MHSAA introduces concussion testing pilot programs, insurance

By HUGH BERNREUTER

More than 25 years ago, Pete Ryan was blindsided during a football game and couldn’t remember the second half.

Finally, Monday, he was tested for a concussion.

Ryan, the Saginaw Heritage athletic director, was the test subject Monday for a new pilot program provided by the Michigan High School Athletic Association to help schools diagnose and document concussions.

“You already have a lot of schools out there doing things as far as in-game testing,” MHSAA information director John Johnson said. “The pilot programs are tests of the programs we’re using and the schools are using. We wanted to have enough schools involved to get some meaningful data back.”

Seventy schools will participate in two testing programs for the 2015-16 school year, committing to involve at least two sports for each gender each season.

The two programs are the King-Devick Test and the XLNTbrain Sport program.

Ryan, a member of the MHSAA Representative Council, was the test subject for the King-Devick Test, which asks athletes to read single-digit numbers on a tablet to detect changes in eye movement, attention, language and concentration after a hit to the head.

“It’s not hard,” said Ryan, who played football for Iron Mountain in 1987. “The idea is that ocular relations can determine if there is a concussion. The average baseline time is between 28 and 40 seconds.”

Athletes are tested prior to competition to determine a baseline number to compare against post-collision numbers. Ryan took the test twice. The first time took 41 seconds, the second 31.

The XLNTbrain Sport program involves a series of balance and cognitive tests to measure reaction time, attention, inhibition, impulses, memory, information processing, moods, anxiety and stress.

“They are two very different kinds of tests,” Johnson said. “King-Devick is well-established as far as what it does, and it’s endorsed by the Mayo Clinic. We will get feedback for both tests.

“The XLNT takes longer, from 26 to 30 minutes. The King-Devick only takes a few minutes. They are two completely different set-ups to get to the same end, basically to let coaches know if there are any red flags that come up to withhold a child from playing.”

The high school association will also mandate record-keeping for all member schools regarding potential concussion events from detection to the athlete’s return to play. The requirement applies to both genders and all levels of sports, from seventh grade through 12th grade.

“This is an all-sports thing,” Johnson said. “People think concussions, and they think football. But concussions cover all sports at all levels. We’re covering a lot of ground and anticipate getting a lot of data that we can use.”

The association will also provide extra insurance, free to its member schools and athletes. The insurance will help pay accident medical expenses, covering deductibles and co-pays left unpaid by other policies.

“It’s something that’s been well-received,” Johnson said. “We’re the first state association in the country to provide this insurance and the only one to do it at no expense to the school.”

Source: Bernreuter, Hugh. “MHSAA Introduces Concussion Testing Pilot Programs, Insurance.” N.p., 04 Aug. 2015. Web. 04 Aug. 2015.


New Concussion Tests to Help School Athletes

A new concussion screening couldsave our kids’ lives.

Football has been at the forefront of concussion talk and with high school training camps beginning on Monday,parents can feel better that schools will be more prepared to handle their athletes’ well-being.

After a year of strict testing, the Mayo Clinic is introducing a new sideline concussion test called King-Devick. It can be completed in just minutes using a pattern of numbers that becomes impossible to follow when the brain suffers a trauma. Doctors say this is important because a person does not have to lose consciousness to sustain a concussion.

Current regulations on concussions say that an athlete must be symptom-free in order to return to the playing field, however Dr. Royce says the brain can take up to two months to full heal after suffering one. He believes athletes should be required to sit out a minimum of one month before being cleared for activity.

“The athlete may have sustained a concussion without actually hitting his or her head. There may be an indirect blow to the body rattling the brain around within the cranium which could cause the concussion,” said Dr. Jeffrey Royce.

Source: “New Concussion Tests to Help School Athletes.” WIFR RSS. N.p., 03 Aug. 2015. Web. 03 Aug. 2015.


High School Football: Governor approves concussion law

Illinois Gov. Bruce Rauner has approved a measure requiring students who suffer a concussion to get permission from a doctor or trainer before they may fully return to class or sports.

The legislation Rauner signed on Monday becomes law immediately.

The law extends some concussion-related measures already in place in high schools to elementary and middle schools and expands them. It includes private as well as public schools.

