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REGIONAL RULES:SPORT SCIENCE INSTITUTE OVERVIEW
Brian Hainline, MDNCAA Chief Medical OfficerClinical Professor of NeurologyIndiana University School of MedicineNew York University School of Medicine
MISSIONTo promote and develop safety, excellence, and wellness in college student-athletes, and to foster life-long physical and mental development.
VISIONTo be the pre-eminent sport science voice for all student-athletes and NCAA member institutions, and to be the steward of best practices for youth and intercollegiate sports.
Cardiac Health
Concussion
Doping and Substance Abuse
Mental Health
Nutrition, Sleep and Performance
Overuse Injuries and Periodization
Sexual Assault and Interpersonal Violence
Athletics Healthcare Administration
Data-Driven Decisions
STRATEGIC PRIORITIES
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CONCUSSION
We do not understand the natural history of concussion.
We do not understand neurobiological recovery in concussion.
Solution:
NCAA-DoD Grand Alliance.
CARE Consortium.
Mind Matters Educational Grand Challenge.
Inter-Association Guidelines and Legislation
CONCUSSION
>80% of military TBIs are concussions.
85% of military concussions are biomechanically similar to sport-related concussion.
15% are from blast injuries.
College s-a and military service are similar in age, athleticism, risk taking and pushing to the edge of excellence.
The military theatre is poorly controlled; college sports are a much more controlled environment.
Numerous meetings, evaluations, culminating in NCAA-DoD MOU and CRADA and White House announcement.
NCAA AND DoD JOINT ENDEAVOR
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CSC & ARC ASSESSMENT PROTOCOL
Pre-Season
Acute Concussion Sub-Acute ConcussionPost-
Concussion
Baseline<6hrs
Post-Injury24-48hrs
Post-Injury
Asymptomatic / Cleared for
Return to Play Progression
Unrestricted Return to Play 7 days
following Return to
Play
6 Months Post-Injury
Neurocognitive and Behavioral Testing (CSC)
X X X X X X X
Blood Biomarker & DNA Collection X X X X X X
Multi-modal MRI Studies O X X X X
Head Impact Measurement: HITS (FB) and non-helmeted sensors (FB, SCR, LAX, IH)
• Data extracted in April, 2016.
• N= 18,370 evaluations – 17,490 unique subjects
– 2,643 in their 2nd year
– 2014‐2015: 3,818 baseline evaluations
– 2015‐2016: 13,569 baseline evaluations
• N= 939 concussions– 1/3 female
DATA SUMMARY
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NCAA-DoD MIND MATTERS GRAND CHALLENGE
Executive CommitteeRauch (DoD), Hack & Hainline (NCAA), Koroshetz (NIH)
Education and Research Challenge
Consortium(Operating Committee)
NCAA: Dawn Buth, Amy Dunham, Dana ThomasDoD: Tara Cozzarelli, Stephanie Maxfield-Panker, Kathleen Quinkert
CDC: Kelly Sarmiento
Education Challenge Research Challenge
Administrative Coordinating Center:Indiana U School of Public HealthNir Menachemi, Ross Silverman
MomsTEAMInstitute(de Lench)
University of Arizona(Valerdi)
U. of South Alabama(Marass)
Creative Street Media (Katzenberger)
Johnson C. Smith U.(Williams)
UNC Greensboro
(Wyrick)
U. Wis-Madison(Warmath)
UNC Chapel Hill
(Mihalik)
Colorado State U.
(Coatsworth)
U. of Georgia(Schmidt)
Northern Arizona U.
(Craig)
U.S. Air Force
(D’Lauro)
Arizona State U.(Corman)
Chestnut Hill College(Ernst)
Goal: To change important concussion safety behaviors and the culture of concussion reporting and management by funding research to better understand behavior change strategies and by identifying novel educational approaches.
Aim 1 (Immediate Impact Challenge)
Develop a multi-media educational program based on the best evidence currently available about how to change culture in young and emerging adults.
Aim 2 (Long-term Impact Challenge)
Identify key factors and ways to affect change in the culture and behavior of young and emerging adults and their influencers around concussion.
