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
Przystas Helps 'Shape' Fitness for Future
By
Geoff Kimmerly
MHSAA.com senior editor
December 20, 2016
By Geoff Kimmerly
Second Half editor
Scott Przystas had plans earlier this week to “crash” a Grand Haven schools party with vegetables grown in his classroom’s hydroponic garden. It may be winter outside, but in his physical education class, it’s time to harvest.
But the Michigan chill doesn’t mean his students – ranging from Young 5’s to fourth grade – will be restricted to the gym for the next three months. When they return in 2017, they’ll head outside and give snow-shoeing a try.
Teaching includes a lot more than daily dodgeball or rolling out the basketballs for Przystas, a member of the MHSAA Multi-Sport Task Force and this fall’s honoree as Michigan Physical Education Teacher of the Year by the state’s chapter of Society of Health and Physical Educators (SHAPE).
The task force over its first few months has determined that the message on the many benefits of participating in multiple sports must be delivered to students and their families long before these students reach high school and even junior high – making passionate educators like Przystas especially key. He passes on a perspective that “PE is the most important thing we can teach kids, how to be physically active for life” while teaching students at Grand Haven’s Mary A. White and Rosy Mound elementary schools.
“That’s our goal with the elementary PE department in Grand Haven, to make it relevant again,” Przystas said. “Because it’s really easy in our profession (to say) here’s the ball kids, do you want to do. But it’s not gratifying at all. It’s not satisfying to the kid or the teacher.”
Przystas brings the MHSAA task force a wealth of experience as a coach – he’s in charge of the high school’s girls cross country team, serves as freshman coach and varsity assistant for girls basketball and leads the middle school track & field teams. But he also provides an important voice for physical education, an area the task force considers crucial to growing interest in playing many sports instead of specializing in one – which studies have shown can lead to chronic injuries when playing that one sport while leading those children to become adults who are less likely to be physically active and fit. He is in his eighth year in the Grand Haven district and has taught in nine buildings at the elementary, middle, high school and alternative education levels.
“Scott has been instrumental in leading changes to the PE program in Grand Haven,” Mary A. White principal Valerie Livingston said in a report for the Grand Haven Tribune. “His excitement about life-long fitness and nutrition is contagious in the school. Under Scott's direction we have students who look forward to smoothie bars at lunch and are excited to see our new tower garden grow.”
Many teachers
Przystas’ philosophy is deeply-rooted in the positive experience he had growing up in Gladwin, a much smaller community than Grand Haven located north of Midland and Mount Pleasant.
His father Ronald – who formerly worked at the Lansing State Journal and Cadillac Evening News before becoming a reporter, editor at later publisher at the Gladwin County Record – died in a car crash in 1996. But he left his then 10-year-old son a love for sports photography – Scott minored in journalism at Michigan State University – and also plenty of familiarity with athletics. A track & field meet hosted by Gladwin Junior High School bears Ron’s name.
Sports provided an outlet during that tough time. During middle school, Scott would go from a basketball game to hockey practice that same night, filling his time with those sports, golfing and a variety of other like activities.
A few years after his dad’s death, Przystas became a manager for the Flying G’s boys basketball varsity coached by Kirk Taylor, who had gotten to know Ron well over the years. Ron had made sure Kirk understood the importance of Gladwin beating county rival Beaverton – they play for a trophy dating back to 1937 – and so it was memorable when Scott, as a senior during the 2005-06 season, scored a career-high 25 points to help the Flying G’s beat the Beavers despite the fact he really wasn’t a scorer as much as a solid all-around player.
“Scott was part of the best group of captains I have had here at Gladwin in the past 23 years,” Taylor said. “One of his co-captains was quiet and out-worked everybody. Another of his tri-captains was very direct with players. Scott was a little of both, but he always delivered the message with the most positive manner.
“I did not know that Scott would become a teacher and/or a coach, but I did know that he would be very successful at whatever profession he chose.”
Przystas made the all-Jack Pine Conference second team as a senior in 2004 while also earning all-league honors in golf and serving as a pinch-runner in baseball for a couple of seasons – but that was just a start on his athletic endeavors. At MSU, as he was studying toward a degree in kinesiology, Przystas played on the practice scout team that daily took on the women’s basketball team as the Spartans prepped for multiple NCAA Tournament runs. He knew he wanted a career in sports, and that experience got him interested in coaching. He also participated on the MSU triathlon club team, which got him into endurance sports.
He graduated from MSU and before the fall of 2009 latched on at Grand Haven. His first call was to Buccaneers girls hoops coach Katie Kowalczyk-Fulmer, and he was on her bench as an assistant for the program’s back-to-back Class A championships in 2012 and 2013 – while also for a time living in her basement before marrying his wife Renee.
Przystas also inherited the high school’s girls cross country program, which he coaches with Renee, and which has made the MHSAA Finals 17 straight seasons. In addition, he became the Lakeshore Middle School track & field coach – and he sees all of these as being related.
“At a Class A school like this, I’d like to say having most (students) participating in high school sports is because of the elementary PE teachers rocking it,” Przystas said. “Our numbers in cross country are up there (50-60 athletes the last few seasons), our numbers in track are getting up there, and the kids are seeing a familiar face and enjoying the process and sticking with it.”
Passing those lessons on
In addition to Taylor and Kowalczyk-Fulmer, Przystas credits his high school golf coach Ben Ball and Gladwin’s former girls varsity and boys subvarsity boys basketball coach Andy Miceli among those who helped shape his growing up. He also gained valuable experience during his student teaching as an assistant with the Bath High School girls under Craig Poppema, and retired longtime Grand Haven boys hoops coach Craig Taylor – Kirk’s dad – has provided plenty of mentoring.
Przystas – who has served a two-year term on the Governor’s Council on Physical Fitness, Health and Sports – teaches from a philosophy based on a pyramid. The bottom level is health and knowing how to take care of oneself, with the middle level physical literacy and the body’s ability to solve movement problems to avoid injury. The top of his pyramid is adventure, and that’s what he’s trying to deliver to his students.
But to do so, he also has to be able to relate and communicate with them.
“Scott makes it fun. He’s just very organized – and he connects with whatever age group, whether it’s kindergarten kids or high school girls,” said Kowalczyk-Fulmer, recalling how excited her 5-year-old son was to have “Coach P” as a teacher. “Freshman girls can sometimes be an interesting group to coach … but he never changes who he is. I’ll stand in the locker room after games and listen to the things he says. Just the quality of person he is, he’s a role model, he and his assistant Kelly Kieft. He’s just a good, positive role model for young people.”
Przystas noted how SHAPE America is pushing for the generation of children being born now becoming an “active” next generation, and as a newer father this hits home – and also helps fuel his desire to help.
He said it’s harder to plant that seed when students are older – but that’s where his responsibility as a cultivator at the elementary level comes in.
“I had a great childhood experience,” Przystas said. “That was the big thing. I fully remember all of the pickup games we had in our neighborhood, the outdoor adventures exploring, playing ping-pong on a chipped-up table.
“(That’s why) I promote to kids in middle school, elementary school, to go check out a lacrosse game. Go to swim camp. Be active this summer. Don’t just be sitting around. We’ve just got to get them outside more and have kids be active.”
PHOTO: (Top) Teacher Scott Przystas (kneeling) works with one of his elementary school classes in Grand Haven. (Middle) Przystas (back row, second from left) has been an assistant on two Class A girls basketball championship teams. (Top photo courtesy of the Grand Haven Tribune.)