All schools also must create a plan for dealing with concussions.

State Sen. Kwame Raoul sponsored the measure after both of his teenage children suffered concussions. The Chicago Democrat said he saw the impact the injury had on their academic performance.

The Illinois High School Association, which oversees prep sports in the state, supported the measure.

Source: “High School Football: Governor Approves Concussion Law.” The Register-Mail. N.p., 03 Aug. 2015. Web. 03 Aug. 2015.

Concussions Are Common During Sports Practice

New research from the New York Institute of Technology suggests that concussion awareness should be a part of a high school and college athlete’s sports education.

“Practice is the common time when athletes suffer concussions,” Dr. Hallie Zwibel, researcher and acting director for New York Institute of Technology Center for Sports and Wellness, said in a statement. “For student-athletes, it’s important to know the signs and symptoms of concussion, work on your balance and muscle strength, be aware of where you are in the space of a playing field or court and the actions you’re taking, and of course making sure your helmet fits properly, is well-maintained and is worn correctly.”

According to Zwidel, parents and coaches should know enough about concussions to be able to recognize its symptoms. They should also direct athletes suspected of suffering from a concussion to sit out the rest of a game or match and seek evaluation and treatment within 24 hours.

“A simple set of questions and exams to check mental status, speech, and physical reactions should be done immediately on the field,” he said. “Just because you have an injury to the head, it doesn’t mean it’s a concussion. It could be even more serious — so get seen by a physician for an evaluation.”

That’s where pre-season baseline testing is important.

“We can screen for increased risk factors, such as ADHD or history of a previous concussion,” Zwibel added. “We can test for memory, processing speed, and reaction time — information that’s useful when we have a patient who later suffers a suspected concussion.”

Treatment and rehabilitation has changed greatly since the days when those with concussions were told to simply rest.

“We treat visual issues, balance, cognition, headaches, and sleep disorders that may result from a concussion,” Zwibel said. “Just because someone suffers a concussion, it doesn’t mean there’s nothing we can do. And we look at the student-athlete as a whole. It’s not just getting back in the field — it’s returning to play and returning to learn.”

Source: “Concussions Are Common During Sports Practice.” University Herald RSS. N.p., 31 July 2015. Web. 31 July 2015.


Glen Rock school board updates concussion policy

By RICHARD DE SANTA

Amid ongoing health concerns about sports-related head injuries, the Glen Rock Board of Education adopted a revised concussion management policy at its July 6 public meeting.

Citing Centers for Disease Control and Prevention statistics that at least three million sports and recreation-related concussions occur in the U.S. every year, the policy language states that the “competitive athletic culture of playing through pain or ‘toughing it out’ puts student-athletes at risk of brain injury, disability and death.”

While noting that allowing a student athlete to return to play before recovering from a concussion increases the chance of more serious brain injury, the policy holds that the effects of concussion, while not preventable, can be “mitigated by proper recognition and appropriate response.”

To that end, the BOE policy now stipulates that all coaches, school nurses, school/team physicians and certified athletic trainers must complete an interscholastic head injury training program, such as the National Federation of State High School Association’s online “Concussion in Sports Training” program, or a comparable program that meets mandated criteria.

The chosen program must include training in the recognition of the symptoms of head and neck injuries, concussions and injuries related to “second impact syndrome,” and a description of the need for appropriate time to delay the return to sports competition or practice of a student athlete who has sustained a concussion or other head injury.

However, the policy also states that if no additional time is specified for a particular age group or sport, the student athlete may return “when written medical clearance is given to the athlete, stating that he or she is symptom-free and has already completed an appropriate, graduated, individualized return-to-play protocol.”

The guideline also requires annual baseline (cognitive response) testing for all middle school and high school student athletes prior to sports participation using the ImPACT online testing program.

Regarding in-game incidents, it mandates that any student athlete suspected of sustaining a concussion or “exhibiting or complaining of” concussion-related symptoms — or any student who has sustained a concussion or has become unconscious during a practice or athletic contest — be removed from play and not permitted to return that day.

In each instance, a medical evaluation must be performed by a certified athletic trainer (ATC) and/or school doctor or other certified and approved medical personnel to determine the “presence or absence of a concussion.” If a student is diagnosed with a concussion, a minimum seven-day wait before returning to activity is imposed.

