Transcript
February 27, 2025, 11:03PM
Sara Hennessy 0:13
OK, finally got the check going.
Oh, you’re amazing.
We do have some people that are.
Coming in, I don’t know where they’re from.
Hello we’ve got a flu.
We’ve got Jessica and we’ve got Dakota.
They could be anywhere in Kimberley.
They could be from Broome.
They could be from kamnara, dirty or Fitzroy, so welcome.
I hope you can hear. OK, so please sleep nice and loud.
Thanks man.
I’m sure you will, and thank you for all giving up early coming to our first morning minds, everybody very excited about this.
Thanks Sarah.
Good morning, everyone.
Welcome. Thanks for your patience.
For those of you who don’t know, my own state of Louis 14 position, I’ve got Gary, Gary and Jaron. Man, recently been back home about 12 minutes ago to work full time as a as a sports physician here at Brooke.
They’re trained.
I’m basically down any Perth but also in Canberra.
US. I’m here to talk about action this morning and it’s a pretty tough topic to get something very complex to 60 minutes of really 40 minutes where I’m hoping we get some time for some questions at the end.
And there’s clearly lots of, you know, really tricky parts to concussion. If we, you know, knew more about it and probably, you know, not have a state of affairs like we do with it, but.
I’ll try to simplify the best we can today.
And I want to make obviously reference that this is some sport related concussion and that some of the demand that we sports physicians really work in. I try not to get too much into the non sport related concussions, although it might be similar in some patophysiology and how.
To occur, you know, I’ve lost someone particularly work.
Very Gray area and people really struggle with those.
Normally allow questions, but given we’re trying to while I throw, let’s try and save some questions until we get to the end and hopefully we have time from these. Some of the things I’d like to touch on today the why this still relevant, who’s at risk bit about.
The path of fist it’s pretty dry, but I think it’s good to sort of understand that they’ve had assess.
Ment about the return to work and return to sports stuff that I think everyone in this room is a healthcare.
So the professional reassured having good understanding of and then what are some of our predictors of clinical recovery?
Who are the patients that we’re worried about?
Respect and think they’re out of really protracted recovery then I don’t want to ask too much on ctva in case we actually don’t know much about the other things that get sensationalized in the media, of course.
So why has concussions still be issuing in 2025?
We still really struggle with evidence in this space.
Be really hard to get good quality evidence you know specifically about return to sport with guidelines, but what we’re ultimately aiming to do is we’re trying to avoid short term disruption to life activities.
We’re trying to minimize the risk of recurrent concussion, which is really important, and we’re trying to protect against the impacts of long term brain health.
This is a really good principle. Yeah. And I do that rehab space physios.
Umm, so excuse of a lot? Umm, we really know that all damaged tissues, whether it’s muscle, bone, need rehab. But the brains exactly the same.
It’s a tissue that needs rehabilitation, and that’s beyond the resolution of pain like the day after, someone feels better from a concussion.
Like they still have a brain injury that they can’t deal with. We can’t see it and I think that’s the really tricky bit with concussion is that you can’t see the pathology. A lot of the time it’s really.
What the patient often feels and people really struggle with them, so we need a rehabilitation buffer, particularly youth and Community support.
Really, what the focus of this talk is not elite sports and youth and community sport, and we need to be really cautious.
We know that parents are concerned about long term health.
We know that teach and coaches are concerned about their duty of care.
We know that sporting organizations and schools are also concerned about the health and well-being of athletes and students, and probably the leading implications of it as well.
And governments are concerned about attaining physical activity levels and ensuring a safe sport environment, so every level.
People are concerned about concussion.
The scary thing is that 95% of all concussions occur in youth and community sport.
You know, we all we hear about is in AFL NRL, concussion, concussion, concussion.
But most of it’s occurring often in the community sporting field, you know, from kids all the way through Seattle.
And the problem we have, we have a massive workforce shortage.
There will never be enough doctors.
Loan to provide appropriate concussion care for the community sport. It’s quite sobering and scary thought to think about.
We are so well resourced, you know we support, I do work in an elite sports space in AFL with your rugby union, but we have too many doctors.
We’ve got concussion doctors, we’ve got someone who’s there watching a video on game day.
Here’s a photo of the NRL bunker for those who are close ladies.
Literally, you’ve got people dedicated with Hawkeye cameras of nine different views watching every contact impact.
Direct writing or direct communication down to doctors on the field in rugby union, we’ve got an independent match that Doctor Who literally is there to make decisions around head impacts.
We don’t have that in this space.
Who’s at risk, really?
We know children, Youth Services 19 to really concerned about and that’s due to that time of yearoplastic change in brain development.
Vulnerable brains are extra vulnerable to trauma.
Females appear to be more prone to concussion as well, but the evidence is still a bit conflicting.
But we certainly know the prone to the prolonged recovery.
And factors that can be associated with a complicated or prolonged recovery also include previous history of impossible head injury, headache disorder, or migraine. Can see how that gets pretty grave.
Some of their symptoms might be headache related post concussion and there certainly exists post traumatic migraines, which are some sit in a bubble next to the concussion.
Anyone with a learning disability or dyslexia?
Anyone with attention deficit disorder or any other sort of mood?
So anxiety or psychological disorder?
