ARTICLE IN BRIEF
Sports neurologist Jeffrey S. Kutcher, MD, provides a behind-the-scenes look at what it was like to be the first and only US neurologist at the Winter Olympics in Sochi this past February.
For the field of sports neurology, Jeffrey Kutcher, MD, brought home an exciting victory from the 2014 Winter Olympic Games in Sochi. Dr. Kutcher was not there to compete, but his presence in Sochi as the first full-time sports neurologist for Team USA was a game-changer.
Dr. Kutcher's journey to the Winter Olympics began more than two years ago, when he was first approached by the medical director of the US Ski and Snowboard Association (USSA). The USSA was looking to update concussion management to reflect changes in the understanding of brain injury — and they wanted a neurologist on board.
As the director of the Michigan Neurosport Program, an associate professor of neurology at the University of Michigan School of Medicine, and team physician with the Michigan Athletic Department, Dr. Kutcher came with a lot of credentials. In addition to his training as a sports neurologist and concussion specialist, he also knew his way around the slopes and the hockey rink.
Dr. Kutcher was the official head neurologist for the USSA and all National Hockey League (NHL) players in Sochi — regardless of their country, and also served as a consultant for the entire US Olympic team in cases of concussions or brain injuries.
In an e-mail interview with Neurology Today, Dr. Kutcher described what life and medicine really looked like in the Olympic Village.
HOW DID YOU HAVE TO PREPARE FOR BEING PART OF THE WINTER OLYMPIC MEDICAL TEAM?
I dedicated time over the past two years getting to know the sports, athletes, and particular challenges that come along with the venues. Also, every December, the USSA has a course for team physicians in Beaver Creek, CO, where we practice our on-course emergency response. I've truly been amazed at how different these sports are from what I'm used to (team sports like football and hockey). I also spent some time out in Park City, UT, at the USSA Center of Excellence, getting to know the staff.
TELL US ABOUT THE ON-COURSE EMERGENCY TRAINING YOU RECEIVED IN BEAVER CREEK AND HOW IT TRANSLATED TO YOUR EXPERIENCE IN SOCHI.
The annual USSA medical course is invaluable and the type of thing you go back to again and again to become more comfortable in your job and keep your skills sharp. There, we go through standardized stations on the Beaver Creek “Birds of Prey” downhill course, each of us taking turns being the first medical responder to an acute injury.
Think of it as a specialized type of Advanced Trauma Life Support training on a steep ice rink. The scenarios are realistic, as is the environment. It's incredibly challenging to provide this type of care, and going through each scenario definitely prepares you for the real thing. Even just getting around on skis with a trauma pack on your back and knowing how to handle yourself on ice and snow is a challenge. Without a doubt, this training was directly translatable to my experiences in Sochi.
WHAT DID YOU (OR THE OTHER DOCTORS) ENCOUNTER NEUROLOGICALLY? WERE ANY PARTICULAR EVENTS MORE PRONE TO INJURY THAN OTHERS?
First, I need to emphasize that I was just one part of a world-class team of clinical providers brought over by the United States Olympic Committee. Every day, we interacted with the medical staff from other countries, providing support and receiving support as needed. In addition, there were onsite emergency personnel provided by the host country. Together, the medical community on the mountain worked together for the health and safety of all athletes, regardless of country.
It was truly an amazing experience to work in that environment — something that I will never forget. We saw concussions, of course, in addition to a wide spectrum of trauma. There was a very typical injury rate at these games, across all of the different events, despite what you may have heard in the media. As far as which events are more prone to injury, I need only say that I spent a lot of time at the Extreme Park.
WHAT WERE THE MEDICAL FACILITIES IN SOCHI LIKE FOR ASSESSING AND TREATING ATHLETES?
Absolutely incredible, really. We had a clinic in the mountain village 50 steps from my front door, with onsite X-ray, CT, and MRI, as well as procedure rooms and local specialists. We could even get same day optometry exams and glasses made next day. For more significant trauma, we had several options nearby that were easily accessible by ambulance or helicopter.
WHICH CONCUSSION/COGNITIVE TOOL DO YOU USE FOR MEASURING THE ATHLETES' BASELINE AND COMPARISON?
