Category: Concussion

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Junior Seau’s Family Will Not Be Allowed to Speak at His Hall of Fame Induction

Junior Seau’s induction into the Pro Football Hall of Fame was always going to be awkward, a chance to celebrate a marquee player known for his bone-crushing career while not dwelling on the injuries that might have precipitated his death.

When his induction was announced at the Super Bowl, his family rejoiced and started thinking about what to say at the ceremony in Canton, Ohio, on Aug. 8. Seau had told them that if he ever made it, he wanted his daughter, Sydney, to introduce him.

But the Hall of Fame does not plan to let Sydney or anyone else speak on Seau’s behalf. Instead, it will show a video commemorating his career, while avoiding questions about his suicide in 2012 at age 43 and the subsequent diagnosis of traumatic brain injury that doctors said they believed was brought on by hits to his head. Nor will the video mention the lawsuit that Seau’s family has filed against the N.F.L., which is trying to curb injuries in active players and address brain disease among its almost 20,000 retired players.

To the Hall of Fame officials, simply showing the video, which will not invoke Seau’s suicide, will keep the focus on his playing days. To his family still grappling with his death, though, the decision diminishes the tribute to one of the sport’s best linebackers and a highly regarded figure in Southern California, where he grew up and played most of his career.

“It’s frustrating because the induction is for my father and for the other players, but then to not be able to speak, it’s painful,” Sydney said. “I just want to give the speech he would have given. It wasn’t going to be about this mess. My speech was solely about him.”

The Hall said Seau’s brain injury and suicide had nothing to do with its decision to show only a video, but Seau’s death continues to haunt theN.F.L., which collaborates with the Hall on the induction ceremony and for years denied any link between repeated hits on the field and brain disease.

Typically, a video produced by NFL Network is shown for each inductee. For living inductees, a family member or a close associate then introduces the player on stage for what is often an emotion-filled speech.

In the past, for deceased inductees, presenters spoke, but Joe Horrigan, a spokesman for the Hall who has overseen the enshrinement ceremony for 20 years, said they often repeated what was in the video, prolonging an already lengthy ceremony. So a few years ago, the Hall eliminated speeches in these cases.

“There was an acceptance speech for deceased players, but it got redundant,” Horrigan said. “The honor is supposed to be for the individual.”

In 2011, no one spoke for Les Richter, a linebacker with the Los Angeles Rams who died a year earlier.

Seau’s video tribute will be five minutes, two minutes longer than for living inductees, Horrigan said. It will include parts of an interview his daughter gave to NFL Network before, she said, she learned that no one would be making a speech.

Not allowing any testimonials raises thorny questions because Seau’s death has cast such a long shadow over his stellar 20-year career, much of which was played in San Diego for the Chargers. The decision comes as the N.F.L. tries to repair the damage to its reputation after years of denying that playing the sport could cause brain disease.

The league agreed to pay hundreds of millions of dollars to settle a lawsuit brought by thousands of retired players who said they were misled about the dangers of concussions. Game rules have been adjusted slightly to reduce the chance of violent collisions, and neuro-trauma specialists now roam the sidelines. The league has committed to spending at least $40 million on concussion-related research.

The Hall of Fame has tiptoed past these issues and focused solely on players’ exploits in the gridiron.

“We’re not the N.F.L., but the Pro Football Hall of Fame,” said David Baker, the executive director of the Hall. “Our mission is to honor the heroes of the game, and Junior is a hero of the game. We’re going to celebrate his life, not the death and other issues.”

At times, the separation can feel artificial. The Hall is an independent nonprofit organization. But the N.F.L. is its largest donor and works closely with it to stage the induction ceremony, which is televised on the league-owned network. The league also organizes the Hall of Fame Game, the kickoff of the preseason, the day after the induction ceremony, and it moved its rookie symposium to Canton, in part so every incoming player could visit the Hall.

