December 29, 2012 by mike?
Diving on the floor for loose basketballs anytime following an Athletic Concussion is dangerous to the Athlete and counterproductive. It defeats the entire prupose of Sports, Recreation and Exercise participation.
Athletes might become permanetly injured, disabled or expire and the teams success will be hampered when the team doesn?t have enough healthy athletes to practice and play.
Hustle and aggressive basketball play are the most satisfying aspects to the coach during drills, practice and games. Aggression is often associated with boys more than girls, but both child and youth boy and girl athletes can play aggressively.
Child and youth girls cannot equally match-up physically and aggressively with boys, matched for age, size and skill even after intense skill drills, practice and conditioning. They are made differently. Aggression is not regulated in basketball by strong, violent emotions but regulated by playing hard, smart, controlled as a team.
Hustle for pure satisfaction of a macho Coach?s warped psychodynamics if factitious and only window dressing for the athlete. Mental Toughness is key to Sports Psychology.
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ATHLETE MENTAL TOUGHNESS, SPORTS PSYCHOLOGY
Champions have a competitive advantage. How does an athlete develop a competitive advantage rather than the weakness of a mental Achilles? Heel?
Mental Athlete Toughness (MAT) is the competitive advantage.
Mental Athlete Toughness is derived from the love, passion, soul and spirit for the game. MAT is inspired by a mentor, credible, truthful, and trustworthy coach who coaches by the 4 R?s of Coaching. Trust is the Core of Coaching.
The mentor doesn?t have to be an employed athletic coach but a parent, friend, minister or another confidant. Naturally it is better if the mentor is the designated athletic coach.
The 4 R?s of Coaching are the backbone of Trust because they are the key of Positive Motivation.
Not all athletes have Mental Toughness. Authentic, genuine Mental Athlete Toughness is multidimensional. First the athlete is gifted with athletic intelligence and ability. The athlete also has a ?5 star Will To Win.?
At the same time, the athlete has passion for the game. This passion is an extreme emotional feeling for the game. The athlete plays for the love of the game and enjoys the aggressive play and self-denying physicality of the game.
The athlete studies the game and is focused with his or her destination in sight without distracting obstacles while playing the game. Nothing impedes that focus.
The athlete is dedicated, self-sacrificing, determined, plays aggressively, maintains strict conditioning and stays in excellent shape year round. They never dissipate and seize every moment to stay in top condition. The athlete desires to be a player in something bigger than self, part of a successful team. The athlete places the team victory first before personal achievement.
The nucleus of Mental Toughness is a Mentor Coach of the athlete and his or her Coaching Philosophy. The Coach must cultivate respect in themselves and then EARN respect from the athletes and others around them. Trust must be established and earned by the coach over time. A coach cannot lead without enthusiastic followers.
Athletes trust, respect and follow the coach who Coaches with the 4 R?s of Coaching i.e. Respect, Responsibility, Coach-Player Relationship, Recognition.
The Coach must have the best interest of the athlete at heart to prevail in the mind of the athlete and their mental state, ?toughness?.
Some coaches, who are not in step with the prevailing concept of Mental Athletic Toughness, and, conversely, practice physical and psychological athlete maltreatment, give Mental Athletic Toughness lip service and profess the awareness of its importance.
These negatively motivating coaches are convinced that Mental Athletic Toughness is achieved by over working, over practicing and physically and psychologically abusing their athletes.
They often cross the line and push and punish their Athletes beyond their physical and mental limits. More is not better and is extremely counterproductive, tending to defeat the Holistic Athletic Purpose. [http://www.cappaa.com/holistic-athletic-experience]
Out of step, that coach will demand and command respect and mistreat their athletes in the process. They will play head games verbally, physically and emotionally for admiration, approval, esteem, prominence, success and winning. But, pushing athletes too far will waste some athletes physically and emotionally and, at the same time, waste their careers. That coach will lose many games, because they lack athletes accepting their misdirection, which negates teamwork. Teamwork is the key to success; not brainwashing brutality that emphasizes tearing down and remolding elite athletes.
The athlete develops a belief based on absolute certainty that he or she is better than their opponent. The mentally tough athlete ?really wants it? more than their opponent and is not distracted by their own or their teammates mistakes. The mentally tough athlete wants the pressure and never is critically negative about themselves. A negative mind set is not in them. They always want the ball or the challenge and are confident when they are the center of the action.
