Interview with Dearbhla Gallagher PhD, ARTC on the recently published Consensus Statement on Concussion in Sport (the 5th International Conference on Concussion in Sport), the Sport Concussion Assessment Tool (SCAT 5), the Child SCAT 5 and the Concussion Recognition Tool 5th Edition (CRT5). By ARTI vice PRO Tom Quinn MSc, ARTC.

(Please use links provided to access the material via BJSM)

TQ: “What are the most significant changes or updates to the consensus statement on concussion in sport that would be of interest to ARTC’s working in sport at all levels?”

DG: “Several papers have emerged from the 5th Consensus. The overall summary would be that the SCAT5 provides “the most well established and rigorously developed instrument for sideline testing”. This is true.

One of the most important outcomes of the Berlin Conference is the publication of not only their findings but thorough descriptions of how such vital guidelines were built. The highest scientific standard was adhered too for the purpose of transparency and quality.  Clinicians should now be appropriately comfortable and confident with the SCAT based on several versions now being common practice. All previous versions should be removed from circulation and best practice should be parallel to the SCAT5, Child SCAT5 and CRT5.

Some of the most significant changes include changes to the……

Consensus statement

  • There are 11 ‘R’s’ to the management of sports related concussion. The statement is laid out by each ‘R’ (recognise, remove, re-evaluate, rest, rehabilitation, refer, recovery, return to sport, reconsider, residual effects and sequelae, risk reduction). (They have laid the document in a very concise manner all italic writing demonstrating new or changed opinion).

Further changes to the definition

  • The best approach to the recognition of SRC is a multidimensional test guided by the exert consensus.
  • The SCAT is best utilised immediately after injury with its utility decreasing significantly from 3-5 days post injury.
  • The symptom checklist is beneficial in tracking recovery.
  • Baseline testing may be useful but not necessary for interpreting post injury data.
  • Additional testing that can be helpful includes timed reaction testing, gait/balance assessment, video observable signs and oculomotor screening.
  • When concussion is suspected the athlete should be removed and tested with a multidimensional assessment.
  • Sporting bodies should allow adequate time for this assessment  (10 min) and provide and adequate environment both on and off-field.
  • Rule changes may need to occur in some sports to allow for this without unduly penalising the injured players team or the flow of the game.
  • The final determination regarding a sports related concussion diagnosis and/or fitness to play is a medical decision based on clinical judgement.
  • A return to school strategy table has been provided.
  • Advanced neuroimaging, biomarkers and genetic testing are valuable research tools but still require further validation in SRC evaluation.
  • There is currently insufficient evidence that complete rest is required. After a brief acute period of rest (24-48hrs) patients can be encouraged to become gradually more active while staying below their cognitive and physical symptom threshold. The exact amounts are not yet well defined and further research is required.
  • Literature has not yet evaluated early interventions for rehabilitation as most recover in 10-14 days. Data supports interventions that include psychological cervical and vestibular rehabilitation. Closely monitored active rehabilitation that includes controlled submaximal exercise at sub-symptom-threshold level has shown to be safe and beneficial. The evidence around this and several other areas of rehabilitation requires further work.
  • A whole section has been added in as persistent symptoms under “refer”. It is suggested that a definition should be determined for post-concussive symptoms which occurs (10-14 days adults, >4 weeks children) beyond typical recovery.
  • The best predictor for slower recovery is the severity of symptoms initially. A new paragraph has been added which makes specific reference to those with a history of migranes, mental health or ADHA.
  • Establishing time to recovery has also been a significant addition but remains a grey area.
  • A specific call has been made that the next consensus should have adequate evidence for children. It has suggested that schools should have a concussion policy that includes education on SRC prevention and management for teachers, staff, students, parents and should offer appropriate academic accommodation and support during a students recovery. Children should not return to sport until they have returned to school.
  • The literature on neurobehavioral sequelae and long-term consequences of repeated head trauma is inconsistent. The potential to develop Chronic Traumatic Encephalopathy must be considered…….a cause-and-effect relationship has not yet been demonstrated between CTE and SRC or exposure to contact sports.
  • A significant addition has been made in the area of prevention detailing emerging research.
  • The conclusion states “while agreement exists on the principal messages conveyed by this document the authors acknowledge that the science of concussion is incomplete and therefore management and return to play decisions lie largely in the realm of clinical judgement on an individualised basis.”

