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[1] Revert first and ask questions later? Is that policy? 129.7.254.33 06:19, 23 October 2007 (UTC)
Hi!
Usually in talk pages of articles in Wikipedia, no one is addressed in particular. In this case it's different. I know the one I am addressing has actually nurtured the article since more than last 20 months.
So, hi dilldot (on public computer)!
As I started reading your article, it just occurred to me that I should see the page history. I was amazed and overwhelmed to see the entire article being edited singlehandedly by you. Congratulations! I also happened to see your user page, Wikipedia (and neurology, in particular) seems to keep you really busy. I really feel overwhelmed by users who have put in as much effort as you. Well, I have just gone through "your" article
months post-injury have been found to range from 24–84%". Reworded for clarification. delldot talk 21:12, 7 May 2008 (UTC)
I hope I haven't been very harsh in my review.
You must have noticed the entry of an article that I'd created-- polyclonal response right below the entry of your nomination for good article. I'd be happy if you could go through it and share some views on it.
Best wishes for "GA" nomination.
Regards.
Ketan Panchal, MBBS ( talk) 18:02, 7 May 2008 (UTC)
I'm not convinced that a photo of a woman massaging her temples while reading in the library is a helpful representation in this article. Axl ( talk) 09:24, 17 May 2008 (UTC)
This review is transcluded from Talk:Post-concussion syndrome/GA1. The edit link for this section can be used to add comments to the review. This is a very good article that does a great job of presenting a controversial topic, but it still has one major issue that prevents me from passing it—the prose. Here are a few suggestions for the lead:
I'll add comments on the remainder of the article later. Best, Fvasconcellos ( t· c) 00:10, 2 June 2008 (UTC)
Looking good so far, thank you for the prompt responses. Now, for some more! Let's take it from the bottom, with "History" :)
More to come. Don't change the channel! Fvasconcellos ( t· c) 15:56, 2 June 2008 (UTC)
OK, here we go:
Not done yet... :) Fvasconcellos ( t· c) 15:00, 3 June 2008 (UTC)
OK, final comments:
Well, that's it. Please don't take it personally if any of the above was inordinately harsh, or unnecessary; I just like to know that I did my best to ensure that a Good Article is actually a good article :) Best, Fvasconcellos ( t· c) 02:35, 5 June 2008 (UTC)
I'm not sure this redirect is quite right -- I've also seen chronic brain syndrome used as a term for dementia in general ( here for example) -- maybe a disambiguation page? Matt Kurz ( talk) 19:14, 1 June 2009 (UTC)
The opening sentence of the article currently says that post-concussion syndrome was "historically known as shellshock" - I've removed that because afaik it seems whoever wrote that was thinking of post-traumatic stress, but thought I'd mention it here in case I'm wrong. :-) 86.131.92.88 ( talk) 17:20, 5 November 2009 (UTC)
This article could use an image in the lead. Not sure what but... Doc James ( talk · contribs · email) 03:02, 19 December 2009 (UTC)
Should not this be mentioned? As a layperson I see no clear differences.
~~ —Preceding unsigned comment added by Elemming ( talk • contribs) 07:43, 26 October 2010 (UTC)
This passage is either intentionally misleading, or not precise enough in what it entails. For instance, severity of symptoms and likelihood of litigation are profoundly confounded variables and this is not well documented in the section. It seems that the passage is trying to make the point that because the disorder is not well understood it is likely abused by attorneys and victims of trauma, but never makes this point explicit, and rather relies on "statistical trickery" (not necessarily on the part of the author) to make the claim that because litigation and severity of symptoms are positively correlated that it is likely that litigation increases the severity of these symptoms, which is undecidable. It should either be directly explained that the relationship is causal, or interpreted as an open question, for which the only evidence is speculation. I will only edit this section out once more, and after that I will leave it to the rest of the community.
108.67.152.150 ( talk) 08:11, 17 November 2010 (UTC)
Does brain injury link NFL players, wounded warriors?, CNN, Stephanie Smith, May 16, 2012.
“ . . CTE derives some of its notoriety from cases like that of Dave Duerson, a former Chicago Bear who shot himself in the chest in 2011 and was found to have dense clusters of tau protein permeating his brain and spinal cord.
“Tau is released by neurons when the brain is rocked inside the skull and, when unleashed, tends to lodge in parts of the brain responsible for memory, judgment and mood.
“The same group of researchers at the Boston University School of Medicine who examined Duerson's brain excised thin slivers of brain tissue from four U.S. veterans who died suddenly. Those were compared to tissue taken from two other groups: three amateur football players and a professional wrestler with a history of concussion; and a control group of four young people who died suddenly with no history of concussion. . ”
" . . What the mouse study does is ask a very specific question lingering in the field, which is, can exposure to even a single blast result in brain damage that persists and possibly progresses?" Goldstein said.
“To answer that question, researchers exposed a group of mice to blast winds -- some up to 330 miles per hour -- that mimic what might occur in the wake of an IED blast and compared them to a group of mice the same age, living in the same conditions, that were not exposed to blasts.
“The effect of the blast is described by researchers as a "bobblehead effect," the brain rocking back and forth inside the skull, similar to what happens during a concussion, and in some people it leads to brain damage.
“Two weeks after exposure to the blast, brain tissue in mice showed evidence of tau protein. . ”
from . .
Wikipedia:Identifying reliable sources (medicine)
“ . . biomedical information in articles be based on reliable, third-party, published sources and accurately reflect current medical knowledge.
“Ideal sources for such content includes general or systematic reviews published in reputable medical journals, academic and professional books written by experts in the relevant field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognised expert bodies. . ”
TRAUMATIC BRAIN INJURY Chronic Traumatic Encephalopathy in Blast-Exposed Military Veterans and a Blast Neurotrauma Mouse Model, ABSTRACT, Science Translational Medicine, Goldstein, Fisher, Tagge, et al., Vol. 4, Issue 134, 16 May 2012.
“We examined a case series of postmortem brains from U.S. military veterans exposed to blast and/or concussive injury. We found evidence of chronic traumatic encephalopathy (CTE), a tau protein–linked neurodegenerative disease, that was similar to the CTE neuropathology observed in young amateur American football players . . ”
“ . . a blast neurotrauma mouse model . . ”
“ . . The contribution of blast wind to injurious head acceleration may be a primary injury mechanism . . ”
Certainly we can make exceptions, but this doesn't seem to be one of those cases. There are good reasons why we don't generally use primary sources in wikipedia, especially in medical articles. -- sciencewatcher ( talk) 18:35, 26 May 2012 (UTC)
Agree with Yobol, user in question needs to provide recent secondary sources. Doc James ( talk · contribs · email) 21:43, 29 May 2012 (UTC)
"Post-concussion syndrome, also known as postconcussive syndrome or PCS, and historically called shell shock, [1] is a set of symptoms that a person may experience for weeks, months, or occasionally up to a year or more after a concussion – a mild form of traumatic brain injury (abbreviated TBI). . . "
" . . occasionally up to a year or more . . " No, incorrect, there are guys who are retired NFL players who have had serious symptoms for a lot longer than a year. Watch some ESPN in recent weeks and see this. And maybe this is a case in which just people telling their stories is running ahead of formalized research. Although I suspect this is the wiki disease of understating. When in doubt, when there's controversy, just understate, sand it down even more. Well, we end up doing our readers a disservice. If we have the sources to back it up (good not perfect sources) I don't think we need to excessively understate.
And the part about shell shock, I have most commonly heard that in reference to World War I and I've heard it described as serious depression. Well, maybe the concussive injuries were the cause of a lot of these cases of depression. "Shell shock" is how they best understood it at the time. I'm not sure we should lead with a historical term which is partially right, partially not. FriendlyRiverOtter ( talk) 00:01, 24 May 2012 (UTC)
And look at the last sentence of the opening paragraph: " . . In late, persistent, or prolonged PCS (PPCS), symptoms last for over six months, or by other standards, three."
We are again emphasizing short-term. At the very least, we are taking a definite viewpoint when there is still considerable controversy and unknown. And actually, a lot of the news coverage is emphasizing a heck of a lot longer than six months. FriendlyRiverOtter ( talk) 18:56, 26 May 2012 (UTC)
The shell shock part confusion is due to WWI misinterpretation of combat stress reaction, it was thought at the time, that the injury was due to explosives injuring the brain. Later study found that the issue was psychological, which is the current belief. There also seems to be some confusion in concepts. One can have traumatic brain injury that doesn't cause long term issues and one can have traumatic brain injury that causes damage that the brain cannot compensate for. The tau protein detection is an early finding in research that indicates damage has occurred in the past, with some being probable multiple injury induced changes. Even so, it's rather outside of the scope of the article, as it is ongoing research that is still poorly understood and utterly useless in diagnosing PCS. Head trauma is still not well understood. Relatively mild head injuries can result in significant emergent conditions, while more severe injuries can result in no significant medical issues, with little to lead researchers anything to ascertain why there is such a wide difference in spectrum with disparate mechanisms of injury. As an example, a man is hit with a back hoe and thrown two meters, his head being part of what was struck by the bucket. He got up and returned to work, only reporting bruising. Another man fell off the lowered back gate of a truck he was climbing into, landing on an unimproved dirt road. He was hospitalized for a subdural hematoma after complaining of vision changes several hours later. So, we have to consider when writing our rather poor level of understanding injuries of the head overall and the current extremely poor understanding of concussions in general. Wzrd1 ( talk) 00:21, 15 August 2012 (UTC)
The Causes section is generally taking the either-or approach, whereas I think the newer understanding is that it's BOTH-AND. That both interact to cause a downward spiral.
In general, our article here needs a lot of work. And perhaps paradoxically, maybe we should seemingly lower our standards and go with a healthy number of good sources, rather than a scant number of 'perfect' or 'great' sources. FriendlyRiverOtter ( talk) 00:15, 24 May 2012 (UTC)
The whole news coverage on concussions and brain injury, that it’s typically not the first concussion. But rather that it’s the fourth, or the seventh, or the second, that it is highly variable depending on each individual. For example, let’s say a cyclist (not just to pick on football) has experienced a concussion and has largely recovered, and this cyclist asks his or her doctor: “Doctor, will I be okay even if I get a second concussion?”
As I understand it, with current knowledge and information, the doctor cannot say one way or another. (although with each concussion, the third, the fourth, the fifth, the risk increases that the next one will prove to be damaging).
This has been a central fact in the news coverage of concussions. And yes, I think someone who has maybe worked ten years or longer as a medical journalist, like a reporter for CNN, LA Times, etc, etc, etc, often are pretty good sources. They can act as ‘bridge’ persons between medical publications written for doctors and interested lay persons like ourselves. And we don’t need to dive into how much experience a particular medical journalist has or what his or her credentials are. Rather, this is where we trust the credibility of the source (with all kind of judgment calls on our part of course). And so, I come back to the not very dramatic conclusion that we want a variety of good sources.
And to be clear, I am not a medical journalist either. I am just someone who is interested in the topic. FriendlyRiverOtter ( talk) 19:34, 26 May 2012 (UTC)
from Prognosis section (last paragraph):
" . . . If another blow to the head occurs after a concussion but before its symptoms have gone away, there is a very slight risk of developing the extremely rare but deadly second-impact syndrome (SIS). In SIS, the brain rapidly swells, greatly increasing intracranial pressure. People who have repeated mild head injuries over a prolonged period, such as boxers and Gridiron football players, are at risk for Chronic traumatic encephalopathy (or the related variant dementia pugilistica), a severe, chronic disorder involving a decline in mental and physical abilities."
" . . a very slight risk . . "
" . . the extremely rare but deadly . . "
Wow. How definite we are without any references whatsoever.
And I'm not saying we should emphasize the danger side. I'm advocating middle-of-the-road. Let's just try to lay the known information onto the table without either over-stated or under-stating.
(And the little bit I've read, this second-impact syndrome may be different from post-concussion syndrome with depression, irritability, memory loss.) FriendlyRiverOtter ( talk) 20:13, 26 May 2012 (UTC)
1) We don't mention tau protein.
2) We don't mention in the lead that it's primarily a danger of subsequent concussions.
3) The first sentence of our entire article estimates lower time periods, and this is simply not always the case.
4) We are taking an either-or approach to the question of physiological or psychological.
Maybe it did at one time, and we didn't keep it. Or maybe it's been changed over time.
I have pretty much decided to request and recommend that this article be demoted from being classified as a Natural sciences good article. Now, in keeping with the spirit of openness, I invite people's comments. And I'm willing to wait a couple of days. In fact, I hope the discussion both informally and more formally about whether to demote this article will draw people in with the interest and, more importantly, the time to make our article better.
As it currently stands, if a young person is in the 10th grade and is thinking about medical school, or if he or she is a senior in college, I don't see how our article does that good a job in providing an overview of known information. Or, if our reader is a parent who has a 14-year-old son interested in playing football, I don't see how our article provides a very good overview of what is known regarding post-concussion syndrome. In fact, we might end up doing that parent a disservice. FriendlyRiverOtter ( talk) 21:10, 26 May 2012 (UTC)
ORIGINAL ARTICLE, “Permanent post-concussion symptoms after mild head injury,” Brain Injury, 25(5): 462–470, NIGEL S. KING & SIMON KIRWILLIAM, May 2011.
