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Handbook of Neurological Sports Medicine

Handbook of Neurological Sports Medicine


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    Handbook of Neurological Sports Medicine: Concussion and Other Nervous System Injuries in the Athlete presents techniques for diagnosis and treatment of head-related injuries to enable medical professionals to provide the best care possible. Authored by a respected team of neurosurgeons, including highly regarded concussion researcher Julian Bailes, this evidence-based reference offers expert guidelines for managing these serious injuries.

    A strong focus is placed on concussion due to the risk involved with this common injury. The text outlines how to recognize, assess, and treat concussions, preparing practitioners to calmly respond to athletes who are exhibiting signs of this dangerous condition. It also reviews the biomechanics and pathophysiology at the core of concussions to better understand their clinical presentations.

    Critical return-to-play guidelines and participation recommendations for patients with preexisting neurological conditions or structural lesions arm medical professionals with the principles needed for making appropriate decisions for athletes’ safety. The text explains the roles of pharmacological management, natural treatment approaches, rehabilitation strategies, and education. In addition, chapters provide coverage of postconcussion syndrome, subconcussion, and second-impact syndrome.

    Handbook of Neurological Sports Medicine also takes a look at other traumatic injuries, including injuries to the cervical, thoracic, and lumbar spine, and the soft tissue and fascia within the spinal unit. It provides an overview of peripheral nervous system injuries to ensure medical professionals understand those serious and potentially career-ending issues, reviews facets of optimal response with suspected or proven spinal injury, and discusses the evaluation and management of athletes with non-concussion-related headaches and heat illness or heatstroke. The text includes additional features to address issues surrounding critical injuries:
    • Guidance on developing an action plan for athletic events prepares first responders for emergency situations.
    • A review of cases of interest provides examples of situations that can—and do—occur.
    • Medicolegal considerations educate practitioners about negligence, standard of care, and proximate cause.
    • More than 150 photos and illustrations offer visual support to further explain the injuries.
    The evaluation and management of sport-related neurological injuries have matured at an unprecedented rate. Handbook of Neurological Sports Medicine is a critical resource for all who encounter and treat neurological injuries, providing the foundation for the clinical decisions that all athletic medical practitioners must make to give their patients the best treatment possible.

    Continuing education credits and units may also be earned based on the subject matter in this book. Explore online CE course options in Human Kinetics’ Continuing Education store.


    Reference for professionals who may encounter neurological injuries in their athletes or patients, including athletic trainers, physical therapists, emergency medical technicians, and physicians, as well as students studying in these fields.

