Treating concussions: A baseline for success

By MIKE FORNABAIO

The University of Bridgeport student in the corner of the Human Performance Lab looks like she is auditioning for a marching band.

Up, down. Up, down.

But to Dr. Frank Zolli, a professor of clinical sciences, each step is another clue to how well her central nervous system is functioning.

The muscles, the cadence, the foot strikes, it’s all measured with sophisticated equipment to establish a tailored baseline.

Or, in the event of a concussion, to find the deviation from that baseline.

“We’re providing objective data and relating it to performance,” said Zolli, a former St. Peter’s College football player who has spent the last 25 years teaching and conducting research at UB.

“As a result of a concussion or some other injury, we can use the new data to measure it against a baseline, and then measure the progress during the recovery process.

“Once that deviation is corrected, then you can objectively say, ‘This athlete is ready to return to play.’ That’s a big difference from, ‘Well, the symptoms went away — the headaches, the dizziness, the nausea — so this athlete can return to play now.’ This is much more scientific.”

The marching test — once with your eyes open, once with your eyes closed — is among several tests that Zolli and his colleagues use at UB.

There is a treadmill that measures the smallest details of gait, the way a person walks. There is also a room with lights that flash in certain sequences to test reaction time and how that dovetails with cognition, how a person thinks.

“We’ve never had anything like this. We’ve never had access to this kind of objective data before,” Zolli said. “We know it’s absolutely critical to exercise the central nervous system. That’s got to be part of the recovery process, especially with concussions.

“You’ve had a traumatic brain injury. You don’t know what the results have been. We can now translate those results to how the body is functioning or not functioning based on your baseline. It helps us create a strategy for the recovery process.”

For the high school athlete, and even the middle school athlete, recent state legislation has established guidelines to help reduce exposure to concussions.

Concussion data must be tracked and submitted to the state Department of Education. Information about concussions — recognizing the signs and learning about treatment — must be shared with coaches, parents and students.

High schools and middle schools must also have a protocol in place for when a student may return to class, never mind athletic competion.

But what about youth sports? What about their baselines and using sophisticated tools to track their recoveries?

What about the little boy who suffers a head injury playing football? What about the little girl who bumps her head playing soccer?

In Norwalk, social worker and concussions-awareness advocate Katherine Snedaker says the new state law covers just 1-in-11 kids in her city.

A three-year pilot study will now collect data on concussions incurred by Norwalk’s children. The city also requires youth sports groups using its fields to follow guidelines similar to the state law.

Anyone using a field in Norwalk needs to follow the city’s guidelines: educate coaches, educate parents, make sure parents are notified about possible concussions, and make sure parents have the information about a particular injury to give to medical providers.

In addition, Snedaker wants to make sure that parents notify schools of any concussions involving their children.

“This fall, we’ll have trained almost 1,000 coaches,” said Mike Mocciae, Norwalk’s director of recreation and parks, during a recent concussion summit.

“That’s non-profit groups that use our field. That’s for-profit groups that use our fields. And that’s for all programs the recreation department runs, from our playgrounds, to our basketball program, to everything that we offer.”

Mocciae said he has worked in parks and recreation for 31 years, and this is among his most important accomplishments.

As part of the “C4 Project” — concussion care connected community — data was collected from school nurses.

For the 2014-15 school year, there were 111 reported concussions in Norwalk: 51 were sports concussions, 60 were non-sports concussions.

Only 27 of the sports concussions were incurred in high school sports, which are covered by the law. Another 24 sports concussions occurred outside of high school, which are not protected under the new state law.

State legislators moved this summer to try and educate families of even younger athletes.

A section was inserted into the legislation that will require youth organizations, as of Jan. 1 2016, to provide parents with either written or online information about concussions that is consistent with recommendations by the U.S. Centers for Disease Control and Prevention.

The provision, however, specifically says that youth sports organizations won’t be subject to civil liability if they don’t adhere to the new recommendations.

“The worry is, if you think of, say, T-ball, (the coaches) are all volunteers,” said state Rep. Diana Urban, a Democrat who represents North Stonington and Stonington. “The worry is that if we ask them to be trained, they’re not going to want to volunteer.”

But Norwalk hasn’t seen that, Urban said.

The bigger issue for youth sports programs is making sure parents get the necessary concussion information.

“It wasn’t so bad for the coaches because they’re used to having to jump through hoops,” said Jack Couch of Norwalk Youth Lacrosse. “Getting paper from parents is like herding cats in a nightmare.”

Snedaker likes to use a video with parents called “Brain 101: What’s a Concussion?” — http://bit.ly/1uLCmoM — from theOregon Center for Applied Science.

“It’s funny. It’s cute. It doesn’t scare kids,” Snedaker said. “It’s kind of fun. There’s vomit. There’s all kinds of things to appeal to kids.”

But the concussion video makes clear that it’s important to get treatment for an injury that, left untreated, can have long-term detrimental effects on many facets of a child’s life.

“The good news is that in a lot of ways, a lot of the coaches, parent organizations, youth programs are somewhat out ahead of where a lot of folks think they are,” said state Rep. John Shaban, a Republican from Weston, and the president of Aspetuck Youth Football.

But there’s still room for improvement.

“When you think about it, not every kid plays sports,” said Bob Fosina of Norwalk Junior Soccer. “Every kid walks up and down stairs. Every kid gets in a car. Every kid goes on a scooter. I would love to see this be implemented at the (primary) school level.”

