Asha De Fre­itas-Mose­ley

As an ath­let­ic train­er, the first re­spon­der role falls with­in our scope of pro­fes­sion­al du­ties. It is one of the ways that ath­let­ic train­ers stand unique from oth­er sports spe­cif­ic pro­fes­sions. While a game is go­ing on and most peo­ple would be look­ing on for en­ter­tain­ment pur­pos­es, the cer­ti­fied ath­let­ic train­er is work­ing dur­ing this time alert to in­ci­dences of in­jury.

In­ci­dences of mild trau­mat­ic brain in­jury (mT­BI) are one that can be eas­i­ly mis­han­dled by un­trained per­sons. This in­cludes, but is not lim­it­ed to, in­ci­dences of con­cus­sions or frac­tures to the skull. Be­ing able to prop­er­ly as­sess an ath­lete who may have sus­tained such in­jury is im­por­tant to lim­it any long-term ef­fects, par­tic­u­lar­ly with chil­dren and ado­les­cents where symp­toms can of­ten be pro­longed.

In Zurich, No­vem­ber 2012, the 4th In­ter­na­tion­al Con­fer­ence on Con­cus­sion in Sport was held. The 2012 Zurich con­sen­sus state­ment that came out of this is de­signed to build on al­ready ex­ist­ing prin­ci­ples as well as "to de­vel­op fur­ther con­cep­tu­al un­der­stand­ing of this prob­lem us­ing a for­mal con­sen­sus-based ap­proach." It is a re­flec­tion of the some­what com­plex na­ture of deal­ing with head trau­ma and con­cus­sions, which is why, as ath­let­ic train­ers, we are al­ways con­scious of the need to keep up with the lat­est state­ments and trends in head in­jury man­age­ment.

The third world ap­proach in Trinidad to this as­pect of sport is very ob­vi­ous, the main rea­son for this be­ing lim­it­ed re­sources. Still, there are cost ef­fec­tive ways of ad­dress­ing some of the ba­sic med­ical needs, par­tic­u­lar­ly when it comes to high con­tact sports, with just the pres­ence of a sin­gle prop­er­ly trained med­ical pro­fes­sion­al such as an ath­let­ic train­er and/or physi­cian.

Ac­cord­ing to the new 2012 Zurich Con­sen­sus state­ment, a con­cus­sion is a sub­set of trau­mat­ic brain in­jury (TBI) and it is de­fined as "a com­plex patho­phys­i­o­log­i­cal process af­fect­ing the brain, in­duced by bio­me­chan­i­cal forces." It can be brought on by a di­rect blow to the head, neck or face re­gion or to the body with force trans­mis­sions to the head. The symp­toms of a con­cus­sion can be im­me­di­ate or they can evolve over a pe­ri­od of min­utes to hours and there­in lays the skill of this area of ath­lete in­jury man­age­ment.

As an ath­let­ic train­er cov­er­ing a game, there are a num­ber of fac­tors that are con­sid­ered when deal­ing with an ath­lete who has sus­tained pos­si­ble in­jury to the head. Aside from the ob­vi­ous one be­ing the gen­er­al health and well-be­ing of the ath­lete, there are al­so the ac­cess lim­i­ta­tions as dic­tat­ed by the rules and time-con­sid­er­a­tions of the sport.

If un­sure of how to han­dle the sit­u­a­tion it can lead to er­ror. When fans, ref­er­ees, coach­es and ath­letes are all watch­ing, in a very time sen­si­tive sit­u­a­tion where symp­toms of a pos­si­ble con­cus­sion may not have yet start­ed to show, the pres­sure and stress of the sit­u­a­tion can be over­whelm­ing. This is why pub­li­ca­tions such as these put out by the In­ter­na­tion­al Con­fer­ence on Con­cus­sion in Sport are so valu­able.

Clin­i­cal symp­toms fol­low­ing con­cus­sions are grad­ed and 80 per cent to 90 per cent of the time, they last a pe­ri­od of sev­en to ten days (in chil­dren and ado­les­cents this may be longer). Symp­toms can in­clude any one or more of the fol­low­ing:

a) Phys­i­cal as with loss of con­scious­ness or am­ne­sia.

b) Be­hav­ioral as with an ir­ri­ta­ble dis­po­si­tion.

c) Cog­ni­tive as with de­layed re­ac­tion time.

d) Sleep dis­tur­bance as with in­som­nia.

Med­ical as­sess­ments in­clude a com­pre­hen­sive his­to­ry and a de­tailed neu­ro­log­i­cal ex­am­i­na­tion which can start with some­thing as man­u­al as em­ploy­ing a "Pock­et Con­cus­sion Recog­ni­tion Tool" and as­sess­ing cog­ni­tive func­tion, gait and bal­ance in the ath­lete to in­volv­ing neu­ropsy­chol­o­gists for more thor­ough men­tal as­sess­ments.

The "Pock­et Con­cus­sion Recog­ni­tion Tool" is a struc­tured check­list sys­tem that is en­dorsed by the Fed­er­a­tion In­ter­na­tionale de Foot­ball As­so­ci­a­tion (Fi­fa), In­ter­na­tion­al Olympic Com­mis­sion ( IOC), In­ter­na­tion­al Rub­gy Board (IRB), and In­ter­na­tion­al Ice Hock­ey Fed­er­a­tion (IIHF) all bod­ies that are very in­volved in var­i­ous forms of knowl­edge trans­fer on the top­ic of con­cus­sion man­age­ment and re­turn to play prin­ci­ples.

Rug­by in­ter­ests seems to be in­creas­ing in Trinidad while re­search stud­ies demon­strate that up­per limb-to-head con­tact as with head­ing con­tests ac­count for about 50 per cent of con­cus­sions in sport. In an ef­fort to re­main proac­tive, our lo­cal ini­tia­tives need to re­main in sync with these re­al­i­ties, in­creas­ing aware­ness for con­cus­sions and mT­BI on the whole.

Asha De Fre­itas-Mose­ley is a cer­ti­fied ath­let­ic train­er with the Na­tion­al Ath­let­ic Train­ers' As­so­ci­a­tion of the USA. She has over ten years of ex­pe­ri­ence re­ha­bil­i­tat­ing ath­letes and mem­bers of the ac­tive pop­u­la­tion from in­jury to full play. She can be reached at Pulse Per­for­mance Ltd., lo­cat­ed at #17 Hen­ry Pierre Street, St James. Tel: 221-2437.

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