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Concussions/return-to-play (HR)

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  • Concussions/return-to-play (HR)

    The NFL just introduced a new "Sideline Concussions Exam", a neurologic test to determine – on the field – whether an injured player may return to the game. It is designed to be administered within 6-8 minutes of a suspected concussion. All players will be tested before the season to determine a baseline – how they perform on the test when healthy.

    As I was listening to a report on this, I wondered if/how this would be applicable to eventing, in particular regarding a rider who has a fall then wants to ride again later in the day/show.

    The NFL is evidently leading the field in this area. One thing they have is a certain number of qualified medical professionals immediately available to administer the test, whereas it could be hard to do the same for an eventer who is in the back 40 leading his horse to the stabling area after a fall.

    Would love to hear your opinions on this!
    Blugal

    You never know what kind of obsessive compulsive crazy person you are until another person imitates your behaviour at a three-day. --Gry2Yng

  • #2
    Eventing has similar guidelines, although not as comprehensive as the NFL's guidelines.

    http://useventing.com/resources/file...n-Brochure.pdf
    Head Geek at The Saddle Geek Blog http://www.thesaddlegeek.com/

    Comment


    • #3
      Originally posted by jn4jenny View Post
      Eventing has similar guidelines, although not as comprehensive as the NFL's guidelines.

      http://useventing.com/resources/file...n-Brochure.pdf
      If only this part of the document were still true:
      What happens if the rider answers all the questions correctly and appears to be
      physically all right?
      The rider can immediately continue with the course.

      Kinda tells you how dated the document it.

      However, if you will check the new rules...
      In conjunction with GR1317, the following apply in the case of a fall/accident or other injury likely to cause concussion (as determined by qualified medical personnel):
      a. No loss of consciousness and no sign of concussion - No mandatory suspension;
      b. No loss of consciousness but with brief symptoms of concussion e.g. confusion,
      loss of memory, altered mental state (all symptoms of concussion must have resolved within 15 minutes both at rest and exercise) - minimum of 7 days mandatory suspension. The day of injury counts as the first day of suspension period.
      c. Any loss of consciousness, however brief, or symptoms of concussion persisting
      after 15 minutes - minimum 21 days mandatory suspension. The day of injury counts as the first day of the suspension period.
      d. Notwithstanding the above, riders who have established a baseline neurocognitive skills level through a Federation approved testing program e.g. IMPACT test may return to competition upon submission to the Federation of certification that they have passed an exam establishing that they have suffered no impairment of that level. In addition, they must submit clearance as required under GR1317.6.
      e. All other riders may, at the expiration of the mandatory suspension period, return to competition by complying with the requirements of GR1317.5.

      Comment


      • #4
        I'm glad they've altered the rules to be more comprehensive. If I sustained a concussion, I would retire on course--but others who are more competition-minded might be tempted to continue, which is extremely dangerous.
        Head Geek at The Saddle Geek Blog http://www.thesaddlegeek.com/

        Comment


        • #5
          Originally posted by jn4jenny View Post
          I'm glad they've altered the rules to be more comprehensive. If I sustained a concussion, I would retire on course--but others who are more competition-minded might be tempted to continue, which is extremely dangerous.
          The problem is how many of us can self-diagnose a concussion? How many times have you had a fall and thought you were fine but the after effects contradict that thought and you are sore places that you did not even remember impacting? Ever had a fall and not even know that you have hit your head?

          Are the regular medical personel on site at a HT qualified to field-diagnose a concussion 100%?

          We don't have the "bank" that the NFL has nor have we really admitted to the same degree that we have a problem. Lots of room for education with riders IMO.

          Lots of ULRs ride hurt. Whats to stop them if they had a crash at home? I know of an ULR who had a very bad crash last year who had shown up to ride already quite injured. Perhaps if he/she had needed to pass a medical clearance exam before riding that crash would not have occured? Hard to say but it certainly could have been a factor.