The negative, mental Achilles heel will impair the proper movement coordination and restrict athletic performance. Mental Athlete Toughness allows the fluidity of muscle synergy during practice and during competitions, because the muscle agonists and antagonists are moving the extremities and athletic body parts as they should be moved in sink together for successful athletic coordination and performance.
The mentally tough athlete always comes with their game, every game, because their mind set is developed supported by a trustworthy mentor coach.
[http://www.cappaa.com/index.php?s=Mental+Toughness]
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?Remember, coaches love hustle! So make sure your going all-out, if there is a loose ball on the floor.. you better be the first one diving for the ball. You should always play this way regardless, but you better take it up a notch if your trying out for a team!
[Making The Team: Things You Should Know to make the team? BASKETBALLTRAININGGHQ by Coach Monty]
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Basketball Drill: Hustle Level: Beginner and up Instructions:
The basketball team will divide and form two lines underneath the basket. The coach will roll the basketball and then say ?GO!? The two players that are first will have to CHASE & DIVE on the floor for the basketball. The player who gets it, gets up and now the players play a one on one situation. It?s then the defenders responsibility to play defense and to rebound the basketball after the offense has shot.
[www.basketballplans.com , ultimate-youth-basketball-guide.com]
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?I was at in attendance for a few of those practices during his (Billy Gillispie) two years, and saw firsthand some of his tirades. Joe Crawford could barely run recovering from knee problems, yet he hounded him relentlessly to run up and down the court and ?hustle.? He had Jodie Meeks diving on the floor for balls on the sideline so hard he would slide into the seats ? how he avoided getting hurt is a miracle. Patrick Patterson had a stress fracture from over-use in year 2 (with later surgery) that could have compromised his NBA career. I watched him storm down the hall at Rupp one day acting like a 3-year-old that didn?t get his way, and chew people out for the slightest of reasons. Bizarre experience looking back on it, but at the time I was just trying to figure out if that?s how they coached in Texas or something?? [Is this the end of the line for Billy Gillispie? DaveUK Says: Sept 5, 2012 at 6:50 pm Kentucky Sports Radio]
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Texas Tech on Wednesday disclosed that it had reprimanded men?s basketball coach Billy Gillispie earlier this year after learning he was exceeding NCAA practice-time limits.[ Coach Gillespie accused of holding practices too long, leading to injuries The Associated Press, September 5, 2012 LUBBOCK, Texas ?
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?All of us as coaches become quite frustrated when players refuse to dive on the floor for a lose ball because we all know how much those 50/50 balls matter in a close game. It also infuriates us because it shows that we are soft and that's something we just can't tolerate.
Building the Habits
Building proper habits for loose balls essentially boils down to doing two things - emphasizing it and rewarding it.
Emphasizing It:
1. Have it subconsciously be a part of every drill in practice. You don't need to do 10 loose ball drills a week for this to kick in, in my opinion. Loose ball drills are only something you run to start the year, or as a fun change up mid to late season. Their only real purpose is to get players over their fear of going for the ball. After that anytime there is a loose ball in a drill, in ANY drill for that matter, players need to dive on it. Even if a player fumbles the ball while passing it around in shell drill players need to sprint over and dive on it. This creates
2. Chart It In Games
Teaching the Form
When teaching the form there are a few key points I like to make.
1.The first is to dive at the earliest possible spot you can get the ball. No sense in waiting until the last moment - after someone else has started their dive.
2. Leading with your shoulder is another important point. All players want to lead with their head, but I teach them to go shoulder first to prevent injury.
3. Slide on your side is another key phrase I use. Have the players slide on their hip, it helps to turn the body and lead with the shoulder. I don't want guys landing on the palms of their hands either - sure way to break a hand or wrist. Side should hit first, then shoulder while the arms reach out.
[John Carrier, varsity assistant at St. Thomas Academy in Medota Heights, MN. under head coach in Dan Rubishko]
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?Nothing endears a player to a coach more than hustle. The willingness to give every last drop of sweat, often compromising well-being and risking livelihood to make a play is the ultimate act of basketball selflessness.? [All-Hustle Team: Diving on the floor, making things happen, Art Garcia, Oct 11 2010 NBA News]
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Scott Schumacher Quotes
It?s playing defense, diving after loose balls, sprinting back on defense to break up a fast break. People forget sometimes that these are 18- and 19-year-old young adults. They go through so many personal things while playing college basketball and taking college courses.