Introduction
“ . . ‘mild head injury’ (MHI) . . ”
“ . . ‘postconcussion symptoms’ (PCS) . . ”
“ . . Twenty-to-forty per cent may, however, continue to experience PCS at 6 months post-injury [5] and a small minority still have difficulties at 1 year and beyond [6]. . ”
“ . . Studies have also identified predisposing factors to experiencing more severe or longer lasting PCS. These include; (i) being over the age of 40 [11, 12]; (ii) being female [12, 13]; (iii) sustaining previous MHIs [12, 14]; (iv) having pre- or post-morbid psychopathology or substance misuse [15]; and (v) pursuing a compensation claim [16]. . ”
References
[5.] Englander J, Hall K, Simpson T, Chaffin S. Mild traumatic brain injury in an insured population; subjective complaints and return to employment. Brain Injury 1992;6:161–166.
[6.] Binder LM, Rohling ML, Larrabee GJ. A review of mild head trauma. Part 2: clinical implications. Journal of Clinical and Experimental Neuropsychology 1997;19:432–457.
.
.
[12.] Edna TH, Cappelen J. Late postconcussional symptoms in traumatic head injury. An analysis of frequency of risk factors. Acta Neurochirurgica 1987;86:1–12.
.
[14.] Gronwall D, Wrightson P. Cumulative effects of concussion. Lancet 1975;2:995–999.
My local library has databases which includes Brain Injury, including a PDF of the full article. I'm not sure whether it's available generally over the Internet.
Here's the abstract: http://informahealthcare.com/doi/abs/10.3109/02699052.2011.558042 But apparently one needs to log in to see the entire article. FriendlyRiverOtter ( talk) 19:45, 29 May 2012 (UTC)
There are at least four current substantial problems with our article:
1) The very first sentence of our article emphasizes lower time periods, and this is not always the case.
[Immediately above in discussion section]
2) We don't mention in the lead that it's primarily a danger of subsequent concussions.
3) We don't mention tau protein.
4) We are taking an either-or approach to the question of physiological or psychological.
And these are just the parts I've looked at. There are probably other parts as well. Yes, we probably do need to demote the article, and at the same time we need people helping with the research. FriendlyRiverOtter ( talk) 18:10, 29 May 2012 (UTC)
ORIGINAL ARTICLE, “Permanent post-concussion symptoms after mild head injury,” Brain Injury, 25(5): 462–470, NIGEL S. KING & SIMON KIRWILLIAM, May 2011.
Introduction
“ . . ‘mild head injury’ (MHI) . . ”
“ . . ‘postconcussion symptoms’ (PCS) . . ”
“ . . Studies have also identified predisposing factors to experiencing more severe or longer lasting PCS. These include; . . . . (iii) sustaining previous MHIs [12, 14] . . . . ”
References
[12.] Edna TH, Cappelen J. Late postconcussional symptoms in traumatic head injury. An analysis of frequency of risk factors. Acta Neurochirurgica 1987;86:1–12.
.
[14.] Gronwall D, Wrightson P. Cumulative effects of concussion. Lancet 1975;2:995–999.
This is a primary article which reports an original study; [u]however, the Introduction section is a review of previous studies[/u]. Or, at least it sure seems that way to me. Or we can ask, how small and narrow a box are we going to put ourselves in. FriendlyRiverOtter ( talk) 22:29, 29 May 2012 (UTC)
Physicians must be brought up to speed on concussion risks, CMAJ News, Canadian Medical Association Journal, Jordan Fallis, 2012 Feb 7; Vol. 184 (2), pp. E113-4. Date of Electronic Publication: 2011 Dec 19.
' . . added Dr. Mark Aubry, chief medical officer for Hockey Canada. “We’re getting more severe in our return-to-play guidelines because we’re learning more about the injury. We’re realizing it doesn’t heal that fast, and what may appear mild, may be more severe and prolonged than you think.” . '
' . . Part of that problem has been that players’ symptoms recede and they are often eager to get back out on to the ice, Aubry said. But 30% of those players score abnormally on neuropsychological tests, he added. “This means cognitive recovery may follow the resolution of symptoms. And we should probably be keeping our athletes out that much longer.” . '
' . . the Canadian Medical Association and the Canadian Academy of Sport and Exercise Medicine cohosted a workshop for physicians in December 2011 which brought together representatives from major national physician groups as a part of bid to collaboratively develop guidelines to optimize the care of concussed patients, Kissick said. . '
' . . The current guidelines were developed in 2008, when the Third International Conference on Concussion in Sport developed the Consensus Statement on Concussion in Sport, which lays out evidence-based guidelines for physicians, trainers and other health care professionals on how to treat concussed patients ( http://sportconcussions.com/html/Zurich%20Statement.pdf). An update is expected to be released after a conference to be held in Zurich, Switzerland in November 2012.'
I suspect we're going to say that this is not good enough!
So, we're going to so quickly dismiss Dr. Mark Aubry ? ? ?
And what's at risk, well, a student writes a paper based on the current article and feels really burned when he or she gets a mediocre grade because our article is not quite accurate. Or more seriously, a parent goes to our article for information and later decides 'Well, I guess it went okay. The doctor we got was actually pretty good. Wikipedia sure didn't help.' No, we're not trying to give medical advice, nor should we. But we are trying to provide medical information which enables a parent or anyone else to ask better questions. FriendlyRiverOtter ( talk) 19:09, 30 May 2012 (UTC)
'Canadian physicians have often been uninformed about the long-term consequences of concussions suffered in sport . . ' And what is "long-term consequences" if not post-concussion syndrome? And . .
' . . With the evidence continuing to mount on the negative long-term consequences of head injuries . . '
Dr. Aubry: “ . . We’re realizing it doesn’t heal that fast, and what may appear mild, may be more severe and prolonged than you think.”
' . . The severity of those consequences is becoming ever more apparent, said Dr. Kristian Goulet, medical director at the Eastern Ontario Concussion Clinic and the Pediatric Sports Medicine Clinic of Ottawa. Every year in the United States, “225 000 new patients are showing effects of long-term head injury. This isn’t necessarily just mild headaches, but chronic depression, substance abuse, and dementia as well.” . '
And from the above ORIGINAL ARTICLE, “Permanent post-concussion symptoms after mild head injury,” Brain Injury, KING & KIRWILLIAM, May 2011:
" . . Historically these have been termed ‘mild’ and ‘moderate’ injuries (for PTA<1 hour and 1–24 hours, respectively). More recent taxonomies, however, have classified all injuries witha PTA of less than 24 hours as ‘mild head injury’(MHI) [2]. . "
Our prognosis section previously ended with this paragraph:
" . . . If another blow to the head occurs after a concussion but before its symptoms have gone away, there is a very slight risk of developing the extremely rare but deadly second-impact syndrome (SIS). In SIS, the brain rapidly swells, greatly increasing intracranial pressure. People who have repeated mild head injuries over a prolonged period, such as boxers and Gridiron football players, are at risk for Chronic traumatic encephalopathy (or the related variant dementia pugilistica), a severe, chronic disorder involving a decline in mental and physical abilities."
Notice the emphatic phrases such as "very slight risk" with no supporting references whatsoever!
I removed this paragraph. Doc James, to his credit, added it back, added some references, and toned down the phraseology. You can read about this in the history:
http://en.wikipedia.org/?title=Post-concussion_syndrome&action=history
To me, our article seems to have a general skeptical bias.
Be that as it may, the question can be raised, how did a free-standing paragraph stay so long in a GA article? We seem to have very high standards as far as gate keeping for any new changes (maybe even impossibly high standards, or we've put ourselves in such a small box we can hardly move). And at the same time, very little time and effort is spent reviewing the article and making sure it's still up to date. FriendlyRiverOtter ( talk) 20:28, 30 May 2012 (UTC)
Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008, Journal of Clinical Neuroscience, P. McCrory, W. Meeuwisse, K. Johnston, J. Dvorak, M. Aubry, M. Molloy, R. Cantu, 16 (2009) 755–763.
Doc James ( talk · contribs · email) 23:30, 31 May 2012 (UTC)McCrory, P (2009 Jul-Aug). "Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008". Journal of athletic training. 44 (4): 434–48. PMID 19593427.
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Some selected parts from this article:
“ . . . . the authors acknowledge that the science of concussion is evolving and therefore management and return to play (RTP) decisions remain in the realm of clinical judgment on an individualized basis. . . . ”
1.1. Definition of concussion “ . . . . In a small percentage of cases, however, post-concussive symptoms may be prolonged. . . . ”
1.2 Classification of Concussion “There was unanimous agreement to abandon the “simple” versus “complex” terminology . . . . The panel, however, unanimously retained the concept that most (80–90%) concussions resolve in a short period (7–10 days), although the recovery time frame may be longer in children and adolescents.”
2.1. Symptoms and signs of acute concussion
“ . . . . The suspected diagnosis of concussion can include one or more of the following clinical domains:
(a) symptoms: somatic (e.g. headache), cognitive (e.g. feeling like in a fog) and/or emotional symptoms (e.g. lability)
(b) physical signs (e.g. loss of consciousness, amnesia)
(c) behavioral changes (e.g. irritablity)
(d) cognitive impairment (e.g. slowed reaction times)
(e) sleep disturbance (e.g. drowsiness).”
. .
2.2. On-field or sideline evaluation of acute concussion
“ . . . and particular attention should be given to excluding a cervical spine injury. . . . ”
“ . . . . Brief NP test batteries that assess attention and memory function have been shown to be practical and effective. Such tests include the Maddocks questions and the Standardized Assessment of Concussion (SAC). Standard orientation questions (e.g. time, place, person) have been shown to be unreliable . . . . It should also be recognized that the appearance of symptoms might be delayed several hours following a concussive episode.”
3.2. Objective balance assessment “Published studies, using both sophisticated force plate technology, as well as those using less sophisticated clinical balance tests (e.g. the Balance Error Scoring System), have identified postural stability deficits lasting approximately 72 hours following a sport-related concussion. . . . ”
4) CONCUSSION MANAGEMENT
“The cornerstone of concussion management is physical and cognitive rest until symptoms resolve and then a graded program of exertion prior to medical clearance and RTP. . . . ”
“ . . . . With this stepwise progression, the athlete should continue to proceed to the next level if asymptomatic at the current level. Generally each step should take 24 hours . . . . ”
4.5. The role of pre-participation concussion evaluation “ . . . . A structured concussion history should include specific questions as to previous symptoms of a concussion; not just the perceived number of past concussions. It is also worth noting that dependence upon the recall of concussive injuries by teammates or coaches has been demonstrated to be unreliable. . . . Questions pertaining to disproportionate impact versus symptom severity matching may alert the clinician to a progressively increasing vulnerability to injury. . . . ”
7) INJURY PREVENTION
“There is no good clinical evidence that currently available protective equipment . . . . In specific sports such as cycling, motor, and equestrian sports, protective helmets may prevent other forms of head injury (eg, skull fracture) . . . . ”
7.3 Risk Compensation “ . . . . This is where the use of protective equipment results in behavioural change, such as the adoption of more dangerous playing techniques . . . . ”
Concussion injury advice (To be given to concussed athlete)
“If you notice any change in behavior, vomiting, dizziness, worsening headache, double vision or excessive drowsiness, please telephone the clinic or nearest hospital emergency department immediately.”
“ . . Use paracetamol or codeine for headache. Do not use aspirin or anti-inflammatory medication . . ”
This section starts out with:
"Post-concussion syndrome is usually not treated,[24] though specific symptoms can be addressed;[16] for example, people can take pain relievers for headaches and medicine to relieve depression, dizziness,[40] or nausea.[24] Rest is advised, but is only somewhat effective.[41] . . . "
Which is not exactly saying the same thing as the above censensus statement:
“The cornerstone of concussion management is physical and cognitive rest until symptoms resolve and then a graded program . . . . ”
The Medication subsection of Treatment states:
" . . there may be a benefit to avoiding narcotic medications.[43] In addition, headache medications may cause rebound headaches when they are discontinued.[44] . . "
which is not the same thing at all as the concensus statement:
“ . . Use paracetamol or codeine for headache. Do not use aspirin or anti-inflammatory medication . . ”
[24] The Merck Manual Home Health Handbook, Concussion, last full review/revision January 2008 by Kenneth Maiese, MD.
“ . . . Later, people may experience headache, the sensation of spinning, light-headedness, fatigue, poor memory, inability to concentrate, irritability, depression, and anxiety. These symptoms are called the postconcussion syndrome. . . ”
“ . . . Postconcussion syndrome symptoms are common during the week after concussion and commonly resolve during the second week. However, sometimes, symptoms persist for months or, rarely, years. People who have had a concussion also seem to be more susceptible to another one, particularly if the new injury occurs before symptoms from the previous concussion have completely gone away. . . ”
“ . . . For concussion, acetaminophen [Tylenol] is given for pain. Aspirin or another nonsteroidal anti-inflammatory drug (NSAID— . . . ) should not be taken because they interfere with blood clotting and may contribute to bleeding from damaged blood vessels. Rest is the best treatment for a concussion.
