WEBVTT
1
00:00:15.880 --> 00:00:19.879
Hi guys, Welcome to another episode
of The Factor podcast. I'm your host
2
00:00:20.079 --> 00:00:24.199
Jessica Riddle. Today we wrap up
the second part of our series on concussion
3
00:00:24.239 --> 00:00:28.480
and return to Play with doctor Michael
Olson. In our last episode, we
4
00:00:28.480 --> 00:00:34.719
were introduced to the concept of crafting
individualized concussion management plans and discuss the importance
5
00:00:34.719 --> 00:00:38.880
of ensuring every member of the healthcare
team is in agreement on the best path
6
00:00:38.920 --> 00:00:43.920
forward for optimal patient recovery. In
today's episode, we will be discussing the
7
00:00:43.960 --> 00:00:48.679
finer details of OURTP or return to
play protocols, and how to manage the
8
00:00:48.719 --> 00:00:54.600
delicate balance between healing and returning to
daily activities. Doctor Olsen highlights the differences
9
00:00:54.640 --> 00:01:00.479
in special considerations in working with elite
level athletes versus recreational or youth athletes,
10
00:01:00.799 --> 00:01:03.879
and he will also discuss the important
role that hormones and blood pressure can have
11
00:01:04.040 --> 00:01:08.599
in recovery from a TBI. Finally, he will guide us through the RTP
12
00:01:08.840 --> 00:01:14.920
formula, his structured approach for getting
athletes back in the game safely, focusing
13
00:01:14.920 --> 00:01:19.560
on gradual increases in activity and constant
monitoring. So grab something to take notes
14
00:01:19.599 --> 00:01:23.760
with and be sure to hit the
save button. This is one you'll definitely
15
00:01:23.760 --> 00:01:38.480
want to listen to more than once. Let's dive in. Now we're going
16
00:01:38.519 --> 00:01:42.959
to get into oh real quick.
Here, this is my this is what
17
00:01:42.120 --> 00:01:47.799
I give the athletes. Here.
Again, my form's slightly outdated, and
18
00:01:47.840 --> 00:01:51.480
that technically now this complete rast is
twenty four to forty eight hours. This
19
00:01:51.560 --> 00:01:56.040
is considered step one. So that's
why when we see step five is return
20
00:01:56.079 --> 00:01:59.439
to players. Now they list us
as step six, but same thing,
21
00:01:59.680 --> 00:02:02.000
just lines and at any time an
athlete of mind to save the concussion,
22
00:02:02.560 --> 00:02:06.640
I give them this form and we
just walked through it with him, and
23
00:02:06.680 --> 00:02:07.800
the coach is going to get one, Mom and Dad's going to get one,
24
00:02:07.840 --> 00:02:12.639
and the school administration is going to
get this form, so that they
25
00:02:12.719 --> 00:02:16.360
were all on the same page and
following the same plan. Some barriers to
26
00:02:16.479 --> 00:02:23.039
recovery, okay, could there be
genetic barriers, age differences. Really,
27
00:02:23.039 --> 00:02:29.800
what we're seeing is a couple of
barriers are in our own developmental factors thus
28
00:02:29.879 --> 00:02:34.159
as like ADHD, family history of
migraines, or other mental health problems,
29
00:02:34.199 --> 00:02:38.680
as these can be substantially altered or
changed, But our biggest barrier is having
30
00:02:38.719 --> 00:02:43.960
it or the biggest risk factors.
If we've had a previous concussion or a
31
00:02:43.960 --> 00:02:47.560
brain injury. A lot of times
we're going to see those individuals have a
32
00:02:47.560 --> 00:02:53.280
lot of the harder time progressing through
and returning to their normal state. So
33
00:02:53.400 --> 00:02:57.680
very of a person's initial symptoms in
the first day after injury is the strongest
34
00:02:58.039 --> 00:03:01.560
predictor. So what that means is
that you diagnose some with concussion, but
35
00:03:01.599 --> 00:03:05.280
there are symptoms are on the fence, like and I don't know if it
36
00:03:05.360 --> 00:03:08.159
is this is If it is,
it's very mild. You maybe have a
37
00:03:08.199 --> 00:03:12.840
two out of ten headache, and
he also don't know that just from like
38
00:03:13.599 --> 00:03:17.840
your skull hurts from the hit type
of thing, or or again, they
39
00:03:17.960 --> 00:03:23.479
have all the signs and concussion that's
gonna tell us a lot how fast are
40
00:03:23.479 --> 00:03:27.439
going to recover, So you can
you can use those as pretty good predictive
41
00:03:27.479 --> 00:03:32.400
indicators as you as you start to
manage this and the factors aiding recovery is
42
00:03:32.520 --> 00:03:38.240
there's more and more literature out cardiovascular
exercise, which is why after that twenty
43
00:03:38.240 --> 00:03:39.919
four to forty eight hours, we
want to start getting them up and getting
44
00:03:39.919 --> 00:03:45.080
them moving a little bit, get
that meta balt rate increased. And I'm
45
00:03:45.120 --> 00:03:51.280
also seeing more more and more literature
on B twelve and specifically at a lot
46
00:03:51.280 --> 00:03:54.080
of times, I'm seeing more providers
just give them the whole B complex to
47
00:03:55.000 --> 00:03:59.400
aid in their recovery. But there
is indication that B twelve is going to
48
00:03:59.439 --> 00:04:04.479
help prove our nerve in their own
repair and restore nerve function. But again
49
00:04:04.879 --> 00:04:12.000
rest primary treatment in that twenty four
forty eight hours and then move into rehabilitation
50
00:04:12.479 --> 00:04:16.040
specific to dysfunction. That's going to
be completely different. I'll be talking about
51
00:04:16.040 --> 00:04:20.279
concussion management at the upcoming TCC convention. We're going to gear a little bit
52
00:04:20.279 --> 00:04:25.240
more into some of that rehabilitation standpoint. So if you're interested in tuning into
53
00:04:25.319 --> 00:04:28.879
that, that's going to be good. But there's there's three types of post
54
00:04:28.920 --> 00:04:32.839
concussion and that's a cervical, genetic, physiologic, and vestibular ocular. So
55
00:04:33.439 --> 00:04:39.079
from a cervicogenic standpoint, the chiropractors, if they're looking at into rehabbing,
56
00:04:39.079 --> 00:04:43.600
it fit in while there. If
they're falling into pystibular ocular they may need
57
00:04:43.600 --> 00:04:47.560
to see rehab specialists, they may
need to work with a behavioral optometrist and
58
00:04:48.079 --> 00:04:53.240
do more things along those lines.
But all of those things help aid in
59
00:04:53.360 --> 00:04:58.360
recovery and depending on what type of
care that athlete is getting from a reheb
60
00:04:58.439 --> 00:05:04.000
standpoints going to definitely help improve their
recovery. Elite versus non elite athletes,
61
00:05:04.040 --> 00:05:10.040
guys, concussion doesn't matter. Shouldn't
matter if you're twelve and on the Sandlot
62
00:05:10.079 --> 00:05:15.360
team or if you're Tom Brady.
They concussion need to manage to be managed
63
00:05:15.399 --> 00:05:17.839
the same. The only spot where
they differ is depending on how fast or
64
00:05:17.839 --> 00:05:21.680
slow an athlete is recovering. But
there's not a different set of rules for
65
00:05:21.720 --> 00:05:29.079
an elite versus non elite athlete.
And there's a few different guidelines depending on
66
00:05:29.240 --> 00:05:32.839
if your child or adolescent or an
adult, and something that you as you
67
00:05:32.879 --> 00:05:36.680
read through the consenstent statements you can
look at and see, let's move into
68
00:05:36.720 --> 00:05:44.360
this return to school here quickly,
and the return to school guidelines and what
69
00:05:44.560 --> 00:05:49.879
you could also modify to return to
work are new with just the recent consensus
70
00:05:49.920 --> 00:05:55.839
in sport update that fifth edition never
really used to have these guidelines out there,
71
00:05:55.839 --> 00:06:00.600
and there's not a step by step
progression with these like there is with
72
00:06:00.120 --> 00:06:04.120
sport. Again, but the more
you manage concussions, that easier this is
73
00:06:04.160 --> 00:06:12.160
going to get. And so typically
I managed our football team the most typically
74
00:06:12.800 --> 00:06:18.279
concussion during the game Friday night game. I have them rest Saturday Sunday typically,
75
00:06:18.279 --> 00:06:20.839
what they'll do with me for me
then, and then I'll send them
76
00:06:20.839 --> 00:06:26.000
to a half day on school on
Monday, and then follow up with me
77
00:06:26.079 --> 00:06:29.480
right after that half day and we
see where they're at. If they had
78
00:06:29.480 --> 00:06:32.639
to struggle with that half day of
school, I'll hold back farther, maybe
79
00:06:32.720 --> 00:06:35.560
get them a couple more days and
rest from school. But it's kind of
80
00:06:35.600 --> 00:06:41.560
the same thing. You want to
gradually reintroduce things, and this chart does
81
00:06:41.600 --> 00:06:45.839
a good job of Stage one is
we're looking at do some things at home,
82
00:06:46.120 --> 00:06:48.639
okay that are going to be similar
to what they're doing at school.
83
00:06:48.720 --> 00:06:54.399
Maybe that's just trying to read or
text the friends or do a couple of
84
00:06:54.480 --> 00:06:59.319
math problems and see and if that
goes fine, then yeah, let's get
85
00:06:59.360 --> 00:07:01.360
them back to school. Well,
things that you're gonna have to limit it
86
00:07:01.399 --> 00:07:04.839
initially with amount of homework for doing
them on a reading and the difficulty of
87
00:07:04.920 --> 00:07:12.040
cognitive levels, and again returning into
school part time first prior to returning in
88
00:07:12.040 --> 00:07:17.759
to the full time activity there full
time school. So it is also important
89
00:07:17.839 --> 00:07:24.160
with schools is that if you're going
to start managing the concussions and your school
90
00:07:24.199 --> 00:07:28.720
doesn't have a program, that won't
be established. Okay, school should have
91
00:07:29.120 --> 00:07:32.519
a return to school policy or you
should help them create one. So if
92
00:07:32.560 --> 00:07:38.720
you're sending Johnny back to school,
you're informing the teacher, Hey, he
93
00:07:38.759 --> 00:07:42.360
needs to be doing this. He
might need to be allowed to wear sunglasses
94
00:07:42.360 --> 00:07:45.680
at school. He might need to
be allowed to sit in front of the
95
00:07:45.759 --> 00:07:48.800
classroom so he doesn't have to strain
his eyes. She might need to take
96
00:07:48.879 --> 00:07:55.240
more breaks or be allowed to be
dismissed her next class a little bit sooner
97
00:07:55.279 --> 00:07:59.240
so she can avoid noisy hauls.