[Scott Schumacher, a 25-year coaching veteran with 22 years? experience coaching junior college basketball, NJCAA,was named the new head men?s basketball coach at Blinn College, the school announced Schumacher comes to the Buccaneers with a career record of 426-249, including the last four seasons at North Dakota State College of Science, where he has served as athletic director the last three years.
Thursday, May 10th. May 16, 2012]
[Tiffin University, Inspirational Quotes]
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?The problem of concussions in professional sports gets a lot more attention now than it used to, especially in the NFL and NHL.
?But Dr. Robert Cantu worries that concussions in youth sports aren?t taken as seriously. Cantu is a clinical professor of neurosurgery at the Boston University School of Medicine, and he?s co-author with Mark Hyman of the new book ?Concussions and Our Kids: America?s Leading Expert on How to Protect Young Athletes and Keep Sports Safe,?
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?They write that sometimes in youth sports there?s a ?walk it off? attitude among some players and parents and coaches. And that means head injuries in young athletes sometimes go overlooked, even though they can be especially detrimental in kids.
[Robin Young, 90.9 WBUR NPR Radio, Friday, September 28, 2012, Web Chat: The Risks Of Concussions In Youth Sports]
?We still have this culture where it?s hard to convince people that a concussion is a very serious brain injury,??Dawn Comstock, principal investigator, Center for Injury Research and Policy, The Research Institute, Nationwide Children?s Hospital, Ohio State University (Time)
?In the late 1950s, I was a student at Cal-Berkeley and a member of Cal?s baseball team. We were playing Stanford one afternoon, and I came to bat. This was the dark ages before batters wore helmets with ear flaps. Our protection?if you can call it that?was a flimsy liner inside our felt caps.
?A pitch came inside and tight, and I didn?t react as quickly as I needed to. The ball caught me flush on the side of the head. The cap and the hard liner were just about worthless. The force of the blow stunned me, and I wobbled a bit as I made my way down the line to first base. This didn?t seem to bother anyone as much as the blood trickling from my ear. It wasn?t really coming from my ear?the force of the pitch had shattered the cap liner, which sliced into my scalp.
?The coaches didn?t know that, of course. They took one look at me and thought, ?My God, Cantu has a skull fracture! Get him to the hospital!?
?We?ve come a long way since those unenlightened times. Now head trauma in sports is a topic that leads nightly newscasts and is debated at every level of amateur and professional sports.
?A Concussion Is?
?The word derives from the Latin concutere for ?to shake violently.? Concussions are just that?a shaking of the brain inside the skull that changes the alertness of the injured person. That change can be relatively mild. (She is slightly dazed.) It can be profound. (She falls unconscious.) Both fall within the definition.
?According to the Centers for Disease Control and Prevention,
? almost four million sports- and recreation-related concussions are recognized every year, with many times that number occurring but going unrecognized.
? For young people ages fifteen to twenty-four years, sports are the second leading cause of traumatic brain injury behind only motor vehicle crashes.
? According to research by the New York Times, at least fifty youth football players (high school or younger) from twenty different states have died or sustained serious head injuries on the field since 1997.
? One study estimates that the likelihood of an athlete in a contact sport experiencing a recognized concussion is as high as 20 percent each season.
? In my office, there is a very discernible cycle in the number of concussion patients. In the fall (football season) and winter (ice hockey) the numbers go up, sometimes exceeding fifteen new young athletes with a concussion per week. In the spring and summer, they slide back down.
?Concussions happen to all types of athletes?young and old, boys and girls, and in every conceivable sport. In a typical year, I see hundreds of children and adolescents in my office. We see more than athletes, of course. Some patients have suffered concussions in traffic accidents, mishaps around the house (they walked into a door), or a slip and fall in the grocery store.
?In a chapter later in this book, I offer observations about concussions in ?non-collision? sports such as volleyball and tennis that parents?for good reason?do not think of as posing a great risk of concussion. However, there is risk in every sport. I would have to think a long time before naming one that has not sent a single patient to our office at Emerson Hospital in Concord, Massachusetts.
?Many patients get well over two to three weeks, pretty much as expected. Other cases take unexpected turns. Mario was an eleven-year-old kid making one of those typical recoveries. After his concussion, he had a number of symptoms. We held him back from sports, gym, and physical activity. He was also under restrictions regarding his schoolwork. Just as he was about ready to resume normal activity, Mario hit his head on a bedpost and suffered another concussion. The process started all over again. I can?t count the number of stories like that. Unfortunately, they happen a lot.
