ACSM

National Winter Sports Traumatic Brain Injury (TBI) Awareness Month

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Brad Endres, MS, ATC, CSCS

Assistant Director of Sport Safety, Korey Stringer Institute

The new year is upon us, and with the changing of the calendar comes the increased participation in our beloved winter sports. Fittingly, January is National Winter Sports Traumatic Brain Injury (TBI) Awareness Month, so before you dust off the skates or head up the ski-lift, here is a breakdown of what you need to know to stay safe out on the slopes or in the rink.

What is a traumatic brain injury (TBI)?

The types of traumatic brain injuries include sport-related concussion (SRC), diffuse brain injury, second impact syndrome, subdural hematoma, and epidural hematoma.  Although cerebral concussions rarely cause death, they can be the starting point for other deadly brain injuries.

 

How often does TBI occur?

Between 1.6 million-3.8 million TBIs are seen in sports each year in the United States. Athletes under the age of 15 represent the majority of TBIs. Also, in every age group males show a higher rate of TBIs than females.

 

What is a sport-related concussion?

According to the 5th International Conference on Concussion in Sport held in Berlin, October 2016, a SRC is defined as a TBI induced by biomechanical forces. Several common features that may be utilized in clinically defining the nature of a concussive head injury include:

  • SRC may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.
  • SRC typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over a number of minutes to hours.
  • SRC may result in neuropathological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.
  • SRC results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged.

 

What are the signs and symptoms of a SRC?

The suspected diagnosis of SRC can include one or more of the following:

  1. Mechanism of Injury (eg, direct blow to the head)
  2. Physical signs (eg, loss of consciousness, memory loss, neurological deficit)
  3. Balance impairment (eg, unsteady gait)
  4. Behavioral changes (eg, irritability)
  5. Cognitive impairment (eg, slowed reaction times)
  6. Sleep/wake disturbance (eg, sleepiness, drowsiness)
  7. Signs and Symptoms including the following:
Signs Symptoms
  • Disorientation, confusion
  • Retrograde/anterograde amnesia
  • Loss of consciousness
  • Automatism
  • Unequal pupil size
  • Combativeness
  • Slowness to answer questions
  • Loss of balance
  • Atypical behavior/personality changes
  • Vacant stare
  • Nystagmus
  • Headache
  • Nausea
  • Balance issues/dizziness
  • Tinnitus (ringing in the ears)
  • Diplopia (double vision)
  • Blurred vision
  • Trouble sleeping
  • Trouble concentrating
  • Memory issues
  • Irritability, sadness,
  • Sensitivity to light or noise

 

What to do if a TBI / SRC is suspected?

Any person suspected of a SRC should be removed from the mountain or event area immediately and evaluated by a licensed healthcare professional who is trained in the evaluation and management of concussions. The injured person suspected of a SRC should not return to activity on the same day as injury. Finally, continued monitoring of an athlete evaluated of having a SRC is necessary in order to observe any deterioration of physical or mental status (which warrants transport to local healthcare facility).

 

How do you treat an individual with a TBI / SRC?

After being evaluated by a health professional, treatment and management of a TBI/SRC includes:

  • Physical and Cognitive Rest: Physical and Cognitive activities that result in an increase in symptoms should be avoided during the acute phase of concussion treatment
  • Medications that mask the symptoms of a concussion (NSAIDS, Aspirin, stimulants, and antidepressant) should be avoided, especially in the acute phase of the injury.
  • The use of acetaminophen (Tylenol) may be considered in treating symptoms such as headache but should be used after the acute phase of the injury
  • Athletes sustaining a concussion should have a follow-up appointment with their general practitioner to evaluate the mechanism of injury, the course of symptoms, and any previous history of concussive injuries.
  • Return-to-play following a concussion should follow a graded return-to-play protocol. This protocol should consist of 5-7 stages and take 5-7 days to complete (if there is no recurrence of symptoms). The graded return to play protocol should begin once the athlete has a cessation of symptoms for at least 24 hours. An athlete must be prohibited from returning to activity if they are still experiencing symptoms.
  • The goal of the return to play protocol is to progressively increase the duration and intensity of exercise to ensure that there is no return of symptoms with physical exertion. See the table below to see an example of a 6-stage return-to-play protocol.
Rehabilitation Stage Functional Exercise at each Stage of Rehabilitation
1.  No activity Complete physical and cognitive rest
2.  Light aerobic exercise Walking, swimming, or stationary cycling keeping intensity <70%
No resistance training
3.  Sport specific exercise Skating skills in ice hockey, slide board for skiing, general agility drills
No head impact activity
4.  Non-contact training drills Progression to more complex training drills (eg: passing drills in ice hockey, bunny slopes for skiing/snowboarding)
May begin progressive resistance training
5.  Full-contact practice Participate in normal training activities
6.  Return to play Normal game play or event competition

 

How do I prevent a TBI / SRC?