They you might need to set up and
98
00:07:59.279 --> 00:08:03.560
excuse apps as policy. So all
of these things are things that schools need
99
00:08:03.600 --> 00:08:09.759
to consider when they're working with athletes
and groups that are trying to manage these
100
00:08:09.920 --> 00:08:13.959
concussions. Obviously, I think all
of our teachers need to be familiar like
101
00:08:15.040 --> 00:08:18.680
some things that we're looking for for
acussion, the athlete, the parents,
102
00:08:18.720 --> 00:08:22.600
the school nerders, the principle.
The teachers need to that and especially those
103
00:08:22.639 --> 00:08:26.120
I really know that child. Are
they having difficulty paying attention? Are they
104
00:08:26.199 --> 00:08:31.000
having problems remembering things? Are they
needing more time than usual, and are
105
00:08:31.039 --> 00:08:35.320
their grades dropping a little bit?
Do they not seem like they're their normal
106
00:08:35.440 --> 00:08:39.879
self? Are they irritable? Emotional? Are they falling asleep in class?
107
00:08:41.120 --> 00:08:43.519
So these are all things that we
need to educate our schools on and teachers
108
00:08:43.559 --> 00:08:48.480
on and and making sure that they're
paying attention to so that think they can
109
00:08:48.559 --> 00:08:52.320
report back to the physician who might
be managing this individual as well. Obviously,
110
00:08:52.559 --> 00:08:56.960
as as you're probably where concussions can
affect our athletes' ability to learn,
111
00:08:58.559 --> 00:09:03.240
and thus hearing to a well thought
out plan of the return to school is
112
00:09:03.279 --> 00:09:07.879
going to be important, but it's
also going to be unique to each student.
113
00:09:07.240 --> 00:09:11.480
Twilight might be all to go back
on that Monday and do just fine
114
00:09:11.519 --> 00:09:13.919
for a half day, where John
said, hey, a half day is
115
00:09:13.960 --> 00:09:20.480
still too much. In most cases
concussions won't significantly limit, but again there's
116
00:09:20.480 --> 00:09:26.399
always these cases where that concussion is
severe at will. So again read it's
117
00:09:26.440 --> 00:09:31.440
just important to read through those contestant
statements and get a good general understanding of
118
00:09:31.440 --> 00:09:37.320
how these return to school guidelines and
again you might have to alter it to
119
00:09:37.399 --> 00:09:39.480
return to work guidelines, how they
work and things that we need to be
120
00:09:39.519 --> 00:09:46.039
cognizant of and pay attention to.
When are they ready to return to school?
121
00:09:46.120 --> 00:09:48.840
Well, that's going to be your
call essentially, that's end, and
122
00:09:50.159 --> 00:09:54.679
that's their ability to problem solve,
to think, to stay away, to
123
00:09:54.799 --> 00:09:58.039
sleep again. Go back to that
that line graph I drew life. It
124
00:09:58.240 --> 00:10:03.919
just it's it doesn't just pertain to
physical thing. It's a physical cognitive checklist.
125
00:10:05.320 --> 00:10:09.600
As the days progress outward, they
should be able to cognitively start to
126
00:10:09.600 --> 00:10:13.600
do more and more as well.
A lot of times with my cognitive rehabilitation,
127
00:10:13.679 --> 00:10:18.840
I'm printing out third grade multiplication tables
or math charts and having them do
128
00:10:18.919 --> 00:10:22.200
some of those that during the day. If they're pretty symptom free, I'll
129
00:10:22.240 --> 00:10:24.399
have them fly through them through a
couple of sheets in my office to say,
130
00:10:24.440 --> 00:10:28.000
Hey, how do you do what
pose to that made a headache?
131
00:10:28.039 --> 00:10:31.720
To that strain your eyes at all? Paying attention to that, and also
132
00:10:33.399 --> 00:10:37.000
if you're using any type of neurocognitive
test, that's going to tell you a
133
00:10:37.039 --> 00:10:39.600
lot. I have a baseline for
all of my athletes before the start of
134
00:10:39.600 --> 00:10:45.840
every season, and so I will
put them through post injury tests when they
135
00:10:45.840 --> 00:10:50.039
start to be pretty asymptomatic, and
I can see when they line up from
136
00:10:50.080 --> 00:10:54.639
a standpoint of post injury compared to
their baseline, and I want to put
137
00:10:54.639 --> 00:11:00.559
them back to baseline before obviously they're
return to play physically, and before I
138
00:11:00.799 --> 00:11:05.240
remove all limitations from the school.
Can understanding concussion symptoms help identify with the
139
00:11:05.279 --> 00:11:11.600
specific student's individual needs. Absolutely,
if you're dealing with an individual who has
140
00:11:13.320 --> 00:11:16.919
a cervicogenic post concussion syndrome, the
way you're treating and managing them from a
141
00:11:16.960 --> 00:11:22.799
rehabilitative standpoint and a cognitive standpoint is
completely different than if you're dealing with some
142
00:11:24.120 --> 00:11:28.919
a stibular ocular. Okay, have
cervicogenetic patient might not have any problems seeing
143
00:11:28.000 --> 00:11:33.399
the chalkboard. They might not have
any problems with like if their balance,
144
00:11:33.720 --> 00:11:39.399
things like that, and so I
might allow them, Hey, you can
145
00:11:39.440 --> 00:11:41.879
sit in the back of the room. I'm not worried about eye strain with
146
00:11:41.919 --> 00:11:46.559
you. Whereas that vestibular ocular,
they're sensitive to bright lights. And again
147
00:11:46.600 --> 00:11:50.399
I might have tower classes or they
might need to sit closer, or if
148
00:11:50.399 --> 00:11:54.159
they have a computer class, I
might say you're only in class for twenty
149
00:11:54.240 --> 00:11:58.720
minutes with the computer because I want
to avoid that strain. So understanding what
150
00:11:58.799 --> 00:12:05.039
air the brain are affected with concussion
is going to vastly help you continue to
151
00:12:05.120 --> 00:12:16.559
manage this these individual symptoms. If
earning a certification is on your CE plan
152
00:12:16.639 --> 00:12:20.559
this year, then you're in luck. Southeast Professional Education Group just launched four
153
00:12:20.559 --> 00:12:26.639
new certifications on our online learning platform. You can complete your certification in dry
154
00:12:26.679 --> 00:12:33.080
needling, functional nutrition, chiropractic acupuncture, or clinical human performance with immediate access
155
00:12:33.120 --> 00:12:37.919
to get started learning right away.
To learn more and get started, click
156
00:12:37.000 --> 00:12:43.159
the new certifications link in our show
notes or visit online dot Sports Hyphenseminars dot
157
00:12:43.200 --> 00:12:48.799
com today. Oh and one more
thing. If you have no idea what
158
00:12:48.840 --> 00:12:52.799
a CE plan is or why you
should have one, don't stress. We've
159
00:12:52.799 --> 00:12:56.519
got you covered. Simply check out
episodes twenty six and twenty seven where doctor
160
00:12:56.559 --> 00:13:01.039
Tom Teeter explains what the rehab continuum
is and lays out a plan for developing
161
00:13:01.080 --> 00:13:07.000
and expanding a strong clinical skill set
through CE courses. Now back to the
162
00:13:07.039 --> 00:13:16.360
show, but essentially this is a
breakdown of the limitations that I give My
163
00:13:16.799 --> 00:13:18.919
kids wanted to go back to school, and you also got to be cognizant.
164
00:13:20.000 --> 00:13:22.919
Is if they're not an athlete,
but they have a gym class in
165
00:13:22.080 --> 00:13:26.879
Jim, they got to follow the
same return to return to play essentially return
166
00:13:26.919 --> 00:13:31.799
to gym guidelines. But I have
a form that I developed that is a
167
00:13:31.879 --> 00:13:35.919
checklist essentially of how these kids go
back to school. So here this top
168
00:13:37.000 --> 00:13:41.519
example is deals with testing. If
there's some important test, I might have
169
00:13:41.600 --> 00:13:43.679
that conversation without suit and hey,
I don't mind if John takes the test,
170
00:13:43.679 --> 00:13:46.919
but right now he just he needs
to open book or can he take
171
00:13:46.960 --> 00:13:50.440
the test? Broken down in a
couple of days, I give him the
172
00:13:50.440 --> 00:13:54.799
first page this day, the second
page the next day, and so forth
173
00:13:54.120 --> 00:14:00.519
and again broken down right stages.
We want this this is the the first
174
00:14:00.519 --> 00:14:03.039
side here, but we want stage
one of these just daily activities to be
175
00:14:03.080 --> 00:14:07.039
done at home, okay, so
that we know if it's going to be
176
00:14:07.080 --> 00:14:09.559
safe to get them back into school
and start with that five to fifteen increment
177
00:14:11.480 --> 00:14:16.320
five five or fifteen minutes. Stage
two some easy light school activities, all
178
00:14:16.360 --> 00:14:18.960
a little bit on the homework,
all a little bit of reading. There
179
00:14:18.960 --> 00:14:22.120
are cognitive activities outside of a classroom, but they still might be at school
180
00:14:22.120 --> 00:14:26.039
only part time during this stage.
And we're just trying to build out that
181
00:14:26.120 --> 00:14:30.600
tolerance to cognitive work, right we're
trying to as days progress out, we're
182
00:14:30.600 --> 00:14:35.679
trying to move up along that symptom
line again back to school, reintroducing more
183
00:14:35.720 --> 00:14:39.879
school work and just classroom activity,
the noise levels. If they're a band
184
00:14:39.960 --> 00:14:43.679
required, you might have to hold
from that for a week, sometimes ending
185
00:14:43.720 --> 00:14:50.559
on the band set up and still
building up that tolerance level until we can
186
00:14:50.679 --> 00:14:56.120
get them to return into school full
time and back to them all academic activities.
187
00:14:56.519 --> 00:14:58.799
And then ideally they might have to
play some catchup. And so is
188
00:14:58.840 --> 00:15:03.559
it it's safe when and is it
safe for them to do their normal stuff
189
00:15:03.600 --> 00:15:07.519
and play catch up? Those are
all some things to think about and consider
190
00:15:07.720 --> 00:15:13.919
again. I'll be at TCC and
then factor on through selfies sports education has
191
00:15:15.000 --> 00:15:18.159
I believe it was an eight hour
module just if you can correct me,
192
00:15:18.200 --> 00:15:22.879
that I put together and that kind
of deals with that whole entire bubble on
193
00:15:22.200 --> 00:15:28.039
our on the second side of mine
and explains and pulls you the entire concussion
194
00:15:28.159 --> 00:15:33.879
management procedures that I work with them
where it was going to get involved.
195
00:15:33.879 --> 00:15:37.919
But I can open up the floor
to any questions here to know if anyone
196
00:15:37.960 --> 00:15:39.799
has in here. Awesome, Thank
you so much, doctor Olson. And
197
00:15:39.879 --> 00:15:45.799
as he mentioned, we do have
a full eight hour online on demand course
198
00:15:45.960 --> 00:15:48.799
on our course online learning website.
