Equestrian Medical Safety Association

Concussion & Return To Play

Head Injury and Prevention

Concussion and Head Injury

Horse JumpEMSA’s editors and writers, in addition to our experts, continue to provide support, articles, videos and blogs on the latest in concussion assessment and management and the dangers of traumatic brain injury and its sequellae. Our goal is to try and minimize both the risk of serious head injury and to minimize the long-term sequellae that head injury can pose to the athlete. The Equestrian Medical Safety Association aims to provide objective and practical concussion information to parents, coaches and trainers that reflects the most recent consensus of experts and the advances in research and technology in a direct, concise, and practical format that has always been our format.

There is a huge body of information concerning mild traumatic brain injury (MTBI-concussion) including its definition, assessment and treatment. Some useful websites include:

Children’s Hospital of Alabama has solid recommendations in its Concussion Discharge Instructions with signs, symptoms, Dos and Don’s for those diagnosed with a concussion and are allowed to go home. There are recommendations for how to return to daily activities.

To help ensure the health and safety of horse people, the EMSA has developed the Wake up to Concussion, Concussion Palm Card, and Return to Play Criteria to offer information about concussion to coaches, parents and athletes involved in youth sports.

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A presentation on concussion by Dr. Mark Lovell from ImPact Applications, Inc, to the Jockey Club gives an overview of concussion, the forces that are involved and associated brain function impairment. There are suggestions fof concussion management and return to play using the ImPACT screening program.

Other established programs such as Standardized Assessment of Concussion and the King Devick Test a provide alternative models for baseline testing that can increase accuracy of the return to play decisions. CogSport an Australian cognitive test has proven effective.

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CDC Free Online Concussion Course

The Center for Disease Control and Prevention has developed a free online Concussion course for schools and team sports. The basics are the same for those in horse sports. There are several accompanying information fact sheets and educational materials for parents, athletes, coaches and leaders. The course takes just over half an hour to complete. A certificate of completion is available for those who take the course and quiz.

HEADS UP Concussion in Youth Sports is a free, online course available to coaches, parents, and others helping to keep athletes safe from concussion. It features interviews with leading experts, dynamic graphics and interactive exercises, and compelling storytelling to help you recognize a concussion and know how to respond if you think that your athlete might have a concussion.

The CDC says: This course will help you:

  • Understand a concussion and the potential consequences of this injury,
  • Recognize concussion signs and symptoms and how to respond,
  • Learn about steps for returning to activity (play and school) after a concussion, and
  • Focus on prevention and preparedness to help keep athletes safe season-to-season.

We can help athletes stay active and healthy by knowing the facts about concussion and when it is safe for athletes to return to play. Concussion Training Saves Lives

Support materials for coaches, parents and athletes are available from the CDC and pdf downloads are in the EMSA Resource Library.

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Helmets and Concussion

Rider SafetyThe EMSA strongly recommends the wearing of a properly fitted ASTM/SEI certified equestrian helmet with the harness secured during equestrian activities. Head injuries account for approximately 60% of deaths resulting from equestrian accidents. Properly fitted ASTM/SEI certified helmets can prevent death and reduce the severity of head injuries sustained while riding.

There are many other available models on the market. For a current list of helmets certified by the Safety Equipment Institute, Inc. to ASTM standard F1163, please go to www.seinet.org and click on “Certified Products”, then click on Equestrian Helmets. The SEI list changes very frequently, constantly adding new products and manufacturers. These are the helmets required by many equestrian rule-making bodies and organizations.

Certain sports use different standards, and we have included some of those as well, for the sports of Polo and Bull Riding. Standardbred Racing requires helmets made to the Snell Standard, and a list of their certified models can be found at www.smf.org. Helmets, like shoes or saddles fit differently. Proper fit is essential for effectiveness. This video has good tips for helmet fit and longevity.

A few words to the wise: ASTM/SEI helmets contain their date of manufacture and the SEI seal. Since most manufacturers recommend replacement after five years or so, or whenever the helmet takes a hard blow. When buying a new helmet it makes sense to check that date, especially if buying online or from an auction site, since some helmets sold there may be remaindered stock several years old.

Some manufacturers offer replacement helmets for those which have been impacted at a reduced price. That information should be contained in the box with the helmet in a “User’s Manual” or on a tag attached to the helmet. To take advantage of this policy you will need your original bill of sale, so it is wise to keep it in a safe place. And the truly wise will read and keep the fitting instructions and the Manual for future reference.

There are a myriad of riding helmets available with prices from very modest to extravagant, and all of them surpass the requirements of the standard. It has become much easier to find properly fitting models for all the disciplines, including through catalog and internet sales. One manufacturer of ASTM certified helmets has a fact sheet about them. Another has information about choosing the right helmet.

Past issues of the EMSA newsletter contain many articles on riding helmets. The index on the newsletter page can be sorted by subject or author to guide you to more information.

For specific questions and concerns, please contact Dru Malavase, the Co-Chairman of the ASTM Equestrian Headgear Task Group.

This last link to a course taught by a military physician in the Identification and Treatment of concussion TBI in soldiers. This is an excellent resource for learning about concussion for parents, coaches and instructors. While some translation from military injuries is required, the injured brain unifies all who seek to prevent, identify and recover from concussions/TBI.

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New Concussion Sideline Tests

An additional sideline diagnostic  concussion tool is available that can be administered by parents or coaches. The King-Devick Test is well researched. It was developed by optimists Alan King, O.D. and Steven Devick, O. D. and was developed in association with the Mayo Clinic.

The King–Devick Test, a remove-from-play concussion screening tool, is a two-minute test that requires an athlete to read single digit numbers displayed on test cards, a computer, or an iPad and can be administered by coaches, athletic trainers, medical professionals and parents. Athletes must establish an individual preseason or pregame baseline. A baseline is the cumulative amount of time it takes to read the three test cards aloud. For baseline testing, the entire test should be administered twice. The fastest cumulative time of the two attempts with no errors is considered to be the baseline. Immediately or soon after a suspected head trauma, the athlete is given the King–Devick Test once and if the time to complete the test is any worse (longer) than the athlete’s baseline test time and/or if there are errors, the athlete should be removed-from-play and should be evaluated by a licensed professional.

It is a cheaper alternative to other concussion related programs that require medical qualifications. This tool may be of interest to riding programs and scholastic programs that are already using sideline concussion evaluation in field sports. It may be a good tool for competitions, show and group activities which require medial coverage. More information is available at the King-Devick Test website.