Based on the most updated consensus statement created by a committee of sports medicine professionals at the 5th International Conference on Concussion in Sport, the following steps were recommended for TBI prevention:

  • Protective Equipment: There is sufficient evidence in terms of reduction of overall head injury in skiing/snowboarding to support strong recommendations and policy to mandate helmet use in skiing/snowboarding. The evidence for mouthguard use in preventing SRC is mixed, but suggests a positive trend towards a protective effect in collision sports (such as hockey).
  • Rule Change/Risk Compensation: The strongest and most consistent evidence evaluating policy is related to body checking in youth ice hockey (ie, disallowing body checking under age 13), which demonstrates a consistent protective effect in reducing the risk of SRC.
  • Aggression/Violence: Appropriate competition and the aggressive nature of some sports is not discouraged, however unnecessary violence or other aspects should be evaluated based on the merit they provide in the sport.
  • Education: The ability to detect and deal with a TBI is enhanced when everyone on the slope or ice is looking out for the safety of the athletes.  Education should include the athletes themselves, coaches, administrators, and parents.  It should cover basic tools for recognition, what to do if they suspect a concussion, and the process of treatment and returning to participation.

What are the risk factors for SRC?

  • Previous concussions: A previous history of a concussion increases the risk of sustaining another concussion on the order of 2-5.8 times greater risk
  • Number, severity and duration of symptoms: Evidence has shown that those who report a greater number of symptoms, or report a greater severity of symptoms or duration, may experience a longer recovery than those who experience less severe symptoms.
  • Sex: Research has shown that females experience a higher incidence of concussion in addition to reporting a increased number/severity/duration of symptoms, and prolonged recovery.
  • Age: Young athletes may experience a prolonged recovery from a concussion and may be due to the differences in the developing brain of a child/adolescent compared to that of an adult brain
  • Sport, position, and style of play: Depending on the sport, position, and the athlete’s style of play increases the risk of concussion. In sports where there is player-to-player contact, the risk of concussion increases. The table below outlines the incidence the risk of concussion for various sport.
  • Mood Disorders: Mood disorders such as depression, anxiety, and irritability may complicate both the diagnosis and management of a concussion
  • Learning disabilities and attention disorders: Learning disabilities such as ADD/ADHD or others that result in some form of cognitive dysfunction can complicate the management of a concussion and may lead to a longer recovery time post-concussion

So bundle up, have fun, and most importantly stay safe this Winter! For further information, check out the TBI page at the Korey Stringer Institute’s website at https://ksi.uconn.edu/emergency-conditions/traumatic-brain-injury/. The 5th International Conference on Concussion in Sport publication can be found at https://bjsm.bmj.com/content/51/11/837.full.pdf.

KSI Summer 2018 Conferences

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2018 ACSM National Conference

Yasuki Sekiguchi, MS, CSCS, Associate Director of Athlete Performance and Safety

The American College of Sports Medicine (ACSM) Annual Meeting was held in Minneapolis from May 29 – June 2. Most of the KSI staff attended this outstanding conference and they were honored with the opportunities to present their research. We had great discussions with other attendees and received feedback for future work via these presentations.