Source: Fornabaio, Mike. “Treating Concussions: A Baseline for Success.” Connecticut Post. N.p., 31 Oct. 2015. Web. 31 Oct. 2015.


Concussions In Sports: The Latest On A Deadly Month For High School Football

By JUSTIN CABA

As more and more parents start to pull their children away from organized football, high school football programs across the country just capped off a deadly start to the 2015 season. The number of deaths associated with high school football rose to seven this past Friday following the tragic death of 17-year-old Andre Smith, who died as a result of “blunt force head injuries due to a football accident.”

Deaths like Smith’s have both parents and health care professionals deciding if the benefits tied to organized contact sports outweigh the sometimes fatal risks. Smith, a senior at Bogan High School in Illinois, was able to walk off the field after sustaining a hit to the head during the game’s final play this past Thursday, but would collapse soon after. He was taken to nearby Advocate Christ Medical Center where he passed away early Friday morning.

Although Smith’s death was the first in Illinois since a player died due to an enlarged heart in 2012, it was also the seventh nationally since the start of the season in early September, according to the Illinois High School Association (IHSA).

“As anyone who has participated in athletics knows, there is a risk of injury any time a player steps on the field of play,” the IHSA said in a statement. “Football, in particular, has been under the microscope over the last decade, and organizations at all levels of play, including high school, have been taking aggressive steps to try and reduce injury over time.”

Other high school football players who have passed away this season, including Kenney Bui from Washington state and Ben Hamm from Oklahoma also suffered traumatic brain injuries that ultimately led to their death. It comes as no surprise that concussions played a role in part of this deadly month for high school football, but they’re not to blame for all or even most of this season’s death toll.

The death of Evan Murray from New Jersey back in September was caused by massive internal bleeding from a lacerated spleen. Roddrick “Rod” Williams from Georgia died as the result of a preexisting medical condition. So in spite of everything we know about the relationship between concussions and football, can we really say contact sports are excessively dangerous?

“These events are incredibly tragic,” Dawn Comstock, an associate professor at the University of Colorado School of Public Health, told Fox8. “I would love to never see another high school athlete die while they play their game, but the positive benefits of playing sports in terms of lifelong health are greater.”

According to the National Center for Catastrophic Sports Injury Research survey, at least 12 high school and college football players die each year. Complications caused by a concussion may seem like the safe bet when it comes to leading cause of death among football players, but its actually sudden cardiac arrest — something that could affect a long-distance runner or a baseball player.

Officials on all levels of organized football are doing everything in their power to ensure the safety of athletes. For example, a rule in Wisconsin limiting contact in high school football practices significantly cut down on the number of concussions sustained throughout the season. To help improve player safety among players in the NFL, league officials have started emphasizing how players and coaches address safety in the locker room and out on the field.

No one knows a player’s risk for a sports-related health complication better than that player. It’s up to him or her to speak out if something isn’t right. Covering up injuries is commonplace among athletes in order to keep playing the game they love. It has become the coaches’ and parents’ duty to make players aware of the danger they put themselves in by not reporting an injury.

Risk is everywhere in the world. If it’s going to stop you from getting the recommended amount of exercise or participating in activities that you genuinely enjoy, then stay inside.

Source: Caba, Justin. “The Latest On A Deadly Month For High School Football.” Medical Daily. N.p., 28 Oct. 2015. Web. 28 Oct. 2015.


New guidelines for youth football follow injuries, deaths

By DEAN REYNOLDS

The American Academy of Pediatrics issued new guidelines Sunday aimed at improving the safety of youth football, played by more than a million American kids.

It comes as a Tennessee high school football player, Baylor Bramble, is in critical condition after suffering a head injury during a game Friday night and a high school in Chicago mourns the death 17-year-old Andre Smith.

The recommendations include zero tolerance for illegal head-first hits; having athletic trainers on sidelines of games; and offering non-tackle football games as an alternative, reports CBS News correspondent Dean Reynolds.

“There’s too many head-to-head hits and leading with the head, known as spearing — that’s been against the rules since 1976 and for some reason referees and coaches have gotten away from enforcing that rule,” said Dr. Greg Landry, co-author of the recommendations and member of AAP Council on Sports Medicine and Fitness.

Based on a review of scientific research on the relationship between tackling and football-related injuries, the AAP policy recommendation said head and neck injuries are usually more severe than injuries to the legs and back, and often a result of illegal tackling techniques.

High school football deaths are way down from where they were back in the 1960s and ’70s, but in a sport that is by its nature violent, the question is whether it can ever be made truly safe.

Friends and family gathered over the weekend to remember Smith, who suffered a fatal injury playing football for his high school. The Bogan High School senior collapsed during a game Thursday against Chicago Vocational after taking a hit right at the end of the game. Though he was rushed to a local hospital, he died there the following morning.

Over the weekend, the Cook County medical examiner ruled the death “accidental,” caused by “blunt force head injuries due to football.”

“You understand the risks but it’s a game, you know, it’s a game,” Smith’s stepfather, Dwayne, said.

Smith is the seventh high school football player to die in the U.S. this year. Just days ago, Cam’ron Matthews of Texas died after collapsing on the sidelines. And last month, Evan Murray of New Jersey died from a lacerated spleen he suffered during a game.

To Andre Smith’s teammates his brother, Erick, had this to say: “Just be aware, protect yourself and be cautious because something as simple as a football injury can end a whole life.”

The Chicago Public Schools insists it follows all state safety regulations governing football games. Smith is the first high school football player to die in Illinois since 2012.