All of our USSA athletes went through baseline testing and we were able to repeat those tests very simply in the clinic. Baseline testing is a potentially useful approach, but it can also be problematic if not used in conjunction with a more comprehensive and critical neurological evaluation.
As an example, I don't find computerized baseline neurocognitive testing to be clinically valuable typically, especially in this environment. I apply my clinical examination skills through a comprehensive sports neurological examination, performed serially and tailored specifically to the situation.
The neurological examination in the sports setting is in itself unique and requires a very specialized approach, examining the nervous system both at rest and under different physical conditions. It's really a dynamic evaluation and isn't something typically taught or experienced in the realm of general neurology.
Only by spending a lot of time with athletes in their sport-specific settings can you develop a good sense of this. Now, having the ability to perform a comprehensive sports neurology examination on athletes prior to any injury can be incredibly useful.
HOW DO YOU TAILOR THE NEUROLOGIC EXAM TO DIFFERENT SPORTS?
The idea is to first understand the cognitive skills that are emphasized in each particular sport, such as reaction time, visuo-spatial awareness, vestibular control, etc., and not only testing these functions specifically, but doing so under the physical conditions of the sport. Testing the eye movements of a hockey player at rest, for example, can give you different results than testing them immediately after the patient completes a complex drill. You try to uncover examination findings that point to their pathology.
What I find is that while the nervous system may not produce abnormal findings during a time of relative physical rest, it will often do so under challenging conditions. Then, the additional task of the sports neurologist is to understand what findings you would expect to see given the specific sport situation versus those that may be an indicator of pathology.
DID YOU ENCOUNTER ANY PRESSURE FROM ATHLETES TO RESUME COMPETITION POST-INJURY?
None. Naturally, there is disappointment and no shortage of tears when you tell an athlete their Olympic games are over. The incredible amount of time, dedication, sacrifice, and pain that it takes to get there all comes to a quick and dramatic conclusion. In the end, however, you see an incredible amount of respect for brain injury and gratitude that somebody was there to look out for them.
COMING BACK FROM SOCHI, WHAT TIPS WOULD YOU HAVE FOR OTHER NEUROLOGISTS WHO MAY BE WORKING WITH ATHLETES AND/OR SPORTS TEAMS?
Make sure you're in it for the right reasons. Remember that you have an ethical obligation to work for your patient and your patient alone.
Do not get caught up in the outcome or the environment. You absolutely cannot be a fan. Not everybody can do this and stay objective, so do some serious introspection before you put yourself in a situation that might compromise your patient's health.
Of course, you need to be very comfortable making decisions and sticking with them. Finally, respect the unique nature of the sports you work with. Work to understand the game itself and the athlete's motivation for playing. It will make you a better clinician.
DO YOU THINK NEUROLOGISTS WILL HAVE A GREATER ROLE TO PLAY IN THE OLYMPIC GAMES GOING FORWARD?
Absolutely. I provided neurological consultation for several countries over the past three weeks, which I see as direct evidence that neurologists need to be more involved across the board.
Actually, I've already had discussions about going to Rio in 2016 and I suspect I won't be the only neurologist at the games this time. What you're seeing with the Olympics is really another example of the increasing role that neurologists are playing across sports in general.
FINALLY, PLEASE SHARE ANY LASTING IMPRESSIONS OR OBSERVATIONS FROM YOUR EXPERIENCE IN SOCHI.
Without a doubt, I came away from Sochi with an even greater respect for my patients. They are an inspiration. I learned something from them every day, about commitment and sacrifice, perseverance and humility, about myself ultimately as well.
One thing I will never forget is spending time with some of the hockey players from both USA and Russia, together in the NHL Players' Association lounge at the rink, only 30 minutes after their epic battle. Despite the outcome, the fellowship of the athletes was amazing. Afterward, we swung back through the athletes' dining hall in the village for a late-night McDonald's run (the best McDonald's I ever had). There was something very reassuring about sharing your McNuggets with an NHL all-star. They just want to have the same experience as every other athlete at the games.
Our Russian hosts were unbelievably friendly. I've heard various media outlets describing negative things. As somebody who lived it from start to finish — 19-20 hours a day — I will tell you emphatically that you should not believe a single negative story. It was amazing. Russia can be quirky to somebody from North America, but that just it made all the more enjoyable!
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