Concussion Corner Podcast Episode I Dr. Jeffrey Kutcher Part I

Concussion Corner Podcast: Introduction to Dr. Jeffrey Kutcher

Overview of the Podcast and Guest Introduction

• The podcast, hosted by Dr. Jessica Schwartz, aims to provide trusted resources for healthcare professionals dealing with concussions.

• Dr. Jeffrey Kutcher is introduced as a leading voice in concussion management, serving as the global director of the sports neurology clinic.

• He has extensive experience, including founding the University of Michigan neuro sport program and being team neurologist for various Olympic teams.

Dr. Kutcher's Background and Contributions

• His roles include directing the NBA concussion program and advising major sports leagues like NFL, NHL, and MLS on concussion policies.

• He was instrumental in creating the sports neurology section of the American Academy of Neurology and served as its first chair.

Understanding Concussions: Dr. Kutcher's Journey

Personal Experience with Concussions

• Dr. Kutcher shares his background as an athlete who experienced multiple concussions while playing hockey.

• His medical career began with a focus on brain function and neurological conditions, which shaped his understanding of concussions.

Evolution of Sports Neurology

• Initially starting in stroke care, he recognized a significant need for neurological care within sports medicine during his time at University of Michigan.

• In early 2000s, he noted that concussions were not taken seriously in medical education or practice.

The Need for Interdisciplinary Collaboration

Establishing Sports Neurology as a Field

• Dr. Kutcher emphasizes the importance of merging neurological expertise with sports medicine to address athletes' needs effectively.

• He recalls challenges faced when advocating for recognition of concussion issues within professional organizations like the American Academy of Neurology.

Advocacy and Awareness Efforts

• Despite initial resistance from peers regarding concussion awareness, he continued to push for organized efforts to improve understanding and treatment protocols in this area.

The Evolution of Sports Neurology and Concussion Management

Establishing Sports Neurology (0:00 - 6:00)

• The speaker discusses the initial challenges faced in establishing a sports neurology section within the Academy, noting a lack of interest or support for the first few years.

• A significant shift occurred in fall 2008 when media attention from sources like the New York Times highlighted concussion issues in the NFL, prompting increased focus on sports neurology.

• Collaboration with Chris Giza led to rewriting clinical guidelines on sports concussions, marking a pivotal moment in formalizing standards within the field.

• By 2008, the speaker dedicated their career entirely to sports neurology, emphasizing the importance of interdisciplinary approaches involving neurologists and physical therapists.

• The conversation around neck injuries began internationally in 2012, highlighting an evolving understanding of concussion-related injuries.

Shifting Perspectives on Concussions (6:00 - 12:00)

• The speaker reflects on how early 2000s attitudes towards concussions were dismissive, stressing the need to reintegrate care into healthcare for concussion patients across all stages.

• Recognition is given to Brian Hainesline's contributions as chief medical officer of NCAA and his articulate approach to managing concussion protocols.

• In 2015, formal training for TBI and concussion management was integrated into neurology residency programs, indicating a paradigm shift in medical education regarding brain injuries.

• The speaker emphasizes that while concussions weren't formally part of neurological curricula previously, neurologists have always been experts in related areas such as headache management and cognitive issues.

• Current training exposes new neurologists more comprehensively to concussion management compared to those trained earlier.

Identifying Competent Neurologists (12:00 - End)

• When seeking a neurologist for concussion management, it's crucial to find someone who has recent training and understands current practices surrounding these injuries.

• Engaging with potential neurologists about their perspectives can reveal their depth of knowledge; thoughtful answers indicate serious consideration of complex issues related to concussions.

• Warning signs include simplistic advice regarding multiple concussions; competent professionals should recognize individual complexities rather than offering blanket statements about injury risks.

• Effective communication from healthcare providers is essential; it demonstrates their understanding and respect for patient concerns regarding brain health.

Understanding Concussions: Insights and Misconceptions

The Origin of the "Three" Concussion Rule

• The notion that three concussions can lead to retirement is criticized as a misunderstanding of the injury's complexity.

• The number three resonates culturally, often seen as a significant figure in various contexts (e.g., "three strikes you're out," religious references).

• Research from the early 2000s indicated that former NFL players reporting three or more concussions had a higher risk of depression, marking this number's first investigation.

Time-Based Return to Activity: A Flawed Approach

• Clinicians often prescribe time-based returns to play or activity (e.g., two weeks), which may not reflect current understanding.

• New data challenges previous guidelines, suggesting that recovery timelines are inaccurate and should be reassessed.

• Emphasis on comprehensive evaluations over formulaic symptom checklists is crucial for effective concussion management.

Importance of Comprehensive Evaluation

• Brains do not adhere to strict calendars; recovery varies individually, necessitating ongoing assessments rather than fixed timelines.