I'll put that in the chat so that
199
00:15:48.879 --> 00:15:52.679
you guys linked to that so you
can check it out if you're interested in
200
00:15:52.759 --> 00:15:56.159
learning more. We'll also follow up
via emails. We'll let you guys know
201
00:15:56.200 --> 00:15:58.200
a little bit more about that.
Again, there's only so much that we
202
00:15:58.279 --> 00:16:03.799
can cover in this one hour format
when it comes to a big topic such
203
00:16:03.840 --> 00:16:08.440
as concussion, and doctor Olsen gives
some really great in depth directives on post
204
00:16:08.440 --> 00:16:14.759
concussion care and of course helping patients
with their recovery from that from a rehab
205
00:16:14.799 --> 00:16:18.799
standpoint in that online course. That
being said, we have had a few
206
00:16:18.879 --> 00:16:22.200
questions that have come in from our
live audience. Very early on, you
207
00:16:22.320 --> 00:16:29.679
were talking a little bit about the
fact that there's been this fourfold increase in
208
00:16:29.759 --> 00:16:33.440
concussion in recent years, especially with
you with athletes, and that as of
209
00:16:33.559 --> 00:16:40.039
today at least, the research hasn't
come to a conclusion about why that is
210
00:16:40.159 --> 00:16:44.320
or why we've seen that increase in
prevalence. But I'm sure as a provider
211
00:16:44.360 --> 00:16:48.360
that works with a lot of patients
that have concussion, you have ideas or
212
00:16:48.440 --> 00:16:52.159
thoughts or maybe correlations that you're seeing. What do you think? And I
213
00:16:52.240 --> 00:16:56.360
know, obviously this is your opinion, not based on research because they haven't
214
00:16:56.360 --> 00:17:00.879
come up with a definitive conclusion yet. But why do you think we've seen
215
00:17:00.960 --> 00:17:07.279
this increase in concussion in recent years? Yeah? I think if i'm I'm
216
00:17:07.279 --> 00:17:10.839
gonna go if we're going to use
four fold, I'm gonna go give a
217
00:17:10.880 --> 00:17:15.559
three to one ratio. So I
talked to a lot of older athletes that
218
00:17:15.920 --> 00:17:18.319
may have played sports back in the
seventies the eighties, my dad being one
219
00:17:18.359 --> 00:17:22.880
of them, and he's just like, man, I probably had several concussions
220
00:17:22.920 --> 00:17:27.000
going through football, but half the
time you're just told to get back in
221
00:17:27.079 --> 00:17:33.000
there. So that being said,
I think we have so much more knowledge
222
00:17:33.039 --> 00:17:37.519
nowotles oodles more and so of that
fourfold, I would say at least three
223
00:17:37.519 --> 00:17:41.799
of it is we are recognizing concussions
faster. Okay, So a lot of
224
00:17:41.799 --> 00:17:45.440
these concussions back in the seventies,
eighties and early nineties probably going miss,
225
00:17:45.559 --> 00:17:51.839
probably not being dealt with at all
or even reported as a concussion. However,
226
00:17:51.920 --> 00:17:55.400
that one fold, I do think
like bigger, faster, stronger,
227
00:17:55.519 --> 00:17:59.559
Right, our athletes are getting bigger, they're faster, the stronger collusions are
228
00:17:59.599 --> 00:18:06.440
harder and probably substantially substantially more compared
to again seventies eighty nineties. But with
229
00:18:06.519 --> 00:18:10.759
that being said, or protective equipments
get better too, okay, and our
230
00:18:10.799 --> 00:18:14.599
practices are better at how we're managing
these. So I mean, personally,
231
00:18:15.039 --> 00:18:19.160
don't think it's that drastic change in
the sport as much it is is our
232
00:18:19.359 --> 00:18:25.359
awareness to recognize and manage these.
But I think there's a little bit of
233
00:18:25.400 --> 00:18:30.279
both, definitely just heavier on the
recognition standpoint. Now, I can absolutely
234
00:18:30.359 --> 00:18:34.880
see that, And I note even
within kind of the general public's knowledge and
235
00:18:34.960 --> 00:18:41.440
understanding of concussion, I think parents
on the whole are probably way more cognizant
236
00:18:41.519 --> 00:18:47.480
of the brain help for their kids
now, since major movies have come out
237
00:18:47.480 --> 00:18:51.720
about it, since the NFL has
had the major news stories that they've had
238
00:18:51.759 --> 00:18:55.920
about CTE and the long term effects
of concussion. So I can certainly see
239
00:18:55.960 --> 00:18:59.599
how a lot of that factors into
public awareness, which in turn, a
240
00:18:59.599 --> 00:19:03.440
lot of times parents might be the
ones kind of looking at that for their
241
00:19:03.559 --> 00:19:06.599
kids a little bit more than their
young athletes who are just trying to get
242
00:19:06.599 --> 00:19:11.160
back in the game. Absolutely now
kind of going along that same line,
243
00:19:11.319 --> 00:19:17.400
you mentioned that a lot of times
you'll have those conversations, especially with parents
244
00:19:17.480 --> 00:19:22.200
when you're dealing with an underage athlete, someone that their parents are typically the
245
00:19:22.240 --> 00:19:26.559
ones bringing them in. Do you
find that most of the time having those
246
00:19:26.559 --> 00:19:30.880
conversations with parents is a really effective
way to make sure that their young athlete
247
00:19:30.960 --> 00:19:37.160
is recovering on an appropriate timeline.
Do you often get a little bit of
248
00:19:37.160 --> 00:19:42.640
pushback from the athletes themselves because they
want things to hurry up and get better
249
00:19:42.680 --> 00:19:48.000
faster. How do you have those
conversations with the athletes so that they understand
250
00:19:48.319 --> 00:19:52.960
that this is a process and that
recovery takes time. Absolutely, And I'm
251
00:19:53.160 --> 00:19:57.559
very blessed and fortunate to be practicing
in such a small, rural, remote
252
00:19:57.599 --> 00:20:04.880
area. I believe that aids to
the betterment of the athletes, simply because
253
00:20:06.079 --> 00:20:10.480
a lot of these athletes, our
parents are my friends now. And over
254
00:20:10.480 --> 00:20:15.319
the twelve years of doing this,
you start to be recognized as the concussion
255
00:20:15.319 --> 00:20:18.000
of rule. And so when I
first started, yeah, I had a
256
00:20:18.039 --> 00:20:22.079
little bit more pushback twelve years ago. Are you sure he's got one?
257
00:20:22.160 --> 00:20:26.440
Or you know what? I And
it also goes to the level of our
258
00:20:26.480 --> 00:20:30.160
team used to be better. Twelve
years ago, we were competing for stayed
259
00:20:30.200 --> 00:20:33.079
a couple. So you have those
athletes and they're not going to miss a
260
00:20:33.079 --> 00:20:38.319
game. But I think again,
in these past ten to twelve years,
261
00:20:38.319 --> 00:20:42.599
the amount of concussion as that's come
out right now, you're almost having athletes
262
00:20:44.119 --> 00:20:47.839
more worried for themselves and you than
you used to, like, Hey,
263
00:20:47.920 --> 00:20:51.039
I had a little headache, or
what do you think should I go back
264
00:20:51.079 --> 00:20:56.200
in? And I think we're finding
more and more athletes with concussion wanting to
265
00:20:56.279 --> 00:21:00.519
play an air inside of caution or
air on the safe side. The more
266
00:21:00.559 --> 00:21:04.000
people I can get involved in again
during a football game, if it happens,
267
00:21:04.039 --> 00:21:07.640
mom and dad come over and I
sit my talk with the parent and
268
00:21:08.319 --> 00:21:11.960
mom and dad about this, what's
going on at the end of the game.
269
00:21:11.039 --> 00:21:15.039
Of the coaches wasn't able to come
home during the game, we discuss
270
00:21:15.119 --> 00:21:18.160
it a lot of the teachers,
I have their number and I can send
271
00:21:18.160 --> 00:21:22.799
them a message, Hey, got
a concussion. Here's what we got to
272
00:21:22.839 --> 00:21:26.039
do. What's your what's your weekly
schedule look like? How can we get
273
00:21:26.240 --> 00:21:30.680
this individual back to school safely?
And so the more the more education,
274
00:21:30.799 --> 00:21:33.400
I mean, the big the biggest
part of percussion management is education, and
275
00:21:33.400 --> 00:21:37.400
if you can tell that athlete what
to expect that's going to come a dong
276
00:21:37.440 --> 00:21:41.200
and need nerves or fears, that's
that helps, especially if mom and dad
277
00:21:41.279 --> 00:21:44.720
knows so that they're not you know, on the athlete and making them more
278
00:21:44.799 --> 00:21:48.039
nervous. The more people you can
get to understand this, the better.
279
00:21:48.240 --> 00:21:52.759
And every year I gave a concussion
management talk towards school at the beginning of
280
00:21:52.799 --> 00:21:55.519
the year, and so the teachers
are on board, the parents are on
281
00:21:55.599 --> 00:21:59.440
board, everyone everyone just has a
good awareness. And I would say,
282
00:21:59.680 --> 00:22:03.799
I don't say a role model for
a program, but I do think it
283
00:22:04.359 --> 00:22:07.440
is a second hold heres. But
I think we have a really good,
284
00:22:07.640 --> 00:22:15.519
good program here and parents fully understand
and the teachers fully understand how to operate
285
00:22:15.599 --> 00:22:18.559
this. It's made it's made my
job easier. No, absolutely, I
286
00:22:18.599 --> 00:22:22.519
can. I can see that,
and I know that along those same lines,
287
00:22:22.559 --> 00:22:29.279
it's really important when you are dealing
with an athlete that has coaches involved,
288
00:22:29.279 --> 00:22:33.079
and athletic trainers involved, and maybe
their medical doctor involved and other other
289
00:22:33.599 --> 00:22:38.960
members of their healthcare team, that
you communicate regularly with them about their care.
290
00:22:40.839 --> 00:22:45.039
What are some kind of tips or
best practices that you utilize in your
291
00:22:45.079 --> 00:22:51.279
office to communicate with those other members
that are overseeing that young athlete as members
292
00:22:51.319 --> 00:22:55.319
of their healthcare team. I was
I'm trying to think of kipt here if
293
00:22:55.880 --> 00:23:00.319
I would have to say, it
was allowing myself to establish KA it's in
294
00:23:00.359 --> 00:23:06.559
the community concussion expert, concussion guru. And that didn't happen overnight. That
295
00:23:06.680 --> 00:23:11.759
happened with years of practice, years
of reading the literature, following the guidelines.
