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The prevention and management of concussion in Australian football
The prevention and management of concussion in Australian football P McCrory Dept of Neurology, University of Melbourne, Melbourne Austin & Repatriation Medical Centre, Melbourne Objective: Concussion is a problem common to all collision sports. In Australian football during the period 1992 to 1997 inclusive, the rate of concussive injuries increased from 2 per 1000 hours to 4.7 per 1000 player hours. The reasons for this increase in injury prevalence are unknown. Concussion injury prevention strategies have traditionally relied on rule enforcement and strict penalties for illegal plays. This study has identified that only 5% of concussive injuries may be attributed to such mechanisms, thus the likely effect of such strategies is small. This paper will discuss the current research strategies employed in Australian football to prevent concussive injury and its sequelae.
Methods: Study l:
All concussions are prospectively analysed using computerised videoanalysis. The injury mechanisms are determined and injury outcome variables (duration of loss of consciousness, convulsions, time to return to sport, clinical and neuropsychological (NP) deficits) are then analysed using logistic regression. Concussive sequelae such as tonic posturing, righting, cerebral oedema and impact convulsions are identified and their specific risk factors and outcomes determined.
Study 2:
Serial NP testing using a scientifically validated test battery is used to assess players on the day of injury and to determine recovery in order to safely guide return to play. The NP test battery includes questions of memory, digit symbol substitution, trails B and choice reaction time.
Results: The data shows that head to head contact produces a significantly worse outcome and contact to the face is associated with the convulsive manifestations of concussion. The various convulsive manifestations are demonstrated to have a benign outcome. The NP tests have also shown that there is no evidence over a 13 season time flame that cumulative damage occurred from repeated concussions.
Conclusions: This study suggests that helmets may have a role to play in injury prevention. This determination of impact force and velocity from the videoanalysis provides a scientific basis for determination of helmet material requirements. Using a variety of research methods, the prevention and management of concussion in Australian football is moving into an era of evidence-based medicine.
55.
Methods: Study l:
All concussions are prospectively analysed using computerised videoanalysis. The injury mechanisms are determined and injury outcome variables (duration of loss of consciousness, convulsions, time to return to sport, clinical and neuropsychological (NP) deficits) are then analysed using logistic regression. Concussive sequelae such as tonic posturing, righting, cerebral oedema and impact convulsions are identified and their specific risk factors and outcomes determined.
Study 2:
Serial NP testing using a scientifically validated test battery is used to assess players on the day of injury and to determine recovery in order to safely guide return to play. The NP test battery includes questions of memory, digit symbol substitution, trails B and choice reaction time.
Results: The data shows that head to head contact produces a significantly worse outcome and contact to the face is associated with the convulsive manifestations of concussion. The various convulsive manifestations are demonstrated to have a benign outcome. The NP tests have also shown that there is no evidence over a 13 season time flame that cumulative damage occurred from repeated concussions.
Conclusions: This study suggests that helmets may have a role to play in injury prevention. This determination of impact force and velocity from the videoanalysis provides a scientific basis for determination of helmet material requirements. Using a variety of research methods, the prevention and management of concussion in Australian football is moving into an era of evidence-based medicine.
55.