As we get ready for football season, Dr. Anthony Alessi brings on a fellow expert in sports neurology, Dr. Stephanie Aless-LaRosa, program director of our sports neurology fellowship. They discuss not only concussions (which is more than just a football issue) but also other conditions they see in the sports context, how more folks seem be active for longer, the perspective of a team physician on the sideline, ways to possibly reduce injury risk, and other specialties involved in sports neurology.
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Transcript
Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you up-to-date and timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery, and a grant from Coverys. It is not designed to direct your personal healthcare, which should only be done by your physician.
I’m your host, Dr. Anthony Alessi, and it’s great to have today as my guest, Dr. Stephanie Alessi-LaRosa, who some of you may know is also my daughter, of whom I’m very proud of her accomplishments as assistant professor of neurology here at UConn Health, and also team consultant for UConn Sports. Steph, welcome to the show.
Dr. Alessi-LaRosa: Thanks for having me.
Dr. Alessi: Let’s talk a little bit. You’re a sports neurologist. Can you explain to our listeners your training and what a sports neurologist does?
Dr. Alessi-LaRosa: Absolutely. So I am a board-certified neurologist, and I completed a residency in neurology here at UConn, and I did a fellowship, an additional training year, in sports neurology at the Kutcher Clinic for Sports Neurology in Michigan, and now I’m a practicing sports neurologist here in Connecticut.
Dr. Alessi: What are some of the conditions that you run across? I think right away when people think sports neurologist, they think concussion, but it’s obviously a lot more. So can you talk about some of the conditions people come to you with?
Dr. Alessi-LaRosa: Yes. Concussion is certainly the number one thing, I think, again, like you said, most people think of, but we treat most commonly headaches or migraines. Those are the number one thing we treat outside of that. But really anything neurologic that occurs in active people is really our patient population. That could be patients who have dizziness or neurologic symptoms that we will then determine what’s the source of it, how to get them back playing and participating in their life the way that they want.
Dr. Alessi: What do you find are some of the typical sports the laypeople — We know you see a lot of football players and high-level athletes, but — during the course of your day when you say active people, what are people doing now? Because it seems like people who are older and older are becoming more active in sports. What are some of the sports you see people participating in now that you may not have seen previously?
Dr. Alessi-LaRosa: I think there’s all levels of participation. I do think that overall the population, especially in the aging population, has recognized that activity is very important for longevity of their life. So I do think that I see older folks even doing hockey leagues, and so there’s just quite a spectrum. Some folks do yoga and more gentle sort of exercises, but really being active does seem to be carrying people through their life in a healthy way.
Dr. Alessi: Well, we’re coming up on football season, so let’s talk a little bit about football itself. Obviously, the thing we fear most and people fear most are injuries to the brain and spine, as a result of a high-velocity collision sport like football. When we’re on the sideline working, can you share with our listeners a little bit about what we’re doing on the sideline, and what is our job, our role standing on the sideline?
Dr. Alessi-LaRosa: Yes. Really, we have to be paying attention to every play, because if we miss the hit, that’s really our first examination, how players are getting up from each play. So our observation is extremely important, especially because a lot of the players want to continue to play and act like nothing happened, and they may have even lost consciousness and not be aware of what happened. So if we don’t see it, then that does put us at a disadvantage, and we really want to keep the athletes as safe as possible, so our awareness is key. But also, we’re available to evaluate anybody for potential concussions, or other even peripheral nerve injuries, or, like you mentioned, spinal cord injuries, anything that may have occurred during the play.
And sometimes we use the tent that’s on the sideline at UConn or even taking athletes into the locker room and assessing them to try and limit the distractions.
Dr. Alessi: Since we’re chatting about the sideline, when I started out in this field, we didn’t have a lot of video. But now, how important is having video available instantaneously on the sideline for you to make a decision?
Dr. Alessi-LaRosa: I find it’s extremely helpful. I think that’s one of the benefits of having a spotter that they put high up, someone else who can actually watch just the plays and look at all the monitors that are happening above, and then getting us that information on the sideline, because our view is not great, to be honest, where we’re standing.
So it makes it hard in a lot of ways, but at the same time, we need to be there. So it’s difficult, but I find that the videos help a lot because you can see different angles, you could slow it down, you can see what happened after the hit, how long it took the person to get up, what initial post-impact signs there were.
Dr. Alessi: Well, now we have the tent, which we’ve had in the last few years, where we bring a player in and do an assessment. Can you share with the audience what we’re doing in the tent to help make a decision?
Dr. Alessi-LaRosa: Well, certainly we take the, especially in football, we take the athlete’s helmet off. Someone has to hold the helmet so that they don’t try to run back out on the field too quickly.
Dr. Alessi: Good, good point.
Dr. Alessi-LaRosa: Yes, that’s number one. But really we’re asking a couple of questions, really just doing our assessment. Neurologically, we would be asking some questions about what happened, what they recall, what quarter we’re in, who they played last week, things like that. And then going into our assessment, checking their eyes, checking their coordination, checking their eye movements, balance, some things like that, to get to a decision that everyone’s comfortable with. And there’s very few people usually in the tent, because it is a small space. So it’s usually just the necessary folks there.