296
00:23:11.799 --> 00:23:15.519
The more you know, the easier
is to talk about something, and
297
00:23:17.119 --> 00:23:21.400
the smarter you are about that sort
if you fully understand all this sitting through
298
00:23:21.440 --> 00:23:25.079
this presentation, you're not going to
really walk away and say, Okay,
299
00:23:25.079 --> 00:23:27.559
I can go manage concussion like It's
not a one hour it's not a one
300
00:23:27.559 --> 00:23:33.680
hour webinar. It's a lot of
research and almost trial and error and getting
301
00:23:33.720 --> 00:23:37.519
those concussion patients. And if your
first concussion patient you have, you might
302
00:23:37.559 --> 00:23:41.200
not want to be the primary guy
that manages that. You might just want
303
00:23:41.240 --> 00:23:44.680
to be a part of the team. But then after that, if you
304
00:23:44.720 --> 00:23:48.920
stick to the internationally accepted guidelines,
and essentially a SODA has adopted the nationally
305
00:23:48.960 --> 00:23:52.240
accepted guidelines, so I can go
right on in my Minnesota state high school
306
00:23:52.319 --> 00:23:59.000
league and print off that same step
wise progression and use those forms. And
307
00:23:59.039 --> 00:24:03.079
if I'm evaluating this, but that
athletes also they chose to see their medical
308
00:24:03.119 --> 00:24:06.920
doctor first and he wants to do
it, and then they come to me
309
00:24:07.519 --> 00:24:11.680
for symptom management. I'll write those
guidelines out and say, hey, here's
310
00:24:11.720 --> 00:24:15.640
what i'm finding. Here's our state
guidelines. He should be on step one
311
00:24:15.759 --> 00:24:19.319
or on step four. Hey,
I see like you didn't hold him from
312
00:24:19.359 --> 00:24:23.640
school. I think he's not quite
ready for that. That and I'm the
313
00:24:23.680 --> 00:24:29.240
one that administers all the nal cognitive
baselines. So most of the time now
314
00:24:29.279 --> 00:24:32.680
it's like if there can cost,
nurse will just say you just got to
315
00:24:32.920 --> 00:24:36.680
you know, follow up with doctor
also, he's going to progress you through
316
00:24:36.680 --> 00:24:40.799
it. But it's I think it's
just it takes time to develop and it's
317
00:24:40.880 --> 00:24:44.920
in the biggest The biggest help is
you if you're going to manage it,
318
00:24:45.119 --> 00:24:48.359
establishing yourself as the expert in it. No, absolutely, And I think
319
00:24:48.400 --> 00:24:52.079
that's that's key again, just kind
of keeping everyone in the loop and them
320
00:24:52.119 --> 00:24:57.319
know that what's going on with the
athlete and how they're doing. As you
321
00:24:57.400 --> 00:25:03.000
mentioned before, I mean there's so
much coming out still in the research.
322
00:25:03.039 --> 00:25:07.559
They're still updating things regularly, which
I think it's nice that the medical community
323
00:25:07.640 --> 00:25:11.599
is now really paying attention to this
and has this as a high priority,
324
00:25:11.680 --> 00:25:15.920
especially when it comes to sports and
athletics, And it seems like we're just
325
00:25:15.000 --> 00:25:21.799
kind of scratching the surface on our
understanding of the brain and long term effects
326
00:25:21.880 --> 00:25:26.160
of concussion. So if you could
kind of speak a little bit to some
327
00:25:26.240 --> 00:25:30.119
of the long term effects of concussion
that you've seen with patients. Obviously,
328
00:25:30.200 --> 00:25:34.599
there's the recovery period where we know
we're going to have specific symptoms, But
329
00:25:36.440 --> 00:25:41.720
have you had any cases where even
years after the fact, or after having
330
00:25:41.799 --> 00:25:48.279
multiple concussions over time, you're seeing
patients that have symptoms that just become chronic
331
00:25:48.519 --> 00:25:52.519
throughout the rest of their life.
Or what are those things that you're seeing
332
00:25:52.559 --> 00:25:56.319
that make you ask that question in
that initial exam with a patient. Have
333
00:25:56.400 --> 00:26:00.799
you ever had a concussion in the
past, have you had one recent years
334
00:26:00.920 --> 00:26:03.799
or multiple, et cetera. Okay, A couple of answers to this question
335
00:26:03.880 --> 00:26:07.319
is, well, I've only been
in practice again for twelve years. In
336
00:26:07.599 --> 00:26:14.559
my twelve years here, I've had
two that have had multiple concussions, and
337
00:26:14.680 --> 00:26:19.880
unfortunately one was multiple concussions within five
minutes. So he fell into the second
338
00:26:19.880 --> 00:26:25.079
impact and the room he essentially was
got knocked over in gym class, hit
339
00:26:25.119 --> 00:26:27.319
his head, and then as he
was walking out of gym class, someone
340
00:26:27.359 --> 00:26:32.640
threw basketball from one before to the
other hit him in the head and then
341
00:26:32.640 --> 00:26:36.200
he fell over the ground in his
head hitting the ground again. He was
342
00:26:36.240 --> 00:26:40.920
top of this class student, He
was I believed sixth grade at the time,
343
00:26:41.480 --> 00:26:47.519
and just really took a turn from
them for the worst and struggled with
344
00:26:47.599 --> 00:26:52.400
school and mother's name and things like
that, and his recovery was a long
345
00:26:52.519 --> 00:26:55.599
time. He had to get pulled
out of school and going to homeschooling,
346
00:26:55.759 --> 00:26:59.480
and with all that just came,
he was a different individual. And so
347
00:26:59.880 --> 00:27:03.480
I think this individual is learning how
to adjust to someone that he wasn't used
348
00:27:03.480 --> 00:27:10.559
to being. And with that middle
school age friends and bullying and picking on
349
00:27:10.599 --> 00:27:15.559
each other, I think came some
social issues. These other two individuals that
350
00:27:15.599 --> 00:27:21.400
I spoke about with that previous concussion
was the biggest thing is like depression.
351
00:27:21.519 --> 00:27:26.480
Right, they can't provide for their
friends and their family or their kids like
352
00:27:26.640 --> 00:27:30.119
they were so used to doing.
Such a light switch change right, It's
353
00:27:30.119 --> 00:27:33.640
like boom, here's your injury and
all, so you can't do this.
354
00:27:33.279 --> 00:27:38.759
And those are the biggest things that
I see with patients that I know very
355
00:27:38.759 --> 00:27:42.400
well before they get to concussion.
And again, small town unfortunately, where
356
00:27:42.799 --> 00:27:47.119
a lot of my athletes. I
know these athletes, and so I have
357
00:27:47.160 --> 00:27:52.079
an easier time managing concussions because I
know this individual's normal, whereas my worst
358
00:27:52.119 --> 00:27:56.519
fears starting to manage your concussion,
I have no clue who this individual is.
359
00:27:56.720 --> 00:27:59.039
It's the first time I see him
was post concussion. I don't know
360
00:27:59.079 --> 00:28:02.920
what they like, how they cock, how they act, and what they're
361
00:28:03.720 --> 00:28:08.160
normal. So that being said,
the concussions I've managed, I'm just getting
362
00:28:08.160 --> 00:28:11.400
to the to the point now,
whereas like some of my early ones would
363
00:28:11.440 --> 00:28:15.720
be yeah, have they fallen into
any long term deficits now From just a
364
00:28:15.920 --> 00:28:19.519
regular provider side of things, like
do I get patients that I come in
365
00:28:19.559 --> 00:28:22.359
and say, yeah, I've had
multiple concussions when I was a kid,
366
00:28:22.400 --> 00:28:27.079
and now I have like after my
third concussion, I've had chronic headaches and
367
00:28:27.160 --> 00:28:33.079
chronic neck pain. Yeah, I
see that with a couple of patiently and
368
00:28:33.200 --> 00:28:36.960
think of quicker to get angered a
little bit more, higher anxiety and never
369
00:28:37.079 --> 00:28:41.440
used to be anxious or agitated.
And I think I think that agitates I
370
00:28:41.480 --> 00:28:45.640
get irritated more. And both of
them will probably say, I don't know
371
00:28:45.680 --> 00:28:51.640
if that's related to pain and or
just brain dysfunction, but I think those
372
00:28:52.000 --> 00:28:53.680
those are kind of the top things
that I can think of that come to
373
00:28:53.759 --> 00:28:57.000
mind. Wonderful. Thank you so
much, and thank you so much for
374
00:28:57.039 --> 00:29:02.640
this presentation today. Again, thank
you so much doctor Olsen for tackling this
375
00:29:02.839 --> 00:29:06.400
very big topic for us today.
You provided a lot of great information that
376
00:29:06.440 --> 00:29:10.920
I think our providers will be able
to take into practice immediately. Thank you
377
00:29:11.000 --> 00:29:14.200
so much. Everyone. We're signing
off for today. Thank you doctor Olson.
378
00:29:14.279 --> 00:29:26.799
Yes, thank you guys for having
me. That's it for today's episode.
379
00:29:26.960 --> 00:29:30.000
Be sure to tune in for episode
seventy nine, where we kick off
380
00:29:30.039 --> 00:29:36.680
a brand new series on harnessing the
science of HRV or heart rate variability for
381
00:29:36.799 --> 00:29:40.519
enhance patient care with doctor David Hopper. You won't want to miss it.
382
00:29:40.680 --> 00:29:44.960
Episode seventy nine drops in two weeks. If you're more of a visual learner
383
00:29:45.039 --> 00:29:48.640
or want to see the full presentation
slide deck from today's training, be sure
384
00:29:48.640 --> 00:29:51.880
to visit the link in our show
notes to watch the full recorded replay of
385
00:29:51.920 --> 00:29:55.640
this webinar. You can also scroll
through our show notes to find a link
386
00:29:55.720 --> 00:30:00.680
to our newly launched Factor Podcast website
Factor podcast dot Com, as well as
387
00:30:00.720 --> 00:30:03.240
links to all of the special offers
from our sponsors. We'll see you next
388
00:30:03.240 --> 00:30:10.960
time. Hey guys, if you
like what you heard today, I encourage
389
00:30:11.000 --> 00:30:15.400
you to visit our website at Factor
hyphenstore dot com. That's spelled fa k
390
00:30:17.000 --> 00:30:22.559
tr hyphenstore dot com to find out
more information about all that we have to
391
00:30:22.640 --> 00:30:26.079
offer. We have a variety of
online offerings as well as our hands on
392
00:30:26.240 --> 00:30:30.440
Factor Rehab System course scheduled in cities
around the globe. Be sure to also
393
00:30:30.519 --> 00:30:34.240
check out our event calendar and bookmark
any of these upcoming live webinar dates coming
394
00:30:34.279 --> 00:30:37.079
up in the near future so you
can join us live. And of course,
395
00:30:37.119 --> 00:30:41.160
the biggest compliment we can receive is
for you to help us spread the
396
00:30:41.200 --> 00:30:44.960
word to your friends, colleagues,
and classmates. You'll find all the important
397
00:30:45.000 --> 00:30:48.000
links, as well as info about
our sponsors in the show notes, so
398
00:30:48.079 --> 00:30:48.200
be sure to check those out.
