Our findings indicate that underreporting of concussion among those players interviewed appears to be prevalent and associated with misconceptions about injury risk, and a culture that both reinforces and encourages underreporting with tacit or overt complicity of parents and coaches. Our findings support the need to alter the culture of violence and tough play in hockey by education, rule changes, economic measures, and changes in governance of the sport. Interviewing more stakeholders and policy makers would shed light on such potential interventions.

58Mild traumatic brain injury (mTBI) presents a major public health concern worldwide. [1][2][3][4][5] Approximately 10-15% of those who sustain mTBI develop long-term disability with health, psychosocial functioning and quality of life consequences. 6 Currently, there is no consensus regarding the diagnosis and treatment of mTBI, 4,7 and assessment of clinical symptoms and signs and other indicators are not able to predict which patients will develop permanent disability compared to those with a better prognosis. Development of novel biomarkers to predict this high-risk population is critical to improve follow-up and for optimal use of clinical resources. It is therefore essential, from a clinical perspective, that we develop user-friendly, and cost-ABSTRACT: Objective: To investigate whether repeat saccadic reaction time (SRT) measurements using a portable saccadometer is useful to monitor patients with mild traumatic brain injury (mTBI). Methods: Seven patients with newly-diagnosed mTBI and five agematched controls were prospectively recruited from an emergency Department. Saccadic eye movements, symptom self-reporting and neuropsychological tests were performed within one week of injury and again at follow-up three weeks post-injury. Control patients underwent saccade recordings at similar intervals. Results: Median saccade reaction times were significantly prolonged within one week post-injury in mTBI compared to controls. At follow-up assessment there was no significant between-groups difference. Changes in median SRT between the two assessments were not statistically significant. Four of the seven mTBI patients showed significantly increased SRT at follow-up; three of the mTBI patients and all controls showed no significant change. Among the three mTBI patients with persistent decreased SRT, two experienced loss of consciousness and reported the greatest symptoms, while the third was the only subject with significant decrease in neuropsychological testing scores at both assessments. Conclusion: In three of seven mTBI patients, saccadic eye movements remained delayed within three weeks post-injury. These three patients also showed persistent symptoms or no improvement on neuropsychological testing. This pilot study using a portable saccadometer suggests that comparing SRT from three weeks post-injury to that within one week of injury may be useful for early detection of a subpopulation at risk of persistent disability from mTBI. This finding suggests that further investigation in a large study population is warranted.RÉSUMÉ: Les saccades oculaires dans le traumatisme cérébral léger : une étude pilote. Objectif : Le but de l'étude était d'évaluer si les mesures répétées du temps de réaction saccadique (TRS) au moyen d'un saccadomètre portable est utile pour le suivi des patients atteints d'un traumatisme cérébral léger (TCL). Méthode : Sept patients chez qui un diagnostic de TCL venait d'être posé et 5 sujets témoins appariés pour l'âge ont été recrutés prospectivement au département des urgences. Les sacca...

BackgroundIn North America, more than 800,000 youth are registered in organized ice hockey leagues. Despite the many benefits of involvement, young players are at significant risk for injury. Body-checking and aggressive play are associated with high frequency of game-related injury including concussion. We conducted a qualitative study to understand why youth ice hockey players engage in aggressive, injury-prone behaviours on the ice.MethodsSemi-structured interviews were conducted with 61 minor ice hockey participants, including male and female players, parents, coaches, trainers, managers and a game official. Players were aged 13–15 playing on competitive body checking teams or on non-body checking teams. Interviews were manually transcribed, coded and analyzed for themes relating to aggressive play in minor ice hockey.ResultsParents, coaches, teammates and the media exert a large influence on player behavior. Aggressive behavior is often reinforced by the player’s social environment and justified by players to demonstrate loyalty to teammates and especially injured teammates by seeking revenge particularly in competitive, body-checking leagues. Among female and male players in non-body checking organizations, aggressive play is not reinforced by the social environment. These findings are discussed within the framework of social identity theory and social learning theory, in order to understand players’ need to seek revenge and how the social environment reinforces aggressive behaviors.ConclusionThis study provides a better understanding of the players’ motivations and environmental influences around aggressive and violent play which may be conducive to injury. The findings can be used to help design interventions aimed at reducing aggression and related injuries sustained during ice hockey and sports with similar cultures and rules.

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