http://bjsm.bmj.com/content/early/2017/04/26/bjsports-2017-097699

TQ: “What are the main differences or practical implications between the Scat 5 (new edition) and previous edition (Scat 4)?”

DB: “The SCAT5 is very similar to the previous. This was a decision based on its world-wide use, common understanding and familiarity. The changes are outlined in box 1 SCAT 5 modifications. Changes include but are not limited to; a declaration that it cannot be completed in less than 10 min. Indications for emergency management, clarified symptom checklist instructions, additional post injury questions, SAC 10 word option. A notation of the last word recall time. A rapid neurological screen has been included, return to sport  states rest should last no longer than 24-48hr. A school progression has been added and specific indication that return to sport should occur only by written approval by a healthcare professional.”

“THE MOST SIGNIFICANT ADDITION IS THE NEUROLOGICAL SCREEN WHICH INCLUDES READING AND EYE MOVEMENTS AMONGST OTHERS.”

http://bjsm.bmj.com/content/51/11/851

TQ: “Can you tell us briefly about the CRT5 and its relevance for non-medical practitioners involved in sport?”

DB: “The CRT5 is again a follow up document. It is for the lay-person and should not be used for a diagnosis. It is to recognise possible SRC and to lead to appropriate steps and action taken if one is suspected. Little research has been conducted on its utility of efficacy. Again this presents another call for research by the CISG.

Key modifications include that it is not a diagnosis, greater emphasis for recognise and remove, expansion of red flags, immediate referral points, list of signs and symptoms, awareness questions and cautions regarding acute management and restrictions on behaviours.

It of course is a helpful tool as long as it is utilised. It should be widely disseminated. It provides instructions with clear language for the lay person thus assisting in the identification and care of concussion in many populations.”

http://bjsm.bmj.com/content/51/11/872

TQ: “Are there any new emerging trends in concussion research that may have future potential to help with our diagnosis of concussion?” 

DB: “Several references were made to video analysis and other diagnostic tests (that don’t yet have sufficient power to support their use). Although force sensor analysis was discussed again there is a lack of consistent evidence to support its use. Further mention was given to sophisticated areas of research such as neuroimaging, genetic testing, pharmacology and fluid biomarkers to assist in diagnosis but again insufficient evidence is currently available.” 

TQ: “Return to learning/work and return to play is an extremely important aspect for practitioners using the SCAT 5. Can ARTC’s working in sport be confident that the SCAT 5 is sufficient in this regard?  or would you recommend using the SCAT 5 in conjunction with other concussion assessment tools such as the VOMS (vestibular/ocular motor screening assessment)?”

DB: “The consensus outlines that medical practitioners must use experience and judgement. This adds to their suggestion that the SCAT5 is the most robustly testing assessment strategy available but others may be used in addition to the SCAT5 to further inform the clinician. I think the additional of reading and eye-movement to the SCAT5 is a significant development which can be viewed at a nod towards further assessment in these areas for example VOMS. With any additional testing it is important to consider the population and the practitioners understanding and training to utilise a test correctly and effectively. Though they may not have appropriate power and be lacking in quality in areas, there is certainly research to support other methods of testing. I think the area of vestibular and oculomotor examination will continue to have positive findings in support of their use”.

TQ:  “Dearbhla, on behalf of the ARTI board I would like to thank you very much for your time and for this invaluable information that is of such great importance to our members.”

