Concussion Testing Pilots Kick Off Fall

August 4, 2015

By Geoff Kimmerly
Second Half editor

The Michigan High School Athletic Association kicked off the 2015-16 school year Monday by hosting 70 member high schools for training in two pilot sideline concussion testing programs aimed at assisting in decision-making regarding the removal of athletes from activity after possible concussion events and record-keeping of those events beginning this fall.

Illinois-based King-Devick Test and Maryland-based XLNTbrain Sport each will be used to monitor approximately 10,000 Michigan high school student-athletes drawn from schools representing all four classes and a variety of regions statewide.

The pilot programs are part of a three-pronged advance by the MHSAA in concussion care this fall. In addition to becoming the first state association to offer pilot sideline concussion testing, the MHSAA will be the first to mandate record-keeping by member schools of all possible concussion events from detection to an athlete’s return to play. The requirement applies to both practices and events, all levels of all sports in grades 7 through 12.

The MHSAA also this fall is the first state association to provide all participants at every MHSAA member high school and junior high/middle school with insurance intended to pay accident medical expense benefits – covering deductibles and co-pays left unpaid by other policies – resulting from concussions sustained during MHSAA practices or competitions. There is no cost to either schools or families.

“These pilot programs are intended to not only improve what’s actually happening on the sidelines at practices and contests in these communities that are part of the pilot programs, they’re intended to spread the word of the need for improved concussion detection across every community,” MHSAA Executive Director John E. “Jack” Roberts said. “We hope these schools involved will become involved in their leagues and conferences and with their peers across the state as we expand the awareness of the need for better sideline detection and provide ways to get it done.”

The MHSAA asked schools at the end of this spring to volunteer for the pilot programs and then selected participants in order to guarantee a variety of schools based on enrollment and location. Schools are committed to involving at least two sports for each gender each season.

Schools participating in the XLNTbrain Sport pilot program are: Adrian, Adrian Madison, AuGres-Sims, Bay City Central, Bear Lake, Brethren, Belding, Birmingham Groves, Brighton, Chesaning, Corunna, Detroit Collegiate Prep, East Kentwood, Fennville, Fowlerville, Gibraltar Carlson, Grand Rapids Christian, Grandville, Greenville, Grosse Ile, Hamilton, Harrison Township L’Anse Creuse, Hazel Park, Kalamazoo Christian, Lansing Christian, Macomb L’Anse Creuse North, Owosso, Pewamo-Westphalia, Portland, Reese, Rochester Hills Lutheran Northwest, St. Clair Shores Lakeview, St. Johns, Stanton Central Montcalm, Vermontville Maple Valley, West Bloomfield and Wyoming Kelloggsville.

Schools participating in the King-Devick Test pilot are: Bay City Western, Benton Harbor, Buchanan, Calumet, Caro, Caseville, Detroit Cody, Detroit Martin Luther King, Fenton, Flint Kearsley, Frankenmuth, Fruitport, Garden City, Grand Ledge, Grand Rapids Northview, Lake Leelanau St. Mary, Lake Linden-Hubbell, Lincoln Alcona, Midland Bullock Creek, Montague, Muskegon, Niles, Pontiac Notre Dame Prep, Romeo, Saginaw Heritage, Scottville Mason County Central, Shelby, St. Charles, St. Joseph, Tawas, Vicksburg, Whitehall and Yale.

The King-Devick Test is a rapid eye movement screening evaluation that requires athletes to read single-digit numbers displayed on a tablet computer in order to detect impairments of eye movement, attention, language, concentration and other symptoms of abnormal brain function. The test has been validated in more than 50 recent peer reviewed articles published in elite medical journals and is associated with the Mayo Clinic.

The test is administered on the sidelines during evaluations for suspected head injuries, and the post-injury results are then compared to an athlete’s preseason baseline. Any worsening of performance (increased time and/or errors) suggests a concussion has occurred and the athlete should be “removed from play” for further evaluation.

“The first and most critical step in managing concussion in the youth athlete is to recognize when one has occurred – not always a simple task,” said Dr. David Dodick, professor of neurology and director of sports concussion services at the Mayo Clinic. “The King-Devick test helps take the guesswork and subjectivity out of the sideline evaluation in a rapid, accurate, and objective way.”

XLNTbrain Sport includes balance and web-based neuro-cognitive tests also used before the start of a season to create a baseline measurement of reaction time, attention, inhibition, impulsivity, memory, information processing efficiency and executive function. The test also assesses mood, anxiety, stress and emotionality.

After a possible head injury, a sideline assessment is done using a smartphone or tablet with those results then compared with the athlete’s baseline measurements. The program documents the severity of a concussion, provides a guide for on-the-field decision making regarding treatment and recovery time and can report results via email to parents, coaches, training staff and medical professionals.

Dr. Harry Kerasidis, who designed the XLNTbrain Sport software, presented at the Coalition for Concussion Treatment Summit at the United Nations building in 2014.

“We included an objective balance test that relies on smartphone accelerometer technology which is effective in the field during practice and game situations,” Kerasidis said. “Should a concussion injury be suspected, the system automatically generates a notification to parents and medical professionals and creates a recovery protocol and post-injury tracking so the right people can monitor the athlete’s progress. Then, the system assists medical professionals with the all-important return-to-learn and return-to-play clearance.”

Click for information on XLNTbrain Sport. Click for information on the King-Devick Test.

For more on Health & Safety, including preseason physical examination, hydration and cardiovascular resources in addition to concussion information and online training sessions, visit the MHSAA’s redesigned Health & Safety web page.

PHOTOS: (Top) Saginaw Heritage athletic director Peter Ryan (right) is administered the King-Devick baseline test by K-D's Samantha Figueroa. (Middle) XLNTbrain Sport creater Dr. Harry Kerasidis provides insight on his program to those being trained to use it Monday. 

