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