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. 

‘Tis (out of) the Season

April 2, 2015

By Rob Kaminski
MHSAA benchmarks editor

Those who live in close proximity to high schools throughout Michigan don’t even need a calendar to know what time of year it is when a new sports season begins.

Whistles piercing through the hum of their air conditioners on the first Monday morning in August mark the start of fall from nearby football facilities. The ping of aluminum as sidewalks and grass re-appear from winter’s grip signifies the start of spring.

Office supply stores could see calendar sales soar in those households – or occupants might at least do a double-take when checking smartphone calendars – in the near future if MHSAA out-of-season coaching regulations are modified. The familiar sounds of the seasons could resonate in non-traditional months as well.

A major topic of the recent MHSAA Update Meetings and AD In-Services in the fall was the possibility of revamping the regulations regarding out-of-season contact for school coaches with school teams during the school year. The Summer Dead Period would remain in place and has been largely supported by membership since it was implemented for the 2007-08 school year.

It should be noted that out-of-season revision is not a certainty, but simply in the exploratory stage at this point.

Yet, the time was ripe to initiate discussion on this topic in the fall. The growth of non-school athletic programs and demands placed upon students by such entities in recent years was one factor. The difficulty the MHSAA has enforcing – and schools have interpreting – current out-of-season coaching regulations is another factor.

“The fundamental question is how to allow more contact between coaches and students out of season without encouraging single-sport participation,” MHSAA Executive Director Jack Roberts said.

Can this be done? Can trends toward specialization and away from multi-sport participation be reversed through greater contact periods for each sport within the school year?

Proponents of this school of thought believe that time otherwise spent with non-school coaches would be best served with education-based coaches who, in theory, would be on the same page with peers at their school, all encouraging multi-sport participation.

“Part of the explosion of AAU and club involvement has been the perpetuation of the notion that without additional training and competition, students will not reach their potential nor maximize their chances of being recruited by colleges,” said Scott Robertson, athletic director at Grand Haven. “When our high school coaches have the ability to provide a similar experience, but with an education-first mindset regulated by athletic directors, the expectations of student-athletes by coaches can be tempered.”

It is a lively debate that will be picking up momentum for the remainder of this school year and into the next.

Following are some of the concepts and comments from the fall, with key points from a statewide survey to be published later this week. The MHSAA's Representative Council discussed these results at its March meeting, and action is possible during its final meeting of the school year in May.

Let's begin 

Perhaps the most criticized, misinterpreted, ignored, and/or difficult to enforce rule in the MHSAA Handbook resides in Regulation II, Section 11 (H): the three- and four-player rule for coaches out of season during the school year. (See bottom of this page.)

Debate has long spiraled in dizzying circles around definitions such as “open gyms,” “under one roof,” “conditioning,” “drills,” and other components.

“One of the problems is the MHSAA finds this specific rule difficult to enforce and interpret,” MHSAA Associate Director Tom Rashid said. “Another perceived problem is that there might be a disconnect between school coaches and students out of season, which might be driving students toward non-school programs.”

It’s simple to recognize lightning rods, but quite another to construct a device for harvesting the sparks in a productive manner. To that end, Rashid prepared an outline for discussion on the topic as he hit the trails around Michigan this fall for Update Meetings and AD In-Services.

“We felt we needed to see if we could do better,” Rashid said. “Rather than say to 600 ADs, ‘What do you think about out-of-season coaching rules?’ we asked about a new concept. We created a starting point for discussion.”

The basic premise brought forward to the masses was this: a voluntary contact period of one month to six weeks with a limit of 10 or 15 days of contact in that period – and perhaps three in any one week – between a coach and his/her athletes out of season with any number of students, grade 7-12. Due to large participation numbers in football, some consideration was given to limiting the number of players in any one out-of-season session to 11, thus not creating “spring football.”

A straw poll from the gatherings in the fall indicated nearly 70 percent of attendees in favor of “contact periods” versus the current rule, prompting a detailed survey to all member schools sent in October to further measure the climate and hone in on specifics for desired changes.

“It was a very open process with great discussion,” Rashid said. “All size schools, all demographics, and all corners of the state weighed in.”

As always, the devil is in the detail, and the October survey yielded plenty of detail.

Numbers favor no numbers

As mentioned earlier, nearly 70 percent of attendees at MHSAA fall gatherings indicated that they might prefer a rule that specified coaching contact periods outside their sport during the school year, as opposed to limiting the number of student-athletes per session.

