OET Listening Partie C : Sports Concussion Guidelines Overview

My guest today is Dr Ian Marsh,

a specialist in the treatment of concussion in sport and a co-author on a new set of guidelines.

So, Dr Marsh, what's the aim of these new guidelines?

Well the aim was really to provide a resource,

not for the top-level professional sports people, but for parents, teachers and coaches of young people playing sport.

The guidelines basically offer some expert information from a GP (an emergency physician),

and myself as a neurosurgeon,

about what the condition is, also how to identify the symptoms and how to manage it.

If any of your listeners have ever had a concussion doing sports, you'll know how frightening it can be.

It's confusing and painful,

and difficult sometimes for teachers, parents, or whoever to work out if someone with concussion is okay.

I mean... we hope to remedy that.

And how do we know when someone is suffering from concussion?

Well, obviously, if the person's actually knocked out, it's clear.

But not all patients actually lose consciousness.

Often following a hard knock to the head, they become disorientated

or experience headaches, nausea or vomiting.

These are signs of concussion and they may clear initially,

but then return when the individual actually undertakes further physical activity;

when they start to train, say.

So, it can actually take quite a while for things to really clear up.

The essence of it is that people shouldn't start playing again until those warning signs have completely subsided.

Yes, and you say that waiting anything less than fourteen days after all the symptoms have cleared would be too early to return?

Yeah, that's right.

If they go back too early, they risk a second concussion

and, as we know from professional athletes,

they may have to give up their sport if they have too many concussions.

So it's better, particularly in a young person with a developing brain,

to allow all of the symptoms to settle, and only then return to play.

Well, usually return to train first, then return to play after that.

It used to be thought that receiving another concussion, could lead to severe brain swelling,

and that could be fatal or at least involve a visit to the emergency room.

I think the evidence is fairly slim for that.

What we do know though is that the compounding effect of having one concussion followed by another

seems to be more severe than just the one.

So it's always better to let the brain recover fully before playing again.

Right, so who's at the highest risk of sports concussion?

Well, actually a concussion can happen whenever anyone receives a blow to the head.

Usually it's a sort of twisting blow, not a straight-on blow.

But, obviously people playing sports like rugby, where there's bodily contact,

stand more chance of being at the receiving end of such a blow.

But having said that, it's just as likely to affect kids kicking a ball around a park as it is to affect top professional players in big matches.

Do you think that youth sports need specialist concussion doctors on hand?

Like the professionals do?

There's always a risk and we know that it happens from time to time,

but I mean most games, even the most dangerous ones, are without incident at all.

I think people who are involved in running youth sports, whether they be referees, coaches, or parents,

can be made aware of how to manage concussion,

the signs that they need to look out for,

and maybe the warnings of something more serious,

so that they can take the appropriate actions.

But I think always having a doctor on the sidelines where young people are playing is just an over-reaction.

Right, in the USA, college football is big business.

They're trialling helmet sensors and impact sensors.

Do you think that's something we need everywhere?

Well, I don't think it'll come to that.

I think there are two scenarios here.

The first is one where a concussion's a one-off event following a significant blow to the head.

The second's quite different and involves Chronic Traumatic Encephalopathy.

This comes about particularly in American Football,

where players use their helmets and heads almost like weapons.

That type of repeated impact seems to add up over the player's career.

That's something we've heard being discussed, mostly in the USA.

Naturally there's interest generally in protecting players,

particularly in the professional levels of sport,

but I see that as a different matter to the management of concussion itself.