So what is concussion?
We know it’s a type of traumatic brain injury.
It’s defined by the concussion and Sport group has been induced by biomechanical forces.
It typically results from impact the head or the face or the neck.
That being said, it can also occur if it impacts anywhere on the body. Anything where there’s a big sort of a base enough collision which transmits force.
Up through the neck.
Into the brain can cause a concussion.
The analogy I’m using by patients is often like that.
The brain is like a sort of the head’s like a tissue box, perhaps.
Your skull and the tissues on the inside are the actual sort of brain you can show them by when you give the tissue box a shaking. The tissue is kind of moving it.
It’s very akin to what happens with our brain when we actually get some trauma.
We know if there is a temporary impairment on neurological function.
For some people it can be superflteen seconds.
Of your brain reset.
It’s a really complex injury and they’re difficult to evaluate. They manage and what I really think is no true concupance present exactly the same. Everyone’s concussion is a little bit different.
We know they evolve over time and that symptoms can change in the first few hours and days of presentation.
The good news is, in most adults, symptoms generally resolve within 14 days following an injury.
I’m sorry about the slight advance for the intellects in the room, but from a pad, a physiological point of view, we have a whole scale of things that go on for scale that will we won’t spend too long on it, but we know we get these by mechan.
Forces.
That cause cellular abnormalities.
We see altered blood flow and metabolism, which affects the membrane permeability.
And causes increased neurotransmitter release and contributes to this newer information as they coin it. We know we’re getting.
Sort of affecting cerebride and we get some excommal stretching. We get iron changes where you’ll get basically an eye on flux.
The potassium. So leaving calcium sort of coming in, causing sort of abnormal dermal depolarization tend to get a lot of glutamate release student disc depolarization.
We often see this energy demand change where there’s an over activity of these ATP dependent ion pumps, you know which increases the glucose demand, which does lead to energy depletion of these sort of systems.
It’s thought that actually they relate to some of the fatigue that also they feel the mitochondrial dysfunction that comes with that now also do to do with calciums that are rushing in, you know, further exacerbating some of these energy supply issues. And we know we get off stage.
Of stress due to action.
Free radicals, so the whole host of this stuff is going on. When we had trauma to the brain.
We know there’s some sex differences in brain injury as well as sort of touched on before, but male and female brains have quite significant structural differences that affect the impact of these brain injuries.
Females are a greater risk in a thought to be because the axons is smaller with fewer micro tubules and are more susceptible to trauma under the identical forces.
The role of imaging counselors.
Quite sort of controversial. If you see someone Ed or someone’s gone and they’ve had act head, you don’t really expect to see anything on act head when you sort of do that, you’re kind of looking for the more serious traumatic brain injury as the scalp fractures et.
When you see 10 someone’s head, there are some.
It’s very flash sort of images that have been used. Now the Mrs. which is magnetic resonance spectroscopy.
Functional MRI.
Diffusion tensor imaging.
Cerebral blood flow measures electrophysiology and pet scans for all sorts.
Potential scansion.
Broome so, but either way, you know, like there’s an example of this.
Is that the Mrs. can detect metabolic changes up to 30 days post percussion, and we know that some of these things help to guide some of the evidence that just because you feel OK that three days, there’s a whole lot of stuff going on in the background that.
That we can’t actually see if we know.
You’ve got all the brain function during that time.
Actual mirage shows altered brain activation up to 23 months post injury.
And there’s changes in a white matter orientation setting up to six months after concussion.
The problem with that with these at the moment is there’s no real good evidence based to work from, so they’re not recommended for routine clinical assessment at present.
How do we sort of assess concussion?
Like I’ve said, it’s quite a challenge.
But it’s really crucial for us to try and do our best to get that sort of diagnosis.
So we can appropriately manage and then prevent further injury associated with the diagnosis primarily relies on a clinical assessment of symptoms and signs.
There is no specific diagnostic test.
That confirm.
Or rules out concussion.
It’s a truckload of research going on at the moment.
Everyone’s bracing to come up with some blood tests, some saliva tests where they’re going to be the first one to try to know this person who does not have a very rich person at the moment exists.
The thing we should all be referring to, and I’m giving you all the copy on the table, is the sport concussion assessment at all assets.
For all political assessments, it’ll guide you through what to do.
There is also a paediatric 1 which is for those who are under the age of 13. They want to buy through 12 and you can modify one for Pediatrics.
That is really the thing we should be using, particularly those first time presentations in Ed or seeing these sort of patients.
There’s also for the non medical expansive to talk to your friends about the kids playing sports, self playing sport.
There is a concussion recognition tool, 612, spread about 1 minus AIDS, non medical individuals and recognizing perpetual concussions as well.
The other one I haven’t included because it’s like series.
It’s even longer than the scan.
Scan’s pretty long. How many tabs there?
A lot.
So the scan is the sports Concussion Office assessment tool. It offers more tools for diagnosis, goes into a few of the different domains cancers that persist for three days or more.
The **** lose, the sum of its validity.
Its best really use in the 1st 72 hours, so that’s where the Scala also exists.
I reckon I’m pretty good at days bashing through.
That’s scary.
Do it a lot. You do it.
I don’t reckon I can get through a scour in less than 50 minutes.
