Joel Selwood of the Cats in the hands of trainers after a heavy bump during the AFL Round 2 in 2012

New look at concussion

Saturday, December 01, 2012

By Peter Ryan
afl.com.au

The AFL is looking at including a reaction time test on the sidelines as another way to improve the process of evaluating players who may suffer concussion during a game.

The potential use of such a test - which could come in many forms - is considered a relatively simple, inexpensive addition to the Sport Concussion Assessment Tool (SCAT2) test currently used that runs at 90 per cent accuracy in determining whether a player is concussed or not.

The AFL also revealed last week it was considering giving club doctors access to broadcast footage on the boundary line in 2013 as another tool to further guide their evaluation of potential concussion cases in real time.

The SCAT2, and other potential sideline assessment methods, was one of many topics discussed at the 4th International Concussion Consensus Conference held in Zurich last week.

The conference will deliver an updated consensus statement on concussion in March/April next year.

AFL medical officer Dr Peter Harcourt, one of several representatives of the AFL concussion-working group to attend, said the conference confirmed the League was on the right track when it came to managing concussion.

"It was a really good conference and we got a lot out of it, both in affirming that what we were doing was right but [we] also got some ideas on how we can go forward and make it better," Harcourt said.

Those attending the conference confirmed there should be no play on the day of concussion and that the team doctor should most definitely be the person that makes the call on concussion.

Harcourt said it was agreed the team doctor was in the best position to pick subtleties in a player's behaviour because they knew the player best.

However, he did not rule out the use of independent doctors in the days following the event if circumstances made it necessary.

Conference attendees dismissed the notion that players concussed three times should automatically be stopped from playing, finding no evidence to support that thesis.

Harcourt said the SCAT2 test was likely to be updated after the conference into a SCAT3 to clear some grey areas and tighten the definition of concussion further.

There would also be moves made to create a SCAT test that parents and coaches can apply in junior leagues where trained medical personnel are often not in attendance.

This was an important development said Harcourt, and was being led by Australian representatives including noted neurosurgeon Professor Gavin Davis.

Harcourt also said those attending the conference aimed to create a sporting environment for children that meant youngsters did not receive any concussions playing their sport. This could be achieved through rule modifications and skill development programs, applicable to specific sports.

The conference also heard scientific research presented around the
controversial issue of CTE (chronic traumatic encephalopathy) - a subject that has caused much public debate particularly in relation to cases involving former NFL players in America.

The presentation on CTE proved the most contentious session of the conference, with a wide range of views about the relationship between CTE and concussion and the capacity to determine that relationship.

"There's a lot of work to be done [in that area]," Harcourt said.

The conference gathered about 300 experts to discuss and debate emerging evidence around the issue of concussion.

Chosen representatives then examine all the material presented and gathered during the conference to develop a consensus statement, which will be released next year alongside research presented at the conference.

The 2008 consensus statement underpinned the AFL's concussion guidelines and the SCAT2 test.

"Different sports implement it in different ways to make sense to their sport," Harcourt said. "[The conference] reinforced the way we (the AFL) have been approaching it which is to interpret that document in the context of the AFL."

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