Retirement from sport is a big decision for any athlete. Currently there are no evidence- or cons... more Retirement from sport is a big decision for any athlete. Currently there are no evidence- or consensus-based guidelines for retirement from sport following multiple concussions. This gap is compounded by the lack of objective biomarkers to guide such decision-making. Current recommendations for retirement center around worrisome neurological findings on exam or brain imaging, prolonged recovery following concussion, low threshold for developing concussion, and shortened time intervals between concussions. Retirement from sport following one (or multiple) concussions should be based on multiple factors, including evidence of neurologic impairment, prolonged recovery, lower threshold for developing concussion, and personal/family concerns.
This study sought to determine whether completion of the National Collegiate Athletic Association... more This study sought to determine whether completion of the National Collegiate Athletic Association’s “Supporting Student-Athlete Mental Wellness” online module for coaches increased mental health literacy, reduced stigma, and increased intentions to: 1) communicate proactively with team members about the importance of mental health care seeking, and 2) respond appropriately to support an athlete believed to be struggling with a mental health issue. College head coaches completed pre-test surveys (n = 969) and immediate post-test surveys (n = 347, completion rate = 36%). Module completion was associated with increased mental health literacy, decreased stigma about help seeking and increased intentions to engage in culture setting communication. These findings suggest that the online module is a good start for coach education about mental health; however, additional modifications may be warranted to the extent coach referral to sports medicine staff or provision of emotional support to student-athletes struggling with mental health concerns are considered desired behaviors.
Vestibular dysfunction is common following concussion, and the development of severe dizziness is... more Vestibular dysfunction is common following concussion, and the development of severe dizziness is a predictor of prolonged post-concussion recovery. Vestibular dysfunction is also a clinical domain of concussion that benefits from domain-specific rehabilitation. Unfortunately, post-concussion patients with complaints of dizziness, or worsening vestibular symptoms with exercise, are too often advised to rest, and prolonged rest can worsen vestibular dysfunction. If vestibular dysfunction does manifest in an individual with concussion and is not addressed, it can lead to persistent post-concussive symptoms that may be misunderstood as a more severe brain injury or prolonged recovery from concussion.
Objective: For elite athletes to train and compete at peak performance levels, it is necessary to... more Objective: For elite athletes to train and compete at peak performance levels, it is necessary to manage their pain efficiently and effectively. A recent consensus meeting on the management of pain in elite athletes concluded that there are many gaps in the current knowledge and that further information and research is required. This article presents the crystallization of these acknowledged gaps in knowledge. Data sources: Information was gathered from a wide variety of published scientific sources that were reviewed at the consensus meeting and the gaps in knowledge identified. Main Results: Gaps have been identified in the epidemiology of analgesic use, the management of pain associated with minor injuries, and the field of play management of pain for athletes with major injuries. From a pharmacological perspective, there is a lack of information on the prescribing of opioid medications in elite athletes and more data are required on the use of local anesthetics injections, corticosteroids, and nonsteroidal anti-inflammatory drugs during training and in competition. Pain management strategies for the general population are widely available, but there are few for the elite sporting population and virtually none for elite athletes with a disability. More research is also needed in assessing cognitive-behavior therapies in improving specific outcomes and also into the new process of psychologically informed physiotherapy. A key issue is the paucity of data relating to incidence or prevalence of persistent pain and how this relates to persistent dysfunction, exercise performance, and physiological function in later life. Conclusions: The identification of the gaps in knowledge in the management of pain in elite athletes will provide a unified direction for the retrieval of information and further research that will provide reassurance, speed return to active sport, and benefit performance.
Nine patients presented with ataxia as the primary manifestation of epidural spinal cord compress... more Nine patients presented with ataxia as the primary manifestation of epidural spinal cord compression. Eight had known cancer, the ninth an epidural abscess. Lower-extremity dysmetria, gait ataxia, or both, were the only neurologic signs in five patients. An incorrect initial diagnosis led to delay in treatment and subsequent neurologic deterioration in six patients. Failure to recognize isolated, painless ataxia as the initial manifestation of spinal cord compression and appropriately treat the disorder can result in irreversible spinal cord deterioration.
