FEATURE STORY / UNDERSTANDING CONCUSSIONS
months, she was back to making long
commutes to Ottawa on weekends.
Dr. Crawford believes that
chiropractors are well positioned to further
investigate concussion injuries from a
biomechanical perspective along with
cervical spine issues such as a disruption
in proprioception and cervical spineassociated headaches.
Dr. Cameron Marshall
D
r. Cameron Marshall is a 2011
graduate from CMCC and is
currently completing his Sports
Sciences Residency at CMCC. He is the
President and Chief Executive Officer
of Complete Concussion Management
Inc. (CCMI), a multidisciplinary
network of sports medicine, chiropractic,
physiotherapy and specialist medical
and neuropsychological clinics. CCMI
is designed to educate various medical
and allied health practitioners on the
most up-to-date evidence regarding
concussion, post-concussion syndrome,
and Chronic Traumatic Encephalopathy
(CTE) pathophysiology, management, and
rehabilitation.
Dr. Marshall recently conducted
a literature synthesis on available sport
concussion research. It encompasses
biomechanics, pathophysiology, diagnosis
and sideline management. It also examines
cervical spine involvement in sport
concussions. Concussions are commonly
perceived as solely head injuries, yet the
cervical spine plays a critical role in the
severity and prognosis of an mTBI. “The
cervical spine is not only a potential source
of injury that we must be aware of, but it
is also implicated as a factor in concussion
itself,” Dr. Marshall said.n
As an extension of this, Dr.
Marshall is currently finishing up a
22
FALL 2014
project in collaboration with CMCC
and the renowned University of Buffalo
Concussion Program on the relationship
between mTBIs and whiplash. Chronic
concussion patients and chronic whiplash
patients were compared and contrasted
based on both whiplash and concussion
outcome measures.
Results found no difference between
patients who had suffered an mTBI
through a direct head impact (concussion
diagnosis) and those who did not suffer a
direct head impact (whiplash diagnosis) in
terms of their reported symptoms between
one month and one year after injury.
There were also no differences in terms
of secondary signs and symptoms such as
memory or concentration impairments or
neck pain between the two groups.
This may imply that concussion
patients are also suffering concurrent
whiplash injuries, the signs and symptoms
of which directly overlap making diagnosis
somewhat difficult for the untrained
practitioner. There are a number of factors
that come in to play when dealing with
concussion injuries and Dr. Marshall
encourages any practitioner thinking of
Recommended Reading
David Cassidy, Carol Cancelliere, et.al. “Systematic Review of Self-Reported
b
Prognosis in Adults After Mild Traumatic Brain Injury: Results of the International
Collaboration on Mild Traumatic Brain Injury Prognosis,” American Congress of
Rehabilitation Medicine 95 (2014): 132-51.
Catherine Nygren-de Boussard, Lena W. Holm, Carol Cancelliere et al. “Nonsurgical
D
Interventions After Mild Traumatic Brain Injury: A Systematic Review. Results of the
International Collaboration on Mild Traumatic Brain Injury Prognosis,” American
Congress of Rehabilitation Medicine 95 (2014): 257-64.
Maja Stulemeijer. Recovery After Mild Traumatic Brain Injury (Ipskamp Drukkers,
s
Enschede, the Netherlands, 2009), 10-19.
Vini G. Khurana, Andrew H. Kaye. “An overview of concussion in sport,” Journal of
u
Clinical Neuroscience 19 (2012): 1-11.
Carol Cancelliere, Cesar A. Hincapie et al. “Systematic Review of Prognosis and
l
Return to Play After Sport Concussion: Results of the International Collaboration
on Mild Traumatic Brain Injury Prognosis,” American Congress of Rehabilitation
Medicine 95 (2014): 210-29.
Cameron Marshall. “Sports-related concussion: A narrative review of the literature,”
n
Journal of the Canadian Chiropractic Association 56 (2012): 299-309.
Additional Resources:
L. Rachid Salmi, David Cassidy, et al. “Introduction to the Findings of the International
Collaboration on Mild Traumatic Brain Injury Prognosis: What is a Prognostic Study?”
American Congress of Rehabilitation Medicine 95 (2014): 95-100.
Concussions Ontario: www.concussionsontario.org/guidelines-for-pediatric-
concussion/