A spokesman for the league said that it was involved in many aspects of the Hall of the Fame weekend, including the production of the enshrinement ceremony, but that it left decisions about allowing any speeches to the Hall.

Seau’s former wife, Gina, was “very surprised” by the Hall of Fame’s policy to use only a video because she did not “think Sydney or any of us were going to use the Hall of Fame as a platform.”

Horrigan said the Seaus were given incorrect information about the ceremony before the Hall of Fame formally notified them of its policy on July 9, five months after they had learned Seau would be inducted.

But Gina Seau said she did not question the Hall of Fame’s motives and in the end agreed the focus should be on Junior and his legacy.

“It’s already difficult enough as it is,” she said.

The family’s dispute with the N.F.L. was another matter. After an autopsy showed that Junior Seau suffered from chronic traumatic encephalopathy, a degenerative brain disease linked to repeated head hits, Gina filed a wrongful-death suit against the league on behalf of Seau’s two younger children, Jake and Hunter. Sydney and her brother Tyler, who are adults, joined the suit. They are seeking the equivalent of what their father would have earned, which could amount to several million dollars.

The case, though, was swept into the class-action suit brought by 5,000 retired players. In the settlement, which is being appealed, Gina could have received up to $4 million. The Seaus opted out, though, because the settlement did not address the children’s claims.The family’s lawyer, Steve Strauss, said that the league had declined to negotiate and that he was told by a representative to “take the deal.” The lawsuit should be separate from the settlement, he said, because Seau’s children sued as heirs and “are not party to the collective bargaining agreement” between the players and the N.F.L.

Strauss has asked the federal judge overseeing the settlement to allow the Seau lawsuit to go forward in state court in California, but the judge, Anita B. Brody, has indicated that she wanted to rule on any opt-out cases collectively, he said.

“We want to move forward,” Strauss said. “We have waited two and a half years.”

While the Seaus wait for a resolution to their case, they continue to wonder whether they could have done more to recognize and maybe slow Junior’s decline.

In retrospect, the signs of C.T.E. were there: the memory lapses, the mood swings, the suicidal tendencies.

In October 2010, Seau drove his sport utility vehicle off a cliff along the beach in Carlsbad, Calif., where it landed about 100 feet below. Seau said he had fallen asleep, but it came soon after he had been arrested on suspicion of domestic violence involving his girlfriend.

“I didn’t know the severity of it,” Gina said. “I didn’t want to acknowledge what it was, his first suicide attempt.”

After their marriage ended years before, Gina spoke regularly with Seau, and when she called him a few months after the Carlsbad incident, he seemed depressed.

“He said, ‘I had no idea how many hours are in a day, the days are so long,’ ” she said. “That was a completely obvious statement of a man who was scared. He had so many opportunities, and he couldn’t get there. He was stuck in a bubble.”

Seau’s family and many of his friends will travel to Canton for induction weekend, lamenting that Seau, a lively public speaker known for delivering upbeat messages and for poking fun at himself and the audience, would not take the stage. The Seau family is preparing for a bittersweet weekend.

“It’s been like planning a wedding party without the groom,” Gina said.

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Concussion protocols heading in right direction in Indiana

It was the fall of 2013, and the Northeastern High School football team was in the middle of a run toward the program’s first Tri-Eastern Conference championship.

With an 8-0 lead against Centerville, Northeastern’s star quarterback Joey Claypoole was shaken up during a play and removed for the remainder of the game.

Claypoole stood on the sidelines, and to outsiders, looked perfectly fine.

The symptoms of a potential concussion were not visible to most spectators, and head coach Mike Roeder, Claypoole and the Knights took criticism, for it was the biggest game remaining in the conference season.

Eventually, Centerville rallied for a 34-22 victory over Northeastern, forcing what was at the time a three-way tie atop the conference.

Roeder maintains he made the right call.

“If a trainer or an official or a coach thinks there might be something there, you have to honor that,” Roeder said.