Source: Reynolds, Dean. “American Academy of Pediatrics Releases New Guidelines for Youth Football Safety.” CBSNews. CBS Interactive, 26 Oct. 2015. Web. 26 Oct. 2015.


Pediatricians Suggest Changes To Youth Football To Improve Safety

By LIONEL MOISE

CHICAGO (CBS) — After an alarming number of high school football player deaths, a leading doctors’ group is suggesting new guidelines to address player safety and save lives.

The recommendations from the American Academy of Pediatrics include requiring athletic trainers on the sidelines of youth football games, offering non-tackle football games as an alternative and instituting a zero-tolerance policy for illegal head-first hits.

“There’s too many head-on-head hits, and leading with the head – known as spearing – that’s been against the rules since 1976, and for some reason referees and coaches have gotten away from enforcing that rule,” said Dr. Greg Landry, a pediatrician who co-authored the AAP policy statement.

The AAP says flag football is an alternative for parents and students who are concerned about recent injuries and deaths linked to the sport.

“Definitely on the lower levels, yes there should be flag football,” said Barrington High School athletic trainer Russ Schellhase.

Pop Warner football, serving kids 5 to 15 years old, offers flag football as an alternative, but says those teams make up only about 15 percent of leagues.

The Chicagoland Youth Football League, the largest in the area, offers it for five to seven year olds, with no plans to expand citing low demand.

The IHSA doesn’t host flag football on the high school level, due in part to lack of demand.

The AAP announcement comes as the Bogan High School community mourns the death of 17-year-old Andre Smith. He collapsed during a game Thursday night against Chicago Vocational Academy, after taking a hard hit on the last play of the game.

Over the weekend, the Cook County Medical Examiner’s office ruled Andre Smith’s death accidental, caused by blunt force head injuries due to football.

Andre was the seventh high school football player to die from game-related injuries in the U.S. this year.

Many advocates have been pushing for changes in youth football rules to bring that number to zero.

“Just be aware; protect yourself, and be cautious, because something as simple as a football injury can end a whole life,” said Andre’s brother, Erick.

Meantime, a high school football player in Tennessee was in critical condition Monday morning, after a head injury during a game on Friday. And on Oct. 18, 16-year-old Cam’ron Matthews died two days after collapsing during a football game in Texas.

Source: Moise, Lionel. “Pediatricians Suggest Changes To Youth Football To Improve Safety.” CBS Chicago. N.p., 26 Oct. 2015. Web. 26 Oct. 2015.


Every head injury is not a concussion

By MIKE FORNABAIO

Michael Lee figures he’s seen thousands of patients with concussions, many of them in his Fairfield office.

Sometimes, the children are athletes — youth soccer players or high school football players — but plenty of times they’re just kids who have fallen off their bikes or dropped out of their favorite trees.

But just because a child suffers a head injury, the diagnosis isn’t always a concussion, which doctors describe as a jolt to the head or body that disrupts the function of the brain and causes the brain to move rapidly within the skull.

Sometimes, it’s simply a bump on the head that will go away pretty quickly. Other times, it’s a clear concussion that requires prompt, vigilant attention. Still other times, it’s a much worse injury, perhaps even a fatal one.

“There are so many cases, times when there are glaring examples of (head injuries) — the actress (Natasha Richardson, who died after a 2009 accident), skiing … ‘Oh, a concussion,’ ” Lee said.

“No, that was a brain bleed. You’ve got to distinguish a concussion, a mild traumatic brain injury, from a (more severe) brain injury.”

Given the recent attention surrounding concussions, the temptation is to view every head injury through the same lens. That isn’t just a mistake, it can also be dangerous.

“Science is moving fast,” said Patricia McDonough Ryan, a pediatric neuropsychologist at Gaylord Specialty Hospital in Wallingford. “You’ve got to keep on top of it. … And the media is outpacing science. So what you read on the Internet, what you hear on TV, the majority is not true.”

And so, anxious parents can lead to anxious patients, Ryan said. This can sometimes delay a child’s recovery from a concussion injury.

“(The media) catastrophize concussions, making it sound like the effects of a single concussion can have lifelong detrimental brain damage,” Ryan said. “They apply what we know from adult literature to kids. They’re not mini-adults. Kids’ brains are still growing.

“There was a research study that was just completed that talked about changes in the hippocampus of football players. It was related to a certain group of athletes that had concussions, but the headlines read, ‘NFL players have changes in hippocampus.’ ”

A uniform state policy is trying to take some of the mystery and misinformation out of the equation.

With stronger concussion legislation passed last year, state lawmakers now require schools and youth groups to get concussion information into the hands of parents and young athletes, urging them to seek medical attention at the first sign of a symptom.

“Better recognition, earlier recognition and diagnosis leads to better outcomes,” Ryan said flatly.

Concussions are like snowflakes, she added. No two are alike and no two patients respond the same way to treatment.

In a concussion, rapid movement stretches and damages the brain, Ryan said. It’s also a rotational injury. Force against the head doesn’t necessarily mean there will be a concussion.

Youngsters and teenagers are at greater risk, and can take longer to heal than adults, according to doctors. Certain studies also indicate that girls are at greater risk than boys.

Some people may also be at a higher risk for concussions, including those with migraines, learning or developmental disabilities, or those with previous concussions.

A first concussion isn’t the end of the line, doctors stress, but every concussion must be taken seriously. It’s no different with the treatment of concussions, Ryan said.

Each treatment must be tailored to fit a person’s symptoms, risk factors and the amount of time that has passed since the injury. Ryan will often reduce stimulation for a few days, and then increase it gradually.