The ensuing survey sent to member schools in late October reflects that sentiment in schools of all sizes, and in all zones of the state. On the topic of counting contact days out of season with no limit on the number of students involved, more than 72 percent of 514 responding schools favored the plan. Class A schools led the way with nearly 76 percent  in support. Class D schools chimed in at 69 percent in favor. Support was strong across the zones of the state as well, led by the Detroit metro area (Zone 3) at 76.5. The middle of the state (Zone 5) was the low, but still found close to 60 percent in favor of such a revision.

The survey revealed consistencies across the board relative to the amount of three- and four-player sessions currently utilized by schools of different sizes, and the support and opposition to questions regarding revised regulations on the topic. For instance, nearly 50 percent of Class A schools indicate that their coaches work with students under the current rule most every week during the offseason, while 40 percent of Class D schools report that most of their coaches never utilize the three- or four-player rule at all out of season. Not surprisingly then, in questions posed where three-and four-player stipulations might still exist, the larger schools favored such changes at a higher rate than the smaller schools.

Survey data also reveals a reason for such opposition at lower-enrollment schools: a simple numbers game. In Class C and D, the majority of schools report that 60-80 percent of their student-athletes participate in more than one sport. So, with more students busier year-round than at their larger school counterparts, there are fewer people to attend out-of-season sessions.

Similarly, the concept of extending the current preseason down time for all sports was supported more in Class C and D schools than Class A and B. 

“It is always a challenge for individual schools to see things from the other schools’ perspectives,” Rashid said. “It’s hard for people to say, ‘It might be different for us, but for the greater good, we might have to change our culture here.’”

But, that line of thinking is certainly understood at Chelsea High School, a Class B school of more than 800 students. Athletic director and football coach Brad Bush is an advocate of multi-sport participation, regardless of school size.

“The current three- or four-player rule benefits kids by developing skills, but does not force kids to feel pressure to be at a full practice,” Bush said. “Changing this rule could reduce the number of multiple-sport athletes. Our staff and league is united in believing that changing this rule could be a big mistake.”

Outside influence

Part of the balancing act in attempting to revise out-of-season rules is to encourage greater participation on school teams, while not promoting specialization.

Interestingly, a number of schools in the survey reported that they have policies in place limiting in-season athletes from attending sports-specific training from out-of-season coaches. The percentages ranged from 27.6 percent in Class D to 41 percent in Class B.

Most schools allow weightlifting during the season, followed in decreasing order by three- or four- player workouts, conditioning and open gyms. However, more than 40 percent of responding schools have in place a policy prohibiting non-school competition for in-season athletes. The message seems to be that if activity is taking place, the preference is for it to be under supervision, and for that supervision to come from school coaches.

“If a coach is going to hold three workouts per week out of season, a student may leave another sport to play in the offseason of their preferred  sport,” Rashid said. “As such, many ADs identified that it would be the role of each school to regulate  out-of-season coaching. Right now, the ADs have to keep a handle on out-of-season activities and if the rules change, depending on their demographic, they might need to be involved even more.”

With advance planning, an environment can be created in which all of a school’s sports can exist in harmony and encourage multi-sport membership.

“Athletic directors can guide all coaches on their staffs to work together to create 12-month calendars that focus on the needs of kids and respect the desire of many to participate in multiple sports,” Robertson said. “In doing so, coaches can work to avoid overlaps in important opportunities where kids may be put in win-lose situations. With careful planning student-athletes will be afforded more opportunities to train and develop with their classmate peers and within their own communities.”

Chris Ervin, athletic director at St. Johns High School, is one of many in the camp that believes the current system accomplishes a school’s missions when properly supervised.

“Our coaches have ample opportunities to coach in the three- or four-player setting, and our athletes have plenty of opportunities to improve their skill sets through open gyms which are not coach-directed,” Ervin said.

Others agree that any change might introduce unwanted consequences. One source, an administrator in a strong football community, speculates in that town and others like it, football programs could smother other sport programs by scheduling full workouts on top of other in-season sports. Voluntary or not, it is opined that kids would gravitate toward the out-of-season football workouts if that’s the signature sport in town.

Ervin can see the same point. “I don't see this affecting my role too much, but I do believe this could lead to even more specialization. For example, if football coaches are able to work with their players 11 at a time in the offseason, I believe athletes will feel more pressure to be part of that football workout while they are in-season with another sport.”

Under another scenario, school coaches might someday be allowed to coach non-school teams during the school year. The rationale is that if students are participating outside the school campus anyway, wouldn’t it be better that they are coached by school personnel so that the educational message is delivered appropriately?