1
00:00:15.880 --> 00:00:19.879
Hi guys, Welcome to another episode
of The Factor podcast. I'm your host
2
00:00:20.079 --> 00:00:24.199
Jessica Riddle. Today we wrap up
the second part of our series on concussion
3
00:00:24.239 --> 00:00:28.480
and return to Play with doctor Michael
Olson. In our last episode, we
4
00:00:28.480 --> 00:00:34.719
were introduced to the concept of crafting
individualized concussion management plans and discuss the importance
5
00:00:34.719 --> 00:00:38.880
of ensuring every member of the healthcare
team is in agreement on the best path
6
00:00:38.920 --> 00:00:43.920
forward for optimal patient recovery. In
today's episode, we will be discussing the
7
00:00:43.960 --> 00:00:48.679
finer details of OURTP or return to
play protocols, and how to manage the
8
00:00:48.719 --> 00:00:54.600
delicate balance between healing and returning to
daily activities. Doctor Olsen highlights the differences
9
00:00:54.640 --> 00:01:00.479
in special considerations in working with elite
level athletes versus recreational or youth athletes,
10
00:01:00.799 --> 00:01:03.879
and he will also discuss the important
role that hormones and blood pressure can have
11
00:01:04.040 --> 00:01:08.599
in recovery from a TBI. Finally, he will guide us through the RTP
12
00:01:08.840 --> 00:01:14.920
formula, his structured approach for getting
athletes back in the game safely, focusing
13
00:01:14.920 --> 00:01:19.560
on gradual increases in activity and constant
monitoring. So grab something to take notes
14
00:01:19.599 --> 00:01:23.760
with and be sure to hit the
save button. This is one you'll definitely
15
00:01:23.760 --> 00:01:38.480
want to listen to more than once. Let's dive in. Now we're going
16
00:01:38.519 --> 00:01:42.959
to get into oh real quick.
Here, this is my this is what
17
00:01:42.120 --> 00:01:47.799
I give the athletes. Here.
Again, my form's slightly outdated, and
18
00:01:47.840 --> 00:01:51.480
that technically now this complete rast is
twenty four to forty eight hours. This
19
00:01:51.560 --> 00:01:56.040
is considered step one. So that's
why when we see step five is return
20
00:01:56.079 --> 00:01:59.439
to players. Now they list us
as step six, but same thing,
21
00:01:59.680 --> 00:02:02.000
just lines and at any time an
athlete of mind to save the concussion,
22
00:02:02.560 --> 00:02:06.640
I give them this form and we
just walked through it with him, and
23
00:02:06.680 --> 00:02:07.800
the coach is going to get one, Mom and Dad's going to get one,
24
00:02:07.840 --> 00:02:12.639
and the school administration is going to
get this form, so that they
25
00:02:12.719 --> 00:02:16.360
were all on the same page and
following the same plan. Some barriers to
26
00:02:16.479 --> 00:02:23.039
recovery, okay, could there be
genetic barriers, age differences. Really,
27
00:02:23.039 --> 00:02:29.800
what we're seeing is a couple of
barriers are in our own developmental factors thus
28
00:02:29.879 --> 00:02:34.159
as like ADHD, family history of
migraines, or other mental health problems,
29
00:02:34.199 --> 00:02:38.680
as these can be substantially altered or
changed, But our biggest barrier is having
30
00:02:38.719 --> 00:02:43.960
it or the biggest risk factors.
If we've had a previous concussion or a
31
00:02:43.960 --> 00:02:47.560
brain injury. A lot of times
we're going to see those individuals have a
32
00:02:47.560 --> 00:02:53.280
lot of the harder time progressing through
and returning to their normal state. So
33
00:02:53.400 --> 00:02:57.680
very of a person's initial symptoms in
the first day after injury is the strongest
34
00:02:58.039 --> 00:03:01.560
predictor. So what that means is
that you diagnose some with concussion, but
35
00:03:01.599 --> 00:03:05.280
there are symptoms are on the fence, like and I don't know if it
36
00:03:05.360 --> 00:03:08.159
is this is If it is,
it's very mild. You maybe have a
37
00:03:08.199 --> 00:03:12.840
two out of ten headache, and
he also don't know that just from like
38
00:03:13.599 --> 00:03:17.840
your skull hurts from the hit type
of thing, or or again, they
39
00:03:17.960 --> 00:03:23.479
have all the signs and concussion that's
gonna tell us a lot how fast are
40
00:03:23.479 --> 00:03:27.439
going to recover, So you can
you can use those as pretty good predictive
41
00:03:27.479 --> 00:03:32.400
indicators as you as you start to
manage this and the factors aiding recovery is
42
00:03:32.520 --> 00:03:38.240
there's more and more literature out cardiovascular
exercise, which is why after that twenty
43
00:03:38.240 --> 00:03:39.919
four to forty eight hours, we
want to start getting them up and getting
44
00:03:39.919 --> 00:03:45.080
them moving a little bit, get
that meta balt rate increased. And I'm
45
00:03:45.120 --> 00:03:51.280
also seeing more more and more literature
on B twelve and specifically at a lot
46
00:03:51.280 --> 00:03:54.080
of times, I'm seeing more providers
just give them the whole B complex to
47
00:03:55.000 --> 00:03:59.400
aid in their recovery. But there
is indication that B twelve is going to
48
00:03:59.439 --> 00:04:04.479
help prove our nerve in their own
repair and restore nerve function. But again
49
00:04:04.879 --> 00:04:12.000
rest primary treatment in that twenty four
forty eight hours and then move into rehabilitation
50
00:04:12.479 --> 00:04:16.040
specific to dysfunction. That's going to
be completely different. I'll be talking about
51
00:04:16.040 --> 00:04:20.279
concussion management at the upcoming TCC convention. We're going to gear a little bit
52
00:04:20.279 --> 00:04:25.240
more into some of that rehabilitation standpoint. So if you're interested in tuning into
53
00:04:25.319 --> 00:04:28.879
that, that's going to be good. But there's there's three types of post
54
00:04:28.920 --> 00:04:32.839
concussion and that's a cervical, genetic, physiologic, and vestibular ocular. So
55
00:04:33.439 --> 00:04:39.079
from a cervicogenic standpoint, the chiropractors, if they're looking at into rehabbing,
56
00:04:39.079 --> 00:04:43.600
it fit in while there. If
they're falling into pystibular ocular they may need
57
00:04:43.600 --> 00:04:47.560
to see rehab specialists, they may
need to work with a behavioral optometrist and
58
00:04:48.079 --> 00:04:53.240
do more things along those lines.
But all of those things help aid in
59
00:04:53.360 --> 00:04:58.360
recovery and depending on what type of
care that athlete is getting from a reheb
60
00:04:58.439 --> 00:05:04.000
standpoints going to definitely help improve their
recovery. Elite versus non elite athletes,
61
00:05:04.040 --> 00:05:10.040
guys, concussion doesn't matter. Shouldn't
matter if you're twelve and on the Sandlot
62
00:05:10.079 --> 00:05:15.360
team or if you're Tom Brady.
They concussion need to manage to be managed
63
00:05:15.399 --> 00:05:17.839
the same. The only spot where
they differ is depending on how fast or
64
00:05:17.839 --> 00:05:21.680
slow an athlete is recovering. But
there's not a different set of rules for
65
00:05:21.720 --> 00:05:29.079
an elite versus non elite athlete.
And there's a few different guidelines depending on
66
00:05:29.240 --> 00:05:32.839
if your child or adolescent or an
adult, and something that you as you
67
00:05:32.879 --> 00:05:36.680
read through the consenstent statements you can
look at and see, let's move into
68
00:05:36.720 --> 00:05:44.360
this return to school here quickly,
and the return to school guidelines and what
69
00:05:44.560 --> 00:05:49.879
you could also modify to return to
work are new with just the recent consensus
70
00:05:49.920 --> 00:05:55.839
in sport update that fifth edition never
really used to have these guidelines out there,
71
00:05:55.839 --> 00:06:00.600
and there's not a step by step
progression with these like there is with
72
00:06:00.120 --> 00:06:04.120
sport. Again, but the more
you manage concussions, that easier this is
73
00:06:04.160 --> 00:06:12.160
going to get. And so typically
I managed our football team the most typically
74
00:06:12.800 --> 00:06:18.279
concussion during the game Friday night game. I have them rest Saturday Sunday typically,
75
00:06:18.279 --> 00:06:20.839
what they'll do with me for me
then, and then I'll send them
76
00:06:20.839 --> 00:06:26.000
to a half day on school on
Monday, and then follow up with me
77
00:06:26.079 --> 00:06:29.480
right after that half day and we
see where they're at. If they had
78
00:06:29.480 --> 00:06:32.639
to struggle with that half day of
school, I'll hold back farther, maybe
79
00:06:32.720 --> 00:06:35.560
get them a couple more days and
rest from school. But it's kind of
80
00:06:35.600 --> 00:06:41.560
the same thing. You want to
gradually reintroduce things, and this chart does
81
00:06:41.600 --> 00:06:45.839
a good job of Stage one is
we're looking at do some things at home,
82
00:06:46.120 --> 00:06:48.639
okay that are going to be similar
to what they're doing at school.
83
00:06:48.720 --> 00:06:54.399
Maybe that's just trying to read or
text the friends or do a couple of
84
00:06:54.480 --> 00:06:59.319
math problems and see and if that
goes fine, then yeah, let's get
85
00:06:59.360 --> 00:07:01.360
them back to school. Well,
things that you're gonna have to limit it
86
00:07:01.399 --> 00:07:04.839
initially with amount of homework for doing
them on a reading and the difficulty of
87
00:07:04.920 --> 00:07:12.040
cognitive levels, and again returning into
school part time first prior to returning in
88
00:07:12.040 --> 00:07:17.759
to the full time activity there full
time school. So it is also important
89
00:07:17.839 --> 00:07:24.160
with schools is that if you're going
to start managing the concussions and your school
90
00:07:24.199 --> 00:07:28.720
doesn't have a program, that won't
be established. Okay, school should have
91
00:07:29.120 --> 00:07:32.519
a return to school policy or you
should help them create one. So if
92
00:07:32.560 --> 00:07:38.720
you're sending Johnny back to school,
you're informing the teacher, Hey, he
93
00:07:38.759 --> 00:07:42.360
needs to be doing this. He
might need to be allowed to wear sunglasses
94
00:07:42.360 --> 00:07:45.680
at school. He might need to
be allowed to sit in front of the
95
00:07:45.759 --> 00:07:48.800
classroom so he doesn't have to strain
his eyes. She might need to take
96
00:07:48.879 --> 00:07:55.240
more breaks or be allowed to be
dismissed her next class a little bit sooner
97
00:07:55.279 --> 00:07:59.240
so she can avoid noisy hauls.
