tag:theconversation.com,2011:/global/topics/collision-sports-5298/articlesCollision sports – The Conversation2015-01-16T10:58:00Ztag:theconversation.com,2011:article/353042015-01-16T10:58:00Z2015-01-16T10:58:00ZConcussions aren’t only a medical issue<figure><img src="https://images.theconversation.com/files/68316/original/image-20150106-18632-18u1cou.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is there more to the concussion crisis than what the science can tell us? </span> <span class="attribution"><a class="source" href="http://upload.wikimedia.org/wikipedia/commons/5/58/2006_Lone_Star_Showdown_Colt_McCoy_injured.jpg">Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The sports media has a fascination with concussions. Not only is there a huge volume of stories about the issue, but there’s also an urgency to the tone of the reporting. The heightened coverage has served to increase awareness of the concussion problem and encourage public debate about sport, health and safety. </p>
<p>But what’s often missing from the media’s discussion of the topic is a recognition that the concussion problem is not merely a health issue: it’s also a <em>social issue</em>. We’re generally less inclined to look at how concerns about head injuries influence our understanding of ourselves and the identities of others.</p>
<p><a href="http://www.basijcssc.ir/sites/default/files/Sport,%20Culture%20and%20Society%20An%20Introduction.pdf">Sport plays a significant role in our culture</a>. It’s used as a lens to discuss what it means to be a man or woman, how to belong to a nation or community, or how hard work can overcome long odds. </p>
<p>Shouldn’t our conversations about a topic that could change the very nature of sport also consider these social and cultural issues? </p>
<p>The absence of social commentary stems from a tendency in the mainstream media to frame concussions as a science and technology problem. Scientists have undertaken essential research that has helped us learn about what happens to the brain after a concussion. Meanwhile, groundbreaking <a href="http://leagueofdenial.com/">investigative reports</a> and <a href="http://www.imdb.com/title/tt2239400/">documentaries</a> have made the results of this research accessible to the general population to the point where the symptoms of <a href="http://www.bu.edu/cte/about/what-is-cte/">Chronic Traumatic Encephalopathy</a> have become part of everyday dialogue about sport. </p>
<p>The media is also keen to cover the latest <a href="http://time.com/3190/some-helmets-better-than-others/">technological breakthrough</a> for new <a href="http://www.usatoday.com/story/sports/ncaaf/2013/07/30/concussions-college-football-nfl-guardian-caps/2601063/">“concussion-resistant” helmets</a>, but just as quick to report on <a href="http://espn.go.com/espn/otl/story/_/id/9228260/report-warned-riddell-no-helmet-prevent-concussions-nfl-helmet-maker-marketed-one-such-anyway">rulings </a>requiring companies to <a href="http://www.theglobeandmail.com/report-on-business/industry-news/the-law-page/bauer-agrees-to-back-off-claims-of-concussion-protection/article21571129/">withdraw claims</a> about the superior protection offered by their products. The bulk of the coverage of concussions in the media seems to be organized around one basic understanding: to solve the “concussion crisis” and make sports safer, <em>we simply need better science</em>. </p>
<p>I certainly don’t want to downplay the scientific advances made by concussion researchers or claim to know more about the brain than neuroscientists. But as the media places so much emphasis on the science behind the concussion debates, important cultural factors are left largely untouched. </p>
<p>One of these factors involves how we make sense of the concussion problem within the hyper-masculine culture of many sports. Most commentators will concede that the era of shaking off a head injury as “getting your bell rung” is over. But the concussion issue should force us to <a href="http://jmm.sagepub.com/content/15/2/152.abstract">re-think</a> the value systems that make violence and playing through pain manly symbols of toughness.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/68135/original/image-20150103-8229-1fubrjc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/68135/original/image-20150103-8229-1fubrjc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/68135/original/image-20150103-8229-1fubrjc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/68135/original/image-20150103-8229-1fubrjc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/68135/original/image-20150103-8229-1fubrjc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/68135/original/image-20150103-8229-1fubrjc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/68135/original/image-20150103-8229-1fubrjc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Gender plays an important role in how concussions occur, are diagnosed and are treated.</span>
