pwhl/p ... d-injuries
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greybeard58
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- Joined: Sat Aug 21, 2004 11:40 pm
Don't play around with a hit to the head
nice video
Don't play around with a hit to the head - YouTube
https://www.youtube.com/watch?v=TdWY5Dd8qqg
Don't play around with a hit to the head - YouTube
https://www.youtube.com/watch?v=TdWY5Dd8qqg
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greybeard58
- Posts: 2512
- Joined: Sat Aug 21, 2004 11:40 pm
'It's coming' - Experts worried about female athlete brain injuries
'It's coming' - Experts worried about female athlete brain injuries
The experts at the forefront of researching brain injuries in athletes say it is inevitable women will be affected by Chronic Traumatic Encephalopathy (CTE).
Further, Dr Ann McKee from the Boston Brain Bank – the world’s leading authority on CTE – and colleague Chris Nowinski, a neuroscientist and the CEO of the Concussion Legacy Foundation, say it’s possible that females are more susceptible than males to CTE.
In interviews conducted by TVNZ’s Sunday program in the course of telling the story of Justin Jennings, the first New Zealand rugby player to be diagnosed with CTE, the degenerative brain disease linked to repeated head knocks, both McKee and Nowinski expressed concern about what contact sports may doing to women's brains.
McKee said CTE – only diagnosable after death – has not yet be found in female athletes (although it has been in domestic assault victims), but that it’s only a matter of time before it is.
“We have far fewer female brains than we have male brains [to examine],” she said. “And as we’re getting more and more female athletes… especially soccer players, those are starting to come in and it’s just a matter of time now before we see our first CTE case.
“There is evidence that women actually are more susceptible to concussion. And that they recover more slowly from the effects of a concussion.
“There are so many benefits to sports participation physically and also psychologically for our children... so I certainly am a proponent of active sports, keeping physically fit and most sports.
“But you do need to play sport sensibly and to remember that you've only got one brain and it has to last you the rest of your life. And you need to protect it from those early instances where you may be damaging it. And parents need to recognize that if a child gets blows to the head they could have long-lasting effects.”
Black Fern Portia Woodman Wickliffe is a recent high-profile victim of concussion after she was hit in a high tackle by Lydia Thompson during New Zealand’s World Cup final victory against England at Eden Park in November.
Now fully recovered and having starred in two World Series sevens tournaments, Woodman Wickliffe said in an interview with 1News that she suffered from headaches for about a fortnight after the World Cup final.
“The first two weeks afterwards I would have a headache coming outside, as soon as I stepped outside - I think it was from the brightness and the noise going around,” she said.
Asked whether the danger of head injuries concerned her, she replied: “I guess it’s in the back of your mind.
“I think I’ve had a couple now and that was my most significant one, but it’s no different to boxing or fighting and I wouldn’t want to stop doing sport or be scared to play a sport because of something… That’s not the only thing that’s going to affect me in the long term - my back's probably the age of a 50 -year-old right now.”
Asked for comment, New Zealand Rugby said in a statement that it "prioritizes player safety at all levels of the game and improvements continue to be made, including education, law changes and policies.
"Research and support for women and girls’ rugby is a specific focus, and NZR is supporting several world-leading studies at both the community and professional levels of the game which will significantly contribute to an improved understanding of player safety in women’s sport.”
Nowinski, who with McKee set up the Boston Brain Bank - the largest sports brain bank in the world housing the brains some famous athletes including the NFL’s Aaron Hernandez – shares McKee’s concerns about the potential effects on women.
“We absolutely have to be concerned about the proliferation of contact sports for women,” he said.
“We’ve lived in a world where essentially almost exclusively men were getting hit in the head a thousand times a year in sports. And now we’re inviting women to do the same thing, which is great for equality, but it’s terrible for CTE.
"And maybe that’ll help change the argument, because we seem to be fine with men getting this.
"Like, our dads getting it, our sons, our brothers [and] people are not blinking. But if it’s our mums, our sisters, if it’s our daughters, maybe we’ll change.
“But I promise you this is coming for women too, because they're now playing these same sports.”
'It's coming' - Experts worried about female athlete brain injuries
Read more: https://www.1news.co.nz/2023/02/20/its- ... -injuries/
The experts at the forefront of researching brain injuries in athletes say it is inevitable women will be affected by Chronic Traumatic Encephalopathy (CTE).
Further, Dr Ann McKee from the Boston Brain Bank – the world’s leading authority on CTE – and colleague Chris Nowinski, a neuroscientist and the CEO of the Concussion Legacy Foundation, say it’s possible that females are more susceptible than males to CTE.
In interviews conducted by TVNZ’s Sunday program in the course of telling the story of Justin Jennings, the first New Zealand rugby player to be diagnosed with CTE, the degenerative brain disease linked to repeated head knocks, both McKee and Nowinski expressed concern about what contact sports may doing to women's brains.
McKee said CTE – only diagnosable after death – has not yet be found in female athletes (although it has been in domestic assault victims), but that it’s only a matter of time before it is.
“We have far fewer female brains than we have male brains [to examine],” she said. “And as we’re getting more and more female athletes… especially soccer players, those are starting to come in and it’s just a matter of time now before we see our first CTE case.
“There is evidence that women actually are more susceptible to concussion. And that they recover more slowly from the effects of a concussion.
“There are so many benefits to sports participation physically and also psychologically for our children... so I certainly am a proponent of active sports, keeping physically fit and most sports.
“But you do need to play sport sensibly and to remember that you've only got one brain and it has to last you the rest of your life. And you need to protect it from those early instances where you may be damaging it. And parents need to recognize that if a child gets blows to the head they could have long-lasting effects.”
Black Fern Portia Woodman Wickliffe is a recent high-profile victim of concussion after she was hit in a high tackle by Lydia Thompson during New Zealand’s World Cup final victory against England at Eden Park in November.
Now fully recovered and having starred in two World Series sevens tournaments, Woodman Wickliffe said in an interview with 1News that she suffered from headaches for about a fortnight after the World Cup final.
“The first two weeks afterwards I would have a headache coming outside, as soon as I stepped outside - I think it was from the brightness and the noise going around,” she said.
Asked whether the danger of head injuries concerned her, she replied: “I guess it’s in the back of your mind.
“I think I’ve had a couple now and that was my most significant one, but it’s no different to boxing or fighting and I wouldn’t want to stop doing sport or be scared to play a sport because of something… That’s not the only thing that’s going to affect me in the long term - my back's probably the age of a 50 -year-old right now.”
Asked for comment, New Zealand Rugby said in a statement that it "prioritizes player safety at all levels of the game and improvements continue to be made, including education, law changes and policies.
"Research and support for women and girls’ rugby is a specific focus, and NZR is supporting several world-leading studies at both the community and professional levels of the game which will significantly contribute to an improved understanding of player safety in women’s sport.”
Nowinski, who with McKee set up the Boston Brain Bank - the largest sports brain bank in the world housing the brains some famous athletes including the NFL’s Aaron Hernandez – shares McKee’s concerns about the potential effects on women.
“We absolutely have to be concerned about the proliferation of contact sports for women,” he said.
“We’ve lived in a world where essentially almost exclusively men were getting hit in the head a thousand times a year in sports. And now we’re inviting women to do the same thing, which is great for equality, but it’s terrible for CTE.
"And maybe that’ll help change the argument, because we seem to be fine with men getting this.
"Like, our dads getting it, our sons, our brothers [and] people are not blinking. But if it’s our mums, our sisters, if it’s our daughters, maybe we’ll change.
“But I promise you this is coming for women too, because they're now playing these same sports.”
'It's coming' - Experts worried about female athlete brain injuries
Read more: https://www.1news.co.nz/2023/02/20/its- ... -injuries/
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greybeard58
- Posts: 2512
- Joined: Sat Aug 21, 2004 11:40 pm
Ask the Pediatrician: What to know about mental health in teen athletes
Ask the Pediatrician: What to know about mental health in teen athletes
The single most important thing parents can do is create a safe environment.
Some potential effects of being a competitive athlete, like perfectionism, external pressures to perform or severe injuries, may increase the risk of mental illness. (Dreamstime/TNS)
PUBLISHED: September 19, 2023 at 11:27 a.m. | UPDATED: September 19, 2023 at 11:27 a.m.
By Dr. Drew Watson, American Academy of Pediatrics
Mental illness is an extremely common and important issue among teenagers. Although sports and physical activity have tremendous mental health benefits, young athletes are not exempt from the ongoing mental health crisis.
In fact, some potential effects of being a competitive athlete, like perfectionism, external pressures to perform or severe injuries, may increase the risk of mental illness. Improving mental health and well-being can not only help make young athletes feel better, it can even have important benefits for performance and reducing illness and injury risk.
The single most important thing parents can do is create a safe environment for your child that promotes ongoing conversations about mental health.
Assure your child that they can tell you anything, without judgment. Recognize and communicate to your child that mental health is health. The goal is to normalize conversations about it. Bring up the topic of mental health yourself, and make yourself available when your child wants to talk.
Watch for symptoms of anxiety, which can include:
· Significant worries about things before they happen
· Constant concerns about family, school, friends or activities
· Fears of embarrassment or making mistakes
· Low self-esteem and lack of self-confidence
Some symptoms of depression can include:
· Feeling or appearing depressed, sad, tearful or irritable
· Loss of interest in friends, academics or activities
· Changes in appetite and/or weight
· Sleeping more or less than usual; having more trouble concentrating
· Having thoughts of self-harm or suicide
If you think your child is struggling with their mental health, talk with them and help them get help.
Encourage athletes to talk with you or with other family members, friends and health care providers. You can also call the Suicide and Crisis Lifeline (9-8-8).
If you feel your child is experiencing a mental health emergency (expressing an intent to harm themselves or others), call 911 or go to the emergency department.
Remember, if you have any questions or concerns about your child’s mental health, don’t hesitate to talk with your pediatrician.
ABOUT THE WRITER
Drew Watson, MD, MS, FAAP is a member of the American Academy of Pediatrics Council on Sports Medicine & Fitness. He practices pediatric sports medicine within the Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin–Madison and is a team physician for the university’s athletic department.
https://www.twincities.com/2023/09/19/a ... -athletes/
The single most important thing parents can do is create a safe environment.
Some potential effects of being a competitive athlete, like perfectionism, external pressures to perform or severe injuries, may increase the risk of mental illness. (Dreamstime/TNS)
PUBLISHED: September 19, 2023 at 11:27 a.m. | UPDATED: September 19, 2023 at 11:27 a.m.
By Dr. Drew Watson, American Academy of Pediatrics
Mental illness is an extremely common and important issue among teenagers. Although sports and physical activity have tremendous mental health benefits, young athletes are not exempt from the ongoing mental health crisis.
In fact, some potential effects of being a competitive athlete, like perfectionism, external pressures to perform or severe injuries, may increase the risk of mental illness. Improving mental health and well-being can not only help make young athletes feel better, it can even have important benefits for performance and reducing illness and injury risk.
The single most important thing parents can do is create a safe environment for your child that promotes ongoing conversations about mental health.
Assure your child that they can tell you anything, without judgment. Recognize and communicate to your child that mental health is health. The goal is to normalize conversations about it. Bring up the topic of mental health yourself, and make yourself available when your child wants to talk.
Watch for symptoms of anxiety, which can include:
· Significant worries about things before they happen
· Constant concerns about family, school, friends or activities
· Fears of embarrassment or making mistakes
· Low self-esteem and lack of self-confidence
Some symptoms of depression can include:
· Feeling or appearing depressed, sad, tearful or irritable
· Loss of interest in friends, academics or activities
· Changes in appetite and/or weight
· Sleeping more or less than usual; having more trouble concentrating
· Having thoughts of self-harm or suicide
If you think your child is struggling with their mental health, talk with them and help them get help.
Encourage athletes to talk with you or with other family members, friends and health care providers. You can also call the Suicide and Crisis Lifeline (9-8-8).
If you feel your child is experiencing a mental health emergency (expressing an intent to harm themselves or others), call 911 or go to the emergency department.
Remember, if you have any questions or concerns about your child’s mental health, don’t hesitate to talk with your pediatrician.
ABOUT THE WRITER
Drew Watson, MD, MS, FAAP is a member of the American Academy of Pediatrics Council on Sports Medicine & Fitness. He practices pediatric sports medicine within the Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin–Madison and is a team physician for the university’s athletic department.
https://www.twincities.com/2023/09/19/a ... -athletes/
-
greybeard58
- Posts: 2512
- Joined: Sat Aug 21, 2004 11:40 pm
Fitness: Keeping kids’ heads in the game
Fitness: Keeping kids’ heads in the game
Concussions are one of the most serious injuries in hockey, especially for underdeveloped brains.
Author of the article:
Jill Barker
Published Sep 10, 2023 • Last updated Sep 10, 2023 • 4 minute read
Every year, half-a-million kids lace up their hockey skates in rinks across the country. But for all the face-offs taken, passes made and goals scored, injuries remain part of the game, with concussions arguably one of the most serious, especially for underdeveloped brains.