“I think of ‘Goldilocks and the Three Bears.’ Too much stimulation is not good. Too little stimulation is not good, either,” Ryan said. “You’ve got to find that sweet spot: Where is it just right? And that takes a lot of training and education.”

Lee agreed.

His “Cocoon Therapy” treatment was never meant for extended use, but some have used it that way.

“I felt kids should sleep as much as they could in a dark room for a day or two to help them get better quicker,” Lee said. “That got misinterpreted by a lot of people to keep kids locked up in dark rooms for days on end, which was never what we wanted to do.”

Most children with concussions show signs of improvement relatively quickly, according to doctors. For athletes, the protocol is usually a step-by-step return to activity, then to practice, then to playing games.

However, few medical tests provide clarity about what’s going on with a concussion inside a person’s head. Cognitive tests can be revealing, Ryan said, but it’s key to make sure the tests are administrated correctly and consistently.

Recovery can be helped by setting expectations and reviewing biofeedback, she said, generally helping kids take control of their lives.

“We can do things to empower kids around their habits,” Ryan said.

But what about multiple concussions? When does that pattern lead to the possibility of giving up a contact sport?

“There used to be this notion of three (concussions) and you’re out. There’s no research behind it,” Ryan said. “It was just kind of let’s-just-put-a-number-out-there. You’ve got, really, the research pushing toward an understanding of the individual.”

The return-to-learn protocol must also be a part of this discussion, according to many experts.

“If a child has a concussion, looking at formal policies to help them return to school could be the next step to the concussion laws,” said Diana Coyne, a Westport parent who has pushed for stronger state laws and served on the state’s concussion task force. “Some states have them in place. That could be a possibility.”

Shelton High School athletic director John Niski appreciates the balance between school and sports.

Niski said a teacher who sees a student with a broken right arm understands the child won’t be writing essays anytime soon. But some teachers don’t quite get that a concussion may temporarily force a child to miss math class for a while.

“If students miss three or four days of AP European History class, three or four days of AP Calculus, they start to really panic,” Niski said. “That exacerbates the (concussion) recovery process.”

But it doesn’t have to be this way, Niski said. The best recovery protocol is a collaborative process involving the student, family, doctors, school officials and athletic officials.

“There are so many great things about sports,” Ryan said. “There are so many benefits. Exercise, mental health. Learning how to be team players, how to lose with dignity, win with grace.”

With more and more concussion questions being answered, there just may be safety in numbers.

Source: Fornabaio, Mike. “Every Head Injury Is Not a Concussion.” Connecticut Post. N.p., 24 Oct. 2015. Web. 24 Oct. 2015.


Football and concussions: Michigan leaders take safety steps, but the hits keep coming

By TED ROELOFS

On a late August night in Chelsea, there were two football scores of note as visiting Northview High School collided with Chelsea High. There was the final tally, which after the usual assortment of helmet-smacking hits stood at: Chelsea 27, Northview 14.

But along the sideline, Jesse Brinks, the athletic trainer for Northview, a school north of Grand Rapids, was focused on a second set of numbers. Brinks handed an iPad to a Northview defensive back who just absorbed a hard blow while making a tackle. The player was asked to track a series of single-digit numbers on the screen. His score would give Brinks a good idea if the boy had a concussion.

In this case, he passed – and after clearing other tests, the player returned to the game in the second half.

Brinks guessed he’s used the test about 10 times this season, confirming a concussion in one case for a cheerleader who took an elbow to the head as she spotted for another cheerleader. In two other cases, it helped confirm concussions in football practice. “It’s a great tool for us,” Brinks said.

Amid growing fears nationally about the risks and long-term impact of concussions in sports, Northview’s sideline protocol is part of an ambitious pilot program in Michigan launched in August for 10,000 athletes in 70 public and private high schools.

According to the Michigan High School Athletic Association, it is the first of its kind in the nation. The association contends that Michigan is also first to require member schools to record suspected concussions in practice and in games at middle and high schools across the state.

“We’re trying to be on the front line, to make sure we’re doing everything we can to make sure our kids are safe,” said Northview athletic director Jerry Klekotka.

That may be. But while Michigan appears to be ahead of the curve in how closely it tracks concussions, Bridge found that Michigan is behind many other states in limiting time young players can engage in full-contact practices during the week. Michigan, for instance, allows six times as much full-contact football practice each week as in the neighboring states of Wisconsin and Ohio.

These and many other states are sharply limiting full-contact scrimmaging in the face of research showing the routine, daily collisions in sports such as football or soccer can alter the brains of athletes, even when players are not specifically diagnosed with a concussion. Repeated, sub-concussive blows from full-contact scrimmages and games can have a significant impact over time. Other research has found that the risk of brain trauma to young players can commence well before high school.

“Common sense tells you that bopping your head all the time for a number of years is not going to be a good thing,” said Larry Levenerz, a Purdue University clinical professor of health and kinesiology and member of the school’s Purdue Neurotrauma Group, which has studied the effects of football on cognition since 2009.

More attention, more warnings

Northview High School athletic trainer Jesse Brinks tests athletes for concussion with a specialized iPad program. (Photo courtesy Northview High School)

Warnings over the risks of football have been building by years, as events like the 2012 suicide of ex-NFL linebacker Junior Seau cast the issue into sharp national focus. An autopsy found that Seau suffered from chronic traumatic encephalopathy, or CTE, a progressive degenerative disease linked to repetitive brain trauma, often marked by depression and cognitive deterioration. CTE, which can only be detected by examining the brain after death, has been detected in dozens of former NFL players.

