Head Injuries And Concussion
When Dr Craig Roberts does his rounds, he watches 15 potential patients hurl barrages of their own body weight at one another for eighty minutes.
Since 2008 he’s been the team doctor to the Springboks, tasked with repairing the battered bodies of the country’s top athletes and sending them back to their national duties, each time a little more battle-hardened and educated in the school of hard knocks.
Besides being an expert in reviving, strapping, nose-straightening, hydrating, icing and taping, Dr Roberts’s pitchside manner includes being a firm negotiator. And it was this particular skill that was tested in the second Test of the 2009 British and Irish Lions Tour when he had to convince a dazed, 120kg Danie Rossouw that it was time to leave the field in front of his home crowd after he had just come on as a substitute.
A minute earlier, Rossouw and Brian O’Driscoll had both rushed at each other, in an attempt to get their hands on a ball that Fourie du Preez had popped up from the back of a ruck. Neither succeeded. Instead, the right shoulder of the determined Irishman slammed into Rossouw’s skull and the Newtonian laws that were entrusted with holding an upright Danie Rossouw firmly on Loftus Versfeld soil were temporarily deranged.
“He tried to stand up to carry on playing and was dizzy and fell over again,” says Dr Roberts. “It was a pure concussion.”
This was where the doc’s mediation skills came in. “The challenge for me was to get him off because he was adamant that he was going to stay on the field,” Roberts says. “Danie’s quite a big guy so it took a lot of persuasion to get him off the field, but it was non-negotiable – he had to come off.”
The brain cased inside the hardy shell that is Danie Rossouw’s skull, believe it or not, is just like yours – it weighs about 1.3kg and has a similar consistency to that of tofu. That’s right, beneath the tough exterior of Tuilagis and Tysons of this world is a dollop of vegetarian snack that floats freely and snugly inside their skulls. The familiar grey folds are connected by networks of white matter – nerve cells with long, spindly tendrils called axons that relay signals from cell to cell in milliseconds. The connections among axons account for every function of your brain, including memory, concentration, movement, emotion and even maintaining consciousness – as long as a jarring hit doesn’t deprive you of it.
How South Africa is treating concussion
Dr Craig Roberts speaks highly of South Africa’s initiative in dealing with the hard knocks in sport. “There’s a group of sports physicians who’ve said, “We’ve got the science, lets use it not only for professional team and use the science across the board and make sport safer.” “We’ve adopted and help develop international protocol quite stringently, particularly in rugby,” says Dr Jon Patricios. “We’ve implemented them across the board at all levels; it’s not just a professional thing, we’ve really focused on implementing these at an amateur level. We have delivered several research papers and will be presenting our protocols at the International Conference on Sports Concussion in Zurich in November.”
“The education process is very important,” says Patricios. “Now in SA Rugby we have a programme called BokSmart which is our injury prevention programme. BokSmart targets referees and coaches because they’re closest to the players. They will be at the practice or the match where the player gets injured and we educate them on what to look for in a potentially head-injured player and how to react to that. Individuals will react if they are aware of concussion or if they’re surrounded by people who are aware of concussion and its potential dangers.”
Dr Jon Patricios is the brain behind the SARU-endorsed Sports Concussion Programme, which is used across the levels of rugby from school to Springboks, as well as in other sports like horse riding, soccer and cycling.
All participants are tested at the beginning of a season. “We obtain a computerised baseline measure of their brain function, so we know how their reaction times and their information-processing ought to be in an uninjured state. We save that data so if they get injured we re-run these tests and we compare them to the baseline,” says Patricios. This allows medical professionals to “see” what is usually an invisible wound. “In South Africa we’ve found that the most suitable computerised protocol is the Australian-developed CogState Sport, used by the All Blacks, Wallabies and England.”
Return to play
“We are one of the leaders in terms of setting up a program for whether it’s safe to return to play,” says Dr Roberts. “We have very specific protocols for returning to play with concussion, that’s one of the areas that is very well documented.”
“We come up with an assessment of the patient’s brain status and we guide them back, according to the criteria which must be that their symptoms must have cleared, their neurological examination must be normal and the tests must be equivalent to the baseline or if we don’t have a baseline, to age-appropriate norms,” he says. “We then put them through a non-contact or semi contact return-to-play progamme and we get them back to sport,” says Patricios.
For emergency concussion assistance, call Spineline at 0800 678678
*Read the full six-page feature in our March issue, on sale now.
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