They you might need to set up and
98
00:07:59.279 --> 00:08:03.560
excuse apps as policy. So all
of these things are things that schools need
99
00:08:03.600 --> 00:08:09.759
to consider when they're working with athletes
and groups that are trying to manage these
100
00:08:09.920 --> 00:08:13.959
concussions. Obviously, I think all
of our teachers need to be familiar like
101
00:08:15.040 --> 00:08:18.680
some things that we're looking for for
acussion, the athlete, the parents,
102
00:08:18.720 --> 00:08:22.600
the school nerders, the principle.
The teachers need to that and especially those
103
00:08:22.639 --> 00:08:26.120
I really know that child. Are
they having difficulty paying attention? Are they
104
00:08:26.199 --> 00:08:31.000
having problems remembering things? Are they
needing more time than usual, and are
105
00:08:31.039 --> 00:08:35.320
their grades dropping a little bit?
Do they not seem like they're their normal
106
00:08:35.440 --> 00:08:39.879
self? Are they irritable? Emotional? Are they falling asleep in class?
107
00:08:41.120 --> 00:08:43.519
So these are all things that we
need to educate our schools on and teachers
108
00:08:43.559 --> 00:08:48.480
on and and making sure that they're
paying attention to so that think they can
109
00:08:48.559 --> 00:08:52.320
report back to the physician who might
be managing this individual as well. Obviously,
110
00:08:52.559 --> 00:08:56.960
as as you're probably where concussions can
affect our athletes' ability to learn,
111
00:08:58.559 --> 00:09:03.240
and thus hearing to a well thought
out plan of the return to school is
112
00:09:03.279 --> 00:09:07.879
going to be important, but it's
also going to be unique to each student.
113
00:09:07.240 --> 00:09:11.480
Twilight might be all to go back
on that Monday and do just fine
114
00:09:11.519 --> 00:09:13.919
for a half day, where John
said, hey, a half day is
115
00:09:13.960 --> 00:09:20.480
still too much. In most cases
concussions won't significantly limit, but again there's
116
00:09:20.480 --> 00:09:26.399
always these cases where that concussion is
severe at will. So again read it's
117
00:09:26.440 --> 00:09:31.440
just important to read through those contestant
statements and get a good general understanding of
118
00:09:31.440 --> 00:09:37.320
how these return to school guidelines and
again you might have to alter it to
119
00:09:37.399 --> 00:09:39.480
return to work guidelines, how they
work and things that we need to be
120
00:09:39.519 --> 00:09:46.039
cognizant of and pay attention to.
When are they ready to return to school?
121
00:09:46.120 --> 00:09:48.840
Well, that's going to be your
call essentially, that's end, and
122
00:09:50.159 --> 00:09:54.679
that's their ability to problem solve,
to think, to stay away, to
123
00:09:54.799 --> 00:09:58.039
sleep again. Go back to that
that line graph I drew life. It
124
00:09:58.240 --> 00:10:03.919
just it's it doesn't just pertain to
physical thing. It's a physical cognitive checklist.
125
00:10:05.320 --> 00:10:09.600
As the days progress outward, they
should be able to cognitively start to
126
00:10:09.600 --> 00:10:13.600
do more and more as well.
A lot of times with my cognitive rehabilitation,
127
00:10:13.679 --> 00:10:18.840
I'm printing out third grade multiplication tables
or math charts and having them do
128
00:10:18.919 --> 00:10:22.200
some of those that during the day. If they're pretty symptom free, I'll
129
00:10:22.240 --> 00:10:24.399
have them fly through them through a
couple of sheets in my office to say,
130
00:10:24.440 --> 00:10:28.000
Hey, how do you do what
pose to that made a headache?
131
00:10:28.039 --> 00:10:31.720
To that strain your eyes at all? Paying attention to that, and also
132
00:10:33.399 --> 00:10:37.000
if you're using any type of neurocognitive
test, that's going to tell you a
133
00:10:37.039 --> 00:10:39.600
lot. I have a baseline for
all of my athletes before the start of
134
00:10:39.600 --> 00:10:45.840
every season, and so I will
put them through post injury tests when they
135
00:10:45.840 --> 00:10:50.039
start to be pretty asymptomatic, and
I can see when they line up from
136
00:10:50.080 --> 00:10:54.639
a standpoint of post injury compared to
their baseline, and I want to put
137
00:10:54.639 --> 00:11:00.559
them back to baseline before obviously they're
return to play physically, and before I
138
00:11:00.799 --> 00:11:05.240
remove all limitations from the school.
Can understanding concussion symptoms help identify with the
139
00:11:05.279 --> 00:11:11.600
specific student's individual needs. Absolutely,
if you're dealing with an individual who has
140
00:11:13.320 --> 00:11:16.919
a cervicogenic post concussion syndrome, the
way you're treating and managing them from a
141
00:11:16.960 --> 00:11:22.799
rehabilitative standpoint and a cognitive standpoint is
completely different than if you're dealing with some
142
00:11:24.120 --> 00:11:28.919
a stibular ocular. Okay, have
cervicogenetic patient might not have any problems seeing
143
00:11:28.000 --> 00:11:33.399
the chalkboard. They might not have
any problems with like if their balance,
144
00:11:33.720 --> 00:11:39.399
things like that, and so I
might allow them, Hey, you can
145
00:11:39.440 --> 00:11:41.879
sit in the back of the room. I'm not worried about eye strain with
146
00:11:41.919 --> 00:11:46.559
you. Whereas that vestibular ocular,
they're sensitive to bright lights. And again
147
00:11:46.600 --> 00:11:50.399
I might have tower classes or they
might need to sit closer, or if
148
00:11:50.399 --> 00:11:54.159
they have a computer class, I
might say you're only in class for twenty
149
00:11:54.240 --> 00:11:58.720
minutes with the computer because I want
to avoid that strain. So understanding what
150
00:11:58.799 --> 00:12:05.039
air the brain are affected with concussion
is going to vastly help you continue to
151
00:12:05.120 --> 00:12:16.559
manage this these individual symptoms. If
earning a certification is on your CE plan
152
00:12:16.639 --> 00:12:20.559
this year, then you're in luck. Southeast Professional Education Group just launched four
153
00:12:20.559 --> 00:12:26.639
new certifications on our online learning platform. You can complete your certification in dry
154
00:12:26.679 --> 00:12:33.080
needling, functional nutrition, chiropractic acupuncture, or clinical human performance with immediate access
155
00:12:33.120 --> 00:12:37.919
to get started learning right away.
To learn more and get started, click
156
00:12:37.000 --> 00:12:43.159
the new certifications link in our show
notes or visit online dot Sports Hyphenseminars dot
157
00:12:43.200 --> 00:12:48.799
com today. Oh and one more
thing. If you have no idea what
158
00:12:48.840 --> 00:12:52.799
a CE plan is or why you
should have one, don't stress. We've
159
00:12:52.799 --> 00:12:56.519
got you covered. Simply check out
episodes twenty six and twenty seven where doctor
160
00:12:56.559 --> 00:13:01.039
Tom Teeter explains what the rehab continuum
is and lays out a plan for developing
161
00:13:01.080 --> 00:13:07.000
and expanding a strong clinical skill set
through CE courses. Now back to the
162
00:13:07.039 --> 00:13:16.360
show, but essentially this is a
breakdown of the limitations that I give My
163
00:13:16.799 --> 00:13:18.919
kids wanted to go back to school, and you also got to be cognizant.
164
00:13:20.000 --> 00:13:22.919
Is if they're not an athlete,
but they have a gym class in
165
00:13:22.080 --> 00:13:26.879
Jim, they got to follow the
same return to return to play essentially return
166
00:13:26.919 --> 00:13:31.799
to gym guidelines. But I have
a form that I developed that is a
167
00:13:31.879 --> 00:13:35.919
checklist essentially of how these kids go
back to school. So here this top
168
00:13:37.000 --> 00:13:41.519
example is deals with testing. If
there's some important test, I might have
169
00:13:41.600 --> 00:13:43.679
that conversation without suit and hey,
I don't mind if John takes the test,
170
00:13:43.679 --> 00:13:46.919
but right now he just he needs
to open book or can he take
171
00:13:46.960 --> 00:13:50.440
the test? Broken down in a
couple of days, I give him the
172
00:13:50.440 --> 00:13:54.799
first page this day, the second
page the next day, and so forth
173
00:13:54.120 --> 00:14:00.519
and again broken down right stages.
We want this this is the the first
174
00:14:00.519 --> 00:14:03.039
side here, but we want stage
one of these just daily activities to be
175
00:14:03.080 --> 00:14:07.039
done at home, okay, so
that we know if it's going to be
176
00:14:07.080 --> 00:14:09.559
safe to get them back into school
and start with that five to fifteen increment
177
00:14:11.480 --> 00:14:16.320
five five or fifteen minutes. Stage
two some easy light school activities, all
178
00:14:16.360 --> 00:14:18.960
a little bit on the homework,
all a little bit of reading. There
179
00:14:18.960 --> 00:14:22.120
are cognitive activities outside of a classroom, but they still might be at school
180
00:14:22.120 --> 00:14:26.039
only part time during this stage.
And we're just trying to build out that
181
00:14:26.120 --> 00:14:30.600
tolerance to cognitive work, right we're
trying to as days progress out, we're
182
00:14:30.600 --> 00:14:35.679
trying to move up along that symptom
line again back to school, reintroducing more
183
00:14:35.720 --> 00:14:39.879
school work and just classroom activity,
the noise levels. If they're a band
184
00:14:39.960 --> 00:14:43.679
required, you might have to hold
from that for a week, sometimes ending
185
00:14:43.720 --> 00:14:50.559
on the band set up and still
building up that tolerance level until we can
186
00:14:50.679 --> 00:14:56.120
get them to return into school full
time and back to them all academic activities.
187
00:14:56.519 --> 00:14:58.799
And then ideally they might have to
play some catchup. And so is
188
00:14:58.840 --> 00:15:03.559
it it's safe when and is it
safe for them to do their normal stuff
189
00:15:03.600 --> 00:15:07.519
and play catch up? Those are
all some things to think about and consider
190
00:15:07.720 --> 00:15:13.919
again. I'll be at TCC and
then factor on through selfies sports education has
191
00:15:15.000 --> 00:15:18.159
I believe it was an eight hour
module just if you can correct me,
192
00:15:18.200 --> 00:15:22.879
that I put together and that kind
of deals with that whole entire bubble on
193
00:15:22.200 --> 00:15:28.039
our on the second side of mine
and explains and pulls you the entire concussion
194
00:15:28.159 --> 00:15:33.879
management procedures that I work with them
where it was going to get involved.
195
00:15:33.879 --> 00:15:37.919
But I can open up the floor
to any questions here to know if anyone
196
00:15:37.960 --> 00:15:39.799
has in here. Awesome, Thank
you so much, doctor Olson. And
197
00:15:39.879 --> 00:15:45.799
as he mentioned, we do have
a full eight hour online on demand course
198
00:15:45.960 --> 00:15:48.799
on our course online learning website.