<span class="attribution"><a class="source" href="http://commons.wikimedia.org/wiki/File:USA-Womens-Hockey-Olympics-2.jpg">Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>Ideas about gender even influence how we define the scope of the concussion problem. There are important gender differences, for example, in how often athletes report head injuries, with women tending to report at <a href="http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2813%2970287-4/fulltext?rss=yes">significantly higher</a> rates than men. <a href="http://theallrounder.co/2014/10/01/from-neurons-to-neighborhoods-how-to-think-about-concussions-and-sports/">Some</a> <a href="http://blogs.scientificamerican.com/mind-guest-blog/2014/11/24/concussion-culture-how-to-protect-young-athletes/">analysts</a> have pointed to how men could be more likely to “play through” a concussion to live up to masculine ideals of toughness. These same stereotypes might also lead coaches and trainers to be more attuned to the head injuries of female athletes. </p>
<p>In addition to gender, socioeconomic status may influence reporting rates – as well as which athletes choose to play violent sports. When NFL defensive back Richard Sherman <a href="http://mmqb.si.com/2013/10/23/richard-sherman-seahawks-concussions-in-the-nfl/">spoke out</a> about changes to the NFL’s concussion protocol last season, he made strong statements about the role that socioeconomic status plays in how people would react to the concussion problem. Sherman wrote, “People are always going to play football, and if higher income families choose to pull their kids out of the sport, it will only broaden the talent pool, giving underprivileged kids more opportunities to make college rosters.” </p>
<p>Similarly, safety Brandon Meriweather made waves later that season by <a href="http://www.nfl.com/news/story/0ap2000000274670/article/brandon-meriweathers-remarks-resonate-with-players-coaches">claiming</a> that the league’s new concussion rules force defensive players to hit opponents low rather than head on. Meriweather went on to say that the new rules meant he would have no choice but to hit players in the knees, “tear people’s ACLs” and “end people’s careers” (he’s assuming, apparently, that a concussion is less likely to end a player’s career than a torn knee ligament). </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/68136/original/image-20150103-8229-1utxfzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/68136/original/image-20150103-8229-1utxfzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=415&fit=crop&dpr=1 600w, https://images.theconversation.com/files/68136/original/image-20150103-8229-1utxfzm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=415&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/68136/original/image-20150103-8229-1utxfzm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=415&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/68136/original/image-20150103-8229-1utxfzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=522&fit=crop&dpr=1 754w, https://images.theconversation.com/files/68136/original/image-20150103-8229-1utxfzm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=522&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/68136/original/image-20150103-8229-1utxfzm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=522&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Richard Sherman’s comments about concussions shed some important light on how the problem is experienced by those of different socioeconomic classes.</span>
<span class="attribution"><a class="source" href="http://commons.wikimedia.org/wiki/File:Richard_Sherman_vs._Redskins_2014.jpg">Keith Allison/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>You don’t have to agree with Sherman or Meriweather to recognize that the concussion issue relates to people’s work and careers, and athletes from a lower socioeconomic class might think they have more at stake than someone with a more privileged upbringing. Beyond the medical ramifications of concussions, it’s important to look at how being diagnosed with a concussion might (or might not) be perceived as affecting an athlete’s career or financial goals. This applies to professional athletes, but also rings true for <a href="http://mmqb.si.com/2013/10/24/nfl-draft-concussions-jahvid-best/">aspiring professional athletes</a> or those with <a href="http://www.usatoday.com/story/sports/college/2013/11/20/ncaa-concussion-testing-scholarships-joyce-beatty-charles-dent/3654673/">athletic scholarships</a>. Even at the youth or recreational levels, how concussions are diagnosed and treated can be influenced by an athlete’s access to health care or his or her ability to take time off from work or school. </p>
<p><a href="http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health">Social determinants of health</a> – the social and economic factors that impact health for different groups of people – need to become a bigger part of the way we talk about concussions. Yes, policy and rule changes are important, but so is looking at how the media packages this issue for consumers. </p>