Ranked just below rugby when it comes to documenting the highest number of concussions in youth sports, bodychecking was identified as one of the leading causes of head injury among hockey players. So it was no surprise when a decade ago it was banned for all 14-year-old and under (U-15 or Bantam) players. But young hockey players are still getting head injuries, which led a team of Canadian researchers from the University of Calgary to look at other variables that may factor into concussion risk, like sex, weight, level of play and player position.
Using data collected from a study of 4,418 hockey players’ ages 11 to 17 from British Columbia and Alberta that spanned five seasons and included players from all levels of play, including leagues that both permitted and prohibited bodychecking, the researchers examined the number of concussions that occurred during games and practices.
Of the more than 4,000 players (including girls playing on girls-only teams and teams with boys and girls playing together), 617 reported having a concussion, the majority of which occurred in games — which is consistent with previous studies. What was unexpected, however, is that a higher proportion of females participating on female-only teams suffered concussions as compared with females playing on predominately male teams — even though there’s no bodychecking in women’s hockey.
“Our results suggest that, relative to male players, females had a 79-per-cent higher rate of game-related concussion and a two-fold greater rate of game-related concussion with greater than 10 days of time-loss,” the researchers said. “Females also had over a two-fold greater rate of practice-related concussion than males.”
Peter Smith, who coached the McGill University women’s hockey team for 20 seasons and was assistant coach on the Canadian women’s teams who won gold in the 2006 and 2010 Olympic Games, knows a thing or two about women’s hockey. He says some of his players have had career-ending concussions, despite the fact that concussion knowledge, prevention and treatment has come a long way since his early days behind the bench.
It’s a similar scenario south of the border with the NCAA reporting that women’s varsity hockey has the highest rate of concussions among 16 male and female collegiate-level sports, despite body checking being prohibited.
Adrienne Crampton is the associate director of Business Development at Healthy Brains, Healthy Lives in Montreal. Concussions forced her early retirement from the McGill Martlets and led to her pursuit of a PhD in concussions and mild traumatic brain injury. She welcomes more research into why female athletes are at greater risk for concussion. Intuitively, based on her knowledge in the field and in the sport, she has a few ideas as to the reason behind this phenomenon.
“Big hits still happen in women’s hockey, yet very few women are taught how to give and take a hit,” Crampton said.
She mentions that among various other factors, differences in anatomy between both sexes could be a factor, including smaller neck girth, which may make it harder to stabilize the head during body-to-body contact. There’s also less education in girls’ hockey around how to effectively give and take a hit, which can increase the risk of injury, including head trauma.
Despite this sex-based gap in concussion knowledge, the University of Alberta researchers couldn’t be clearer in their assertion that prohibiting body checking in youth hockey remains the right decision when it comes to reducing the risk of head injury in young hockey players.
“The substantial evidence showing significant reductions in injury risk following policy disallowing bodychecking provides further support that the greatest public health impact specific to youth ice hockey is realized through disallowing bodychecking,” the researchers said.
And contrary to the argument that waiting too long to implement bodychecking will result in more injuries when players are bigger but less skilled at using their body to move someone off the puck, there’s no evidence that a late introduction to bodychecking resulted in more injuries.
Also debunked is the idea that player weight (within the same age group) increased the risk of concussion, with smaller players more likely to be concussed than their larger teammates.
“Based on the evidence, restricting youth ice hockey leagues based on age and weight to reduce concussion risk like some American football leagues have performed may not be warranted,” the researchers said.
As for player position, goalies were the least likely players on the ice to have a head injury, with statistics suggesting all other positions were of equal risk.
One risk factor, however, remains consistent among all ages, sizes, sex, playing position and sport, and that’s if you’ve had a previous concussion, you’re more at risk for another.
“Those with a previous injury and concussion history had higher rates of game-related concussion, which was also well supported by previous youth ice hockey studies and across sports,” the researchers said.
The best approach is to strive for fewer concussions, which was the focus of the 6th annual International Conference on Concussion in Sport and their latest Consensus Statement. The document outlines prevention strategies, including supporting prohibiting bodychecking in all youth and most adolescent hockey leagues. It also suggests mouth guards be mandated for this same age group, citing a 28-per-cent reduced rate of concussion when worn.
Every little bit counts when it comes to making it safer to pull on a hockey jersey, including changes to the game and equipment. Kids play hockey to have fun, not sit on the sidelines
https://montrealgazette.com/health/diet ... n-the-game
Concussions are one of the most serious injuries in hockey, especially for underdeveloped brains.
Author of the article:
Jill Barker
Published Sep 10, 2023 • Last updated Sep 10, 2023 • 4 minute read
Every year, half-a-million kids lace up their hockey skates in rinks across the country. But for all the face-offs taken, passes made and goals scored, injuries remain part of the game, with concussions arguably one of the most serious, especially for underdeveloped brains.
Ranked just below rugby when it comes to documenting the highest number of concussions in youth sports, bodychecking was identified as one of the leading causes of head injury among hockey players. So it was no surprise when a decade ago it was banned for all 14-year-old and under (U-15 or Bantam) players. But young hockey players are still getting head injuries, which led a team of Canadian researchers from the University of Calgary to look at other variables that may factor into concussion risk, like sex, weight, level of play and player position.
Using data collected from a study of 4,418 hockey players’ ages 11 to 17 from British Columbia and Alberta that spanned five seasons and included players from all levels of play, including leagues that both permitted and prohibited bodychecking, the researchers examined the number of concussions that occurred during games and practices.
Of the more than 4,000 players (including girls playing on girls-only teams and teams with boys and girls playing together), 617 reported having a concussion, the majority of which occurred in games — which is consistent with previous studies. What was unexpected, however, is that a higher proportion of females participating on female-only teams suffered concussions as compared with females playing on predominately male teams — even though there’s no bodychecking in women’s hockey.
“Our results suggest that, relative to male players, females had a 79-per-cent higher rate of game-related concussion and a two-fold greater rate of game-related concussion with greater than 10 days of time-loss,” the researchers said. “Females also had over a two-fold greater rate of practice-related concussion than males.”
Peter Smith, who coached the McGill University women’s hockey team for 20 seasons and was assistant coach on the Canadian women’s teams who won gold in the 2006 and 2010 Olympic Games, knows a thing or two about women’s hockey. He says some of his players have had career-ending concussions, despite the fact that concussion knowledge, prevention and treatment has come a long way since his early days behind the bench.
It’s a similar scenario south of the border with the NCAA reporting that women’s varsity hockey has the highest rate of concussions among 16 male and female collegiate-level sports, despite body checking being prohibited.
Adrienne Crampton is the associate director of Business Development at Healthy Brains, Healthy Lives in Montreal. Concussions forced her early retirement from the McGill Martlets and led to her pursuit of a PhD in concussions and mild traumatic brain injury. She welcomes more research into why female athletes are at greater risk for concussion. Intuitively, based on her knowledge in the field and in the sport, she has a few ideas as to the reason behind this phenomenon.
“Big hits still happen in women’s hockey, yet very few women are taught how to give and take a hit,” Crampton said.
She mentions that among various other factors, differences in anatomy between both sexes could be a factor, including smaller neck girth, which may make it harder to stabilize the head during body-to-body contact. There’s also less education in girls’ hockey around how to effectively give and take a hit, which can increase the risk of injury, including head trauma.
Despite this sex-based gap in concussion knowledge, the University of Alberta researchers couldn’t be clearer in their assertion that prohibiting body checking in youth hockey remains the right decision when it comes to reducing the risk of head injury in young hockey players.
“The substantial evidence showing significant reductions in injury risk following policy disallowing bodychecking provides further support that the greatest public health impact specific to youth ice hockey is realized through disallowing bodychecking,” the researchers said.
And contrary to the argument that waiting too long to implement bodychecking will result in more injuries when players are bigger but less skilled at using their body to move someone off the puck, there’s no evidence that a late introduction to bodychecking resulted in more injuries.
Also debunked is the idea that player weight (within the same age group) increased the risk of concussion, with smaller players more likely to be concussed than their larger teammates.
“Based on the evidence, restricting youth ice hockey leagues based on age and weight to reduce concussion risk like some American football leagues have performed may not be warranted,” the researchers said.
As for player position, goalies were the least likely players on the ice to have a head injury, with statistics suggesting all other positions were of equal risk.
One risk factor, however, remains consistent among all ages, sizes, sex, playing position and sport, and that’s if you’ve had a previous concussion, you’re more at risk for another.
“Those with a previous injury and concussion history had higher rates of game-related concussion, which was also well supported by previous youth ice hockey studies and across sports,” the researchers said.
The best approach is to strive for fewer concussions, which was the focus of the 6th annual International Conference on Concussion in Sport and their latest Consensus Statement. The document outlines prevention strategies, including supporting prohibiting bodychecking in all youth and most adolescent hockey leagues. It also suggests mouth guards be mandated for this same age group, citing a 28-per-cent reduced rate of concussion when worn.
Every little bit counts when it comes to making it safer to pull on a hockey jersey, including changes to the game and equipment. Kids play hockey to have fun, not sit on the sidelines
https://montrealgazette.com/health/diet ... n-the-game
-
greybeard58
- Posts: 2512
- Joined: Sat Aug 21, 2004 11:40 pm
Recent estimates from the Centers for Disease Control and Prevention
Recent estimates from the Centers for Disease Control and Prevention indicate that sport and recreational traumatic brain injuries (TBIs) have increased from 300,000 per year
1
to approximately 1.6 million to 3 million per year in the United States.
2
This trend suggests that concussions are a growing problem that affects athletes at both the high school and collegiate level. An increase in female participation in sport shows that there are currently more than 178,000 women participating on National Collegiate Athletic Association (NCAA) teams
3
and approximately 3 million women playing organized high school sports.
4
These trends have provided an impetus for researchers to examine differences between the genders, which might affect the assessment and management of sport-related concussion. Therefore, this article addresses the role of gender in the assessment and management of sport-related concussion.
Gender differences in the epidemiology of sport-related concussions
Several researchers have identified differences in the incidence of sport-related concussion among collegiate athletes of different genders. Covassin and colleagues
5
examined NCAA injury data from 1997 to 2000 and found collegiate female athletes to be at a higher risk of concussions occurring in games than collegiate male athletes. Specifically, women’s soccer (2.09/1000 athlete exposure [AE]) and basketball (0.74/1000AE) had a higher injury rate than men’s soccer (1.36/1000AE) and basketball (0.48/1000AE).
5
Hootman and colleagues
6
recently summarized 16 years (1988–2004) of NCAA injury data and reported concussions accounted for a higher injury rate in women’s ice hockey (0.91/1000AE), soccer (0.41/1000AE), and basketball (0.22/1000AE) than men’s ice hockey (0.41/1000AE), soccer (0.28/1000AE), and basketball (0.16/1000AE). Women’s ice hockey may be misleading because data were collected only for 3 years (2000–2003) for this sport versus 16 years for the other sports.
6
According to these data, it appears that female collegiate athletes are at a higher risk for concussion than male collegiate athletes.
There are only a few studies published that have examined gender differences on incidence rates for sport-related concussion in high school athletes. One of the first studies to examine concussion at the high school level was conducted in the 1990s by Powell and Barber-Foss.
7
Similar to the epidemiologic trends observed at the collegiate level, in high school sports played by both sexes, girls had a slightly higher game injury rate than boys. Specifically, girl’s soccer (0.71/1000AE), basketball (0.42/1000AE), and softball (0.13/1000AE) had a higher game injury rate for concussions than boy’s soccer (0.57/1000AE), basketball (0.28/1000AE), and baseball (0.12/1000AE). A more recent investigation by Gessel and colleagues
8
reported that concussions accounted for a higher game injury rate in high school girls’ sports (soccer, 0.97/1000AE; basketball, 0.60/1000AE) than in high school boys’ sports (soccer, 0.59/1000AE; basketball, 0.11/1000AE). It appears that the incidence rates of concussion differ by gender at both the collegiate and high school levels.
Numerous explanations have been proposed to account for female athletes being more at risk for concussion than male athletes. Studies have found that women have a decreased head-neck segment mass compared with male athletes, which could result in greater angular acceleration to the head after a concussive impact.
9
,
10
,
11
,
12
,
13
College-age women have been found to have approximately 43% less head-neck segment mass compared with college-age men.
10
Researchers have also suggested that female soccer players have a larger ball-to-head size ratio than men, possibly predisposing them to concussion.
13
,
14
Moreover, female athletes have decreased neck strength and neck girth compared with male athletes.
10
,
11
,
15
Tierney and colleagues
10
reported that female collegiate students showed 49% less neck strength and 30% less neck girth compared with male collegiate students. Similarly, Garces and collegues
15
reported that male collegiate students had 30% to 40% more strength in cervical extensors and flexors than female collegiate students. Mansell and colleagues
16
investigated an 8-week cervical resistance training program on neck girth, cervical strength, and head-neck segment dynamic stabilization in collegiate soccer players. Although the neck girth and strength were increased in female soccer players, there were no gender-related differences in head-neck segment dynamic stabilization during a force application (ie, weight) in collegiate soccer players.