“Sometimes there is nothing there and it kind of frustrates you, but the other end of it is, if you do put someone back in, they could be harmed for the rest of their lives. Nobody wants to take that chance.”

Roeder’s coaching staff faced a dilemma seen too often from coaches and high school athletes.

Revelations from former professional athletes have shown concussions have potential for long-term damages.

The Indiana High School Athletics Association recently has implemented new standards and requirements to ensure players are cleared before returning to competition after a possible concussion.

The IHSAA also requires coaches at every level to take online courses on what to do in case of a concussion, while starting a new data collection study this past sports season.

“I think it’s very important. I think the responsibility of us collectively as an association, a staff, as a member school, administrators and coaches — I think we have a collective duty to ensure the health and safety of our athletes,” IHSAA commissioner Bobby Cox said.

“Everyone is responsible, we can do all we want with it, but if we don’t have cooperative parents, we’re not going to be successful. We can have cooperative parents, but if we have schools that don’t enforce these standards; if the association is not providing vehicles — it’s a collective effort.”

According to data provided by Cox and the IHSAA, there were a total of 2,194 instances of concussions reported to the IHSAA this past season among all sports.

Hamilton Southeastern topped the state with 65, followed by Bishop Chatard at 48.

Like the incident involving Claypoole, the symptoms of a concussion might not be visible right away, but it differs from other injuries because of the sensitivity of the brain.

“For us, obviously what makes it so bad, you’re messing with a person with a young person’s head and cognitive function potential cognitive ability. That’s one of those things there should be no gray area in regards to siding on the side of safety when it comes to concussions,” Richmond coach Matt Holeva said.

“Not to minimize other forms of injuries, but bumps and bruises are going to heal with today’s technology. Just 10, 15 years ago a torn ACL would ruin a young person’s career even at the high school level. Now with medicine — obviously no one wants to see those injures — but those injuries are repairable to some degree. Obviously, when you’re dealing with the human mind and the brain, there’s so much to learn.”

Hagerstown athletic director Gerry Keesling formerly coached football at Earlham College in Richmond. He cautions that helmets only can do so much.

“I think our football players are in the best helmets in the history of the game,” he said. “I think there’s no such thing as a concussion-preventing helmet, there’s nothing out there, because the helmet doesn’t protect the brain, it protects the skull, depending on the space between the brain and the skull. You don’t read anything about fractured skulls. We can’t protect the brain inside the skulls.”

To help prevent concussions, Keesling, Cox, Roeder and Holeva emphasize proper tackling techniques and teaching them at a younger level.

“The best thing is the way you teach tackling,” Roeder said. “We’ve taken the head completely out of it. We do not teach it that way at all. Pete Carroll (head coach) with the Seattle Seahawks has developed a style called ‘The hawkroll,’ where you teach these guys to come in and keep their heads out of it.

“It seems to work. Our kids took to it. They took some pride to learn how to do it right. As far as ball carriers, if a ball carrier lowers their head before impact, they can be penalized.”

Football gets the most attention, but it’s not the only sport where athletes suffer concussions.

A study from the University of Colorado was released earlier this week on concussions in soccer that demonstrated most concussions don’t come from heading the ball but from collisions among athletes.

“There has to be some correlation with long-term brain damage and doing that over the course of a lifetime if you continue to do it,” Richmond soccer coach Matt Haynes said. “People are more worried about dangerous high kicks, (but) head-on-head collisions are the worst.”

Haynes also alluded to a recent World Cup game where Germany forward Alexandra Popp banged heads with United States midfielder Morgan Brian.

Both returned quickly after being checked by doctors, despite the fact that Popp had blood soaking her head.

According to Germany’s coach, Popp had a laceration but no concussion.

“At that level, what does a coach say?” Haynes said. “At that level, a professional says, ‘I’m going back in.’ Kids at this (high school) level, you have a bit of authority, saying, ‘No you’re not.'”

For Courtney McCord, a two-year athletic trainer at Richmond High School, it’s taken time to adjust.

