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By: Kevin Halford - Toronto FC

Assessment and Management of Sport Related Concussions: A Change in Perspective

      Earlier this season our club’s medical staff had the privilege of taking a course focusing on the advanced techniques in assessment and management of Sport Related Concussions (SRC). Shinya Nakamoto, our course instructor hailing from Japan, holds a masters in Sports Medicine from the University of Tsukuba and is currently in the process of completing his doctorate in sports medicine, focusing on Sports Related Concussion research. He was able to provide 3 in-depth workshops based on his years of experience and practice within Japan’s High Performance Centre. This course was well attended in our club by not only our first team medical staff but also staff members from our club’s 2nd team and academy.  


      This course was able to build on much of our previous knowledge in the area of SRC’s and provide a different perspective and outlook when it comes to the assessment process and management of SRC’s. This course focused on moderate to severe head injuries that may take additional recovery time as well as alternative rehabilitative techniques compared to many mild traumatic brain injuries. With a neuropsychological approach to assessment, a thorough evaluation of all cognitive elements including subjective symptomology, concentration, coordination/balance, visual tracking and speed of processing is necessary to provide a complete picture of the patient’s neurological dysfunction resulting from SRC’s. In particular, the Vestibular Ocular-Motor Screening (VOMS) was a focus in this course for the rehabilitative progress of moderate to severe SRC’s. A graduated return to play process was discussed with these assessment elements in mind through a research-based case study of a national level rugby athlete from Japan. Although the RTP process used was not too dissimilar to our protocol here in the MLS, a focus was again placed on monitoring and rehabilitating the vestibular and ocular-motor systems to enhance and accelerate the RTP timeline and efficacy.  


      As Sport Related Concussions and research regarding such become much more prevalent and readily available to us, its increasingly more important to investigate, understand and utilize alternative approaches to the assessment, management and rehabilitation of SRC’s moving forward. Our club medical staff is forever invested in the continuing research and education that comes with an evolving high performance environment the MLS is promoting. The value we’ve seen from this course has already been returned since its completion and we look forward to growing ours, as well as the league’s, knowledge and awareness on this topic. As we all hope our athletes remain head injury-free, we all know that is never going to be the case which makes this topic so interesting to remain on the forefront of the research and rehabilitative techniques as they evolve.  


      Personally, as an Assistant Athletic Therapist here with our first team at Toronto FC, an ever-growing base of knowledge and experience in this field has always been important to me. As I bridge the gap between my experience as an academy therapist within the club to now being in the middle of my 4th season with the first team, its easy to understand why the realm of head injuries is still a hot topic to discuss. Seeing how the MLS and MLSPA have evolved in this area over my time in the league and the direction it is heading in is very encouraging to see and look forward to where it is going. As always, player health and safety is of the utmost importance, especially when dealing with head injuries and the aforementioned course we’ve participated in as a club will certainly help to not only keep the high standards of practice but also prepare our younger academy therapists for what may lie ahead in their pursuit of professional employment amongst the league.  


All the best to the rest of PSATS, Athletic Therapists/Trainers, and club staff on the remainder of this season, 

Kevin Halford CAT(C), ATC  

Assistant Athletic Therapist 

Toronto FC First Team