<p>This involves admitting that there might be limits to what folks in white coats can tell us from looking at brain scans or tissue slides. The conversation needs to shift from the comfortable confines of the lab and into the messy world of identity and politics. Only then will the thousands of athletes, coaches, and parents affected by concussions have a clearer picture of how complex the solutions to this problem might actually be.</p><img src="https://counter.theconversation.com/content/35304/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matt Ventresca does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The sports media has a fascination with concussions. Not only is there a huge volume of stories about the issue, but there’s also an urgency to the tone of the reporting. The heightened coverage has served…Matt Ventresca, PhD Candidate, School of Kinesiology and Health Studies, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/349642015-01-05T10:54:53Z2015-01-05T10:54:53ZWhat every parent should know about concussions<figure><img src="https://images.theconversation.com/files/67396/original/image-20141216-14144-1fmodw7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Watch your head. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&searchterm=kids%20and%20sports&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=103514210">Soccer players via Wallenrock/Shutterstock.</a></span></figcaption></figure><p>This fall, the deaths of <a href="http://www.cnn.com/2014/10/02/us/new-york-football-player-death/">three high school football players</a> were linked to direct head injuries on the field of play and one collegiate football player’s <a href="http://www.si.com/college-football/2014/12/05/kosta-karageorge-ohio-state-death">death</a> has been potentially attributed to unresolved post concussion syndrome. Even though these athletes were football players, any sporting or recreational events can pose a risk for concussions and head injuries.</p>
<p>Despite the tragic news recently associated with sport, the amazing outcomes of sport participation grossly outweigh the negative consequences of injuries. But injuries should not be considered as just a part of the game, especially when an injury to the brain occurs. </p>
<p>I have been an athletic trainer for sports of all levels for over two decades. And over the past four years, I have fielded more questions from friends and family members about concussions than any other injury during my career. It has become clear to me that parents of youth athletes and their families still need more information about the definition of concussions and symptoms to look for, as well as the appropriate treatment protocols. </p>
<p>Families should know the first step is understanding what makes a child’s brain unique. Then, parents must be ready to take steps to spot concussions and take action.</p>
<h2>What makes a child’s brain unique</h2>
<p>Concussions are a type of mild traumatic brain injury and are considered to result from a traumatic shaking of the brain. They can cause acute and long-term changes in brain physiology and function including cognition. And for children with developing brains, they can be especially dangerous.</p>
<p>Children have smaller brains in relation to their skulls. Compared to an adult, the young child <a href="http://www.sciencedirect.com/science/article/pii/S0022347603001161">brain</a> has less mass and more cerebrospinal fluid between the brain and the skull. By way of analogy the child’s brain is like the egg yolk in an egg – there is room for it to move. Because children’s brains have less mass in relation to the skull, their brains experience more acceleration. This means the brain can hit the skull with more force. </p>
<p>A child’s brain also appears to be far more plastic or impressionable than the <a href="http://www.sciencedirect.com/science/article/pii/S1751616111002475">adult brain</a>. This helps during maturation, but can have negative effects associated with brain injury because the child’s brain is less resistant to trauma. </p>
<p>We can’t fix brain injuries like we can fix damage done to ligaments and bones. Therefore, it is important for parents to be protective when it comes to their children’s brains and to be aware of the potential long-term effects a concussion can have on normal brain development. </p>
<h2>Recognizing signs and symptoms</h2>
<p>Recent <a href="http://journals.lww.com/jtrauma/Abstract/2014/09001/Knowledge_assessment_of_sports_related_concussion.5.aspx">research</a> has shown that parents had misconceptions regarding the definition, symptoms and treatment about concussions. </p>
<p>They didn’t know that concussions can occur from trauma other than a blow to the head and that concussions are considered traumatic brain injuries. They also did not readily recognize key symptoms of concussions including irritability and sleeping difficulties and incorrectly identified arm and leg weakness or numbness as signs, which they are not. </p>
<p>Parents are in a prime position to recognize the signs and symptoms of a concussion in their child. The culture of sport encourages children to play and win so a child will often hide symptoms from medical practitioners. But parents are able to pick up on the subtle signs of problems associated with a previous concussion. Signs and symptoms are usually classified into <a href="http://bjsm.bmj.com/content/47/1/15.short">four categories</a> including physical, cognitive, emotional and sleep patterns. </p>