I'll put that in the chat so that
199
00:15:48.879 --> 00:15:52.679
you guys linked to that so you
can check it out if you're interested in
200
00:15:52.759 --> 00:15:56.159
learning more. We'll also follow up
via emails. We'll let you guys know
201
00:15:56.200 --> 00:15:58.200
a little bit more about that.
Again, there's only so much that we
202
00:15:58.279 --> 00:16:03.799
can cover in this one hour format
when it comes to a big topic such
203
00:16:03.840 --> 00:16:08.440
as concussion, and doctor Olsen gives
some really great in depth directives on post
204
00:16:08.440 --> 00:16:14.759
concussion care and of course helping patients
with their recovery from that from a rehab
205
00:16:14.799 --> 00:16:18.799
standpoint in that online course. That
being said, we have had a few
206
00:16:18.879 --> 00:16:22.200
questions that have come in from our
live audience. Very early on, you
207
00:16:22.320 --> 00:16:29.679
were talking a little bit about the
fact that there's been this fourfold increase in
208
00:16:29.759 --> 00:16:33.440
concussion in recent years, especially with
you with athletes, and that as of
209
00:16:33.559 --> 00:16:40.039
today at least, the research hasn't
come to a conclusion about why that is
210
00:16:40.159 --> 00:16:44.320
or why we've seen that increase in
prevalence. But I'm sure as a provider
211
00:16:44.360 --> 00:16:48.360
that works with a lot of patients
that have concussion, you have ideas or
212
00:16:48.440 --> 00:16:52.159
thoughts or maybe correlations that you're seeing. What do you think? And I
213
00:16:52.240 --> 00:16:56.360
know, obviously this is your opinion, not based on research because they haven't
214
00:16:56.360 --> 00:17:00.879
come up with a definitive conclusion yet. But why do you think we've seen
215
00:17:00.960 --> 00:17:07.279
this increase in concussion in recent years? Yeah? I think if i'm I'm
216
00:17:07.279 --> 00:17:10.839
gonna go if we're going to use
four fold, I'm gonna go give a
217
00:17:10.880 --> 00:17:15.559
three to one ratio. So I
talked to a lot of older athletes that
218
00:17:15.920 --> 00:17:18.319
may have played sports back in the
seventies the eighties, my dad being one
219
00:17:18.359 --> 00:17:22.880
of them, and he's just like, man, I probably had several concussions
220
00:17:22.920 --> 00:17:27.000
going through football, but half the
time you're just told to get back in
221
00:17:27.079 --> 00:17:33.000
there. So that being said,
I think we have so much more knowledge
222
00:17:33.039 --> 00:17:37.519
nowotles oodles more and so of that
fourfold, I would say at least three
223
00:17:37.519 --> 00:17:41.799
of it is we are recognizing concussions
faster. Okay, So a lot of
224
00:17:41.799 --> 00:17:45.440
these concussions back in the seventies,
eighties and early nineties probably going miss,
225
00:17:45.559 --> 00:17:51.839
probably not being dealt with at all
or even reported as a concussion. However,
226
00:17:51.920 --> 00:17:55.400
that one fold, I do think
like bigger, faster, stronger,
227
00:17:55.519 --> 00:17:59.559
Right, our athletes are getting bigger, they're faster, the stronger collusions are
228
00:17:59.599 --> 00:18:06.440
harder and probably substantially substantially more compared
to again seventies eighty nineties. But with
229
00:18:06.519 --> 00:18:10.759
that being said, or protective equipments
get better too, okay, and our
230
00:18:10.799 --> 00:18:14.599
practices are better at how we're managing
these. So I mean, personally,
231
00:18:15.039 --> 00:18:19.160
don't think it's that drastic change in
the sport as much it is is our
232
00:18:19.359 --> 00:18:25.359
awareness to recognize and manage these.
But I think there's a little bit of
233
00:18:25.400 --> 00:18:30.279
both, definitely just heavier on the
recognition standpoint. Now, I can absolutely
234
00:18:30.359 --> 00:18:34.880
see that, And I note even
within kind of the general public's knowledge and
235
00:18:34.960 --> 00:18:41.440
understanding of concussion, I think parents
on the whole are probably way more cognizant
236
00:18:41.519 --> 00:18:47.480
of the brain help for their kids
now, since major movies have come out
237
00:18:47.480 --> 00:18:51.720
about it, since the NFL has
had the major news stories that they've had
238
00:18:51.759 --> 00:18:55.920
about CTE and the long term effects
of concussion. So I can certainly see
239
00:18:55.960 --> 00:18:59.599
how a lot of that factors into
public awareness, which in turn, a
240
00:18:59.599 --> 00:19:03.440
lot of times parents might be the
ones kind of looking at that for their
241
00:19:03.559 --> 00:19:06.599
kids a little bit more than their
young athletes who are just trying to get
242
00:19:06.599 --> 00:19:11.160
back in the game. Absolutely now
kind of going along that same line,
243
00:19:11.319 --> 00:19:17.400
you mentioned that a lot of times
you'll have those conversations, especially with parents
244
00:19:17.480 --> 00:19:22.200
when you're dealing with an underage athlete, someone that their parents are typically the
245
00:19:22.240 --> 00:19:26.559
ones bringing them in. Do you
find that most of the time having those
246
00:19:26.559 --> 00:19:30.880
conversations with parents is a really effective
way to make sure that their young athlete
247
00:19:30.960 --> 00:19:37.160
is recovering on an appropriate timeline.
Do you often get a little bit of
248
00:19:37.160 --> 00:19:42.640
pushback from the athletes themselves because they
want things to hurry up and get better
249
00:19:42.680 --> 00:19:48.000
faster. How do you have those
conversations with the athletes so that they understand
250
00:19:48.319 --> 00:19:52.960
that this is a process and that
recovery takes time. Absolutely, And I'm
251
00:19:53.160 --> 00:19:57.559
very blessed and fortunate to be practicing
in such a small, rural, remote
252
00:19:57.599 --> 00:20:04.880
area. I believe that aids to
the betterment of the athletes, simply because
253
00:20:06.079 --> 00:20:10.480
a lot of these athletes, our
parents are my friends now. And over
254
00:20:10.480 --> 00:20:15.319
the twelve years of doing this,
you start to be recognized as the concussion
255
00:20:15.319 --> 00:20:18.000
of rule. And so when I
first started, yeah, I had a
256
00:20:18.039 --> 00:20:22.079
little bit more pushback twelve years ago. Are you sure he's got one?
257
00:20:22.160 --> 00:20:26.440
Or you know what? I And
it also goes to the level of our
258
00:20:26.480 --> 00:20:30.160
team used to be better. Twelve
years ago, we were competing for stayed
259
00:20:30.200 --> 00:20:33.079
a couple. So you have those
athletes and they're not going to miss a
260
00:20:33.079 --> 00:20:38.319
game. But I think again,
in these past ten to twelve years,
261
00:20:38.319 --> 00:20:42.599
the amount of concussion as that's come
out right now, you're almost having athletes
262
00:20:44.119 --> 00:20:47.839
more worried for themselves and you than
you used to, like, Hey,
263
00:20:47.920 --> 00:20:51.039
I had a little headache, or
what do you think should I go back
264
00:20:51.079 --> 00:20:56.200
in? And I think we're finding
more and more athletes with concussion wanting to
265
00:20:56.279 --> 00:21:00.519
play an air inside of caution or
air on the safe side. The more
266
00:21:00.559 --> 00:21:04.000
people I can get involved in again
during a football game, if it happens,
267
00:21:04.039 --> 00:21:07.640
mom and dad come over and I
sit my talk with the parent and
268
00:21:08.319 --> 00:21:11.960
mom and dad about this, what's
going on at the end of the game.
269
00:21:11.039 --> 00:21:15.039
Of the coaches wasn't able to come
home during the game, we discuss
270
00:21:15.119 --> 00:21:18.160
it a lot of the teachers,
I have their number and I can send
271
00:21:18.160 --> 00:21:22.799
them a message, Hey, got
a concussion. Here's what we got to
272
00:21:22.839 --> 00:21:26.039
do. What's your what's your weekly
schedule look like? How can we get
273
00:21:26.240 --> 00:21:30.680
this individual back to school safely?
And so the more the more education,
274
00:21:30.799 --> 00:21:33.400
I mean, the big the biggest
part of percussion management is education, and
275
00:21:33.400 --> 00:21:37.400
if you can tell that athlete what
to expect that's going to come a dong
276
00:21:37.440 --> 00:21:41.200
and need nerves or fears, that's
that helps, especially if mom and dad
277
00:21:41.279 --> 00:21:44.720
knows so that they're not you know, on the athlete and making them more
278
00:21:44.799 --> 00:21:48.039
nervous. The more people you can
get to understand this, the better.
279
00:21:48.240 --> 00:21:52.759
And every year I gave a concussion
management talk towards school at the beginning of
280
00:21:52.799 --> 00:21:55.519
the year, and so the teachers
are on board, the parents are on
281
00:21:55.599 --> 00:21:59.440
board, everyone everyone just has a
good awareness. And I would say,
282
00:21:59.680 --> 00:22:03.799
I don't say a role model for
a program, but I do think it
283
00:22:04.359 --> 00:22:07.440
is a second hold heres. But
I think we have a really good,
284
00:22:07.640 --> 00:22:15.519
good program here and parents fully understand
and the teachers fully understand how to operate
285
00:22:15.599 --> 00:22:18.559
this. It's made it's made my
job easier. No, absolutely, I
286
00:22:18.599 --> 00:22:22.519
can. I can see that,
and I know that along those same lines,
287
00:22:22.559 --> 00:22:29.279
it's really important when you are dealing
with an athlete that has coaches involved,
288
00:22:29.279 --> 00:22:33.079
and athletic trainers involved, and maybe
their medical doctor involved and other other
289
00:22:33.599 --> 00:22:38.960
members of their healthcare team, that
you communicate regularly with them about their care.
290
00:22:40.839 --> 00:22:45.039
What are some kind of tips or
best practices that you utilize in your
291
00:22:45.079 --> 00:22:51.279
office to communicate with those other members
that are overseeing that young athlete as members
292
00:22:51.319 --> 00:22:55.319
of their healthcare team. I was
I'm trying to think of kipt here if
293
00:22:55.880 --> 00:23:00.319
I would have to say, it
was allowing myself to establish KA it's in
294
00:23:00.359 --> 00:23:06.559
the community concussion expert, concussion guru. And that didn't happen overnight. That
295
00:23:06.680 --> 00:23:11.759
happened with years of practice, years
of reading the literature, following the guidelines.