  • Douglas J. Casa, PhD, ATC, FACSM- Alcohol and hydration
  • Ryan M. Curtis, MS, ATC, CSCS- The effects of sleep duration on sleep quality in elite soccer athletes
  • Courteney L. Benjamin, MS, CSCS- Sleeping patterns of NCAA D1 collegiate athletes: A sex comparison
  • Gabrielle EW. Giersch, MS- Validity and reliability of a short-based integrated GPS sensor
  • Gabe also did an excellent job as a moderator of the hydration thematic poster session with Dr. Cheuvront
  • Rachel K. Katch, MS, ATC- Effects of wrist cooling on balance and cognitive performance in the heat
  • Yasuki Sekiguchi, MS, CSCS- Factors influencing hydration status during a NCAA Division 1 soccer preseason
  • William M. Adams, PhD, ATC- Hormonal, steroidal and inflammatory responses in collegiate male soccer players and female cross-country runners
  • Yuri Hosokawa, PhD, ATC- Comparison of rectal temperature responses during a modified heat tolerance test

Attending this conference allows the KSI staff to obtain further knowledge, skills and new ideas as well as make new relationships with other professionals. This conference certainly helps to develop KSI and execute our goals to maximize performance, optimize safety and prevent sudden death for the athlete, soldier and laborer. The KSI staff members are thankful to all of the presenters and attendees for their contributions to this field as well as helping make this conference one where individuals who are passionate about similar topics can meet, collaborate, and enjoy one another.

 

 

 

 

2018 NATA Clinical Symposia

Alicia Pike, MS, ATC, Director of Education

View of the Mississippi River near the Convention Center

During the last week of June, a majority of the KSI staff traveled to the “Big Easy” for the 69thannual National Athletic Trainers’ Association Clinical Symposia. New Orleans may have been ready for us, but we sure weren’t ready to face the very hot and humid days. Despite the sweltering weather, this year’s conference was filled with presentations and meetings that not only showcased the numerous projects KSI is actively engaged in, but also served as a platform to continue our mission of optimizing safety and preventing sudden death in sport.

 

The week kicked off with our Medical & Science Advisory Board Meeting at one of Dr. Casa’s favorite restaurants – Bubba Gump Shrimp Co. We were very thankful to have so many familiar faces in the room, and even saw a little competitiveness come out in a friendly game of Bubba Gump Trivia. Following dinner and a lot of laughs, Dr. Casa spoke to the Board regarding the recent accomplishments of KSI, especially three primary initiatives that have been the focus over the last couple years: (1) the ‘Raise Your Rank Campaign’, a state-specific approach aimed at improving mandated best practices policies to reduce catastrophic injuries in sport, (2) the Athletic Training Locations and Services (ATLAS) database, which has now officially mapped the extent of athletic trainer services provided to every public and private secondary schoolacross the United States, and (3) the Perceptions of Athletic Training study, which is currently assessing perceptions of the profession from athletic directors, principals, superintendents, legislators, coaches, and parents in order to develop educational strategies to further raise awareness of the value of the athletic training profession.

The remaining days of the conference flew by, as they always do, with various presentations by our staff members. The following presentations showcased the work of KSI at this year’s conference:

  • Rebecca Stearns & Alicia Pike- Legislators Perceptions of the Athletic Training Profession
  • Samantha Scarneo- Implementation of Emergency Action Plan Policies in Secondary School Athletics Without Previous Athletic Training Services
  • Brad Endres- Epidemiology of Sudden Death in Adult Organized Recreational Sport in the United States, 2007-2016
  • Robert Huggins:- Athletic Trainer Services in the Secondary School Setting: The ATLAS Project
  • Rebecca Stearns- Heat Tolerance Test Results from Exertional Heat Stroke Patients Receiving Cold Water Immersion Treatment
  • Sarah Attanasio- Athletic Trainer Education Level and Employment Models: The ATLAS Project

In addition to the presentations, our staff enjoyed manning the KSI booth at the NATA Expo. We love when people stop by; even if it’s to tell us a personal story, talk to us about one of our presentations they attended, or reach out to us as a resource for whatever circumstance they may be encountering in their current clinical position or state. Every year we have more attendees stop by and share with us how they’ve heard about KSI or thank us for the work we do to improve health and safety for student-athletes. It really is the biggest motivation to continue our mission day after day.

The 2018 conference was a unique one for KSI, since we also held two separate events to raise awareness and support initiatives we are currently engaged in. The first was a ‘launch event’ for the Comprehensive Safety Initiative (CSI), a collaborative effort between KSI, University of Connecticut, University of North Carolina at Chapel Hill, and Player’s Health, to help secondary school athletic trainers identify areas for improvement related to health and safety best practice adoption. A comprehensive library of resources will be accessible on the Player’s Health platform by the end of 2018. All secondary school athletic trainers are encouraged to complete the Safety Needs Assessment located at: assessment.playershealth.com.