She says male athletes tend to fight back against leaving a competition more than female athletes do.

“It’s such a hot topic, I usually err on the side of caution,” she said. “They only do have one brain. High school sports are a part of their lives, but in the long term, I usually err on the side of caution. I don’t think that makes them too happy because they want to keep playing.”

When players hit their heads, or appear to be banged up, McCord checks for dilated pupils, dizziness, strange behaviors and thirst.

She also conducts memory exercises, such as asking them to recite the months backwards starting with December and giving athletes five words to check their memory recall.

There is no perfect cure for concussions, but from the IHSAA down to schools, coaches, officials and student-athletes, strides are being made to minimize the damage.

“I think that they’ve made a lot of good steps in the right direction,” McCord said. “Just seeing how old football players, old athletes are now having that problems from undiagnosed concussions, they’ve definitely made steps in educating everyone.

“… I think parents are more understanding of it, older generations of parents they’d be like, ‘Oh I did this many, many times.’ I think parents are more aware and understanding of when you want to hold their kids out.”

ORIGINAL ARTICLE:

http://www.indystar.com/story/sports/high-school/2015/07/21/indiana-high-school-football-concussion-protocol-prevention-ihsaa/30455109/

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NFL and GE announce prize-winning concussion research

Six innovative studies on identifying concussions, the severity of brain trauma injuries and speed of the healing process have been named winners of the GE & NFL Head Health Challenge.
Some practical applications from the researchers, who each received a $500,000 award to advance their work, could be seen within the next two years, said Jeff Miller, the NFL senior vice president of the league’s Health and Safety Policy.
“It’s not too far in the future,” Miller told Reuters in an interview.
“This partnership has proven to be all that we had hoped and vastly more in terms of being able to advance the neuro sciences in ways that will lead to better protection and the health and safety of our players.
“And have significant impacts beyond the football field, other sports and throughout our community and the military.”
Head injuries have become a high priority for the NFL in recent years.
The issue of concussion and the effects of chronic traumatic encephalopathy (CTE) on former players was intensified following the suicide deaths of Junior Seau and Dave Duerson, who shot themselves in the chest to preserve their brains for study.
In April, the league also reached a final settlement of a lawsuit brought by former players over concussions that could cost the NFL $1 billion.
Three of the winning projects, Banyan Biomarkers Inc. of San Diego, University of Montana, Missoula, and Quanterix of Lexington, Massachusetts, study blood for biomarkers that inform different aspects of concussion.
The other three, BrainScope Company Inc. of Bethesda, Maryland, Medical College of Wisconsin, Milwaukee and the University of California, Santa Barbara, focus on neuroimaging tools and EEG-based traumatic brain injury detection to analyse and understand concussions.
“The lessons we are learning and the innovations we are helping to accelerate are not only going to help us and society overall around mild traumatic brain injury and the safety of the game, and improve safety for athletes across other platforms,” Alan Gilbert, director GE’s Global Government and NGO Strategy, told Reuters.
“We’re going to learn and be able to apply those lessons to things like ALS (Amyotrophic lateral sclerosis or Lou Gehrig’s disease), Alzheimer’s and Parkinson’s.
“We feel that it’s already happening — partnerships we’re doing right now with ALS are a direct result around this multiplier effect because we partnered with the NFL.”
Miller envisioned tests being administered on NFL sidelines or at the stadium to quickly diagnose concussions and their severity.
“Blood tests on the sideline, better imaging to identify a concussion — that’s the sort of transcendant science we were hoping to capture and encourage by running this challenge,” he said.
Two other NFL Head Health Challenge projects to protect the brain and to find materials that better absorb or dissipate energy in protective equipment are also ongoing in conjunction with GE and equipment manufacturer Under Armour.