296
00:23:11.799 --> 00:23:15.519
The more you know, the easier
is to talk about something, and
297
00:23:17.119 --> 00:23:21.400
the smarter you are about that sort
if you fully understand all this sitting through
298
00:23:21.440 --> 00:23:25.079
this presentation, you're not going to
really walk away and say, Okay,
299
00:23:25.079 --> 00:23:27.559
I can go manage concussion like It's
not a one hour it's not a one
300
00:23:27.559 --> 00:23:33.680
hour webinar. It's a lot of
research and almost trial and error and getting
301
00:23:33.720 --> 00:23:37.519
those concussion patients. And if your
first concussion patient you have, you might
302
00:23:37.559 --> 00:23:41.200
not want to be the primary guy
that manages that. You might just want
303
00:23:41.240 --> 00:23:44.680
to be a part of the team. But then after that, if you
304
00:23:44.720 --> 00:23:48.920
stick to the internationally accepted guidelines,
and essentially a SODA has adopted the nationally
305
00:23:48.960 --> 00:23:52.240
accepted guidelines, so I can go
right on in my Minnesota state high school
306
00:23:52.319 --> 00:23:59.000
league and print off that same step
wise progression and use those forms. And
307
00:23:59.039 --> 00:24:03.079
if I'm evaluating this, but that
athletes also they chose to see their medical
308
00:24:03.119 --> 00:24:06.920
doctor first and he wants to do
it, and then they come to me
309
00:24:07.519 --> 00:24:11.680
for symptom management. I'll write those
guidelines out and say, hey, here's
310
00:24:11.720 --> 00:24:15.640
what i'm finding. Here's our state
guidelines. He should be on step one
311
00:24:15.759 --> 00:24:19.319
or on step four. Hey,
I see like you didn't hold him from
312
00:24:19.359 --> 00:24:23.640
school. I think he's not quite
ready for that. That and I'm the
313
00:24:23.680 --> 00:24:29.240
one that administers all the nal cognitive
baselines. So most of the time now
314
00:24:29.279 --> 00:24:32.680
it's like if there can cost,
nurse will just say you just got to
315
00:24:32.920 --> 00:24:36.680
you know, follow up with doctor
also, he's going to progress you through
316
00:24:36.680 --> 00:24:40.799
it. But it's I think it's
just it takes time to develop and it's
317
00:24:40.880 --> 00:24:44.920
in the biggest The biggest help is
you if you're going to manage it,
318
00:24:45.119 --> 00:24:48.359
establishing yourself as the expert in it. No, absolutely, And I think
319
00:24:48.400 --> 00:24:52.079
that's that's key again, just kind
of keeping everyone in the loop and them
320
00:24:52.119 --> 00:24:57.319
know that what's going on with the
athlete and how they're doing. As you
321
00:24:57.400 --> 00:25:03.000
mentioned before, I mean there's so
much coming out still in the research.
322
00:25:03.039 --> 00:25:07.559
They're still updating things regularly, which
I think it's nice that the medical community
323
00:25:07.640 --> 00:25:11.599
is now really paying attention to this
and has this as a high priority,
324
00:25:11.680 --> 00:25:15.920
especially when it comes to sports and
athletics, And it seems like we're just
325
00:25:15.000 --> 00:25:21.799
kind of scratching the surface on our
understanding of the brain and long term effects
326
00:25:21.880 --> 00:25:26.160
of concussion. So if you could
kind of speak a little bit to some
327
00:25:26.240 --> 00:25:30.119
of the long term effects of concussion
that you've seen with patients. Obviously,
328
00:25:30.200 --> 00:25:34.599
there's the recovery period where we know
we're going to have specific symptoms, But
329
00:25:36.440 --> 00:25:41.720
have you had any cases where even
years after the fact, or after having
330
00:25:41.799 --> 00:25:48.279
multiple concussions over time, you're seeing
patients that have symptoms that just become chronic
331
00:25:48.519 --> 00:25:52.519
throughout the rest of their life.
Or what are those things that you're seeing
332
00:25:52.559 --> 00:25:56.319
that make you ask that question in
that initial exam with a patient. Have
333
00:25:56.400 --> 00:26:00.799
you ever had a concussion in the
past, have you had one recent years
334
00:26:00.920 --> 00:26:03.799
or multiple, et cetera. Okay, A couple of answers to this question
335
00:26:03.880 --> 00:26:07.319
is, well, I've only been
in practice again for twelve years. In
336
00:26:07.599 --> 00:26:14.559
my twelve years here, I've had
two that have had multiple concussions, and
337
00:26:14.680 --> 00:26:19.880
unfortunately one was multiple concussions within five
minutes. So he fell into the second
338
00:26:19.880 --> 00:26:25.079
impact and the room he essentially was
got knocked over in gym class, hit
339
00:26:25.119 --> 00:26:27.319
his head, and then as he
was walking out of gym class, someone
340
00:26:27.359 --> 00:26:32.640
threw basketball from one before to the
other hit him in the head and then
341
00:26:32.640 --> 00:26:36.200
he fell over the ground in his
head hitting the ground again. He was
342
00:26:36.240 --> 00:26:40.920
top of this class student, He
was I believed sixth grade at the time,
343
00:26:41.480 --> 00:26:47.519
and just really took a turn from
them for the worst and struggled with
344
00:26:47.599 --> 00:26:52.400
school and mother's name and things like
that, and his recovery was a long
345
00:26:52.519 --> 00:26:55.599
time. He had to get pulled
out of school and going to homeschooling,
346
00:26:55.759 --> 00:26:59.480
and with all that just came,
he was a different individual. And so
347
00:26:59.880 --> 00:27:03.480
I think this individual is learning how
to adjust to someone that he wasn't used
348
00:27:03.480 --> 00:27:10.559
to being. And with that middle
school age friends and bullying and picking on
349
00:27:10.599 --> 00:27:15.559
each other, I think came some
social issues. These other two individuals that
350
00:27:15.599 --> 00:27:21.400
I spoke about with that previous concussion
was the biggest thing is like depression.
351
00:27:21.519 --> 00:27:26.480
Right, they can't provide for their
friends and their family or their kids like
352
00:27:26.640 --> 00:27:30.119
they were so used to doing.
Such a light switch change right, It's
353
00:27:30.119 --> 00:27:33.640
like boom, here's your injury and
all, so you can't do this.
354
00:27:33.279 --> 00:27:38.759
And those are the biggest things that
I see with patients that I know very
355
00:27:38.759 --> 00:27:42.400
well before they get to concussion.
And again, small town unfortunately, where
356
00:27:42.799 --> 00:27:47.119
a lot of my athletes. I
know these athletes, and so I have
357
00:27:47.160 --> 00:27:52.079
an easier time managing concussions because I
know this individual's normal, whereas my worst
358
00:27:52.119 --> 00:27:56.519
fears starting to manage your concussion,
I have no clue who this individual is.
359
00:27:56.720 --> 00:27:59.039
It's the first time I see him
was post concussion. I don't know
360
00:27:59.079 --> 00:28:02.920
what they like, how they cock, how they act, and what they're
361
00:28:03.720 --> 00:28:08.160
normal. So that being said,
the concussions I've managed, I'm just getting
362
00:28:08.160 --> 00:28:11.400
to the to the point now,
whereas like some of my early ones would
363
00:28:11.440 --> 00:28:15.720
be yeah, have they fallen into
any long term deficits now From just a
364
00:28:15.920 --> 00:28:19.519
regular provider side of things, like
do I get patients that I come in
365
00:28:19.559 --> 00:28:22.359
and say, yeah, I've had
multiple concussions when I was a kid,
366
00:28:22.400 --> 00:28:27.079
and now I have like after my
third concussion, I've had chronic headaches and
367
00:28:27.160 --> 00:28:33.079
chronic neck pain. Yeah, I
see that with a couple of patiently and
368
00:28:33.200 --> 00:28:36.960
think of quicker to get angered a
little bit more, higher anxiety and never
369
00:28:37.079 --> 00:28:41.440
used to be anxious or agitated.
And I think I think that agitates I
370
00:28:41.480 --> 00:28:45.640
get irritated more. And both of
them will probably say, I don't know
371
00:28:45.680 --> 00:28:51.640
if that's related to pain and or
just brain dysfunction, but I think those
372
00:28:52.000 --> 00:28:53.680
those are kind of the top things
that I can think of that come to
373
00:28:53.759 --> 00:28:57.000
mind. Wonderful. Thank you so
much, and thank you so much for
374
00:28:57.039 --> 00:29:02.640
this presentation today. Again, thank
you so much doctor Olsen for tackling this
375
00:29:02.839 --> 00:29:06.400
very big topic for us today.
You provided a lot of great information that
376
00:29:06.440 --> 00:29:10.920
I think our providers will be able
to take into practice immediately. Thank you
377
00:29:11.000 --> 00:29:14.200
so much. Everyone. We're signing
off for today. Thank you doctor Olson.
378
00:29:14.279 --> 00:29:26.799
Yes, thank you guys for having
me. That's it for today's episode.
379
00:29:26.960 --> 00:29:30.000
Be sure to tune in for episode
seventy nine, where we kick off
380
00:29:30.039 --> 00:29:36.680
a brand new series on harnessing the
science of HRV or heart rate variability for
381
00:29:36.799 --> 00:29:40.519
enhance patient care with doctor David Hopper. You won't want to miss it.
382
00:29:40.680 --> 00:29:44.960
Episode seventy nine drops in two weeks. If you're more of a visual learner
383
00:29:45.039 --> 00:29:48.640
or want to see the full presentation
slide deck from today's training, be sure
384
00:29:48.640 --> 00:29:51.880
to visit the link in our show
notes to watch the full recorded replay of
385
00:29:51.920 --> 00:29:55.640
this webinar. You can also scroll
through our show notes to find a link
386
00:29:55.720 --> 00:30:00.680
to our newly launched Factor Podcast website
Factor podcast dot Com, as well as
387
00:30:00.720 --> 00:30:03.240
links to all of the special offers
from our sponsors. We'll see you next
388
00:30:03.240 --> 00:30:10.960
time. Hey guys, if you
like what you heard today, I encourage
389
00:30:11.000 --> 00:30:15.400
you to visit our website at Factor
hyphenstore dot com. That's spelled fa k
390
00:30:17.000 --> 00:30:22.559
tr hyphenstore dot com to find out
more information about all that we have to
391
00:30:22.640 --> 00:30:26.079
offer. We have a variety of
online offerings as well as our hands on
392
00:30:26.240 --> 00:30:30.440
Factor Rehab System course scheduled in cities
around the globe. Be sure to also
393
00:30:30.519 --> 00:30:34.240
check out our event calendar and bookmark
any of these upcoming live webinar dates coming
394
00:30:34.279 --> 00:30:37.079
up in the near future so you
can join us live. And of course,
395
00:30:37.119 --> 00:30:41.160
the biggest compliment we can receive is
for you to help us spread the
396
00:30:41.200 --> 00:30:44.960
word to your friends, colleagues,
and classmates. You'll find all the important
397
00:30:45.000 --> 00:30:48.000
links, as well as info about
our sponsors in the show notes, so
398
00:30:48.079 --> 00:30:48.200
be sure to check those out.
