New Concussion Research from CJSM


claire and katie

With the dog days of summer come concussions. And with concussions come research!

I think of August as the ‘lull before the storm’:  with the dog days of summer come two-a-days in American football.  Around the country, the school  fields fill with kids playing the most popular contact sport in the U.S.:  football, to an American; ‘gridiron football’ to the rest of the world.

And with these days we begin, in our clinics, to see a steady, inexorable rise in the number of concussions to be evaluated. By mid-September, we can’t seem to open enough clinic space to see everyone clamoring to get in.

Last year, at this time, I wrote a post on the freely available concussion offerings we have at CJSM, and I am re-posting that entry(see what follows this new entry, below) for folks to read and see what we have in store when you visit the main website.

Over the past year, we have published many additional research articles, some of which are in the print queue and only available on line.  I wanted to draw your attention to a couple of those offerings, as they have real, clinical impact on the way we may practice.

The authors Carrie Rahn, Barry Munkasy, Barry Joyner et al.  looked at the BESS test as performed on the sideline of actual events, and found that the test performance deteriorated when compared to more controlled environments.  They conclude that ” Clinicians need to consider the role of the local environment when performing the BESS test and should perform postinjury tests in the same environment as the baseline test.”

And a very interesting article with a group of authors including Bob Cantu and Chris Nowinski looked at the efficacy of concussion education programs and determined:  “Preseason concussion knowledge was not significantly associated with in-season reporting behavior. Intention to report concussion symptoms was significantly related to in-season reporting behavior.”   Important to the understanding of this article is their discussion on the psychosocial construct of ‘reporting intention.’  As ever, one finds in the realm of public health that education alone is unlikely to alter behavior.

Read these studies: “Sideline Performance of the Balance Error Scoring System During a Live Sporting Event” and  “Concussion Reporting Intention:  A Valuable Metric for Predicting Reporting Behavior and Evaluating Concussion Education,” by Emily Kroshus, Christine Baugh, Daniel Daneshvar, et al.

There’s a lot to learn!



Originally posted on Clinical Journal of Sport Medicine Blog:

We’ve been profiling sports-related concussions (SRCs) in the August posts here on the CJSM blog.

We’ve taken a peek at the use of computerized neurocognitive tests in the diagnosis and management of SRCs; conducted a poll on the entity known as “Second Impact Syndrome”; and interviewed Dr. Jason Mihalik of the University of North Carolina, who is one of the principal developers of a celebrated app helping laypeople identify when an athlete might be concussed.

In this post, I wanted to alert the readership to a special set of journal articles CJSM is releasing for free for a limited time, a set devoted to this issue of SRCs.

chris hughes 2

No, that’s not “Big Brother,”
that’s the CJSM Editor-in-Chief,
Christopher Hughes MBBS, MSc

Our Editor-in-Chief, Dr. Chris Hughes, describes the special collection of ten journal articles in this YouTube video.

I am very excited to pass this…

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Published On-Line First


What we once dubbed ‘Published Ahead of Print’ (PAP), we now call ‘Published On-Line First‘ (POLF???). Whatever the phrase or acronym, I can attest to the benefit as an editor, a reader, and an author.  The publication flexibility that publishing on line provides is extraordinary.  We get many excellent manuscripts submitted for consideration.  The few that make it through our rigorous peer review must then wait in the queue to get on the actual pages of the journal; and so, with publishing on line, we can make the authors’ scientific findings available immediately, even before we have copy on paper.  The articles are immediately found on PubMed and are citable with their unique digital object identifier (DOI) number.

As a reader, I enjoy this functionality.  I rarely get my medical information any more from paper.  I still receive CJSM and other journals (Sports Health, JAMA, MSSE, etc.) in the mail.  I might page through them as I eat breakfast; I will have them on my nightstand to skim prior to sleep.  But most of the time, I am reading my medical journals on the laptop or iPad.  Or I’m sharing a link to a study with someone on twitter.  All of this can only be done with an on-line publishing functionality.  It’s brilliant.

Finally, as an author:  it is always exciting to get your manuscript through peer review.  Always exciting to see the months to years of hard work culminate with an accepted manuscript.  Historically, one would then wait for some time before actually seeing the manuscript in print.  Now, once a CJSM author has completed their post-acceptance corrections, reviewed the galley proofs, and so on, their work can be disseminated immediately.  As an example, here is a recent bit of excitement I just had as an author in the pages of CJSM: ‘Reliability of a computerized neurocognitive test in baseline concussion testing of high school athletes.’ 

I am off on vacation, and so I thought I would share a post on PAP from 2013.  More soon!

Originally posted on Clinical Journal of Sport Medicine Blog:

Time to time, I like to share with readers of this blog some of the features of CJSM with which they may not be familiar.  Our journal’s website has a wealth of resources that I’d encourage you to check out regularly.