    Table of Contents

    Part 1: General Concepts
    Chapter 1. Athletes and Neurological Injuries: A View From 10,000 Feet
    A Stroll Through History
    The Present
    Spectrum of Neurological Injury in Sports
    Concluding Thoughts
    Chapter 2. Medicolegal Considerations in Neurological Sports Medicine
    With Increased Awareness Comes Increased Scrutiny
    The King of Concussions
    Duty and Breach
    Violation of a Statutory Duty
    Standard of Care Defined by Experts
    Standard of Care Established Through Literature, Rules, Protocols and Textbooks
    Good Samaritan Laws
    Proximate Cause
    Assumption of the Risk
    Theories of Negligence
    Cases of Interest
    NFL and NCAA Concussion Litigation Concluding Thoughts
    Chapter 3. Having a Game Plan
    Developing an Emergency Action Plan
    Caring for Athletic Injuries Responsibilities of Host and Visiting Medical Staff
    Concluding Thoughts
    Part 2: Sport-Related Head Injuries
    Chapter 4. Biomechanics, Pathophysiology, and Classification of Concussion
    Biomechanics and Basic Concepts
    Lessons Learned From Football
    Lessons Learned From Other Sports
    Pathophysiology of Concussion
    Classification of Concussion and Grading Systems
    Concluding Thoughts
    Chapter 5. In the Trenches: Acute Evaluation and Management of Concussion
    Acute Evaluation
    Concluding Thoughts
    Chapter 6. Neuroimaging and Neurophysiological Studies in the Head-Injured Athlete
    Standard Neuroimaging
    Advanced Structural Techniques
    Advanced Functional Techniques
    Neurophysiological Techniques
    Concluding Thoughts
    Chapter 7. Neuropsychological Assessment in Concussion
    Use of Symptom Checklists
    Value of Neuropsychological Assessment of Concussion
    Issues With Computerized Assessments
    Other Considerations
    Other Issues Addressed by Neuropsychologists in the Assessment of Concussed Patients
    Concluding Thoughts
    Chapter 8. Role of Balance Testing and Other Adjunct Measures in Concussion
    Balance Assessment in Concussion
    Emerging Technology and Future Directions for Adjunct Measures of Assessment in
    Concluding Thoughts
    Chapter 9. Postconcussion Syndrome
    What’s in a Definition
    Scope of the Problem
    A Neuroanatomical Substrate for Prolonged Symptoms
    Psychogenesis of PCS and PPCS
    A Modern Conceptual Framework for PCS and PPCS
    Concluding Thoughts
    Chapter 10. Neuropathology of Chronic Traumatic Encephalopathy
    Definition of Chronic Traumatic Encephalopathy
    Posttraumatic Encephalopathy Versus Chronic Traumatic Encephalopathy
    Gross Morphology and Histomorphology of Chronic Traumatic Encephalopathy
    Concluding Thoughts
    Chapter 11. The Emerging Role of Subconcussion
    A Working Definition
    Laboratory Evidence of Subconcussive Effects
    Clinical Evidence of Subconcussion
    Concluding Thoughts
    Chapter 12. Severe Head Injury and Second Impact Syndrome
    Cerebral Contusions and Intraparenchymal Hemorrhage
    Traumatic Subarachnoid Hemorrhage
    Subdural Hematoma
    Skull Fractures
    Epidural Hematoma
    Diffuse Axonal Injury
    Arterial Dissection and Stroke
    Other Posttraumatic Sequelae
    Second Impact Syndrome
    Concluding Thoughts
    Chapter 13. Neurological Considerations in Return to Sport Participation
    History of Return to Play
    Symptom Complex and Identification
    Return to Play and Brain Abnormalities
    Addressing and Resolving Return to Play Issues
    Concluding Thoughts
    Chapter 14. The Role of Pharmacological Therapy and Rehabilitation in Concussion
    The Decision to Treat Pharmacologically
    Somatic Symptoms
    Sleep Disturbance Symptoms
    Emotional Symptoms
    Cognitive Symptoms
    The Role of Rehabilitation in Concussion Management
    Concluding Thoughts
    Chapter 15. The Research Behind Natural Neuroprotective Approaches to Concussion
    Eicosapentaenoic Acid and Docosahexaenoic Acid
    Green Tea
    Vitamins E and C
    Vitamin D
    Scutellaria baicalensis
    Examples of Other Neuroprotective Nutraceuticals
    Another Natural Approach: Hyperbaric Oxygen Therapy
    Concluding Thoughts
    Concluding Thoughts
    Part 3: Sport-Related Injuries of the Spine and Peripheral Nervous System
    Chapter 16. Cervical, Thoracic, and Lumbar Spine Injuries: Types, Causal Mechanisms, and Clinical Features
    Background and Epidemiology
    Normal Anatomy
    Types of Tissue Injuries and Neurologic Syndromes
    Common Cervical Injuries and Conditions
    Common Thoracic Injuries
    Common Lumbar Injuries
    Concluding Thoughts
    Chapter 17. Management of Spine Injuries, Including Rehabilitation, Surgical Considerations, and Return to Play
    On-the-Field Assessment
    Radiological Assessment
    Treatment and Rehabilitation
    Surgical Considerations
    Cervical Spine Injuries and Their Management and Treatment
    Cervical Spine Injury: Return to Play
    Thoracic and Lumbar Spine Injuries and Their Management
    Concluding Thoughts
    Chapter 18. Peripheral Nerve Injuries in Athletes
    Clinical Evaluation
    Additional Testing
    Management Rationale
    Surgical Options: Primary Nerve Surgery
    Surgical Options: Secondary Surgery (Soft Tissue or Bony Reconstruction)
    Postoperative Management and Return to Play
    Legal Implications
    Concluding Thoughts
    Part 4: Other Sport-Related Neurological Issues
    Chapter 19. Headaches in Athletics
    Clinical Approach and Assessment
    Commonly Recognized Headache Syndromes Coincidental to Sporting Activity
    Prolonged Sporting Activity as a Trigger for Commonly Recognized Headache Syndromes
    Primary Exertional Headache
    Headaches Attributed to Head or Neck Trauma
    Headaches Attributed to Sport-Specific Mechanisms
    Concluding Thoughts
    Chapter 20. Heat Illness in Sports
    Contributory Factors in Heat Illness
    The Spectrum of Heat Illness and Management
    Return to Play
    Concluding Thoughts
    Appendix A: American Spinal Injury Association (ASIA) Standard Neurological Classification of Spinal Cord Injury
    Appendix B: Concussion Symptom Checklist
    Appendix C: Sport Concussion Assessment Tool (SCAT3)
    Appendix D: Concussion in Sports Palm Card