In September, researchers at the Department of Veterans Affairs and Boston University found that 87 of 91 deceased NFL players whose brains were tested had evidence of CTE (That percentage is likely skewed since many of the players suspected they had CTE and asked that their brains be tested after they died).

But the disease is not limited to 30-something NFL veterans.

The same year Seau died, Joseph Chernach, who had played football since he was a young boy and became an Upper Peninsula high school football star, killed himself at age 25. An autopsy found significant evidence of CTE and brain damage. His mother, Debra Pyka, said he never had a confirmed concussion.

Mounting evidence of the dangers of repeated head contact has caused state bodies that regulate high school sports to reconsider how much contact should be permitted in practice. The era of hours-long, full-contact practices throughout the week appears to be on the wane, even in football factory states such as Ohio.

In July, the Ohio High School Athletic Association adopted guidelines aimed at curtailing hits during practice. It now limits schools to no more than two 30-minute, full-contact football practices a week. The Ohio change was driven by research showing that 58 percent of concussions among high school and college football players occurred in practice, compared with 42 percent in games.

Nate Moore, coach of perennial Ohio football powerhouse Massillon High School, told Bridge he considers the movement to curb full-contact at practices a positive step.

“I think it’s definitely a good direction to go. The safety of the players has to be number 1,” Moore said.

Moore added that he doesn’t believe the restrictions will limit his ability to prepare his team to play its best football. “I don’t feel it’s negative at all,” he said. “The days of hammering ourselves in two-a-days (practices) in the summer are done.”

Wisconsin also limits full-contact practice to 60 minutes a week, after the first three weeks of practice and games. Other states, including Alabama, Iowa, Kansas, Georgia, Texas, California and Tennessee limit practice contact to 90 minutes a week. In California, that limit was imposed not by a high school athletic association, but by the state legislature, and was then signed into law last year by Gov. Jerry Brown

According the National Federation of State High School Associations, there is evidence these limits “resulted in a statistically significant decrease in concussion rates during practices.”

More hitting in Michigan

By contrast, Michigan allows two full-contact practices a week after the first game of the football season – with a maximum length of three hours per practice, for a total of six hours a week of hitting. That’s six times what Ohio and Wisconsin allow.

Even that six-hour restriction, adopted in 2014, met resistance from some old-school Michigan coaches.

Tom Mach, a 10-time state champion and for 27 years head coach at Detroit Catholic Central, was quoted at the time saying the six-hour limit would make it harder to teach proper tackling techniques.

“When they get into the game, it has to be an automatic thing,” he said. “The more time we take away from being able to teach that (in live game speed), the worse results we’re going to get.”

The recent focus on concussions and player safety seems to be giving some parents and players second thoughts about playing tackle football. The number of participants in Michigan high school football has declined seven straight years. It’s also changing the way football is being taught, with coaches from youth leagues to the NFL focusing on safer tackling techniques that cut down on helmet-to-helmet contact.

Other sports too are paying attention. Safety advocates in sports like soccer have begun to question whether young players should be allowed to “head” the ball, a routine skill taught to players but one that is also linked to concussions.

But no sport features as many opportunities to knock heads as football.

Hundreds of blows

The 2012 Purdue University study, which tracked a couple dozen high school football players over the course of two seasons, found that players logged anywhere from 200 to 1,800 hits to the head over the course of a season. MRI tests found that 17 players – who wore special helmets equipped with sensors – had measurable changes to their brain, with the magnitude of change to brain activity corresponded with the number of hits the player took. None of the players logged having a concussion.

Purdue University kinesiology professor Larry Leverenz: “Common sense tells you that bopping your head all the time for a number of years is not going to be a good thing.” (Photo courtesy Purdue University)

Leverenz, of Purdue, said it’s unclear at what point the cognitive changes documented in these studies will lead to serious impairment. He said the group’s research is finding that the football players’ brains – though changed – can essentially rewire themselves, finding new neural tracks, so that outward cognitive functioning seems the same. “At what point,” he asked, “do enough of these (neural) tracks get damaged?”

John E. “Jack” Roberts, the executive director of MHSAA, which has a voluntary membership of over 1,500 public and private middle and high schools in the state, said he believes most Michigan schools conduct full-contact football practices that are considerably shorter than the two three-hour practice maximums allowed.

But given the steps taken by other states to more strictly limit full-contact practice, Roberts acknowledged to Bridge that it’s an issue his organization should reconsider. That decision would be made by its 19-member governing board, which is next scheduled to meet in December.

“We don’t want to be behind that curve,” Roberts said. “Now we can go back and revisit this to see if there is some tweaking we should do.”

In the meantime, research on head trauma in sports is finding that the risk of injury can begin as young as age 5, the minimum age to participate in Pop Warner youth football:

A 2013 study of football players ages 9 to 12 in the Annals of Biomedical Engineering found that the players averaged 240 high-magnitude in the course of a season between practice and games.

Another study in the Journal of the American Medical Association Pediatrics found that one-in-30 football players http://www.ibtimes.com/football-concussions-head-injuries-not-confined-nfl-youth-high-school-college-players-1907108 ages 5 to 14 will sustain one concussion per season.

Other sports taking notice

Studies of young soccer players are detecting brain changes from the repetitive heading of the soccer ball, regardless of whether concussions were reported. A 2013 Texas medical study of 24 teenage girls found indications of “cognitive dysfunctions” in half of them from headed the ball, compared with none recorded among 12 non-soccer players.