“Treatment for postconcussion syndrome is based on the severity of the symptoms. Rest and close observation are important. People who experience emotional difficulties may need psychotherapy. Repeated concussions may increase a person's risk in later life for dementia, Parkinson's disease, and depression. People should not return to contact sports after a concussion until all ill effects have resolved and medical evaluation has been completed.”
from the 2008 consensus statement:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2707064/
" . . During this period of recovery while symptomatic following an injury, it is important to emphasize to the athlete that physical AND cognitive rest is required. Activities that require concentration and attention (eg, scholastic work, video games, text messaging, etc) may exacerbate symptoms and possibly delay recovery. . "
" . . The panel strongly endorsed the view that children should not be returned to practice or play until clinically completely symptom free, which may require a longer time frame than for adults. . "
Summarizing the return-to-play steps in table 1:
1. Complete physical and cognitive rest
2. light aerobic activity (less than 70% of maximum predicted heart rate, no resistance training)
3. sport-specific activities such as running drills and skating drills
4. non-contact training drills (exercise, coordination and cognitive load)
5. full-contact practice.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2707064/table/attr-44-04-01-t01/
“ . . If any postconcussion symptoms occur while in the stepwise program, then the patient should drop back to the previous asymptomatic level and try to progress again after a further 24-hour period of rest has passed. . ”
I also find issue with the treatment section of the article. Treatment for post-concussion syndrome is becoming much more common, with a variety of treatment options. One thing that should probably be added is that a combination of multiple treatment options is usually more effective than just one.
[2]
Lmorgan9 (
talk)
16:49, 11 June 2012 (UTC)
The lead to the Treatment section did include the phase " . . or nausea. . .ref name="merck"/>" when in fact the Merck reference does not even use the word nausea a single time. Wow. I think we should simply take a deep breath and acknowledge that the accuracy of wiki articles can erode over time. And then let's do what we can to bring our article up to date.
I corrected some of these problems and added a subsection entitled "Physical and cognitive rest." Everyone, please, jump in and help if you have the time. Thanks. FriendlyRiverOtter ( talk) 00:37, 12 June 2012 (UTC)
Trying to get good link for Willer and Leddy source.
Willer B, Leddy JJ (2006).
"Management of concussion and post-concussion syndrome". Current Treatment Options in Neurology. 8 (5): 415–426.
doi:
10.1007/s11940-006-0031-9.
PMID
16901381. {{
cite journal}}
: Unknown parameter |month=
ignored (
help)
dead link
http://www.springerlink.com/content/d7w2n822k2u6507v/fulltext.pdf
" . . Evidence from basic animal research suggests that an initial period of physical and cognitive rest is therapeutic after concussive injury [10, Class II], but in a randomized human trial complete bed rest was ineffective in reducing symptoms [26, Class I]. The literature is in general agreement that relative rest (ie, avoiding studying and physical exertion but resuming normal activities of daily living as soon as possible [24, Class III]) for the first 2 to 5 days after concussion is important because strenuous cognitive and physical activity may exacerbate symptoms and delay recovery [12••, Class III]. . "
" . . Activity – Once the patient is asymptomatic at rest, he or she is advised to progress stepwise from light aerobic activity such as walking or stationary cycling up to sport or work-specific activities (see following text) [12••, Class III]. However, there is no evidence-based research to quantify specific activity type, intensity, and progression rate. . "
some references in lead:
Legome E. 2006. Postconcussive syndrome. eMedicine.com. Accessed January 1, 2007.
" . . Depending on the definition and the population examined, 29-90% of patients experience postconcussive symptoms shortly after the traumatic insult. . "
" . . . Although no universally accepted definition of postconcussive syndrome exists, most of the literature defines the syndrome as the development of at least 3 of the following symptoms: headache, dizziness, fatigue, irritability, impaired memory and concentration, insomnia, and lowered tolerance for noise and light. Confusion exists in the literature, with some authors defining it as symptoms of at least 3 months' duration, while others define it as symptoms appearing within the first week. In this article, the syndrome is loosely defined as symptom occurrence and persistence within several weeks after the initial insult. Persistent postconcussive syndrome (PPCS) is generally defined as symptoms lasting more than 6 months, though some authors define it as symptoms lasting more than 3 months. [We use a fair amount of this in lead, probably too much]
"The ICD-10 criteria include a history of traumatic brain injury (TBI) and the presence of 3 or more of the following 8 symptoms: (1) headache, (2) dizziness, (3) fatigue, (4) irritability, (5) insomnia, (6) concentration or (7) memory difficulty, and (8) intolerance of stress, emotion, or alcohol.
"The DSM-IV criteria are . . [similar and even more complicated] . . "
Schnadower D, Vazquez H, Lee J, Dayan P, Roskind CG (2007). "Controversies in the evaluation and management of minor blunt head trauma in children". Current Opinion in Pediatrics. 19 (3): 258–264.
doi:
10.1097/MOP.0b013e3281084e85.
PMID
17505183.{{
cite journal}}
: CS1 maint: multiple names: authors list (
link) <--currently available only as abstract
Currently in our article: "In order to meet these criteria, a patient must have had a head injury with loss of consciousness[23] and develop at least three of the eight symptoms marked with a check mark in the table at right under "ICD-10" within four weeks.[33][34]"
Notice the part "with loss of consciousness" That is incorrect. And that is way old school.
As an example of one of the many more modern sources, the above 2008 Consensus statement: http://sportconcussions.com/html/Zurich%20Statement.pdf " . . . Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. In a small percentage of cases, however, post-concussive symptoms may be prolonged. . . "
Okay, plot thickens, and I'm willing to acknowledge messy facts, from ICD-10
ICD-10, International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010, F07.2 Postconcussional syndrome, World Health Organization.
"A syndrome that occurs following head trauma (usually sufficiently severe to result in loss of consciousness) and includes a number of disparate symptoms such as headache, dizziness, fatigue, irritability, difficulty in concentration and performing mental tasks, impairment of memory, insomnia, and reduced tolerance to stress, emotional excitement, or alcohol."
"usually sufficient severe" That's different from what our article currently says. And then ICD-10itself was approved in 1990 and implemented in 1993, i.e. close to twenty years ago. Let's just lay this on the table as clearly as we can.
Pediatric Psychopharmacology: Principles and Practice, Andres Martin, Oxford University Press, 2003 page 749: “The ICD-10, which was developed by the WHO as a classification of diseases, was approved in 1990 and implemented in 1993 (World Health Organization, 1993).”
From our article: "The ICD-10 established a set of diagnostic criteria for PCS in 1992."
Boake C; McCauley SR; Levin HS; Pedroza C; Contant CF; Song JX; et al. (2005).
"Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury". Journal of Neuropsychiatry and Clinical Neurosciences. 17 (3): 350–6.
doi:
10.1176/appi.neuropsych.17.3.350.
PMID
16179657. {{
cite journal}}
: Unknown parameter |author-separator=
ignored (
help)
I changed this to approved in 1990 and implemented in 1993.
From our article: "Preoccupation with the injury may be accompanied by the assumption of a "sick role" and hypochondriasis.[32]"
Perhaps the next project is to check the following source:
Yeates KO, Taylor HG (2005). "Neurobehavioural outcomes of mild head injury in children and adolescents". Pediatric Rehabilitation. 8 (1): 5–16. PMID 15799131. This is the source previously used to say post-concussion syndrome required loss of consciousness and then 3 of 8. And perhaps this link to whole article. http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&hid=15&sid=6977537d-264d-4416-b6f1-5d1fbd1a7250%40sessionmgr110 (library database)
"The vast majority of closed-head injuries (CHI) in children are of mild severity. Even if only a small proportion of children with mild CHI suffer persistent negative outcomes, then mild CHI is a serious public health problem. . "
Neurobehavioural outcomes of mild CHI
" . . In some cases, moreover, the post-concussive symptoms persist over time, lasting months or even years, despite the resolution of any deficits on standardized cognitive testing, and may be associated with significant functional morbidity [16–19]. The reason for the inconsistency of the findings concerning standardized cognitive testing as opposed to subjective symptom reports is a major source of debate in the scientific literature regarding mild CHI. . "
" . . the diagnostic criteria in ICD-10 and DSM-IV embody a longstanding controversy . . "
" . . The ICD-10 criteria reflect the assumption that post-concussive symptoms have a functional aetiology. Although the ICD-10 requires a history of head trauma associated with a loss of consciousness [the above 2010 version of ICD-10 downsteps this to a parenthetic note "(usually sufficiently severe to result in loss of consciousness)"], the subjective symptoms are said to occur in the absence of neuropsychological impairment and in association with psychological pre-occupation, hypochondriasis and adoption of a sick role. . "
" . . Although ‘psychogenesis’ and ‘physiogenesis’ are often described as competing explanations, they are not mutually exclusive [23,34]. . "
" . . Factor analyses of postconcussive symptom questionnaires have indicated that the symptoms can be arrayed along several dimensions, which are typically labelled cognitive (e.g. inattention, forgetfulness), somatic (e.g. headaches, dizziness, fatigue), emotional (e.g. irritability, depression) and behavioural (e.g. impulsivity, poor social judgement). . "
" . . In previous research on children with moderate-to-severe CHI, it was found that symptoms occurring shortly after an injury were more strongly related to pre-morbid child and family status, injury severity and post-injury cognitive functioning than to post-injury parent and family adjustment. In contrast, later symptoms, especially those involving emotional or behavioural problems, were related less to pre-morbid factors or injury characteristics and more to post-injury parent adjustment and family stressors and resources unrelated to the injury [39]. . "
Conceptual and methodological issues in research
" . . Children with positive findings on neuroimaging have usually been omitted and participants have not always been required to have any concussive symptoms associated with their injuries. . "
" . . More recently, non-injured children matched on demographic variables have been used as a comparison group [14]. Non-injured children do not constitute the best comparison group, however, because they are not equated to head-injured children in terms of the experience of a traumatic injury or ensuing medical treatment. Research also suggests that children who sustain traumatic injuries are more likely to display pre-morbid behavioural disorders, such as attention-deficit/hyperactivity disorder [43]. . "
" . . the measurement of post-concussive symptoms has typically been limited to questionnaires and rating scales, which almost always have been completed only by parents [15,16,18,39]. The agreement between child and parent reports of post-concussive symptoms has not been examined, nor has the agreement in symptom reports generated using different methods (i.e. questionnaire/rating scale vs structured interview). . "
" . . Previous research has also often focused on neuropsychological outcomes and paid scant attention to the relationship between mild CHI in children and functional outcomes such as school performance, general physical health and health care utilization. In adults, mild CHI and persistent post-concussive symptoms have been associated with chronic occupational disability (e.g. delayed return to work) [19,27]. . "
" . . Children with mild CHI are often treated as a homogenous group and compared to children without mild CHI without regard to whether factors such as loss of consciousness or abnormalities on neuroimaging increase the risk of negative outcomes [12,14]. . "
" . . Research also needs to incorporate measures of non-injury related risk factors, such as pre-morbid child status, post-injury parental coping . . "
" . . In many cases, children with pre-morbid learning or behaviour problems are omitted from studies, despite the possibility that those children are most at risk for persistent post-concussive symptoms. . "
" . . Below-average parent and family functioning exacerbate the negative effects of severe CHI, whereas above-average parent and family functioning buffer those effects. In a study focused specifically on neurobehavioural symptoms, it was found that parental psychological adjustment and family resources were significant predictors of emotional and behavioural symptoms in the first year post-injury, accounting for more variance than injury severity [39]. . "
" . . Of the existing longitudinal studies, moreover, few have followed children for more than relatively brief periods [50,51]. . "
" . . Existing longitudinal studies also can be criticized for failing to adopt a developmental approach in modelling outcomes. . "
" . . Studies of the outcomes of mild CHI have typically focused on group outcomes, in part because most common statistical techniques yield results that are based on group data. . "
" . . In clinical practice, however, one is interested in knowing whether the occurrence of mild CHI accounts for outcomes in a particular patient . . "
" . . Fortunately, the advent of techniques such as random slopes regression, in which regression coefficients vary systematically across individuals, and mixture modelling, which can be used to identify latent classes of individuals based in part on variations in background factors, should enable a more sophisticated examination of factors related to individual outcomes [55]. However, these techniques require relatively large samples, so that future studies are likely to require multiple sites to generate a sufficient number of participants. . "
I have notice that this has been open for over two months now. Are we any closer to getting a resolution? AIRcorn (talk) 08:37, 14 August 2012 (UTC)
1.a: I am a healthcare professional with quite a bit of training in the topic and there are parts of the [Post-concussion_syndrome#Causes] section that were to technical for me to understand.
b: looks good to me
2.a: Very well referenced
b: Some of the references used are too old. There has been an enormous amount of information that has come out in the last five years and I personally wouldn't trust anything that came out before 2010.
c: I didn't find any original research in this article; however, I didn't go through the article with a fine toothed comb
3.a: The article seems to cover all the major points on the topic
b: The article seems to stay on topic
4.a: The article seems to have a neutral point of view
5.a: The article doesn't seem to be in dispute although there is a large amount of editing going on to improve the article for this review
6.Note: This article would benefit from additional images.
a: Image has appropriate CC licence
b: Image is appropriately used and captioned
7.Fail
ITasteLikePaint ( talk) 02:11, 18 October 2012 (UTC)
Given the discussion here and at FriendlyRiverOtter ( talk · contribs) I have decided to go ahead and delist this article. There are some good suggestions for improving the article. AIRcorn (talk) 11:51, 13 October 2012 (UTC)
Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008, Journal of Clinical Neuroscience, P. McCrory, W. Meeuwisse, K. Johnston, J. Dvorak, M. Aubry, M. Molloy, R. Cantu, 16 (2009) 755–763.
