Tag: Concussion

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Sports-Medicine Staffs Report Pressure to Clear Concussed Athletes Prematurely

More than half of the 900 respondents to a 2013 survey of NCAA athletic trainers and team physicians said they had felt pressure to return concussed players to action before the athletes were medically ready.

Sixty-four percent of responding clinicians said that the athletes had sought premature clearance to play, while nearly 54 percent of the surveyed medical-staff members had felt pressure from coaches, according to the study, published in the Journal of Athletic Training.

Athletic trainers and physicians experienced greater pressure from coaches when their jobs were under the purview of the athletic department rather than an independent medical institution.

There were also differences in the pressure reported by male and female medical-staff members, with more women than men reportedly feeling pressure from coaches to put players back on the field too early.

The authors did not quantify the frequency or intensity of the pressure on medical staffs, nor did they determine whether such pressures had affected return-to-play decisions.

Nonetheless, they called the findings “troubling” and urged institutions to review their supervisory structure to reduce conflicts of interest in the care of athletes and to introduce “interventions” to improve communication among coaches, athletes, and clinicians.

The study, which includes responses from medical professionals at all three NCAA levels, is the most extensive to examine concussion-treatment pressures on athletic trainers and team physicians.

In 2013, The Chronicle surveyed medical professionals at the 120 most-prominent NCAA institutions. Of the 101 who responded, more than half said they had felt pressure from football coaches to return concussed players to action faster than was in their best interest medically.

ORIGINAL ARTICLE:

http://chronicle.com/blogs/ticker/sports-medicine-staffs-report-pressure-to-clear-concussed-athletes-prematurely/102451

REFERENCED ARTICLE:

http://natajournals.org/doi/pdf/10.4085/1062-6050-50.6.03

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David Hamen and Aaron Sage implement New Ohio guidelines

When high school football practice begins for the 2015 season in Ohio on Saturday, coaches and players will be functioning under a new set of national guidelines addressing concussions, which was adopted and introduced by the Ohio High School Athletic Association on July 13.

In a memo to the OHSAA membership of more than 700 high schools, commissioner Dan Ross said the association “has joined dozens of states in adopting recommendations from the National Federation of State High School Associations’ Concussion Summit Task Force, which will reduce the risk in football for concussions and head impact exposure.

Ross has long stated that the top priority of the OHSAA is the safety of its athletes, and the new guidelines are designed to give football coaches some direction in the intended reduction, recognition, and treatment of head injuries in practices and games.

“With the support and leadership from the football coaches association, we have been out in front of concussion awareness and education, and these changes will now bring Ohio up to a place as a national leader in this area,” Ross stated in the memo. “Like many of our regulations, these guidelines are to be followed and monitored by member schools and coaches, but we are fortunate in Ohio that many coaches have already been following these safety measures.

“There will always be a risk for concussion, but football is safer now than it has ever been, and these guidelines will make it even safer.”

According to the OHSAA memo, the three principles that the guidelines reflect include exposure of an individual athlete to full contact in terms of frequency and duration, the cumulative effect of the exposure on an individual athlete, and recovery time for each athlete after contact.

The recommendations adopted include spring, summer and all off-season contact. Already the rule in Ohio, there is no contact permitted except during the season, and pads may not be worn at any time except during the season.

The new guidelines are aimed at preseason practice and practice during the season.

New to preseason practice, full contact will be limited during two-a-day practices.

When more than one practice takes place in a day, full contact is permitted only during one of the practices. Further, if full contact occurs during the second session of two-a-days, full contact will not be permitted during the first session the following day.

Once the season has begun, individual athletes are limited in full contact on consecutive days to 30 minutes in practice per day and to 60 minutes per practice week. An athlete can only be involved in full contact in a maximum of two practices in a seven-day span.

Contact with soft equipment such as bags, shields, sleds, etc., does not count toward full contact limitations.

“These regulations are being put into place for the safety of our student-athletes, and it is incumbent on coaches to monitor the contact in their practices,” Ross said. “Our coaches are educators and leaders. They want what’s best for kids, and these regulations are in line with these safety recommendations.

“These regulations will evolve and may become more restrictive as additional concussion research emerges.”

Adapting to the changes

The changes adopted by the OHSAA will not be viewed as drastic to most Ohio high school football programs, as many coaches had already become more vigilant to the potential for head injuries.

Head coaches at three of the Toledo area’s top football programs from recent seasons each said they have long been aware of the danger of concussions, and that the safety of their players is paramount.

Last season, coach Matt Kregel’s Perrysburg team finished 11-1 and was the top-ranked Division II team in Ohio. Greg Dempsey has coached Central Catholic to three state playoff championships in the past 10 years (2005, 2012, 2014). Whitmer’s Jerry Bell guided his 14-1 Panthers to a Division I state runner-up finish in 2012.

“I think we’ve always done a good job of controlling the hitting,” Kregel said. “We don’t have enough kids to two-platoon, so we have to monitor the hitting ourselves. I don’t think [the new OHSAA rules] will have a huge effect on us and how we coach things.

“We monitor ourselves. It’s a common-sense approach. We’ve always done it this way, and the good coaches in the area that I’ve talked to have said they’ve always done it this way.

“I don’t think this is going to have a huge effect on how guys coach high school football. At least for the guys who do the right thing and are concerned about the kids.”

Safety is first and foremost.

“I definitely think things have to be done to protect the kids that participate in football,” Dempsey said. “And, by doing so, you’re protecting the future of the sport.

“You definitely need to be better educated, and there needs to be some parameters set.

“I’d say 99 percent of the coaches are doing it right. But there’s some people who, for whatever reason, usually cause rules like this to be put into effect.”