Such findings prompted a group of World Cup soccer stars in 2014 to call for a ban on heading the ball until age 14.

In May 2014, a Pennsylvania middle school decided to ban heading in middle school soccer in the 2015 season, perhaps the first school in nation to do so.

Roberts of the MHSAA said he has been pushing member schools and coaches to consider a similar ban on heading in middle-school soccer, perhaps junior varsity as well ‒ thus far to no avail.

“The purists think that’s the end of soccer,” Roberts said.

Given the nature of football, it’s no surprise the sport leads the ways in the risks posed by concussion. But it’s not alone among high school sports.

According to a report by the American Journal of Sports Medicine, football had an average rate of 64 concussions per athlete per 100,000 games or practices in 2008 through 2010.That was followed by ice hockey, at 54 per 100,000, boys’ lacrosse at 40, girls’ lacrosse at 35 and girls’ soccer at 34.

But with some 40,000 players, far more than any other high school sport in Michigan, football leads the way in concussions. The U.S. Centers for Disease Control estimates there are more than 25,000 emergency room visits a year for traumatic brain injury among football players under age 19, second only to bicycling among all sports and recreational activities as a cause of head trauma.

The sweet science

To be sure, it’s not as if sports like football and soccer suddenly became dangerous.

Boxing had been known to cause what is now known as CTE since the 1920s, an era when ex-fighters were commonly described as “punch drunk.”

But in 2005, a forensic neuropathologist published findings on his examination of the brain of former Pittsburgh Steeler linebacker Mike Webster, who died in 2002 with severe dementia. He concluded Webster had CTE ‒ the first time it was confirmed in an NFL player.

A 2015 Boston University study of former NFL players concluded that the risks to cognitive functioning rise the longer an individual plays football. Players who began football before age 12, had “greater later-life cognitive impairment” as measured by a battery of cognitive tests, the study found.

By then, states, including Michigan, were taking notice.

In October 2012, Gov. Rick Snyder signed legislation that requires coaches to remove any youth athlete suspected of a concussion. Players removed cannot return to competition without written clearance from a health care professional. It is similar to legislation passed by all 50 states since 2007.

It’s the hope of the MHSAA pilot study to take diagnosis of concussion to a more precise level.

Participating schools use one of two devices to gauge concussion, taking baseline cognitive results from before the season begins to compare with results in practice or competition. It is to be used for two sports each season for both boys’ and girls’ sports, ranging from football to hockey to soccer to volleyball – and yes, cheerleading.

The system used by Northview High School, known as the King-Devick test, compares the baseline ability of an athlete to rapidly repeat single-digit numbers on a computer screen to results recorded after a suspected concussion. The test detects impaired rapid eye movement, attention and concentration that are symptoms of concussion.

Other schools are employing a program called XLNTbrain Sport, which assesses an athlete’s balance and cognition using a smartphone or tablet, comparing the result in competition or practice with baseline scores.

Giving parents pause

In the meantime, it may be the concussion issue is eroding participation in high school football.

According to the MHSAA, the number participants in 11-player football fell 15 percent in Michigan between 2007 and 2014, with declines each of the last 8 years. That exceeds an 11 percent decline in boys attending MHSAA-member schools over that period.

Despite the parade of scary headlines, Northview athletic director Klekotka said he believes recent changes in the way coaches teach football fundamentals is making a positive difference. Northview is in line with many other schools in putting greater focus on tackling without using the crown of the helmet to bring a player down.

In 2012, the NFL endorsed this approach, called Heads Up Football, geared to encourage coaches from youth through high school to teach this technique. Michigan State University football coach Mark Dantonio has even begun teaching players rugby tackling techniques in an effort to reduce the percentage of head-first strikes.

“I think football is safer than it has ever been,” Klekotka said.

Brinks, the trainer, has twin 5-year-old boys, Samuel and Mason, who he says are just becoming aware what the sport of football is about. Though he’s seen his share of concussions, Brinks said he won’t stand in their way if they want to strap on a helmet in a few years.

Brinks still views the sport as relatively safe, and one that builds important qualities of teamwork and leadership.

“I do think the positive life lessons learned through competing in football outweigh the negative consequences. If they want to play football,” he said, “I would support that.”

Source: Roelofs, Ted. “Football and Concussions: Michigan Leaders Take Safety Steps, but the Hits Keep Coming.” Michigan Live. N.p., 24 Oct. 2015. Web. 24 Oct. 2015.


How I Learned to Stop Being a Sideline Coach and Just Enjoy the Game

By CATHERINE PEARLMAN

Today’s parents are not just parents. They are coaches and referees and umpires. I don’t mean the kindhearted people who volunteer their time. I’m talking about the parents on the sidelines. As parents, we don’t just watch our children play sports any more. We are in the game.

Lately I have been focusing on how parents behave at my kids’ games. I have seen some ugly behavior. So many moms and dads have no qualms about yelling at umpires who are only behind the plate because no one else volunteered. I recently saw a parent scream at his kid, “Come on! You can do better!” The child was 8.

I never viewed myself as that kind of mother. For the first few years of parenting my husband and I avoided organized sports. Our kids weren’t competitive killers chomping at the bit to play on a team, and we were plenty psyched to keep our weekends together as a family.

Inevitably, though, our kids decided they wanted to get in the game. My son played baseball and basketball. My daughter, who never cared much for sports, was strongly encouraged (by us) to find a healthy physical activity. She chose water polo — a game we knew nothing about.