Also, from the American Academy of Pediatrics, Clinical Report, "Sport-Related Concussion in Children and Adolescents", Pediatrics, Mark E. Halstead, MD, Kevin D. Walter, MD, The Council on Sports Medicine and Fitness, Vol. 126 No. 3, September 1, 2010. (This is a review article we are not yet using in Post-concussion syndrome.)
I am concerned by the recent additions which seem to be adding material about concussions in general, rather than a discussion about post-concussion syndrome in particular. This does not seem appropriate here. Yobol ( talk) 22:33, 14 June 2012 (UTC)
{{
cite journal}}
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(
help); Unknown parameter |coauthors=
ignored (|author=
suggested) (
help)In our Diagnosis section, it currently states: "In order to meet these criteria, a patient must have had a head injury with loss of consciousness[23] and develop at least three of the eight symptoms marked with a check mark in the table at right under "ICD-10" within four weeks.[33][34]"
Now, what ICD-10 actually says,
ICD-10, International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010, F07.2 Postconcussional syndrome, World Health Organization.
"A syndrome that occurs following head trauma (usually sufficiently severe to result in loss of consciousness) and includes a number of disparate symptoms such as headache, dizziness, fatigue, irritability, difficulty in concentration and performing mental tasks, impairment of memory, insomnia, and reduced tolerance to stress, emotional excitement, or alcohol."
I think there's a lot of benefit to the 2008 Consensus statement where they talk about a graded series of steps as far as reintroducing oneself to activities. And they emphasize both physical rest and cognitive rest, including such activities as school and video games. The graded series and the cognitive rest are two things a lot of people are not going to know, or only know partially, and we have an authoritative source backing them up.
I've read some doctors prescribe antidepressants after a stroke in an attempt to help a patient grow new nerve connections (not new nerve cells themselves). I mean, what it is, is what it is. Don't know if this works, don't know if physicians also prescribe antidepressants post concussion. I do think depression is starting to get the attention it deserves as a serious condition and a treatable condition. I've also read that the first antidepressant is not necessarily the one which will work for a patient, and that it's sometimes important for a person to step down from an antidepressant in phases even if the medication doesn't seem to be working. Now, this is getting a little far afield, but I've heard depression mentioned often enough in the context of post-concussion, that I think it's valuable to include some of this information, provided we can find good sources.
Merck recommends aspirin or similar NOT be used for headache that if there's damaged blood vessels, can lead to bleeding.
2008 Consensus Statement end material,
Concussion injury advice:
“ . . Use paracetamol or codeine for headache. Do not use aspirin or anti-inflammatory medication . . ”
Concussion, last full review/revision January 2008 by Kenneth Maiese, MD:
" . . For concussion, acetaminophen is given for pain. Aspirin or another nonsteroidal anti-inflammatory drug (NSAID—see Pain: Nonsteroidal Anti-Inflammatory Drugs) should not be taken because they interfere with blood clotting and may contribute to bleeding from damaged blood vessels. . "
Whereas our article currently writes: " . . Side effects of medications may affect people suffering the consequences of MTBI more severely than they do others, and thus it is recommended that medications be avoided if possible; . . ref name="McAllister02"/> there may be a benefit to avoiding narcotic medications. . . ref name="ropper"> . . " Well, the obvious contradiction is that codeine is an opiate and thus arguably a 'narcotic,' and I don't know about paracetamol. Of course, doesn't mean it's a bad thing. Like any medication, properly used, under a doctor's guidance, can be beneficial. And I think we should put at least a fair amount of weight on the 2008 Consensus Statement.
And then there's the whole dynamic aspect. From Merck: " . . Repeated concussions may increase a person's risk in later life for dementia, Parkinson's disease, and depression. . " From the Consensus statement . . . Zurich, November 2008: "4.5. The role of pre-participation concussion evaluation . . . . Questions pertaining to disproportionate impact versus symptom severity matching may alert the clinician to a progressively increasing vulnerability to injury. . . ”
I take it, this rather technical formal language, what they're saying is if a football player or a hockey player gets another concussion from a smaller blow, wow, that's kind of a warning sign, a sign to ease back, to start enjoying your non-contact sports, and to give the contact sports a good. Once again, the dynamic aspect, which needs to be a part of the conversation.
And what about the old school advice that after a head injury, a person should be watched, and the first night sleeping they should be woken up every 90 minutes (?) or so. And then there's the tragedy which happened to the actress Natasha Richardson several years ago while skiing. This may have been a different type of head injury, highlighting the importance of a clinician evaluating for a range of potential injuries. FriendlyRiverOtter ( talk) 20:51, 16 June 2012 (UTC)
Physicians must be brought up to speed on concussion risks, CMAJ News, Canadian Medical Association Journal (CMAJ), Jordan Fallis, Vol. 184 (2), February 7, 2012, (first published electronically December 19, 2011).
" . . . Revisions to international concussion guidelines are also needed, the panelists argued [special seminar on concussions in hockey held at Scotiabank Place in December 2011]. The current guidelines were developed in 2008, when the Third International Conference on Concussion in Sport developed the Consensus Statement on Concussion in Sport, which lays out evidence-based guidelines for physicians, trainers and other health care professionals on how to treat concussed patients ( http://sportconcussions.com/html/Zurich%20Statement.pdf). An update is expected to be released after a conference to be held in Zurich, Switzerland in November 2012."
I was just reading the source for this claim, and it doesn't convincingly show that (depending on what exactly is meant by 'psychological'). The author may believe this is true, but that would only justify saying something like "Some researchers are convinced that it has been shown that psychological factors play an important role in the presence of post-concussion symptoms."
Given the difficulty of meaningfully diagnosing PCS and the potential for confounding factors, I think that this claim needs to be more cautiously phrased. Evidence that, post-concussion, those with on-going symptoms are also likely to develop emotional or cognitive cannot really be used to claim that they play an important role in the presence of post-concussion symptoms, particularly given how little we understand as to what causes people to suffer from mental health problems. — Preceding unsigned comment added by 87.115.186.110 ( talk) 01:40, 9 November 2013 (UTC)
the DSM V is out and it doesn't have "postconcussional disorder" in it. so all references to that should either be removed, or adjusted to show that it is only in the DSM-IV (and maybe earlier). i'd think this is obvious/factual enough, but if a source is needed: http://www.acnr.co.uk/2015/04/postconcussion-syndromedisorder-or-mild-traumatic-brain-injury-diagnostic-issues-and-treatment/ or, to show that others were wondering about it: https://www.researchgate.net/post/Where_did_the_Post-Concussive_Disorder_of_DSM- Colbey84 ( talk) 13:13, 27 November 2016 (UTC)
some of the sources are pretty old, especially for a medical article, and especially for a medical topic that has had a LOT of interest. combining these older sources with the use of phrases like "most experts agree," "it has been argued," "it appears that," "it has been argued" (and others) makes this article appear slanted. i mean, one of these sources is from 1995, and as was noted on this Talk page in another section, we should "use reviews from the last 5 or 10 years at most."
i don't have time to really dig into this (or into editing this page), but i note that others have shown quite an interest in this article, so maybe someone will find the time to work on this. i did find some possible sources. this one was mentioned before on this Talk page, but it was updated, so this is a link to the newer version: "Military blast exposure, ageing and white matter integrity" http://brain.oxfordjournals.org/content/138/8/2278
but the biggest issue with this article is now summed up by this: "A longstanding controversy surrounding PCS concerns the nature of its etiology..." and then the way the rest of the article is presented (as i noted, with the above phrases). i don't know for sure whether this is still a controversy, but my quick perusal of some of the following sources seems to indicate that it's not. or not as much of one.
http://emedicine.medscape.com/article/828904-overview "While recent research has shown that psychological factors may be present early, other studies using imaging techniques such as magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), and magnetoencephalography (MEG) have demonstrated the presence of organic brain injury in patients with persistent postconcussive syndrome at greater than 1 year after injury."
http://emedicine.medscape.com/article/326643-overview
https://www.ncbi.nlm.nih.gov/pubmed/27027526
http://emedicine.medscape.com/article/326510-overview
https://www.ncbi.nlm.nih.gov/pubmed/26479126
https://www.ncbi.nlm.nih.gov/pubmed/22980474
http://www.aqua.ac.nz/upload/resource/Current%20controversies%20in%20traumatic%20brain%20injury.pdf
https://www.ncbi.nlm.nih.gov/pubmed/20051900
https://www.ncbi.nlm.nih.gov/pubmed/21181651
this page has MANY sources on it (and an interesting discussion). but one of the participants noted that the following 5 sources were directly related to this controversy:
How soon can the demyelinating process start in mild traumatic brain injury?:
https://www.researchgate.net/post/How_soon_can_the_demyelinating_process_start_in_mild_traumatic_brain_injury
Stapert et al 2006 http://arnop.unimaas.nl/show.cgi?fid=4933 Silver et al, 2009 http://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2009.08111676 Bigler, 2013a http://journal.frontiersin.org/article/10.3389/fnhum.2013.00395/abstract Le et al 2008 http://online.liebertpub.com/doi/abs/10.1089/neu.2008.0566 Spencer et al 2010 http://online.liebertpub.com/doi/abs/10.1089/neu.2008.0566
Colbey84 ( talk) 13:39, 27 November 2016 (UTC)
Decided i should probably put this is a separate section, as i noted in the "Dubious" tag there would be one. It's not so much that i think a Merck online manual is "dubious," but that i thought the way it was being used was. As in, for a sentence talking about malingering and, basically, people lying about their medical symptoms to get a benefit in some other way, the source was a Merck manual that discussed PEDIATRIC PCS.
AND...that Merck page is no longer available. So it can't even be perused to see if Merck truly asserted that children were claiming they had concussive symptoms so they could get a check from someone. I did find 2 available Merck pages, but didn't change that reference because i was unsure what the intent of the original author was.
http://www.merckmanuals.com/home/injuries-and-poisoning/head-injuries/concussion
Colbey84 ( talk) 13:46, 27 November 2016 (UTC)
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Yesterday I added a paragraph to say:
This was promptly reverted by User:Sciencewatcher with the comment that the study had no control and that a controlled study of 2012 found no effect. So I reverted back to my versioin with the comment that he should read the reference in New Scientist. Now he has reverted that again saying that New Scientist is not a reliable source for medical information. I doubt that he read the article, because rather than making medical claims, it quotes Lindell Weaver, the author of a study in 2015 which concluded that hyperbaric oxygen therapy was no better than a sham treatment. He admits that the "sham" treatment did involve putting people into a hyperbaric chamber, so actually they were getting a higher-than-normal oxygen pressure, and that "the burden of evidence is starting to suggest there is a favourable effect". The New Scientist article also says that in the new research they could see that the hyperbaric oxygen therapy caused regrowth of blood vessels and nerve fibre in the affected region of the brain. This would not happen in a sham treatment. This is in the "reliable source" in the second reference I gave. But I object to excluding a source like the New Scientist article on the excuse that the magazine is not a reliable reference. Can Sciencewatcher deny that Weaver said the above, just because it's in New Scientist rather than the Lancet? Let's not be slaves to technicalities. Let's try to give readers the most up-to-date information on what's going on in this field of research! Eric Kvaalen ( talk) 07:44, 12 November 2017 (UTC)
Hi @ Fanman1999: thanks for all your hard work to improve this article. I reversed your edit for now, but it is still archived. Do you mind adding your suggestions here so we can go through them slowly and ensure that all the content is appropriate for Wikipedia before adjusting the article live? I encourage you to also speak with your instructor and consult WP:MEDRS to help determine which sources are appropriate for Wikipedia. This is a tough topic to edit on. You may need to use your instructor as well to help you interpret the secondary study papers that you find. Concussion research is evolving rapidly (and is super interesting), basically anything pre-2017 is outdated. Thanks so much. It is great to see new editors here, we hope that you stick around and help improve the article! JenOttawa ( talk) 23:03, 1 December 2021 (UTC)
I was bold and removed a small paragraph on chiropractic methods as it was based on one case series report. Here is the removed text (pasted below. If anyone has ideas for how to improve this section with higher quality sources that meet MEDRS please add in.
Upper cervical care Post-concussion syndrome can sometimes be the result of a misalignment in the upper cervical spine (neck) specifically the C1 (Atlas) or C2 (Axis) which surround the brain stem. Some individuals have found relief through upper cervical care. An upper cervical chiropractor is a specialist who uses x-rays to identify misalignments in the upper cervical spine then gently repositions the top two bones of the neck. There are currently approximately seven different chiropractic methods of repositioning the C1 bone, however the three most popular techniques are NUCCA (adjustment done by hand), Blair Technique (adjustment done by hand), and Atlas Orthogonal (adjustment done by a machine). [5]
JenOttawa ( talk) 17:36, 19 July 2023 (UTC) JenOttawa ( talk) 17:36, 19 July 2023 (UTC)
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[1] Revert first and ask questions later? Is that policy? 129.7.254.33 06:19, 23 October 2007 (UTC)
Hi!