Dr. Alessi: A lot of people are curious about baseline testing. Baseline testing has become kind of a buzzword, with, I think it was back in the early 2000s, maybe even the 1990s, when impact became available, and they started doing impact testing, which is still done today. And then there’s sway testing and, C3 Logic. How important do you find baseline testing in your work?
Dr. Alessi-LaRosa: I think it’s, it has a role. In some ways, it’s very important to understand what somebody looked like before if you have that information available. But in the most recent consensus statement that came out, it really does not emphasize too much of that.
You can actually use normative data of what we would expect in people that age. So you don’t have to have baseline testing, but I do find that clinical over computerized baseline testing is the most beneficial because you can really put any findings into a clinical context, whereas with a computer, it’s leaving that part out.
So impact or sway or some of these other computerized testing, they do have their limitations, but really the clinical evaluation and baseline testing from like a SCAT type of evaluation, which an athletic trainer typically can do preseason, is usually higher quality there.
Dr. Alessi: Now, your research has actually looked at doing clinical examinations as baselines in athletes before they would have an injury, meaning an actual clinical examination. Can you tell us a little bit about, um, how... what you found by, by looking at that in high school athletes?
Dr. Alessi-LaRosa: Sure. We have a small study being done, and over time of a high school career, so over the four years of a high school career, we haven’t found any significant changes in the athlete’s neurologic examination, their eye movements. We do a depression screening before each season starts with their first contact practice, and we have not seen dramatic changes. So over the course of a high school career, I think that’s important information, that there is maybe more benefits than risks at that level.
Dr. Alessi: So it sounds like the brain is a fairly resilient organ if you treat it right.
Dr. Alessi-LaRosa: Absolutely. Yes.
Dr. Alessi: Let’s move on to injury prevention. Everybody wants to know, how do I prevent a concussion? And people are always coming up with new designs for helmets. Do I buy a more expensive helmet? Is that the best helmet? But there are other ways, so can you talk a little bit about some of the other ways that we’re able to prevent concussions from happening in young athletes?
Dr. Alessi-LaRosa: Yes, I think there’s a few that certainly the helmets and mouth guards, those get a lot of the focus. People think that wearing something better would be helpful. But what we’re finding actually clinically is having a stronger neck, the neck musculature, having stronger muscles there, more balanced out musculature can actually prevent the biomechanical force that’s imparted to the brain, and that would be preventive.
So that’s something we talk a lot about as well. But really exposures to hits, so reducing the exposures is a way of preventing concussion, meaning less contact practices for football, as an example, and just reducing the potential for further hits. Those are some of the other ways that we focus on. And certainly in the youth level, where their neck musculature just really is not developed yet, heading the ball in soccer is something that we really don’t like to see in young, young kids because of this issue.
Dr. Alessi: One of the things you and I have talked about is the importance now of integrating other people into sports neurology and treating patients neurologically, like physical therapy, like kinesiology, from that standpoint. And I bring this up because UConn is fairly unique here at UConn Health, we have all of the necessary elements. If you were to design the single best program for addressing the neurologic needs of athletes, what would be the elements, the integration in a program like that?
Dr. Alessi-LaRosa: I mean, there’s certainly a lot of disciplines, so a multidisciplinary sort of program would be, like you mentioned, physical therapy, athletic training, neurologists, sports neurologists obviously. Neurosurgeons can be part of that team at times. I even often use sports cardiologists. That can be helpful. But neuropsychologists, psychologists, they’re an important piece of the team as well. So I think those are just to name a few. There are some centers in our country that have these components, maybe not all of them, but you can really tailor it to your population in a way which I think is really the goal.
Dr. Alessi: Steph, in closing, what are the things that parents need to know now that their children are going to be going out there to play, whether it be at the Pop Warner level or high school level? First of all, what should parents know before letting their children play a high-velocity collision sport, whether it be football, soccer or something of that nature?
Dr. Alessi-LaRosa: Yeah, in the under-14 age group, in terms of football, tackling is dangerous, but I think there’s some ways that if your child really expresses that they’ve got to do this and play tackle football, that the safest way to go about that and the best way for parents to help, with that process is to meet with the coach, get to know them, make sure they have some concussion training as is required in the state of Connecticut of coaches. But to really understand their philosophy. Are they big on hitting in practice? Are they big on maybe they hit, they use sleds or some other objects to hit rather than each other in practices. And having an athletic trainer available is really key in the safety of all sports, I feel, and especially at this level, but unfortunately at the youth level, there really are not many athletic trainers that are part of that picture, and so having some medical training in the coaches and especially the parents and the kids themselves, some understanding of concussion signs, symptoms, recognition is very important for best outcomes and the safest participation.
Dr. Alessi: One of the things we like to chat about here at the Healthy Rounds Podcast are unique programs and unique things that we can develop here at UConn Health. Steph, certainly a program in sports neurology complementing, all the sports specialists in the Department of Orthopedic Surgery has been one of those.
Thank you for your time today, and thank you for all that you do for patients in our community.
Dr. Alessi-LaRosa: Thanks for having me.
Dr. Alessi: Your mom and I are very proud.
Dr. Alessi-LaRosa: Thank you.
Dr. Alessi: If you have any questions or ideas for future programs, you can reach out to me at healthyrounds@uchc.edu. Jennifer Walker is executive producer for the Healthy Rounds Podcast. Chris DeFrancesco is our studio producer.
Until next time, this is Dr. Anthony Alessi. Please stay healthy.