 

 

Dry Needling Course

A dry needling course for ARTI members will be running in July and August 2017 in DCU. This is a world class Trigger Point Dry Needling Course presented by Dr Johnston McEvoy of the David G Simmons Academy.

The first part of this bi-modular (DN1 & DN2) course will commence on July 6th.
The course will be held over 6 days, which is separated into two 3 day periods, totalling 48 CPD hours.

Course Dates:
Dry Needling 1: July 6th, 7th 8th (Thurs, Fri, Sat) 2017
Dry Needling 2: August 24th, 25th 26th (Thurs, Fri, Sat) 2017

For more information:
Visit: www.unitedphysiocourses.com
Phone: (061) 339991

Dry Needling Course ARTI 2017 PDF

ARTC needed for Gaynor Cup – Soccer Competition, Limerick, June 21-25th.

ARTC required for Gaynor Cup U14 Female (soccer) competition in Limerick between 21-25th June (Wednesday/Thursday/Friday/Saturday/Sunday). This paid role will involve covering matches during the day and providing treatments during the evenings. Accommodation and food will be provided. Suitable for newly graduated ARTC with potential for future work at upcoming competitions.
 
Please contact Tom Quinn ARTC for more details.
 
087-7515480

Phil Glasgow – Hip and Groin Pain In Sport Workshop (2 days) – Kilkenny 04/05 Feb 2017

Hip and Groin Pain in Sport (2 day workshop) with Phil Glasgow available to ARTI members. See following link for more details. Cost – 275.00 euro.

http://www.iscp.ie/node/37281

Course Overview:

This highly practical two-day course will enable participants to enhance their assessment, treatment and rehabilitation skills in the management of sport-related hip and groin pain. Course participants will learn about pathomechanics of pelvic function and its role in high-speed activities such as running, kicking and throwing. Hip and groin pain in sport will be discussed and a sport specific approach to assessment will be taught to improve physical examination and diagnostic skills. Sport specific treatment techniques to address specific dysfunctions will be taught. This will include manual techniques for both the joints and the muscle-tendon unit as well as exercise interventions. This course will provide participants will the skills necessary to retrain appropriate movement patterns, enhance energy transfer and restore sport-specific function.

Two ARTI members conduct workshops at FSEM conference

Two ARTI members will be conducting workshops as part of this month’s FSEM Annual Scientific Conference 2016.

The highly regarded annual conference, which is supported by ARTI, will take place in the RSCI from September 15 to 17, and will feature workshops from Dearbhla Gallagher and Diarmaid Brennan.

Dearbhla’s topic is entitled, “Risk factors and modifiers – application of concussion tools” and will take place on Thursday September 15 from 3pm to 5pm. Meanwhile Diarmaid’s workshop is on “Prevention and Rehabilitation of Hamstring injuries”, and will be conducted on Saturday at 2pm. Given the topical nature of both talks they are sure to attract great interest among those attending the conference.

Concussion is Dearbhla’s area of special interest and she decided on this particular topic for the workshop due to her concern in relation to concussion for those at grassroots and school sport particularly among female and child athletes.

“There are several problems that those in these groups face but I believe that many of these can be solved by identifying risk factors and modifiers of concussion injury and how these can be applied to useful tests”, she stated and explained that the workshop will look at several tests that can facilitate a concussion assessment.

Dearbhla

“The Standardised Concussion Assessment Tool (SCAT) is the industry wide endorser tool and is due for review this October at the 5th International Concussion in Sport Conference. Several advances in research suggest there will be several likely changes to the test in the months after the conference. The SCAT has several limitations that clinicians should understand and take into consideration during utilisation of the test both in the immediate aftermath of the concussive event and in the rehabilitation/return to sport process. Many of these limitations can be remedied with other complimentary tools”, added Dearbhla.

Dearbhla, who graduated from the Athletic Therapy and Training programme in DCU in 2010 and is an Alumni of the Placement at University of Pittsburgh (USA), is currently combining private clinical work in London while studying for a PhD in Concussion at St Mary’s University London.