?Concussions in sports occur when an athlete is slammed and makes sudden and forceful contact. That contact can be with the ground, court, or pool deck. It also can be with a batted ball, a thrown ball, a kicked ball, a goalpost (football), the boards (hockey), the scorer?s table (basketball), and of course another player. Dylan Mello, a high school soccer and ice hockey player from Rhode Island, suffered a severe concussion in a collision with a player who smashed him with the plaster cast on his arm.
?Concussions can and frequently do occur without any contact with the head. Rather, the player?s body receives a jolt that causes his shoulders and head to change speed or direction violently. It?s the whiplash effect. Inside the skull, the brain shifts in the cerebrospinal fluid and bangs against the inside of the skull.
?Even falling from five or six feet and landing upright, if it?s unexpected, and therefore jarring, can send a shock through the spine and shake the head with a force that may cause a concussion. Concussions that are the most damaging to the brain tend to be the ones that involve a direct blow to the head, however. When you?re struck in the head, the forces generated are about fifty times greater than being struck in another part of the body.
?With such a blow, the brain pushes forward until it crashes into the skull, reverses, and bumps against the back of the skull.
[Book Excerpt: ?Concussions and Our Kids: America's Leading Expert on How to Protect Young Athletes and Keep Sports Safe byDr. Robert Cantu (Author), Mark Hyman]
[Robin Young, 90.9 WBUR NPR Radio, Friday, September 28, 2012, Web Chat: The Risks Of Concussions In Youth Sports]
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?Basketball is a constantly evolving contact sport. Concussions in basketball put players at high risk for short and long-term head trauma effects.
?Contrary to the degree of contact seen in men?s basketball, there is equal number if not more, in women?s basketball. According to a study by the National Athletic Trainers Association of all divisions of the NCAA sports, there is an increase of head and facial injuries in basketball by an annual average of 6.2 percent.
?Of all the injuries reported 3.6 percent were concussion related. The study also showed women basketball players were three times more likely to get a concussion than men.
?Any contact sport puts you at risk for a concussion,? Williamson said. ?Sports are inherently at risk activity, you recognize it and accept it. We are now seeing more contact in women?s sports.?
?The women?s basketball team has had its own share of concussion experience with players. Skyler Warrick, a junior in mass communication, plays forward for the Mustangs and is no stranger to concussions herself.
?With the first one I thought I was having an off day, and it just kept getting worse,? Warrick said. ?My first concussion was my freshman year in the second week of workouts during a block out drill.?
Warrick has sustained four concussions in her college basketball career and is familiar with the rigorous testing that is required before a player is cleared. Typically, for a concussion to be diagnosed, the player is asked a series of questions and then put through a series of balance exercises.
?After a player concusses, there should be a side-line evaluation,? Williamson said. ?If you concuss in a game you should not go back in the game.?
?A balance test would include standing on one leg with eyes open then closed or lifting both arms. Some of the exercises are similar to a sobriety test and ironically the symptoms of a concussion are similar to inebriation.
?There are several signs and symptoms; disorientation, physical skill, nausea, ability to articulate and the content of speech,? Williamson said. ?The obvious would be unconsciousness but also visual accuracy and amnesia are other signs as well.?
?Warrick has experienced symptoms such as these however her first few concussions neglected proper diagnoses right away. Her first concussion she was elbowed in the face, immediately following this her head hit the floor, then the player who elbowed her fell on top of Warrick?s head.
?The day after my first concussion I ran all of practice, by the end of the day I couldn?t walk straight,? Warrick said.
Later in practice Warrick ran into a wall and fell. The coach approached her to scold her for falling, and then she realized something was wrong.
?I did not do well in any of the balance test,? Warrick said. ?At practice when running my head felt like it was going to explode.?
This was only the beginning to multiple concussions, Warrick would sustain in her first three years of college basketball. Warrick is no longer allowed to play unless she is wearing a protective helmet, which has become her signature as a Mustang.
?I am not as self-conscious of my head hitting anything, now I can play without worrying about it,? Warrick said. ?A downside of the helmet is it is hard to hear because the helmet has small holes and it is hot.?
Other college teams are also taking preventative measures with their players who have sustained concussions. The University of Louisville men?s basketball team uses helmets during practice. The team?s trainer, Fred Hina, made the decision for the team as a precaution.
