Staying Ahead on Head Safety
July 6, 2015
By Rob Kaminski
MHSAA benchmarks editor
Three stacks of concussion-related material offered precious little space on MHSAA Executive Director Jack Roberts’ desk, and perhaps consumed even more room in his head as he tried to wrap his mind around the seemingly daily “latest and greatest” documents outlining signs, detection and return-to-play elements involving head trauma.
Without a doubt, the scene is quite similar on any given day in the offices of his cohorts across the country as school sports leaders are faced with the daunting, dizzying task of devising plans to address concerns aimed at the health of their games.
Lawmakers, rules makers, medical experts and the court of public opinion all want the same thing for student-athletes: a reduction in the chances of head-related injuries. And they all are perfectly willing to offer instant fixes to those in charge.
They often expect those in Roberts’ position to analyze, digest and create action plans as soon as possible without considering the research and resources it will take to get there.
“All parties involved want the same thing. We all want to provide the safest environment for educational athletics through protocols and practices that will offer the most minimal risk of injury,” Roberts said. “But, this can’t be accomplished through unfunded mandates which would stifle the already struggling athletic budgets in many schools.
“Changes have to occur through training and education, orchestrated through state offices and executed locally. And, it takes time to research the best and most effective means. There is so much information, and so many devices in the field today that those in athletic leadership roles almost have to have a medical background as well.”
For instance, there are documents which list as few as five symptoms for concussions, and those listing as many as 15. There are sideline detection methods which purport to take 20 minutes and those which claim to determine concussions in 20 seconds. There are as many return-to-play protocols as there are state associations.
Increasingly, state high school associations are seeking opinions and expertise from local medical personnel. In March, in one of many such meetings, Roberts and other MHSAA staff welcomed several from the Michigan Department of Health and Human Services to their office to discuss sideline detection methods and return-to-play issues.
“There are two areas that concerned us most,” Roberts said. “One, sideline detection of head injuries is inconsistent across the state in terms of both results and resources. Two, we need methods which generate immediate reports and permanent records.”
As the group which convened in March discussed the topic, potential hurdles and new perspectives on sideline management came to the forefront.
On the money and manpower front, who would be responsible for administering sideline tools? Most ideally they would need to be overseen by medical personnel rather than coaches or team managers.
From a perspective standpoint, an interesting view was volleyed out to the group: could sideline detection actually speed up a student’s return to play rather than slow it down? Current protocol prescribes that if competition continues while an athlete is withheld for an apparent concussion, that athlete may not be returned to competition that day but is subject to the return-to-play protocol. And, clearance may not be on the same date on which the athlete was removed from play. Only an M.D., D.O., Physician’s Assistant or Nurse Practitioner may clear the individual to return to activity. With immediate sideline detection, are parties more vulnerable should a student pass immediate tests, only to have undetected effects of the incident increase over time?
“The group shed a different light on the various scenarios, which was a primary purpose for the meeting,” Roberts said. “As one can see, there are so many variables to consider when attempting to determine the next plausible and practical steps toward minimizing and detecting head injuries.
“Further, we have to take into consideration practice sessions as well as competitions, and all sports, not just select sports.”
Adding to the challenge is simply the nature of athletics. Competitors at any level are just that: competitive. Often, students – or their parents – will attempt to hide symptoms or be reluctant to come forward with injuries, particularly head injuries which can’t be seen.
In more cases, perhaps the symptoms simply are not recognized, which is why education is paramount.
First, association leaders have to tackle the due diligence of researching issues and potential solutions to situations currently threatening the well-being of scholastic sports. Considering that some 1,620,000 results are offered when “sideline concussion detection tools” is typed into a search engine, this is a laborious and continual chore.
Such information then needs to be packaged and presented to leaders at the local levels – athletic directors – to pass on to coaches, the individuals who have as much or more influence on students that perhaps any other adults, including parents in some cases.