    About the Authors

    About the Author

    Anthony L. Petraglia, MD, graduated from the University of Chicago in 2002 with a BA in neuroscience and earned his medical degree from the University of Rochester School of Medicine and Dentistry in 2007. He completed his residency in neurological surgery at the University of Rochester Medical Center in 2014. Petraglia was the first neurosurgery resident to complete a neurological sports medicine fellowship, and is currently an attending neurosurgeon at Unity Health System in Rochester, New York, where he is also the director of the concussion program.

    Petraglia has presented nationally and internationally on neurological sports medicine, has published numerous manuscripts and book chapters on various aspects of neurological surgery, and performs editorial duties for several medical journals. His membership in professional organizations includes the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS), and he has served as an assistant to the Sports Medicine Section of the AANS/CNS. He has worked as a physician with several collegiate and high school football teams, as a neurosurgical consultant for the Webster Youth Sports Council, and as a medical director for cyclocross racing.

    Julian E. Bailes, Jr., MD, earned a BS from from Louisiana State University in 1978, and his MD from Louisiana State University School of Medicine in New Orleans in 1982. He completed a general surgery internship at Northwestern Memorial Hospital in 1983 and a neurological surgery residency at Northwestern University in Chicago in 1987, as well as a fellowship in cerebrovascular surgery at the Barrow Neurological Institute in Phoenix.

    Bailes was director of cerebrovascular surgery at Allegheny General Hospital in Pittsburgh from 1988 until 1997 and later at Celebration Health Hospital in Orlando, where he also was the director of emergency medical services at both the city and county levels. In 2000, Bailes assumed the position of professor and chair in the department of neurosurgery at West Virginia University School of Medicine in Morgantown. He most recently assumed the position of chair of the department of neurosurgery at NorthShore University Health System in Chicago and is co-director of the Neurological Institute.

    Bailes is a past chair of the Sports Medicine Section for the American Association of Neurological Surgeons. He has more than 100 publications concerning various aspects of neurological surgery, including three books on neurological sports medicine, and performs editorial duties for numerous medical journals. He is an internationally recognized expert on neurological athletic injuries and has been a team physician at either the National Football League (NFL) or collegiate level for more than 20 years. Since 1992, he has been the neurological consultant to the NFL Players’ Association (NFLPA), which has sponsored his research on the effects of head injuries on professional athletes. He is the director of the NFLPA’s Second Opinion Network. He is the medical director of the Center for Study of Retired Athletes, which is affiliated with the NFLPA and the University of North Carolina, and is the medical director of Pop Warner Football, the nation’s largest youth football association.

    Arthur L. Day, MD, graduated from Louisiana State University Medical School in 1972.

    He completed his surgical internship iin Birmingham, Alabama, and subsequently completed his residency in neurological surgery and fellowship in brain tumor immunology at the University of Florida College of Medicine in Gainesville, Florida.

    Day practiced at the University of Florida for 25 years, ultimately rising to the positions of professor, co-chair, and program director of the department of neurological surgery at the University of Florida. In 2002, he moved to Boston to assume a position as a professor of surgery at Harvard Medical School with a clinical practice at Brigham and Women’s Hospital. While there, he served as the associate chair and residency program director of the department of neurological surgery at Brigham and Women’s and Children’s Hospital in Boston. Subsequently, he was the chair of the department and also the director of the Cerebrovascular Center and the Neurologic Sports Injury Center at Brigham and Women’s Hospital. He co-founded and directed an annual meeting at Fenway Park addressing the latest knowledge and treatments of athletic-related neurological injuries. He currently is professor, vice chair, residency program director, and director of clinical education in the department of neurosurgery at the University of Texas Medical School at Houston.

    Day has held leadership positions in many medical professional societies and has received numerous awards and honors. He has published almost 170 journal articles and book chapters and has co-edited a book about neurological sports injuries. He is an internationally recognized expert in neurological sports medicine. For the past 30 years, he has served as a consulting physician for multiple NCAA and National Football League (NFL) teams.


    “…[T]he authors make detailed and potentially difficult study material easy to read and understand throughout.”

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