The policy states the student “must be free of all concussion symptoms for seven days prior to return.”

In addition, the same cognitive ImPACT test administered previously as a baseline is to be used to determine whether physical clearance and return to activity are appropriate. The test would be administered and/or evaluated by a BOE-approved, concussion-trained doctor.

Following such clearance, the certified athletic trainer and coach are directed to implement a “gradual and acclimated” return to activity under “Zurich Consensus Statement” guidelines.

The revised policy also requires that the N.J. Department of Education Concussion and Head Injury fact sheet — and the Glen Rock district’s Concussion Policy Acknowledgement form — be distributed annually to every student athlete who participates in interscholastic sports.

Parents must sign and return the form prior to student participation in any athletic practice or event.

Source: De Santa, Richard. “Glen Rock School Board Updates Concussion Policy.”NorthJersey.com. N.p., 31 July 2015. Web. 31 Aug. 2015.


Concussion prevention, recovery a top priority

Nebraska is taking serious steps to limit sports concussions by training athletes ages 19 and younger how to avoid the injuries, and, just as importantly, how to ensure athletes completely recover from concussions before they return to competition. Coaches are helping athletes to avoid concussions, and medical professionals are assisting with recovery.

The Nebraska Sports Concussion Network has trained more than 450 physicians, mid-level practitioners, and other health care providers across the state in a program that will help them make safer, more objective management decisions for sports-related concussions.

Nebraska’s Concussion Awareness Act is a new law that affects schools and sports organizations for youths, including club sports, or any youth organization sponsoring a sporting activity where there is a cost to participants or where such costs are sponsored.

Among the critical elements of concussion prevention and rehabilitation is the ImPACT test. Athletes take a computer-based preseason baseline test that charts their mental performance. Then, if an athlete sustains a concussion, he or she takes the test again. Athletes are allowed to compete again only when they can perform the post-injury test as well as they did on the baseline test and when they can pass a physical examination. A physician or other licensed health care provider and a parent must provide written clearance or the athlete cannot return to play.

Physicians will have the opportunity on Aug. 18 to attend training in Kearney for the ImPACT test in their clinical practice.

Dr. Daniel J. Tomes will conduct the training and educate primary care, pediatric, internal medicine, trauma emergency physicians and mid-level practitioners who treat concussed athletes. Tomes is the medical director for the Nebraska Sports Concussion Network and board certified in neurosurgery, The training session with Tomes is scheduled for 6:30-9:30 p.m. at CHI Health Good Samaritan in Kearney.

How coaches, trainers, parents and local physicians respond to concussion injuries is important because it involves the future development and well-being of the young injury victims.

“Research has indicated multiple concussions can affect academic performance, prolonged recovery, and hasten the development of neuro-degenerative disease, namely dementia,” Tomes said.

Sports concussions are serious injuries that demand the appropriate response. The Aug. 18 training is an opportunity for front-line physicians and other medical professionals to be ready to respond when young patients need help.

Source: “Concussion Prevention, Recovery a Top Priority.” Kearney Hub. N.p., 21 July 2015. Web. 21 July 2015.


Research suggests football helmet tests may not account for concussion-prone actions

When modern football helmets were introduced, they all but eliminated traumatic skull fractures caused by blunt force impacts. Mounting evidence, however, suggests that concussions are caused by a different type of head motion, namely brain and skull rotation.

Now, a group of Stanford engineers has produced a collection of results that suggest that current helmet-testing equipment and techniques are not optimized for evaluating these additional injury-causing elements.

The ideal way to test any protective gear is to gain a sense of what causes the trauma, set up a system that replicates the way the trauma occurs, and then evaluate the gear against the injury-causing criteria. For the past several years, David Camarillo, an assistant professor of bioengineering and, by courtesy, of mechanical engineering at Stanford, and his students have been collecting and analyzing data in hopes of identifying the signature skull motions that cause concussions.

The brain is like a bowl of Jell-O. Give the bowl a push, and the dessert takes some time to react, but once it gets moving, the Jell-O overshoots its limits and begins wiggling back and forth. This period of brain movement within the skull is a potentially dangerous time for injury to occur.