Usually in talk pages of articles in Wikipedia, no one is addressed in particular. In this case it's different. I know the one I am addressing has actually nurtured the article since more than last 20 months.
So, hi dilldot (on public computer)!
As I started reading your article, it just occurred to me that I should see the page history. I was amazed and overwhelmed to see the entire article being edited singlehandedly by you. Congratulations! I also happened to see your user page, Wikipedia (and neurology, in particular) seems to keep you really busy. I really feel overwhelmed by users who have put in as much effort as you. Well, I have just gone through "your" article
months post-injury have been found to range from 24–84%". Reworded for clarification. delldot talk 21:12, 7 May 2008 (UTC)
I hope I haven't been very harsh in my review.
You must have noticed the entry of an article that I'd created-- polyclonal response right below the entry of your nomination for good article. I'd be happy if you could go through it and share some views on it.
Best wishes for "GA" nomination.
Regards.
Ketan Panchal, MBBS ( talk) 18:02, 7 May 2008 (UTC)
I'm not convinced that a photo of a woman massaging her temples while reading in the library is a helpful representation in this article. Axl ( talk) 09:24, 17 May 2008 (UTC)
This review is transcluded from Talk:Post-concussion syndrome/GA1. The edit link for this section can be used to add comments to the review. This is a very good article that does a great job of presenting a controversial topic, but it still has one major issue that prevents me from passing it—the prose. Here are a few suggestions for the lead:
I'll add comments on the remainder of the article later. Best, Fvasconcellos ( t· c) 00:10, 2 June 2008 (UTC)
Looking good so far, thank you for the prompt responses. Now, for some more! Let's take it from the bottom, with "History" :)
More to come. Don't change the channel! Fvasconcellos ( t· c) 15:56, 2 June 2008 (UTC)
OK, here we go:
Not done yet... :) Fvasconcellos ( t· c) 15:00, 3 June 2008 (UTC)
OK, final comments:
Well, that's it. Please don't take it personally if any of the above was inordinately harsh, or unnecessary; I just like to know that I did my best to ensure that a Good Article is actually a good article :) Best, Fvasconcellos ( t· c) 02:35, 5 June 2008 (UTC)
I'm not sure this redirect is quite right -- I've also seen chronic brain syndrome used as a term for dementia in general ( here for example) -- maybe a disambiguation page? Matt Kurz ( talk) 19:14, 1 June 2009 (UTC)
The opening sentence of the article currently says that post-concussion syndrome was "historically known as shellshock" - I've removed that because afaik it seems whoever wrote that was thinking of post-traumatic stress, but thought I'd mention it here in case I'm wrong. :-) 86.131.92.88 ( talk) 17:20, 5 November 2009 (UTC)
This article could use an image in the lead. Not sure what but... Doc James ( talk · contribs · email) 03:02, 19 December 2009 (UTC)
Should not this be mentioned? As a layperson I see no clear differences.
~~ —Preceding unsigned comment added by Elemming ( talk • contribs) 07:43, 26 October 2010 (UTC)
This passage is either intentionally misleading, or not precise enough in what it entails. For instance, severity of symptoms and likelihood of litigation are profoundly confounded variables and this is not well documented in the section. It seems that the passage is trying to make the point that because the disorder is not well understood it is likely abused by attorneys and victims of trauma, but never makes this point explicit, and rather relies on "statistical trickery" (not necessarily on the part of the author) to make the claim that because litigation and severity of symptoms are positively correlated that it is likely that litigation increases the severity of these symptoms, which is undecidable. It should either be directly explained that the relationship is causal, or interpreted as an open question, for which the only evidence is speculation. I will only edit this section out once more, and after that I will leave it to the rest of the community.
108.67.152.150 ( talk) 08:11, 17 November 2010 (UTC)
Does brain injury link NFL players, wounded warriors?, CNN, Stephanie Smith, May 16, 2012.
“ . . CTE derives some of its notoriety from cases like that of Dave Duerson, a former Chicago Bear who shot himself in the chest in 2011 and was found to have dense clusters of tau protein permeating his brain and spinal cord.
“Tau is released by neurons when the brain is rocked inside the skull and, when unleashed, tends to lodge in parts of the brain responsible for memory, judgment and mood.
“The same group of researchers at the Boston University School of Medicine who examined Duerson's brain excised thin slivers of brain tissue from four U.S. veterans who died suddenly. Those were compared to tissue taken from two other groups: three amateur football players and a professional wrestler with a history of concussion; and a control group of four young people who died suddenly with no history of concussion. . ”
" . . What the mouse study does is ask a very specific question lingering in the field, which is, can exposure to even a single blast result in brain damage that persists and possibly progresses?" Goldstein said.
“To answer that question, researchers exposed a group of mice to blast winds -- some up to 330 miles per hour -- that mimic what might occur in the wake of an IED blast and compared them to a group of mice the same age, living in the same conditions, that were not exposed to blasts.
“The effect of the blast is described by researchers as a "bobblehead effect," the brain rocking back and forth inside the skull, similar to what happens during a concussion, and in some people it leads to brain damage.
“Two weeks after exposure to the blast, brain tissue in mice showed evidence of tau protein. . ”
from . .
Wikipedia:Identifying reliable sources (medicine)
“ . . biomedical information in articles be based on reliable, third-party, published sources and accurately reflect current medical knowledge.
“Ideal sources for such content includes general or systematic reviews published in reputable medical journals, academic and professional books written by experts in the relevant field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognised expert bodies. . ”
TRAUMATIC BRAIN INJURY Chronic Traumatic Encephalopathy in Blast-Exposed Military Veterans and a Blast Neurotrauma Mouse Model, ABSTRACT, Science Translational Medicine, Goldstein, Fisher, Tagge, et al., Vol. 4, Issue 134, 16 May 2012.
“We examined a case series of postmortem brains from U.S. military veterans exposed to blast and/or concussive injury. We found evidence of chronic traumatic encephalopathy (CTE), a tau protein–linked neurodegenerative disease, that was similar to the CTE neuropathology observed in young amateur American football players . . ”
“ . . a blast neurotrauma mouse model . . ”
“ . . The contribution of blast wind to injurious head acceleration may be a primary injury mechanism . . ”
Certainly we can make exceptions, but this doesn't seem to be one of those cases. There are good reasons why we don't generally use primary sources in wikipedia, especially in medical articles. -- sciencewatcher ( talk) 18:35, 26 May 2012 (UTC)
Agree with Yobol, user in question needs to provide recent secondary sources. Doc James ( talk · contribs · email) 21:43, 29 May 2012 (UTC)
"Post-concussion syndrome, also known as postconcussive syndrome or PCS, and historically called shell shock, [1] is a set of symptoms that a person may experience for weeks, months, or occasionally up to a year or more after a concussion – a mild form of traumatic brain injury (abbreviated TBI). . . "
" . . occasionally up to a year or more . . " No, incorrect, there are guys who are retired NFL players who have had serious symptoms for a lot longer than a year. Watch some ESPN in recent weeks and see this. And maybe this is a case in which just people telling their stories is running ahead of formalized research. Although I suspect this is the wiki disease of understating. When in doubt, when there's controversy, just understate, sand it down even more. Well, we end up doing our readers a disservice. If we have the sources to back it up (good not perfect sources) I don't think we need to excessively understate.
And the part about shell shock, I have most commonly heard that in reference to World War I and I've heard it described as serious depression. Well, maybe the concussive injuries were the cause of a lot of these cases of depression. "Shell shock" is how they best understood it at the time. I'm not sure we should lead with a historical term which is partially right, partially not. FriendlyRiverOtter ( talk) 00:01, 24 May 2012 (UTC)
And look at the last sentence of the opening paragraph: " . . In late, persistent, or prolonged PCS (PPCS), symptoms last for over six months, or by other standards, three."
We are again emphasizing short-term. At the very least, we are taking a definite viewpoint when there is still considerable controversy and unknown. And actually, a lot of the news coverage is emphasizing a heck of a lot longer than six months. FriendlyRiverOtter ( talk) 18:56, 26 May 2012 (UTC)
The shell shock part confusion is due to WWI misinterpretation of combat stress reaction, it was thought at the time, that the injury was due to explosives injuring the brain. Later study found that the issue was psychological, which is the current belief. There also seems to be some confusion in concepts. One can have traumatic brain injury that doesn't cause long term issues and one can have traumatic brain injury that causes damage that the brain cannot compensate for. The tau protein detection is an early finding in research that indicates damage has occurred in the past, with some being probable multiple injury induced changes. Even so, it's rather outside of the scope of the article, as it is ongoing research that is still poorly understood and utterly useless in diagnosing PCS. Head trauma is still not well understood. Relatively mild head injuries can result in significant emergent conditions, while more severe injuries can result in no significant medical issues, with little to lead researchers anything to ascertain why there is such a wide difference in spectrum with disparate mechanisms of injury. As an example, a man is hit with a back hoe and thrown two meters, his head being part of what was struck by the bucket. He got up and returned to work, only reporting bruising. Another man fell off the lowered back gate of a truck he was climbing into, landing on an unimproved dirt road. He was hospitalized for a subdural hematoma after complaining of vision changes several hours later. So, we have to consider when writing our rather poor level of understanding injuries of the head overall and the current extremely poor understanding of concussions in general. Wzrd1 ( talk) 00:21, 15 August 2012 (UTC)
The Causes section is generally taking the either-or approach, whereas I think the newer understanding is that it's BOTH-AND. That both interact to cause a downward spiral.
In general, our article here needs a lot of work. And perhaps paradoxically, maybe we should seemingly lower our standards and go with a healthy number of good sources, rather than a scant number of 'perfect' or 'great' sources. FriendlyRiverOtter ( talk) 00:15, 24 May 2012 (UTC)
The whole news coverage on concussions and brain injury, that it’s typically not the first concussion. But rather that it’s the fourth, or the seventh, or the second, that it is highly variable depending on each individual. For example, let’s say a cyclist (not just to pick on football) has experienced a concussion and has largely recovered, and this cyclist asks his or her doctor: “Doctor, will I be okay even if I get a second concussion?”
As I understand it, with current knowledge and information, the doctor cannot say one way or another. (although with each concussion, the third, the fourth, the fifth, the risk increases that the next one will prove to be damaging).
This has been a central fact in the news coverage of concussions. And yes, I think someone who has maybe worked ten years or longer as a medical journalist, like a reporter for CNN, LA Times, etc, etc, etc, often are pretty good sources. They can act as ‘bridge’ persons between medical publications written for doctors and interested lay persons like ourselves. And we don’t need to dive into how much experience a particular medical journalist has or what his or her credentials are. Rather, this is where we trust the credibility of the source (with all kind of judgment calls on our part of course). And so, I come back to the not very dramatic conclusion that we want a variety of good sources.
And to be clear, I am not a medical journalist either. I am just someone who is interested in the topic. FriendlyRiverOtter ( talk) 19:34, 26 May 2012 (UTC)
from Prognosis section (last paragraph):
" . . . If another blow to the head occurs after a concussion but before its symptoms have gone away, there is a very slight risk of developing the extremely rare but deadly second-impact syndrome (SIS). In SIS, the brain rapidly swells, greatly increasing intracranial pressure. People who have repeated mild head injuries over a prolonged period, such as boxers and Gridiron football players, are at risk for Chronic traumatic encephalopathy (or the related variant dementia pugilistica), a severe, chronic disorder involving a decline in mental and physical abilities."
" . . a very slight risk . . "
" . . the extremely rare but deadly . . "
Wow. How definite we are without any references whatsoever.
And I'm not saying we should emphasize the danger side. I'm advocating middle-of-the-road. Let's just try to lay the known information onto the table without either over-stated or under-stating.
(And the little bit I've read, this second-impact syndrome may be different from post-concussion syndrome with depression, irritability, memory loss.) FriendlyRiverOtter ( talk) 20:13, 26 May 2012 (UTC)
1) We don't mention tau protein.
2) We don't mention in the lead that it's primarily a danger of subsequent concussions.
3) The first sentence of our entire article estimates lower time periods, and this is simply not always the case.
4) We are taking an either-or approach to the question of physiological or psychological.
Maybe it did at one time, and we didn't keep it. Or maybe it's been changed over time.
I have pretty much decided to request and recommend that this article be demoted from being classified as a Natural sciences good article. Now, in keeping with the spirit of openness, I invite people's comments. And I'm willing to wait a couple of days. In fact, I hope the discussion both informally and more formally about whether to demote this article will draw people in with the interest and, more importantly, the time to make our article better.
As it currently stands, if a young person is in the 10th grade and is thinking about medical school, or if he or she is a senior in college, I don't see how our article does that good a job in providing an overview of known information. Or, if our reader is a parent who has a 14-year-old son interested in playing football, I don't see how our article provides a very good overview of what is known regarding post-concussion syndrome. In fact, we might end up doing that parent a disservice. FriendlyRiverOtter ( talk) 21:10, 26 May 2012 (UTC)
ORIGINAL ARTICLE, “Permanent post-concussion symptoms after mild head injury,” Brain Injury, 25(5): 462–470, NIGEL S. KING & SIMON KIRWILLIAM, May 2011.