Three times a week I watch my daughter in the pool and twice per week my son is on the field. After seeing the craziness many parents bring to youth sports, I was determined not to join the insanity. I wasn’t going to yell or advise. I wasn’t going to praise every minute play or action. My plan was to simply enjoy watching them enjoy themselves.

Only I couldn’t. As much as I tried, I still found myself shouting. I wanted my daughter to swim more aggressively. I wanted my son to put his hand behind his back while catching. He should swing through the ball more. She should call for the ball more. Blah blah blah. I became so disgusted with myself that I became determined to sit at a game and say not utter word of advice. But, well, I couldn’t do it. I failed. Repeatedly.

And then, in eight minutes, I was cured.

My daughter’s water polo team had a family polo game, kids against parents, yesterday morning. My husband and I suited up, put on the ridiculous headgear and eagerly jumped in. The old folks warmed up for a minute and tried to stay afloat. Everyone was laughing, giggling, having a fun ol’ time. Then, one second after the initial whistle from the coach, it became clear this was no laughing matter. We had to swim back and forth and back and forth. I could barely keep my head above water while trying to throw the ball. Another player nearly drowned me, appropriately, trying to get the ball (She’s 9). After three minutes I was tempted to tap out.

I didn’t, and wound up playing a whole eight minutes. I didn’t do the team’s requisite 20 laps as a warm up, and I didn’t practice for another hour after that. Eight minutes total. As I clumsily slogged out of the pool, deprived of breath and barely able to pull my own body weight, I realized I had no business telling my daughter what to do in the water (and there is no added benefit to nitpicking my son’s game, either).

My kids are not playing sports for the scholarship potential. There is absolutely no justified reason I need to coach them from the sidelines. The only outcome I can see is that they get so sick of hearing my commentary that they stop playing. I read in a recent survey that 70 percent of kids stop playing sports by 13. I can see why. There is so much pressure even without comments from the bystanders. From now on I am a spectator. I am not there to help my kids get better or stronger or more adept at the game. I am not there to teach the coach or the umpire how to do their jobs. I am simply going to enjoy the game, keep my big mouth shut …

… and stay dry.

Source: Pearlman, Catherine. “How I Learned to Stop Being a Sideline Coach and Just Enjoy the Game.” The Huffington Post. TheHuffingtonPost.com, 23 Oct. 2015. Web. 23 Oct. 2015.

 


Confronting concussions: The real heads-up play

By MIKE FORNABAIO

GREENWICH — Like most everyone else who has ever put on a helmet, John Marinelli figures he had a few concussions during his career.

They were collateral damage, the risk associated with playing football in the best league in the state, and later, at Division III Trinity College in Hartford.

Now, as the first-year head coach of the Greenwich High School football team, Marinelli is among those all across the country who are keenly aware of these game-changing head injuries and are working to identify them swiftly and address them deeply.

“Concussions have always been a concern in football,” Marinelli said Friday night. “In the era when I played, your teammates would help you hide it so you could play. But as a kid, you don’t realize how important it is to get the proper treatment.

“I played for two great programs at New Canaan and Trinity. The practice schedules, the techniques, the fundamentals, all of it was geared toward avoiding contact until game day.”

Striking a balance between competing at full speed and confronting concussions isn’t always easy.

In this Hearst series about concussions, we’ll look at how evaluation and treatment have evolved in recent years. We’ll also examine the push at every level — local, state and national — to improve concussion awareness and to ensure that young athletes who suffer concussions get the medical attention they need to recover.

A concussion, according to the U.S. Centers for Disease Control and Prevention, is a mild traumatic brain injury. The CDC describes it as an injury that changes the way the brain normally works.

Symptoms include headaches and dizziness, but unusual behavior such as altered sleep patterns and a sensitivity to light can also be signs.

Judicious treatment is essential — not only to rule out a more-serious head injury, but because delayed treatment can lead to a longer recovery time, experts say.

Tricia McDonough Ryan, a pediatric neuropsychologist at Gaylord Specialty Hospital in Wallingford, noted in a recent presentation in Norwalk that of the three million concussions reported each year in the United States, two million are suffered by children.

The recovery process is critical, an incremental regimen of mental stimulation and rest from activities, including classwork and athletic competition.

After three games this season — Greenwich High had a bye this weekend — Marinelli said four of his players have been diagnosed with mild concussions. At this point last year, another 10 to 15 players had experienced concussions, he said.

“A lot of coaches used to think the more you hit, the better you’re going to be on game day. I couldn’t disagree with that more,” Marinelli said. “It’s more important to teach good tackling fundamentals in practice so when game day comes, the kids are in a situation where they have the proper tools and technique to succeed.”

As research on the long-term effects of multiple concussions continues, the narrative focuses on the likes of former San Francisco 49ers linebacker Chris Borland, who retired this year after playing just one season in the NFL because of his concern for future head injuries.

There is a dramatic difference between one or a few concussions, and repeated ones that go ignored, experts say.

In Connecticut, state legislators have passed laws aimed at increasing awareness of concussions in youth sports, including high schools. The Connecticut Interscholastic Athletic Conference has also made big changes in football to limit exposure to concussions.

The state Board of Education now requires schools to compile head injury data. The new protocol calls for athletes to be removed from competition the moment a concussion is even suspected. Athletes with concussions are not allowed to resume play until they are cleared by a medical professional, typically a neurologist.

That awareness is a good thing, says Shelton High athletic director John Niski.

“We don’t want to go overboard and swing the pendulum too far, where it’s flag football and everyone’s running around in bubbles,” Niski said.

The careful inspection of equipment and the proper use of techniques on the field will also help limit exposure to concussions. But they won’t eliminate them.