That’s long.
Time your lines will be here.
But and this is when we’re thinking about someone in a sport related environment now who sustained a dock, these are some of the things that we really have to look out for is our sort of red flag of critical nature identified.
Any individual who presents with back pain, particularly with a suspicious mechanism of injury, increasing confusion, agitation or irritability, repeated repeated vomits, have one drink, a lot of fluid.
So once it is OK, then it’s a repeated vomiting.
You get worried.
Anyone who has a seizure or convulsion?
Any weakness or tingling burning in the arms or legs?
Probably not thinking about concussion.
They were thinking about some other sort of neurological sort of trauma, and he’s got to GCS conscious stack.
A severe or increasing headache, unusual behaviour. Change of diabetesion.
Really concussion there. You know, we’re really worried about serious structural brain injuries. Serious cervical spine injuries, other neurological stuff. And that should have everyone’s sort of, you know, alarm bells ringing present. Any guys.
The obvious concussion one and as much as I thought I could want my wife to be easy when I was covering an AFL game.
Because it’s really great sometimes with some of these guys who run 15 KS in a game and tackle each other, you know, let’s try and work out effect and customers. They get to get impacts all the time.
It’s really easy for me when someone gets knocked down.
We call these our criteria or category one signs as soon as you are knocked out, it’s concussion.
Days over. There’s no Gray. They’re done.
Even though I’ve had a few patients in the last four months who came in and said I was knocked out, but I got up, I passed on my concussion test and I was barking.
Doesn’t work like that.
You’re knocked out. You are being cast.
And I understand where some of it comes from, because you sometimes you do get these guys who get knocked out, get their brain reset and such, and then they can get back up, actually do feel fine.
I agree with fine.
Well, that can exist.
But that’s the easy one.
The other one is the fall like get a fit and then fall towards the fall.
What do we all do when we actually fall?
We put our arms out to break our fall, but you’re not fully, you know, live. You’ll see it.
It will get sort of hit and they fall with their arms by their sides.
They don’t put their arms out to break their fall.
Another one again.
They’re easy when they’re like that.
Anyone with leisure or jerking movements post impact.
I mean, you see that every now and then.
And someone is sort of having my point sort of movements on the floor. The other one is they’re sort of, you know, deserve a poke during their arm stuck up in the air as you get in front.
They’re easy when they do. When they do that.
Confusion. Disorientation is a bit harder, you know, we run out when doctors run out to check players on the field.
I’ve got a little battery of questions we’re trying to screen all those players.
What they’re doing? Where are we today?
Yeah. And if I tell you in the wrong place.
You know you don’t.
Have noise, just that some of my players have taken to writing the answers.
I practice with one another.
Sing for the game.
Yeah, right to stadium.
It’s Saturday the 14th.
Yeah, we played this person last week, right?
So for guys who are supposedly trying to help me do my job.
It’s tricky.
Memory paper that fits into that same one.
So one of the initial questions we often ask is.
Who are we playing now?
Obviously today, but who did we play last week?
So it goes that you actually make them work out who they play their last game.
Win or lose.
The outstanding another good one and I see coaches now training misses Welch.
I hate someone gets knocked and the coach will tell them when you get up. Just take a knee.
For a bit ’cause, if I get off and I wobble, they’re unsteady or they’re toxic.
They don’t.
Any new or progressive students support by upgrade you’ll see in ****. There’s a symptoms of apparent, there’s a whole lot.
22 different symptoms.
You know any of those sort of things across multiple domains?
Report or the days appearance of blank data, but there you know there often are channel sort of symptoms. They’re easy.
We don’t need to take them off for a **** during a game. If people, how many of those kids and media can capture the scatter and help us down?
We can do one later to see where symptoms are.
But i’t need to do one of those again.
This is where it starts to get tricky. When you start getting more of these subtle signs.
A bit of change.
They’re a little bit more agitated.
They’re a little bit anxious, a little bit buoy, headache, right?
Alright, everyone thinks about headache as a concussion.
Sort of.
I think it’s the one that we see barely sort of often, but you don’t need to have a headache to have a compassion.
Able to describe pressure sensation in the head.
It was a urine vomiting. You know, the dizziness.
Or vision.
Balance issues. These are all subjective.
Sort of things that you know that will tell you or you kind of like digit stumble.
I mean, it’s just run the trick up and down the field repairably for 10 minutes like a tackleton tackle and chase.
So it’s really hard to say sometimes, but these other ones feeling slowed down or in a fall, I just don’t feel right.
To be concentrating or remembering people who are not remembering face game plans or usual sort of things.
Or may not see ones where players are going go. The other teams haven’t as well, like every now and then to watch that putty, these are all business signs, not so subtle with that one.
The obvious things that something’s gone right?
But then the fatigue and low energy feeling drowsy, get hurt, emotion, sadness, nervousness, anxiety. We probably like to basically anything.
Represents a passion.
We have to be aware there can be, you know, something as subtle as as as these things. And I think the tricky thing with often when we’re trying to pick these things, people can have these symptoms as part of their baseline.
They’re gone.
You know anxiety or they’ve got stuff.
I’ve been feeling complete for three months.
It can be really hard to tease some of that stuff out.
