IOC Concussion Conference Amsterdam 2022

The podium at CISG meeting in Amsterdam — Dr. Jacklyn Caccese of Ohio State University presenting

What is the definition of a concussion?

If you are wondering whether this is a rhetorical question, would it confuse you still more to know this is how the IOC Concussion in Sport Group (CISG) Consensus Conference in Concussion began in Amsterdam?

Would it concern you that this is still an open question for one of the more vexing problems we deal with in sports medicine? Even among the panel of world experts gathered to bring together the most recent update of consensus statement for concussion in sport?

I think the answer is — yes. Yes to the confusion, yes to the concern.

I had never been to an IOC CISG meeting. As many of the journal’s readers will know, there have heretofore been several meetings with a consensus statement as their output: 2001 Vienna was the first, 2016 Berlin was the most recent.

CISG was set for a meeting to take place in Paris in the autumn of 2020, but we all know what occurred in that year’s spring.  And so the 6th meeting was rescheduled for 2022 and for a new venue: Amsterdam.

I have just returned home from Amsterdam and wanted to collect my thoughts to give you the reader a brief rundown.

These meetings have become huge, and I am not merely referring to the number of participants (hundreds).  The worldwide press recognizes the importance of the CISG and its influence on global sports.  Over the past year the press has been following closely the story of the previous leader, and now discredited academician, Paul McCrory. And……..immediately prior to the gathering in Amsterdam, the news broke that America’s NIH formally acknowledges the causal link between concussion and chronic traumatic encephalopathy (CTE). 

That’s a lot. Read more of this post

CJSM May 2021 Journal Club — Blood Biomarkers in Pediatric Concussions

The May 2021 CJSM issue has just published, and as always it is full of articles you will want to read.

As I gaze at the table of contents, a non-random sampling of eye catching articles includes

CJSM Junior Associate Editor Jason Zaremski, MD breaks it all down for us.

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Clinical Journal of Sports Medicine

Online Journal Club May 2021

CJSM Junior Associate Editor Jason Zaremski, MD

Jason L Zaremski, MD, CAQSM, FACSM, FAAPMR

Anzalone AJ, et al. Blood Biomarkers of Sports-Related Concussion in Pediatric Athletes.

Introduction:  There has been a substantial amount of interest in the diagnosis, evaluation, and management sports related concussions (SRC) in the past decade. An emerging area of interest has been the study of biomarkers as a more objective measure of head trauma. Two blood biomarkers — Neurofilament light polypeptide (Nf-L), primarily found in axons, and Tau, a microtubule-associated protein necessary for axonal transport — have been studied at advanced level of sport (collegiate, professional, and Olympic athletes).

The authors of this new study evaluated these blood biomarkers in pediatric athletes.  The main outcome measures they looked at were correlations between self-reported symptom measures biomarker concentration levels.

Purpose/Specific Aims: The authors examined patterns of blood biomarker concentrations (tau and Nf-L) in pediatric athletes seen in clinic in the days following a SRC and at a six-month follow up.  A comparator group of non-injured controls were assessed as well.  Correlations between biomarker concentrations and self-reported symptom scores were assessed. Read more of this post

CJSM Blog Journal Club — Preinjury & Postinjury Factors Predicting Recovery in Sports-related Concussions

The new year is upon us, and the first issue of the 2021 Clinical Journal of Sports Medicine has published.

There is much to commend in the issue.  It is always difficult to pick one manuscript among many to highlight in the CJSM Blog Journal club (that’s a good ‘problem’ to have).  

This month, our Jr. Associate Editor Jason L Zaremski, MD has decided to evaluate an original research article looking at pre- and post-injury risk factors that affect clinical recovery time in sport-related concussions.

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Jr. Associate Editor Jason L Zaremski MD

Jason L Zaremski, MD

Introduction:  As we finish up a fall sport season that has been like no other and begin 2021 with renewed spirit, the editors of CJSM and the CJSM blog journal club would like to take a moment to thank all of the health care professionals working tirelessly to keep all of our athletes, patients, support staff, and family members safe. We are proud of how the sports medicine community has conducted itself during this pandemic, and we are hopeful that vaccination will allow us to put this pandemic in the rear view mirror in the not-too-distant future.

To kick off 2021 we would like to review a wonderful manuscript from a team headed by Margot Putukian, M.D., past-president of the AMSSM, which analyzes preinjury and post-injury factors that predict sports-related concussion and clinical recovery time.

Purpose/Specific Aims:

1) The authors evaluated a possible relationship between preinjury risk factors (RFs) and resultant occurrence of concussion.

2) They also sought to examine whether preinjury RFs or post-injury assessments predicted clinical recovery in collegiate athletes

  • defined as days until symptom-free (DUSF) and days until full return to play (DUFRTP)

Read more of this post

Exercise as a prescription to address post-concussion syndrome: The CJSM Blog Journal Club

Sports like American football are taking place in the midst of COVID19 — concussions are sure to follow

Our September 2020 edition has just published, and this edition is a particularly compelling one, full of original research.  You have to check it out.

As ever our Jr. Associate Editor Jason Zaremski M.D. has just posted his newest submission to the CJSM journal club.

While COVID19 is wreaking havoc with sports schedules around the globe, there are enough high schools and youth sports programs active that concussions will continue to remain a challenge for clinicians to treat.  And post-concussion syndrome is one particularly challenging aspect to this injury.  Dr. Zaremski walks us through original research looking at an ‘exercise prescription’ to treat post-concussion syndrome.

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Jason Zaremski MD

Gauvin-Lepage J, Friedman D, Grilli L, Sufrategui M, De Matteo C, Iverson, GL, Gagnon I. Effectiveness of an Exercise-Based Active Rehabilitation Intervention for Youth Who Are Slow to Recover After Concussion, Clinical Journal of Sport Medicine: September 2020 – Volume 30 – Issue 5 – p 423-432 doi: 10.1097/JSM.0000000000000634

Introduction:  With the change of seasons, many of our readers return to covering pediatric and adolescent sport. In the Northern Hemisphere, summer vacation is over, and academics and school sports are commencing. Fall is the start of the gridiron football season and there is often a surge of concussed youth who need effective, evidence-based management.

This month the CJSM Journal Club has chosen to highlight original research on the effectiveness of exercise-based rehabilitation in 8-17 year youth who have sustained a concussion. In this age group, return to school is even more important than return to sport, and the lingering difficulties in intellectual ability, vestibular system function, memory, and/or attention can be particularly debilitating.  The authors in this new study report that between 20% and 30% of all concussed youth will endorse post-concussive symptoms (PCS) 1 month after injury. Further research into treatments and modalities aimed at reducing the frequency with which children and adolescents experience PCS is paramount.

Purpose: The authors state two aims:

1) To determine the impact of providing participants (aged 8 to 17 years) who are slow to recover after a concussion with an active rehabilitation intervention (ARI) compared to receiving standard care alone, at 2 and 6 weeks after the initiation of the ARI.

2) To investigate functional recovery 6 weeks after initiation of the ARI.

Setting: Tertiary care pediatric trauma center and associated community health care providers. Read more of this post

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