Sports Concussion MeyerDC

UPMC Concussion Expert Panel Includes Dr. Kelly Ryder as the Only Chiropractor

UPMC Concussion Expert panel includes Dr. Kelly Ryder as the only ChiropractorIn 2015 I was invited by the University of Pittsburgh Medical Center team to participate as a concussion expert (and the only Chiropractor) in the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting.

Acknowledgments
The authors would like to acknowledge the following individuals who were participating investigators who attended the meeting, assisted in the development of the statements of agreement, and provided feedback on the manuscript: Debra Babcock, MD, PhD (NIH, Washington, District of Columbia), Jeneita Bell, MD (CDC, Atlanta, GA), George Chiampas, DO (US Soccer, Chicago, Illinois), Peter Chiarelli, Gen (Ret.) (One Mind, Seattle, Washington), Joan Demetriades (One Mind, Seattle, Washington), Dallas Hack, MD, Col (Ret.) (Brain Health Consultant; NCAA, Indianapolis, Indiana), Brian Hainline, MD (NCAA, Indianapolis, Indiana), Col Sidney R. Hinds II, MD (Defense and Veterans Brain Injury Center, Silver Spring, Maryland), Hamish Kerr, MD (USA Rugby, Albany, New York), Patrick Kersey, MD (USA Football, Indianapolis, Indiana), Jennifer Langton (NFL, New York, New York), Mark Lovell, PhD (ImPACT Applications, Inc, Pittsburgh, Pennsylvania), Jeff Miller, JD (NFL, New York, New York), Kelly Ryder, DC (The Ryder Clinic, Dallas, Texas), Richard Shoge, PhD (US Army Medical Research and Material Command at Ft. Detrick, Maryland), and Capt Jeffrey Timby, MD (US Marine Corps Health Services Headquarters, Arlington, Virginia). The authors would like to thank the following individuals from Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania, for their contributions to the meeting and the paper: Jamie McAllister-Deitrick, PhD; Alicia Sufrinko, PhD; Melissa N. Womble, PhD; Valerie Reeves, PhD; and Cyndi Holland, MPH.

On October 14 to 16, 2015, the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion meeting was convened in Pittsburgh, Pennsylvania. The meeting was supported through grants from the National Football League (NFL) and University of Pittsburgh Medical Center. Neither organization influenced the content of the meeting or this document. Concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research (referred to as authors throughout this document), as well as individuals representing sports, the military, and public health organizations (referred to as participants throughout this document), attended the meeting.

A total of 38 authors, representing 33 clinical and academic institutions, and 14 participants, representing 12 sport, military, and public health organizations, attended the meeting. Before the meeting, the statements of agreement, along with supporting information and references, were drafted by the primary authors and circulated to contributing authors for review and comment. All primary authors, contributing authors, and invited participants were required to sign an International Committee of Medical Journal Editors Form for Disclosure of Potential Conflicts of Interest.

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After an initial day of presentations by experts in the relevant areas and discussion of this document with the author and participants, key statements of agreement were voted on, evaluated, and revised by the authors. During the month after the meeting, authors were assigned (by the primary authors on the basis of expertise and meeting group assignments) in groups of 2 to 3 to develop 1 to 2 statements of agreement and subsequently revise a supporting section. After 2 rounds of revisions with authors, the primary authors edited and compiled a final document that was then reviewed and approved by all primary and contributing authors.

Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

BACKGROUND
Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment.

OBJECTIVE
To describe the current landscape of treatment for concussion and to provide summary agreements related to treatment to assist clinicians in the treatment of concussion.

METHODS
On October 14 to 16, 2015, the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion meeting was convened in Pittsburgh, Pennsylvania. Thirty-seven concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device.

RESULTS
A total of 16 statements of agreement were supported covering (1) Summary of the Current Approach to Treating Concussion, (2) Heterogeneity and Evolving Clinical Profiles of Concussion, (3) TEAM Approach to Concussion Treatment: Specific Strategies, and (4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97% to 100%.

CONCLUSION
Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies on the basis of modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery after concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments.

The Statement Paper was recently published in Neurosurgery:

December 2016 – Volume 79 – Issue 6 – p 912–929

http://journals.lww.com/neurosurgery/Fulltext/2016/12000/Statements_of_Agreement_From_the_Targeted.27.aspx

http://wolterskluwer.com/investors/investor-news/2016/11/after-concussion-rest-may-not-always-be-the-best-medicine-experts-say.html

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