Can you do a brief but comprehensive examination of a concussed patient in your clinic?

October 15, 2020

Well, can you?

If your exam is brief, can it be comprehensive? If it’s comprehensive, will you be able to get through all of the patients on your schedule?

These are some practical questions that most of us in the world of sports medicine struggle with.

I’m looking at my clinic schedule tomorrow, and I have 15 minutes for most patients; for new concussed patients I’m ‘given’ 30 minutes.

Most of us know these clinic slots are a Procrustean bed – there really is little chance we can fit the patient and their needs, as well as our obligation to diagnose and manage the injury, in these time frames.

M. Nadir Haider, M.D.

Good news, then – authors from the University of Buffalo Concussion Management Clinic have just produced a Practical Management article that promises to make your approach much more efficient when you next see a clinic patient with a sports related concussion (SRC).

The first and corresponding author of this manuscript, M Nadir Haider, M.D., is our guest on the newest CJSM blog post. Dr. Haider is affiliated with the Jacobs School of Medicine, State University of New York (SUNY), Buffalo where he is an Assistant Professor of Orthopedics and Sports Medicine and the Assistant Director of Research at the University Concussion Management Clinic. Many of the readers of CJSM and listeners of the podcast will be familiar with the voluminous research that comes out of the SUNY, Buffalo center.  This work has been transformative in the area of SRCs.

Listen in on our conversation, where Dr. Haider walks us through the evidence-based exam, and then go to the September 2020 CJSM where you will find the Practical Management article itself, currently free of charge.

As always you can find the podcast on our journal website, or you may go to iTunes to listen in and subscribe as well.

Any way you read, listen or engage with CJSM, we are happy you are part of our sports medicine community.

Filed under CJSM Podcasts, Concussion in Sport, General Interest

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

September 8, 2020

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

Filed under Concussion in Sport, Exercise Medicine, Journal Club Tagged with

The warrior athlete in 2020 — sports and military medicine in the era of COVID-19

July 13, 2020

Francis O’Connor MD, MPH (L) and Daniel Fosselman D.O. (R)

We have two special guests for our most recent podcast. This episode explores the impact of the novel SARS-CoV-2 on the clinicians in our world who have one foot in military medicine and the other in sports medicine.

Two physicians who care for ‘warrior athletes’ join us for this special podcast:  Francis O’Connor MD, MPH, Retd. Col. US Army and Daniel Fosselman D.O., Capt. US Army Reserve.

Dr. O’Connor is, among many other things, a past-President of the American Medical Society for Sports Medicine (AMSSM) and a current Professor at the Uniformed Services University of the Health Sciences in Bethesda, MD.  He is also the Medical Director of the Consortium for Health and Military Performance at the University, and he shares with us in the podcast the challenges of keeping a force of soldiers at the ready during this pandemic.  Dr. O’Connor like many is working through the intricacies of teaching over Zoom and is coming to grips with the impact of the virus on issues ranging from quarantine to ‘return to play’.  He reminds us that resting indefinitely on the sideline or playing in a ‘bubble’ are not options when it comes to national security.

Dr. Fosselman is a young sports medicine clinician who had just started his career in central Ohio in primary care sports medicine and family medicine when, as a Captain in the US Army Reserve, he was called up for duty.  We caught up with him as he was nearing the end of his two-week quarantine, which came on the tail of end of many weeks of service on the true front lines of the battle with this new foe:  in the hospitals of the Bronx, in the midst of the COVID spike that devastated the NYC area this spring.  His story is one of true service to patients and to his country. Read more of this post

Filed under CJSM Podcasts, COVID-19, Military Medicine Tagged with ,

CJSM July Blog Post Journal Club — A Physical Activity Vital Sign

July 9, 2020

Our Jr. Associate Editor and Journal Club Author, Dr. Jason Zaremski, sporting the contemporary COVID-era look

Our July 2020 issue has just published, and it’s full of many important new position statements and original research publications.

Among the latter is an investigation of a physical activity ‘vital sign’ and its association with cardiometabolic disease.

As always, our Jr. Associate Editor Jason Zaremski, MD will walk us through the study in this edition of the CJSM Blog Post Journal Club.

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Jason Zaremski, MD — Jr. Associate Editor, CJSM

Title: Nelson VR, Masocol RV, Ewing JA, Johnston S, Hale A, Widederman M, Asif IM. Association Between a Physical Activity Vital Sign and Cardiometabolic Disease in High-Risk Patients. Clinical Journal of Sport Medicine: July 2020 – Volume 30 – Issue 4 – p 348-352. doi: 10.1097/JSM.0000000000000588.

Introduction:  The challenges posed by the COVID pandemic are legion.  A less publicized aspect of ‘stay home’ or ‘shelter-in-place’ orders has been the reduction in physical activity in all ages. This new publication by Nelson VR et al. examining a physical activity vital sign (PVS) arrives in the pages of CJSM at just the right time.

Physical inactivity is known to be associated with increased rates of cardiovascular disease, cancer, and increased mortality rates. The ability of physicians to potentially screen patients using efficient means during clinical encounters could be extremely helpful to improve measures of all cause morbidity and mortality of patients.

This month’s journal club focuses on this interesting new study assessing the use of a PAVS and its correlation with cardiometabolic markers and disease in medically complex patient population in a large family medicine clinic in South Carolina. Read more of this post

Filed under Exercise Medicine, Journal Club

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