          I hang out with a polo crowd and scrimmage/stick and ball with them sometimes and I always wear my helmet. They only wear helmets when they have to. I am quite sure that they find it funny that I wear a helmet. Things are changing but overall as horseman we sure have a long way to go.

          I have read studies that discuss the cumulative effect of mild concussions and have to wonder how many of us suffer from this but are unaware.

          My point is that this is an issue and it needs attention. I just don't know how it can be done since the majority of riders seem to almost be proud of riding hurt and not always making use of proven safety equipment, the different challanges of dealing with athletes that train on their own, the funding required etc etc
          "look deep into his pedigree. Look for the name of a one-of-a-kind horse who lends to his kin a fierce tenacity, a will of iron, a look of eagles. Look & know that Slew is still very much with us."

          Comment


          • #6
            Originally posted by sisu27 View Post
            The problem is how many of us can self-diagnose a concussion? How many times have you had a fall and thought you were fine but the after effects contradict that thought and you are sore places that you did not even remember impacting? Ever had a fall and not even know that you have hit your head?
            Yes I have, and that's why I did not rely on myself to make the diagnosis. The people around me, and ultimately the EMS, took steps to assess the severity of the concussion and decide if I should go to the hospital for further testing. But the point is that even for people like myself that I would consider responsible and informed about concussion injuries, there's still a measure of personal decision involved. So it comes down to a question of whether the USEA should step in when the rider's judgment abilities may be impaired. I don't have an answer to that.

            Are the regular medical personel on site at a HT qualified to field-diagnose a concussion 100%?
            No, and anyone who tells you that even the NFL folks are qualified to field-diagnose 100% are full of it. Even the best medical team can't 100% diagnose a TBI without MRI and other expensive, hospital-bound diagnostics. There are doctors who even feel that THAT'S not sufficient because TBI is so complex and there can be cognitive issues even if the MRI is clean. The only 100% foolproof way to prevent TBI would be to not have head injuries.

            Are there steps that can be taken on the field to help prevent a total catastrophe, and is it a good idea to be extra cautious and assume the worst based on the symptoms? Of course. And I wish that eventers had better guidelines, although I don't think the concussion brochure is a bad start (names symptoms, gives time spans during which the symptoms may or may not occur, etc.) An updated concussion brochure would go a long way toward that goal, as does the presence of a well trained EMS at an event.

            Lots of ULRs ride hurt. Whats to stop them if they had a crash at home? I know of an ULR who had a very bad crash last year who had shown up to ride already quite injured. Perhaps if he/she had needed to pass a medical clearance exam before riding that crash would not have occured? Hard to say but it certainly could have been a factor.
            Hate to break it to you, but the problem is even bigger than that. Even with the necessary diagnostics like MRI, many doctors seriously underestimate the potential consequences of TBI. And even those who recognize those consequences can't necessarily predict them since every patient's recovery is different. So there are people running around with full medical clearance who might be VERY not okay.

            In short, I think we can agree that the USEA could use better guidelines and procedures. But I also think we need to recognize that as with helmet use, at some point this comes down to the scary grey area of personal decision making. It's terrifying that those decisions might be made by someone with impaired judgment, but it becomes very difficult to tell if someone's judgment is impaired by a head injury or because they're just a hard-headed type who comes from a "tough it out" background.
            Head Geek at The Saddle Geek Blog http://www.thesaddlegeek.com/

            Comment


            • #7
              Having seen one of our barn kids being given a leg up and sent on her way WITH a concussion prior to the one fall rule, I wouldn't want to see the ground jury making that kind of call again...

              It became quickly apparent there was a huge problem... kid was galloping circles and jumping random fences trying to remember her course... (thankfully she was quickly flagged down and halted).
              "Adulthood? You're playing with ponies. That is, like, every 9 year old girl's dream. Adulthood?? You're rocking the HELL out of grade 6, girl."

              Comment


              • #8
                Originally posted by Ibex View Post
                kid was galloping circles and jumping random fences trying to remember her course... (thankfully she was quickly flagged down and halted).
                Gee, sounds like a normal cross country ride for me!! ;-)

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