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The understanding of concussion remains poor among the general population, including schools. In parallel with educational efforts, having pre-season assessments of athletes to document their normal performance and detect medical conditions that might affect their risk for concussion and their routine medical assessment after concussion is critical if doctors are to be able to manage athletes safe return to play and activities. Cooperation at all levels (parents, coaches, athletic trainers, doctors) is critical for athletes to be managed properly with such programs encompassing pre-participation and post-injury aspects. The Axon Sports Computerized Cognitive Assessment Tool (CCAT) is one of the tools used by doctors to assess and manage individual recovery of thinking and memory performance after a concussion. Axon Sports is a joint venture with CogState Ltd, a publicly traded Australian technology company, and Quixote Investment, a Portland, Ore.-based investment group. The technology behind the Axon Sports Computerized Cognitive Assessment Tool (CCAT) was conceived in 2000 by CogState to help medical providers measure the cognitive function of Athletes after suspected concussions or Traumatic Brain Injuries (TBI). After Injury testing with the Axon Sports CCAT is at the discretion of the athlete’s doctor since there are many other aspects to consider medically after a concussion. The CCAT compares After Injury performance with the individual athlete’s Baseline performance to determine whether there is a significant decline still.
Baseline Testing, together with a pre-season evaluation, is an essential part of the concussion management process.
In addition, athletes may injure themselves in non-supervised sporting or recreational activities between school sporting seasons. By definition, a concussion is associated with disturbances of function of the athlete’s brain. Given that there are no such unusual complications of a concussion; the main risk is exposing the injured brain to further injury before it is recovered.
When there is a baseline test result available, a doctor can compare results to help indicate whether the brain has fully recovered. If an athlete returns to play or activity before recovery from a brain injury, they may experience persistent or prolonged symptoms and cognitive impairment.
The concise and clear information obtained from the results of a CCAT test is therefore very helpful for doctors managing an athlete’s individualized recovery assessment since it is one of the most sensitive means for determining whether the brain is still showing impairment in comparison to their own Baseline performance. Such definitions of mTBI emphasize the importance of assessment of an athlete who has suffered a significant head injury by an informed health practitioner. The role of the Axon Sports CCAT in such injuries is minor around the time of initial assessment, but can certainly be useful for comparison later in their recovery to a Baseline CCAT assessment.
This is currently an area of active research but, in my opinion, it remains premature to make firm conclusions about the relationship between repeated exposure of these athletes to concussive (or subconcussive) injuries during their careers and the neuropathological changes found by Dr McKee and colleagues. It is my speculation that future research in human concussion will focus on subconcussive injuries. David Darby graduated from Medicine at the University of Melbourne in 1981, completing a PhD in neurology and neuropsychology in 1990, and his neurology training in 1991. Signup for the Healthy Brain Update: Science & research based articles on cognitive health, plus useful tips for maintaining a healthy brain!
MyBrainTest.org provides research and analysis on brain health screening tools, and the cognitive health testing market.
We are at the front edge of a rising wave of dementia impairment as the population ages, and this wave of millions will severely strain national health care systems. You have gone through your pregnancy and have given birth to your child, who is hopefully healthy and perfect.
Postpartum depression is moderate to severe depression that manifests in women after childbirth. While some blue days are to be expected after delivery, due to changing hormones, postpartum depression is a serious matter. Thoughts of harming yourself or your child are certainly very scary, but statistically they are very rarely acted upon.
If after reading the list of symptoms, you feel that you might have postpartum depression, please contact a health professional, preferably your personal doctor. Just as there is no single test to determine if you have postpartum depression, there is not just one course of action.
Other tips for successfully navigating your way through the painful experience of postnatal depression include asking for more support from your partner and family. If you’ve had the baby blues for longer than two weeks and your life is being affected by your symptoms, please contact your doctor.