More from: http://www.gmanetwork.com/news/story/527558/sports/othersports/nfl-league-and-ge-announce-prize-winning-concussion-research

ORIGINAL ARTICLE:

http://www.reuters.com/article/2015/07/23/us-nfl-concussions-idUSKCN0PX1CB20150723

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Air Force Academy takes part in nation-wide concussion study

Hundreds of basic cadets lined up at the Air Force Academy July 13 to help experts learn more about head trauma.

All Academy cadets are taking part in a three-year, $30M collaboration between the Defense Department and the NCAA to study concussions. Eighteen universities in the United States and the military service academies are participating in the research project.

The study coincides with the White House Summit on sports concussions, a presidential commission created in May 2014 to encourage the identification, treatment and prevention of serious head injuries.

Each basic cadet spent about an hour in a Fairchild Hall laboratory completing   concussion history and symptom inventories, and balance, memory and cognitive tests.

“The collected results of these evaluations will be compiled into a database and form a baseline of a cadet’s complete physical assessment,” said Col. Darren Campbell, director of the Academy’s Concussion Center.

“By having a baseline, we then have something to compare when they are injured,” Campbell said. “We know what their ‘norm’ should look like.”

This baseline is collected by computer-based neurocognitive assessments and one-on-one testing of brain and balance performance given when cadets are healthy, and compared to results when a cadet returns to duty or to the athletic field.

Intercollegiate athletes at the Academy account for about 50 percent of concussions reported in the Cadet Wing, said Lt. Cmdr. Brian Johnson, a behavioral science professor at the Academy.

“Regardless of participation in the national research study, all cadets are given the same level of care,” Johnson said. “We treat every cadet the same and we focus on this issue for long-term effect.”

To comply with NCAA standards, the Academy has conducted neurocognitive testing on its athletes for more than 10 years. The Academy began testing all freshmen in 2014 as part of the DOD-NCAA study to collect a larger test group.

“By using the same measures as the other sites, we can (compile) our data to paint a much clearer picture of what concussions and recovery times look like,” said Dr. Chris D’Lauro, a professor in the Academy’s Behavioral Science Department.

Steve Broglio is an associate professor in exercise science at the University of Michigan, and the lead clinical care coordinator for the universities taking part in the study. The information collected by this testing could prove beneficial years in the future, he said.

“The big goal here is to track people,” he said. “We’re trying to track the student. This is incredibly challenging and exciting.”

Campbell said tracking a cadet’s head injury is part of caring for Airmen.

“We want to provide the best medical care possible to our Airmen and cadets,”
Campbell said. “This testing provides a foundation for our research and gives us the data needed to provide the best health care possible.”

The Academy is ahead of the other universities and other military academies involved in the study because it’s conducting this baseline testing for the entire study body, said Dr. Jerry McGinty, director of sports medicine for the Academy’s Athletic Department.

All basic cadets are scheduled to be tested by July 31st.

More than 37,000 intercollegiate athletes and service members will be tested, McGinty said.

Visit www.usafa.af.mil/news/story.asp?id=123420140 for more information on the study.

ORIGINAL ARTICLE

 

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ACC to add athletic trainers to press box

So many of the hurried changes to college sports have that barn-door-after-the-horse-is-gone feeling, a desperate attempt to forestall the wave of lawsuits and other athletic activism that has erupted in recent years.

Giving athletes the same cost-of-attendance benefits as students on academic scholarships was as sensible as it was long overdue, even if the athletic community at large had to be dragged kicking and screaming into the 21st Century and is still complaining about having to pay for it.

On Monday, the ACC announced it has adopted one improvement that is neither forced or overdue. It’s actually timely, and perhaps even forward-thinking: The conference’s application of the NCAA’s new medical-observer protocol for football.

The NCAA last week adopted an experimental rule allowing conferences to use a medical observer to monitor for injuries, not specifically but obviously potential concussions, with the power to stop play if necessary.

The SEC will use one athletic trainer to monitor both teams, in communication with the referee. The ACC’s athletic directors voted Sunday night to adopt a different protocol, with one member of the medical staff for each team in the press box, in communication not with the referee but his sideline.

