This is worth reading. Here is the link in PDF form. You will be able to view it in presentation format with pictures and diagrams, if you go to the above link.
Here bolded below is the impetus to our Zero Tolerance stance. It does say 1/2 of concussions came from illegal hits to the head and back. If rule changes cuts down 50% of the above 1/2... isn't that worth it, in youth ice hockey?
The prevalence of concussions in youth hockey is surprisingly similar to concussion estimates in the NHL (23 per 1000 player game hours). (3) Concussions also frequently occur in high school and college hockey. In a recent Canadian study of 22,400 youth players, most concussions resulted from player to player contact. Half (11,200) were caused by illegal acts, such as checking from behind or hits to the head. Athletes who lost consciousness were sent for medical evaluation, but symptoms of amnesia, headache and dizziness were often ignored. According to trained observers, 71% of concussed athletes returned to play in the same game.
BELOW is the copy of the PDF but it is best viewed in PDF form.
Concussion in Ice Hockey: What’s the Buzz?
A Medical and Psychosocial Perspective
Aynsley M. Smith, RN, PhD 1 , Michael J. Stuart, MD 2
and Dave Dodick, MD 3
1. Background of Concussions
Concussions in ice hockey have been reported since 1890, but were often viewed as minor events
described as “having your bell rung” (1) . Over time, our understanding of the mechanisms,
neurobiology and consequences of concussion has dramatically improved.
A concussion is defined as a transient neurologic dysfunction resulting from a forceful impact (2) .
The Center for Disease Control estimates between 1.6 and 3.8 million concussions occur in sport
annually, but the true incidence is likely much higher. Approximately 54% of concussed athletes
fail to report their symptoms due to a lack of recognition or fear of losing playing time. These
figures speak to the need to address the importance of recognizing and properly treating
concussions in athletes.
Forces transmitted to the head cause an electrical depolarization (the brain cells are stunned),
followed by a serious alteration in: (1) neurotransmitter function, (2) potassium and calcium
exchange, (3) glucose metabolism and (4) brain blood flow. The linear and rotational
acceleration of the brain causes the tail of neurons (axons) to stretch, tangle or die.
Diagram used with permission. "Image courtesy of Dr. Eric H. Chudler, Neuroscience
for Kids, http://faculty.washington.edu/chudler/neurok.html"
This diagram depicts a normal brain cell (neuron). After repeated concussions and rotational
acceleration the stretched, tangled, axons may lead to cognitive and behavioral changes.
1 Dr. Smith is a sport and exercise consultant and research director in the Mayo Clinic Sports Medicine Center who
has worked with ice hockey in all levels of participation.
2 Dr. Stuart is an orthopedic surgeon, codirector
of the Mayo Clinic Sports Medicine Center, and team physician for
the 2010 USA Olympic men’s ice hockey team.
3 Dr. Dodick is a neurologist at Mayo Clinic Scottsdale, AZ, a full professor of neurology, a world expert in
headache and related neurotrauma, and who has expertise in hockey and concussion.
Repetitive head trauma from participation in activities such as boxing, football and ice hockey
can lead to serious consequences such as memory loss or early Alzheimer’s disease. In recent
years, we have learned that concussion symptoms take longer to resolve in children.
2. Who Gets Concussed?
The prevalence of concussions in youth hockey is surprisingly similar to concussion estimates in
the NHL (23 per 1000 playergame
hours). (3) Concussions also frequently occur in high school
and college hockey. In a recent Canadian study of 22,400 youth players, most concussions
resulted from player to player contact. Half (11,200) were caused by illegal acts, such as
checking from behind or hits to the head. Athletes who lost consciousness were sent for medical
evaluation, but symptoms of amnesia, headache and dizziness were often ignored. According to
trained observers, 71% of concussed athletes returned to play in the same game.
Children and adolescent hockey players are more susceptible to concussion because of a larger
head size to body size ratio; weaker neck muscles and less stability on skates when checked or
pushed. Videotape analysis of Bantam players identified onice
skating characteristics that
helped explain why certain players sustain concussion. These players tended to skate with their
heads down watching the puck, positioning themselves in the “danger zone”, which is between
816
feet from the boards, and didn’t optimally position their body to receive a check. Thus,
when checked, these players were more often flung into the boards. Collisions too often occurred
when their heads were down.
3. What are the Symptoms and Signs of a Concussion?
Parents and coaches may witness a deliberate or accidental “impact” between players, a player
and the boards, ice, or a goal post. They should be alert to a players complaints or problems that
range in time of onset and severity.
