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Inside the game 21

who has experience with concussive injuries. A GP may not necessarily be the right doctor to make an accurate assessment. As with AFL players, children need a graded return to training and competition plan. The good news is that a preliminary concussion assessment is simple to do and can be done while the player is still on the field. In fact, it is not mandatory for a player who has taken a knock to the head to leave the field. This initial concussion test is called the Maddocks Score Sideline Assessment and involves a short series of simple questions including: At which venue are we at today? Which half is it now? And who scored last in this match? The Maddocks Score is part of a more comprehensive concussion assessment called the Sports Concussion Assessment Tool 2 or SCAT2. If a player scores poorly in the Maddocks Score, the remainder of the SCAT2, which includes questions about physical health as well as memory, balance and co-ordination testing, can be implemented with the player off the field before a concussion diagnosis is made by the doctor. The SCAT2 can be implemented for any athlete 10 years or older and can be completed in eight 10 minutes. Dr Larkins said there was massive pressure on club doctors under these circumstances, that doctor honesty was paramount and clubs needed to be patient and give the medicos the time to perform thorough assessments. He said that in assessing concussion, familiarity with the player helped with making a correct diagnosis in conjunction with the assessment tools. This point argues against the use of an independent concussion assessor. Not to mention that the use of an independent assessor would imply that club doctors were putting the match result ahead of their patients health, when in fact the opposite is always the case. A concussed player will have their condition assessed and monitored over the days following with the CogState computerised assessment that all AFL clubs use. This tool assesses more subtle changes in a players thinking speed and accuracy. CogState testing enables baseline testing of players during pre-season, which enables comparison of pre and post-concussion test results. New software developments have made it more difficult for the players to fool the doctors during this assessment. There is no set time for recovery from concussion but it generally takes seven to 10 days to become symptom free; sometimes longer for kids. A mandatory exclusion time after a concussion is not supported by medical science, waiting for signs and symptoms to go is the best advice. Its important to know that there is no evidence supporting the use of protective headgear to guard against concussion; though effective in preventing or reducing the severity of a skull fracture, a helmet

'Its important to know that there is no evidence supporting the use of protective headgear to guard against concussion.
players. Theres no question that NFL and AFL are vastly different sports. NFL players use their helmets as weapons and many experience McCRORY dozens of subconcussive blows to the head in every game. Over the coming years, many donated brains from ex-NFL players will hopefully help researchers to understand more about this disease. Dr Paul McCrory, neurologist and director of the Centre for Health, Exercise & Sports Medicine at the University of Melbourne, says that very little is known about what type, frequency, or amount of trauma is necessary to induce the accumulation of the proteins in the brain that are so damaging. Also, since there is no test for this disease, it can be diagnosed only once the brain can be sectioned into slices and stained with a dye for the tau protein and of course, this can be done only after death. Although CTE has never been diagnosed in an ex-AFL player, these findings do suggest that a portion of AFL players may not be immune to some of these devastating and irreversible changes to the brain under certain circumstances. The introduction of new AFL concussion guidelines, a more conservative approach to concussion management, is a great leap forward in best protecting players while researchers continue to work to find answers to the many questions about these conditions. In the meantime, it would be most irresponsible of players, officials and administrators at all levels of football to do anything less than adhere to the new regulations, irrespective of how much a player is needed by his team. n The Consensus Statement on Concussion in Sport, and the Sports Concussion Assessment Tool 2 (SCAT2), are freely available for download and distribution from:

PLAYERS AT RISK: Concussed players can find themselves with CTE.

doesnt protect the brain from colliding with the inside of the skull, which is what causes concussion. Although research is ongoing, possible links between repeated sportrelated concussion and increased risk of clinical depression, dementia and Parkinsons disease are under examination. Former Melbourne player Daniel Bell is seeking compensation for brain damage linked to his history of concussions. The AFL Medical Officers Associations Dr Hugh Seward describes a current AFL study of retired footballers looking for evidence of adverse long-term consequences for previously concussed players. This study requires ex-players to complete questionnaires and undergo specific tests of cognitive function, and will compare previously concussed players with non-concussed players. Dr Seward says the AFL will be monitoring the new guidelines and track to see whether players appear to recover better from concussion by having a more conservative approach. One concussion related condition gaining widespread media attention of late is known as chronic traumatic encephalopathy or CTE. Formerly known in boxers as punch drunk syndrome, can have devastating

STUNNED: Jack Riewoldt was reluctant to stay off the ground after being KOd.

effects on health. The condition develops as an accumulation of a protein called tau in brain cells. Symptoms of CTE include memory loss, headaches, slurred speech, confusion, irritability, aggressive or violent behavior, cognitive decline, unsteadiness, depression, movement InsIde Football

abnormalities consisting of staggered, slowed or shuffled gait, paranoia and apathy, according to an article written by Dr Ann McKee, an international expert in CTE studies from the Boston University School of Medicine. Though most frequently seen in boxers, CTE has now been identified in the brains of deceased former NFL

Wednesday, august 3, 2011