This is why MHSAA rules meetings, Coaches Advancement Program sessions and other statewide forums continue to bang the drum on health and safety issues; to make sure the messages and procedures reach the student-athletes.
And, it’s why the MHSAA is asking coaches and ADs to be accountable in verifying that the plans in place are being carried out.
Less Could Mean Less
There are times when it’s good to say, “less means more,” but in the case of contact sports, practices and competitions, the idea is for less to mean less. As in less time for collisions to occur yielding fewer injures.
It’s early yet, and one year does not constitute a large sample size, but the MHSAA Football Practice Policy instituted last August could be one step toward reducing head injuries.
Beginning this past football season, the number of practices with helmets, shoulder pads and full pads were limited to start the season, and preseason “collision” sessions were limited to one per day. During the season, such practices were limited to two per week, while the length of practices was also regulated.
Dr. Steven Broglio of the University of Michigan Neurosport department is conducting a three-year study of the Ann Arbor Gabriel Richard football program with the assistance of Richelle Williams to determine the “Effects of Concussion and Sub-Concussion.” The study began in 2013, one year prior to the new MHSAA guidelines.
Research in 2013 showed approximately 650 “impacts” per player. In 2014, the number dropped to approximately 500 impacts per player. Impacts are defined as greater than 10 gs of acceleration. Williams stated that a slap on the back is 4 g, coughing is 3.5 g. On average, a helmet hit is 25-45 g. Concussions usually happen (roughly) between 80-150g.
An encoder is embedded into each football athlete’s helmet which monitors head impacts and exactly where the impact is located. Williams sits at each practice and game and through a pager identifies the player’s number and impact from a hit of 90g or more.
They are also looking at those who do not sustain an impact concussion, but rather sustain multiple head impacts and whether those multiple head impacts lead up to brain changes (measured through EEG).
The initial findings, as submitted by the study team, indicated two reasons why there were fewer overall impacts from 2013 to 2014:
Primary reason: The MHSAA adoption that became effective in August 2014 with new limitations that were placed on “collision practices” and conditions that full pads could not be worn until the fifth day of team practice.
Secondary reason: Fewer players evaluated in 2014 than 2013.
Fit for a King?
Editor’s Note: There are many sideline detection tools on the market, as a quick Google on the topic will reveal. The following, the King-Devick test, is among the highly recommended tests, summarized here simply to provide an idea of the types of systems available and how they operate. The following is from King-Devick’s website.
The King-Devick Test is an objective remove-from-play sideline concussion screening test that can be administered by parents and coaches in minutes. The King-Devick Test is an accurate and reliable method for identifying athletes with head trauma and has particular relevance to: Football, Hockey, Soccer, Basketball, Lacrosse, Rugby, Baseball, Softball and Other Collision Activities.
King-Devick Test is an easy-to-administer test which is given on the sidelines of sporting events to aid in the detection of concussions in athletes. King-Devick Test (K-D Test) can help to objectively determine whether players should be removed from games. As a result, King-Devick Test can help prevent the serious consequences of repetitive concussions resulting from an athlete returning to play after a head injury.
How King-Devick Test Works
Concussions are a complex type of brain injury that is not visible on routine scans of the brain, yet are detectable when important aspects of brain function are measured. King-Devick Test (K-D Test) is a two-minute test that requires an athlete to read single digit numbers displayed on cards or on an iPad. After suspected head trauma, the athlete is given the test and if the time needed to complete the test is any longer than the athlete’s baseline test time, the athlete should be removed from play and should be evaluated by a licensed professional.
Remove-From-Play vs. Return-To-Play
Both remove-from-play and return-to-play decisions are crucial in concussion recovery. It is critical to remove a concussed athlete from play in order to prevent further damage. It is also extremely important to keep the athlete from returning to play until they have made a full recovery. There are tools to assist in making both remove-from-play and return-to-play decisions.