· Symptoms: headache, nausea, dizziness, fatigue, sleep disturbances, feeling slow
· Physical signs: loss of consciousness, amnesia (loss of memory), vomiting, balance
problems, visual disturbances, light or noise disturbances
· Behavioral changes: irritability, nervousness, drowsiness, sadness
· Cognitive impairment: slowed reaction times, fogginess
We should all be particularly cognizant of the player with a concussion who sustains additional
minor head trauma and reports an escalation of symptoms. More information is available on the
CDC website: http://www.cdc.gov/ncip3/tbi/getoolkit/coaches (6) .
4. What to do when a Concussion Occurs?
Should concussed players return to the game or practice? No! The following recommendations
emanated from a recent International Symposium on Concussion in Sport conference (or of
medical experts, neurosurgeons?) in Zurich in 2008. (2)
If a player shows ANY symptoms of a concussion:
· The player should be medically evaluated on site using standard emergency management
principles, excluding an associated neck (cervical spine) injury.
· The player should be safely removed from the practice or game, evaluated by a health
care provider on site and/or referred to a physician.
ü Assessment is made using a sideline protocol to evaluate factors such as cognition
and balance.
ü The player is monitored every 1530
minutes for the first several hours after injury.
Concussion symptoms may not appear for several hours after the injury and worsening of
symptoms requires an emergent medical consultation. A more detailed evaluation with
neuropsychological (ImPACT) (7) and balance testing (8) is also helpful, especially if preseason
baseline data is available for comparison.
Obtaining Baseline Data
In the Mayo Clinic Sports Medicine Center, baseline data has been obtained for Rochester, MN
male varsity and junior varsity football and ice hockey players and female varsity ice hockey
players for the past four years. Baseline assessment includes neurocognitive
testing (ImPACT)
(7) and balance testing (8) that provides a reference point in the event players experience head
trauma during the season. In the absence of baseline data, obtaining input from the parents and/or
significant others as promptly as possible is helpful to obtain input on signs or symptoms that
differ from the player’s norm. Parents should consider establishing a baseline for their children
prior to starting any physical activity or contact sport as it may be helpful in diagnosing and
treating a concussion.
6. Educational Programs to Prevent Concussions
a. Hockey Education Program (HEP) (9)
Minnesota Hockey and the Mayo Clinic Sports Medicine Center developed a program to
decrease violence in youth hockey while promoting sportsmanship and skill development. HEP
incorporates Fair Play, a program that rewards sportsmanlike behavior with a point in each game
for teams that do not exceed a specified number of penalty minutes. The teams’ Fair Play point is
forfeited if players, coaches or team parents behave in an unsportsmanlike manner. After the first
four years, statewide
analysis of HEP data revealed approximately a 30% reduction in
potentially dangerous infractions such as checking from behind and hits to the head.
Total Major PenaltiesPer
100 Games:
A Four year Comparison
0
2
4
6
8
10
12
14
16
18
Fighting
Spearing
5" Roughing
High Sticking
Check/Behind
Head Contact
Kicking
D.Q.
0708
Data represents 2210
scoresheets. A 25% sample
from 8839
b. Heads Up Hockey
Heads Up Hockey has long been promoted by USA Hockey in an attempt to reduce the risk of
cervical spine injury (www.usahockey.com ). The Rochester Youth Hockey Association
(RYHA) produced a video in 2008, to instruct players to keep their head up when sliding into the
boards. (http://ryha.pucksystems2.com)
c. Larger Ice Surfaces
A recent study of ice hockey injuries, including concussions in World Junior Ice Hockey
Championships compared risk according to the size of the ice surface. Injuries were less frequent
on the larger ice surface when players of similar age, size and skill competed under otherwise
identical rules and regulations.
d. High School Hockey Concussion Task Force
Concussions in youth and high school hockey are frequent enough and the consequences so
grave that medical professionals felt obligated to take action. A task force of sports medicine
physicians and sport scientists organized by Dr.Aynsley Smith and Dr. Michael Stuart, recently
participated in a teleconference to discuss the necessary steps to reduce concussion occurrences.
Members of the task force included Drs. Joel Boyd, Rob LaPrade, Bill Roberts, Diane WeiseBjornstal
and Maureen Weiss. The Task Force’s initial efforts will be directed toward
accountability and enforcement of existing rules in high school hockey for the 20092010
season.
The prevalence of concussions will be tracked in specific areas and the results will be considered
following the hockey season.
7. Congratulations to MN Hockey and the MN Wild
The action being taken jointly by Minnesota Hockey, under the leadership of Executive Director
Mike Snee, and the Minnesota Wild in developing and implementing the Respect and Protect
Program is to be applauded. Hopefully, players will grow up playing a safer game, knowing that
their respectful behavior is supported by their youth hockey association, the Minnesota Wild and
all of us who love the great game of hockey.
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