Acceleration is important, but so is the timing of deceleration, Camarillo said. If the bowl moves forward right as the Jell-O is decelerating backward, it could cause the Jell-O to deform even further.

“The same is true for the brain moving within the skull,” Camarillo said. “It’s possible that injury happens when the head whips back and accelerates the brain in one direction right as the brain is starting to go in the opposite direction.”

Camarillo’s team first set out to determine what degree of oscillation is dangerous. They fed pre-existing MRI data into a computer model of the brain, and found that the brain’s relative motion is amplified when the head oscillates at 15-20 Hz, completing a single back-and-forth motion in about 50 milliseconds.

They compared this to field data of sports-related head impacts - which they had collected over the past several years from Stanford football players who wear mouthguards instrumented with accelerometers - and found that players frequently experienced head oscillations in the 20 Hz range.

“We know that if the head shakes at that frequency, the brain starts to rattle more violently,” said Kaveh Laksari, a postdoctoral scholar in Camarillo’s lab, and first author on the paper. “So we have this mechanical system that exhibits a dangerous mode of motion, and then we find that the in-game impacts excite it at that frequency or something close to it. This introduces a fresh viewpoint on the possible cause of repetitive brain trauma. We need to keep that in mind when we’re designing protective equipment.”

Testing the test

The standard test for every football helmet used in the NFL or NCAA involves a guillotine-like device that drops a helmet-clad dummy head from multiple heights to approximate various impact magnitudes.

But when Fidel Hernandez, a Stanford doctoral candidate in mechanical engineering, began comparing results from this drop test to what Camarillo’s group had observed in the field, it was like looking at two different data sets.

High rotational velocities, which are thought to induce brain strain and have been predictive of concussions, were observed in the field impacts but not the drop tests. And while field data showed rotational head motions in the 15-20 Hz range, drop tests generated much faster, 100 Hz movements.

Similarly, rotational accelerations were substantially lower in certain drop tests. Drop testing was also unable to produce accelerations across the full six-degrees-of-freedom spectrum of directions observed in field impacts, and which Camarillo’s group has previously shown are important factors in an injury.

“The problem with having a model that doesn’t re-create what players actually experience in the field, is that you could optimize a helmet to perform well in the drop test that unintentionally performs poorly in the field,” said Hernandez, who was lead author on the study. “For instance, you could design a helmet to stop linear head motion or high-frequency head vibration, because that shows up in the test, but that might not be what is most dangerous to your brain.”

Setting a new standard

The new work suggests there’s room for improvement, Camarillo said. Currently, the two primary tests for evaluating helmet safety measure the duration of the acceleration for only 15-36 milliseconds, which he said is probably too short a period given that the brain takes more than 50 milliseconds to begin moving, and the real injury may occur after that.

Camarillo’s group is testing a slingshot-like system that propels an impactor into a stationary head to test impact velocities and accelerations in six degrees of freedom. They are also experimenting with various crash-dummy necks to make sure that it flexes in a way that is more similar to actual humans, and testing if tweaking the drop test could help it better mirror field data.

The work, and ultimately identifying the key trauma-inducing factors, has a long way to go, Camarillo said, and could benefit from stricter guidelines.

“My opinion is that there should be some government regulation in standardizing helmet tests,” Camarillo said. “Hopefully people can use the methods we’ve described here to show that impact forces are being reproduced sufficiently or realistically compared to what’s happening in the field.”

Source: “Research Suggests Football Helmet Tests May Not Account for Concussion-prone Actions.” Research Suggests Football Helmet Tests May Not Account for Concussion-prone Actions. N.p., 20 July 2015. Web. 20 July 2015.


Concussion seminar stresses having plan of action

About 70 area coaches, school nurses, activity directors and others gathered Friday in the Heckart Performing Arts Center at Smith-Cotton High School to learn about symptoms, diagnosis and treatment of concussions in student-athletes during a seminar presented by Bothwell Regional Health Center, the Missouri Orthopedic Institute and Sedalia School District 200.

The session included discussions of concussion incidences in young athletes, the need to create a plan of action to address affected athletes, sideline and locker room management, and methods and timelines for returning students first to the classroom and then to the playing field.