The issue isn’t whether this is a good idea. It is. It’s a no-brainer. The issue is whether what the ACC is doing goes far enough.

The SEC – and presumably Big Ten, which co-sponsored the NCAA legislation – will let its observers halt the game if needed. The ACC decided not to give its observers that ability, which leaves a narrow time frame for an observer to identify a potentially injured player, communicate with the sideline and remove that player from the game.

“We didn’t really see the necessity in that,” ACC commissioner John Swofford said. “The medical observer should be able in talking to the sidelines to have a timeout called or pull a player from the game. But this is all experimental. We’ll see how it actually works in real time. If there needs to be some adjustment to that then we’ll see. This is where we felt was appropriate. It’s a little different than what some other conferences are doing.”

It doesn’t happen often that a clearly staggered player returns to the huddle without the medical staff on the sideline noticing, but it happens often enough that conferences have seen the wisdom of adding an extra set of eyes in the press box. And in those situations, it’s a fair question whether the ACC’s process will work quickly enough to help that player, especially in an era of hurry-up offenses and quick tempo.

In their meeting Sunday night to debate and approve the observer protocol, the ACC’s athletic directors decided not to go as far as the NCAA would allow, focusing on a team-based model instead of a neutral, officiating-based model.

“This seems sufficient,” N.C. State athletic director Debbie Yow said. “It’s a common-sense approach.”

North Carolina athletic director Bubba Cunningham said there are other benefits to the ACC plan.

“There’s so much chaos on the sidelines that it can be confusing,” Cunningham said. “Someone out of the chaos may have a better perspective, especially if they have a view of a TV.”

The far greater priority was having someone doing the assessments who was aware of each individual player’s medical history, which led them to the two-person, two-team model the Pac-12 used on a limited basis last season and is expanding to all games this season.

“The important thing to us was that our observer was connected to the history of the student-athlete,” Pittsburgh athletic director Scott Barnes said. “We need an observer who’s part of our staff and knows the issues involved. That was our primary concern.”

And while there’s some expense involved in bringing an extra staff member on the road, it’s relatively minor compared to the benefits.

Cunningham said North Carolina typically travels with two or three doctors and may reallocate one to the press box.

“There might be an extra hotel room,” Yow said, “but so what?”

It is a small price to pay for an improved level of player safety and a change that is, for once in college sports, as much proactive as reactive.

Read more here: http://www.charlotteobserver.com/sports/spt-columns-blogs/luke-decock/article27944956.html#storylink=cpy

ORIGINAL ARTICLE:

http://www.charlotteobserver.com/sports/spt-columns-blogs/luke-decock/article27944956.html

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Increased Concussions Among Youth Soccer Players?

The question that so many parents of youth soccer players have on their mind is this: Can we better protect our children and make the game of soccer safer if we ban heading at the youth level?

While the answer to this question is yes–banning heading can reduce the number of concussions–the more important part of concussion prevention and reduction at this level would likely come from a change in the style of play and stricter adherence to game rules, the end result of better officiating to limit dangerous body-body contact.

Well, a recent study in JAMA examining the role of heading in youth soccer concussions essentially came to this conclusion: namely, that we need to do a better job of teaching a safer style of play, incorporating approaches and techniques for youth players to best avoid such risky body contact that can lead to soccer players colliding while they are attempting to head a ball—as opposed to the simple act of banning heading alone for concussion prevention.