We are just trying to be proactive and keep our multiple concussions down to a minimum, limit our risk Hina said. It may be overkill, but I really think you are going to see it more and more with the focus being on head injuries he said in an interview with The Associated Press.
These helmets are not mandatory for the whole team but Hina is smart in taking such preventative measures.
Warrick is the only player for the women?s basketball team that is required to wear a helmet while playing, however, she does see a positive side to it all.
?I call it my crown because I am the queen of concussions,? Warrick said. ?When I walk in the gym with it on, all eyes are on me and I like the attention because people think who is this girl in the helmet??
[Basketball concussions on the rise, December 4, 2012 By The Wichitan
By Samantha Forester]
?Louisville is taking a proactive approach to preventing multiple concussions: mixed martial arts helmets.
?Looking to protect players who have had previous concussions, Cardinals trainer Fred Hina came up with the idea of having them wear the padded helmets in practice.
?Wearing a black lid that looks like a cross between a skateboard and motocross helmet might look a little odd, but if it helps keep the players on the floor, no one seems to mind.
?We?re just trying to be proactive and keep our multiple (concussions) down to a minimum, limit our risk,? Hina said Thursday before the Cardinals played Michigan State in the West Regional semifinals. ?It may be overkill, but I really think you?re going to see it more and more with the focus being on head injuries.?
?Hina came up with the idea while sitting on his couch watching a football game between Toledo and Ohio last November. A player who had suffered a previous concussion went down with another after being hit, and Hina figured if a football player wearing a helmet could get multiple concussions like that, what chance does a basketball player with multiple concussions have with no protection?
He then went to the sporting goods store and started doing research on the Internet. After buying a couple of boxers helmets and looking at soccer headgear, he opted for the MMA sparring helmet, which is softsided but still provides protection and allows the players to have good vision on the court.
Hina approached Louisville coach Rick Pitino and he was all for it, especially because three Cardinals had suffered multiple concussions. The helmets aren?t mandatory, but the players have bought into the concept, even if it does make them look a bit odd in practice
?Really, it?s no different than putting an ankle brace on a guy that?s had three or four ankle sprains,? Hina said. ?You?re just trying to limit your risk and hopefully cut down on the possibility of that occurring again.?
Guards Peyton Siva, Tim Henderson and Elisha Justice, who all have had multiple concussions, wear the helmets in practice during any drill that might involve contact. The black helmets are made of plastic foam and have air holes on the top.
Hina said he?s heard of a handful of other schools getting their players to wear protective headgear for practices, but he doesn?t think it?s a common practice.
[Louisville using helmets in practice March 23, 2012, ESPN, Men?s Basketball, AP [Louisville using helmets in practice March 23, 2012, ESPN, Men?s Basketball, AP PHOENIX]
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BASKETBALL CONCUSSION RETURN TO PLAY PROTOCAL
?Blows to the head are not as common in basketball as in football and hockey, but they happen.
?We?ve seen just a quantum change in the way concussions are handled, from players routinely being allowed to go back in the same contest? after a blow to the head to being ruled out indefinitely if a concussion is diagnosed, says Robert C. Cantu, clinical professor of neurosurgery at Boston University School of Medicine and co-director of BU?s Center for the Study of Traumatic Encephalopathy.
?And now it?s even tightening up further,? Cantu says. ?When you can?t rule out that somebody?s had a concussion ? in other words you suspect it, but you can?t be sure ? that?s good enough? to sideline a player. ?The risks are too great.?
Scalabrine took that inadvertent blow to the jaw Jan. 25, 2009. He was held out of games until Feb. 19. Then, four days later, at a game in Denver, he took a blow to the back of the neck and suffered his third concussion in less than a month.The Celtics sent Scalabrine to see Cantu at BU.
Brian David Scalabrine missed the rest of the season and felt symptoms for months, including severe sensitivity to light. ?The whole summer after that, I couldn?t go outside without sunglasses,? he says. ?There were a lot of weird things that happened. At a restaurant, I couldn?t have a conversation with all the background noise.?
Scalabrine couldn?t talk one-on-one if another conversation was going on nearby:
?It would all get blended in, and it would sound like mumbled noise. That wouldn?t go away. That lasted six months. I couldn?t have a conversation with the TV on.?
He couldn?t sleep more than four hours at a stretch ?probably until six or eight months later.?