Introduction
“ . . ‘mild head injury’ (MHI) . . ”
“ . . ‘postconcussion symptoms’ (PCS) . . ”
“ . . Twenty-to-forty per cent may, however, continue to experience PCS at 6 months post-injury [5] and a small minority still have difficulties at 1 year and beyond [6]. . ”
“ . . Studies have also identified predisposing factors to experiencing more severe or longer lasting PCS. These include; (i) being over the age of 40 [11, 12]; (ii) being female [12, 13]; (iii) sustaining previous MHIs [12, 14]; (iv) having pre- or post-morbid psychopathology or substance misuse [15]; and (v) pursuing a compensation claim [16]. . ”
References
[5.] Englander J, Hall K, Simpson T, Chaffin S. Mild traumatic brain injury in an insured population; subjective complaints and return to employment. Brain Injury 1992;6:161–166.
[6.] Binder LM, Rohling ML, Larrabee GJ. A review of mild head trauma. Part 2: clinical implications. Journal of Clinical and Experimental Neuropsychology 1997;19:432–457.
.
.
[12.] Edna TH, Cappelen J. Late postconcussional symptoms in traumatic head injury. An analysis of frequency of risk factors. Acta Neurochirurgica 1987;86:1–12.
.
[14.] Gronwall D, Wrightson P. Cumulative effects of concussion. Lancet 1975;2:995–999.
My local library has databases which includes Brain Injury, including a PDF of the full article. I'm not sure whether it's available generally over the Internet.
Here's the abstract: http://informahealthcare.com/doi/abs/10.3109/02699052.2011.558042 But apparently one needs to log in to see the entire article. FriendlyRiverOtter ( talk) 19:45, 29 May 2012 (UTC)
There are at least four current substantial problems with our article:
1) The very first sentence of our article emphasizes lower time periods, and this is not always the case.
[Immediately above in discussion section]
2) We don't mention in the lead that it's primarily a danger of subsequent concussions.
3) We don't mention tau protein.
4) We are taking an either-or approach to the question of physiological or psychological.
And these are just the parts I've looked at. There are probably other parts as well. Yes, we probably do need to demote the article, and at the same time we need people helping with the research. FriendlyRiverOtter ( talk) 18:10, 29 May 2012 (UTC)
ORIGINAL ARTICLE, “Permanent post-concussion symptoms after mild head injury,” Brain Injury, 25(5): 462–470, NIGEL S. KING & SIMON KIRWILLIAM, May 2011.
Introduction
“ . . ‘mild head injury’ (MHI) . . ”
“ . . ‘postconcussion symptoms’ (PCS) . . ”
“ . . Studies have also identified predisposing factors to experiencing more severe or longer lasting PCS. These include; . . . . (iii) sustaining previous MHIs [12, 14] . . . . ”
References
[12.] Edna TH, Cappelen J. Late postconcussional symptoms in traumatic head injury. An analysis of frequency of risk factors. Acta Neurochirurgica 1987;86:1–12.
.
[14.] Gronwall D, Wrightson P. Cumulative effects of concussion. Lancet 1975;2:995–999.
This is a primary article which reports an original study; [u]however, the Introduction section is a review of previous studies[/u]. Or, at least it sure seems that way to me. Or we can ask, how small and narrow a box are we going to put ourselves in. FriendlyRiverOtter ( talk) 22:29, 29 May 2012 (UTC)
Physicians must be brought up to speed on concussion risks, CMAJ News, Canadian Medical Association Journal, Jordan Fallis, 2012 Feb 7; Vol. 184 (2), pp. E113-4. Date of Electronic Publication: 2011 Dec 19.
' . . added Dr. Mark Aubry, chief medical officer for Hockey Canada. “We’re getting more severe in our return-to-play guidelines because we’re learning more about the injury. We’re realizing it doesn’t heal that fast, and what may appear mild, may be more severe and prolonged than you think.” . '
' . . Part of that problem has been that players’ symptoms recede and they are often eager to get back out on to the ice, Aubry said. But 30% of those players score abnormally on neuropsychological tests, he added. “This means cognitive recovery may follow the resolution of symptoms. And we should probably be keeping our athletes out that much longer.” . '
' . . the Canadian Medical Association and the Canadian Academy of Sport and Exercise Medicine cohosted a workshop for physicians in December 2011 which brought together representatives from major national physician groups as a part of bid to collaboratively develop guidelines to optimize the care of concussed patients, Kissick said. . '
' . . The current guidelines were developed in 2008, when the Third International Conference on Concussion in Sport developed the Consensus Statement on Concussion in Sport, which lays out evidence-based guidelines for physicians, trainers and other health care professionals on how to treat concussed patients ( http://sportconcussions.com/html/Zurich%20Statement.pdf). An update is expected to be released after a conference to be held in Zurich, Switzerland in November 2012.'
I suspect we're going to say that this is not good enough!
So, we're going to so quickly dismiss Dr. Mark Aubry ? ? ?
And what's at risk, well, a student writes a paper based on the current article and feels really burned when he or she gets a mediocre grade because our article is not quite accurate. Or more seriously, a parent goes to our article for information and later decides 'Well, I guess it went okay. The doctor we got was actually pretty good. Wikipedia sure didn't help.' No, we're not trying to give medical advice, nor should we. But we are trying to provide medical information which enables a parent or anyone else to ask better questions. FriendlyRiverOtter ( talk) 19:09, 30 May 2012 (UTC)
'Canadian physicians have often been uninformed about the long-term consequences of concussions suffered in sport . . ' And what is "long-term consequences" if not post-concussion syndrome? And . .
' . . With the evidence continuing to mount on the negative long-term consequences of head injuries . . '
Dr. Aubry: “ . . We’re realizing it doesn’t heal that fast, and what may appear mild, may be more severe and prolonged than you think.”
' . . The severity of those consequences is becoming ever more apparent, said Dr. Kristian Goulet, medical director at the Eastern Ontario Concussion Clinic and the Pediatric Sports Medicine Clinic of Ottawa. Every year in the United States, “225 000 new patients are showing effects of long-term head injury. This isn’t necessarily just mild headaches, but chronic depression, substance abuse, and dementia as well.” . '
And from the above ORIGINAL ARTICLE, “Permanent post-concussion symptoms after mild head injury,” Brain Injury, KING & KIRWILLIAM, May 2011:
" . . Historically these have been termed ‘mild’ and ‘moderate’ injuries (for PTA<1 hour and 1–24 hours, respectively). More recent taxonomies, however, have classified all injuries witha PTA of less than 24 hours as ‘mild head injury’(MHI) [2]. . "
Our prognosis section previously ended with this paragraph:
" . . . If another blow to the head occurs after a concussion but before its symptoms have gone away, there is a very slight risk of developing the extremely rare but deadly second-impact syndrome (SIS). In SIS, the brain rapidly swells, greatly increasing intracranial pressure. People who have repeated mild head injuries over a prolonged period, such as boxers and Gridiron football players, are at risk for Chronic traumatic encephalopathy (or the related variant dementia pugilistica), a severe, chronic disorder involving a decline in mental and physical abilities."
Notice the emphatic phrases such as "very slight risk" with no supporting references whatsoever!
I removed this paragraph. Doc James, to his credit, added it back, added some references, and toned down the phraseology. You can read about this in the history:
http://en.wikipedia.org/?title=Post-concussion_syndrome&action=history
To me, our article seems to have a general skeptical bias.
Be that as it may, the question can be raised, how did a free-standing paragraph stay so long in a GA article? We seem to have very high standards as far as gate keeping for any new changes (maybe even impossibly high standards, or we've put ourselves in such a small box we can hardly move). And at the same time, very little time and effort is spent reviewing the article and making sure it's still up to date. FriendlyRiverOtter ( talk) 20:28, 30 May 2012 (UTC)
Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008, Journal of Clinical Neuroscience, P. McCrory, W. Meeuwisse, K. Johnston, J. Dvorak, M. Aubry, M. Molloy, R. Cantu, 16 (2009) 755–763.
Doc James ( talk · contribs · email) 23:30, 31 May 2012 (UTC)McCrory, P (2009 Jul-Aug). "Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008". Journal of athletic training. 44 (4): 434–48. PMID 19593427.
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Some selected parts from this article:
“ . . . . the authors acknowledge that the science of concussion is evolving and therefore management and return to play (RTP) decisions remain in the realm of clinical judgment on an individualized basis. . . . ”
1.1. Definition of concussion “ . . . . In a small percentage of cases, however, post-concussive symptoms may be prolonged. . . . ”
1.2 Classification of Concussion “There was unanimous agreement to abandon the “simple” versus “complex” terminology . . . . The panel, however, unanimously retained the concept that most (80–90%) concussions resolve in a short period (7–10 days), although the recovery time frame may be longer in children and adolescents.”
2.1. Symptoms and signs of acute concussion
“ . . . . The suspected diagnosis of concussion can include one or more of the following clinical domains:
(a) symptoms: somatic (e.g. headache), cognitive (e.g. feeling like in a fog) and/or emotional symptoms (e.g. lability)
(b) physical signs (e.g. loss of consciousness, amnesia)
(c) behavioral changes (e.g. irritablity)
(d) cognitive impairment (e.g. slowed reaction times)
(e) sleep disturbance (e.g. drowsiness).”
. .
2.2. On-field or sideline evaluation of acute concussion
“ . . . and particular attention should be given to excluding a cervical spine injury. . . . ”
“ . . . . Brief NP test batteries that assess attention and memory function have been shown to be practical and effective. Such tests include the Maddocks questions and the Standardized Assessment of Concussion (SAC). Standard orientation questions (e.g. time, place, person) have been shown to be unreliable . . . . It should also be recognized that the appearance of symptoms might be delayed several hours following a concussive episode.”
3.2. Objective balance assessment “Published studies, using both sophisticated force plate technology, as well as those using less sophisticated clinical balance tests (e.g. the Balance Error Scoring System), have identified postural stability deficits lasting approximately 72 hours following a sport-related concussion. . . . ”
4) CONCUSSION MANAGEMENT
“The cornerstone of concussion management is physical and cognitive rest until symptoms resolve and then a graded program of exertion prior to medical clearance and RTP. . . . ”
“ . . . . With this stepwise progression, the athlete should continue to proceed to the next level if asymptomatic at the current level. Generally each step should take 24 hours . . . . ”
4.5. The role of pre-participation concussion evaluation “ . . . . A structured concussion history should include specific questions as to previous symptoms of a concussion; not just the perceived number of past concussions. It is also worth noting that dependence upon the recall of concussive injuries by teammates or coaches has been demonstrated to be unreliable. . . . Questions pertaining to disproportionate impact versus symptom severity matching may alert the clinician to a progressively increasing vulnerability to injury. . . . ”
7) INJURY PREVENTION
“There is no good clinical evidence that currently available protective equipment . . . . In specific sports such as cycling, motor, and equestrian sports, protective helmets may prevent other forms of head injury (eg, skull fracture) . . . . ”
7.3 Risk Compensation “ . . . . This is where the use of protective equipment results in behavioural change, such as the adoption of more dangerous playing techniques . . . . ”
Concussion injury advice (To be given to concussed athlete)
“If you notice any change in behavior, vomiting, dizziness, worsening headache, double vision or excessive drowsiness, please telephone the clinic or nearest hospital emergency department immediately.”
“ . . Use paracetamol or codeine for headache. Do not use aspirin or anti-inflammatory medication . . ”
This section starts out with:
"Post-concussion syndrome is usually not treated,[24] though specific symptoms can be addressed;[16] for example, people can take pain relievers for headaches and medicine to relieve depression, dizziness,[40] or nausea.[24] Rest is advised, but is only somewhat effective.[41] . . . "
Which is not exactly saying the same thing as the above censensus statement:
“The cornerstone of concussion management is physical and cognitive rest until symptoms resolve and then a graded program . . . . ”
The Medication subsection of Treatment states:
" . . there may be a benefit to avoiding narcotic medications.[43] In addition, headache medications may cause rebound headaches when they are discontinued.[44] . . "
which is not the same thing at all as the concensus statement:
“ . . Use paracetamol or codeine for headache. Do not use aspirin or anti-inflammatory medication . . ”
[24] The Merck Manual Home Health Handbook, Concussion, last full review/revision January 2008 by Kenneth Maiese, MD.
“ . . . Later, people may experience headache, the sensation of spinning, light-headedness, fatigue, poor memory, inability to concentrate, irritability, depression, and anxiety. These symptoms are called the postconcussion syndrome. . . ”
“ . . . Postconcussion syndrome symptoms are common during the week after concussion and commonly resolve during the second week. However, sometimes, symptoms persist for months or, rarely, years. People who have had a concussion also seem to be more susceptible to another one, particularly if the new injury occurs before symptoms from the previous concussion have completely gone away. . . ”
“ . . . For concussion, acetaminophen [Tylenol] is given for pain. Aspirin or another nonsteroidal anti-inflammatory drug (NSAID— . . . ) should not be taken because they interfere with blood clotting and may contribute to bleeding from damaged blood vessels. Rest is the best treatment for a concussion.