In fact, the recent head-to-head collision at the Women’s World Cup between Morgan Brian of the U.S and Alexandra Popp of Germany, was a clear eye opener about the inherent dangers associated with head injuries in soccer, with attendant risk for concussions.
Scenes like this make all of us concerned, but this especially stirs fear among the parents of youth soccer players. In fact, there has been momentum in the past several years among many prominent sports physicians and advocacy groups, including the Sports Legacy Institute, to call for a ban on heading under the age of 14 for concerns of repetitive brain injury from so called sub-concussive hits from the ball itself– traveling up to 70 mph upon impact.
Specialized MRI scans (DTI or Diffusion Tensor Imaging) from players without documented concussions, but who have suffered multiple impacts from long term heading, have indicated structural changes in the white matter tracts of the brain. While some of these players have developed mild cognitive impairment, others have not demonstrated any significant long-term cognitive effects or headaches. The potential role of genetics and other causative factors are not clear at this time.

So the question is whether banning heading outright–as many such experts have called for—would essentially eliminate concussions and traumatic brain injuries at the youth level. But the more pressing issue, as the JAMA study illustrates, is that we have good data at the high school level, but not at the youth level when it comes to evaluating the source of concussions.

The lead author of the study, Dawn Comstock, reviewed data from the National High School Sports-Related Injury Surveillance Study, her online tally of sports injuries collected from certified athletic trainers throughout the U.S. This large database, evaluating high school sports injuries only, reports important factors related to injuries in practices and games, including symptoms after injuries and duration of time to return to play.

Comstock evaluated data encompassing nearly 3 million games and practices from 2005-2014, specifically evaluating how players diagnosed with concussions were injured, with specific attention to whether they were engaged in heading the ball at the time of injury.

One important piece of data they realized was that concussions in soccer games were increasing to a high degree, but it was not headers that were the primary cause of this observed pattern.

The data indicated that it was actually player-to-player contact–more so among boys–that was the main factor in observed concussions (68% among boys and 51% among girls).

Heading did play a role as well, responsible for about 30% of concussions in boys and 25% among girls. But the important distinction is that these concussions were associated with collisions among players, and it was the actual body contact that led to the concussion, as opposed to the heading itself.

Data indicated that direct impact with the ball itself accounted for about 17% of concussions in boys, and 29% among girls.

“This is an interesting and useful analysis of the incidence and causes of concussion in soccer,” said Raj K. Narayan, MD, Chair, Neurosurgery, North Shore University Hospital in Manhasset, NY and LIJ Medical Center in New Hyde Park, NY. “The authors have suggested possible ways to significantly reduce such injuries among players. I believe that such reductions can be achieved without compromising the enjoyment and popularity of this global sport.”

“Since we get only one brain and the effects of injury can sometimes last for a lifetime, anything that we can do to protect this organ is well worth considering,” added Narayan.

While a ban on heading would reduce concussions in high school soccer, the bigger effect would come from teaching techniques and ways to limit body contact, and calling fouls to enforce the rules more strictly. Better attention to the rules to limit player contact would likely result in a reduced number of concussions.

Stricter officiating to play by the rules, along with a greater emphasis from coaches and players to practice using finesse techniques in passing and dribbling would be a way to help make the game safer.

We know that soccer is inherently an aggressive game‎, so making players approach the game with a greater awareness about brain injury may be a step in the right direction.  We know that body-to-body contact can also produce a concussion as concussive force that can be transmitted from the body to the neck, and then to the head.

Specialized body foams and padding that can absorb impacts may be an important step in protecting athletes, adding an additional protective layer to reduce the force of a collision. Specialized headgear may also help to reduce impact forces when worn in practice and game settings. While there has not been any evidence yet that headgear reduces the risk for concussion, the use of such protection may help to reduce blunt impact forces and reduce other injuries such as lacerations or gross tissue injury.

An important limitation, as mentioned earlier, is that this study focused only on high school players, and the players deemed to be most at risk for heading are in middle school and elementary level. There are unfortunately no studies and a lack of data in this younger age group—the group with whom we are most concerned. That said, it will be important to engage in long term studies evaluating the effects of heading and concussions in this younger group of players.

