June 2021 - 28

Another Factor in Diagnosis
By Nick Friar, contributing writer
For all the advancements made with the management
of athletes' injuries, concussions still remain a
complicated matter for everyone involved. Identifying
the long-term side effects has impacted the way everyone
approaches them, but there's still a lot of room for
growth. Even when it comes to concussion protocols at a
university or the high school level, there's variance.
" I can't speak for every institution because everybody's
going to have a different concussion protocol, " St. Mark's
School of Texas in Dallas athletic trainer Natalie Bumpas
said. " But we're going through the cognitive steps. We
have a checklist that we use on the sidelines that we
have - not only cognitive questions, but depending on
how the injury happened, we are also looking at them for
an obvious deformity or injury. Nose bleeds or swelling
where they got hit. "
But there are instances where it's not as easy to
identify when a player has suffered a concussion on the
field. Then there are players who want to play through
injuries - and sometimes coaches who are only focused
on the task at hand: winning. Developments like the
ImPACT testing have made a difference when trying to
identify an athlete who is concussed.
However, the higher up you go, you'll start to find
athletes who claim they purposely perform poorly on the
initial baseline ImPACT test so they can score better if
they're ever required to undergo a test later on.
That's where the findings from the University of
Birmingham come into play. Along with her colleague at
the London Institute, Dr. Valentine Di Pietro conducted a
test from 2017 to 2019, during which they obtained saliva
samples from a group of elite-level male rugby players
with the intent being " to investigate the role of salivary
small non-coding RNAs (sncRNAs) in the diagnosis of
sport-related concussion. "
According to the conclusion from the study Di Pietro
et al produced for the British Journal of Sports Medicine,
the test " identified unique signatures of concussion in the
saliva of male athletes diagnosed with a concussion. "
At first glance, it seems like the complicated, yet delicate
process of identifying a concussion has been simplified
immensely. While the findings might be helpful, some
athletic trainers don't think that would instantly put an end
to all other levels of their concussion protocols.
" It's an interesting concept, but I wouldn't weigh that
as the sole component of diagnosing somebody with a
concussion, " Keaton Mangi, assistant athletic trainer to
both Sacred Heart University's baseball and field hockey
varsity programs, said. " It could help, for sure. But
concussions are a multivariable thing. There's certainly far
more than just one indicator of a concussion. If anything, I
think it could be a factor (in the testing process). "
Furthermore, athletic trainers aren't necessarily looking
to diagnose a concussion. They're trying to identify the
symptoms that indicate an athlete suffered a concussion,
but the diagnosis is carried out by another party.
" We're going through these cognitive and sideline
checklists, but it's the doctors who are diagnosing the
concussions, " Bumpas, formerly an athletic trainer at
Northwestern University, said. " It's not necessarily a
simple fix because it's lab work. So, it's going to take
longer and probably be more expensive.
" Also, in this study, they only tested 150 people. That's
a pretty small sample size of all athletes, and they only
tested for males. Is it different for females? Because,
obviously, chemical makeup between the sexes can differ. "
But for all the apprehension expressed by Bumpas and
Mangi, they'd both happily welcome a more efficient way
to navigate the complex injuries that are concussions.
" We would love any way to make this easier and more
efficient for both the patient and, in my case, the parents,
as well as the academic staff with kids being out of taking
tests (for a class), " Bumpas said. " I'm sure any athletic
trainer would love an easier way to diagnose concussions.
" And I totally understand the development of something
to make this simpler and streamlined, but that obviously
takes money, too. Would that really be accessible to most
people? There's a lot that goes into. More needs to be
done as far as research goes, but I don't think any of us
are jumping to conclusions with one study. "
28 JUNE 2021

June 2021

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