For instance, besides publishing the full journal every two months, we frequently disseminate breaking sports medicine research in a more fluid, continuous fashion via our “Published Ahead of Print” (PAP) feature.  PAP allows us to pursue a major goal we editors have:  to contribute to the world of clinical sports medicine in a contemporary fashion, taking advantage of the multi-media offerings of the digital world.   This goal is reflected in this blog itself; in the podcast feature we have just begun; in our engagement with you on social media; and in the journal’s iPad functionality.

“When you want it….where you want it…the way you want it.”  That’s…

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CJSM Podcast 4: Concussions and the World Cup

jsm-podcast-bg-1In this podcast we had the chance to talk with physicians Cindy Chang and Matthew Gammons about the concussion incidents in the recent FIFA World Cup.  Drs. Chang and Gammons are distinguished members of one of our affiliated societies, the American Medical Society for Sports Medicine:  Dr. Chang is a past president and Dr. Gammons is a current vice-president of the organization.

Our Concussion Collection on our main web page contains several valuable research studies on the subject of concussion, and several of the articles are free.  The collection also includes the important Zurich Consensus Guidelines from 2012, which is one of the subjects up for discussion in the podcast.

At CJSM, we employ various media to ‘spread the word.’  You can get a quick taste of what the Zurich guidelines are about by watching our video of past Editor-in-Chief Willem Meeuwisse.  And all of our podcasts can be found here.

Enjoy this, our fourth one,  and let us know what you think!

Concussion management in professional soccer: an opinion piece

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Dr. Luis Rodriguez, demonstrating his skills.

The 2014 World Cup is getting smaller in the rear-view mirror day by day, and the sporting world’s collective attention is turning to other events.  The Commonwealth Games is about to open in Glasgow; the 2016 Olympics are not far off and will, of course, occur in Brazil (Rio); and another World Cup is coming around the corner:  in a little more than a year the Rugby World Cup will kick off in England.

And for the Americans in the on-line crowd, there is the little matter of NFL preseason training camps opening at the end of this week; my beloved Packers start up this Saturday!

On the other hand, the discussion about the management of concussion at the Brazil World Cup is not diminishing.   From media like the Washington Post to social media such as Twitter–which, frankly, remains all ‘atwitter’ over the issue–the dissection of the events and the discussion of what to do next continues.  The New York Times has captured the ‘zeitgeist’ I think with its headline:  FIFA’s Dazed and Dated Attitude.

We have had several posts on this issue already.  I offer you yet another today.  I take part in a LISTSERV which includes members of one of our affiliated societies, the American Medical Society of Sports Medicine (AMSSM).  Last week, I joined in on a robust and wide-ranging discussion about issues of concussion management in soccer (apologies to some readers, since this on-line football discussion mostly involved Americans, the word that was kicked around was, indeed, soccer).  The LISTSERV discussion was so intriguing that I reached out to the participants and asked if anyone was interested in doing a guest post on this blog.  I got a volunteer!

Dr. Luis Rodriguez is an AMSSM member, a clinician and teacher, and an avid soccer player and fan.  He is the Assistant Program Director – UHS Wilson Memorial Hospital Primary Care Sports Medicine Fellowship Program, Johnson City, NY, and is a Clinical Assistant Professor at SUNY Upstate Medical University, Binghamton Campus.  He is, as well, the Team Physician for the Binghamton University Bearcats, the SUNY Broome Hornets, and the Davis College Falcons.

And he has graciously shared with us his opinions.  Thanks Dr. Rodriguez!

Concussion Management in Professional Soccer–Dr. Luis Rodriguez

According to the Nielsen company, an estimated 26.5 million people in the United States watched Germany’s extra-time win over Argentina in the final game of the FIFA World Cup on Sunday July 13, 2014. Being a huge soccer fan, I played my small part in making this the most watched soccer match in U.S. history, even though I was not rooting for anyone in particular. I also knew I was not the only Sports Medicine doctor watching of course, and this fact became pretty obvious early into the first half of an excellent soccer match (although I prefer the term “futbol” myself).

It was the 16th minute, German midfielder Christoph Kramer was fighting for possession deep into Argentinian territory and received what was surely an unintentional (and perhaps most importantly unexpected) hit to the left side of his head and face from the shoulder of defender Ezequiel Garay. Kramer went to the ground immediately, and the ball was put out of play by Germany after a brief delay. During this time, ESPN’s English commentators mentioned he had tried to get up but went back down. Germany’s medical personnel got to him when the game clock showed 17 minutes, 10 seconds and began evaluation. 30 seconds later he was given the famous “pat in the back” that all of those who cover sports as team physicians are probably familiar with as the universal sign for: “you’re ok, now get back in there!”.

The referee did not let Kramer back in immediately, as per official FIFA rules, he had to leave the pitch since medical personnel came in to provide care. I must say, he looked quite dazed and confused to me as he was making his slow walk around the pitch waiting for permission to come back into the match.

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