ORIGINAL ARTICLE:                                                                                           http://www.forbes.com/sites/robertglatter/2015/07/21/is-heading-leading-to-an-increase-in-concussions-among-youth-soccer-players/

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Athletic Trainers are Key to Concussion Management

Athletes under the age of 18 are the most vulnerable when it comes to sustaining concussions. Accurately diagnosing concussions on the field of play is an important way to protect them, according to research published this month in the Journal of Child Neurology.

“The continued play by a child who has sustained a concussion puts them at significant increased risk,” said Jacob Resch, associate professor at the University of Virginia’s Curry School of Education and co-author of the study. “To keep a concussed child from continuing to play requires immediate and accurate diagnosis.”

Every state but one requires youth athletes suspected of having a sport concussion be removed from play and not allowed to return without written clearance from a health care provider. But, according to Resch, many young athletes are playing without the elements in place needed to accurately diagnose a concussion during a game.

The article, “The Acute Management of Sport Concussion in Pediatric Athletes,” provides a clinical framework for the assessment, evaluation and management of pediatric sports concussions.

One key element: the presence of an athletic trainer or trained clinician at sports events.

“Diagnosing sport concussion requires specific training,” Resch said. “Think of it as a medical specialty that not necessarily all general practitioners or pediatricians are well versed in. There is a range of assessments used in diagnosing concussions and each of them requires specific training.

“The best person to have on a sideline is someone who has specific training in this area, most often seen in a certified athletic trainer.”

Young children often play sports in youth leagues, while adolescents often play in club or school sports. Currently, the only data collected on the presence of athletic trainers is on high school sports, where only 46 percent of high schools have a full-time athletic trainer. In many of those cases, a single athletic trainer is responsible for all of the school’s teams.

In other cases, schools or programs may share an athletic trainer or hire an athletic trainer or clinician to temporarily work a tournament or series of events.

“At this point, we just don’t know how many youth sports are being played with a certified athletic trainer or clinician trained in diagnosing concussions on the sidelines,” Resch said.

In the absence of someone specifically trained to diagnose and treat concussions, the role is often filled by an emergency medical technician.

“EMTs are a vital member of the sports medicine team,” Resch said. “However, EMTs may receive limited training in concussion assessment.”

In the article, Resch and co-author Dr. Jeffrey Kutcher of the University of Michigan reviewed the reliability and validity of assessment tools currently used to diagnose concussions. They recommend these tools be used alongside a clinical evaluation.

Another element needed to accurately and immediately diagnose youth sport concussions is a precursor to the first: taking a baseline measurement of the elements assessed to diagnose a concussion before a young athlete is injured. These elements include a balance test and recording the typical number of headaches a child has per month.

“One challenge in diagnosing concussions is that we are often measuring how a concussion manifests itself in other symptoms in the body,” Resch said. “Because no two children are alike and no two concussions are alike, it is difficult to say a particular score on a particular assessment always means a concussion is present or not.”

Knowing how a child scores on a balance test prior to play gives the individual making the diagnosis a sense of how far from that baseline an injured child is currently scoring. To know a child’s baseline often requires parents to seek a supplemental physical with a sports concussion clinician.

“Parents can certainly ask their pediatrician if they have expertise in diagnosing concussions,” Resch said. “If they don’t, they can often recommend someone who does.”

Preseason is a good time for concussion education, the authors suggested. Many states require student-athletes, their parents, coaches and administrators to participate in concussion education before the start of the season. However, those sessions vary significantly across ages, leagues and states.

Resch and Kutcher recommend that whatever the format, the content should include what signs and symptoms of concussion will lead to the player’s immediate removal from the field of play.

Though increased media attention has led to an added emphasis on the response to and management of concussions, the researchers noted that data is significantly lacking on youth sports concussions and called for more research.

“We need to continue to examine the data around concussions in youth sports and use that data to improve our efforts in education and recommendations for keeping young athletes safe,” Resch said.

ORIGINAL ARTICLE:                                                                                                       http://www.healthcanal.com/brain-nerves/65450-study-immediate-diagnosis-of-concussions-better-protects-youth-athletes.html