<p>The physical signs and symptoms include, but are not limited to, headache, loss of consciousness, dizziness or balance problems, numbness, tingling, fatigue, visual problems, diminished pupil reaction, dazed or stunned expressions, ringing of ears, sensitivity to light and noise, and vomiting. </p>
<p>The cognitive responses include mental slowing or fogginess and the emotional signs and symptoms include irritability, uncharacteristic actions, anxiety, sadness and depression.</p>
<p>Sleep pattern changes including excessive drowsiness, trouble falling asleep and altered patterns of sleep and wakefulness are also common. </p>
<h2>Return to play and return to learn</h2>
<p>Unfortunately, the return to play and return to learn (or classroom) guidelines are not widely understood by parents because of communication gaps in the medical community. If children are treated by emergency room physicians or pediatricians these professionals are often not trained in the long-term management of concussions. This means that children often return to school or athletics too soon.</p>
<p>Often the focus for a child athlete is mainly on return to play but equally important is the return to learn or the classroom and academics. The cornerstone for both the return to play and return to learn plans are REST – physical and cognitive. A child must rest by limiting physical and mental activity (this means reading, TV, games, texting and computer time). </p>
<p>Concussions can cause a metabolic crisis for the brain because blood flow and glucose delivery are impaired. The brain needs energy to function normally and to heal itself, and these metabolic changes mean the active brain may not get as much energy as it normally needs to function properly. This is why rest is important to recovery. </p>
<p>Children with concussions symptoms should be removed from the classroom and provided with work to do at home. Work sessions should remain short with <a href="http://www.ubortho.buffalo.edu/concussion/4109ReturnToLearn.pdf">frequent breaks</a> When a child is able to read for 30 minutes without increasing signs or symptoms then a progressive return to school can begin (half days to full days). Resuming physical activity should be <a href="http://bjsm.bmj.com/content/47/1/15.short">progressive</a> as well.</p>
<p>Following these guidelines can help parents to be protective of their children’s brains and potentially prevent long-term effects or tragic consequences.</p><img src="https://counter.theconversation.com/content/34964/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cindy Trowbridge does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>This fall, the deaths of three high school football players were linked to direct head injuries on the field of play and one collegiate football player’s death has been potentially attributed to unresolved…Cindy Trowbridge, Associate Professor, Department of Kinesiology, University of Texas at ArlingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/176862013-09-11T04:35:18Z2013-09-11T04:35:18ZNFL settlement fails to address impact of collision sports<figure><img src="https://images.theconversation.com/files/31143/original/4526nc9v-1378866111.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The US$10 million allocated to chronic trauma encephalopathy research in the NFL settlement will not explain what this does to the brain.</span> <span class="attribution"><span class="source">LARRY W. SMITH/AAP</span></span></figcaption></figure><p>The US National Football League (NFL) recently paid <a href="http://nfllabor.files.wordpress.com/2013/08/press-release-2.pdf">US$765 million</a> to settle a lawsuit with former players who claimed repeated head injuries and concussions while playing the sport led to brain degenerative diseases.</p>
<p>The impact of “collision sports” has recently been getting attention in Australia as well and the settlement has interesting implications for local football codes.</p>
<p>Despite its small population, Australia sustains four different professional football codes, three of which have been described as “collision sports” - Australian Rules Football (AFL), rugby league, and rugby union. </p>
<p>In the United States, the NFL overshadows all other professional sports in terms of revenue, average attendance and television ratings. But the recent history of American football has been plagued by controversy about the effects of repeated concussions and head injuries.</p>
<h2>The US case</h2>
<p>In 2012, a class action lawsuit against the NFL was filed on behalf of more than 4,500 former players. You can read the full complaint <a href="http://nflconcussionlitigation.com/wp-content/uploads/2012/01/Master_Administrative_Long_Form_Complaint.pdf">here</a>. </p>
<p>Among the most serious allegations made in the “concussion lawsuit” were that: </p>
<ul>
<li>the NFL hid and misrepresented evidence about the long-term neurological effects of football-related head injuries; </li>