“Treatment for postconcussion syndrome is based on the severity of the symptoms. Rest and close observation are important. People who experience emotional difficulties may need psychotherapy. Repeated concussions may increase a person's risk in later life for dementia, Parkinson's disease, and depression. People should not return to contact sports after a concussion until all ill effects have resolved and medical evaluation has been completed.”
from the 2008 consensus statement:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2707064/
" . . During this period of recovery while symptomatic following an injury, it is important to emphasize to the athlete that physical AND cognitive rest is required. Activities that require concentration and attention (eg, scholastic work, video games, text messaging, etc) may exacerbate symptoms and possibly delay recovery. . "
" . . The panel strongly endorsed the view that children should not be returned to practice or play until clinically completely symptom free, which may require a longer time frame than for adults. . "
Summarizing the return-to-play steps in table 1:
1. Complete physical and cognitive rest
2. light aerobic activity (less than 70% of maximum predicted heart rate, no resistance training)
3. sport-specific activities such as running drills and skating drills
4. non-contact training drills (exercise, coordination and cognitive load)
5. full-contact practice.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2707064/table/attr-44-04-01-t01/
“ . . If any postconcussion symptoms occur while in the stepwise program, then the patient should drop back to the previous asymptomatic level and try to progress again after a further 24-hour period of rest has passed. . ”
I also find issue with the treatment section of the article. Treatment for post-concussion syndrome is becoming much more common, with a variety of treatment options. One thing that should probably be added is that a combination of multiple treatment options is usually more effective than just one.
[2]
Lmorgan9 (
talk)
16:49, 11 June 2012 (UTC)
The lead to the Treatment section did include the phase " . . or nausea. . .ref name="merck"/>" when in fact the Merck reference does not even use the word nausea a single time. Wow. I think we should simply take a deep breath and acknowledge that the accuracy of wiki articles can erode over time. And then let's do what we can to bring our article up to date.
I corrected some of these problems and added a subsection entitled "Physical and cognitive rest." Everyone, please, jump in and help if you have the time. Thanks. FriendlyRiverOtter ( talk) 00:37, 12 June 2012 (UTC)
Trying to get good link for Willer and Leddy source.
Willer B, Leddy JJ (2006).
"Management of concussion and post-concussion syndrome". Current Treatment Options in Neurology. 8 (5): 415–426.
doi:
10.1007/s11940-006-0031-9.
PMID
16901381. {{
cite journal}}
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dead link
http://www.springerlink.com/content/d7w2n822k2u6507v/fulltext.pdf
" . . Evidence from basic animal research suggests that an initial period of physical and cognitive rest is therapeutic after concussive injury [10, Class II], but in a randomized human trial complete bed rest was ineffective in reducing symptoms [26, Class I]. The literature is in general agreement that relative rest (ie, avoiding studying and physical exertion but resuming normal activities of daily living as soon as possible [24, Class III]) for the first 2 to 5 days after concussion is important because strenuous cognitive and physical activity may exacerbate symptoms and delay recovery [12••, Class III]. . "
" . . Activity – Once the patient is asymptomatic at rest, he or she is advised to progress stepwise from light aerobic activity such as walking or stationary cycling up to sport or work-specific activities (see following text) [12••, Class III]. However, there is no evidence-based research to quantify specific activity type, intensity, and progression rate. . "
some references in lead:
Legome E. 2006. Postconcussive syndrome. eMedicine.com. Accessed January 1, 2007.
" . . Depending on the definition and the population examined, 29-90% of patients experience postconcussive symptoms shortly after the traumatic insult. . "
" . . . Although no universally accepted definition of postconcussive syndrome exists, most of the literature defines the syndrome as the development of at least 3 of the following symptoms: headache, dizziness, fatigue, irritability, impaired memory and concentration, insomnia, and lowered tolerance for noise and light. Confusion exists in the literature, with some authors defining it as symptoms of at least 3 months' duration, while others define it as symptoms appearing within the first week. In this article, the syndrome is loosely defined as symptom occurrence and persistence within several weeks after the initial insult. Persistent postconcussive syndrome (PPCS) is generally defined as symptoms lasting more than 6 months, though some authors define it as symptoms lasting more than 3 months. [We use a fair amount of this in lead, probably too much]
"The ICD-10 criteria include a history of traumatic brain injury (TBI) and the presence of 3 or more of the following 8 symptoms: (1) headache, (2) dizziness, (3) fatigue, (4) irritability, (5) insomnia, (6) concentration or (7) memory difficulty, and (8) intolerance of stress, emotion, or alcohol.
"The DSM-IV criteria are . . [similar and even more complicated] . . "
Schnadower D, Vazquez H, Lee J, Dayan P, Roskind CG (2007). "Controversies in the evaluation and management of minor blunt head trauma in children". Current Opinion in Pediatrics. 19 (3): 258–264.
doi:
10.1097/MOP.0b013e3281084e85.
PMID
17505183.{{
cite journal}}
: CS1 maint: multiple names: authors list (
link) <--currently available only as abstract
Currently in our article: "In order to meet these criteria, a patient must have had a head injury with loss of consciousness[23] and develop at least three of the eight symptoms marked with a check mark in the table at right under "ICD-10" within four weeks.[33][34]"
Notice the part "with loss of consciousness" That is incorrect. And that is way old school.
As an example of one of the many more modern sources, the above 2008 Consensus statement: http://sportconcussions.com/html/Zurich%20Statement.pdf " . . . Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. In a small percentage of cases, however, post-concussive symptoms may be prolonged. . . "
Okay, plot thickens, and I'm willing to acknowledge messy facts, from ICD-10
ICD-10, International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010, F07.2 Postconcussional syndrome, World Health Organization.
"A syndrome that occurs following head trauma (usually sufficiently severe to result in loss of consciousness) and includes a number of disparate symptoms such as headache, dizziness, fatigue, irritability, difficulty in concentration and performing mental tasks, impairment of memory, insomnia, and reduced tolerance to stress, emotional excitement, or alcohol."
"usually sufficient severe" That's different from what our article currently says. And then ICD-10itself was approved in 1990 and implemented in 1993, i.e. close to twenty years ago. Let's just lay this on the table as clearly as we can.
Pediatric Psychopharmacology: Principles and Practice, Andres Martin, Oxford University Press, 2003 page 749: “The ICD-10, which was developed by the WHO as a classification of diseases, was approved in 1990 and implemented in 1993 (World Health Organization, 1993).”
From our article: "The ICD-10 established a set of diagnostic criteria for PCS in 1992."
Boake C; McCauley SR; Levin HS; Pedroza C; Contant CF; Song JX; et al. (2005).
"Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury". Journal of Neuropsychiatry and Clinical Neurosciences. 17 (3): 350–6.
doi:
10.1176/appi.neuropsych.17.3.350.
PMID
16179657. {{
cite journal}}
: Unknown parameter |author-separator=
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help)
I changed this to approved in 1990 and implemented in 1993.
From our article: "Preoccupation with the injury may be accompanied by the assumption of a "sick role" and hypochondriasis.[32]"
Perhaps the next project is to check the following source:
Yeates KO, Taylor HG (2005). "Neurobehavioural outcomes of mild head injury in children and adolescents". Pediatric Rehabilitation. 8 (1): 5–16. PMID 15799131. This is the source previously used to say post-concussion syndrome required loss of consciousness and then 3 of 8. And perhaps this link to whole article. http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&hid=15&sid=6977537d-264d-4416-b6f1-5d1fbd1a7250%40sessionmgr110 (library database)
"The vast majority of closed-head injuries (CHI) in children are of mild severity. Even if only a small proportion of children with mild CHI suffer persistent negative outcomes, then mild CHI is a serious public health problem. . "
Neurobehavioural outcomes of mild CHI
" . . In some cases, moreover, the post-concussive symptoms persist over time, lasting months or even years, despite the resolution of any deficits on standardized cognitive testing, and may be associated with significant functional morbidity [16–19]. The reason for the inconsistency of the findings concerning standardized cognitive testing as opposed to subjective symptom reports is a major source of debate in the scientific literature regarding mild CHI. . "
" . . the diagnostic criteria in ICD-10 and DSM-IV embody a longstanding controversy . . "
" . . The ICD-10 criteria reflect the assumption that post-concussive symptoms have a functional aetiology. Although the ICD-10 requires a history of head trauma associated with a loss of consciousness [the above 2010 version of ICD-10 downsteps this to a parenthetic note "(usually sufficiently severe to result in loss of consciousness)"], the subjective symptoms are said to occur in the absence of neuropsychological impairment and in association with psychological pre-occupation, hypochondriasis and adoption of a sick role. . "
" . . Although ‘psychogenesis’ and ‘physiogenesis’ are often described as competing explanations, they are not mutually exclusive [23,34]. . "
" . . Factor analyses of postconcussive symptom questionnaires have indicated that the symptoms can be arrayed along several dimensions, which are typically labelled cognitive (e.g. inattention, forgetfulness), somatic (e.g. headaches, dizziness, fatigue), emotional (e.g. irritability, depression) and behavioural (e.g. impulsivity, poor social judgement). . "
" . . In previous research on children with moderate-to-severe CHI, it was found that symptoms occurring shortly after an injury were more strongly related to pre-morbid child and family status, injury severity and post-injury cognitive functioning than to post-injury parent and family adjustment. In contrast, later symptoms, especially those involving emotional or behavioural problems, were related less to pre-morbid factors or injury characteristics and more to post-injury parent adjustment and family stressors and resources unrelated to the injury [39]. . "
Conceptual and methodological issues in research
" . . Children with positive findings on neuroimaging have usually been omitted and participants have not always been required to have any concussive symptoms associated with their injuries. . "
" . . More recently, non-injured children matched on demographic variables have been used as a comparison group [14]. Non-injured children do not constitute the best comparison group, however, because they are not equated to head-injured children in terms of the experience of a traumatic injury or ensuing medical treatment. Research also suggests that children who sustain traumatic injuries are more likely to display pre-morbid behavioural disorders, such as attention-deficit/hyperactivity disorder [43]. . "
" . . the measurement of post-concussive symptoms has typically been limited to questionnaires and rating scales, which almost always have been completed only by parents [15,16,18,39]. The agreement between child and parent reports of post-concussive symptoms has not been examined, nor has the agreement in symptom reports generated using different methods (i.e. questionnaire/rating scale vs structured interview). . "
" . . Previous research has also often focused on neuropsychological outcomes and paid scant attention to the relationship between mild CHI in children and functional outcomes such as school performance, general physical health and health care utilization. In adults, mild CHI and persistent post-concussive symptoms have been associated with chronic occupational disability (e.g. delayed return to work) [19,27]. . "
" . . Children with mild CHI are often treated as a homogenous group and compared to children without mild CHI without regard to whether factors such as loss of consciousness or abnormalities on neuroimaging increase the risk of negative outcomes [12,14]. . "
" . . Research also needs to incorporate measures of non-injury related risk factors, such as pre-morbid child status, post-injury parental coping . . "
" . . In many cases, children with pre-morbid learning or behaviour problems are omitted from studies, despite the possibility that those children are most at risk for persistent post-concussive symptoms. . "
" . . Below-average parent and family functioning exacerbate the negative effects of severe CHI, whereas above-average parent and family functioning buffer those effects. In a study focused specifically on neurobehavioural symptoms, it was found that parental psychological adjustment and family resources were significant predictors of emotional and behavioural symptoms in the first year post-injury, accounting for more variance than injury severity [39]. . "
" . . Of the existing longitudinal studies, moreover, few have followed children for more than relatively brief periods [50,51]. . "
" . . Existing longitudinal studies also can be criticized for failing to adopt a developmental approach in modelling outcomes. . "
" . . Studies of the outcomes of mild CHI have typically focused on group outcomes, in part because most common statistical techniques yield results that are based on group data. . "
" . . In clinical practice, however, one is interested in knowing whether the occurrence of mild CHI accounts for outcomes in a particular patient . . "
" . . Fortunately, the advent of techniques such as random slopes regression, in which regression coefficients vary systematically across individuals, and mixture modelling, which can be used to identify latent classes of individuals based in part on variations in background factors, should enable a more sophisticated examination of factors related to individual outcomes [55]. However, these techniques require relatively large samples, so that future studies are likely to require multiple sites to generate a sufficient number of participants. . "
I have notice that this has been open for over two months now. Are we any closer to getting a resolution? AIRcorn (talk) 08:37, 14 August 2012 (UTC)
1.a: I am a healthcare professional with quite a bit of training in the topic and there are parts of the [Post-concussion_syndrome#Causes] section that were to technical for me to understand.
b: looks good to me
2.a: Very well referenced
b: Some of the references used are too old. There has been an enormous amount of information that has come out in the last five years and I personally wouldn't trust anything that came out before 2010.
c: I didn't find any original research in this article; however, I didn't go through the article with a fine toothed comb
3.a: The article seems to cover all the major points on the topic
b: The article seems to stay on topic
4.a: The article seems to have a neutral point of view
5.a: The article doesn't seem to be in dispute although there is a large amount of editing going on to improve the article for this review
6.Note: This article would benefit from additional images.
a: Image has appropriate CC licence
b: Image is appropriately used and captioned
7.Fail
ITasteLikePaint ( talk) 02:11, 18 October 2012 (UTC)
Given the discussion here and at FriendlyRiverOtter ( talk · contribs) I have decided to go ahead and delist this article. There are some good suggestions for improving the article. AIRcorn (talk) 11:51, 13 October 2012 (UTC)
Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008, Journal of Clinical Neuroscience, P. McCrory, W. Meeuwisse, K. Johnston, J. Dvorak, M. Aubry, M. Molloy, R. Cantu, 16 (2009) 755–763.
