Monday, March 9, 2015

3rd Matthew Gfeller Sport Related Neurotrauma Symposium

This past week, I traveled to the University of North Carolina (not for the "game", but for continuing education.  Continuing education can be many things to professionals; costly, convenient, enlightening, repetitive, etc.  In this case, it was superb.  Simply put, this was one of the best symposiums I have ever had the opportunity to attend.  I would strongly recommend this to any health care professional looking for the most recent and up to date information regarding concussion research and implementation.  The symposium offered a variety of presenters, including researchers, athletic trainers, engineers, lawyers, epidemiologists, optometrists, neuropsychologists, to name a few.  I will do my best to keep this concise, even though my notes alone were well over eleven pages, covering the 30 presentations we heard over the course of two days.
                               Panel discussion of clinical dilemmas in concussion management.

The Matthew Gfeller story is a powerful one.  His parents gave a very emotional speech, entitled "From Tragedy to Advocacy".  If you'd like to learn more about Matt, and the foundation which bears his name, I encourage you to visit:  There is a short video as well which succinctly describes their difficult, yet valiant path.

Some highlights:

Former U.S. Women's Soccer Team member and Olympic Gold Medalist Cindy Parlow-Cone offered a very raw and honest take on her own personal experiences with concussion and symptom persistence afterwards.  She spoke of her difficulty since her career ended and gave a unique perspective that despite what current evidence states, you can be concussed when heading a ball.  She called for more in depth research in this area, specifically in youth soccer, where she currently serves as  a coach.

Dr. Dirk Keene had some interesting comments regarding CTE which certainly educated this clinician.  Chronic Traumatic Encephalopathy (CTE) is a clinical diagnosis (by definition), not a pathological one.  Simply stated, a pathologist cannot diagnose this condition.  To date, all cases of CTE neuropathology described in the literature are derived from a highly selected, non-random, non representative group of mostly former athletes who suffered untimely deaths.  What does this mean?  It means that it's application in an unbiased population base needs to be studied.  Effectively, if you only study one group, it is difficult to draw definitive comparisons and extrapolations.  That's not to say a link doesn't exist, but further research is needed.

Dr. Steven Rowson from Virginia Tech and it's Star Evaluation System (similar to NOCSAE, but definitely different) describing that as little as 5-7mm of movement cause brain injuries stood out to me.  You can find their recommendations for helmets here.  His slides describing the differences in helmet performance in testing were quite eye opening: not all helmets are created, nor perform equally.  If you are looking for a helmet to purchase, whether you are a parent, athlete or coach, you should really check out the link.

Concussion Vital Signs, a computer based neurocognitive assessment tool, made an announcement which will have a substantial effect:  As of April 15, they will offer their tools for free.  No charge.  They cited the desire to provide appropriate care to all, and more specifically "to do the right thing."  If you are interested, you can FMI at

A mock trial was presented based on actual athletic training.  I thought this was very well done, and quite unique.  The level of detail was interesting, and too in depth to delve into here, but some main points were document everything, and make sound clinical decisions devoid of influence, or as Eugene Egdorf more distinctly put it "It will be very easy for me to make you look bad."  Of interesting note, he was also the lawyer who served on the EA Sports settlement case (regarding the unauthorized use of athlete likenesses/names by the NCAA)  as well as the wrongful death settlement against the NCAA, which resulted in all student athletes being required to test for sickle cell.

Dawn Comstock, an epidemiologist who tracks (thanks to the help of ATC's around the country) high school injury data to identify patterns of sports related injury had some interesting data.  You can actually view some of it here.  What a fantastic way to acclimate oneself with a particular sport with which they may have little familiarity.  Perhaps with this information, we can better predict and prevent!

Dr. Erik Swartz also presented on his HuTT(R) helmetless tackling system, which is an interesting approach.  We tend to hear a lot about the need for helmet design advancement to reduce concussions, but, what if we had athletes perform more drills without helmets?  This obviously would reduce the number of "head to head" collisions in practice, while also simultaneously teach proper form.  More on that (along with a good short video) here.  Definitely an intriguing idea.
He also presented on the new EMS spine injury standards, and implications for athletic trainers.  Basically, the new guidelines will not require the use of a backboard.  Stated simply, there is no real data to support their continued use.   Why do we continue to put suspected injuries on a flat, rigid board when the body is neither of those two things? Once they are placed on a backboard (spine board), they then go on a gurney, which is a bit redundant. I blogged about this awhile back. In Europe, for instance, I have seen body vacuum splints being used, which, while certainly inhibitory, appear to be more comfortable.

Dr. Grant Iverson had a fascinating presentation describing the negative effects of rest...and how it's not really a great prescriptive tool for many maladies (back pain, etc.)  Maybe it's not a good idea for a concussion?  He even showed that not one study has shown that rest is beneficial; even going so far as to explain that abrupt cessation of exercise can actually cause headaches.  I really enjoyed his presentation style for sure, and it was SO REFRESHING to hear this presented (especially to AT's).  It's something I think many clinicians have navigated away from, but  many still adhere to, perhaps unnecessarily.  In addition, he stated that suicidality has not been clinically proven to be a symptom of CTE (no studies to support).  Perhaps more surprisingly, he referenced data which stated NFL players actually have a lower mortality rate than that of the general population.  This seems to be contradictory to mainstream media reports...absolutely fascinating stuff.

Honestly, there were many more fantastic topics, including the utilization of a Biopsychosocial model for the treatment of concussion, patient referrals, evaluating visual deficits following concussion and visual rehabilitation.  This post barely scratches the surface of the information presented, but I feel I need to keep it at an appropriate length.  As both an educator and a clinician, I need this information to not only practice at a high level, but to properly inform future health care providers of the latest evidence in clinical practice.  This symposium delivered.

All in all, a tremendous array of information and an absolute top tier, professional event put on by Dr. Jason Mihalik, Dr. Kevin Guskiewicz, and Dr. Johna Register-Mihalik.


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