<li>the NFL was aware of the neurological risks of playing football but deliberately failed to warn players; and </li>
<li>the NFL funded a “falsified body of scientific research” that was conducted by its concussion advisory committee with the intention of raising doubts about independent evidence of the long-term effects of head injuries.<br></li>
</ul>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/31158/original/f49qvn4h-1378872382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/31158/original/f49qvn4h-1378872382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=454&fit=crop&dpr=1 600w, https://images.theconversation.com/files/31158/original/f49qvn4h-1378872382.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=454&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/31158/original/f49qvn4h-1378872382.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=454&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/31158/original/f49qvn4h-1378872382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=571&fit=crop&dpr=1 754w, https://images.theconversation.com/files/31158/original/f49qvn4h-1378872382.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=571&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/31158/original/f49qvn4h-1378872382.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=571&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Players of sports in the Australian football codes have some of the highest rates of concussion of any team sports worldwide.</span>
<span class="attribution"><span class="source">Patrick Hamilton/AAP</span></span>
</figcaption>
</figure>
<p>After failing to have the lawsuit dismissed, the NFL agreed to settle the case for <a href="http://nfllabor.files.wordpress.com/2013/08/press-release-2.pdf">US$765 million</a>. This may sound like a lot of money but it’s less than 10% of the NFL’s annual revenue of more than <a href="http://money.cnn.com/2013/02/01/news/companies/nfl-money-super-bowl/index.html?iid=EL">US$9 billion</a>.</p>
<h2>An easy settlement</h2>
<p>The NFL lawyers probably considered it to be a good price for reducing the cost of fighting the case and risking a much larger payout.</p>
<p>It also means the NFL avoided a forensic examination of its alleged deception. And it achieved these benefits without admitting liability or “that plaintiffs’ injuries were caused by football”.</p>
<p>The players also had good reasons to settle. The payout means players with “cognitive injuries” (which are yet to be defined) will be able to access compensation (US$675 million) and obtain money for medical examinations (US$75 million) sooner than if the case had continued. </p>
<p>If it had proceeded to a jury trial, the players may have received more money but they could also have lost, and received nothing.</p>
<h2>Unanswered questions</h2>
<p>One major weakness of the settlement is the small amount allocated to research and the lack of information on how the independence of any such work will be assured. </p>
<p>Well-designed, independent, and credible research is essential to resolve uncertainty about the seriousness and prevalence of the type of brain damage claimed to be produced by repeated concussions and head injuries. </p>
<p>At present, we only have several dozen postmortem examinations reporting evidence of trauma-related brain degeneration in some former American footballers - called <a href="http://www.ncbi.nlm.nih.gov/pubmed/23208308">chronic traumatic encephalopathy</a>, or CTE. Indeed, the condition is currently only diagnosed after death. </p>
<p>The most recent <a href="http://bjsm.bmj.com/content/47/5/250.short">consensus statement</a> about such injuries by the 4th International Conference on Concussion in Sport held in Zurich, November 2012 stated that: </p>
<blockquote>
<p>a cause and effect relationship has not as yet been demonstrated between CTE and concussions or exposure to contact sports.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/31159/original/f7swtbq3-1378872618.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/31159/original/f7swtbq3-1378872618.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/31159/original/f7swtbq3-1378872618.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/31159/original/f7swtbq3-1378872618.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/31159/original/f7swtbq3-1378872618.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/31159/original/f7swtbq3-1378872618.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/31159/original/f7swtbq3-1378872618.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/31159/original/f7swtbq3-1378872618.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Well-designed, independent, and credible research is essential for a better understanding of the type of brain damage produced by repeated concussions and head injuries.</span>
<span class="attribution"><span class="source">Jeff Crow/AAP</span></span>
</figcaption>
</figure>
<h2>In Australia</h2>