?That combination of multiple concussions before completely clearing is what led him to get into what we call a post-concussion syndrome,? Cantu says, ?where the symptoms lasted a very long time.?
Cantu, a senior adviser to the NFL Head, Neck and Spine Committee, thinks the NBA needs a league-wide policy: ?Any sport ought to have a management protocol in place that reflects the highest level of current thinking.?
[Concussions now a hot issue as leagues toughen policies By Erik Brady and J. Michael Falgoust, USA TODAY Sports 10/25/2011]
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Although concussion rates for basketball players are slightly lower than those for football and ice hockey players, concussions in basketball players still accounted for 4.7% and 3.2% of all injuries for collegiate females and males, respectively.22 In addition, high school basketball concussions accounted for 6.2% of all injuries in females and 5.7% of all injuries in males.21 Thus, concussions in basketball and soccer players are relatively comparable with those in football (6.0%) and hockey (7.9) players.22
Although normative data are available for computerized neurocognitive test batteries, baseline measures still provide the most reliable and accurate comparisons for postconcussion measures. Therefore, ATs should administer baseline neurocognitive tests to all collision-sport and contact-sport athletes to ensure accurate management of sport-related concussions.
As neurocognitive testing increases in popularity in the sports medicine field, it is important for practitioners to take the time to use this tool properly. In addition, practitioners could benefit from reviewing pertinent material (eg, user manuals and relevant publications) on neurocognitive testing administration and interpretation. This information will not only help them interpret and understand the scores but will also place them in a position to educate and help the concussed athlete understand the meaning of the scores. Such knowledge could also enhance communication and adherence to further clinical recommendations made by medical professionals. Future researchers should focus on expanding and improving educational efforts for practitioners using neurocognitive testing as well as other tools (eg, symptom checklists and postural assessments) in the management of sport-related concussion.
[J Athl Train. 2009 Nov-Dec; 44(6): 639?644. , Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) Practices of Sports Medicine Professionals, Tracey Covassin, PhD, ATC,1 Robert J. Elbin, III, MA,1 Jennifer L. Stiller-Ostrowski, PhD, ATC,1 and Anthony P. Kontos, PhD2]
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The Importance of Return-To-Play Decisions: Striking Another Balance
?Avoid potential negative outcomes
?Protect the health of the athlete and avoid:
?Second Impact Syndrome
?Acute and Chronic Cognitive Deficits
?Severe Emotional Problems
?Chronic Traumatic Encephalopathy
?Carry out the mission/goal
?Return to game and play well
?Avoid being lost for future games
Potential Negative Medical Outcomes Associated With Return-To-Play Decisions: CHRONIC TRAUMATIC ENCEPHALOPATHY
?Progressive degenerative neurological process found in some athletes who sustain multiple concussions and sub-concussive blows. This early degenerative process is characterized by cerebral atrophy and increased levels of tau protein, as well as cognitive impairment (dementia) and, in some cases, depression.
LOW-MOD INCIDENCE ? HIGH POTENTIAL CHRONIC IMPACT
McKee /Cantu, 2009; Omalu,/DeKosky 2005. Evidence Level 3 & 4
Return to Play and Practice What Do We Know With Reasonable Certainty?
?Single uncomplicated concussion often results in acute neurocognitive and balance deficits and a rapid (3 to 10 day) recovery curve.
?Once an athlete has sustained a concussion, the risk for subsequent concussion increases 3 to 6 fold.
?Multiple concussions may increase the severity and duration of cognitive symptoms (multiple concussions may result in CTE).
?Children are likely at greater risk for slower recovery.
Return to Play: Consensus Statements Evidence Level 5 [Expert Opinion] American Academy of Neurology Practice Parameters (1997)
Severity grading; no symptom return to play (being revised)
Zurich Conference on Sports Concussion (2009)
Neurocognitive assessment important (verify athlete self report)
Individually based decisions (one size does not fit all)
NCAA and AAN Sports Concussion Guidelines (2010)
Diagnosis of concussion = remove from game no matter how fast the symptoms clear
Conservative Approach to Return to Play and Practice
?Since there is no scientific evidence to support a cut-off for too many concussions in a season or in a lifetime, decisions should be made by the medical/athletic training staff (and the player), taking individual history into account.
?Recommend full neurological and neurocognitive examination when considered necessary by the team physician following multiple concussions. Trigger is
significant neurologic symptoms.