Quickly talking about the minimal Rd. for Country Roads Forum, I just want to try to think about community support now at the moment, but any sort of path later individuals suspected of having a concussion must be immediately removed from play.
It’s not really the end of the quarter.
It’s immediate removal.
And if for like I said, this is a slowdown, I came up with, if in doubt, sit them out.
We need to pull these individuals out.
Again.
They need to have a medical system done.
They need to be continuously monitored, pre signs and deterioration.
They are not to return same day.
Talk about whether they can return, but absolutely it’s not. I got knocked outcome.
They must have a comprehensive assessment evaluating the loss of consciousness symptoms, cognitive impairments, neuro symptoms and imbalance issues that needs to be done.
That’s what an assessment concussion.
It’s to record it and any abnormality across any of those domains. Food represent concussion.
And use the stack.
So what we do, we think we see what go back to our classic first aid principles.
A BCDE to assess their airway.
Make sure they’re breathing.
Make sure they have a circulation issues the disability. Obviously we can start asking some questions about you know, what you think there are virtual confused or GCSE use that.
The next big one.
We know that someone has had concussion.
We can’t trust them to tell us that Bennett is OK.
That is why they are removed from the ground with SIS Brian precautions.
So we need to use a manually launched. That was actually the mills like Cola, which is to take that next midline, which is what you see if you watch a bit of footy up. So on telly of people being removed.
Like they knocked out, which is fine.
Proportions. For that reason, clearing some a neck on a football field.
Probably not an advisable thing to do.
In Bragg and I am.
We need to review the mechanism of injury.
So what happened?
Witness accounts are very important for obvious reasons.
We need to go size of the symptoms. We need to do logical status, including balance. Again, use the stat.
Certain people, again, not really in community stuff, but we sometimes forget computerised euro cognitive testing go through and baseline score is normally done which we can compare them to often a preseason.
Ali Wani’s medical imaging is reserved for any of those red flag types of things that we talked about a few slides ago and we think someone’s got a skull fracture.
We think someone’s going through bleed and we think someone’s got to see sign injury.
So before there are no serum biomarkers that are helpful here, I’ll be doing blood.
I think you need help. When you make your diagnosis.
I’m not doing for the reasons.
That’s what I like.
That’s really interesting though.
It’s a live case because how many of us actually?
Probably not many, and the reality is most people who come and see any of you will be a delayed case.
See if an athlete or individual presents during a week of potential concussion from a weekend. Your job is to assume that a concussion has occurred.
And you have, there is no definitive test.
It’s not by going doctor, and they implicitly sort of said I didn’t have.
Rock up on either Monday or Tuesday night and have you said on the weekend. I’m going to be out of your career.
Don’t care about that.
I think I gave you, OK this one.
OK.
This is just a little sort of algorithm. You know for the healthcare practitioner who sees the off field days after the incident type person come in with an initial concussion decision tree.
Where you usually they come to you if they suspect concussion. You know, a lot of the things that we’ve obviously talked about, the history, the loss of consciousness, etcetera, etcetera.
And you ask if they’ve got any of those.
Huh. And then if I do again, it’s easy.
You sort of got this path right where you go in to do scouting and Scout 6 if they’re after 72 hours, you’re a neuro exam on everyone.
If they’re sort of abnormal, you know, and then you’ve ruled out, you know, intracranial pathology or spinal injuries. You go into a sort of standardized grant and return to play and cash management a little bit.
Lots of the things sort of get us to get into the science of point.
Your job is to obviously exclude those intracranial spinalogies.
Or, Nah, maybe they’re OK. They don’t have any of this.
You know you’ve done a ****.
And there is some normative data that I can share with you if you’re someone who is. Well, I’ve been to see these because in our sort of like sport world, we’ve got baseline tests on everyone.
So we know what.
They’re there.
They have something compared to the problem is when you don’t have.
Or compassion history or your community.
Sort of sports person or a child you don’t have.
The time of what?
You’re all sort of what numbers on your **** indicate that you know concussion, which is hard, but if someone’s continued their reporting symptoms right, it doesn’t matter what their balance score is, if they’ve got symptoms at the same time.
Anyway, that’s one for reference.
I’ve already kind of spread this a little bit, but you know this is the thing.
You should have copies of this copies in a day.
There should be copies in your in your practice and use this.
They’re really handy to be able to have do, give, give the patient to take with them, particularly if they’re going to be stand by a colleague of yours further down monitoring ad you know they’re going to need to follow up with the General practitioner or person, give them.
A copy of their scores because some serial scans are really effective as we.
Watch those symptoms soooo over time.
Watch their imbalance improve over time.
Watch their sort of memory improve over time.
Really valuable to be able to share that data with your colleagues who are sharing management with.
These are some of the other things that I tend to focus do as well.
I get many acute staff from Aroundbooks are doing sort of random Broome.
You know, I’ve never seen sort of more acute in six weeks.
But you know, if someone was speaking to me and get sort of acutely, I would always do obviously a really good C-SPAN exam, which includes radio movements, all patient you know, strength and other sensory nerve testing.
I do vestibular occupational testing.
There’s a very nice sort of screening tool which we’ll touch on in a minute called the bombs test.