<p>Medical officers from the Australian AFL and NRL have downplayed the implications of these US case studies for their sports. In 2012, for instance, the <a href="http://www.smh.com.au/afl/afl-news/us-concussion-study-may-not-apply-to-afl-doctor-20120603-1zq6h.html">director of the AFL Medical Officers Association</a> Hugh Seward said:</p>
<blockquote>
<p>We’ve got no evidence to suggest that the condition we’re seeing in America from multiple head knocks is akin to what we see in Australian football. We have no evidence that CTE is an issue, and the long-term brain damage that they’re talking about in America may not exist in Australia.</p>
</blockquote>
<p>And an <a href="http://www.abc.net.au/4corners/stories/2012/05/10/3499950.htm">NRL doctor</a> has said:</p>
<blockquote>
<p>I think that we need to be pretty careful how we interpret the Boston stuff [CTE case studies from Boston University]. The aim of their game is to actually crash into each other with their heads, so potentially players are being concussed. We don’t have any such thing in our game.</p>
</blockquote>
<p>But, so far, there have been no studies of former players from Australian football codes, even though they have some of the <a href="http://www.ncbi.nlm.nih.gov/pubmed/19204366">highest rates of concussion</a> in any team sports worldwide. </p>
<p>The meagre US$10 million allocated by the NFL settlement for research has a limited capacity to shine a brighter scientific light on: </p>
<ul>
<li>the precise nature of CTE and how to diagnose it while players are still alive;</li>
<li>the risk factors for its occurrence; and </li>
<li>the prevalence of the condition and other related conditions among football players. </li>
</ul>
<p>This is crucial information for all contact sports, not just American football. </p>
<p>It may be timely for Australian football codes to consider ways of facilitating research into CTE and other long-term effects of repeated concussion. But this work needs to be truly independent of the codes if it is to avoid criticism about conflicts of interest on the part of those conducting the research.</p><img src="https://counter.theconversation.com/content/17686/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bradley Partridge receives funding from the NHMRC and ARC.</span></em></p><p class="fine-print"><em><span>Wayne Hall does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The US National Football League (NFL) recently paid US$765 million to settle a lawsuit with former players who claimed repeated head injuries and concussions while playing the sport led to brain degenerative…Bradley Partridge, Postdoctoral Research Fellow in Public Health, The University of QueenslandWayne Hall, Professor & Deputy Director (Policy) UQ Centre for Clinical Research, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/131032013-04-17T04:38:30Z2013-04-17T04:38:30ZSport concussion guidelines rife with conflicts of interest<figure><img src="https://images.theconversation.com/files/22457/original/hjt9hq3z-1366005091.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Collision sports such as AFL have adopted concussion management policies because it's an unavoidable feature of the games.</span> <span class="attribution"><span class="source">AAP Image/David Crosling</span></span></figcaption></figure><p>Athletes and officials in charge of collision sports (such as rugby league, AFL and American football) have an uneasy relationship with concussion; it’s an unavoidable feature of their games and there’s considerable debate about its short and long-term health effects. But the recent focus on concussion has also highlighted conflicts of interest in its management.</p>
<p>Because these codes cannot eliminate concussion, the <a href="http://www.nrl.com/About/ReferenceCentre/ManagementofConcussioninRugbyLeague/tabid/10798/Default.aspx">National Rugby League (NRL)</a>, the <a href="http://www.aflcommunityclub.com.au/fileadmin/user_upload/Manage_Your_Club/3._Club_Management_Program/9._Football_Operations/Trainers/Injury_Management/Management_of_Concussion/Concussion_Man_v7.pdf">Australian Football League (AFL)</a>, and the US <a href="http://www.nfl.com/">National Football League</a> (NFL) have all adopted concussion management policies that claim to protect the health and well-being of their players. </p>
<p>These policies involve using computerised neuropsychological (CNP) tests of memory and reaction time to assess the effects of concussion. In Australia and the United States, the most popular of these concussion tests are marketed by the companies <a href="http://www.impacttest.com/">ImPACT</a> and <a href="http://www.axonsports.com/index.cfm">CogState/Axon</a>. </p>
<p>Typically (but not always), an athlete is given a “baseline test” at the start of a sporting season and, if he sustains a head injury, his initial results are compared with a follow-up test to determine when he has sufficiently recovered to return to play. These tests are used by elite teams and their use is now being mandated every year by amateur and youth players across the globe. </p>
<p>The major corporate sponsor of the AFL, Toyota, has even agreed to provide CogState/Axon testing for a large number of <a href="http://www.axonsports.com/index.cfm?pid=91&pageTitle=Toyota-Good-For-Footy">youth clubs</a>.</p>