The second event was held for all athletic trainers currently employed at high schools who were recipients of the NFL Athletic Trainer Pilot Grant, an initiative aimed at providing secondary schools with resources to start or enhance their athletic training programs. June 2018 marked the end of year one of the pilot grant program, so we invited the athletic trainers currently employed at these schools to attend the meeting, provide them with more detailed information related to the grant program, but more importantly, debrief about their first year and offer as much support to them as possible. The meeting was a success, and not only gave us the chance to meet the athletic trainers in person, but also served as a platform to receive valuable feedback to improve the program in the next two pilot years.

Now the conference really can’t be all work and no play…when in New Orleans, do as the New Orleaners do! We were very fortunate to have our own personal tour of the city from a KSI benefactor, massive supporter, and close friend of Dr. Casa’s, Scott Chafin. Scott, along with colleagues from his law firm, brought us around NOLA for four hours of unforgettable fun. From the Garden District, to an amazing seafood dinner, followed by authentic Italian dessert, and of course, some trolley karaoke, it was a night we are forever thankful for and will never forget.

 

 

It was a very busy, yet rewarding week, and the perfect opportunity to share the work of KSI with athletic trainers across the country. Perhaps my favorite quote of all time is “Alone we can do so little; together we can do so much,” and this year’s conference truly made me realize how muchwe’ve done and how muchwe will continue to do.

 

 

 

 

 

2018 Hydration for Health Conference 

Gabrielle Giersch, MS, Associate Director of Research

 

I had the great opportunity to attend the 10th Annual Hydration for Health Conference in Evian, France. I was able to present research from a study done in collaboration with Dr. Lawrence Armstrong and Dr. Elaine Lee that investigated the role of fluid restriction on perceived sleep duration and quality. This research was presented as a part of the “Pitch Your Science” contest for the Young Researcher Award that consisted of a consolidated 3-minute presentation in a specific session of the conference. This conference is unique in that it unites several disciplines all with specific interest in hydration for health outcomes. This conference provides a great opportunity for a variety of disciplines to discuss with international colleagues on the role of hydration on overall health.

 

 

 

 

 

 

2018 NSCA National Conference

Courteney Benjamin, MS, CSCS, Director of Education & Associate Director of Athlete Performance and Safety

The 2018 NSCA National Conference was held in the beautiful city of Indianapolis, Indiana- home to the NCAA and ACSM headquarters. Members of KSI had the great opportunity to present some of our research during this July conference.

  • Yasuki Sekiguchi- Relationships between resting heart rate, heart rate variability, and sleep characteristics among female collegiate cross-country athletes
  • Ryan Curtis- Sleep Distribution and heart rate-derived autonomic nervous system responses to acute training load changes in collegiate soccer players
  • Courteney Benjamin- Effects of Early Morning Training on Sleep in NCAA Division 1 Female Cross-Country Runners

I was also awarded the opportunity to give a featured presentation titled, “What S&C coaches need to know to prevent sudden death in sports.” During this talk, I reviewed the 2012 best practices document related to collegiate strength and conditioning as well as discussed how this profession can continue to advance by ensuring the safety of athletes.

This talk could not have come at a better time as the NSCA president, Dr. Greg Hoff would announce exciting changes surrounding requirements for obtaining a CSCS certification at the opening ceremonies. According to an article released by the NSCA on July 12th, 2018 the certification process will change as follows.

There will be two principal changes to the certification process:

  1. Effective target date 2030, all CSCS exam candidates must hold a Bachelor’s degree in a strength and conditioning related field, or be enrolled as a senior in such a program.
  2. Effective target date 2030, candidates will need to obtain those degrees from a college or university that has a program accredited by an NSCA-approved accrediting agency.

This conference was a great opportunity to meet other professionals in this field as well as establish relationships for future collaborations. We look forward to attending this conference again next year!

 

2017 ACSM Annual Meeting Recap

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Yasuki Sekiguchi, MS, CSCS, Assistant Director of Athlete Performance

 

The American College of Sports Medicine (ACSM) Annual Meeting was held in Denver, CO from May 30-June 3. Most of the KSI staff attended this outstanding conference and they were honored with the opportunities to present their research. We had great discussion with the audiences and received critical feedback for future work via these presentations.