King-Devick Test for Remove-From-Play Decisions
- Quick, objective sideline testing
- Measures impairments of speech, language and other correlates of suboptimal brain function
- Instant screening feedback in minutes
- Administered by parents, coaches, athletic trainers and medical professionals in remove-from-play decisions
- Neurocognitive Testing for Return-To-Play Decisions
- Computerized concussion evaluation system (in the computer lab)
- Measures verbal and visual memory, processing speed and reaction
- Tracks recovery of cognitive processes following concussion
- Assists clinicians in making return-to-play decisions
'Distinguished' Garvey Serves Hackett Well
By
Pam Shebest
Special for MHSAA.com
March 28, 2017
KALAMAZOO — Mike Garvey’s high school sports career took him to Switzerland, England, West Germany, Belgium and France.
As unorthodox as that was, it set the foundation for his life’s work as a director of athletics, currently at Kalamazoo Hackett Catholic Prep.
For his work in high school athletics, Garvey has a collection of honors and awards, including his latest: a 2016 National Interscholastic Athletic Administrators Association Distinguished Service Award, presented at the national banquet in Nashville, Tenn., in December.
“It was pretty neat,” said Garvey, who prefers talking about his coaches and athletes instead of himself.
“I don’t have a job; I have a mission and my mission is to serve the kids, which is really why this one means so much to me, because it’s a distinguished service award.”
The award, based on service to the NIAAA and interscholastic athletics at the local, state and national levels, followed his 2015 Allen W. Bush Award from the MHSAA for “giving and serving without a lot of attention,” he said. “Mr. Quiet and Humble,” he added with a laugh.
“While Mike’s first priority is at his school and the students there, he involves himself in league, state and national organizations, sharing his knowledge and experience with others so they can become better at what they do,” said Gary Ellis, athletic director at Allegan High School for 17 years before retiring in 2013.
“His willingness to mentor others has had a positive effect on many districts within his conference and throughout the state.”
Coaches enjoy working with Garvey, said Jesse Brown, who is starting his 12th season as Hackett’s head baseball coach.
“The great thing about Mike is that he is focused on the kids first,” Brown said. “As a coach, we put kids first. It puts us on the same page immediately.
“It’s that relationship building he has, even with his coaches. I look at him as a mentor for me. He’s very, very open and is willing to help you grow. He pushes you to do that, too.”
With none of 27 varsity head coaches working in the building, Garvey has an interesting dynamic, keeping in touch with them through emails or phone calls when they are not on campus.
“We have an awesome staff here, and that makes my life easier,” Garvey said. “Our head coaches own their programs. I tell them, ‘If I wanted to be the head coach in your sport, I would have hired me. So go run it.’ I think they like that.”
Garvey recently finished his term as the liaison between the state and national associations, and he is MIAAA coordinator for leadership training.
At the national level, he teaches “Coaching for Character,” starting each class with a quip: “‘I thought this class was characters in coaching.”
New initiatives at Hackett
Garvey was instrumental in starting two initiatives for athletes at Hackett: The Captains Clinic and, this year, an award called Scholar Athletic of Distinction.
He instituted the clinic because with no varsity head coaches in the building, “I felt like throughout my career, I watched coaches and their captains but it really didn’t mean anything,” he said.
“You’re the most popular kid, and you’re going to get one of those little captain’s bars at the end of the season. That wasn’t good enough.”
The clinic is a three-hour session and this year totaled 57 athletes. Any captains who do not attend lose that status.
“This year, we talked about what it means to be a good teammate,” he said. “They appreciated the pizza at the end. Free T-shirt and pizza; I got kids right there.”
Sophomore Natalie Toweson not only attended the clinic but helped design the T-shirts.
“His big thing is quotes,” Toweson said of Garvey. “I think I learned a lot from seeing other leaders and what they take out of certain situations. He has senior captains come in and share their experiences and how you can follow their lead because they’re really big role models to the underclassmen.
“Mr. Garvey brings a lot of energy and experience. He gives us new experiences, like playing Class A schools we’ve never played before, but is also very supportive and is at every game he can be.”