It is currently debated whether estrogen, the primary female sex hormone, has a detrimental or a neuroprotective effect with regard to concussion. Animal models have shown that estrogen treatment before experimentally induced brain injury (eg, fluid percussion brain injury) has protective effects for male rats but detrimental effects for female rats.
17
One reason may be that estrogen acts as a neuroprotector because of the hormone’s lipid antioxidant properties.
18
There is limited research published on the role that estrogen may have on the risk of concussion.
Studies have also found that female athletes tend to report more concussion symptoms than male athletes.
19
This disparity in self-reporting of concussion symptoms could be because of the nature of the male sport environment, especially in contact and collision sports (eg, football, wrestling, hockey) in which the incidence of concussion is highest. Male athletes are under constant pressure to play through pain, to show their masculinity and their toughness. They are oftentimes praised for their courage and rewarded when playing through pain and injury. In contrast, studies have found that female athletes are more concerned about their future health than male athletes.
20
These interesting differences between the male and female sport environments may explain the observed differences in the self-reporting of concussion symptoms between genders.
Differences in sport-related concussion outcomes between genders
Gender differences in cognitive function have been well documented. Specifically, women perform better on tasks involving verbal memory and perceptual motor speed, whereas men perform better on tasks of visuospatial ability.
21
These differences have also been documented by neurocognitive measures commonly used for managing concussion.
22
,
23
,
24
Covassin and colleagues
24
reported that at the college level, women performed higher on verbal memory than men, whereas men showed higher visual memory scores than women. These results warrant consideration of differences between genders in cognitive performance after concussion.
Several researchers have suggested that female athletes present more concussion symptoms acutely and take a longer period to recover from concussions
19
,
25
,
26
than male athletes.
19
Broshek and colleagues
19
found that, in high school and college athletes, concussed women displayed slower reaction times and greater total symptoms than concussed males. When excluding sports that require the use of a helmet (football), women were twice as likely as men to exhibit cognitive impairments.
19
These findings were among the first to suggest that sport-related concussion may affect athletes differently based on gender. However, athletes in this study represent significantly fewer women (28%) than men (72%), which may limit the generalizability of these findings. Nonetheless, more recent studies have also highlighted gender differences in sport-related concussion outcomes.
Covassin and colleagues
26
found gender differences in neurocognitive performance in concussed collegiate athletes. Specifically, female concussed athletes showed significantly lower scores on visual memory than male concussed athletes. In a more recent study, Colvin and colleagues
25
found that concussed collegiate female soccer players showed significantly slower reaction times and higher total symptom scores than concussed male soccer players.
Differences based on gender have also been found in the reporting of postconcussion symptoms. Female athletes tend to have a greater number of and more prolonged symptoms than male athletes.
19
,
27
,
28
Preiss-Farzanegan and colleagues
28
reported that women who incurred a sport-related mild TBI reported increased symptoms, particularly with regard to headache, dizziness, fatigue, and poor concentration, when compared with men. In a meta-analysis by Farace and Alves,
27
women who incurred a TBI had a worse outcome on 85% of measured variables, primarily symptoms, including headache, dizziness, anxiety, fatigue, and poor memory and concentration, than men.
Differences in the reporting of postconcussion symptoms between concussed male and female athletes have been attributed to neuroanatomical factors, organizational (cerebral) variability, hormonal discrepancies, and sports environment/social differences.
19
de Courten-Myers
29
reported that men had a greater number of cortical neuronal densities, whereas women had a greater area of neuropil (ie, containing unmyelinated neuronal processes). Esposito and colleagues
30
found that women have a greater cerebral blood flow rate coupled with a higher basal rate of glucose metabolism. These 2 differences could yield a more exacerbated neurometabolic cascade (ionic fluxes followed by hypoglycolysis) after concussion.
31
In addition, the decrease in cerebral blood flow and increase in metabolic demands caused by brain injury may interact with the already increased metabolic demands in women.
19
There has long been a debate in the literature as to whether estrogen has a detrimental or a protective effect on concussion outcome. If estrogen has a deleterious effect, it may be because of receptor-mediated alterations in energy metabolism
17
or estrogen-potentiating neuronal response to excitatory amino acid.
32
Emerson and colleagues
17
found that estrogen improves neurologic outcome after a TBI in male rats but shows detrimental effects in female rats. In contrast, Kupina and colleagues
33
found that estrogen had a neuroprotective effect because female mice demonstrated a better outcome than male mice after experimental brain injury. Specifically, male mice had a 20% mortality rate, whereas no deaths were recorded among female mice. Most research exploring the protective or deleterious effects that hormones may have on brain injury outcome has been conducted using animal models. Continued research in this area in humans is warranted.
Considering gender differences in the assessment and management of sport-related concussion
The assessment and management of sport-related concussion has seen vast improvement over the past decade. Results from empirical studies have increased the knowledge and awareness of sport-related concussion. As a result, management strategies for this injury have been refined, benefiting both sports-medicine professionals and injured athletes. More specifically, this progress has seen the suggested abolishment of historically used concussion grading scales, improved diagnostic methods, individual case management recommendations, and the use of computerized neurocognitive test batteries.
34
,
35
The management of sport-related concussion continues to be a germane issue for clinicians and researchers alike. Until recently, determining the status of a concussed athlete was primarily a subjective decision made by sports medicine professionals. It is now recommended that the assessment and management of sport-related concussion take on a multifaceted approach that consists of various measures that may include a sideline mental status examination, a postural stability assessment, and a neurocognitive test battery.
36
These measures, used in conjunction with symptom inventories, offer clinicians a wide variety of information on the status of recovery of the concussed athlete. When implemented with the recommended pre- and posttest methodology, these measures add objectivity to concussion assessment and management.
37
Gender differences in the risk, symptoms, and recovery should be considered when assessing and managing a concussed athlete. The incidence of sport-related concussion in high school and collegiate populations may be higher for female athletes in basketball, ice hockey, and soccer.
5
,
6
Therefore, health care professionals, coaches, athletes, and parents need to pay close attention to female athletes who incur a direct or indirect blow to the head, especially in the aforementioned sports. Moreover, sports medicine professionals need to pursue concussion evaluation with the same due diligence for female athletes as for male athletes.
Disparities in the reporting of concussion symptoms between male and female athletes should be a consideration when managing a concussion. Female concussed athletes report more symptoms of dizziness, fatigue, concentration, and lightheadedness than male concussed athletes.
19
,
28
Female soccer players who report headache symptoms 1 week postconcussion have greater cognitive impairments than athletes who do not report headache symptoms. In the general population, women have a higher incidence of headaches than men.
38
Moreover, women have almost double the prevalence of migraine headaches compared with men.
25
,
39
,
40
,
41
Recently, researchers have found that concussed athletes who display migraine headache symptoms take longer periods to recovery postinjury.
42
,
43
This predilection toward migraines may translate to a longer recovery time for female athletes.
Preliminary studies suggest that female athletes take longer periods to recover from a concussion than male athletes,
19
,
25
,
26
including on measures of reaction time
25
and visual memory.
26
More specifically, female concussed athletes may take up to 7 days longer to recover from a concussion than male concussed athletes. As a result of these preliminary studies, clinicians should be aware of varying recovery time from concussion between male and female athletes.
Summary
The detection and management of concussion in sport continue to be an important issue for sports medicine professionals. Advancements in the knowledge of this injury continue to reshape concussion management to ensure the well-being and safety of athletes. Recent studies suggest that the risk and recovery from sport-related concussion may vary between male and female athletes, with women having a higher risk of sustaining a concussion and taking a longer time to recover than men. Therefore, sports medicine professionals should not assume that the recovery from concussion is uniform in both male and female athletes. However, more research is warranted on concussed female athletes, particularly studies examining mechanism, symptoms, and recovery time.
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Article info
Footnotes
The authors have nothing to disclose.
Identification
DOI: https://doi.orghttps://www.sportsmed.th ... 010.08.001
1
to approximately 1.6 million to 3 million per year in the United States.
2
This trend suggests that concussions are a growing problem that affects athletes at both the high school and collegiate level. An increase in female participation in sport shows that there are currently more than 178,000 women participating on National Collegiate Athletic Association (NCAA) teams
3
and approximately 3 million women playing organized high school sports.
4
These trends have provided an impetus for researchers to examine differences between the genders, which might affect the assessment and management of sport-related concussion. Therefore, this article addresses the role of gender in the assessment and management of sport-related concussion.
Gender differences in the epidemiology of sport-related concussions
Several researchers have identified differences in the incidence of sport-related concussion among collegiate athletes of different genders. Covassin and colleagues
5
examined NCAA injury data from 1997 to 2000 and found collegiate female athletes to be at a higher risk of concussions occurring in games than collegiate male athletes. Specifically, women’s soccer (2.09/1000 athlete exposure [AE]) and basketball (0.74/1000AE) had a higher injury rate than men’s soccer (1.36/1000AE) and basketball (0.48/1000AE).
5
Hootman and colleagues
6
recently summarized 16 years (1988–2004) of NCAA injury data and reported concussions accounted for a higher injury rate in women’s ice hockey (0.91/1000AE), soccer (0.41/1000AE), and basketball (0.22/1000AE) than men’s ice hockey (0.41/1000AE), soccer (0.28/1000AE), and basketball (0.16/1000AE). Women’s ice hockey may be misleading because data were collected only for 3 years (2000–2003) for this sport versus 16 years for the other sports.
6
According to these data, it appears that female collegiate athletes are at a higher risk for concussion than male collegiate athletes.
There are only a few studies published that have examined gender differences on incidence rates for sport-related concussion in high school athletes. One of the first studies to examine concussion at the high school level was conducted in the 1990s by Powell and Barber-Foss.
7
Similar to the epidemiologic trends observed at the collegiate level, in high school sports played by both sexes, girls had a slightly higher game injury rate than boys. Specifically, girl’s soccer (0.71/1000AE), basketball (0.42/1000AE), and softball (0.13/1000AE) had a higher game injury rate for concussions than boy’s soccer (0.57/1000AE), basketball (0.28/1000AE), and baseball (0.12/1000AE). A more recent investigation by Gessel and colleagues
8
reported that concussions accounted for a higher game injury rate in high school girls’ sports (soccer, 0.97/1000AE; basketball, 0.60/1000AE) than in high school boys’ sports (soccer, 0.59/1000AE; basketball, 0.11/1000AE). It appears that the incidence rates of concussion differ by gender at both the collegiate and high school levels.
Numerous explanations have been proposed to account for female athletes being more at risk for concussion than male athletes. Studies have found that women have a decreased head-neck segment mass compared with male athletes, which could result in greater angular acceleration to the head after a concussive impact.
9
,
10
,
11
,
12
,
13
College-age women have been found to have approximately 43% less head-neck segment mass compared with college-age men.
10
Researchers have also suggested that female soccer players have a larger ball-to-head size ratio than men, possibly predisposing them to concussion.
13
,
14
Moreover, female athletes have decreased neck strength and neck girth compared with male athletes.
10
,
11
,
15
Tierney and colleagues
10
reported that female collegiate students showed 49% less neck strength and 30% less neck girth compared with male collegiate students. Similarly, Garces and collegues
15
reported that male collegiate students had 30% to 40% more strength in cervical extensors and flexors than female collegiate students. Mansell and colleagues
16
investigated an 8-week cervical resistance training program on neck girth, cervical strength, and head-neck segment dynamic stabilization in collegiate soccer players. Although the neck girth and strength were increased in female soccer players, there were no gender-related differences in head-neck segment dynamic stabilization during a force application (ie, weight) in collegiate soccer players.
It is currently debated whether estrogen, the primary female sex hormone, has a detrimental or a neuroprotective effect with regard to concussion. Animal models have shown that estrogen treatment before experimentally induced brain injury (eg, fluid percussion brain injury) has protective effects for male rats but detrimental effects for female rats.
17
One reason may be that estrogen acts as a neuroprotector because of the hormone’s lipid antioxidant properties.
18
There is limited research published on the role that estrogen may have on the risk of concussion.
Studies have also found that female athletes tend to report more concussion symptoms than male athletes.
19
This disparity in self-reporting of concussion symptoms could be because of the nature of the male sport environment, especially in contact and collision sports (eg, football, wrestling, hockey) in which the incidence of concussion is highest. Male athletes are under constant pressure to play through pain, to show their masculinity and their toughness. They are oftentimes praised for their courage and rewarded when playing through pain and injury. In contrast, studies have found that female athletes are more concerned about their future health than male athletes.
20
These interesting differences between the male and female sport environments may explain the observed differences in the self-reporting of concussion symptoms between genders.
Differences in sport-related concussion outcomes between genders
Gender differences in cognitive function have been well documented. Specifically, women perform better on tasks involving verbal memory and perceptual motor speed, whereas men perform better on tasks of visuospatial ability.
21
These differences have also been documented by neurocognitive measures commonly used for managing concussion.
22
,
23
,
24
Covassin and colleagues
24
reported that at the college level, women performed higher on verbal memory than men, whereas men showed higher visual memory scores than women. These results warrant consideration of differences between genders in cognitive performance after concussion.