• Relying solely on symptom checklists undermines thorough neurological evaluations essential for proper diagnosis and treatment.

Challenges in Concussion Research

• Concerns arise regarding the quality and accuracy of clinical outcomes in large epidemiological studies like the DoD Care Project.

• Variability in physician experience raises questions about diagnostic consistency across studies, impacting research reliability.

Implications for Clinical Practice

• Awareness of biases beyond just physicians is necessary; all professionals involved must have adequate training related to concussions.

• Historical neglect in education about mild traumatic brain injuries (MTBI), including concussions, highlights the need for improved knowledge among healthcare providers.

Understanding the Shift in Concussion Management

Historical Context of Concussion Treatment

• The goal for patients with severe TBI is to initiate movement as soon as they are medically stable, contrasting historical practices where patients were often kept inactive.

• In the early 2000s, there was a lack of discussion around concussions across various medical specialties, indicating a significant gap in awareness and treatment approaches.

Evolution of Awareness and Treatment Approaches

• There has been a notable shift from minimal concern about concussions to widespread advocacy and awareness, particularly between 2000 and 2010.

• Previously, the common advice was to "walk it off," which contributed to misconceptions about concussion severity; this led to an overemphasis on rest until symptoms resolved.

Challenges in Current Practices

• The conservative approach of resting patients until they feel better has become a crutch for healthcare providers concerned about legal implications, often resulting in prolonged inactivity for patients.

• Many patients are advised against any activity until they feel symptom-free, leading to extended periods of feeling unwell due to lack of engagement.

Misunderstandings About Concussion Symptoms

• Historically, if clinicians were unsure how to treat a patient with concussion symptoms, they might suspect malingering or refer them for psychological evaluation instead of addressing the injury directly.

• The invisible nature and heterogeneous presentation of concussions complicate diagnosis and treatment; recent advancements have highlighted the importance of examining various systems involved in recovery.

Recent Developments in Concussion Research

• Over the past five years, there has been an influx of information regarding concussion management that requires clinicians' dedication to stay informed and apply new knowledge effectively.

Role of American Academy of Neurology Sports Concussion Conference

Purpose and Impact of the Conference

• The American Academy of Neurology Sports Concussion Conference aims to unite diverse professionals from different fields (neurologists, neuropsychologists, physical therapists) to discuss current research and best practices in concussion management.

Collaborative Approach

• This conference fosters collaboration among various medical disciplines without serving specific sports or leagues; its focus is on advancing scientific understanding and improving patient care.

Outcomes from Collaboration

• Bringing together experts leads to powerful discussions that enhance critical thinking within the field; this collaborative environment helps propel advancements in concussion management forward significantly.

Understanding the Role of Athletic Trainers in Patient Care

Importance of Therapeutic Alliance

• The rapport built between athletic trainers and athletes is crucial, akin to a therapeutic alliance. This relationship significantly enhances patient care.

• Athletic trainers are highlighted as essential collaborators due to their daily interactions with athletes, providing them unique insights into patient needs.

Expertise in Patient Assessment

• Athletic trainers possess training in triaging patients during events, making them invaluable for immediate assessments and interventions.

Book Discussion: "Back in the Game"

Purpose and Audience

• The book aims to educate a broader audience about concussions, addressing common misconceptions while blending neurology with accessible language.

Content Development

• Conversations from clinical practice inspired the book's content, focusing on educating parents and patients about concussion risks and realities.

Clinical Approach to Concussions

Education Focus

• Clinic visits can last up to three hours, emphasizing thorough education on concussions rather than quick consultations for better long-term outcomes.

Co-authorship Insights

• Dr. Jeffrey Kutcher collaborated with journalist Joanne Gerstner, who shadowed him to gather real-world insights for the book.

Accessibility of Information

• The book "Back in the Game" is designed for a global audience, ensuring that anyone can access high-quality information regardless of location.

Future Discussions and Contact Information

Upcoming Topics

• Future episodes will delve deeper into topics like traveling positions for sports events and clinical pearls related to concussion management.

How to Reach Out

• Listeners can connect via the Sports Neurology Clinic website or through social media platforms like Twitter (@jeffcutchermd).

Concussion Corner: Social Media Engagement

Importance of Following on Social Media

• The speaker emphasizes the importance of not using the content as personal medical advice, highlighting a need for professional consultation regarding health issues.

• Viewers are encouraged to engage with Concussion Corner across various social media platforms including Facebook, Instagram, Twitter, and YouTube.

• The mention of multiple platforms suggests a strategy to reach a wider audience and provide accessible information about concussions.

• The call to action aims to foster community interaction and support among individuals interested in concussion awareness and education.

• The segment concludes with background music, indicating a transition or wrap-up of the discussion.