Ice hockey summit II: zero tolerance for head hits and fighting.

OBJECTIVE: To present currently known basic science and on-ice influences of sport related concussion (SRC) in hockey, building upon the Ice Hockey Summit I action plan (2011) to reduce SRC. METHODS: The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure, for the science and discussion held during Summit II (Mayo Clinic, Rochester MN, October, 2013). Summit II focused on Basic Science of Concussions in Ice Hockey: Taking Science Forward; (2) Acute and Chronic Concussion Care: Making a Difference; (3) Preventing Concussions via Behavior, Rules, Education and Measuring Effectiveness; (4) Updates in Equipment: their Relationship to Industry Standards and (5) Policies and Plans at State, National and Federal Levels to reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were subsequently voted on for purposes of prioritization. The following proceedings include the knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. RESULTS: The Summit II evidence based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. CONCLUSIONS: The highest priority action items identified from the Summit include: 1) eliminate head hits from all levels of ice hockey, 2) change body checking policies, and 3) eliminate fighting in all amateur and professional hockey.

Self-assessment of impairment, impaired self-awareness, and depression after traumatic brain injury.

OBJECTIVE: To identify patient features associated with early and late depression after traumatic brain injury (TBI). PARTICIPANTS: 3 clinical trauma groups (mild TBI, moderate-severe TBI, orthopedic injury) and their significant others. MEASURES: Preinjury: age, education, substance abuse, and psychiatric history; Injury severity: classification using Glasgow Coma Scale and cranial CT scan, posttraumatic amnesia; Early impairment: Neurobehavioral Functioning Inventory (NFI), Impaired Self-Awareness (ISA); Social and family support: Multidimensional Scale of Perceived Social Support, Family Assessment Device; Depression: NFI Depression Scale. METHOD: Regression analyses of predictor variables on early and late measures of depression. RESULTS: Depression rates did not differ among the 3 trauma groups. Preinjury level of education, previous psychiatric history, and perceived level of social support explained a small portion of the variance in depressive symptoms. Patients' self-assessment of their impairment at discharge was most strongly correlated with both early and late depression. ISA was associated with reduced self-report of depressive symptoms. However, when those with ISA were excluded from the analysis, self-assessment of impairment remained strongly associated with depression. CONCLUSIONS: Patients' self-assessment of impairment is strongly associated with early and late depression. Presence and severity of TBI does not appear to play a direct role in depression but does appear related to ISA, which serves as a barrier to the development of depression. Focusing on impairment appears to be a cardinal feature of depression in both patients with TBI and an orthopedic trauma group.

Replicated positive results for the VCC model of vocational intervention after ABI within the social model of disability.

PRIMARY OBJECTIVE: Replicated evaluation of the Vocational Case Co-ordinator (VCC) Model for vocational rehabilitation after acquired brain injury (ABI). RESEARCH DESIGN: Referral cohort studied within the social model of disability. METHODS AND PROCEDURES: One hundred and thirty-eight participants with ABI were assisted by a VCC to develop self-directed vocational plans and networks of medical centre and community services. Early intervention, work trials, temporary or long-term supported employment and employer education are fundamental features of the VCC Model. MAIN OUTCOMES AND RESULTS: One year after initial placement 80% of participants remained in community-based employment, 56% of the total sample with no support. Better outcomes were associated with earlier intervention but not with initial injury severity. CONCLUSIONS: Results replicate original findings of the effectiveness of the VCC Model of vocational rehabilitation after ABI with a different VCC. Implications for social change within the social model of disability are discussed.

An assessment of gait and balance deficits after traumatic brain injury.

OBJECTIVE: To assess the sensations of instability that many patients report after traumatic brain injury (TBI). DESIGN: A controlled study. SETTING: A motion analysis and vestibular and balance laboratory. PARTICIPANTS: Twenty subjects, 10 with TBI and complaints of instability, and 10 without TBI. INTERVENTIONS: Balance and gait analysis. MAIN OUTCOME MEASURES: Dizziness Handicap Inventory (DHI), caloric irrigation, optokinetic testing, Dix-Hallpike Test, posturography, and center of mass (COM) movement. RESULTS: Subjects were well matched in terms of age, height, weight, and gender. DHI scores of those with and without TBI differed significantly (32.2+/-23.0 vs 0.2+/-0.63, P<.001). Caloric and optokinetic circularvection testing were abnormal only in subjects with TBI (8/10 and 4/10, respectively). Benign paroxysmal positioning vertigo was present in only 3 subjects with TBI, and this either resolved spontaneously (n=1) or was successfully treated (n=2). Composite posturography scores of those with and without TBI differed significantly (69.6+/-35.8 vs 79.5+/-40.5, P=.02). Gait parameters also differed significantly between the groups (P=.05), with the subjects with TBI having lower anterior and posterior and higher medial and lateral COM displacements and velocities. CONCLUSIONS: Patients' complaints of instability after TBI may have objective correlates and may be rectifiable. Balance and gait testing in these patients is warranted.