PREVENTION AND REDUCTION OF RISK IN SPORTS
? Education of the athlete and public
? Rules to protect the brain
? Equipment to protect the brain
? Reduction of contact in practice
[University of Virginia BISC Institute ,Brain Injury and Sports Concussion
Jeffrey T. Barth, Ph.D., Donna K. Broshek, Ph.D., Jason R. Freeman, Ph.D.]
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A study recently published by the University of Kentucky?s Scott Livingston shows that physiological problems stemming from a concussion may continue to present in the patient even after standard symptoms subside.
Currently, concussions are diagnosed and monitored through a patient?s self-reported symptoms (including headache, confusion or disorientation, poor concentration, and memory loss) and through computerized neuropsychological testing programs, which measure cognitive abilities including attention and concentration, cognitive processing, learning and memory, and verbal fluency. Post-concussion abnormalities in either of these markers typically return to a normal level within five to 10 days following the injury.
Conducted while he was a graduate student at the University of Virginia, Livingston?s study was just published in the February 2012 issue of the Journal of Clinical Neurophysiology. The study used motor-evoked potentials (MEPs) ? an electrophysiological measurement that can provide hard evidence for changes in brain function ? to determine if any physiological abnormalities followed a similar recovery pattern to self-reported symptoms and neuropsychological testing.
During an MEP test, subjects have electrodes placed on a limb ? such as the hand or foot. A magnetic stimulating device is placed over the head, and they receive a brief pulse of magnetic stimulation to the brain. The ?reaction time? ? the amount of time it takes for the subject?s limb to receive the response from the brain after the stimulation ? is recorded.
Livingston?s study enrolled 18 collegiate athletes ? nine who had been concussed within the previous 24 hours, and nine who had not experienced a concussion. Each concussed subject was matched with a non-concussed subject using age, gender, sport, position played, prior concussion history, and history of learning disability or attention deficit-hyperactivity disorder as inclusion criteria.
Subjects were evaluated for evidence of concussion based on self-reported symptoms, computerized neurocognitive test performance, and MEPs for a period of 10 days. Post-concussion symptoms were more frequent and greater in severity in the immediate timeframe after the injury (24-72 hours) and decreased in the following days. Some subjects reported no symptoms by day 10, though others did not have complete symptoms resolution by that time. Neurocognitive deficits followed a similar pattern, proving greater just after the injury and returning to normal (or closer to normal) by day 10.
MEPs, however, showed delays in response time and smaller MEP size which continued up to day 10, with these physiological changes actually increasing as the concussed athletes? symptoms decreased and cognitive functioning improved.
Livingston, director of the UK Concussion Assessment Research Lab and assistant professor in the Department of Rehabilitation Sciences, says these findings are significant for both athletes and sports medicine clinicians.
?Further investigation of MEPs in concussed athletes is needed, especially to assess how long the disturbances in physiological functioning continue after those initial ten days post-injury,? Livingston said. ?But in the meantime, sports medicine personnel caring for concussed athletes should be cautious about relying solely on self-reported symptoms and neurocognitive test performances when making return-to-play decisions.?
Livingston?s research lab recently began a new program to further study MEPs in athletes pre- and post-concussion. At UK, all athletes who participate in a contact sport ? including football, soccer, volleyball, diving, gymnastics, and basketball ? are assessed preseason using MEP and neurocognitive testing to establish a baseline measure for each athlete.
If an athlete receives a concussion, he or she will come back to the lab as soon as possible after the injury for follow-up testing. This approach allows researchers to get a clearer idea of the extent of an athlete?s injury, Livingston says.
Neurocognitive tests, such as the Immediate Post-Concussion Assessment and Testing (ImPACT)?, are a valuable component of concussion management. While major professional sports organizations like the NFL and NHL, as well as hundreds of colleges, universities, and high schools across the United States follow this standard, UK Athletics did not have a formal, standardized neurocognitive testing protocol in place until last year. The addition of the MEP assessment in the preseason testing and post-concussion management are unique ? UK is the first and only collegiate athletics program to implement a baseline physiologic measure of brain function.
?No other college of university in the country is currently assessing physiologic brain responses and using this information to determine the extent of the functional brain injury,? Livingston said. ?This type of information enables us to closely track recovery, which may not correspond to the decrease in concussion symptoms or recovery of memory and other cognitive functions.?
