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. 

Next Play: Heart of the Matter

June 25, 2015

By Rob Kaminski
MHSAA benchmarks editor

From the retirement of NFL players in their mid-20s fearing long-term disability, to NASCAR drivers suffering injuries against concrete walls when alternative substances are available, to MLB outfielders running into barriers which place aesthetics and tradition over safety, the focus of highlight shows, apps and old-fashioned sports pages is shifting from action inside the lines to the sidelines.

As the reality of human vulnerability continues to invade our favorite escape from reality – athletics – protecting those in the spotlight needs to be Job 1.

While the quest for risk management protocols and health and safety provisions is a never-ending loop, the MHSAA bolted from the starting blocks with a 4H plan (Health Histories, Heads, Heat and Hearts) in the fall of 2009, a mission that enters the fourth turn for the 2015-16 school year.

And, as pulse quickens for the “Heart” stage in the fall, the MHSAA will continue to step up initiatives involving the other three initiatives during the next lap.Think of it as a continuous relay, where the baton is never dropped and fresh runners continue the race.

While organizations at other levels might be asking, “What to do,” the MHSAA is focusing on “What’s next?” 

In this playbook the next plays are critical in allowing student-athletes to continue providing their communities with inexpensive and entertaining breaks from reality.

The Heart of the Matter

The 2015-16 school year brings with it an ambitious but paramount stage in the MHSAA’s mission to protect and promote the well being of student-athletes across the state.

Beginning in the fall, all high school varsity coaches will need to have Cardiopulmonary Resuscitation (CPR) certification by established deadlines which correspond to rules meetings.

The requirement is new, and the volume of personnel affected is vast. Yet, plans have been in place during the past few years, and schools in many communities are ahead of the curve.

“We’ve fielded some questions regarding the requirement, but I think that many of our schools  already have similar protocols in place,” said MHSAA assistant director Kathy Vruggink Westdorp. “Increasingly, schools have become more prudent with regards to health and safety, and programs which emphasize these initiatives have been well received.”

Pete Ryan, MHSAA Representative Council member and athletic director for Saginaw Township Community Schools, concurs.

“The CPR requirement will not be a change for Heritage, as we have required CPR for eight years,” Ryan said. “We offer certification through our district nurse at no charge to the coaches and train about 20-30 coaches per year.”

The training vehicle might vary from district to district, but so long as the end result is certification, the coaches are free to take course by any means possible, whether online or in person.

“I think we’ll see a blend of online and classroom delivery,” Westdorp said. “And, I don’t think it will be just the coaches. At the MIAAA Conference (in March), school leaders were proactive in terms of certification for athletic directors, too.”

Mike Bakker, President of the Michigan Interscholastic Athletic Administrators Association and athletic director at Fenton High School, says CPR certification is a must in the risk management plans for all school settings.

“As an educator who has been a CPR and first aid instructor for the American Heart Association for a number of years, I am excited that the MHSAA will require CPR training for varsity coaches,” Bakker said. 

“I certainly hope that in the future we will see that all coaches are trained in CPR. There might be a bit of a challenge at first to get our coaches trained, as schools look for the most economical as well as timely way to accomplish this mandate. The biggest hurdle that I can foresee is trying to find qualified trainers in all areas of the state that have multiple training dates available to fit the needs of such diverse coaching staffs.”  

Ryan believes there is no substitute for the personal touch.

“We are doing in-person training which I feel is better because the individuals have to perform the procedure on the practice dummy," he said. "It’s simply more hands-on training.”

School nurses and trainers will play a substantial role in the certification process, as will community health organizations in many locales.

“In many of our schools, the health educators are certified to conduct CPR courses,” Westdorp said. “We’ve also had numerous calls from non-school entities alerting us to their availability to provide training, such as fire departments and local medical centers.”

Fenton is one such school with the luxury of on-site personnel to train its staff.

“We are fortunate in Fenton that our athletic trainer and athletic director are certified trainers so we can accomplish our training in-house, but I know that not all schools are as fortunate,” Bakker said.

Which is exactly why it’s necessary for coaches to become certified, and ideally not just the head coaches.

