AMSSM Meeting In San Diego

Drs. Julie Wilson, William Meehan and Naomi Brown

I am in the San Diego airport on my way back home to Columbus, Ohio, reflecting on my whirlwind trip to #AMSSM13, the 2013 American Medical Society of Sports Medicine Conference that will wrap up tomorrow.

I spent my 24 hours on the ground connecting with colleagues, attending an Editorial Board Meeting of the Clinical Journal of Sports Medicine, and catching some great talks this morning, three of which I’d like to profile in this post.

Dr. Julie Wilson, from Nationwide Children’s Hospital, and Drs. William Meehan and Naomi Brown, from Boston Children’s Hospital, all presented very interesting research on different aspects of concussion. Their research abstracts are among the collected abstracts of the AMSSM Research Presentations that can be found in the March 2013 edition of CJSM.

Reaction Time Device

Dr. Wilson presented interesting work that her team (disclosure:  I am the principal investigator; Dr Wilson led this project I am currently discussing) has been pursuing on evaluating reaction time in high school athletes using a simple device:  a dowel stick, weighted with a hockey puck, and coated in friction tape.  The device was developed by Drs. Eckner, Kutcher and Richardson of the University of Michigan; their use of this device has been primarily conducted on university students and has been described in several studies where it is being explored as a simple, inexpensive device that may be able to evaluate reaction time as a tool in the diagnosis and management of concussions.

Dr. Wilson’s team looked at high school students’ reaction time at pre-season baseline and post-concussion using this same device.  Thirty-one individual athletes were followed at various time points post concussion.  It was expected that reaction time would slow post concussion and gradually return to baseline.  Interestingly, she found that immediately post-concussion there was no significant change in these young athletes’ reaction times and, unexpectedly, at time of symptom resolution and return to sport, they had become ‘faster.’  She postulated that there may be a learning effect with the device or that testing environment (pre-season large group sessions in schools vs. on sideline or in a busy athletic training room vs. in a quiet medical clinic examining room) may affect test outcomes. Like all good research, the current study leads to more questions.

Dr. Meehan is a good friend of mine and has had a lot going on his life.  He and I both were granted an AMSSM Young Investigator’s grant several months ago, but his recent accolades hardly end with that.  The other day I received in my email inbox notification that Dr. Meehan was awarded the first AMSSM-ACSM Clinical Research Grant worth $20,000 to pursue investigations into chronic concussive brain injury.  Even more impressively, he is part of the Harvard team that has landed a $100 million grant from the NFL Player’s Association as part of a 10-year initiative studying player safety in the NFL.  Reader’s read that figure right:  $100 million.  That figure rivals LeBron James’ contract!

Dr. Meehan, when you read this blog, please respond to the following:  let me know when you would like to guest blog about your work, as readers of CJSM will surely want to hear about it!

His talk this morning concerned one of his recent studies looking at what constructs might predict prolonged recovery from concussion.  Noting that most concussions would be self-limited and resolve symptomatically prior to 28 days from injury, he and his team looked at possible predictors that might suggest who may take longer to recover than others from a concussion.  They used a logistic regression analysis to evaluate the following predictors:  age, gender, the symptoms of loss of consciousness and of amnesia, and the score on the Post-Concussion Symptom Scale (PCSS).  They found that only the PCSS score was associated with the odds of suffering a prolonged recovery from sports-related concussions.  I found this an especially interesting result, as I had heretofore associated the symptom of amnesia, or a patient’s age as being likely predictors.

Finally, Naomi Brown took a different angle on the issue of what might affect the length of time in recovery from concussion.  She presented her research on “The Effect of Cognitive Activity Level on Duration of Postconcussion Symptoms.”  This issue should be of interest to any clinician caring for concussed athletes, but I would argue it may be especially ‘required reading’ for those of us caring for school-aged children.  A typical proscription including iPhone and video game avoidance in addition to school avoidance can bring young patients and families literally to tears:  what’s the youngster to do?  Dr. Brown’s research suggests that that question most definitely requires an answer, as her large prospective study concludes:  “This study adds to consensus opinion and limited amounts of previous data supporting the use of cognitive rest for the treatment of sport-related concussion.”

Creative suggestions for how a concussed youngster can profitably fill their time when under ‘cognitive rest restrictions’ are welcome, and this blog’s readership is encouraged to comment!  My short list includes fishing and knitting, suggestions which patients and families find grim to humorous, depending on their mood that day.

Approved for post-concussion use!