Alpine TD CONFERENCE 2008
FIS MEDICAL COMMITTEE
CONCUSSION
ISS (INJURY SURVALLENCE STUDY)
FISMedical Committee:
SnowboardAlpine
FreestyleCross-countrySki jumping
Medical Committee Education Sub Committee
News Blast FIS Web page
Ski Trauma Courses
Medical Guide
FIS NEWS BLAST Sport nutrition for ski competition Soft tissue tendon injuries Research conclusions on pre pubertal
strength training Concussion standards Vienna protocols Back rehabilitation for ski racers Future – vision, sport psychology,
orthotics in sport OR????
Snow Sport Trauma course Provincially
Nationally
Internationally – China, Russia
END
CONCUSSION Many Alpine athletes KP, CM, MM
Previously under treated
10% of athletes
Different countries different standards for caring for head injured athletes
CONCUSSION!
Definition Vienna Prague Disturbance of function of brain after
trauma (metabolic not structural) + or - loss of consciousness Short lived neurological impairment
(24 hours to 10 days) Resolves spontaneously following a
sequential predictable course
Recognition difficult Subtle symptoms - wide variety of
symptoms
Reluctance to report
Normal CT, MRI
SYMPTOMS HEADACHE
RINGING IN EARS
DIZZY
NAUSIA VISION CHANGE
POOR BALANCE OR COORDINATION
DIFFICULTY OR INACCURATE ANSWEREING OF QUESTIONS .(DATE,TIME, 3 ARTICLE MEMORY) SAC, SCAT. Memory and attention
Signs: Loss of consciousness Seizure Poor coordination Poor concentration Inappropriate behavior or emotions vomiting
If Suspect Treat as any injury - ABC’s, cervical
spine Don’t leave alone Monitor - Not to train or compete in current
event Requires full medical evaluation
ACUTE INJURY MANAGEMENT Coach or PHSIO or PHYSICIANS
WITH THE TEAM –EVALUATES ATHLETE
Signs and Symptoms
TD’s ROLE Can request independent medical
review of a competitors medical condition – see medical guidelines –FIS MEDICAL GUIDE
This can include completion of SCAT and clearance from an independent medical observer.
TD can:
Propose to the jury the exclusion of any competitor – ICR – 601.4.9.4
TD can:
Request the FIS Medical Supervisor to direct a medical examination or request a medical examination of any racer. ICR 221.2
TD can:
Can act where there is no rule by making proposals to Jury – ICR – 601.4.9
Post Injury management
STOPREST MENTAL AND PHYSICAL NO ALCOHOL OR STIMUALANTS NO MEDICATIONS
PRESEASON PREVENTION ASSESMENTS
Pre Season Assessment Includes: Concussion history:
Previous head injuries and Symptoms Loss of consciousness Cognitive symptoms Time off from skiing or training Identify athletes not fully recovered from
previous concussion injuries Baseline-------
Preseason Testing SAC TEST-1997-Standardized
Assessment of Concussion SCAT TEST – Sport Concussion
Assessment Tool – British Journal Sports Medicine 2005 Neurosurgery 2005 Physician and Sports Medicine 2005 2nd International Symposium on Concussion
in Sport
Pre Season Testing Impact test - Neurocognitive
Baseline neurocognitive testing using computer
Nast BC Ski Team B.C. leads the way in Snow Sports Ontario – entire jr. hockey
Impact Identifies athletes at risk!
Used later in year with repeat concussion
IMPACT ATTENTION PROCESSING SPEED REACTION TIME MEMORY
VISUAL VERBAL WORKING
Return to Snow Protocol
Complete physical and mental rest until asymptomatic – then advance along the return to sport protocol with a minimum of 24 hours between advancing steps. Progression only if completely asymptomatic .
PROGRESSIVE RETURN TO SPORT PROTOC0L STEPS:
1. Complete physical and mental rest until asymptomatic
2. Low intensity aerobic3. Higher intensity aerobic4. Easy free ski/ light exercise5. Train gates6. After medical clearance return to full
competition
separate all by 24 hours at least!
IMPACT TEST BTN STEP 4-5
Role of Impact
Do once athlete is symptom free after step 4.
Prolonged cognitive impairment – prolonged return to sport
Team physician = final clearance before return to sport!
Dr.Karin KauskyCoordinator Impact and concussion management
ISS: Oslo Sports Trauma Institute
(Professor Roald Bahr / Tonje Florenes)
FIFA
? FIS athletes – competition and training
Objectives Reliable data on injuries
Predisposing factors
prevention
The Big 5
Switzerland, Canada, France, Norway, Finland
Data collection Alpine Snowboard Freestyle Nordic combined Cross country
Data Collection TD’s
Team physicians, physios, coaches
Year end interviews
Snowboard Knee
Head / face
Shoulder
Low back
Reporting 25%
25%
90%
TEAM WORK SB ALPINE NORDIC COMBINED FREESTYLE
Medical directors have been notified
THANK YOU