Mark Plummer and Stephen Kara attend to Piers Morgan during a Blues match. Kara has a programme to address concussion in amateur sport. Photo / photosport.nz
Mark Plummer and Stephen Kara attend to Piers Morgan during a Blues match. Kara has a programme to address concussion in amateur sport. Photo / photosport.nz
It may not be the silver bullet but Blues doctor Stephen Kara is taking a fresh approach to tackling concussion.
Kara, in partnership with Dr Mark Fulcher, has set up Axis Sports Concussion - a free Auckland clinic based alongside the University Rugby Club.
The pair have been granted fullACC funding for a one-year pilot scheme that studies the potential of active recovery to assist in removing concussion symptoms.
Using a model based on findings from Canadian researcher Kathryn Schneider, the basis of the approach is that, in some cases, exercise can produce better results than rest.
In more serious cases, exercise is used in combination with addressing neck related issues and retraining balance organs.
Kara first became interested in this concept when he applied the method to James Parsons, the Blues hooker who played two tests for the All Blacks.
Parsons arrived at the Blues this year after taking a blow to the head while playing for North Harbour. He spent five months on the sideline before being cleared to play - and the active recovery approach eventually helped him regain full fitness.
"He was the first one we took through the whole system," Kara said.
With his extensive experience in the professional field, Kara linked up with Fulcher and identified community sport may benefit from a similar approach.
"The brain is the same no matter where you are playing, so therefore the standard of care and protocols should be similar."
The clinic, operational three days a week since March, has taken a multi-pronged approach. Education has been delivered to clubs, referees, schools, parents and coaches about the simple 'remove and refer' policy which prevents further immediate injury.
While macho attitudes are rapidly improving, amateur sport is still far more at risk of someone playing on after a head knock than the professional arena, where accountability is prevalent.
Blues doctor Stephen Kara.
Kara's clinic has proved popular. It has seen 235 patients across rugby, league, football, water polo, lacrosse, boxing, skateboarding and netball. Half have been under the age of 19; many would not be able to afford the assessment and treatment otherwise.
"ACC's involvement is important to removing the cost barrier. Some of the kids I see battle financially."
To attend the clinic, patients must suffer a sports related concussion, and it must have occurred in the previous two weeks.
Once initially assessed, patients are seen again after 10 to 14 days. Eighty per cent are better in that time-frame and put on programmes to safely return to sport.
The remaining 20 per cent go through the active recovery. This involves running on a treadmill to see how hard they can exercise before symptoms get worse.
A heart-rate reading of 80 per cent is taken and patients then work out on an exercycle, which minimises jarring and decision-making needed when running.
Actively using the brain, whether at work or school, is also encouraged.
"We've moved away from rest. That is for the first 24-48 hours and then we want them to do exercise. We talk to them about relative mental rest, which means activating but not overusing the brain. These are the people that get better quicker."
Kara believes muscles and tendons respond to graduated loading, so the brain might be similar in terms of the repair process.
Of the 235 patients seen since March, 145 have been discharged. Of those, 115 were simple concussion cases which cleared in the initial 10-14 day period, and 30 were complex cases, with each taking an average of 34 days to get better.
Some still remain in the programme. Those who do not improve are referred to ABI Rehabilitation, a centre which works with major brain trauma.
Once embedded fully, research will be passed on to ACC and potentially rolled out elsewhere. Kara also hopes to take those in the active group and try nutritional experiments to see if that may also help recovery.