And any of those and again, don’t deal with the 1st 72 hours after 72 hours you can degrade bonds test which tries to highlight. Is there an investigative holdocular dysfunction?
And autonomic testing, I don’t think anyone going to be able to do this very unfortunately. But you know, some people have autonomic dysfunction with heart rate, blood pressure dysregulation post concussion.
And when I was sick, I thought I was gonna pass away.
Treadmill test again.
I had treadmill and we walked on their heart rate does has been increased.
So density, real specialist level stuff.
This kind of like similar watching what they do not make perspective when we gradually increase exercise and bring on symptoms with you. Abnormalities in there. So the academic status.
Concussions. We talked about symptoms in a broad range of domains.
And what we’re really trying to do with our patients is try workout.
Have they gotten more physical symptoms which are not being sort of next to the eye or to be on ocular neurological?
Are they more that cognitive sort of symptomatic heart disease or concentrated?
Do things like symptoms, the emotional sort of.
Wear mood and anxiety symptoms and behavioural changes are a bigger issue.
The fatigue.
I’m just so tired and fatigued with everything I do.
And then the sleep is function.
So we’re trying to say which cluster these patients fit into and the really bad ones have symptoms across all the correct domains.
But really sort of horrible slide in a minute which shows you how they all crossover.
This is a bombs test.
Can I give you this one? I did.
This is the AIS version of it.
The idea behind a bombs test.
It’s a screening test.
It’s not diagnostic, but what you will do in advance test you ask a patient baseline sitting in front of you before you harass there. Sort of the studio ocular system, you get a headache at baseline out of 10, you get the nausea out of sort of 10 you.
Get dizziness. Score out of 10 and then you get a fogginess score out of 10.
Then you go through and you challenge smooth pursuits to start with.
So challenge.
That was super ocular system.
And see if their symptoms increase off a little bit of a headache.
Then you may be follow your finger.
And now I feel headaches. Worse. I feel terrible because, you know, sick probably have the symptom.
Ocular sort of component to their symptoms.
Go through scades tend to never do convergence.
It’s like never actually, you know.
Watch it come in and work out when they’re actually accommodating anymore.
But even if you’re getting some of this done like.
So it’s the saccades. You know the vestibular ocular reflex. At least some of it. It kind of gives you an idea of how this a vestibular occupant dysfunction here, this individual is probably going to need some ocular rehabilitation as part of their sort of recovery. This is sort.
Of the complex stuff, right?
A lot of concussions will get better without the stuff, but for the tougher ones like it’s good to know that these, you know, exist.
This is the sort of the really, the very important stuff that you give. This is that initial sort of acute advice. You made a concussion diagnosis.
What are we going to do?
Simple stuff.
We make sure they go home or they’re with the company, have a supervised, sensitive adult. They’re not allowed to drive.
You don’t clear them to drive if they have any of those symptoms where they’re brandished, not functioning normally.
We don’t let them break alcohol.
Obviously.
We review medications and the ones that they say we should particularly look into are they on any aspects of therapeutic AB weighted risk, a complex or can trauma.
Is it theoretically because a lot of people we we get the role nurra from a triage those have never seen any issues?
Yeah, but I I think I think your risk level is probably above that line.
But yeah, the pals the baby put together days.
You know that illustrious guidelines suggest that there’s a theoretical risk there of, you know, half of the bulk I know play on that team anyway.
That’s I haven’t seen anyone go off and have played because of it, but I agree.
I think that one’s probably a bit bright, but the guidelines say ask them about, you know.
It’s. I really think the bigger one, though, is probably sleeping tablets.
Acns depressant, you know, which may vast or worse, their symptoms is probably not the way to go.
The 1st and initial management strategy for all of these patients with concussion, they need physical and cognitive rest for the 1st 2448 hours.
That’s no work.
That’s no going down to play. You know, a lot of play live lead.
You know what’s not a lot of screen time.
You know, they really need to take it easy, you know, from school, away from school, or work for at least 24 to 48 hours to start it from. Then we want a gradual resumption of activity down to 24 hours, beginning with some lot to moder.
Intensity physical activity as well as long as our symptoms don’t worsen as we go to sort of increase our heart rate a little bit.
Majority of people, 90% of people recover in 10 to 14 days.
It’s really only 10% that have these lingering symptoms.
Keeping people away.
I’ve certainly been guilitiveness and really my symptom burns. But keeping people away is actually be shown to be detrimental long term as well.
So we need to make accommodations for these patients.
I’m sorry about this slide.
It’s like very small.
This is trying to show you the different domains of concussion. We talked a bit about the Sybil attack and the cognitive stuff that’s migraine.
But as you can see, they can all cross something up before it was frustrating. You can have symptoms of multiple domains at once, and really what we.
Share is something that read an article, but it shows us the different sort of domains kind of needs targeted rehab and management in those areas for stuff needs a vestibular rehabilitation for a vestibular train physio, and then a greater exposure to stimuli. Things that challenge that.
Y’all killer stuff is that it’s ocular radio attention which crosses over with that supercular stuff.
And often they need some lens changes with their eyes, signals, neural optometry, headache, migraine stuff.
You can do really well with manual therapy sometimes.
And treatment of the headaches.
