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. 

CPR Training, CAP Add to Preparedness

By Geoff Kimmerly
MHSAA.com senior editor

October 12, 2015

A recent graduate from Ovid-Elsie High School named Chris Fowler started classes this fall at Michigan State University, his days representing the Marauders on the basketball court, football field and golf course now memories as he starts the next chapter of his young adult life.

But his story also will remain a reminder as his high school’s athletic department prepares each year to keep its athletes as safe as possible.

Three years ago next month, Fowler collapsed on the football practice field in cardiac arrest. The then-sophomore was brought back to life by two of his coaches, who revived him with CPR and an AED machine.

There’s no need for athletic director Soni Latz to recount the events of that day when explaining the importance of being ready to respond to a medical crisis – her coaches are well aware of why Fowler survived and understand completely why they too must be prepared.

“Everyone is very aware of what happened and the importance of being trained and knowing what to do, and actually feeling comfortable to step in and administer CPR when needed,” Latz said. “You can feel it’s never going to happen to you, but once it has, it makes you more aware and conscientious to be prepared.”

But Fowler’s story is worth noting on a larger level as varsity coaches at all MHSAA member schools are required this year for the first time to become certified in CPR, and as the largest classes in Coaches Advancement Program history begin course work that includes up to four modules designed to make them aware of health and safety situations that may arise at their schools as well.

The CPR requirement is the most recent addition to an MHSAA thrust toward raising expectations for coaches’ preparedness. The first action of this effort required all assistant and subvarsity coaches at the high school level to complete the same rules and risk minimization meeting requirement as high school varsity head coaches beginning with the 2014-15 school year.

The next action, following the CPR mandate, will require all persons hired as a high school varsity head coach for the first time at an MHSAA member school after July 31, 2016, to have completed the MHSAA’s Coaches Advancement Program Level 1 or Level 2. 

In addition, MHSAA member schools this summer received the “Anyone can Save a Life” program, an emergency action plan curriculum designed by the Minnesota State High School League to help teams – guided by their coaches – create procedures for working together during medical emergencies.

“Coaches get asked to do a lot, and even if a school has an athletic trainer or some other health care professional, that person can’t be everywhere all the time. Coaches often are called upon to be prepared for (medical) situations,” said Gayle Thompson, an adjunct assistant professor at Albion College who formerly directed the athletic training program at Western Michigan University and continues to teach CAP sports medicine modules.

“The more (coaches) can learn to handle the situations that can inevitably arise, the better off they’re going to feel in those situations and the better care they’ll be able to offer their athletes. It’s proven that the faster athletes are able to get care, the quicker they’re able to come back to play.”

Pontiac Notre Dame Prep – which has sent a number of coaches through the CAP program – began a focus on heart safety about five years ago after a student-athlete was diagnosed with a heart issue that allowed her to continue to play volleyball and softball, but not basketball. Athletic director Betty Wroubel said that prior to the student’s diagnosis, the school did provide training in CPR, AED use and artificial respiration; however, that situation put coaches and administrators further on the alert.

Her school offers CPR training also to subvarsity and middle school coaches, using a combination of video instruction from the American Red Cross and in-person guidance by members of the school community who are certified to teach those skills. Students at the school also have received training – and it paid off a few years ago when one of them gave CPR to a baby who had stopped breathing at a local shopping mall.

Portage Central scheduled two sessions this fall for its coaches to receive not only CPR certification, but AED training as well. Central was fortunate to have an American Red Cross first-aid trainer in house, teacher Rachel Flachs, who also is close to the athletic side as the girls swimming and diving coach at Mattawan High School.

Central athletic director Joe Wallace said the training was offered not just to varsity head coaches, but every head coach on every level of the program so that “at least we know that at every given practice, every game, we’d have someone recently trained,” he said.

And he was proud of how his coaches immersed themselves in the subject matter.

“They were putting themselves in scenarios to see how it related to their own sports and asking really great questions,” Wallace said. “It was thought provoking.”

The CAP sports medicine modules are designed to do the same as coaches consider the medical situations they could face. They aren’t designed as “medical training,” said Tony Moreno, a professor of kinesiology at Eastern Michigan University and teacher of all four CAP sports medicine modules. Rather, attendees receive an awareness and basic education on common injuries, injury mechanisms and prevention, and how to create an action plan in the event of an injury incident.

The CAP program touches on a variety of safety topics in several of the available seven levels of coach education.

CAP 1 – which is part of the mandate for new coaches beginning next school year – includes “Sports Medicine and First Aid.” Cap 4 has modules titled “Understanding Athlete Development” and “Strength and Conditioning: Designing Your Program.” CAP 5 includes the session, “Peak Health and Performance.” Attendees also have the option of receiving CPR and AED training as an addition to some courses.  

With a quick Internet search, coaches have no trouble finding a variety of resources on sports medicine, performance enhancement, nutrition and healthy living regarding young athletes. “However, some of these sources are more credible and scientifically-based in comparison to others,” Moreno said. “CAP strives on an annual basis to continue to update and improve the quality and credibility of this information and in a face-to-face manner where coaches have the opportunity to ask questions about their experiences and specific programs.”

“Having the CAP requirement will only make them better informed. Many have had this kind of information before, but there’s always something new coming,” Thompson added. “I think we do a good job, not of trying to tell them they were wrong, but maybe taking what they’ve known a step further and making them better prepared – empowering them to do their best.”

Wroubel may understand more than most athletic directors the growing list of tasks coaches are asked to accomplish; she’s also one of the winningest volleyball and softball coaches in MHSAA history and continues to guide both Fighting Irish programs.

But she and Wallace both said the CPR mandate isn’t considered another box to check on a to-do list; there’s enthusiasm because of its importance and the opportunity to carry those skills into other areas of community life as well.

Wroubel has served as a coach since 1975 and said this renewed emphasis on coaches having knowledge of sports medicine actually is a return to how things were when she started. Back then, coaches were responsible for being that first line of medical know-how, from taping ankles to providing ice and evaluating when their athletes should make a trip to the doctor’s office.

“When I first started coaching, we didn’t have sports medicine people, trainers, or team doctors other than for football. You did everything yourself,” Wroubel said. “I think everybody got away from that, but I think it’s coming back because a trainer can’t be everywhere.

“It’s healthy and it’s good for kids. … The more of us with emergency skills, the better we’re able to serve our community.”

PHOTOS: (Top) Portage Central coaches receive CPR training earlier this fall. (Middle) Pontiac Notre Dame Prep coaches practice during AED training. (Photos courtesy of school athletic departments.)