  • Douglas J. Casa, PhD, ATC, FACSM- Catastrophic Heat and Exertional-Related Conditions among Athletes
  • Robert A. Huggins, PhD, ATC- Biomarkers of Endocrine, Muscle, and Inflammatory Health Track Training Loads of a Collegiate Soccer Season

  • William M. Adams, PhD, ATC- Monitoring Cardiovascular, Hepatic, Renal, and Hematological Markers of Health in Collegiate Soccer Players
  • Yuri Hosokawa, PhD, ATC- Outcomes from a Modified Heat Tolerance Test to Track Thermal Strain

  • Samantha E. Scarneo, MS, ATC- Assessing the Reliability and Validity of an Objective Method of Measuring Postural Stability: Preliminary Data

  • Luke N. Belval, MS, ATC, CSCS- Comparison of Rectal Temperature Prediction Models Utilizing Machine Learning

  • Ryan M. Curtis, MS, ATC, CSCS- Starters and Non-starters Require Separate Load Monitoring and Analyses Throughout a Collegiate Soccer Season
  • Rachel K. Katch, MS, ATC- Weighted Heat Stress Score as a Predictor of Rectal Temperature in a Warm Weather Race

  • Courteney L. Benjamin, MS, CSCS- Monitoring Markers of Nutrition Status Throughout a Collegiate Soccer Season

  • Gabrielle EW. Giersch, MS- The Effect of the Cypla2 -163 c>A Polymorphism on the Metabolism of Caffeine and Effect on Performance

  • Yasuki Sekiguchi, MS, CSCS- Thirst Modulates Cycling Performance in the Heat in Dehydrated Males
  • Andrea R. Fortunati, MS, ATC- Monitoring Markers of Oxygen Transport Throughout a Collegiate Soccer Season
  • Brad D. Endres, BS, ATC- Epidemiology of Sudden Death in American Youth Sports.

 

 

Furthermore, the ACSM annual meeting provided great opportunities to meet with former colleagues. The University of Connecticut Alumni Association Reception was held on Thursday night (6/1). A lot of attendees spent time with old friends and shared current work with them. This kind of reunion always enables us to recall great memories and have energy for future work. We are grateful for all of the people who helped coordinate this event.

 

 

This conference also allows attendees to make new relationships with other professionals through attending various sessions and meetings. These opportunities lead KSI staff to obtain further knowledge, skills and new ideas. They certainly help to develop KSI and execute our mission “to provide research, education, advocacy and consultation to maximize performance, optimize safety and prevent sudden death for the athlete, soldier and laborer.” The KSI staff members are thankful to all of the presenters and attendees for their contributions to this field as well as helping make this conference one where individuals who are passionate about similar topics can meet, collaborate, and enjoy one another. We look forward to seeing everyone again soon!!!

 

Medical and Science Advisory Board Meeting

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KSI Med Sci Board

By Lesley Vandermark, Director of Research

On the heels of our uber-successful board meeting and fundraiser gala in early May, KSI held our annual Medical and Science Advisory Board meeting on May 26th, in conjunction with the 62nd annual American College of Sports Medicine Symposium in sunny San Diego, CA. KSI staff members and the MSAB members had the opportunity to discuss progress with on-going initiatives like the Mission Heat Safety Pledge, and discuss future initiatives and directions over a nice dinner. This meeting was an important opportunity for our MSAB to meet and talk about potential collaborations with our new Chief Medical Advisor, Dr. John Jardine.

We also updated the MSAB on our on-going and upcoming research projects. KSI will be going to the Falmouth Road Race to provide medical coverage and perform research on thermoregulation and heat illness with the race participants. Additionally over the next 6 months KSI will be doing research in a field that continues to gain importance in athletics, wearable technology. We also discussed our upcoming travel plans and public appearances. Don’t miss a chance to meet the staff and board members, and pickup information, at the National Athletic Trainers’ Association 66th Clinical Symposium in St. Louis, MO at the end of June.

Several corporate and supply partners were also in attendance, showing continued support of our research and education initiatives. Additionally, one of our educational partners, Jones & Bartlett Learning attended to give an update on our progress with the online continuing education course on preventing sudden death in sport. The course should be available this summer, and is a great resource for athletic trainers in need of evidence-based practice (EBP) CEUs due in December.