Several researchers have suggested that female athletes present more concussion symptoms acutely and take a longer period to recover from concussions
19
,
25
,
26
than male athletes.
19
Broshek and colleagues
19
found that, in high school and college athletes, concussed women displayed slower reaction times and greater total symptoms than concussed males. When excluding sports that require the use of a helmet (football), women were twice as likely as men to exhibit cognitive impairments.
19
These findings were among the first to suggest that sport-related concussion may affect athletes differently based on gender. However, athletes in this study represent significantly fewer women (28%) than men (72%), which may limit the generalizability of these findings. Nonetheless, more recent studies have also highlighted gender differences in sport-related concussion outcomes.
Covassin and colleagues
26
found gender differences in neurocognitive performance in concussed collegiate athletes. Specifically, female concussed athletes showed significantly lower scores on visual memory than male concussed athletes. In a more recent study, Colvin and colleagues
25
found that concussed collegiate female soccer players showed significantly slower reaction times and higher total symptom scores than concussed male soccer players.
Differences based on gender have also been found in the reporting of postconcussion symptoms. Female athletes tend to have a greater number of and more prolonged symptoms than male athletes.
19
,
27
,
28
Preiss-Farzanegan and colleagues
28
reported that women who incurred a sport-related mild TBI reported increased symptoms, particularly with regard to headache, dizziness, fatigue, and poor concentration, when compared with men. In a meta-analysis by Farace and Alves,
27
women who incurred a TBI had a worse outcome on 85% of measured variables, primarily symptoms, including headache, dizziness, anxiety, fatigue, and poor memory and concentration, than men.
Differences in the reporting of postconcussion symptoms between concussed male and female athletes have been attributed to neuroanatomical factors, organizational (cerebral) variability, hormonal discrepancies, and sports environment/social differences.
19
de Courten-Myers
29
reported that men had a greater number of cortical neuronal densities, whereas women had a greater area of neuropil (ie, containing unmyelinated neuronal processes). Esposito and colleagues
30
found that women have a greater cerebral blood flow rate coupled with a higher basal rate of glucose metabolism. These 2 differences could yield a more exacerbated neurometabolic cascade (ionic fluxes followed by hypoglycolysis) after concussion.
31
In addition, the decrease in cerebral blood flow and increase in metabolic demands caused by brain injury may interact with the already increased metabolic demands in women.
19
There has long been a debate in the literature as to whether estrogen has a detrimental or a protective effect on concussion outcome. If estrogen has a deleterious effect, it may be because of receptor-mediated alterations in energy metabolism
17
or estrogen-potentiating neuronal response to excitatory amino acid.
32
Emerson and colleagues
17
found that estrogen improves neurologic outcome after a TBI in male rats but shows detrimental effects in female rats. In contrast, Kupina and colleagues
33
found that estrogen had a neuroprotective effect because female mice demonstrated a better outcome than male mice after experimental brain injury. Specifically, male mice had a 20% mortality rate, whereas no deaths were recorded among female mice. Most research exploring the protective or deleterious effects that hormones may have on brain injury outcome has been conducted using animal models. Continued research in this area in humans is warranted.
Considering gender differences in the assessment and management of sport-related concussion
The assessment and management of sport-related concussion has seen vast improvement over the past decade. Results from empirical studies have increased the knowledge and awareness of sport-related concussion. As a result, management strategies for this injury have been refined, benefiting both sports-medicine professionals and injured athletes. More specifically, this progress has seen the suggested abolishment of historically used concussion grading scales, improved diagnostic methods, individual case management recommendations, and the use of computerized neurocognitive test batteries.
34
,
35
The management of sport-related concussion continues to be a germane issue for clinicians and researchers alike. Until recently, determining the status of a concussed athlete was primarily a subjective decision made by sports medicine professionals. It is now recommended that the assessment and management of sport-related concussion take on a multifaceted approach that consists of various measures that may include a sideline mental status examination, a postural stability assessment, and a neurocognitive test battery.
36
These measures, used in conjunction with symptom inventories, offer clinicians a wide variety of information on the status of recovery of the concussed athlete. When implemented with the recommended pre- and posttest methodology, these measures add objectivity to concussion assessment and management.
37
Gender differences in the risk, symptoms, and recovery should be considered when assessing and managing a concussed athlete. The incidence of sport-related concussion in high school and collegiate populations may be higher for female athletes in basketball, ice hockey, and soccer.
5
,
6
Therefore, health care professionals, coaches, athletes, and parents need to pay close attention to female athletes who incur a direct or indirect blow to the head, especially in the aforementioned sports. Moreover, sports medicine professionals need to pursue concussion evaluation with the same due diligence for female athletes as for male athletes.
Disparities in the reporting of concussion symptoms between male and female athletes should be a consideration when managing a concussion. Female concussed athletes report more symptoms of dizziness, fatigue, concentration, and lightheadedness than male concussed athletes.
19
,
28
Female soccer players who report headache symptoms 1 week postconcussion have greater cognitive impairments than athletes who do not report headache symptoms. In the general population, women have a higher incidence of headaches than men.
38
Moreover, women have almost double the prevalence of migraine headaches compared with men.
25
,
39
,
40
,
41
Recently, researchers have found that concussed athletes who display migraine headache symptoms take longer periods to recovery postinjury.
42
,
43
This predilection toward migraines may translate to a longer recovery time for female athletes.
Preliminary studies suggest that female athletes take longer periods to recover from a concussion than male athletes,
19
,
25
,
26
including on measures of reaction time
25
and visual memory.
26
More specifically, female concussed athletes may take up to 7 days longer to recover from a concussion than male concussed athletes. As a result of these preliminary studies, clinicians should be aware of varying recovery time from concussion between male and female athletes.
Summary
The detection and management of concussion in sport continue to be an important issue for sports medicine professionals. Advancements in the knowledge of this injury continue to reshape concussion management to ensure the well-being and safety of athletes. Recent studies suggest that the risk and recovery from sport-related concussion may vary between male and female athletes, with women having a higher risk of sustaining a concussion and taking a longer time to recover than men. Therefore, sports medicine professionals should not assume that the recovery from concussion is uniform in both male and female athletes. However, more research is warranted on concussed female athletes, particularly studies examining mechanism, symptoms, and recovery time.
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Article info
Footnotes
The authors have nothing to disclose.
Identification
DOI: https://doi.orghttps://www.sportsmed.th ... 010.08.001
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greybeard58
- Posts: 2512
- Joined: Sat Aug 21, 2004 11:40 pm
Up to 30 percent of people with a TBI will develop post-concussion syndrome.
Up to 30 percent of people with a TBI will develop post-concussion syndrome.
KEY POINTS
• As many as 3.8 million concussions occur each year.
• Up to 30 percent of people with a TBI will develop post-concussion syndrome.
• Depression is the most common psychiatric disorder after TBI, with a prevalence of over 25 percent.
• Current treatment recommendations for post-concussion syndrome involve multiple modalities.
I spend most of my professional time as a general psychiatrist. However, I also practice forensic psychiatry, the subspecialty of psychiatry that deals with mental health issues and the law. A frequent request from an attorney involves examining a claimant who asserts mental health issues after suffering a concussion. A percentage of these individuals suffer from post-concussion syndrome.
Dr. “A” was injured in a motor vehicle accident when the Lyft she hired was rear-ended. Subsequently, she complained of neck and back pain as well as cognitive disturbances. These included headaches, problems with memory and concentration, and a lack of a “filter,” so she often spoke before thinking, saying hurtful things to her friends, coworkers, and family, all of which is out of character. She has a Ph.D. in one of the natural sciences.
At the time of my evaluation, she was seeing a psychiatrist for medication management due to depression. She described her current mood as “not too bad.” At times, she was very irritable. She had a “complete breakdown” in her sleep cycle following her injury. This resolved when a sleep specialist prescribed medication that allowed her to sleep 6-7 hours per night.
She told me that her memory was “terrible,” and she was having difficulty concentrating. The neuropsychological testing report ordered by her attorney noted “intellectual functioning that remained very strong across both verbal and nonverbal abilities. However, weaknesses noted included ‘difficulty initiating tasks and problems, recalling complex geometric designs not consistent with her level of education."
What Is Post-Concussion Syndrome?
According to the Concussion Legacy Foundation, a concussion is a type of traumatic brain injury, or TBI, caused by an impact on the body resulting in a rapid back-and-forth movement of your brain inside your skull. This sudden movement can stretch and damage brain tissue and trigger a chain of harmful changes that interfere with normal brain activities. Since your brain is your body’s control center, the effects of a concussion can cause disability in all of your brain functions. These may include but are not limited to vision, hearing, balance, memory, a feeling of “fogginess,” mood changes, problems with temperature and blood pressure, and sleep disorders.
For most people, symptoms will clear in a matter of days or weeks, depending on the severity of the injury. However, for 10-30 percent of people, an extended recovery with persistent symptoms will develop a post-concussion syndrome. Headache is the most common and long-lasting symptom. Over 50 percent of individuals experience this symptom even one year after the initial injury. Patients with post-concussion syndrome often describe problems with sleep, memory, concentration, increased irritability, and mood changes. Up to 75 percent of TBI patients suffer from major depressive disorder.
When you have a concussion, your immune system responds to the injury by causing inflammation near the injury site. The affected parts of your brain experience a temporary breakdown of structures in and around those cells. This results in an oxygen deficit your brain typically uses to accomplish a task. Because of neuroplasticity, other parts of your brain attempt to take over. However, this process is less efficient, resulting in the deficits described by sufferers.
Treatment Options
Current treatment recommendations for post-concussion syndrome involve multiple modalities.
• Rest: The most common recommendation following a concussion is symptom-limited cognitive and physical rest for at least 24-72 hours. This includes sleep, low levels of light and noise, and limited screen time. Rest is recommended because your brain is vulnerable after an injury.
• Physical therapy: The idea of exercise after a head injury may sound counterintuitive. Indeed, a period of rest is recommended. However, prolonged rest may worsen your symptoms. After a concussion, there may be damage to a part of your nervous system that is not under voluntary control. This is called the autonomic nervous system, a part of which (sympathetic) is involved in the “fight or flight” response during a perceived threat, and also the parasympathetic, which is involved in relaxation after the danger is over. After a concussion, your body may remain in the “fight or flight” mode, leading to an elevation in your heart rate, slowed digestion, and increased anxiety. Exercise stimulates your parasympathetic nervous system.
An article published in The International Journal of Sports Physical Therapy reviewed multiple studies on physical exercise of varying degrees after a head injury. The results of this systematic review indicate there is evidence supporting the use of physical therapy interventions, including aerobic or multi-modal treatments, for patients after a concussion.
• Vestibular therapy: Vestibular rehabilitation therapy involves exercises that help you manage dizziness and balance. Exercises may include eye movement control, balance retraining, stretching, and strengthening your muscles.
A recent study published in Healthcare reported the positive effects of vestibular therapy for patients with traumatic brain injuries. Specifically, the researcher noted decreased reports of dizziness, improved gait, and self-reported improved quality of life.
Cognitive behavioral therapy: CBT is based on the idea that how we think, feel, and act are all closely related and can be helpful for people who have suffered a traumatic brain injury. Many people with TBI struggle with depression or anxiety because of fear of further injury or loss of functioning. Someone with a brain injury might be anxious about situations that present the possibility of another injury occurring. CBT would help identify this fear and develop alternative ways of thinking and coping.
• Medication: A common complaint in those who have experienced a brain injury is memory loss and poor concentration. Many of the patients I see after this type of injury look as if they have attention deficit disorder even though they have no prior history. Short-term use of stimulant medications that are used to treat those who suffer from ADD also works for patients with post-concussion syndrome. These medications can aid in improving daytime energy and can assist with cognitive skills. They work quickly, often within 30 minutes, and do not last more than a few hours, so their effectiveness is predictable and timed to accommodate individual patient’s needs and schedules.
Depression is the most common psychiatric disorder after a TBI, with a prevalence of over 25 percent. A 2022 study published in Cureus found a significant proportion of people who had a mild traumatic brain injury (MTBI) later developed depression or anxiety. The current literature regarding antidepressants for those who have suffered a TBI is mixed. A study published in The Journal of Neuropsychiatry suggests that pharmacological treatment may be mild to moderately effective in treating depression following a TBI. Nevertheless, untreated depression in this population is associated with worse psychosocial functioning, cognition, and reintegration into the community. Some studies of antidepressant treatment after TBI indicate that certain classes of medication are more effective. These are the selective serotonin reuptake inhibitors (SSRIs), with Zoloft and Celexa having the fewest side effects.
As many as 3.8 million concussions occur each year, and almost half of concussions that occur go undetected and untreated. The good news is that most deficits are not permanent, and with appropriate diagnosis and treatment, many can be reversed with a multiple-disciplined approach.
Understanding Post-Concussion Syndrome Up to 30 percent of people with a TBI will develop post-concussion syndrome.
Read more at: https://www.psychologytoday.com/us/blog ... n-syndrome
KEY POINTS
• As many as 3.8 million concussions occur each year.
