Legislation effective for concussion prevention/management

SUMMARY: Legislation/regulation is an effective strategy to prevent and manage neurological injuries (including concussion).

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The recent article of Gibson and colleagues 1 in JAMA paediatrics indicates that legislation can be effective in improving concussion management in children. Similarly, Cusimano et al. 2 concluded that there is more evidence to support wide-spread mandatory interventions (form of legislation/regulation) than protective equipment for the prevention of rugby-related neurological symptoms. This success could be related to the fact that some form of behaviour change is required if an intervention is to reduce injuries 3. Also, the advantage of legislation is that its effects are not dependent on a specific coach or player 4.

In combination, these two articles would suggest that nationwide prevention programmes such as RugbySmart or BokSmart are useful interventions for preventing and managing rugby-related neurological injuries.

References:

  1. Gibson TB, Herring SA, Kutcher JS, Broglio SP. Analyzing the Effect of State Legislation on Health Care Utilization for Children With Concussion. JAMA Pediatr. 2014 Dec 22.
  2. Cusimano MD, Nassiri F, Chang Y. The Effectiveness of Interventions to Reduce Neurological Injuries in Rugby Union: A Systematic Review. Neurosurgery. 2010 Nov;67(5):1404–18.
  3. Gielen AC. Application of Behavior-Change Theories and Methods to Injury Prevention. Epidemiol Rev. 2003 Aug 1;25(1):65–76.
  4. Benson BW, MCINTOSH AS, Maddocks D, Herring SA, Raftery M, Dvorák J. What are the most effective risk-reduction strategies in sport concussion? Br J Sports Med. 2013 Apr;47(5):321–6.

Fundamental movement skills and fundamental games skills are complementary pairs…

…and should be taught in complementary ways at all stages of skill development 

In this recent discussion piece published in Sport, Education and Society (2014), Wayne Smith from the University of Auckland, New Zealand argues against the following notions…
  1. The binary logic that separates techniques from tactics, technique from skill, and tactics from skill
  2. The assumption that good technique will emerge as a natural process of adaptive play while playing games
  3. Children need fundamental movement skills before developing fundamental games skills
To argue against these notions, Smith (2014) draws on concepts from complexity theory and complimentary pairs theory. Basically, FMS and FGS should be viewed as having a complimentary relationship and both game-centred learning and technical teaching approaches need to be employed at all stages of skill development.
When we view skill in the traditional sense, we observe and focus on the actual movements of the athlete. But this is only one part of skill. Smith (2014) suggests we see skill as an expression of relational dynamics that emerge from non-linear, self-organising interacting parts. Skill is dependent on the inextricbale interactive dynamics of multiple interactions between physical, psychological, social, ideational factors acting at all levels, over multiple time frames. Simply, skill is highly complex and dynamic, and not just an individual’s physical actions. (Side note, we touched on how social influences may relate to skill in a previous article).
For teaching and coaching, Smith (2014) has broken down skill to 3 primary levels.
  1. Intrinsic – internal co-ordination patterns or techniques (repetition)
  2. Individual – immediate goal-directed tasks (drills)
  3. Interactive – Broader goal directed dynamics at the environmental level e.g. (small-sided games)
Although these levels can be taught separately, they are related, and each level should be coached equally at all ages or stages of development.
Agree or disagree?
Sharief

Are rugby-related Traumatic Brain Injuries (TBIs) comparable to Shark attacks?

SUMMARY: Rugby-related TBIs are relatively rare events, yet the public’s perception of their actual risk may be greatly exaggerated. This mismatch could be explained by the feeling that partaking in volitional (such as sport) should be safer than non-volitional activities (e.g. driving one’s car). Nonetheless, TBIs should be reduced as much as practically possible to enhance the enjoyment of volitional activities.

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PLEASE NOTE: This article does NOT consider concussions, which are a subset of mild Traumatic Brain Injuries (mTBIs)

This is a common misconception that contact or collision sports are the main cause of traumatic brain injuries (TBIs). This public misconception was highlighted recently in an article by a Sports Physician, Dr Bergeron, with over 20 years of clinical experience in the Pittsburgh Post-Gazette (Link to article). In this response to an earlier article in the same tabloid calling for an end to American Football, Dr Bergeron argues that general activities such as bike riding should be blamed long before ‘organised sport’ (such as rugby, cricket, soccer).

Moreover, evidence unequivocally shows that TBIs from recreational activities (organised sports and other activities such as bike riding) only account for approximately 10% (Bruns, 2003) of all brain injuries. Obviously, the majority of TBIs result from motor vehicle or ‘transport-related’ accidents. In South Africa for example, there are on average only two rugby-related traumatic brain injuries per year.

Of course travelling by car to work or school is not comparable to voluntarily partaking in an organised activity (such as rugby). However, research conducted on risk perceptions of soccer and rugby spectators indicates that what is considered ‘acceptable risk’ in these sports is not different to occupational levels (Fuller, 2008). This suggests that people consider the inherent of risks of sport to be comparable to those of everyday work-related activities.

So then why do organised sports have such a bad reputation for their association with brain injuries? The answer may lie in recent research on the Australian publics’ perception of shark attacks – an event that is as equally rare as rugby-related traumatic brain injuries (Crossley 2014). The Australia public’s fear of sustaining a shark attack was far greater than the true risk of such an event. The reason for this mismatch is complex, but related to the fact that humans’ emotions override logic when there is the possibility of any form of loss (unfortunately this is a loss of human life, in this context). Humans could also be more emotional about death resulting from volitional activities (swimming in the ocean or rugby) than driving one’s car to work because the volitional activities are done for enjoyment whereas driving one’s car could be seen as more of a necessity.

Nonetheless, if there is any possibility of reducing the risk of TBI, regardless of the activity, then these measures should obviously be employed. RugbySmart and BokSmart are two examples of prevention programmes that have the prevention of rugby-related TBIs as part of their mandate in New Zealand and South Africa, respectively. With on-going research, it is hoped that these programmes will be able to reduce the risk of these injuries as much as possible while still allowing the participants to enjoy the activities that they love.

What are your thoughts on this controversial topic of head injuries in sport? We’d like to hear them!

James