Meet world renowned concussion expert Professor John Olver
22 Mar 2019
Concussion awareness is important for teachers and parents, and those supervising sports in schools. Having a concussion protocol can reduce risks for students if they suffer a head knock.
The amount of contact sports in our school sporting curriculum and the national passion for anything that has a ball and an umpire doesn’t need to change, but how we manage a knock to the head should be undertaken with care and based on a medical protocol. With the help of Professor John Olver, we explain how schools can confidently tackle this risk in the playground and on the oval.
The difficulty in understanding the nature of concussion lies in what is often an evolving condition with symptoms that have a delayed onset, he explains. Professor Olver says we have a common misconception that symptoms can be short-lived and require no need for medical follow-up. It’s a mistake to think that a concussion sorts itself out. In 85 per cent of cases it may well self-resolve within two weeks, but for more severe traumatic brain injury (TBI), managing concussion is more complex and needs medical supervision.
With much focus on elite sport and on-field protocols, concussion management awareness is already very good at the professional level, but hasn’t trickled down to schools and local community sports clubs, he explains.
“At the AFL club level, it’s okay, but awareness hasn’t filtered down correctly so there are either good policies or none at all.”
“Children need to be conservatively treated if they are returning to activity. Any off-field assessment needs to be administered by a doctor. There has to be recognition of the need for follow up on medical assessments and understanding about how to return a person to activity. The SCAT 5 is a reasonable field assessment tool. If a child is taken off-field, they should then have a medical examination by a doctor.”
Professor Olver also explains that the latest research shows gender differences in recovery, and that children should be more conservatively returned to sport. Bianca Fedele, Research Assistant – Rehabilitation Epworth HealthCare, says “females fare worse for a range of reasons that include the strength of their neck, their estrogen levels and other factors.”
With increasing female participation in contact sports, there is a tendency for women to experience more symptoms, with females aged 11-20 years taking longer to return to play when compared with aged-matched male athletes.
One research study shows that in the US, most female concussions occur in basketball, among other sports that are played with balls. It seems women also present with more concussive incidents and risks compared with men. After a TBI, women don’t recover as well as men and have more difficulty with sleeping and memory tasks.
Professor Olver says that depending on how severe symptoms are, male or female players should withdraw from the field after the on-field assessment determines that the knock to the head needs further attention. Players should then sit out the rest of the game.
“They should be rested for a short time of one or two days before resuming a graded return to activity. With a TBI that requires acute management, there are unknowns such as the usefulness of imaging. MRI and CT scans have limited benefit.”
“But here’s the thing…men are less likely to report an incident because they feel they may let the team down,” he adds.
In this field of treatment for brain injury, a key difference with Epworth’s Concussion Unit is the strides made in treating symptoms to help earlier resolution and reduce secondary psychological issues associated with brain injury trauma.
“My team includes a physiotherapist and a neuropsychologist. We treat visual problems, balance issues, sleep hygiene, stress management, depression and anxiety. Headache symptoms sometimes require aggressive management. What is very important is the graded return to exercise and giving patients pacing strategies to return to their previous level of physical activity, whether for a child playing footy or for a professional athlete.”
Recent CCI research shows the current state of concussion awareness and treatment in schools is very low.
“I’m not at all surprised,” says Professor Olver.
“What needs to happen is that schools must have a concussion protocol. They need to use the SCAT 5 tool for on-field assessment which will help to determine whether or not a child needs to come off and sit out the game. If that is the case then they should be assessed by a doctor. The school protocol must be that children are given a more conservative return to sports, with a managed and graded return to physical activity.”
About Professor John Olver AM MBBS MD (Melb) FAFRM (RACP)
John Olver is an internationally-renowned expert in Acquired Brain Injury rehabilitation, and was recognised in Australia Day Honours in 2014 for his many decades of service improving rehabilitation for people suffering from Traumatic Brain Injury. He supervises a team at Epworth’s Rehabilitation and Concussion facilities who treat patients and are involved in pioneering research. He advised on the clinical panel of Victoria’s Transport Accident Commission (TAC) for many years, and mentored and trained rehabilitation doctors across Australia over two decades. He is the Victor Smorgon Chair of Rehabilitation Medicine, Victoria’s only chair in rehabilitation medicine – a position that comprises dual relationships with the Epworth Rehabilitation division and Monash University’s Faculty of Medicine, Nursing and Health Sciences. In 2012, Professor Olver chaired the seventh World Congress for NeuroRehabilitation (WCNR) in Melbourne. He was selected to bring the Conference to Australia for the first time, following his presentations and involvement at others in Malaysia and Austria previously. More than 1800 rehabilitation personnel from 53 countries including the USA, Canada, Scandinavia, Europe, Malaysia and Australia, arrived at the Melbourne Conference to hear leading international experts and to discuss the latest clinical advances, patient treatment, and research in neuro-rehabilitation.