Farrell, Kyle J

Abstract The brain vital signs framework is a portable, objective, neurophysiological evaluation of brain function at point-of-care. We investigated brain vital signs at pre- and post-season for age 14 or under (Bantam) and age 16–20 (Junior-A) male ice hockey players to (i) further investigate previously published brain vital sign results showing subconcussive cognitive deficits and (ii) validate these findings through comparison with head-impact data obtained from instrumented accelerometers. With a longitudinal study design, 23 male ice hockey players in Bantam (n = 13; age 13.63 ± 0.62) and Tier II Junior-A (n = 10; age 18.62 ± 0.86) divisions were assessed at pre- and post-season. None were diagnosed with a concussion during the season. Cognitive evoked potential measures of Auditory sensation (N100), Basic attention (P300) and Cognitive processing (N400) were analysed as changes in peak amplitudes and latencies (six standard scores total). A regression analysis examined the relationship between brain vital signs and the number of head impacts received during the study season. Significant pre/post differences in brain vital signs were detected for both groups. Bantam and Junior-A players also differed in number of head impacts (Bantam: 32.92 ± 17.68; Junior-A: 195.00 ± 61.08; P < 0.001). Importantly, the regression model demonstrated a significant linear relationship between changes in brain vital signs and total head impacts received (R = 0.799, P = 0.007), with clear differences between the Bantam and Junior-A groups. In the absence of a clinically diagnosed concussion, the brain vital sign changes appear to have demonstrated the compounding effects of repetitive subconcussive impacts. The findings underscored the importance of an objective physiological measure of brain function along the spectrum of concussive impacts.

Fair Play (FP) is a behavioral modification program originally created in Quebec, Canada, by Edmund Vaz when injuries, violence, aggressive infractions, and expense drastically decreased ice hockey registration numbers. He found that emphasizing sportsmanship had the potential to reduce dangerous plays. FP awards teams one additional point in the district standings after each game if the following criteria are met: (a) the team remained below the predetermined penalty minute threshold, (b) a coach was not assessed a game misconduct, and (c) none of the spectators were ejected from the arena. In collaboration with the Mayo Clinic, Minnesota Hockey adopted FP successfully in 2004. However, it was only applied to district games, accounting for just 36% of the games in a team's season. FP is currently a loosely recommended model in tournaments and plays no role in nondistrict games. In a study of two youth hockey tournaments, the tournament governed by intensified FP found significantly fewer head hits than the tournament without FP. Junior gold-level tournaments also experienced fewer injuries and concussions when using FP. Despite its established effectiveness, FP is underutilized by Minnesota Hockey. The Mayo Clinic Ice Hockey Research Team (MCIHRT) has therefore determined that FP requires a complete relaunch. The Minnesota Hockey board members, district leaders, and MCIHRT have agreed that increasing visibility and establishing universal application by Minnesota Hockey leadership are the most urgent needs. The MCIHRT action plan addressing shortcomings includes: (a) making a FP announcement before and after games; (b) publishing shortened, universal booklets solely regarding FP; (c) coordinating a distribution of new booklets to coaches, officials, and players/parents; and (d) creating webpages on all district and association sites including the rules of FP and access to the FP standings. Finally, creative ways to increase FP's power to favorably modify behavior will be solicited.

The Ice Hockey Summit III provided updated scientific evidence on concussions in hockey to inform these five objectives: 1) describe sport-related concussion (SRC) epidemiology, 2) classify prevention strategies, 3) define objective, diagnostic tests, 4) identify treatment, and 5) integrate science and clinical care into prioritized action plans and policy. Our action plan evolved from 40 scientific presentations. The 155 attendees (physicians, athletic trainers, physical therapists, nurses, neuropsychologists, scientists, engineers, coaches, and officials) voted to prioritize these action items in the final Summit session. 1) Establish a national and international hockey data base for SRC at all levels, 2) eliminate body checking in Bantam youth hockey games, 3) expand a behavior modification program (Fair Play) to all youth hockey levels, 4) enforce game ejection penalties for fighting in Junior A and professional hockey leagues, 5) establish objective tests to diagnose concussion at point of care (POC), and 6) mandate baseline testing to improve concussion diagnosis for all age groups. Expedient implementation of the Summit III prioritized action items is necessary to reduce the risk, severity, and consequences of concussion in the sport of ice hockey.

Abstract Removing fighting from ice hockey is an essential concussion prevention strategy that will improve the safety of the game at all levels.