Alpine TD CONFERENCE 2008 FIS MEDICAL COMMITTEE CONCUSSION ISS (INJURY SURVALLENCE STUDY)

FIS Medical Committee: Snowboard Alpine Freestyle Cross-country Ski 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 –

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 –

Post Injury management STOP REST 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 nd 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 aerobic 3. Higher intensity aerobic 4. Easy free ski/ light exercise 5. Train gates 6. 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 Kausky Coordinator 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% 90%

TEAM WORK SB ALPINE NORDIC COMBINED FREESTYLE Medical directors have been notified

THANK YOU