• Up to 30 percent of people with a TBI will develop post-concussion syndrome.
• Depression is the most common psychiatric disorder after TBI, with a prevalence of over 25 percent.
• Current treatment recommendations for post-concussion syndrome involve multiple modalities.
I spend most of my professional time as a general psychiatrist. However, I also practice forensic psychiatry, the subspecialty of psychiatry that deals with mental health issues and the law. A frequent request from an attorney involves examining a claimant who asserts mental health issues after suffering a concussion. A percentage of these individuals suffer from post-concussion syndrome.
Dr. “A” was injured in a motor vehicle accident when the Lyft she hired was rear-ended. Subsequently, she complained of neck and back pain as well as cognitive disturbances. These included headaches, problems with memory and concentration, and a lack of a “filter,” so she often spoke before thinking, saying hurtful things to her friends, coworkers, and family, all of which is out of character. She has a Ph.D. in one of the natural sciences.
At the time of my evaluation, she was seeing a psychiatrist for medication management due to depression. She described her current mood as “not too bad.” At times, she was very irritable. She had a “complete breakdown” in her sleep cycle following her injury. This resolved when a sleep specialist prescribed medication that allowed her to sleep 6-7 hours per night.
She told me that her memory was “terrible,” and she was having difficulty concentrating. The neuropsychological testing report ordered by her attorney noted “intellectual functioning that remained very strong across both verbal and nonverbal abilities. However, weaknesses noted included ‘difficulty initiating tasks and problems, recalling complex geometric designs not consistent with her level of education."
What Is Post-Concussion Syndrome?
According to the Concussion Legacy Foundation, a concussion is a type of traumatic brain injury, or TBI, caused by an impact on the body resulting in a rapid back-and-forth movement of your brain inside your skull. This sudden movement can stretch and damage brain tissue and trigger a chain of harmful changes that interfere with normal brain activities. Since your brain is your body’s control center, the effects of a concussion can cause disability in all of your brain functions. These may include but are not limited to vision, hearing, balance, memory, a feeling of “fogginess,” mood changes, problems with temperature and blood pressure, and sleep disorders.
For most people, symptoms will clear in a matter of days or weeks, depending on the severity of the injury. However, for 10-30 percent of people, an extended recovery with persistent symptoms will develop a post-concussion syndrome. Headache is the most common and long-lasting symptom. Over 50 percent of individuals experience this symptom even one year after the initial injury. Patients with post-concussion syndrome often describe problems with sleep, memory, concentration, increased irritability, and mood changes. Up to 75 percent of TBI patients suffer from major depressive disorder.
When you have a concussion, your immune system responds to the injury by causing inflammation near the injury site. The affected parts of your brain experience a temporary breakdown of structures in and around those cells. This results in an oxygen deficit your brain typically uses to accomplish a task. Because of neuroplasticity, other parts of your brain attempt to take over. However, this process is less efficient, resulting in the deficits described by sufferers.
Treatment Options
Current treatment recommendations for post-concussion syndrome involve multiple modalities.
• Rest: The most common recommendation following a concussion is symptom-limited cognitive and physical rest for at least 24-72 hours. This includes sleep, low levels of light and noise, and limited screen time. Rest is recommended because your brain is vulnerable after an injury.
• Physical therapy: The idea of exercise after a head injury may sound counterintuitive. Indeed, a period of rest is recommended. However, prolonged rest may worsen your symptoms. After a concussion, there may be damage to a part of your nervous system that is not under voluntary control. This is called the autonomic nervous system, a part of which (sympathetic) is involved in the “fight or flight” response during a perceived threat, and also the parasympathetic, which is involved in relaxation after the danger is over. After a concussion, your body may remain in the “fight or flight” mode, leading to an elevation in your heart rate, slowed digestion, and increased anxiety. Exercise stimulates your parasympathetic nervous system.
An article published in The International Journal of Sports Physical Therapy reviewed multiple studies on physical exercise of varying degrees after a head injury. The results of this systematic review indicate there is evidence supporting the use of physical therapy interventions, including aerobic or multi-modal treatments, for patients after a concussion.
• Vestibular therapy: Vestibular rehabilitation therapy involves exercises that help you manage dizziness and balance. Exercises may include eye movement control, balance retraining, stretching, and strengthening your muscles.
A recent study published in Healthcare reported the positive effects of vestibular therapy for patients with traumatic brain injuries. Specifically, the researcher noted decreased reports of dizziness, improved gait, and self-reported improved quality of life.
Cognitive behavioral therapy: CBT is based on the idea that how we think, feel, and act are all closely related and can be helpful for people who have suffered a traumatic brain injury. Many people with TBI struggle with depression or anxiety because of fear of further injury or loss of functioning. Someone with a brain injury might be anxious about situations that present the possibility of another injury occurring. CBT would help identify this fear and develop alternative ways of thinking and coping.
• Medication: A common complaint in those who have experienced a brain injury is memory loss and poor concentration. Many of the patients I see after this type of injury look as if they have attention deficit disorder even though they have no prior history. Short-term use of stimulant medications that are used to treat those who suffer from ADD also works for patients with post-concussion syndrome. These medications can aid in improving daytime energy and can assist with cognitive skills. They work quickly, often within 30 minutes, and do not last more than a few hours, so their effectiveness is predictable and timed to accommodate individual patient’s needs and schedules.
Depression is the most common psychiatric disorder after a TBI, with a prevalence of over 25 percent. A 2022 study published in Cureus found a significant proportion of people who had a mild traumatic brain injury (MTBI) later developed depression or anxiety. The current literature regarding antidepressants for those who have suffered a TBI is mixed. A study published in The Journal of Neuropsychiatry suggests that pharmacological treatment may be mild to moderately effective in treating depression following a TBI. Nevertheless, untreated depression in this population is associated with worse psychosocial functioning, cognition, and reintegration into the community. Some studies of antidepressant treatment after TBI indicate that certain classes of medication are more effective. These are the selective serotonin reuptake inhibitors (SSRIs), with Zoloft and Celexa having the fewest side effects.
As many as 3.8 million concussions occur each year, and almost half of concussions that occur go undetected and untreated. The good news is that most deficits are not permanent, and with appropriate diagnosis and treatment, many can be reversed with a multiple-disciplined approach.
Understanding Post-Concussion Syndrome Up to 30 percent of people with a TBI will develop post-concussion syndrome.
Read more at: https://www.psychologytoday.com/us/blog ... n-syndrome
-
greybeard58
- Posts: 2512
- Joined: Sat Aug 21, 2004 11:40 pm
A Parent's Guide to Concussions
A Parent's Guide to Concussions
We’re a national leader in the care and management of concussions.
Nationwide Children’s Hospital Sports Medicine wants you to be aware of concussions and how to keep your young athlete safe. Safety begins by educating yourself!
Concussion Identification:
What is a concussion?
A concussion may be caused by a blow, bump, or jolt to the head or by any fall or hit that jars the brain. This “invisible” injury disrupts the brain’s normal physiology which can affect mental stamina and function, causing the brain to work longer and harder to complete even simple tasks. A concussion may involve loss of consciousness (being “knocked out”), but the majority does not. Ultimately, ALL concussions are serious because they are brain injuries!
How do I tell if my child has sustained a concussion?
A concussion can affect a child in many different ways: physically, cognitively, emotionally, and by disturbing sleep. The table below indicates common symptoms for each category.
Common Concussion Symptoms
Physical Cognitive Emotional Sleep
Headache Feeling mentally foggy Irritability Trouble falling asleep
Dizziness Feeling slowed down Sadness Sleeping more than usual
Balance problems Difficulty concentrating Nervousness Sleeping less than usual
Nausea/Vomiting Difficulty remembering More emotional than usual
Fatigue Difficulty focusing
Sensitivity to light
Sensitivity to noise
While a blow to the head may not seem serious immediately, concussion symptoms can develop upon impact or up to 48 hours after the incident. Ignoring any signs or symptoms of a concussion is putting the child’s long- and short-term health at risk.
Underreporting of concussions: The importance of honesty.
Even though concussions are very serious and potentially life threatening to the young athlete, studies show that less than 50% of high school athletes will report their concussions. Even after being diagnosed, many athletes feel pressured to say they do not have symptoms when they still do. This is dangerous and should always be avoided. Almost all athletes who have died or suffered serious complications from repeated concussions did not report their continued concussion symptoms to their parents, athletic trainer, or doctor. Therefore, it is vitally important that parents, coaches, and athletes recognize the signs and symptoms of concussions and encourage honesty in reporting them.
Is it dangerous for my child to play sports with a concussion?
Yes, without question. Second impact syndrome is a catastrophic event that can occur when a second blow to the head happens before an athlete has completely recovered from a concussion. This second impact, which may be even a minor blow, causes brain swelling, resulting in severe consequences such as brain damage, paralysis, and even death. This condition occurs only in youth and adolescents up to age 21. Therefore, no child should be allowed to participate in any physical activity if he or she has sustained a possible concussion. In addition, no child should return to participation after sustaining a concussion before he or she is cleared by a qualified medical professional.
Concussion Management:
If my child sustains a concussion, what should I do?
First, the child should be monitored for worsening signs and symptoms in the 24 to 48 hours following the injury. If any of the following danger signs present themselves, the child should be evaluated by a physician immediately.
• Severe or increased headache
• Double vision
• Unequal pupils
• Convulsions
• Unusual/increased drowsiness
• Bleeding/clear fluid from the ear/nose
• Projectile or repeated vomiting
• Unusual stiffness in the neck area
• Severe personality changes
• Weakness in either arm(s) or leg(s)
• Numbness in the face/extremities
Second, follow these recommendations:
• Do not let the child perform any strenuous activity or go back to playing in sports.
• Do not use aspirin or ibuprofen for headaches for the first 48 hours. Use acetaminophen (Tylenol) only.
• Encourage your child to rest and eat a light diet.
• Allow them to use ice packs on the head and/or neck to ease pain.
• Let them sleep in a cool, dark, quiet room.
Third, arrange for your child to be evaluated by a medical professional qualified and educated in concussion evaluation and management, such as an athletic trainer or sports medicine physician. Knowledge about concussions is rapidly evolving. The previous severity scales, such as a grade 1 or grade 3 concussion are no longer used. Preventing your child from going to sleep or to wake him or her every hour after a concussion is also an outdated practice. Don’t be afraid to ask the healthcare provider if he or she is aware of the up-to-date concussion protocols.
Concussion Recovery:
Concussion recovery should be a collaborative approach
A concussion can affect school, work, and sports. Along with coaches and teachers, the child’s school nurse, athletic trainer, employer, and other school administrators, such as a guidance counselor, should be aware of the child’s injury and their roles in helping the child recover. Varying or mixed messages from any of these parties may cause the child unnecessary distress and confusion, so clear communication among the group is vital.
Why is mental rest important to recovery?
A concussion affects how the brain works, so resting the brain as much as possible is necessary for recovery. In this context, mental activities are defined as those in which the brain must work hard to process information. This includes critical thinking and problem solving activities such as schoolwork, homework, and technology use.
What can I do to help my child achieve mental rest?
Consider restricting or limiting the following activities as they can increase brain function, worsen symptoms & delay healing:
• Computer work/Internet use
• Video games
• Television
• Text messaging/cell phone use
• Bright lights, such as strobe lights at school dances
• Listening to loud music or music through headphones
• Loud noises
• Parties, concerts, pep rallies, etc.
• Driving
• Work
How do I know when my child is using his or her brain too much?
Continued activity when symptoms are moderate to severe can prevent the brain from healing. Therefore, the key to concussion recovery is to reduce mental activities until symptoms improve and then gradually begin increasing the length and difficulty of those activities as symptoms allow.
On days where the symptoms are severe (which often occur in the first few days after injury), it may be better to suspend any scheduled mental activities (i.e. school, work, homework, etc.) and have the child rest at home.
As symptoms improve, the child may begin to gradually resume simple school-related mental activities. As difficulty is increased, continue monitoring symptoms. Ask, “Do you have any symptoms? Are your symptoms getting worse since you started this activity?” If the child states symptoms are worsening, have him or her stop what they are doing and rest. If the symptoms resolve with rest in a short period of time (20 minutes or less), the child may be allowed
to resume the mental activity. If symptoms remain elevated, the child should discontinue the activity and rest and
re-attempt when symptoms have improved (such as the next day).
Note that there may be good days when symptoms are very mild and bad days when symptoms may be a little worse. This is a normal part of recovery. Sometimes there is a fine line between how much mental activity is okay and how much is too much. The key is to try to figure out where that line is to minimize symptoms as much as possible.
How is school affected by a concussion?
Schoolwork demands focus, memory, and concentration – all brain processes that are affected by a concussion. Academic accommodations, ranging from medically necessary absences to tutoring or extra time for test taking, may be necessary in some cases to decrease symptoms and begin the healing process.
Notify your child’s teachers that he or she has sustained a concussion and provide them with any written recommendations you were given during your visit to your healthcare professional. Nationwide Children’s Hospital Sports Medicine has a document specifically for teachers, called An Educator’s Guide to Concussions in the Classroom which highlights academic accommodations for students healing from concussion.