[Scott Livingston, Effects of a Concussion May Last Longer Than Symptoms Feb. 29, 2012 ?Share this story on Facebook, Twitter, and Google] [Journal Reference: Scott C. Livingston, Howard P. Goodkin, Jay N. Hertel, Ethan N. Saliba, Jeffrey T. Barth, Christopher D. Ingersoll. Differential Rates of Recovery After Acute Sport-Related Concussion. Journal of Clinical Neurophysiology, 2012; 29 (1): 23 DOI: 10.1097/WNP.0b013e318246ae46]
[University of Kentucky (2012, February 29). Effects of a concussion may last longer than symptoms. ScienceDaily. Retrieved December 29, 2012, from http://www.sciencedaily.com? /releases/2012/02/120229155055.htm]
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Post-Concussion Protocol
If a student-athlete exhibits signs and symptoms consistent with a concussion (even if not formally
diagnosed), the student-athlete is to be removed from play and is not allowed to return to play (game,
practice, or conditioning) on that day.
Student-athletes are encouraged to report their own symptoms, or to report if peers may have
concussion symptoms. Coaches, parents, volunteers, first responders, school nurse, licensed athletic
trainers (if available), are responsible for removing a student-athlete from play if they suspect a
concussion.
Following the injury, the student-athlete should be evaluated by a qualified medical professional with
training in concussion management. It is strongly recommended that each institution seek qualified
medical professionals in the surrounding community to serve as resources in the area of concussion
management.
In order for a student- athlete to return to play without restriction, he/she must have written clearance
from appropriate medical personnel. The form that should be used for this written clearance is posted
on this website.
A blow to the head can disrupt the normal function of the brain. Doctors often call this type of brain injury a ?concussion? or a ?closed head injury.? They may describe these injuries as ?mild? because concussions are usually not life threatening.
However, the effects of a concussion can be serious. After a concussion, some people lose consciousness or are ?knocked out? for a short time, but not always ? you can have a brain injury without losing consciousness.
Some people are simply dazed or confused. Because the brain is very complex, every brain injury is different. Some
symptoms may appear right away, while others may not show up for days or weeks after the concussion. Sometimes the injury makes it hard for people to recognize or admit that they are having problems.
The signs of concussion are subtle. Early on, problems may be missed. People may look fine even though they are acting or feeling differently.
Because all brain injuries are different, so is recovery. Most people with mild injuries recover fully, but it can take time. Some symptoms can last for days, weeks, or longer. People with a concussion need to be seen by a Doctor.
Signs and Symptoms
Some of the symptoms of a concussion are:
_ Low-grade headaches that won?t go away
_ Feeling light-headed or dizzy
_ Increased sensitivity to sounds or lights
_ Blurred vision
_ Ringing in the ears
_ Slowness in thinking, acting, speaking, or reading
_ Getting easily confused
_ Memory loss
_ Difficulty paying attention or concentrating
_ Neck pain
_ Lack of energy
_ Severe mood changes - feeling sad, anxious, or angry
Danger Signs
In very rare cases, along with a concussion, a dangerous blood clot may form on the brain and crowd the brain against the skull. Contact your Doctor or Emergency Department right away if you have any of the following symptoms:
_ Headaches that get worse
_ Weakness, numbness, or decreased coordination
_ Repeated vomiting
The people checking on you should take you to an Emergency Department right
away if you:
_ Cannot be awakened
_ Have one pupil (the black dot of your eye) larger than the other
_ Have convulsions or seizures
_ Have slurred speech
_ Are getting more confused, restless, or agitated
Recovery
How fast people recover from a concussion varies from person to person. Although most people have a good recovery, how quickly depends on many factors. These factors include how severe the concussion was, what part of the brain was injured,
their age, and how healthy they were before the concussion.
Rest is very important after a concussion because it helps the brain to heal. You will need to be extremely patient because healing takes time. As the days go by, you can expect to gradually feel better. While you are healing, you should be very careful to avoid doing anything that could cause a blow to your head. On rare occasions, receiving another blow before a
concussion has healed can be fatal. Here are some tips for healing:
_ Get plenty of sleep at night and rest during the day
_ Return to activities gradually, not all at once
_ Avoid activities that could lead to a 2nd brain injury until cleared by the
Doctor
_ Take only those drugs that your Doctor has approved
[www.loveland.k12.oh.us/lhs/athletics/pages/Injury_Protocol.pdf]
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