June 20, 2013 6 Comments Ok, I promise I am not going to bore you with nothing but baby stuff from now on, but after keeping this secret for over a month I just have a lot of stuff in my head that I need to get out! So very excited for you all :) For us, it was the best and, at times, most stressful, experience of our lives!!!

David Darby, Chief Medical Officer of CogState, for his views on the hot topic of concussions in school sports. Education is the key initiative required to both improve awareness of the features, consequences and management of concussion at all levels, including athletes, parents, coaches, trainers, teachers and doctors.
Pre-season assessments should include a Baseline computerized cognitive assessment since it is not possible to be sure of an athlete’s pre-concussion performance once they have been injured. Jon Almquist at Fairfax County Public Schools runs an integrated concussion management program.
It is an 8-10 minute test available online from Axon Sports, and is usable anywhere there is a connection to the internet in standard web browsers. The joint venture is based in Wisconsin where it is centrally located to service North America.
It is usually performed after symptoms have resolved since the effects of concussion on thinking and memory usually linger beyond the symptoms for several days and hence suggest that the athlete’s brain function is still not back to normal. Due to the lack of practice effects in the Axon Sports CCAT, it can then be used repeatedly to document recovery of the athlete’s cognitive performance back to their Baseline, which in over 80% of athletes will occur within 7-10 days. Some of these injuries may be concussions and may not be reported to school teachers or sport supervisors.
What are the risks for student athletes returning to the playing field after a concussion, and how does post-concussion cognitive testing provide information to coaches, physicians, students, and parents? These changes are thought to be transient, which means they do recover, though sometimes recovery may be prolonged beyond the usual seven to 10 days. These will be evident to health practitioners by unusual features (such as finding asymmetrical responses to reflex testing), an unexpected deterioration in symptoms, or imaging abnormalities. There are currently no gold standards to allow medical practitioners to easily determine full recovery, but the CCAT seems to be one of the most sensitive measures available at the moment so is a useful tool for the doctor to use in assessing recovery. In addition, we risk exposing the athlete to further collisions or injury if they are not as alert or reactive as usual. Coaches, students and parents can therefore benefit by understanding whether or not the athlete’s brain needs further rest and can monitor the recovery process.
The typical definition of a mild Traumatic Brain Injury (mTBI) is loss of consciousness for up to 30 minutes and post-trauma amnesia for up to 24 hours. Clearly if there are features that are unusually prolonged or atypical for an uncomplicated concussion injury, the athlete should be managed appropriately. The professional sports world has seen the tragic deaths of active and retired players who exhibited signs of the degenerative brain condition chronic traumatic encephalopathy (CTE).
These may be milder forms of concussion and more common than is currently suspected (as suggested by recent studies at Purdue University).
Do you think we will find that personal genetics plays a role in the susceptibility (or resiliency) to concussions?
He served as an instructor in Behavioral Neurology at Beth Israel Hospital, Harvard Medical School from 1992 to 1995. You’ve weathered through the first couple of weeks and survived the anxiety, irritation, and tearfulness that are so common during that time. Although it most often occurs in the three months immediately following delivery, the depression can pop up anytime in the first year.
However, it is important that you tell your medical doctor right away if at any time you have those feelings.
While there is no single test that diagnoses postpartum depression, your doctor may have questionnaires for you to fill out. You and your doctor will decide your best treatment path, which can include one or more of several actions. Help is out there, and making that first step, while difficult, sets the ball rolling for positive change and growth. I try not to put too much stock in due dates since they are just an educated guess, but technically my due date is January 30, 2014. Darby, concussions in school team sports have received substantial attention in the media and public policy settings in the past few years. There is also a free preview of the test available at the Axon web site which we encourage all athletes to try out.
Thereafter, a graduated individualized return to activity and play program will usually be recommended by the athlete’s doctor. Having an annual Baseline test will detect deteriorations in Baseline abilities that otherwise might not be suspected by the athletes, parents, school staff or their medical practitioners. It is a well-accepted medical principle that recovery after injury should be allowed to occur, and this principle applies equally for the injured brain.