Retirement from sport is a big decision for any athlete. Currently there are no evidence- or cons... more Retirement from sport is a big decision for any athlete. Currently there are no evidence- or consensus-based guidelines for retirement from sport following multiple concussions. This gap is compounded by the lack of objective biomarkers to guide such decision-making. Current recommendations for retirement center around worrisome neurological findings on exam or brain imaging, prolonged recovery following concussion, low threshold for developing concussion, and shortened time intervals between concussions. Retirement from sport following one (or multiple) concussions should be based on multiple factors, including evidence of neurologic impairment, prolonged recovery, lower threshold for developing concussion, and personal/family concerns.
This study sought to determine whether completion of the National Collegiate Athletic Association... more This study sought to determine whether completion of the National Collegiate Athletic Association’s “Supporting Student-Athlete Mental Wellness” online module for coaches increased mental health literacy, reduced stigma, and increased intentions to: 1) communicate proactively with team members about the importance of mental health care seeking, and 2) respond appropriately to support an athlete believed to be struggling with a mental health issue. College head coaches completed pre-test surveys (n = 969) and immediate post-test surveys (n = 347, completion rate = 36%). Module completion was associated with increased mental health literacy, decreased stigma about help seeking and increased intentions to engage in culture setting communication. These findings suggest that the online module is a good start for coach education about mental health; however, additional modifications may be warranted to the extent coach referral to sports medicine staff or provision of emotional support to student-athletes struggling with mental health concerns are considered desired behaviors.
Vestibular dysfunction is common following concussion, and the development of severe dizziness is... more Vestibular dysfunction is common following concussion, and the development of severe dizziness is a predictor of prolonged post-concussion recovery. Vestibular dysfunction is also a clinical domain of concussion that benefits from domain-specific rehabilitation. Unfortunately, post-concussion patients with complaints of dizziness, or worsening vestibular symptoms with exercise, are too often advised to rest, and prolonged rest can worsen vestibular dysfunction. If vestibular dysfunction does manifest in an individual with concussion and is not addressed, it can lead to persistent post-concussive symptoms that may be misunderstood as a more severe brain injury or prolonged recovery from concussion.
Objective: For elite athletes to train and compete at peak performance levels, it is necessary to... more Objective: For elite athletes to train and compete at peak performance levels, it is necessary to manage their pain efficiently and effectively. A recent consensus meeting on the management of pain in elite athletes concluded that there are many gaps in the current knowledge and that further information and research is required. This article presents the crystallization of these acknowledged gaps in knowledge. Data sources: Information was gathered from a wide variety of published scientific sources that were reviewed at the consensus meeting and the gaps in knowledge identified. Main Results: Gaps have been identified in the epidemiology of analgesic use, the management of pain associated with minor injuries, and the field of play management of pain for athletes with major injuries. From a pharmacological perspective, there is a lack of information on the prescribing of opioid medications in elite athletes and more data are required on the use of local anesthetics injections, corticosteroids, and nonsteroidal anti-inflammatory drugs during training and in competition. Pain management strategies for the general population are widely available, but there are few for the elite sporting population and virtually none for elite athletes with a disability. More research is also needed in assessing cognitive-behavior therapies in improving specific outcomes and also into the new process of psychologically informed physiotherapy. A key issue is the paucity of data relating to incidence or prevalence of persistent pain and how this relates to persistent dysfunction, exercise performance, and physiological function in later life. Conclusions: The identification of the gaps in knowledge in the management of pain in elite athletes will provide a unified direction for the retrieval of information and further research that will provide reassurance, speed return to active sport, and benefit performance.
Nine patients presented with ataxia as the primary manifestation of epidural spinal cord compress... more Nine patients presented with ataxia as the primary manifestation of epidural spinal cord compression. Eight had known cancer, the ninth an epidural abscess. Lower-extremity dysmetria, gait ataxia, or both, were the only neurologic signs in five patients. An incorrect initial diagnosis led to delay in treatment and subsequent neurologic deterioration in six patients. Failure to recognize isolated, painless ataxia as the initial manifestation of spinal cord compression and appropriately treat the disorder can result in irreversible spinal cord deterioration.
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