She believes this workshop will be of benefit to clinicians as it is vital to keep up with advances in this area.

“With hundreds of articles released every month on concussion, it is important to review the current evidence regularly. The Consensus Statement on Concussion is released every four years but during these periods advances in clinical knowledge should not cease as it is highly likely that major evidence could emerge during these times whereby care of the concussed athlete be advanced and be up to date”, she stated.

The workshop will no doubt provide very useful information for clinicians as Dearbhla reveals.

“I am aiming to provide emerging and up to date evidence from a applied practitioner stand point for the assessment and rehabilitation of concussion – not just endorsed information. Combining the evidence and the application of current and available (reliable and valid) tools in order to leave with practical information that can be implemented in a variety of settings”, she explained.

 

Meanwhile, Diarmaid’s workshop is also expected to be very popular given that he will discuss another important topic – that of hamstring injury prevention and rehab.

It is an area that Diarmaid is very familiar with in his role as Senior Injury & Rehabilitation Coach with Leinster Rugby, and sharing his knowledge will benefit those in attendance.

 

He will discuss various types of strains from the severe Grade 3 to the less serious from the viewpoint of prevention and rehabilitation.

diarmaid

“I am looking forward to the workshop as I think it will be interesting as it covers different levels of hamstring injury. I will discussing at the return to play process and how to benchmark where a player should be at a particular time in relation to recovery”, revealed Diarmaid who graduated from Carlow IT with a degree in Sports Rehabilitation and also runs the DB Sports Injury Clinic.

“I think the workshop will be of benefit to everyone and hopefully they will find it interesting. How to differentiate the types of hamstring strain, how to load them and exercise selection are the main components of the workshop.

“I will look at area such as when the athlete is ready to run and what exercise is best as this is a big part of the rehab”, explained Diarmaid.

For full details on the FSEM Annual Scientific Conference 2016 visit http://fsem2016.com/ 

 

Billy Martin ARTC becomes first ARTI member to gain qualifications in Canada

Billy Martin ARTC

Billy Martin ARTC, CAT(C) in Vancouver

Billy Martin has recently become the first ARTI member to take on the Canadian Athletic Therapists Association’s certification exams and is now recognised as a Certified Athletic Therapist (Canada). This success comes not long after passing the ARTI exams and gaining ARTC status in January 2015.

ARTI President, Paul Berry, congratulated Billy on his achievements

‘On behalf of ARTI I would like to congratulate Billy Martin on being the first ARTI member to successfully sit and pass the CATA exam. Billy’s success follows shortly after ARTI member Paddy McEvoy passed the BOC exam in the USA last December. We’re delighted to see ARTI members avail of the historic agreement between ARTI, CATA and BOC which came into effect on January 1st 2015. This trilateral agreement entitles members of each organisation to sit the certification exams of the other two countries. Well done Paddy and Billy – blazing a trail for ARTI!’

Speaking from Vancouver, Canada, where he is currently practicing as an CAT(C), Billy describes his journey to getting ther

‘I certified with ARTI in January 2015. I emigrated to Vancouver in March of that year. I started out by contacting several registered CATA members; initially to seek advice about preparing for the national certification exams. Over time, this led me in the right direction, and I became acquainted with fellow Canadian colleagues that were also challenging the exams.

 

The exams consisted of a three hour, 200 question multiple choice theory, and four 30 minute practicals between clinical and field. This required regular practice within groups, which was hard to come by, as the only athletic therapy school in British Columbia is located on Vancouver island. It’s fair to say that I only realised the size of the task at hand, once I was well into the process. For an international, the exams consist of nuances that one can only comprehend by attempting them.