Current those anxiety and mood stuff. I don’t know if you can read it, but the main 1 Thomas says it maintains social engagement.
The people who you take away from everything don’t let go school. Don’t let go to work. They sit at home with all their symptoms.
They do terribly.
It’s really important that we keep them engaged in their team, in their school, in their work.
Help them out and make sure that counselor, psychologist. You know some CBT is really effective there.
The T ones are also a bit tricky.
Again, CBT.
Sort of recommended you know, graded exertional tolerance of building stuff up.
You know, in the chronic setting, that’s they’re really hard, predominantly fatigued using some pacing strategies and then the cognitive stuff, you know, they need an academic or whatever modifications, more breaks, more time to do their work.
Short of that is to stop weird and then keep going to get some formula evaluation for Euro site if that’s whatever the case is not try and can’t go into a list today, but this is just a brief look at some of the things that some of these.
Patients need.
Really try and crack along here, children, right?
We know that they’re really common. Obviously in kids we have to be more conservative in this age group.
Right. We know they have slower recovery from American customers.
We know that there’s significant developmental differences, you know, with physical, cognitive and emotional differences at younger ages.
We know there’s increased variability due both biological and anatomical sort of factors.
And alterations in serum. Do I drive the kids who are trying to push them along aggressively and I guess not the way to go?
Would really got to be slow with the kids these ones.
This is the restaurant, right?
So this is all we use in communities for doesn’t matter, you know, kids or adults, they need this rest period. You know, we know at the same time that prolonged physical and cognitive rest is detrimental.
I can’t certainly be guilty of this. In the past few years where science can’t get this going during them because they just grow any symptoms up too much. Like lots of schools are a lot better with it now.
Have it saying how the Broome schools go, or anything like that, but keeping people away, they get worse.
We’re really better off getting them back into grading modifications rather than isolating them away from from anything socially bypass.
But you know the relative rest of 24 hours is pretty manager and we’re trying to get them to the northern limit.
You know, but no significant physical exertion. And that’s not for kids to go in play stations and you know, spend all that time doing that as well.
Their turn to sports staff.
So it goes like this, you know, we know beyond that 24 foot, 8 hours, lots of people are starting to feel better.
We want to gradually increase competitive physical activity.
Where majority of students have actually returned.
So RTL has returned to work.
So it’s getting them back to school.
By day 10, we really want to get them back quickly.
Before this per second, but the return to learn.
Takes priority over return to school.
Everyone’s focused on. Yeah, I need to get back 48.
I need to get back to that.
I need to get back to that our priority really needs to be, you know, let’s get you back to school.
First, let’s get you back to work.
Let’s get you back to your studies. That is the priority first and the sport starting following.
The new guidelines and this is probably the one take home thing from today is that the minimum time you can return to contact sport from a concussion is now 21 days.
It’s a long talk.
People in the community do not like this.
The other comment to that is and that’s if all goes well. That is, I had symptoms for 2448 hours, but they also have to have been symptom free for 14 days first.
If your symptoms drag on for a week and a bit, your 14 days doesn’t start until your symptoms starting may start.
And it’s going to be longer than 21 days.
You can see why people don’t always tell us the truth about their symptoms when the earliest you can return now is 3 weeks when you’re diagnosed.
But I presume this is a diagnosis done by health professionals because when you go to 1st, there’s the old 40 pool 2020 have their own little database with it’s it’s nothing.
The medic, they are happy to call everybody. Concussion, you’re like.
You can see the head Bob here, by the way.
And then and I think that’s where the the the problem comes from. There is a lot of they just overcall it just like any 13 year old, they they come up with field and they’re really talking about atheroscopies and 5 minutes later they want to go back in.
The field because they need.
So that happened like that, but I guess they’re daring to get stopped.
They’ve got a problem with Brian anyway.
We’re trying to be conservative.
I wouldn’t make we cannot. Probably going to have everyone along the same.
You know, people are going to like this, but the reality is with the, you know, the stuff we now know where it’s at. Like if you make a diagnosis with healthcare practitioner by patients need to stick to this and I’ll show this on the interview, they can help.
You with that?
Could be touch and return to learn.
We know that you know it’s about facilitating a graduated return.
To regular school retains, again, taxpayers over to export. We need to give them more frequent breaks.
Extended rest periods additional time to complete any of their work or tasks.
Has really our job as healthcare practitioners to communicate this to schools and workplaces. Overall, there is actually a nice and classical protective way on campus.
It’s actually a nice way to use to do that instead of going to school.
So with the kid and I can the schools. So the role is to accommodate.
We talked about that 1421 days.
And where people get really ****** *** is that a late sport is not the same.
Oh yeah, but the footy players go back at you know, you know much quicker.
They go back to two weeks and I understand why.
The sort of you know, there’s, you know, people are upset about that, but the reality is, at least for guidelines are completely different.
Sort of.
Multiple resources to look after these and it’s not that you know a elite sport brain heals quicker.
There’s lots of political stuff that goes on with these conversations, but you know, they have obviously baseline data, you know, to compare to the scatter cognitive testing.
So we kind of probably diagnose them more accurately. You know the sideline care or contacts with doctors.
We have video recordings, so we don’t really miss these things.
You know, we have access to critical management training for multiple people, you know to manage these sort of things.