Dawn Belmore, a recreational and club sports athletic trainer at the University of Missouri-Columbia, told the group that a student who typically is outgoing and high performing in school can become quiet, moody and disruptive after a traumatic brain injury, and the priority must be to help the student through the process of recovery, which can include short-term academic accommodations such as advance notes for a class discussion.

Bryan Smith, S-C’s athletic trainer, stressed the mindset of “when in doubt, sit them out.” He also noted that every athlete and every head injury is different, so comprehensive and often repeated evaluation is needed.

The seminar was an enhancement included in Sedalia 200’s contract with Bothwell for athletic training services.

Source: “Concussion Seminar Stresses Having Plan of Action - Sedalia Democrat - Sedaliademocrat.com.” Sedalia Democrat. N.p., 17 July 2015. Web. 17 July 2015.


Letter: Player safety a priority

By MIRANDA ROGLIANO

Dear Editor:

Due to the recent United States Women’s World Cup victory, high intensity contact sports have once again been brought to the public eye. These contact sports have become a lifestyle — with the competitive demands of the sport increasing with a child’s age.

Children today are asked to choose one sport to invest all of their time and energy in hopes of a ticket to college or becoming a professional. However, are children capable of making a decision that will affect their lives long-term?

Recent discoveries have shown that serious brain damage is occurring in the form of Chronic Traumatic Encephalopathy. With modern technological advances, we are now able to recognize and record cases of Chronic Traumatic Encephalopathy, a disease that has previously been unacknowledged. It is caused by trauma and impact to the head.

As a result, it is most commonly found in individuals involved in the military and contact sports such as American football, soccer, hockey, and lacrosse. This disease attacks the regions of the brain that control emotion and memory, but effects differ based on age.

The players’ safety needs to be prioritized rather than validating the controlled brutality of the sports. Because children and parents struggle to make unbiased decisions, the ruling bodies of contacts sports, such as the NFL, have created some regulations.

Nevertheless, further measures need to be taken. Increasing the playing field’s size and reducing the number of players on the field would help to decrease the amount of head trauma.

Source: Rogliano, Miranda. “Letter: Player Safety a Priority.” The Sentinel. N.p., 17 July 2015. Web. 17 July 2015.


Why Concussion Recovery Takes Longer for Some Kids

By ROBERT PREIDT

Some children recover more slowly from concussion and other types of traumatic brain injury because they have extensive damage to the protective coating around brain nerve fibers, a new study says.

Researchers looked at 32 patients, aged 8 to 19, who had suffered a moderate to severe brain injury in the previous five months. The kids underwent tests to assess how fast they could process and recall information.

The researchers also recorded electrical activity in the patients’ brains to determine how quickly their brain nerve fibers could transmit information. And imaging scans assessed the structural condition of the youngsters’ brain wiring.

“Just as electricians insulate electrical wires to shield their connections, the brain’s nerve fibers are encased in a fatty tissue called myelin that protects signals as they travel across the brain,” Dr. Christopher Giza, a professor of pediatrics and neurosurgery at the University of California, Los Angeles, explained in a university news release.

“We suspected that trauma was damaging the myelin and slowing the brain’s ability to transmit information, interfering with patients’ capacity to learn,” he explained.

Half of the patients had widespread damage to the myelin. They did 14 percent worse on the mental skills tests, and their brain wiring worked three times more slowly than healthy children.

The other 16 brain injury patients had nearly intact myelin. Their brains processed information as quickly as healthy children, and they did 9 percent better on the mental skills tests than those with more myelin damage.

The study, published in the July 15 issue of the Journal of Neuroscience, offers possible indicators that doctors could use to identify higher-risk brain injury patients who require closer monitoring, the researchers said.

“Our research suggests that imaging the brain’s wiring to evaluate both its structure and function could help predict a patient’s prognosis after a traumatic brain injury,” first author Emily Dennis, a postdoctoral researcher at Keck School of Medicine of the University of Southern California, said in the news release.

Traumatic brain injury is the single most common cause of death and disability in American children and teens, according to the U.S. Centers for Disease Control.

Source: Preidt, Robert. “Why Concussion Recovery Takes Longer for Some Kids.” US News. U.S.News & World Report, 14 July 2015. Web. 14 July 2015.