 

As I was awaiting certification, I acquired my own insurance, and began picking up a lot of field work as a certification candidate; most of which was with two minor ice hockey academies. From September 2015 – March 2016, I covered a lot of hockey games, which included extensive travel throughout British Columbia and Alberta.  In between there have been opportunities in Canadian football, soccer, lacrosse and basketball. Since March, an opening became available for an athletic therapist at an interdisciplinary concussion clinic in Vancouver. I had been lucky to be able to work there as a certification candidate, and now that I have achieved certification, there is an opportunity for me to develop the role of the athletic therapist among an experienced and talented team of health professionals. I worked extremely hard to achieve certification, and at times it felt like a bridge too far. In the end, I’m satisfied, and it brought home to me what progess ARTI has made since it’s recent inception.

I’d like to extend my gratitude to all ARTI members who have worked diligently in helping it to become a reputable organisation, and the opportunities it has afforded to it’s members, home and abroad.

Life in Canada has been very good for me, so far. It seems like there many opportunities, and it is a beautiful country, with friendly people, much like our own. I’d be happy to offer advice to ARTI members considering coming to Canada in the future.’

Congratulations again to Billy and we all wish him best of luck in his future career.

If you have any comments or questions regarding the CATA certification process or any other query arising from Billy’s story then please leave a comment or get in touch at artipublicrelationsofficer@gmail.com

 

Paddy leads the way by getting recognition in America

An ARTI member has once again highlighted the exceptional standards of practitioners in Ireland after successfully passing the exams that entitle him to practise in America.

Paddy McEvoy became the first ARTI member to pass the exams since the establishment of the Mutual Recognition Arrangement which enables him to complete the Board of Certification (BOC) exam and become a member of the National Athletic Trainers of America (NATA).

Naturally, Paddy is thrilled with the achievement and he is certainly not going to let the hard work go to waste as he has already finalised his plan to further his studies in the USA.

Paddy McEvoy2

In August, the 23-year-old from Ballyragget, Co Kilkenny, will commence a Masters in Health and Exercise Science and graduate assistantship in Ithaca College in upstate New York which he believes will be a huge boost to his career.

“I took the exam in November and found out the results in December so I was delighted that it all worked out. It was very difficult because the exam is a lot different to the ARTI exams due to the fact that it is all theory and there is more focus on general medical issues.

“I suppose the knowledge base is broader and you also have a lot more in terms of the legal side of things”, added Paddy who graduated from Carlow IT in 2015.

Having decided over the summer while working in a clinic that he wanted to go for the exam, Paddy was virtually in full-time preparation from September to November and based himself in Carlow IT.

Having spent four months in Ithaca College in early 2015 as part of his degree, Paddy’s contacts there enabled him to get advice and direction on many topics for the exam. He admits that this support base was a vital factor in getting through the exam.

“I really enjoyed my spell at Ithaca as it is recognised as one of the foremost colleges for Athletic Training in the USA. I made a lot of contacts and while I was studying, if there was anything I wasn’t sure of there was somebody available to help me so I think that support base as essential for me”, he explained.

Passing the exams gave Paddy the opportunity not only to study at Ithaca but also gain some valuable work experience with the college teams.

“Doing a Masters is very expensive but fortunately I will also be employed by the college for about 20/25 hours per week so that means I don’t have to worry about tuition fees and I will also get hands-on experience with a team.

“I have a choice of field hockey, track and field or rowing, so hopefully I will get hockey as I would prefer work with a contact sport”, explained Paddy who is looking forward to the new venture.

“I never had any intentions of going back to America once I had done my four month placement as I would consider myself more of a home bird. However, when the opportunity came up for 12 months I decided to go for it. At the end I will have a degree and a Masters along with practical experience so that should make me a lot more employable”, he added and pointed out that he expects many others to follow his example in taking the exam.

“I think the fact that somebody has taken the exam and passed it shows that it is possible and already I have had other people on to me looking for a bit of advice”, continued Paddy who will be strengthening the links between the colleges during his stint.

“From my experience there is a good relationship between the Irish and USA colleges and the fact the Americans are so keen to have Irish students which shows the quality of the courses we have here in Carlow IT, Athlone IT and DCU.”, he concluded.