Clearly careful supervision of concussed athletes is important to detect such complications.
Whether athletes with incompletely recovered concussion injuries are more at risk of catastrophic brain swelling after further head injury (a condition known medically as Second Impact Syndrome or SIS) is controversial. This may include stabilization of the athlete at the field, ambulance and paramedical evaluation and hospital assessment. In particular, research and follow-up is required in the modern era in which players are assessed more extensively than before, along with the changing culture of football to both report concussions and conform to recommended management guidelines. Defining the full spectrum of injury is required before techniques that reliably detect the effects of concussive injuries can be delineated, and studies of true incidence, precipitating factors and outcomes can be evaluated. One example is the reported vulnerability of people with a calcium channel gene mutation (Kors et al Ann Neurol 2001) who are predisposed to both familial hemiplegic migraine and delayed cerebral swelling (edema) and fatal coma after minor head trauma. He was Chairman of the Memory Disorders Service at the Repatriation Campus of the Austin & Repatriation Medical Centre from 1997 to 2000, where he continues to evaluate patients with cognitive impairment. However, you still feel down, or perhaps you don’t feel as loving towards your new baby as you thought you would. It is important to realize that postpartum depression isn’t a character flaw, nor does it mean that you don’t love your new baby. If left undiagnosed and untreated, postpartum depression can last for months or years, and it might eventually progress to the stage of hurting yourself or your child. Don’t try to make huge life changes or be too perfect, this will only exacerbate the feelings you have.
This is in part because SIS seems to be very rare indeed, and can occur in children or adolescents who may not have had a first concussion and may be confused with other causes of collapse after head injury (particularly hemorrhages in or around the brain). Only then can cost-effective diagnostic techniques and therapies, both preventative and therapeutic be rationally evaluated and recommended. These may well be the athletes who are truly susceptible to second impact syndrome (even after only one injury).
If you feel like you might hurt your child, please treat that as an emergency and seek immediate medical attention and help.
Your doctor may also order blood work to screen for any medical conditions that can cause depression-like symptoms, such as hypothyroidism. Fortunately for breast-feeding mothers, there are several groups of depression medications that are safe to take while nursing, like Paroxetine and Sertraline. These improvements occur to at least 15 years of age in prior studies, but may continue in some athletes to age 18 years. There are also suggestions that SIS may occur in particular genetically susceptible individuals only. There are also research findings suggesting that certain cholesterol carrying protein gene types (apolipoprotein E4) may be more vulnerable to head injury due to more extensive post-injury brain inflammation and reactive changes. Prof Darby has published over 70 research papers in international peer-reviewed scientific journals and has co-authored a neuropsychological textbook with Prof Kevin Walsh.
It can feel so overwhelming, and you are probably frustrated with yourself for not handling the transition to parenthood better. Get it out in the open, whether you discuss it with your partner, friends or family, or you join a support group. Repeating the Baseline annually can help reset the Baseline for a maturing athlete to more accurately reflect their true pre-season abilities. Uncomplicated concussions do not show changes in routine neuroimaging studies such as computerized axial tomography (CAT) or magnetic resonance imaging (MRI).
He is a Founder and Chief Medical Officer at CogState Ltd developing computerized cognitive testing instruments including for early detection of dementia and concussion in sports, and is also adjunct Associate Professor at the Centre for Neuroscience, and Senior Research Fellow of the Florey Neurosciences Institute, University of Melbourne. Your doctor will likely refer to you a mental health professional, such as a therapist, and you may need to be under supervision for six months of more. Two types of therapy have traditionally been effective for people suffering from postpartum depression, cognitive behavioral therapy and interpersonal therapy. And unless you are wanting to be induced just avoid telling people your due date at the end.
Strangers will give you crazy looks by the time you are 39 weeks as if your due date is an expiration date!

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