Add to this the fact that 100 percent of surveyed schools reported conducting open gyms in basketball and 66 percent in volleyball – the two most high-profile AAU sports – would it benefit schools to have trained personnel in those non-school leadership roles?

“This would connect our coaches to school kids but also could have the unintended consequence of specialization,” Rashid said. “However, the coaches in place would be our coaches, whereas currently we don’t have a say in the AAU coaches of our students.”

Not yet. This topic on the survey was favored by roughly 60 percent overall, but an equal 20.4 percent were at opposite ends of the spectrum strongly in favor and strongly against, with the highest percentage falling just above lukewarm. 

By Class, the C and D schools were slightly more opposed to this idea than Class A and B. Why? Very often, in the smaller communities, there are no non-school opportunities; school sports are the only option.

Robertson believes that incorporating a revised out-of-season coaching plan could assist families financially in the long run.

“By having the ability to include larger numbers of kids in development activities and allowing for a limited number of competitions, there is a strong likelihood that students and their families will choose the out-of-season activities offered by their schools over the AAU/club activities that exist,” Robertson said. “In doing so, there will be no rental of outside gyms, no mandatory club fees, and reduced costs to families.”

Not all ideas have elicited opposing views. One item on the docket that schools uniformly opposed was the possibility of scrimmages within the out-of-season contact period. Most schools indicate a preference for these periods to be instructional only.

Just a tweak

Perhaps the current rule just needs a splint and not a full cast. Maybe it’s not broken after all.

The most popular proposal to emerge from the survey was simply the removal of three little words in the current regulation: “under one roof.”

More than 80 percent of schools favored removing the phrase “under one roof” from Regulation II, Section 11(H) 2. a., which means as long as only three or four students are receiving coaching, then others may be in the facility working on conditioning, or in groups on their own.

Receiving close to 70 percent support from schools is the prospect of removing the portion of Handbook Interpretation 237 which currently prohibits schools from setting up rotations. This would allow a coach to work with dozens of players, three and four at a time.

And, Robertson says, in less time than coaches are currently expending.

“Most high school coaches already commit an enormous amount of time to the offseason development of student-athletes,” he said. “By removing the limit on number of athletes they can have contact with at one time and by placing a limit on the number of dates they can actually have this direct instructional contact, the net gain will be fewer dates, but with a greater impact.”

Rashid forecasts slight modifications of current rules rather than wholesale changes, at least in the near future.

“It wouldn’t surprise me if a few changes come sooner than later,” Rashid said. “One, allow rotations in the three- or four-player rule. Two, allow more than three kids under one roof as long as only three kids are receiving coaching. These two are a broader interpretations of our current rules.”

Simpler could be the answer. Perhaps over the course of time, in trying to be everything to all schools, the rule became more difficult for schools to follow, and for the MHSAA to oversee. Outside influences that could not have been predicted a generation ago have crept into the picture as well.

“These rules are very old, and that doesn’t mean not good,” Rashid said. “They were written at a time when the majority of students played multiple sports; before students began playing in 3rd and 4th grades, and before the non-school sports explosion.”

Even with the current trends and abundance of choices for some athletes, there are strong feelings from various leaders to leave things status quo.

“Our staff and league believes there needs to be a greater emphasis on the current rules with stronger punishments,” Bush said. “The answer is to enforce to current rules that we have, and not change the rules.”

There is a certain irony to this topic in front of athletic administrators and coaches, who spend so many hours in the here and now; in-season, in practices, in games.

“Who would think that what you do out of season could be the most critical piece of school sports discussion that we’ve had?” Rashid ponders. “It’s not what happens during the season, but in the offseason, that might be at the core of encouraging and maintaining school sports participation.”


Current Out-of-Season Rule (Three- or Four-Player Rule)

From MHSAA Handbook, Regulation II, Section 11(H):

2. These limitations out of season apply to coaches:

a. Outside the school season during the school year (from Monday the week of Aug. 15 through the Sunday after Memorial Day observed), school coaches are prohibited from providing coaching at any one time under one roof, facility or campus to more than three (or four) students in grades 7-12 of the district or cooperative program for which they coach (four students if the coaching does not involve practice or competition with students or others not enrolled in that school district). This applies only to the specific sport(s) coached by the coach, but it applies to all levels, junior high/middle school and high school, and both genders, whether the coach is paid or volunteer (e.g., a volunteer JV boys soccer coach may not work with more than three girls in grades 7-12 outside the girls soccer season during the school year).