Regulation with Roots

December 3, 2015

By Jack Roberts
MHSAA Executive Director

The following is an excerpt from “History, Rationale and Application of the Essential Regulations of High School Athletics in Michigan.”

Throughout the years, schools of this and every other state have identified problems relating to school transfers.

There is recruitment of athletes and undue influence. There is school shopping by families for athletic reasons. There is jumping by students from one school to another for athletic reasons because they couldn't get along with a coach or saw a greater opportunity to play at another school or to win a championship there. There is the bumping of students off a team or out of a starting lineup by incoming transfers, which often outrages local residents. There is the concentration of talent on one team by athletic-motivated transfers. There is friction between schools as one becomes the traditional choice for students who specialize in a particular sport. There is imbalance in competition as a result. And there is always the concern that the athletic-motivated transfer simply puts athletics above academics, which is inappropriate in educational athletics.

All states have developed rules to address the problems related to school transfers. In some states it is called a transfer rule and in other states a residency rule, because linking school attendance to residence is one of the most effective tools for controlling eligibility of transfers. None of the state high school association rules is identical, but all have the intention of preventing recruiting, school shopping and jumping, student bumping, friction, imbalance and overemphasis, as well as the intention of promoting fairness in athletic competition and the perspective that students must go to school first for an education and only secondarily to participate in interscholastic athletics.

The transfer/residency rule is a legally and historically tested but still imperfect tool to control athletic-motivated transfers and other abuses. It is a net which catches some students it should not, and misses some students that should not be eligible. This is why all state high school associations have procedures to review individual cases and grant exceptions; and why all state high school associations have procedures to investigate allegations and to penalize violations where they are confirmed.

Over the years, state high school associations have considered four options to handle transfers. The first two options are the easiest courses:  either (1) let schools decide themselves about transfers, as Michigan once did, but this leads to inconsistent applications and few states now subscribe to such an approach; or (2) make no exceptions at all, rendering all transfer students ineligible for a period of time, but this becomes patently unfair for some students and no state high school association subscribes to that extreme, although it would be easy to administer.

The third option – the ideal approach perhaps – would be to investigate the motivation of every transfer and allow quicker eligibility or subvarsity eligibility to those which are not motivated by athletics, but this is very time consuming if not impossible to administer.  No state high school association has sufficient staff and money to consider every detail of every transfer.

This is why a fourth option has been most popular with most state high school associations. This is a middle ground which stipulates a basic rule, some exceptions (15 exceptions in Michigan), and procedures to consider and grant waivers (a primary role of the MHSAA Executive Committee).

It is certain that the MHSAA transfer rule is imperfect. However, whatever few imperfections exist are remedied through a process by which member school administrators may make application to the MHSAA Executive Committee to waive the rule if, in the committee's opinion, the rule fails to serve any purpose for which it is intended or in its application creates an undue hardship on the student. In a typical year, the Executive Committee will receive approximately 250 requests to waive the transfer regulation, approving approximately 60 percent of those requests.

The committee brings to its considerations the following rationale, most recently reviewed and reaffirmed on Aug. 5, 2015:

  1. The rule tends to insure equality of competition in that each school plays students who have been in that school and established their eligibility in that school.
  2. The rule tends to prevent students from “jumping” from one school to another.
  3. The rule prevents the “bumping” of students who have previously gained eligibility in a school system by persons coming from outside the school system.
  4. The rule tends to prevent interscholastic athletic recruiting.
  5. The rule tends to prevent or discourage dominance of one sport at one school with a successful program, i.e., the concentration of excellent baseball players at one school to the detriment of surrounding schools through transfers and to the detriment of the natural school population and ability mix.
  6. The rule tends to create and maintain stability in that age group, i.e., it promotes team stability and team work expectation fulfillment.
  7. The rule is designed to discourage parents from “school-shopping” for athletic purposes.
  8. The rule is consistent with educational philosophy of going to school for academics first and athletics second.
  9. It eliminates family financial status from becoming a factor on eligibility, thus making a uniform rule for all students across the state of Michigan (i.e., tuition and millage considerations).
  10. It tends to encourage competition between nonpublic and public schools, rather than discourage that competition.
  11. It tends to reduce friction or threat of students changing schools because of problems they may have created or because of their misconduct, etc.

Following the adoption of a more standardized statewide transfer rule in 1982, there were multiple legal challenges. However, in 1986, the Michigan Court of Appeals determined that a rational basis exists for the transfer regulation and that the rule, with its exceptions, is not overbroad and is neither arbitrary nor capricious, noting that neither a fundamental right nor suspect classification is involved. Berschback v. Grosse Pointe Schools 154 Mich App 102 (1986). That decision is also noteworthy for this statement which has halted or decided subsequent legal challenges:  “This Court is not the proper forum for making or reviewing decisions concerning the eligibility of transferring students in interscholastic athletics.”

There were two major changes in the MHSAA transfer regulation during the 1980s. The first, the athletic-motivated transfer rule, led to the busiest period of litigation in the MHSAA’s history. The other major change, arguably of equal impact, was implemented without any controversy.

This second subtle but substantial change occurred in 1987 when language was adopted to limit eligibility after a transfer to the non-public school closest to the student’s residence, as opposed to any non-public school in whose service area the student lived. “Service area” did not have a consistent definition and created unnecessary concern that non-public schools had the advantage of huge, undefined attendance areas, compared to public school districts at that time.

Some high school associations prescribe geographic boundaries or mileage limitations for students transferring to non-public schools. Michigan simply says it’s only the non-public school closest to the student’s residence, where eligibility may be immediate.

PHOTO: The MHSAA Transfer Regulation dates back to the early 1980s when the Association building stood on Trowbridge Road in East Lansing.