P/E. We just don’t have resources for that in the Community, which is why it’s plus other differences exist. But yeah, I also aware of how the optics on it is that you know, a race four goes as fast and communities for goes that fast.
This is a kinda example of how you would approach a community sort of person.
They had their incident that it was recognized concussion appropriately and removed replies and done their rest for 24 hours.
They’re assessed by healthcare practitioner early, sometimes also a tribe, and then they’ve obviously been talked through, you know.
What? They’re girls, you know, going to some learning on the first day, they’re amount to do some skills, stuff and training, obviously with enough control coach buying without marrying their head.
A great deal progresses and moderate Wolf, Saturn bike, etcetera.
And then some sports. Good movement. These stages goes at all 24 hours at a time.
You can’t go.
Well, I did this, this, this and this on, you know.
First over that wins.
Your first day is you try and get through everything else.
Say hi to John. As long as you don’t have significant symptom provocation.
Wake up.
Yeah, it wasn’t too bad.
You couldn’t then go to the next stage if you are struggling to progress without significant symptom provocation, you don’t progress through without rhythm.
You are supposed to have a checkpoint and this is where I think Broome is pretty tricky because both have a checkpoint now early in that six with the health care practitioner check they’re going.
They’re getting a bit of a sign off, yet you’re going pretty well.
Theoretically, around having some resistance.
Try and try to something then.
K again, H 24 hours is adding intensity of days.
But the goal is we want to get back to full capacity work or learning and exercise activities before we then have a second checkpoint.
And suppose we’re supposed to be 14 days symptom free now.
Before we then get cleared by a medical or healthcare practitioner and really they want a medical person at this point to say, hey, you’re all right for contact.
And you don’t go into. This isn’t a game.
This is for contact training.
Thank you, Spen competitive simulation.
Have another checkpoint.
I’ve been tackled, I’ve been bumped, I feel OK, and then go back to a game.
It’s pretty complex to be able to coordinate all that. That’s why we need lots of coach buying and we do a community session soon because we really need to conscious here to be able to help that.
This is the same thing that said in a different way.
I can write you a copy of that one too.
Different, different view of it.
Again, it really highlights that everything has to go perfect for them to return.
Back went through.
I would certainly look up and download this one.
This is where all this information comes from. As a joint sort of sort of document, the concussion Brandon just saying 2024 that was put together.
So last year it talks about all this compassion, paranoia, athletes, workforce issues, how to do stuff, long term brain health etcetera, etcetera.
It’s it’s a really great resource to to cancel.
It’s really quickly as we sort of wrap this up.
There are concussion referral clearance forms that I really think would be a good thing for someone to implement if they can do one of those.
But they basically are away.
You can again have them an eg
where you know diagoncusscussion what their symptoms were and then plans for the initial consultation. It talks about the greater return stuff and then the final stage is healthcare practitioner. We are happy that you’ve reviewed the first section of the form.
We are happy that the person has been symptom free for 14 days.
They will not return to comparative contact.
In less than 21 days from the time concussion.
I completed.
I got a project sport and that’s to stop those people to go back.
Next weekend.
Hard to implement, but you know, I think the medical legal risk here as well for all of us is is also not insignificant.
What’s the risk to returning to early?
We know that if someone goes back to school with a concussion to really.
Big reducing tips and reopening pass on the secondary Impact syndrome, which is the one that people are having, unfortunately died from.
And supporting our diet.
It can’t be this way.
You get at it is very rare, but it’s a fatal sort of brain swelling in a segment occurs for recovering.
We don’t know much about it.
And guess obviously sensationalized in the news.
Community payments. We can get memory, attention, decision making, deficits ongoing, sort of promotional and physiological effects, balance issues.
I think the reduced performance one is a really good one to highlight, but we know that reduced reaction time and processing speed.
And sometimes that’s the way that I sell it to people.
But then, when they’re teenagers, if they were going to go back and they’re not going to play as they normally would.
And we know.
Not sure why, but the concussion threshold seems to decrease with multiple certific and what that means is the initial amount of force that might have been required for that person to 1st experience a concussion tends to lower with the more head knot, say here.
I don’t really sure why, but you know it becomes far easier for some individuals to end up getting a concussion, you know, with Trivial knocks they wouldn’t have actually had actually happen from previously and now causing sort of concussions.
Long term, Brian Health stuff is always what we want to talk about.
How am I gonna get dementia now? That’s really that CTA which we call FB.
The one that I I think is is not talked about enough is the bus.
I didn’t put the stats in, but we know that people who go out to play when they’re still concussed. I’ve got a significant risk of soft tissue injuries and joint disability.
You know, benign drug disability people.
Carrying icos. All right, we know that these people have altered neuromuscular control.
They make bad decisions.
They put themselves into positions that they might not normally do if they’re brand working well.
The real risk is we let someone back it out and then they go and they tear.
An ACL they sustain a another significant loss for a injury which are very real and they can have a real sort of life altering to the way they approach exercise.
These are some of the, you know, these are prolonged recovery.
These are probably the ones where you go like if you’re seeing any of these, you’re like like you’ve got a load of severity and number of concupant symptoms and that **** you initially do is 22 different symptoms.
