NATA Conference Musings.

Holy cow it is amazing how medicine and research is a popularity contest. I went to the National Athletic Trainers Association Meeting recently and did what I love to do. I trolled through the exhibit hall looking for interesting and ridiculous technologies. This year did not disappoint.

I counted something like 25 exhibits with concussion in their banners and advertisements somewhere. I was looking for concussion and mild traumatic brain injury technologies because I work as a technology scout for the Point of care Center for Emerging Neuro Technologies in Cincinnati. Some exhibitor claims were marginally legitimate and some were scare mongering. I tried to go up to every booth that was talking concussion and speak with the vendors to see what they were trying to sell to the athletic trainers and it was often pretty dismal. I’ve written about this conference before (http://www.josephfclark.com/blog/?p=129) so I’m not opposed to telling about how companies tout snake oils to the nation’s athletes. Remember these athletes are often kids on school teams and club sports so I’m talking about children here.

I’ve been doing research into injury of the brain and bleeding in the brain for nearly 20 years and I know there is a lot we do not know. But with a tiny amount of misinformation the people flogging all sorts of things claiming to be the best product for treating concussion. So here I’m going to present my impressions on what I think of a few vendors. I can’t review them all due to space constraints, so I’ll chose a couple of good ones and a couple of bad ones.

Lets start with the bad and ugly. Gladiator Mouth Guards make custom mouth guards. They are good mouth guards for protecting teeth, but the person I spoke with was one the slimiest sales persons I met at the conference. In bold headlines their banner said 1.6 million concussions in the USA. There are 1.5 to 1.7 million traumatic brain injuries in the USA (http://www.cdc.gov/TraumaticBrainInjury). Where does their 1.6 million number come from? After stopping by that booth, I wanted to go back to my room to shower off the slime due to listening to inflated claims of the mouth guards protecting against concussion. First and foremost there are numerous peer reviewed papers that say that mouth guards do NOT prevent concussion (http://www.ncbi.nlm.nih.gov/pubmed/19433427, http://www.chicagotribune.com/health/ct-met-concussion-sidebar-20110625,0,3241267.story.). There are a couple that suggested that mouth guards might lessen concussion, but those have not been substantiated (http://www.ncbi.nlm.nih.gov/pubmed/21228647). Gladiator claims their mouth guards prevent concussion. The sales person tried to snow me with information concerning thickness of the guard, the thickness decreases temporal mandibular joint injury (TMJ) and he kept saying TMJ is concussion. By the way, TMJ is not concussion. Later he redefined concussion as a bruise in the brain – we do not know what a concussion is, so I was amused that a high school graduate trained in molding mouth guards was defining it for me. Next he showed me data that mouth guard thickness dissipates energy. That is true, it dissipates energy to the teeth, not the brain. He rattled off three “published” references to support his claims, which I have since looked up and they do not exist. Gladiator has no data to substantiate their claims and it made me sick. Their mouth guards do not prevent concussion. However, do feel free to use their product to prevent lost teeth, but do not believe them concerning concussion. Before using their product do wash it thoroughly because the whole company seems slimy.

Did you see the balance testing technologies in the exhibits? Those are interesting and may be important, but do you need to be a balance expert to use them? What if you want to do more than balance to assess a concussion? Is it good for pull from play as well as return to play decisions, meaning can you get their little board on the field? They recommend a couple of tests that are scientifically sound that do assess balance and the vestibular system. So you get some solid information from that technology.  If you choose to use their product have someone who knows what the data means and have some standard tests you’re comfortable with. Also, please use more than one test to assess concussion.

All I want to say about ImPACT is if you use it, use something else to compliment it. Players are getting good at gaming the test at baseline and practicing it for their return to play evaluations.

Dynavision. I saw this at the NATA in 2010 and fell in love with it. This year they had a booth and the Gatorade booth had two of their products as a competition. We, in Cincinnati adopted it for our concussion management program and I programmed it to do some tests that I liked. Their off the shelf programs are solid and the platform is flexible enough to be able to assess multiple brain functions. So if you think it just does visual motor, you are wrong. It can assess memory, cognitive function, executive function and even computational competency. I’m not sure if they have a concussion panel of software tests with their devices, but we made a panel to be used with our players in Cincinnati such that they got baseline on the Dynavision and additional testing protocols when a concussion was suspected, so they could not throw the test. Concussion testing for us in the University of Cincinnati takes 5 minutes on the Dynavision. By the way, the University of Cincinnati legal office wants me to remind you that I do not represent the University, and cannot speak for the University, I just work here and have to say that so I can keep my job.

There was an unassuming guy sitting alone at a booth with an iphone app for parents and coaches to do concussion assessment on kids. It was a simple question and answer session on the $4.00 app that can be administered by a lay person with a scoring system that gives recommendations as to what the concussion risk for an athlete is. It was simple by nature but better than having a panicked parent calling me to ask what I think. I’m going to get the app and have a closer look, but they did not over sell it and were not trying to scare people into buying it. While nothing is decided, the Point of Care Center for Emerging Neuro Technologies, a Center funded by the NIH (http://www.ece.uc.edu/POC-CENT/) may evaluate the app and endorse it or help improve it. Every ATC and student trainer should be well beyond needing and using this, but you may want to look at it and recommend to parents or coaches so that if a parent calls you and says; “I have an I phone app concussion score of 27 what should I do?” You’ll know what they are talking about.

There was a booth that advertised, “become a concussion center” on the front of it. As I have mentioned before I’m part of an NIH funded neuro center, so I was interested to see how they were proposing to have organizations become a concussion center. This was a for-profit organization called Concussion Health that would train people on concussion management. Training is well and good, but how does that make a center? I’m not sure where I stand with this organization yet. I scheduled a meeting with one of their people but missed the appointment on Wednesday morning, I was late. When I went to their booth Wednesday morning it was taken down and no one was there. So they were only at the show Monday and Tuesday. But if a-for profit company claims their training will make your organization a recognized concussion center, ask the question, “recognized by whom?” and run a way. If you want to learn concussion management they may have some information to help you but be careful of over inflated claims.

Did you see the booth where a guy was wearing a football helmet and was saying DHA was good for treating concussion? They were touting one study with brain injured rats that DHA was good for the rat brain (http://www.ncbi.nlm.nih.gov/pubmed?term=tbi%20dha%20bailes). The study was done by the same guy who said that creatine supplementation caused heat stroke (http://www.ncbi.nlm.nih.gov/pubmed?term=creatine%20bailes%20heat%20stroke), which was heavily refuted (http://www.ncbi.nlm.nih.gov/pubmed/12532918). I think I’ll leave it at that.

So if like me you left the NATA conference more confused about concussion then when you arrived, I understand. If you left thinking you learned a lot, good for you, but was the information correct? Did you see scientific evidence or did you hear inflated scare mongering claims of science from slimy vendors? Was their science reviewed by peers to validate it and published in reputable journals? There was a lot of junk science packed in colorful marketing schemes with the goal of separating your training room from its money.