“It should be encouraged that all coaching staff become CPR certified so that they are able to take action, especially for schools which do not have an athletic trainer on staff and if the head coach is unavailable or present, in the unfortunate event that a potential cardiac emergency and/or sudden-death incident occurs,” said certified athletic trainer Gretchen Mohney, the Clinical Coordinator and Instructor for Western Michigan University Undergraduate Athletic Training Program.

Mark Mattson, athletic director at Traverse City Central, indicated that while not previously a requirement, the district has been proactive in prepping the coaches.

“From the moment the requirement was announced, we've been out in front of it,” Mattson said. “What’s great is, even though it hasn’t been a requirement for Traverse City Area Public Schools, many coaches are indeed already certified. The district also offers training sessions once a month and those dates are passed on to our coaches. Jason Carmien (AD at Traverse City West) and I have also had conversations about providing training at our preseason coaches meeting for those still in need prior to the start of the fall season.”

Coaches can also count on a familiar training source to come through for certification: the MHSAA Coaches Advancement Program. Westdorp, who heads up the expansive continuing education program for the state’s coaches, envisions coursework at select sites which will build CPR training into the session, giving attendees more added incentive and training opportunities.

CAP has also served as a siren to inform and remind the MHSAA’s constituents about the upcoming regulation.

“In all CAP courses this school year, we’ve been educating the coaches about the CPR requirement,” Westdorp said. “We also can format the courses to include a two-hour block for CPR certification within the CAP training. We could even do it with a league and conference group where we set up rotations, and the CPR aspect would be one of the rotations.”

Westdorp added that many athletic directors currently schedule coaches meetings and additional coursework around CAP training. It’s a perfect fit to deliver pertinent messages while all parties are in one location.

Such gatherings could also provide the opportunity for athletic leaders to share emergency action plans.

Along with the CPR component of the MHSAA’s health mission for the coming school year, schools will be asked to have in place and rehearse emergency action plans involving cardiac and other health-related emergencies.

To assist, schools will receive this summer the “Anyone Can Save a Life” program developed by the Minnesota State High School League and endorsed and delivered nationally by the National Federation of State High School Associations (check back for more on this program later this week).

“The ‘Anyone Can Save A Life’ initiative promotes the need to have and to practice planning for different kinds of emergencies; it involves students as well as adults; and it invites schools to include their previously existing  plans,” said MHSAA Executive Director Jack Roberts.

“The result can be a fresh, comprehensive emphasis on preparing for emergencies well before they occur and then responding with more confidence when those emergencies inevitably happen. It is the perfect link between the last two years when we focused on heat illness and the next two years when we focus on sudden cardiac arrest,” Roberts added.

It will also be of primary concern to place automated external defibrillators (AEDs) in all schools and provide training for use of the devices.

The reasoning behind such a full-court press can be backed by simple facts. 

  • At any one time, an estimated 20 percent of the U.S. population congregates on school grounds, increasing the likelihood of school-based cardiac emergencies.
  • Victims of SCA can be brought back to life by providing chest compressions and early defibrillation with an AED.
  • Every second counts. When SCA occurs, chest compressions and the use of an AED need to start immediately.
  • The AED can only help and will only deliver a shock if it is needed.
  • The AED is very easy to use. Just turn it on and follow the voice prompts.

The best way to combat such situations is to create an atmosphere of preparedness; making sure all people in close proximity to potential victims can respond with quickness, confidence and precision to help reduce fatalities.

“In order for best practices to be achieved, it will require coordinated efforts to establish a quality emergency action plan among the entire athletic department staff, which should be practiced annually. This should be viewed as the first line of preparedness and defense in sports safety,” said James Lioy, an adjunct professor in athletic training at WMU who was named Michigan High School Athletic Trainer of the year in 2000-01.

That’s the goal of action plans such as those included in MHSAA CAP Levels and the Anyone Can Save A Life program.

“We've taken the ‘know-how’ out of it. You don't have to know how to perform the medical procedures to be trained and prepared as part of an effective emergency response team,” said Jody Redman, associate director of the Minnesota State High School League and one of the authors of the Anyone Can Save a Life program.

A common refrain in athletics to assign perspective on sport in society is, “It’s just a game; it’s not life or death.”

However, in the most dire of circumstances, participants indeed can be faced with life or death. Knowing how to respond can make all the difference.