It’s a close call 132, so someone is taking symptoms in 22 boxes with, you know, high symptoms sort of burn.
They’re probably the ones who are going to take a long time, right?
If you got prolonged loss of consciousness, you get knocked out for more than a minute.
I’ve never seen one of them recover quickly.
I sees you, you know, after being sort of ****** as previous history of concussions, everyone with a pity all made those people with history of multiple concussions that take a long time. You know, young people are females today and also those people have gone through psychological they do.
Take a while and they’re probably good ones to flag early and consider referral. You know, early to some of the specialist management.
The multiple can cashless phone is always one that comes up.
How long should someone take off and it used to be really airy about what?
The answer was so they can the concussions.
4 guidelines Now what is the multiple concussion?
It’s too concurrent with it. A three month period.
Or three concussions within a 12 month period.
These require extra conservative approach and the management team you know, really should be someone with some concussion expertise.
Basic tricky while God speaks return to sport time frames exist.
What the guidelines are now recommending is that if you have your second concussion in three months, you must be 28 days symptom free.
And you’re not allowed to return before six weeks. Is the recommendation if you have your third one in 12 months.
The advice we give now is you consider missing an entire season.
Of that contact sport.
So is this for the Ant screen? Pretty similar to stuff?
Long John. That’s what they’re basing on now.
Great. Thanks. And two savings and all that.
One season.
Two season 2.
Recommend retiring.
Yeah, but any recommendation to retiring sport is never one individual’s choice.
It’s just waiting to managed by multiple people.
We usually get a neurologist with important.
Yeah, that’d be a hard one.
At this time experience.
It’s actually a nice one.
Evidence is it’s quite tricky. Last couple traumatic.
Traumatic.
Events air, while still, may have seen that movie percussion, which talks about this like it is a neurogenic pathology linked to history of repetitive pain trauma.
It’s only confirmed through poke mortom.
Nobody can diagnose this while someone is alive.
As yet, it’s only done through this post mortem.
And we know what they get is they get cow accumulations in the brain.
They look like that when you cut it open, but we don’t even have evidence and those are things that can actually diagnose this.
Scary thing about this is that people think that everyone who comes a headache through at some point get to have CTE. See lots of elements.
CTA CTA.
Rush back.
You might have depression or anxiety or some other diagnosis.
Everyone wants to always attribute it to the footy or headdog, not potentially drinking and drug use, mental health. Some things you know, and that the environment, the evidence really doesn’t connect.
It then possibly linked, but I don’t think we should be, you know, listening to these sensations sort of stories that go.
Head contact is inevitable that you end up with CTA because that’s clearly not what the evidence shows.
Because we certainly need more research and good studies that can found for all those areas. And I feel really sad for you guys in the ones in the news have been AFL players who lost their lives. All right.
The biggest cure of sort of men, you know, post your career after this.
Mend themselves from, you know, mental health.
Start depression.
A lot of driving, so alcohol problems. Unfortunately that works well. A lot of whiskey there it comes with that.
One guy’s written became a boxer after his footy career and then the family blamed footy.
Had known to have a, you know, drug and alcohol substance issues in the past, it’s really hard to point your finger at that.
When you’ve got this confounded, we need good status.
Keith, Turbo Damas yavala.
This is whipping.
So we’ve got, you know, we got a bit of this rapid Brian swelling.
Following second enduring, we know that using animal models only that indicated there’s vulnerability period post injury which second impact can cause severe damage such as dysfunction.
So it makes sense.
But why does everyone not get this?
Who gets it?
We don’t really know.
It’s because it’s so rare.
That was very scalable. In particular, you know.
It’s like most things, we need more.
Research I think this is the really big one, because everyone’s kind of slammed contact sport, you know and non contact sport basketball too.
You know, I’m so worried about concussion.
So worried about concussion, Australia’s got an abce Academy.
Individuals who are based children are at risk of poor brand health and midlife as well. Australian adolescents and young adults have high rates of poor mental health.
And they’re dropping out of organised sport.
Provides so many physical, psychological, emotional and social sort of benefits for young people and adults. Such schools now take decisive, don’t even have tech supports because they’re too worried about.
Suicid.
Like, are we having a debt negative result by being too crazy with the concussion stuff?
Almost certainly.
The Thai cobblestone days.
We bashed her a lot.
If you take nothing else other than it needs to be $21.00 both youth and community doesn’t matter whether you’re, you know, a 15 year old footy player doesn’t matter when you’re, you know, a 40 year old.
Like 21 days from the time of concussion until you return to a competitive contact environment.
And no return to contact with this training until September 314 days.
Use your resources.
Use the scan.
Use your 10. Give patients that if they need to send.
We’re trying to make a simple approach to a conditional.
Thanks for your time this morning.
Thank you very much.
He’s given up his time for this. This peer LED education series that we’re doing. All our professionals are doing it of their own back with their their passions.
So thank you very much, Nathan, for that question to run off and teach some old people as well.
You have it signed in.
Please do it and next session is about.
Renal and kidney health in the Kimberley and our next one after that is going to be.
Critical discussions how to talk to people and tell them who they are.
Conflict resolution with summary explain that would be really interesting.
OK.
I’m registered. Do you need their leads?
stopped transcription