Why is physical rest important to recovery?
In the context of concussions, physical activity is any situation in which a child has an elevated heart rate. Such activities include, but are not limited to, sports, gym class, weight lifting, and active play. Due to the risk of Second Impact Syndrome and other complications, a child who has been diagnosed with a concussion should not return to any physical activity and/or athletics until cleared by a healthcare provider experienced in concussion evaluation and management. Physical rest is essential to keep the child safe and to enable the brain to heal.
When can a child who has sustained a concussion safely go back to participating in gym class and/or sports?
A child who has sustained a concussion should not return to physical activity until cleared by an appropriate healthcare provider. The child should be completely symptom free and participating in school fully. Once cleared, the child should participate in a gradual progression back to activity. Ideally, a certified athletic trainer should supervise the child during this timeframe. This gradual progression is critical because a return of any signs or symptoms of concussion during mild physical activity signals that the brain has not healed and the child is not ready to return to activity.
Graduated Return to Sport (RTS) Strategy
Stage Aim Activity Goal of each stage
Stage 1 Symptom-limited activity Daily activities that do not provoke symptoms. Gradual reintroduction to work/school activities
Stage 2 Light aerobic activity Walking or stationary bike at slow to medium pace. No resistance training. Increase heart rate
Stage 3 Sport-specific exercise Running or skating drills. No head impact activities. Add movement
Stage 4 Non-contact training drills Harder training drills, eg. passing drills. May start progressive resistive training. Exercise, coordination and increased thinking
Stage 5 Full contact practice Following medical clearance, participate in normal training activities. Return confidence and assess functional skills by coaching staff
Stage 6 Return to sport Normal game play. How can I keep my child from getting a concussion?
There are a few things you can do to decrease your child’s chances of getting a concussion.
• Ensure your child’s equipment fits properly and is checked and maintained regularly.
• Encourage your child to follow the rules of your sport and practice good sportsmanship.
• Encourage your child to listen to your coaches and practice good technique.
If recognized and treated properly, most children will recover fully from a single concussion. However, children who sustain multiple concussions during an early sports career tend to take longer to recover after each concussion and are more likely to experience prolonged post-concussion symptoms or cognitive impairment. Therefore, make sure your child is getting the best care and management possible for his or her concussion.
How can I share this resource with others?
Nationwide Children’s Hospital Sports Medicine provides an in-service on this topic free of charge. The length of the presentation and content can be tailored to fit the specific needs of the group. Please call (614) 355-6000 for more information.
What if I want to learn more?
We provide further educational resources, presentations, and print materials on concussion management and other sports-related injuries and fitness well-being. Visit www.NationwideChildrens.org/Sports-Medicine or call (614) 355-6000.
The concussion clinic at Nationwide Children’s Hospital utilizes the expertise of Pediatric Sports Medicine specialists and Physical Medicine and Rehabilitation specialists, along with neurologists, neurosurgeons, radiologists, neuropsychologists, physical therapists, and athletic trainers to best manage pediatric concussions.
Nationwide Children’s Hospital Sports Medicine also offers baseline neurocognitive (concussion) testing to evaluate a healthy athlete’s decision making ability, reaction time, attention and memory.
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention provides informational materials about concussions for athletes, parents, coaches, and teachers, including a free Heads Up! tool kit. Visit CDC.gov.
© Copyrighted by Nationwide Children’s Hospital. All rights reserved. Any use or reproduction of these materials without the express written consent of Nationwide Children’s Hospital is prohibited.
Download A Parent's Guide to Concussions
Click here
https://www.nationwidechildrens.org/spe ... oncussions
We’re a national leader in the care and management of concussions.
Nationwide Children’s Hospital Sports Medicine wants you to be aware of concussions and how to keep your young athlete safe. Safety begins by educating yourself!
Concussion Identification:
What is a concussion?
A concussion may be caused by a blow, bump, or jolt to the head or by any fall or hit that jars the brain. This “invisible” injury disrupts the brain’s normal physiology which can affect mental stamina and function, causing the brain to work longer and harder to complete even simple tasks. A concussion may involve loss of consciousness (being “knocked out”), but the majority does not. Ultimately, ALL concussions are serious because they are brain injuries!
How do I tell if my child has sustained a concussion?
A concussion can affect a child in many different ways: physically, cognitively, emotionally, and by disturbing sleep. The table below indicates common symptoms for each category.
Common Concussion Symptoms
Physical Cognitive Emotional Sleep
Headache Feeling mentally foggy Irritability Trouble falling asleep
Dizziness Feeling slowed down Sadness Sleeping more than usual
Balance problems Difficulty concentrating Nervousness Sleeping less than usual
Nausea/Vomiting Difficulty remembering More emotional than usual
Fatigue Difficulty focusing
Sensitivity to light
Sensitivity to noise
While a blow to the head may not seem serious immediately, concussion symptoms can develop upon impact or up to 48 hours after the incident. Ignoring any signs or symptoms of a concussion is putting the child’s long- and short-term health at risk.
Underreporting of concussions: The importance of honesty.
Even though concussions are very serious and potentially life threatening to the young athlete, studies show that less than 50% of high school athletes will report their concussions. Even after being diagnosed, many athletes feel pressured to say they do not have symptoms when they still do. This is dangerous and should always be avoided. Almost all athletes who have died or suffered serious complications from repeated concussions did not report their continued concussion symptoms to their parents, athletic trainer, or doctor. Therefore, it is vitally important that parents, coaches, and athletes recognize the signs and symptoms of concussions and encourage honesty in reporting them.
Is it dangerous for my child to play sports with a concussion?
Yes, without question. Second impact syndrome is a catastrophic event that can occur when a second blow to the head happens before an athlete has completely recovered from a concussion. This second impact, which may be even a minor blow, causes brain swelling, resulting in severe consequences such as brain damage, paralysis, and even death. This condition occurs only in youth and adolescents up to age 21. Therefore, no child should be allowed to participate in any physical activity if he or she has sustained a possible concussion. In addition, no child should return to participation after sustaining a concussion before he or she is cleared by a qualified medical professional.
Concussion Management:
If my child sustains a concussion, what should I do?
First, the child should be monitored for worsening signs and symptoms in the 24 to 48 hours following the injury. If any of the following danger signs present themselves, the child should be evaluated by a physician immediately.
• Severe or increased headache
• Double vision
• Unequal pupils
• Convulsions
• Unusual/increased drowsiness
• Bleeding/clear fluid from the ear/nose
• Projectile or repeated vomiting
• Unusual stiffness in the neck area
• Severe personality changes
• Weakness in either arm(s) or leg(s)
• Numbness in the face/extremities
Second, follow these recommendations:
• Do not let the child perform any strenuous activity or go back to playing in sports.
• Do not use aspirin or ibuprofen for headaches for the first 48 hours. Use acetaminophen (Tylenol) only.
• Encourage your child to rest and eat a light diet.
• Allow them to use ice packs on the head and/or neck to ease pain.
• Let them sleep in a cool, dark, quiet room.
Third, arrange for your child to be evaluated by a medical professional qualified and educated in concussion evaluation and management, such as an athletic trainer or sports medicine physician. Knowledge about concussions is rapidly evolving. The previous severity scales, such as a grade 1 or grade 3 concussion are no longer used. Preventing your child from going to sleep or to wake him or her every hour after a concussion is also an outdated practice. Don’t be afraid to ask the healthcare provider if he or she is aware of the up-to-date concussion protocols.
Concussion Recovery:
Concussion recovery should be a collaborative approach
A concussion can affect school, work, and sports. Along with coaches and teachers, the child’s school nurse, athletic trainer, employer, and other school administrators, such as a guidance counselor, should be aware of the child’s injury and their roles in helping the child recover. Varying or mixed messages from any of these parties may cause the child unnecessary distress and confusion, so clear communication among the group is vital.
Why is mental rest important to recovery?
A concussion affects how the brain works, so resting the brain as much as possible is necessary for recovery. In this context, mental activities are defined as those in which the brain must work hard to process information. This includes critical thinking and problem solving activities such as schoolwork, homework, and technology use.
What can I do to help my child achieve mental rest?
Consider restricting or limiting the following activities as they can increase brain function, worsen symptoms & delay healing:
• Computer work/Internet use
• Video games
• Television
• Text messaging/cell phone use
• Bright lights, such as strobe lights at school dances
• Listening to loud music or music through headphones
• Loud noises
• Parties, concerts, pep rallies, etc.
• Driving
• Work
How do I know when my child is using his or her brain too much?
Continued activity when symptoms are moderate to severe can prevent the brain from healing. Therefore, the key to concussion recovery is to reduce mental activities until symptoms improve and then gradually begin increasing the length and difficulty of those activities as symptoms allow.
On days where the symptoms are severe (which often occur in the first few days after injury), it may be better to suspend any scheduled mental activities (i.e. school, work, homework, etc.) and have the child rest at home.
As symptoms improve, the child may begin to gradually resume simple school-related mental activities. As difficulty is increased, continue monitoring symptoms. Ask, “Do you have any symptoms? Are your symptoms getting worse since you started this activity?” If the child states symptoms are worsening, have him or her stop what they are doing and rest. If the symptoms resolve with rest in a short period of time (20 minutes or less), the child may be allowed
to resume the mental activity. If symptoms remain elevated, the child should discontinue the activity and rest and
re-attempt when symptoms have improved (such as the next day).
Note that there may be good days when symptoms are very mild and bad days when symptoms may be a little worse. This is a normal part of recovery. Sometimes there is a fine line between how much mental activity is okay and how much is too much. The key is to try to figure out where that line is to minimize symptoms as much as possible.
How is school affected by a concussion?
Schoolwork demands focus, memory, and concentration – all brain processes that are affected by a concussion. Academic accommodations, ranging from medically necessary absences to tutoring or extra time for test taking, may be necessary in some cases to decrease symptoms and begin the healing process.
Notify your child’s teachers that he or she has sustained a concussion and provide them with any written recommendations you were given during your visit to your healthcare professional. Nationwide Children’s Hospital Sports Medicine has a document specifically for teachers, called An Educator’s Guide to Concussions in the Classroom which highlights academic accommodations for students healing from concussion.
Why is physical rest important to recovery?
In the context of concussions, physical activity is any situation in which a child has an elevated heart rate. Such activities include, but are not limited to, sports, gym class, weight lifting, and active play. Due to the risk of Second Impact Syndrome and other complications, a child who has been diagnosed with a concussion should not return to any physical activity and/or athletics until cleared by a healthcare provider experienced in concussion evaluation and management. Physical rest is essential to keep the child safe and to enable the brain to heal.
When can a child who has sustained a concussion safely go back to participating in gym class and/or sports?
A child who has sustained a concussion should not return to physical activity until cleared by an appropriate healthcare provider. The child should be completely symptom free and participating in school fully. Once cleared, the child should participate in a gradual progression back to activity. Ideally, a certified athletic trainer should supervise the child during this timeframe. This gradual progression is critical because a return of any signs or symptoms of concussion during mild physical activity signals that the brain has not healed and the child is not ready to return to activity.
Graduated Return to Sport (RTS) Strategy
Stage Aim Activity Goal of each stage
Stage 1 Symptom-limited activity Daily activities that do not provoke symptoms. Gradual reintroduction to work/school activities
Stage 2 Light aerobic activity Walking or stationary bike at slow to medium pace. No resistance training. Increase heart rate
Stage 3 Sport-specific exercise Running or skating drills. No head impact activities. Add movement
Stage 4 Non-contact training drills Harder training drills, eg. passing drills. May start progressive resistive training. Exercise, coordination and increased thinking
Stage 5 Full contact practice Following medical clearance, participate in normal training activities. Return confidence and assess functional skills by coaching staff
Stage 6 Return to sport Normal game play. How can I keep my child from getting a concussion?
There are a few things you can do to decrease your child’s chances of getting a concussion.
• Ensure your child’s equipment fits properly and is checked and maintained regularly.
• Encourage your child to follow the rules of your sport and practice good sportsmanship.
• Encourage your child to listen to your coaches and practice good technique.
If recognized and treated properly, most children will recover fully from a single concussion. However, children who sustain multiple concussions during an early sports career tend to take longer to recover after each concussion and are more likely to experience prolonged post-concussion symptoms or cognitive impairment. Therefore, make sure your child is getting the best care and management possible for his or her concussion.
How can I share this resource with others?
Nationwide Children’s Hospital Sports Medicine provides an in-service on this topic free of charge. The length of the presentation and content can be tailored to fit the specific needs of the group. Please call (614) 355-6000 for more information.
What if I want to learn more?
We provide further educational resources, presentations, and print materials on concussion management and other sports-related injuries and fitness well-being. Visit www.NationwideChildrens.org/Sports-Medicine or call (614) 355-6000.
The concussion clinic at Nationwide Children’s Hospital utilizes the expertise of Pediatric Sports Medicine specialists and Physical Medicine and Rehabilitation specialists, along with neurologists, neurosurgeons, radiologists, neuropsychologists, physical therapists, and athletic trainers to best manage pediatric concussions.