Also, from the American Academy of Pediatrics, Clinical Report, "Sport-Related Concussion in Children and Adolescents", Pediatrics, Mark E. Halstead, MD, Kevin D. Walter, MD, The Council on Sports Medicine and Fitness, Vol. 126 No. 3, September 1, 2010. (This is a review article we are not yet using in Post-concussion syndrome.)
I am concerned by the recent additions which seem to be adding material about concussions in general, rather than a discussion about post-concussion syndrome in particular. This does not seem appropriate here. Yobol ( talk) 22:33, 14 June 2012 (UTC)
{{
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help)In our Diagnosis section, it currently states: "In order to meet these criteria, a patient must have had a head injury with loss of consciousness[23] and develop at least three of the eight symptoms marked with a check mark in the table at right under "ICD-10" within four weeks.[33][34]"
Now, what ICD-10 actually says,
ICD-10, International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010, F07.2 Postconcussional syndrome, World Health Organization.
"A syndrome that occurs following head trauma (usually sufficiently severe to result in loss of consciousness) and includes a number of disparate symptoms such as headache, dizziness, fatigue, irritability, difficulty in concentration and performing mental tasks, impairment of memory, insomnia, and reduced tolerance to stress, emotional excitement, or alcohol."
I think there's a lot of benefit to the 2008 Consensus statement where they talk about a graded series of steps as far as reintroducing oneself to activities. And they emphasize both physical rest and cognitive rest, including such activities as school and video games. The graded series and the cognitive rest are two things a lot of people are not going to know, or only know partially, and we have an authoritative source backing them up.
I've read some doctors prescribe antidepressants after a stroke in an attempt to help a patient grow new nerve connections (not new nerve cells themselves). I mean, what it is, is what it is. Don't know if this works, don't know if physicians also prescribe antidepressants post concussion. I do think depression is starting to get the attention it deserves as a serious condition and a treatable condition. I've also read that the first antidepressant is not necessarily the one which will work for a patient, and that it's sometimes important for a person to step down from an antidepressant in phases even if the medication doesn't seem to be working. Now, this is getting a little far afield, but I've heard depression mentioned often enough in the context of post-concussion, that I think it's valuable to include some of this information, provided we can find good sources.
Merck recommends aspirin or similar NOT be used for headache that if there's damaged blood vessels, can lead to bleeding.
2008 Consensus Statement end material,
Concussion injury advice:
“ . . Use paracetamol or codeine for headache. Do not use aspirin or anti-inflammatory medication . . ”
Concussion, last full review/revision January 2008 by Kenneth Maiese, MD:
" . . For concussion, acetaminophen is given for pain. Aspirin or another nonsteroidal anti-inflammatory drug (NSAID—see Pain: Nonsteroidal Anti-Inflammatory Drugs) should not be taken because they interfere with blood clotting and may contribute to bleeding from damaged blood vessels. . "
Whereas our article currently writes: " . . Side effects of medications may affect people suffering the consequences of MTBI more severely than they do others, and thus it is recommended that medications be avoided if possible; . . ref name="McAllister02"/> there may be a benefit to avoiding narcotic medications. . . ref name="ropper"> . . " Well, the obvious contradiction is that codeine is an opiate and thus arguably a 'narcotic,' and I don't know about paracetamol. Of course, doesn't mean it's a bad thing. Like any medication, properly used, under a doctor's guidance, can be beneficial. And I think we should put at least a fair amount of weight on the 2008 Consensus Statement.
And then there's the whole dynamic aspect. From Merck: " . . Repeated concussions may increase a person's risk in later life for dementia, Parkinson's disease, and depression. . " From the Consensus statement . . . Zurich, November 2008: "4.5. The role of pre-participation concussion evaluation . . . . Questions pertaining to disproportionate impact versus symptom severity matching may alert the clinician to a progressively increasing vulnerability to injury. . . ”
I take it, this rather technical formal language, what they're saying is if a football player or a hockey player gets another concussion from a smaller blow, wow, that's kind of a warning sign, a sign to ease back, to start enjoying your non-contact sports, and to give the contact sports a good. Once again, the dynamic aspect, which needs to be a part of the conversation.
And what about the old school advice that after a head injury, a person should be watched, and the first night sleeping they should be woken up every 90 minutes (?) or so. And then there's the tragedy which happened to the actress Natasha Richardson several years ago while skiing. This may have been a different type of head injury, highlighting the importance of a clinician evaluating for a range of potential injuries. FriendlyRiverOtter ( talk) 20:51, 16 June 2012 (UTC)
Physicians must be brought up to speed on concussion risks, CMAJ News, Canadian Medical Association Journal (CMAJ), Jordan Fallis, Vol. 184 (2), February 7, 2012, (first published electronically December 19, 2011).
" . . . Revisions to international concussion guidelines are also needed, the panelists argued [special seminar on concussions in hockey held at Scotiabank Place in December 2011]. The current guidelines were developed in 2008, when the Third International Conference on Concussion in Sport developed the Consensus Statement on Concussion in Sport, which lays out evidence-based guidelines for physicians, trainers and other health care professionals on how to treat concussed patients ( http://sportconcussions.com/html/Zurich%20Statement.pdf). An update is expected to be released after a conference to be held in Zurich, Switzerland in November 2012."
I was just reading the source for this claim, and it doesn't convincingly show that (depending on what exactly is meant by 'psychological'). The author may believe this is true, but that would only justify saying something like "Some researchers are convinced that it has been shown that psychological factors play an important role in the presence of post-concussion symptoms."
Given the difficulty of meaningfully diagnosing PCS and the potential for confounding factors, I think that this claim needs to be more cautiously phrased. Evidence that, post-concussion, those with on-going symptoms are also likely to develop emotional or cognitive cannot really be used to claim that they play an important role in the presence of post-concussion symptoms, particularly given how little we understand as to what causes people to suffer from mental health problems. — Preceding unsigned comment added by 87.115.186.110 ( talk) 01:40, 9 November 2013 (UTC)
the DSM V is out and it doesn't have "postconcussional disorder" in it. so all references to that should either be removed, or adjusted to show that it is only in the DSM-IV (and maybe earlier). i'd think this is obvious/factual enough, but if a source is needed: http://www.acnr.co.uk/2015/04/postconcussion-syndromedisorder-or-mild-traumatic-brain-injury-diagnostic-issues-and-treatment/ or, to show that others were wondering about it: https://www.researchgate.net/post/Where_did_the_Post-Concussive_Disorder_of_DSM- Colbey84 ( talk) 13:13, 27 November 2016 (UTC)
some of the sources are pretty old, especially for a medical article, and especially for a medical topic that has had a LOT of interest. combining these older sources with the use of phrases like "most experts agree," "it has been argued," "it appears that," "it has been argued" (and others) makes this article appear slanted. i mean, one of these sources is from 1995, and as was noted on this Talk page in another section, we should "use reviews from the last 5 or 10 years at most."
i don't have time to really dig into this (or into editing this page), but i note that others have shown quite an interest in this article, so maybe someone will find the time to work on this. i did find some possible sources. this one was mentioned before on this Talk page, but it was updated, so this is a link to the newer version: "Military blast exposure, ageing and white matter integrity" http://brain.oxfordjournals.org/content/138/8/2278
but the biggest issue with this article is now summed up by this: "A longstanding controversy surrounding PCS concerns the nature of its etiology..." and then the way the rest of the article is presented (as i noted, with the above phrases). i don't know for sure whether this is still a controversy, but my quick perusal of some of the following sources seems to indicate that it's not. or not as much of one.
http://emedicine.medscape.com/article/828904-overview "While recent research has shown that psychological factors may be present early, other studies using imaging techniques such as magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), and magnetoencephalography (MEG) have demonstrated the presence of organic brain injury in patients with persistent postconcussive syndrome at greater than 1 year after injury."
http://emedicine.medscape.com/article/326643-overview
https://www.ncbi.nlm.nih.gov/pubmed/27027526
http://emedicine.medscape.com/article/326510-overview
https://www.ncbi.nlm.nih.gov/pubmed/26479126
https://www.ncbi.nlm.nih.gov/pubmed/22980474
http://www.aqua.ac.nz/upload/resource/Current%20controversies%20in%20traumatic%20brain%20injury.pdf
https://www.ncbi.nlm.nih.gov/pubmed/20051900
https://www.ncbi.nlm.nih.gov/pubmed/21181651
this page has MANY sources on it (and an interesting discussion). but one of the participants noted that the following 5 sources were directly related to this controversy:
How soon can the demyelinating process start in mild traumatic brain injury?:
https://www.researchgate.net/post/How_soon_can_the_demyelinating_process_start_in_mild_traumatic_brain_injury
Stapert et al 2006 http://arnop.unimaas.nl/show.cgi?fid=4933 Silver et al, 2009 http://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2009.08111676 Bigler, 2013a http://journal.frontiersin.org/article/10.3389/fnhum.2013.00395/abstract Le et al 2008 http://online.liebertpub.com/doi/abs/10.1089/neu.2008.0566 Spencer et al 2010 http://online.liebertpub.com/doi/abs/10.1089/neu.2008.0566
Colbey84 ( talk) 13:39, 27 November 2016 (UTC)
Decided i should probably put this is a separate section, as i noted in the "Dubious" tag there would be one. It's not so much that i think a Merck online manual is "dubious," but that i thought the way it was being used was. As in, for a sentence talking about malingering and, basically, people lying about their medical symptoms to get a benefit in some other way, the source was a Merck manual that discussed PEDIATRIC PCS.
AND...that Merck page is no longer available. So it can't even be perused to see if Merck truly asserted that children were claiming they had concussive symptoms so they could get a check from someone. I did find 2 available Merck pages, but didn't change that reference because i was unsure what the intent of the original author was.
http://www.merckmanuals.com/home/injuries-and-poisoning/head-injuries/concussion
Colbey84 ( talk) 13:46, 27 November 2016 (UTC)
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Yesterday I added a paragraph to say:
This was promptly reverted by User:Sciencewatcher with the comment that the study had no control and that a controlled study of 2012 found no effect. So I reverted back to my versioin with the comment that he should read the reference in New Scientist. Now he has reverted that again saying that New Scientist is not a reliable source for medical information. I doubt that he read the article, because rather than making medical claims, it quotes Lindell Weaver, the author of a study in 2015 which concluded that hyperbaric oxygen therapy was no better than a sham treatment. He admits that the "sham" treatment did involve putting people into a hyperbaric chamber, so actually they were getting a higher-than-normal oxygen pressure, and that "the burden of evidence is starting to suggest there is a favourable effect". The New Scientist article also says that in the new research they could see that the hyperbaric oxygen therapy caused regrowth of blood vessels and nerve fibre in the affected region of the brain. This would not happen in a sham treatment. This is in the "reliable source" in the second reference I gave. But I object to excluding a source like the New Scientist article on the excuse that the magazine is not a reliable reference. Can Sciencewatcher deny that Weaver said the above, just because it's in New Scientist rather than the Lancet? Let's not be slaves to technicalities. Let's try to give readers the most up-to-date information on what's going on in this field of research! Eric Kvaalen ( talk) 07:44, 12 November 2017 (UTC)
Hi @ Fanman1999: thanks for all your hard work to improve this article. I reversed your edit for now, but it is still archived. Do you mind adding your suggestions here so we can go through them slowly and ensure that all the content is appropriate for Wikipedia before adjusting the article live? I encourage you to also speak with your instructor and consult WP:MEDRS to help determine which sources are appropriate for Wikipedia. This is a tough topic to edit on. You may need to use your instructor as well to help you interpret the secondary study papers that you find. Concussion research is evolving rapidly (and is super interesting), basically anything pre-2017 is outdated. Thanks so much. It is great to see new editors here, we hope that you stick around and help improve the article! JenOttawa ( talk) 23:03, 1 December 2021 (UTC)
I was bold and removed a small paragraph on chiropractic methods as it was based on one case series report. Here is the removed text (pasted below. If anyone has ideas for how to improve this section with higher quality sources that meet MEDRS please add in.
Upper cervical care Post-concussion syndrome can sometimes be the result of a misalignment in the upper cervical spine (neck) specifically the C1 (Atlas) or C2 (Axis) which surround the brain stem. Some individuals have found relief through upper cervical care. An upper cervical chiropractor is a specialist who uses x-rays to identify misalignments in the upper cervical spine then gently repositions the top two bones of the neck. There are currently approximately seven different chiropractic methods of repositioning the C1 bone, however the three most popular techniques are NUCCA (adjustment done by hand), Blair Technique (adjustment done by hand), and Atlas Orthogonal (adjustment done by a machine). [5]
JenOttawa ( talk) 17:36, 19 July 2023 (UTC) JenOttawa ( talk) 17:36, 19 July 2023 (UTC)
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