Masters Degrees (Sports and Exercise Medicine)

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Browsing Masters Degrees (Sports and Exercise Medicine) by Subject "Brain -- Concussion"

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    The clinical reaction time test as part of a standardised concussion assessment battery
    (University of the Free State, 2016-02-12) Carstens, Charl Sarel von Willigh; Viviers, P.; Holtzhauzen, L. J.
    Background: Concussion is a worldwide challenge and diagnosing, evaluating and monitoring injured athletes places a huge burden on even experienced clinicians. Each concussed athlete presents differently and each one should be treated individually. In an ideal world, enough resources should be available for neuropsychologists and neuropsychology tests to evaluate each athlete. In resource-limited areas, neuropsychologists are replaced by experienced clinicians for treating concussions; these clinicians use as many objective cognitive tests as are available. If computerised neuropsychology tests are unavailable, then low-cost, objective and fast sideline tests, like the clinical reaction time test, may be incorporated in the assessment battery protocol. No one test can be the sole cognitive assessment for recovery after a concussion. It is imperative that all these clinical tests practical limitations and benefits are known. Aims: This study’s primary aim was to compare the Sport Concussion Assessment Tool 3 (SCAT3) total score with the clinical reaction time test (RTClin). The secondary aim was to compare the two tests as recovery tracking evaluations in the days following a concussion. Methods: In one season (2014) a prospective cohort study of amateur collegiate rugby union players who suffered concussion (n = 46, mean age 21, range 18 to 33 years) out of 1 166 registered players were evaluated within 72 hours (Evaluation-1), then weekly (Evaluations 2 to 4) until they became asymptomatic (Evaluation-Asymptomatic) using the SCAT3 total score and RTClin tests. Results: Within the first 72 hours after a concussion the SCAT3 Score and the RTClin showed a moderately positive correlation of 0.47 (Spearman test) and p = 0.04. The Spearman correlation between asymptomatic athletes was poor (0.21 and p = 0.46). A comparison of the SCAT3 Score of the first evaluation (E-1, n = 19, mean 24, range 10 to 74) with the asymptomatic evaluation (E- Asym, n = 14, mean 3.5, range 0 to 9) shows statistical significance (p < 0.01). The RTClin during E-1 (n = 19, mean 190 ms, range 168 to 258 ms) and, compared to E-Asym (n = 14, mean 179 ms, range 147 to 223 ms), came close to showing significance (p = 0.07). The recovery tracking showed the mean time for recovery as 6 days (n = 5, range 4 to 18 days). The SCAT3 Score for E-1 showed a mean of 24, E-Asym mean of 3 and mean difference of 18. The RTClin for E-1 showed a mean of 199 ms, E-Asym mean of 178 ms and a mean difference of 20 ms. There is a strong correlation of SCAT3 Score and RTClin over time, of 0.80, but p > 0.05. The recovery time correlation for SCAT3 Score was moderate (-0.56), but p > 0.05, and for RTClin recovery showed a strong correlation over time (-0.82), but also p > 0.05. Conclusions: In a low-resource environment with only clinical examinations, SCAT3 and RTClin as tools there is evidence that the SCAT3 Score and RTClin may be good sideline diagnostic or screening tools within the first 72 hours after concussion. When athletes become asymptomatic, the RTClin becomes more important for monitoring persistent cognitive impairment than the SCAT3 Score. Further research is needed with larger study populations to confirm the utility of the RTClin as part of a post-concussion assessment battery.
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    Concussion knowledge and practice among role players in primary school rugby in the North West Province
    (University of the Free State, 2013) Jansen van Rensburg, Magrietha; Schoeman, M.; Holtzhausen, L.; Patricios, J.
    Background: Concussion is a common medical problem which can have devastating complications, particularly in young adults and children. Due to the nature of rugby, concussions are frequently sustained by the players engaging in this contact sport. Since children are more susceptible to sustain a concussion, medical personnel such as doctors or paramedics should theoretically be the role players responsible for medical decision making next to the school rugby field. Coaches, who are often teachers, are often the primary source of medical support next to school sports field. Since failure to recognise or mismanagement of a concussion may lead to serious medical complications and delayed recovery, all role players involved with a potentially concussed child should be knowledgeable on the factors influencing medical decision making. These factors include knowledge on the prevention, recognition and management of a concussion, knowledge on the consequences of a sustained concussion and when to clear a child to Return to Play (RTP). Aims: This study aimed to report on the general and essential knowledge to be able to recognise a concussion of role players potentially involved with a concussed primary school rugby player and knowledge of role players regarding the prevention and consequences of concussion. In addition, knowledge and practices of role players regarding the management of a suspected or confirmed concussion, as well as knowledge and practices of role players regarding Return to Play (RTP) decision making following a concussion were assessed. Methods: A self-administered questionnaire was developed according to guidelines from literature to assess the child-specific concussion knowledge and practices of role players. These questionnaires were completed by primary school rugby coaches (n=51), paramedics (n = 39) and doctors (n = 20) in the Klerksdorp, Orkney, Stilfontein and Hartbeesfontein (KOSH) area in the North West Province. The outcome measures consisted of scores (out of a potential 100% if all the correct answers were given) on the prevention, management, recognition, RTP and consequences of a concussion. In addition, the knowledge regarded by literature as being essential to the safe practice of doctors were also assessed among all role players. Results: It was found that coaches and paramedics were generally the most senior persons responsible for medical decision making next to the rugby field. A substantial proportion of coaches (60.8%) were not BokSmart certified at the time of data collection and therefore not adhering to this requirement set out by SA Rugby. There was no relationship between the time since the coaches received their last concussion-related information and their concussion knowledge. There was also no relationship between the coaches’ concussion knowledge and whether they attended a recognised concussion training programme such as BokSmart. The only variable to show a relationship (p = 0.001) with the coaches’ overall essential knowledge needed for safe practice was the amount of years they have been coaching rugby. The coaches, who were also teachers, displayed a general lack in knowledge on the effect of a concussion on a child’s school work and the need for cognitive rest following a concussion. The paramedics displayed a widespread weakness in their knowledge pertaining to the cognitive aspects associated with a concussion. There was general consensus that the decision to clear a child to Return to Play (RTP) should rest with a doctor. However, the results from this study indicates that a considerable proportion of doctors (30.0%) were unaware of the fact that a child should be free from concussion symptoms not only during physical activity, but also at rest, which may result in premature RTP. The role players displayed a less than adequate knowledge on sport-related concussion with the coaches scoring 71.44 ± 12.03%, the paramedics scoring 67.01 ± 12.29% and the doctors scoring 76.67 ± 6.56% on the overall essential knowledge needed for safe practice Conclusions: Despite the fact that the doctors scored significantly better compared to the coaches and paramedics on their overall essential knowledge score (all of the essential knowledge items combined), very few doctors did not present with considerable gaps in their essential knowledge needed for safe practice when dealing with a concussed child. By implication the findings from this study indicates that children suffering from a concussion may be at risk for receiving inappropriate or insufficient medical care when sustaining a concussion. These findings should be communicated to sport governing bodies such as SA Rugby and further research undertaken to address the lack in knowledge among role players potentially dealing with concussed athletes as a matter of urgency.