For the scholar-athlete award, Garvey has a rubric where athletes get points for years on freshman, junior varsity and varsity teams; bonus points for extra service hours, a higher GPA, all-conference, serving as captains and captains clinics attended.
Long way back to Michigan
Growing up in Detroit, Garvey attended Catholic schools, but during his first month as a freshman at Birmingham Brother Rice, his father was transferred to Geneva, Switzerland, for his work with Chrysler.
Mike’s sophomore year, his dad was transferred to the office in London, where Garvey honed his athletic skills.
“I was in an American school, so we did have sports,” he said. “In Europe the school sports aren’t that big because the parents don’t think they’re that good, so we competed with other American schools, which meant that for tournaments or competitions, we’d go to what used to be West Germany.
“We’d go to Belgium; we would go to France. It was really cool. When I moved back at the end of that last year, I had been in way more countries than I had been in states.”
Garvey competed in soccer, rugby, wrestling, baseball and swimming, which “was not my best sport,” he quickly added. “I just kind of had a jock heart and loved sports.”
After high school, he spent the next year in Europe and finally decided he had to choose a career.
“My two options in my brain were teach PE (physical education) and coach or be a dentist,” he said. “Vastly different. The year after I graduated, I stayed to help my previous coaches in London, and I was sold.”
After graduating from Western Michigan University, Garvey took a job in Illinois where he taught four hours of French, a language he learned while in Switzerland, and two hours of religion.
He was also head coach of wrestling and baseball and a football assistant coach.
Four years later, he moved back to Michigan, teaching at Lawton High School. That led to his first job as director of athletics, spanning his last five years there.
Garvey went from Lawton to Delton Kellogg, where he spent seven years as AD.
“I really felt like I grew there because I was away from my comfort zone,” he said. “It was stand up and be the guy. That’s where I got real involved with the state AD association.”
When Delton added assistant principal duties to his job description, Garvey decided he did not want to play the good guy (AD)/bad guy (assistant principal) roles and took a job at Otsego High School.
“I got to be involved in the building process,” Garvey said. “I loved Otsego and the people I worked with, and I worked with an awesome principal (Herve Dardis).
“I was involved in all the building stuff: the stadium, the ball fields, the tennis courts, the building. It was really fun.”
In 2010, Garvey had the opportunity to return to his Catholic roots when the AD position became available at Hackett.
“I went through the interview process, and I decided I had to come home,” he said. “My kids (Erin and Kristy) went here and I knew 20 years ago I was going to finish at a Catholic school.”
As conflicted as he was at making the choice, Garvey knew he made the correct one.
“It was really hard to leave Otsego because as an administrative team we had put together the facilities, which were outstanding.
“But I just couldn’t say ‘No’ to a Catholic school. I just couldn’t do it.”
And he remains up to the two toughest challenges in his work leading Hackett’s athletic department.
“No. 1, keep all our programs strong because we don’t have that many kids, yet we offer a crazy number of opportunities for them,” he said. “To keep those programs viable, we need bodies.
“The other hard part is I’m married to my best friend (Jennifer) and it keeps me away from her. When this becomes a job, then I’m done.”
Pam Shebest served as a sportswriter at the Kalamazoo Gazette from 1985-2009 after 11 years part-time with the Gazette while teaching French and English at White Pigeon High School. She can be reached at [email protected] with story ideas for Calhoun, Kalamazoo and Van Buren counties.
PHOTOS: (Top) Kalamazoo Hackett Catholic Prep athletic director Mike Garvey holds up his NIAAA Distinguished Service Award; adjacent, attendees of a “Captains Clinic.” (Middle) Retired Allegan athletic director Gary Ellis, Hackett baseball coach Jesse Brown, sophomore athlete Natalie Toweson. (Below) Garvey enjoys some down time with grandson Dylan Alexander (left) and granddaughter Maya Wilson. (Photos courtesy of Mike Garvey; plaque photo and head shots by Pam Shebest.)