Nationwide Children’s Hospital Sports Medicine also offers baseline neurocognitive (concussion) testing to evaluate a healthy athlete’s decision making ability, reaction time, attention and memory.
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention provides informational materials about concussions for athletes, parents, coaches, and teachers, including a free Heads Up! tool kit. Visit CDC.gov.
© Copyrighted by Nationwide Children’s Hospital. All rights reserved. Any use or reproduction of these materials without the express written consent of Nationwide Children’s Hospital is prohibited.
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greybeard58
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Not Just For Athletes and Accidents — 7 Surprising Facts About Concussions
Not Just For Athletes and Accidents — 7 Surprising Facts About Concussions
November 22, 2023
A concussion is something that results in a (hopefully temporary) loss of brain function. And it doesn’t just happen to football players or someone involved in a car accident. Concussions can occur whenever the brain moves around within the skull, often due to a direct impact to your head or by experiencing whiplash (a back-and-forth motion).
Anyone can get a concussion or mild traumatic brain injury (TBI) any time. Falling is the most common culprit. Miss a step, trip on your kid’s sneaker or slip on some ice and you could find yourself nursing a concussion.
Komal Ashraf, DO
To help us get our concussion facts straight, we spoke with MU Health Care neurologist, Dr. Komal Ashraf. She shared some surprising insights about concussions:
Concussions are tricky because the symptoms are unique to every person and situation.
“Concussion symptoms vary depending on the person’s age, medical history, current health and a host of other reasons,” Dr. Ashraf says. “Even the same symptoms can be different in intensity and timing.”
Most concussion symptoms fit into five categories:
1. Headaches and neck pain, including symptoms associated with that pain, such as nausea and sensitivity to light and sound.
2. Motor skills, including issues with gross motor skills (balance and spatial awareness), fine motor skills (hand-eye coordination) or vestibular-ocular motor skills (eye movement).
3. Mental health, with symptoms that impact judgment, cause anxiety and affect emotional control.
4. Cognition, affecting your ability to focus, multitask, make decisions, retain information and recall memories.
5. Sleep, causing excessive sleepiness during the acute stage of concussion and later causing insomnia and fatigue.
“After a concussion, we might see any of these symptoms,” Dr. Ashraf says. “And they may show up as entirely new symptoms or worsen existing issues.”
2. Objective Tools Can Help With Concussion Diagnosis
There are no quick and easy, reliable and readily accessible tests used to definitively diagnose a concussion. But some tools provide an objective score based on subjective information, Dr. Ashraf says.
Those tools include:
• Grading scales: These assessments provide a standardized measure of perceived symptoms. They can help measure sleep, ocular (eye) motor skills, nervous system function and gross motor skills. Your doctor can combine those scores with their own observations and evaluation of your condition to help diagnose a concussion and monitor your symptoms as you heal.
• Imaging and electrical studies: CT scans and MRI imaging may provide more information about a brain injury if your symptoms aren’t improving. If you struggle with memory loss, zoning out or experience twitching after a concussion, your doctor may order an EEG (electroencephalogram), which can uncover brainwave abnormalities.
• Thorough evaluations: A variety of exams performed by experts in physical, occupational and speech therapies.
3. Having One Concussion Makes You More Likely to Have Another One Soon After
Concussion symptoms that affect your judgment and motor skills can put you in harm’s way and increase your risk of another concussion. When you suffer a second brain injury and haven’t fully recovered from the first, the symptoms compound and make it harder to heal fully.
Dr. Ashraf explains that having one concussion triples your risk of having another. After a second concussion, you are eight times more likely to have a third.
“It’s so important to get the help you need to heal after a concussion,” Dr. Ashraf says. “If you return to your usual lifestyle without an evaluation or intervention, you could have a second injury. Then it becomes more difficult to recover.”
4. Concussions Can Have a Significant Impact on Mental Health
Concussions commonly affect the frontal lobe — the part of the brain that houses your emotions and judgment. As a result, many people experience pseudobulbar affect (PBA), which involves inappropriate and unexplained surges in emotions that may include:
• Angry outbursts
• Crying spells
• Excessive sadness
• Laughing out of nowhere
These symptoms and sleep issues related to your concussion can cause feelings of isolation, depression and anxiety.
“Concussions have a big impact on mental health that people are often surprised about,” Dr. Ashraf says. “But as long as we identify mental health issues as they arise, we can treat them with medication and other interventions.”
5. Concussions Can Cause Long-Lasting Sleep Issues
Sleep affects all aspects of how we function. So, when a concussion affects your sleep, it makes an impact.
“Inability to sleep well is the number one thing that continues to rear its head after a concussion,” Dr. Ashraf says. “People may have healed in all other ways, but we know that 80% of people who have a concussion end up with some degree of chronic sleep abnormality.”
A concussion affects your sleep acutely (immediately) and chronically (long-term). During the acute stages, you may feel sleepy, like you can’t keep your eyes open. But over time, the issue becomes insomnia — trouble falling asleep and staying asleep. While these sleep issues are new for some people, people with existing sleep issues may find their condition is worse after a concussion.
“When there are baseline sleep issues, it’s easy to miss the connection with a concussion,” Dr. Ashraf says. “But not addressing the escalation of sleep issues after a concussion can be problematic long-term.”
6. “Use It or Lose It” Is the Best Approach to Treating Concussion
You no longer have to rest in a dark, quiet room for weeks to heal a concussion. Quiet rest is still helpful, but experts only recommend it for 24 to 72 hours following a concussion. After that, it’s time to return to physical and cognitive activity — slowly and safely.
“Instead of sitting it out, or what we previously called ‘cocooning,’ we want you to take an approach that is intentional, supervised and monitored,” Dr. Ashraf says. “Staying away from all mental and physical activity makes things worse. Don’t go from zero to 100. Just do a little bit at a time and make modifications and accommodations based on your symptoms.”
7. The Right Care and Treatment Can Help You Heal Faster
Concussions are reversible. A multidisciplinary approach is often the best way to identify and implement the best treatment.
“About 50% of concussions can fully heal within six months,” Dr. Ashraf says. “But you’ll heal sooner with multidisciplinary intervention and take much longer without it.”
Interventions used to help heal a concussion include:
• Physical, occupational or speech therapy: When a concussion impacts your motor skills, you may be more likely to get injured or experience mental health issues. Therapeutic intervention provides exercises that strengthen your motor skills. Language and cognition deficits or changes experienced after a concussion can be improved with speech therapy, while occupational therapy can help a person in job- or lifestyle-specific activities that are impacted after a concussion.
• Medication: Temporary use of drugs to improve headache, mental health and sleep can help you get back to baseline so your brain can heal more efficiently.
The goal is to strengthen areas around the injury to help the injury heal. “If someone has a knee injury, you use therapy to strengthen the areas around the knee so the injured part can heal,” Dr. Ashraf says. “These therapeutic approaches help heal brain injuries the same way.”
________________________________________
Next Steps and Useful Resources
• Learn more about concussion care.
• Have you experienced a concussion during a sports event? Learn about our Sports Medicine Injury Clinic.
https://livehealthy.muhealth.org/storie ... oncussions
November 22, 2023
A concussion is something that results in a (hopefully temporary) loss of brain function. And it doesn’t just happen to football players or someone involved in a car accident. Concussions can occur whenever the brain moves around within the skull, often due to a direct impact to your head or by experiencing whiplash (a back-and-forth motion).
Anyone can get a concussion or mild traumatic brain injury (TBI) any time. Falling is the most common culprit. Miss a step, trip on your kid’s sneaker or slip on some ice and you could find yourself nursing a concussion.
Komal Ashraf, DO
To help us get our concussion facts straight, we spoke with MU Health Care neurologist, Dr. Komal Ashraf. She shared some surprising insights about concussions:
Concussions are tricky because the symptoms are unique to every person and situation.
“Concussion symptoms vary depending on the person’s age, medical history, current health and a host of other reasons,” Dr. Ashraf says. “Even the same symptoms can be different in intensity and timing.”
Most concussion symptoms fit into five categories:
1. Headaches and neck pain, including symptoms associated with that pain, such as nausea and sensitivity to light and sound.
2. Motor skills, including issues with gross motor skills (balance and spatial awareness), fine motor skills (hand-eye coordination) or vestibular-ocular motor skills (eye movement).
3. Mental health, with symptoms that impact judgment, cause anxiety and affect emotional control.
4. Cognition, affecting your ability to focus, multitask, make decisions, retain information and recall memories.
5. Sleep, causing excessive sleepiness during the acute stage of concussion and later causing insomnia and fatigue.
“After a concussion, we might see any of these symptoms,” Dr. Ashraf says. “And they may show up as entirely new symptoms or worsen existing issues.”
2. Objective Tools Can Help With Concussion Diagnosis
There are no quick and easy, reliable and readily accessible tests used to definitively diagnose a concussion. But some tools provide an objective score based on subjective information, Dr. Ashraf says.
Those tools include:
• Grading scales: These assessments provide a standardized measure of perceived symptoms. They can help measure sleep, ocular (eye) motor skills, nervous system function and gross motor skills. Your doctor can combine those scores with their own observations and evaluation of your condition to help diagnose a concussion and monitor your symptoms as you heal.
• Imaging and electrical studies: CT scans and MRI imaging may provide more information about a brain injury if your symptoms aren’t improving. If you struggle with memory loss, zoning out or experience twitching after a concussion, your doctor may order an EEG (electroencephalogram), which can uncover brainwave abnormalities.
• Thorough evaluations: A variety of exams performed by experts in physical, occupational and speech therapies.
3. Having One Concussion Makes You More Likely to Have Another One Soon After
Concussion symptoms that affect your judgment and motor skills can put you in harm’s way and increase your risk of another concussion. When you suffer a second brain injury and haven’t fully recovered from the first, the symptoms compound and make it harder to heal fully.
Dr. Ashraf explains that having one concussion triples your risk of having another. After a second concussion, you are eight times more likely to have a third.
“It’s so important to get the help you need to heal after a concussion,” Dr. Ashraf says. “If you return to your usual lifestyle without an evaluation or intervention, you could have a second injury. Then it becomes more difficult to recover.”
4. Concussions Can Have a Significant Impact on Mental Health
Concussions commonly affect the frontal lobe — the part of the brain that houses your emotions and judgment. As a result, many people experience pseudobulbar affect (PBA), which involves inappropriate and unexplained surges in emotions that may include:
• Angry outbursts
• Crying spells
• Excessive sadness
• Laughing out of nowhere
These symptoms and sleep issues related to your concussion can cause feelings of isolation, depression and anxiety.
“Concussions have a big impact on mental health that people are often surprised about,” Dr. Ashraf says. “But as long as we identify mental health issues as they arise, we can treat them with medication and other interventions.”
5. Concussions Can Cause Long-Lasting Sleep Issues
Sleep affects all aspects of how we function. So, when a concussion affects your sleep, it makes an impact.
“Inability to sleep well is the number one thing that continues to rear its head after a concussion,” Dr. Ashraf says. “People may have healed in all other ways, but we know that 80% of people who have a concussion end up with some degree of chronic sleep abnormality.”
A concussion affects your sleep acutely (immediately) and chronically (long-term). During the acute stages, you may feel sleepy, like you can’t keep your eyes open. But over time, the issue becomes insomnia — trouble falling asleep and staying asleep. While these sleep issues are new for some people, people with existing sleep issues may find their condition is worse after a concussion.
“When there are baseline sleep issues, it’s easy to miss the connection with a concussion,” Dr. Ashraf says. “But not addressing the escalation of sleep issues after a concussion can be problematic long-term.”
6. “Use It or Lose It” Is the Best Approach to Treating Concussion
You no longer have to rest in a dark, quiet room for weeks to heal a concussion. Quiet rest is still helpful, but experts only recommend it for 24 to 72 hours following a concussion. After that, it’s time to return to physical and cognitive activity — slowly and safely.
“Instead of sitting it out, or what we previously called ‘cocooning,’ we want you to take an approach that is intentional, supervised and monitored,” Dr. Ashraf says. “Staying away from all mental and physical activity makes things worse. Don’t go from zero to 100. Just do a little bit at a time and make modifications and accommodations based on your symptoms.”
7. The Right Care and Treatment Can Help You Heal Faster
Concussions are reversible. A multidisciplinary approach is often the best way to identify and implement the best treatment.
“About 50% of concussions can fully heal within six months,” Dr. Ashraf says. “But you’ll heal sooner with multidisciplinary intervention and take much longer without it.”
Interventions used to help heal a concussion include:
• Physical, occupational or speech therapy: When a concussion impacts your motor skills, you may be more likely to get injured or experience mental health issues. Therapeutic intervention provides exercises that strengthen your motor skills. Language and cognition deficits or changes experienced after a concussion can be improved with speech therapy, while occupational therapy can help a person in job- or lifestyle-specific activities that are impacted after a concussion.
• Medication: Temporary use of drugs to improve headache, mental health and sleep can help you get back to baseline so your brain can heal more efficiently.