MIND MATTERS CHALLENGE
www.ncaa.org/concussionsafety
Independent medical care
Year-round practice contact
Concussion diagnosis & management
INTER-ASSOCIATION GUIDELINES
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ENDORSEMENTS
American Academy of Neurology
American College of Sports Medicine
American Association of Neurological Surgeons
American Medical Society for Sports Medicine
American Orthopaedic Society for Sports Medicine
American Osteopathic Academy for Sports Medicine
College Athletic Trainers’ Society
Congress of Neurological Surgeons
National Athletic Trainers’ Association
NCAA Concussion Task Force
Sports Neuropsychological Society
American Football Coaches Association
Football Championship Subdivision Executive Committee
National Association of Collegiate Directors of Athletics
National Football Foundation
Year-round football practice contact.
Concussion diagnosis and management.
Independent medical care.
Primary athletics health care providers.
Director of medical services.
Catastrophic injury.
Second Safety in College Football Summit(February 2016)
Inseason and bowl:
3 days of practice are non-contact.
1 day of live contact/tackling.
1 day of live contact/thud.
Preseason:
3 days of practice are non-contact.
3 days of live contact.
Non-contact follows scrimmage.
One day of no football practice.
2/day not allowed. 2nd session can include walk-throughs.
Spring: day following live scrimmage is non-contact.
CARA: 2 hours can include coaches and football skills without equipment
Year-Round Football Practice Contact: Draft Recommendations
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An active member institution shall establish an administrative structure that provides independent medical care and affirms the unchallengeable autonomous authority of primary athletics health care providers (team physicians and athletic trainers) to determine medical management and return to play decisions related to student-athletes.
An active institution shall designate a director of medical services to oversee the institution’s athletic health care administration and delivery.
This position may become a key for addressing the administration and medical care delivery gaps at member institutions.
Point person for evolving inter-association documents, checklists and health & safety legislation.
Independent Medical Care
MENTAL HEALTH
MENTAL HEALTH OCCURS ON A CONTINUUM
Mental HealthResilience and thriving
Mental health disorders
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Mental Health is not apart from, but rather a part of athlete health.
To promote health is to enhance performance.
It is important to understand sport specific issues related to athlete health and safety, and engage a wide range of experts.
THE NCAA BELIEVES THAT…
Culture of “toughness” can limit help seeking
Perception that “looking fit” or performing well means that the athlete is healthy
Pressure to perform
High Visibility
Practice/travel = missed class = academic stress
Injury
Time demands (and compromised sleep)
Other concerns . .
ATHLETE-SPECIFIC CONCERNS
Clinicians, researchers, advocates, educators, athletics administrators, coaches and student-athletes.
Comprehensive assessment of stressors and mental health disorders in college student-athletes.
Goal: To develop best practices and to recommend research that support member institutions in meeting their membership obligations to provide a healthy and safe environment for student-athletes.
NCAA MENTAL HEALTH TASK FORCE NOVEMBER 2013
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Coach
Athlete Development
Sports Medicine
Sports Nutrition
Strength & Conditioning
Counseling & Sport Psychology
Athlete
SUMMARY OF FINDINGS
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Ensure that mental health care is provided by licensed practitioners qualified to provide mental health services.
Clarify and disseminate referral protocol.
Consider mental health screening in PPEs.
Create and maintain a health-promoting environment that supports mental well-being and resilience.
GUIDELINE SUMMARY
Care should be provided by*:
Clinical or counseling psychologists.
Psychiatrists.
Licensed clinical social workers.
Psychiatric mental health nurses.
Licensed mental health counselors.
Primary care physicians with core competencies to treat mental health disorders.
*Include registered dietician in multidisciplinary team for eating disorders.
Individual providing care should have cultural competency that addresses both societal diversity and the culture of sports.
GUIDELINE #1
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GUIDE #1
“It is important to note that issues that may initially and appropriately be viewed as related to performance may upon further engagement reveal underlying mental health concerns.”
Coach
Athlete Development
Sports Medicine
Sports Nutrition
Strength & Conditioning
Counseling & Sport Psychology
Athlete
Licensed Clinical Psychology
Performance Enhancement Consulting
Additional considerations:
Financial support for dedicated service.
Physical location.
Autonomous authority, consistent with his or her professional licensure, to determine mental health management for student-athletes.
Care should be subject to relevant laws governing patient confidentiality, including possible exemption from mandated reporting.
GUIDELINE #1
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Ensure that athletic departments have clarified their procedures for referring athletes with potential mental health concerns to appropriate personnel.
GUIDELINE #2
Emergency action management plan:
Should address emergency mental health-related situations including:
• Managing suicidal and/or homicidal ideation.