“I started doing this 12, 13 years ago. At that time, nobody really saw that many kids with concussions because they all went into the emergency room,” said Michael Lee, a Fairfield pediatrician who specializes in concussions. “The doctors in the emergency room (back then) said, ‘Oh, take it easy, and when you feel better, go back.’

“I think there are kids who will fall through the cracks,” Lee said. “A kid goes to the emergency room with a fractured nose, very often they forget there’s a concussion associated with it because they’re so focused on the fractured nose. Sometimes, people don’t look for a concussion when it presents itself.”

Traumatic brain injuries can happen anywhere and anytime — a car accident on the Merritt Parkway, the detonation of an IED in Afghanistan, a toddler who stumbles and hits the corner of a coffee table.

Soccer headers are often seen as a primary source of concussions, but a recent study published in JAMA Pediatrics said player collisions are more often the cause.

For example, a hockey player could suffer a concussion on a borderline check, but being hit in the head by a puck could also yield the forces necessary for a concussion.

The scenarios continue in basketball, lacrosse, baseball, softball and other sports.

If concussions aren’t considered an epidemic, they seem to be on everyone’s mind.

Concussions can cost athletes chunks of their careers, pages of their memories, or worse, years of their lives.

Casey Cochran, the former UConn and Masuk High quarterback, abruptly chose to end his football career last season after suffering repeated concussions behind center.

Professional hockey players Mike Richter, Pat LaFontaine, Marc Savard, Jeff Beukeboom, Jeremy Colliton and Patrick Wey have all been impacted by concussions.

But for youngsters playing recreational or high school sports, the focus is on one concussion and how to handle it, making sure removal-from-play guidelines are followed and treatment begins promptly.

Attorney Paul Slager, a partner at Silver Golub & Teitell in Stamford, said at a recent conference in Norwalk that he appreciates concerns about liability. Slager also said that as new legislation is passed, these efforts will help decrease potential liability.

“When things are safer, when policies are put in place designed to keep people from having multiple concussions, for example, or in some cases from having concussions at all, liability decreases,” Slager said.

“When that happens, when people are acting in a safe way, and they don’t subject themselves to liability by acting in a safe way. … We have plenty of other kinds of cases we’d rather be doing than kids getting hurt with concussions.”

Parents can stay informed, too, said Jack Couch of Norwalk Youth Lacrosse: Know the rules of the sport and understand how to keep the game safe.

When injuries happen, following the protocols will get young players back to normal activities quickly.

“I’m not looking to try to pull in sports,” said state Rep. Diana Urban, a Democrat representing North Stonington and Stonington. “I want (sports) to be as safe as they can be.”

Urban said she’s an equestrian rider and her son played tennis at Williams College. As a rider, Urban said, she always wears a helmet.

“That’s a parameter I can control,” she said. “I can’t control if the horse crashes.”

Source: Fornabaio, Mike. “Confronting Concussions: The Real Heads-up Play.” GreenwichTime. N.p., 17 Oct. 2015. Web. 17 Oct. 2015.


Concussion prevention in soccer tied to strength, technique

By RANDY WHITEHOUSE

Researchers, doctors and athletic trainers are always searching for ways to prevent concussions. Part of that requires having a better idea of the risks athletes face.

But parents can put athletes at greater risk for other health problems by taking drastic actions to protect their children.

“My biggest worry with concussions right now is the fact that we are terrifying parents about playing sports, whether it be soccer, football, rugby, lacrosse, hockey, basketball, you name it. We’re terrifying our parents and they’re making decisions about activities, and that’s the worst thing we can do,” said Dr. Paul Berkner, director of the Maine Concussion Management Initiative at Colby College.

“We have a population of young adults who don’t do anything near as much. Our obesity rate in children in Maine is terrible. If we start having people not participating, I think the long-term risks from obesity are probably higher than the long-term risks from concussions,” Berkner said.

Athletes can take steps to reduce their risk of concussions, experts say. Some are quite basic.

“Being in good overall physical condition is very, very important,” said Dr. Chris Lutrzykowski, a specialist with Maine General Health.

Much like tackling in football, experts are still debating banning or placing age restrictions on heading in soccer. Some suggest simply enforcing the rules will reduce aggressive body contact and reduce concussions, while others believe that even repetitive head-to-ball contact in younger children can cause brain trauma.

More and more soccer players are now wearing headgear for protection. The equipment, which can cost anywhere between $20-$80, can prevent external head injuries such as cuts and bruises, but experts say they don’t have a clinical link to reducing concussions.

“There is no data that supports the use of headgear makes a difference whatsoever,” Berkner said. “In football, helmets are designed to reduce skull fractures, not to reduce concussions.”

Lutrzykowski said some studies have shown improved neck strength can reduce the risk of soccer concussions. Stronger necks can reduce the whiplash effect that can cause or exacerbate a concussion.

With that in mind, Colby College head athletic trainer Tim Weston said his athletes are incorporating more exercises to strengthen their necks and trapezius muscles into their conditioning programs.

Contact from heading the ball is the biggest risk factor, although head-to-head or head-to-body contact poses a far greater risk than head-to-ball contact.

“I think it’s critical to have that neck and upper-body strength, particularly in soccer,” he said.

 Source: Whitehouse, Randy. “Concussion Prevention in Soccer Tied to Strength, Technique – Central Maine.” Central Maine Concussion Prevention in Soccer Tied to Strength Technique Comments. N.p., 03 Oct. 2015. Web. 03 Oct. 2015.