The goal is to strengthen areas around the injury to help the injury heal. “If someone has a knee injury, you use therapy to strengthen the areas around the knee so the injured part can heal,” Dr. Ashraf says. “These therapeutic approaches help heal brain injuries the same way.”
________________________________________
Next Steps and Useful Resources
• Learn more about concussion care.
• Have you experienced a concussion during a sports event? Learn about our Sports Medicine Injury Clinic.
https://livehealthy.muhealth.org/storie ... oncussions
-
greybeard58
- Posts: 2512
- Joined: Sat Aug 21, 2004 11:40 pm
“I was left behind once, and it was awful..."
“I was left behind once, and it was awful..."
The women of the Ice Fernz are not to be trifled with on or off the ice.
Take Bella Vogel as a perfect example. She walked through knee-deep floodwater and mud, lugging her brand new ice hockey gear, to join the New Zealand team who flew out of Auckland to Cape Town on Tuesday night.
A late call-up to the team travelling to next week’s world ice hockey championships, Vogel was trapped at Bethells Beach during the peak of Cyclone Gabrielle’s fury. With the help of her dad and a fire fighter, she walked several kilometers to get to safety.
“It just goes to show the resolve of these women,” Ice Fernz coach Jeff Boehme says.
Their day jobs reaffirm that.
Dr Helen Murray, the former captain of the Ice Fernz, is a highly-regarded neuroanatomist who studies a form of dementia associated with repeated head injuries.
The Ice Fernz new captain, Jaime Jones, is on the path to becoming an apprentice electrician.
Defender turned attacker Rikki-Lee McLean is a full-time firefighter, who helped with the clean-up after Auckland’s atrocious flooding.
Anjali Mulari is a Hamilton policewoman, specializing in fingerprint analysis. Already an eight-time world championship veteran, she’s just returned to the ice after having two children.
And Rebecca Lilly, from Gore, now lives in Austria playing in the European Women’s Hockey League.
There’s also a nurse and a fitness guru among the team bound for the IIHF division II group B world championships
Boehme says they’re quite an eclectic bunch, which is “definitely a good thing”.
“As amateurs, where they don’t get paid to play, they always bring so much passion with them,” the French-born coach says.
“Some of them from a financial point of view have put hockey first in their lives. We have a few veterans who say they’d have a house deposit by now if they weren’t playing.
“And all coming from very different careers, they have a lot of respect for each other. So they know what it takes to play for their country. They’re a pretty amazing group of women.”
It’s been three years since the Ice Fernz last played in international competition; in a pandemic-interrupted world, New Zealand Ice Hockey decided to withdraw the team from the world championships in 2021 and 2022.
Captain Jones was forced to miss the world championships in Iceland early in 2020, with a bad concussion. “I was left behind once, and it was awful, so I’ll never get left behind again,” she says.
The 24-year-old grew up in west Auckland and went with her family to the local ice skating rink every school holidays.
“A coach recognized my brother’s good skating technique and encouraged him to give hockey a go. I tagged along and fell in love with it instantly,” she says.
Her two brothers – and even her mum – started playing. Now her brothers also play for New Zealand.
But Jones wore the black jersey first, playing for the Ice Fernz when she was just 15.
She finished her high school years in Canada on a scholarship to the Ontario Hockey Academy. “The idea was to be exposed to top hockey and eventually play in a college team in Canada or the US,” Jones says.
“But when it came to the end of my high school career I didn’t know what I wanted to study, and I missed home so much, I came back. I realised the best place for me to play my hockey was in New Zealand.”
Jones worked as a sports co-ordinator at her old school, Massey High, and returned to playing in the Auckland and national leagues.
But after the lockdowns, she had a momentous change in career. A “very practical person”, Jones started working as a roofer with her dad, then discovered an interest in electrical engineering. She now works as an electrical trade assistant, and will soon start an apprenticeship to become an electrician.
She’s had another change of role this year becoming captain of the Ice Fernz.
“I guess I’ve been playing for a long time and I’m well respected across all the leagues I play in,” she says. “I love the fact Helen is right there by my side getting me through this transition.”
Boehme agrees. “Jaime is highly regarded by her teams and coaching staff. She has a great personality, she’s humble and very competitive,” he says.
“It was time to hand the baton on to someone else. And we saw Helen could help Jaime find her feet as captain.”
Rikki-Lee McLean often finds herself going straight from an ice hockey match and into a night shift at the fire station of the Auckland Airport Emergency Service.
“I sometimes miss a training because I’m on a shift or I get lucky and it’s a morning training and I’m on night shift,” the 28-year-old says.
McLean was working as a volunteer fire fighter in Queenstown when she was introduced to the ice.
“I was 21, and needed a job and there was one at Queenstown Ice Arena teaching kids to skate, but I needed to learn to skate first. I started playing hockey from there,” she says. “I’d tried all kinds of sport as a kid, from kayak polo to netball and touch.
“As a firefighter, hockey didn’t look too scary to me. I love the competitiveness and the physicality of it. And we’re fortunate women have to wear cage face masks.”
McLean became a full-time firefighter, moving to Auckland for work in 2020, and managed to balance her two worlds – one in fire, one on ice.
The national women’s ice hockey league has four teams in Queenstown, Dunedin, Christchurch and Auckland. McLean had wanted to continue playing for Wakatipu Wild (the 2022 champions) but switched to Auckland Steel.
“Wellington is pushing for a team, inline hockey is quite strong there,” she says.
In a sport which has more than 2000 players nationwide playing across 10 ice rinks, the women’s side of the sport is growing, Boehme says.
“The male game is becoming more technical and less physical contact. There’s no body checking in the female game, so they already have the tendency to play technically,” he says. “And in terms of entertainment, the women’s game is just as good as the men’s.”
The Future Fernz have just arrived home for the world U18 women’s championships in Sofia, Bulgaria, celebrating their first game victory at this level, 4-2 over the home nation.
Among the stars of that side was Katya Blong, who won gold at the 2020 Winter Youth Olympics in the multinational team – the only Kiwi to have ever won gold at the Games. Her success as a 14-year-old may have spurred new interest among young women.
New Zealand’s world ranking in ice hockey has fluctuated between 24th and 31st since the world championships began in 2014, and it’s not easy to make it to the next level of competition.
But players and coach are confident this Ice Fernz team can perform well in South Africa.
“Our team is super dedicated and looking super good on the ice. We just have to keep the momentum and we could do really well,” Jones says. “Our biggest competition is Australia, and we play them first up. It’s the best way to judge where you’re at.”
Boehme says the Fernz are hungry to play at this level after a three-year absence. “Part of it is the sheer joy to have a go again,” he says.
“To progress up to the next division is a very tough challenge, that requires a lot of time and investment.
“But one thing that always amazes other nations about our team is our level of passion for the game.”
Floods, fire and ice: Plucky women of the Ice Fernz
Read more: https://www.nzherald.co.nz/sport/floods ... QJKIHRJJU/
The women of the Ice Fernz are not to be trifled with on or off the ice.
Take Bella Vogel as a perfect example. She walked through knee-deep floodwater and mud, lugging her brand new ice hockey gear, to join the New Zealand team who flew out of Auckland to Cape Town on Tuesday night.
A late call-up to the team travelling to next week’s world ice hockey championships, Vogel was trapped at Bethells Beach during the peak of Cyclone Gabrielle’s fury. With the help of her dad and a fire fighter, she walked several kilometers to get to safety.
“It just goes to show the resolve of these women,” Ice Fernz coach Jeff Boehme says.
Their day jobs reaffirm that.
Dr Helen Murray, the former captain of the Ice Fernz, is a highly-regarded neuroanatomist who studies a form of dementia associated with repeated head injuries.
The Ice Fernz new captain, Jaime Jones, is on the path to becoming an apprentice electrician.
Defender turned attacker Rikki-Lee McLean is a full-time firefighter, who helped with the clean-up after Auckland’s atrocious flooding.
Anjali Mulari is a Hamilton policewoman, specializing in fingerprint analysis. Already an eight-time world championship veteran, she’s just returned to the ice after having two children.
And Rebecca Lilly, from Gore, now lives in Austria playing in the European Women’s Hockey League.
There’s also a nurse and a fitness guru among the team bound for the IIHF division II group B world championships
Boehme says they’re quite an eclectic bunch, which is “definitely a good thing”.
“As amateurs, where they don’t get paid to play, they always bring so much passion with them,” the French-born coach says.
“Some of them from a financial point of view have put hockey first in their lives. We have a few veterans who say they’d have a house deposit by now if they weren’t playing.
“And all coming from very different careers, they have a lot of respect for each other. So they know what it takes to play for their country. They’re a pretty amazing group of women.”
It’s been three years since the Ice Fernz last played in international competition; in a pandemic-interrupted world, New Zealand Ice Hockey decided to withdraw the team from the world championships in 2021 and 2022.
Captain Jones was forced to miss the world championships in Iceland early in 2020, with a bad concussion. “I was left behind once, and it was awful, so I’ll never get left behind again,” she says.
The 24-year-old grew up in west Auckland and went with her family to the local ice skating rink every school holidays.
“A coach recognized my brother’s good skating technique and encouraged him to give hockey a go. I tagged along and fell in love with it instantly,” she says.
Her two brothers – and even her mum – started playing. Now her brothers also play for New Zealand.
But Jones wore the black jersey first, playing for the Ice Fernz when she was just 15.
She finished her high school years in Canada on a scholarship to the Ontario Hockey Academy. “The idea was to be exposed to top hockey and eventually play in a college team in Canada or the US,” Jones says.
“But when it came to the end of my high school career I didn’t know what I wanted to study, and I missed home so much, I came back. I realised the best place for me to play my hockey was in New Zealand.”
Jones worked as a sports co-ordinator at her old school, Massey High, and returned to playing in the Auckland and national leagues.
But after the lockdowns, she had a momentous change in career. A “very practical person”, Jones started working as a roofer with her dad, then discovered an interest in electrical engineering. She now works as an electrical trade assistant, and will soon start an apprenticeship to become an electrician.
She’s had another change of role this year becoming captain of the Ice Fernz.
“I guess I’ve been playing for a long time and I’m well respected across all the leagues I play in,” she says. “I love the fact Helen is right there by my side getting me through this transition.”
Boehme agrees. “Jaime is highly regarded by her teams and coaching staff. She has a great personality, she’s humble and very competitive,” he says.
“It was time to hand the baton on to someone else. And we saw Helen could help Jaime find her feet as captain.”
Rikki-Lee McLean often finds herself going straight from an ice hockey match and into a night shift at the fire station of the Auckland Airport Emergency Service.
“I sometimes miss a training because I’m on a shift or I get lucky and it’s a morning training and I’m on night shift,” the 28-year-old says.
McLean was working as a volunteer fire fighter in Queenstown when she was introduced to the ice.
“I was 21, and needed a job and there was one at Queenstown Ice Arena teaching kids to skate, but I needed to learn to skate first. I started playing hockey from there,” she says. “I’d tried all kinds of sport as a kid, from kayak polo to netball and touch.
“As a firefighter, hockey didn’t look too scary to me. I love the competitiveness and the physicality of it. And we’re fortunate women have to wear cage face masks.”
McLean became a full-time firefighter, moving to Auckland for work in 2020, and managed to balance her two worlds – one in fire, one on ice.
The national women’s ice hockey league has four teams in Queenstown, Dunedin, Christchurch and Auckland. McLean had wanted to continue playing for Wakatipu Wild (the 2022 champions) but switched to Auckland Steel.
“Wellington is pushing for a team, inline hockey is quite strong there,” she says.
In a sport which has more than 2000 players nationwide playing across 10 ice rinks, the women’s side of the sport is growing, Boehme says.
“The male game is becoming more technical and less physical contact. There’s no body checking in the female game, so they already have the tendency to play technically,” he says. “And in terms of entertainment, the women’s game is just as good as the men’s.”
The Future Fernz have just arrived home for the world U18 women’s championships in Sofia, Bulgaria, celebrating their first game victory at this level, 4-2 over the home nation.
Among the stars of that side was Katya Blong, who won gold at the 2020 Winter Youth Olympics in the multinational team – the only Kiwi to have ever won gold at the Games. Her success as a 14-year-old may have spurred new interest among young women.
New Zealand’s world ranking in ice hockey has fluctuated between 24th and 31st since the world championships began in 2014, and it’s not easy to make it to the next level of competition.
But players and coach are confident this Ice Fernz team can perform well in South Africa.
“Our team is super dedicated and looking super good on the ice. We just have to keep the momentum and we could do really well,” Jones says. “Our biggest competition is Australia, and we play them first up. It’s the best way to judge where you’re at.”
Boehme says the Fernz are hungry to play at this level after a three-year absence. “Part of it is the sheer joy to have a go again,” he says.
“To progress up to the next division is a very tough challenge, that requires a lot of time and investment.
“But one thing that always amazes other nations about our team is our level of passion for the game.”
Floods, fire and ice: Plucky women of the Ice Fernz
Read more: https://www.nzherald.co.nz/sport/floods ... QJKIHRJJU/