Sunday, October 25, 2015

An active approach to concussions

A meeting of 37 concussion clinicians and researchers this week in Pittsburgh — described as “unprecedented” by UPMC, but viewed with skepticism by others — produced a consensus that prolonged rest, a popular treatment option for concussions, does not aid recovery and can actually worsen it.

“Experts here in Pittsburgh recognized how critical a need it was for us to bring experts together and finally make this statement,” Dr. David Okonkwo of UPMC said. “This is paradigm shifting. People may underestimate the impact of this, but on a global basis, every single person who sustains a concussion is told prolonged rest.

“Now, you have 37 of the best and brightest minds in the field saying ‘That’s wrong and, in fact, concussions are treatable and active treatments are superior to doing nothing.’”

The experts reached those conclusions during the two-day UPMC Concussion Conference, “Targeted Evaluation and Active Management.” While no sweeping protocols were recommended, conference attendees believe this consensus will help research move forward.

The summit, however, did not come without some level of doubt about what it could accomplish.

There were concerns about conflicts of interest. UPMC sponsored the summit, and the health giant has received funding in the past from the NFL, and several of the doctors present have a connection to a sports team or league.

Nicole Fisher — the founder and CEO of HHR Strategies, a health care and human rights focused advising firm — said in an opinion piece she penned for that “many in health and policy circles are calling the events nothing more than PR stunts.”...

Doctors who convened at UPMC this week believe that an active approach in treating concussions, from active rehabilitation to active physical therapy, is preferable to basic rest.

“Exercise is a way of treating this,” said Dr. Javier Cardenas, a neurologist at the Barrow Concussion and Brain Injury Center in Arizona. “Many times, we see patients who are completely restricted from any physical activity.

“As one of the major sources of this injury is sports and athletics, for those who are involved in athletics, this is actually a punishment. They become depressed. They become anxious. So allowing them to participate in physical activity — while keeping them out of harms’ way, of course — is actually a rehabilitation method.”...

“This is not a one-size-fits-all injury,” said Micky Collins of UPMC. “There are different profiles and problems that we see. Now that we understand that and we have treatments that can actively treat those different profiles, we are very confident that progress can be made.”

The group’s findings will be published in a medical journal, likely in the next month or two, and subsequent papers will come from that.
Courtesy of Doximity
See: Cognitive rest 7/27/15

1 comment:

  1. Therefore, despite the NFL footing the bill for flights to Pittsburgh yesterday, several of the attending medical experts were skeptical of the quality of the discussion to be had due to the lack of notice, shortage of invitations (35 researchers), and refusal of outside media or attendees. Adding confusion to this discussion is that concussions, the most frequent injury in the NFL, currently do not even have an agreed upon medical definition.

    While the sudden interest of the NFL in the science of concussion and prevention is heartening, many experts present questioned the feasibility of this group to leave having developed a national protocol for everything from youth sports to professional athletes. This raises the question: Can a small group of individuals who are funded by the U.S.’s richest sports organization – each team worth billions and owned by billionaires – walk away from an impromptu meeting objectively making plans for millions of Americans?...

    Yet, the people at the heart of the PR for this event include Dr. Maroon of UPMC, who has a long-term relationship with the NFL, and the university itself, which has accepted millions of dollars from the NFL. Further, individuals who previously disproved the NFL’s “scientific” work on the issue failed to get an invitation. While this does not mean that the attendees will be coerced by the League in any way, simply acknowledging the issue is far different than creating a definition, standardizing diagnosis and treatment protocol, and agreeing on best practices for the humans on the field.