• Managing victims of sexual assault.
• Managing highly agitated or threatening behavior, acute psychosis or paranoia.
• Managing acute delirium/confusional state.
• Managing acute intoxication or drug overdose.
GUIDELINE #2
Routine mental health referrals
Provide written institutional procedures regarding appropriate referral of student-athletes to all stakeholders within the athletics department.
Identify a point person responsible for facilitating such referrals (e.g., AT, team physician).
GUIDELINE #2
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Consider implementing mental health screening as part of annual pre-participation exams.
Determine screening approach in consultation with licensed mental health professional providing mental health care to student-athletes.
Establish procedure specifying when and to whom symptomatic or at-risk student-athletes identified through this screening process will be referred.
Screening tools are not validated as stand-alone assessments for mental health disorders.
GUIDELINE #3
Create a health promoting environment that supports mental well-being and resilience.
Student-athletes, FARs and coaches should be educated about the importance of mental health, including how to manage mental health concerns.
GUIDELINE #4
Coaches play a central role and should be:
educated on signs and symptoms of mental health disorders;
trained in empathic response;
encouraged to create a positive team culture;
advised of department referral protocols.
GUIDELINE #4
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Medication Management Plan
Ensure that student-athletes with medication are being appropriately monitored.
Require student-athletes to list all medications and supplements they are taking.
Maintain on file documentation from personal physicians to demonstrate appropriate diagnostic evaluation and treatment protocols for medication use.
ADDITIONAL CONSIDERATIONS
Financial Support
Clarify institutional policies related to athletic financial awards and team engagement for student‐athletes who are unable to continue sport participation, either temporarily or permanently, due to mental health considerations.
Clarify institutional policies for financial support of student‐athletes in need of extended outpatient treatment or inpatient care.
ADDITIONAL CONSIDERATIONS
Transitional Care
Establish a clear transition of care plan for athletes who are leaving the college sport environment.
Identify
• Who is responsible for initiating transition of care?
• Who is responsible for providing athletes with information about community mental health resources?
• Who is responsible for ensuring athletes have adequate medication, as necessary, until continuing care is established?
Establish a transition plan for returning student‐athletes who have been away from campus seeking care for mental health issues.
ADDITIONAL CONSIDERATIONS
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Mental health is not apart from, but rather, a part of athlete health.
Athletic environments can support help seeking and facilitate early identification, appropriate referral and care.
Establishing protocols for care means more equitable care across sports and within institutions.
Implementation of Best Practice is an important step towards ensuring a model of care for student‐athlete mental health.
IN SUMMARY
www.ncaa.org/violenceprevention
ADDRESSING CAMPUS SEXUAL ASSAULT AND INTERPERSONAL VIOLENCE
CARDIAC HEALTH
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CARDIAC TASK FORCE
PEER-REVIEWED PUBLICATION
Introduction.
Cardiovascular Risk in Student-Athletes.
The Pre-Participation Evaluation.
Evidence Evaluating the Efficacy of Pre-Participation Screening for Detection of Cardiovascular Risk.
ECG as a Screening Tool for SCD Risk Prediction.
Regional Referral Centers for Evaluation of Athletes Suspected or known to have a Cardiovascular Problem.
Recognition of and Response to Cardiac Arrest.
Cardiac Research Initiatives.
Checklist.
CONSENSUS OUTLINE
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OVERUSE & EARLY SPECIALIZATION
SOCCER SUMMIT
www.ncaa.org/soccerhealth
WRESTLING SUMMIT
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USOC, NGBs, NCAA and invited scientists.
Early Specialization.
Overuse Injuries.
Illnesses.
Periodization.
Concussion Risk.
Rules Implications.
Wellness for Life.
SPORT-SPECIFIC SUMMITS
DOPING & RECREATIONAL DRUG USE
Doping is cheating.
Recreational drug use is different.
Inconsistency is problematic.
Need: Effective deterrence model.
Need: Conference consistency.
Need: Effective intervention.
DOPING AND RECREATIONAL DRUG USE
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DATA ANALYTICS & INFORMATICS
Evidence-based decisions.
No centralized data collection or analysis.
Solution: Datalys.
Solution: Trust.
Target: PPE.
DATA ANALYTICS
THANK YOU
Contact info: Brian Hainline
@ncaa_ssi
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