<h2>Concussion management policies</h2>
<p>The major justification for concussion management polices has been provided by a global “consensus statement” for managing concussion in sport. These guidelines were first drafted by an expert panel in <a href="http://www.ncbi.nlm.nih.gov/pubmed/11867482">2001</a>, updated at conferences in <a href="http://www.ncbi.nlm.nih.gov/pubmed/15793085085">2004</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/19433429">2008</a>, and most recently in <a href="http://www.ncbi.nlm.nih.gov/pubmed/23479479">2012</a>. </p>
<p>Over the last decade, neuropsychological concussion tests have been described by these guidelines as contributing significant clinical value to concussion evaluation, and even as a “cornerstone of concussion management”. </p>
<p>On the face of it, these policies seem designed to protect players from suffering the serious consequences of head injuries. But a closer examination of how they were developed reveals financial and professional conflicts of interest among experts who have recommended their use to manage concussion. </p>
<p>Some experts involved in their development have been members of panels at consensus conferences on the management of concussion. And companies that own and market these tests have been major funders of published research used to support using the tests. </p>
<p>Authors of the publications have included employees or part-owners of the companies and physicians who have received research support or been paid consultants to the companies. Some of these experts have also advised <a href="http://www.ncbi.nlm.nih.gov/pubmed/19130254">professional football leagues</a> on the management of concussion.</p>
<p>It can be difficult to assemble clinical expert panels free of conflicts of interest but when this is not possible, <a href="http://link.springer.com/article/10.1007%2Fs12152-013-9182-z#">transparency</a> about financial and non-financial conflicts of interest is essential. Until very recently, these international guidelines have not fully disclosed the conflicts of interest of all expert panellists.</p>
<h2>Awareness of conflicts of interest</h2>
<p>When discussing computerised neuropsychological testing, international guidelines on concussion in sport have also relied on evidence produced by the companies that own and market these tests (CogState and ImPACT). </p>
<p>In other areas of medicine, <a href="https://theconversation.com/insight-into-how-pharma-manipulates-research-evidence-a-case-study-4071">industry-funded research</a> has been shown to produce results that favour the sponsors’ product. Neutrally sponsored drug trials are much less likely to favour the drug than are trials funded by the pharmaceutical <a href="http://www.ncbi.nlm.nih.gov/pubmed/12775614">industry</a>.</p>
<p>Collectively, the consensus guidelines have also made little mention of research that has raised doubts about the reliability and utility of computerised neuropsychological tests. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23373575">A recent study</a> had a group of concussed and non-concussed footballers complete the CogState and ImPACT tests. The researchers also recorded demographic information such as age, IQ and number of previous concussions. Neither CogState or ImPACT were significantly better at predicting the concussion status of the footballers compared to the demographic information alone.</p>
<p>Another <a href="http://www.ncbi.nlm.nih.gov/pubmed/16284633">review</a> argued that the tests didn’t meet the criteria to warrant routine clinical use. If independent assessment of these tests support the claims made by their designers, then no harm will have been done. But if these tests are not useful in evaluating and managing concussion, then athletes could be mistakenly “passed fit” to return to play and suffer further concussions that may contribute to longer lasting forms of cognitive impairment. </p>
<p>We believe that a high priority should be given to developing evidence-informed policies to manage concussions in sports and that this be done in ways that reduce the potential effects of conflicts of interest on the part of those who design and then evaluate such policies.</p><img src="https://counter.theconversation.com/content/13103/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bradley Partridge receives funding from NHMRC and ARC.</span></em></p><p class="fine-print"><em><span>Wayne Hall receives funding from NHMRC via an Australia Fellowship to research the ethical and social implications of addiction neuroscience research. He has also received funding from ARC for two research projects on topics that are unrelated to the subject of this article.</span></em></p>Athletes and officials in charge of collision sports (such as rugby league, AFL and American football) have an uneasy relationship with concussion; it’s an unavoidable feature of their games and there’s…Bradley Partridge, Postdoctoral Research Fellow in Public Health, The University of QueenslandWayne Hall, Professor & Deputy Director (Policy) UQ Centre for Clinical Research, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.