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Back on the ice after concussion, how the NHL decides

At least 23 professional hockey players with a combined salary of about $87M are currently sitting on the sidelines due to concussions.

All leagues' concussion policies are under scrutiny and the NHL is no exception. The NHL's top concussion expert, and director of the NHL/NHLPA's Concussion Working Group, Dr. Ruben Echemendia, describes the procedure that determines when a player can return to the ice.

"For example, if a player comes off the ice and looks a bit dazed, looks a bit stunned, a big hit just occurred, the athletic trainer would talk to them on the bench ask them what just occurred ask them what they remember about the injury, whether they can remember all the events prior to the injury, whether they can remember the hit itself, and what happened after the injury. 

Then they would ask them questions about orientation, not necessarily who are you but where are we now,who are we playing and what was the score of the last game so that we can assess the extent to which they're "with it"...If as a result of that the athletic trainer suspects that there may be a concussion going on, then the player is taken into the dressing room where they are given a more extensive evaluation that really take a look at their attention and concentration, their short-term learning and memory, their balance, their motor coordination.  All of those factors taken together.

If on that evaluation it is determined that the player has a concussion and the player is symptomatic, then that player will be sat down, and they will be asked not to engage in physical activity or strenuous cognitive activity.  So we'll ask them to stay away from video games, we'll ask them to stay away from doing a lot of reading, we'll ask them to stay away from focusing on a computer monitor, because all of those components also tax the brain and cause an increase in symptoms.

Once a player then feels good, once they feel symptom-free, then we'll begin to exercise them. Typically at first using a stationary bike or an elliptical just to get the heart rate up and see what happens.  If they don't have any symptoms at that point in time, then we will increase, ion intensity, the exercise and if they continue to remain symptom-free, we will go to sport-specific drills, such as putting them on the ice, doing some skating, doing some interval training, some sprints on the ice, seeing how they respond to that.

If they start looking good on all that, then we will subject them to a neuropsychological evaluation, where their attention and concentration, their learning, their memory, their ability to solve problems, their reaction time, all of that is tested far more extensively.  Then those data are compared to the pre-season baseline data that we have on those players to determine whether they're at their baseline from a neurocognitive perspective.

If they're normal neurocognitively, if they have no symptoms at rest, and they have no symptoms upon exertion, then we will put them out for a controlled contact practice.  And if they do well in a controlled contact practice, then in all likelihood, they'll be cleared for full contact play."


Source:

 

Dr. Ruben Echemendia on concussion procedure -- NHL Video Center

 

Questions/comments?  Contact Jean Rickerson at This email address is being protected from spambots. You need JavaScript enabled to view it.

 


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