Even though they already have the athletes’ safety in mind, there will be extra incentive for coaches to adhere tightly to the full-contact limitations.

“All it takes is one parent who’s unhappy with playing time to say ‘You’re hitting too much throughout the week,’ ” Bell said. “We’re going to monitor that throughout our practice plans and make sure we have it right.

“It’s for the safety of our kids. When you look at the way people are practicing nowadays, I think that we already err on the side of caution with concussions to begin with in making sure that the drills we’re doing are putting safety first, and teaching kids the fundamentals of the game.

“Over the years, we’ve learned how to do that without full contact. We want our kids healthy throughout the season, especially with the schedule we play. When I look at the new rules, it really doesn’t change much in how we practice. We’ve been doing this for years.”

Out with the old

Kregel, Dempsey, and Bell have each been around the game long enough to see the evolution of high school football practice from a more physically demanding and dangerous past to today’s more sensible training methods.

That includes greater awareness of head injuries.

“You can’t beat your kids up,” Kregel said. “There were years in the past when everybody was two tight ends and I-formations when that’s all you did was line up and bang. That’s not the case anymore. The guys who have sense will do it the right way.

“The guys who want to stretch the rules and do it the wrong way, I think that’s who this rule is for — to protect those kids. At the beginning of two-a-days, you’ll still have some kind of one-on-one, man-up kind of drills. You’ll do that for 10 minutes. Everybody bangs, and then you go to the next drill.

“But you do something where you’re not hitting full speed. We never just line up and knock the living crap out of each other for an hour and a half.

“I think that’s the direction football is going in. It’s not blood and guts and knocking the crap out of each other. You have to be smart about how you conduct business.”

Dempsey believes today’s high school football is a much safer version of the game.

“I feel better about kids playing football now than ever because of the awareness and the education and the protocol,” Dempsey said. “We’re much more aware and, when an event happens, the protocol for a kid’s return is much safer.

“If a concussion happens, it’s something we’ve got to watch. If two of them happen, it’s something we’ve really got to watch. Right now, I believe it’s as safe as it can be to play football.

“I think we know more about [recognizing concussions] now. It used to be macho to hide stuff as a player, and coaches used to make remarks about a kid having ‘his eggs scrambled’ and stuff like that. It’s much different now. You might even have some things now that are labeled as a concussion that really aren’t. But it’s better to err on the side of caution than it is to ignore it, which is what used to happen.”

Bell sees current high school coaches as much more enlightened regarding the dangers of the game.

“Overall, our coaching profession is very good at understanding the game and understanding the fundamentals, and how to teach the kids the fundamentals without putting them at risk,” Bell said. “The days of you running drills like ‘bull in the ring’ are long gone at the high school level. “With the research that they have done on concussions, and looking at long-term factors for kids with how it can impact them as adults, us being proactive on this is a step in the right direction.

“We can teach and do our jobs without having to put our kids at risk during the training sessions, and still have them function at a high level and be able to make a sound tackle and a good block with these new procedures in place.”

A watchful eye

According to information provided by the Mayo Clinic, signs and symptoms of a concussion might include headache or a feeling of pressure in the head, temporary loss of consciousness, confusion or feeling as if in a fog, amnesia surrounding the traumatic event, dizziness or ‘seeing stars,’ ringing in the ears, nausea, vomiting, slurred speech, delayed response to questions, appearing dazed, and fatigue.

Coaches might not have the ability to diagnose such symptoms, but they have athletic trainers on hand at nearly all practices and every game, and many high school games are staffed by a team physician.

Perrysburg, Central, and Whitmer have a team doctor on hand at every game.

The coaches rely heavily on their athletic trainers to recognize potential concussions. Whitmer, like many area schools, utilizes athletic trainers provided through Mercy Sports Medicine, a division of Mercy Health.

Athletic trainers David Hamen and Aaron Sage work full-time with Panther athletics.

Hamen has been an athletic trainer since 2003 after earning his bachelor of science degree from Bowling Green State University. He has worked with Whitmer athletes since 2008.

As the 2015 football season approaches, Hamen has been busy utilizing one of the most important tools available to medical personnel in recognizing concussions.

He has been conducting what is called baseline testing for all of Whitmer’s fall season athletes who will be competing in contact sports. Nearly the entire football team has already been tested and placed in the accompanying computer system.

The trainers utilize Mercy Health’s ImPACT evaluation procedure to help diagnose concussions in athletes.

ImPACT, which stands for Immediate Post-concussion Assessment and Cognitive Testing, utilizes neurocognitive baseline and post-injury testing to evaluate the athlete’s normal cognitive ability (baseline) versus his or her cognitive ability after a head trauma.

Mercy Health touts that this procedure — comparing baseline to post-injury function — as “the most scientifically validated computerized concussion evaluation system.”

In a nutshell, each individual athlete takes an online test to establish his or her normal “baseline” cognitive ability. When a possible head injury has occurred, athletes are retested to see if there has been a measurable dropoff in their cognitive performance.

“It’s a series of different tests,” Hamen said of ImPACT. “Some of it is a memorization of words, some of it is memorization of shapes or patterns. It gives us a baseline for where the kids are [in normal cognitive state].

“If we ever suspect there is a concussion, we’ll have the kid sit down and take the test again. It will give us a readout of where they were initially and where they are now. Depending on the score, it will give us a better idea if there’s a potential concussion there, and to seek further help. It’s a tool for us to help identify concussions, and to protect our kids.”

The high school football season, for most Ohio teams, begins Aug. 28.

ORIGINAL ARTICLE:

http://www.bcsn.tv/news_article/show/537483

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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