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
Gladstone Coach Smith Built Champions
October 24, 2016
By Dennis Grall
Special for Second Half
ESCANABA — Gerry Smith put his life into helping area youngsters get a foot into the athletic doorway, and in the process touched the lives of so many people.
“Smitty” died Oct. 15 following a lengthy illness.
“God got a great softball coach,” said retired Gladstone athletic director Matt Houle. “He was unique and old school, but his love for kids and the game always showed clearly. He had such a passion for the game of softball and just loved working with kids.”
Smith, 70, worked at Mead Paper Co. for more than 30 years and was IBEW 979’s business agent for 21 years. But he will perhaps be most remembered for his 43 years on softball and baseball fields throughout the area. He spent 11 years as Gladstone High School’s head softball coach, directing the Braves to MHSAA titles in 2004 and 2009. He was 290-77-1, but missed much of the 2008 season because of shoulder surgery. The Braves were 31-10 under interim manager John Malloch, which would give Smith an overall 321-87-1 record.
“He put a lot of trust into people he asked to help him out,” said Ashley Hughes, who succeeded Smith in 2014 and guided the Braves to the MHSAA Division 3 title that year.
Hughes, who joined Smith on the softball staff when she became a teacher at her alma mater in 2009, also pitched for Smith and the Braves before getting a softball scholarship to Lake Superior State University.
She recalled Smith sought her services when she returned to Gladstone. “Hey kiddo, how about helping us out this year,” is how Hughes remembers that conversation.
He then told her, “I’m going to teach you everything I know and in a few years this will all be yours,” Hughes related.
“For me to come as head coach after Smitty, there was so much pressure. I wanted to live up to everything he had provided for this program,” Hughes said. “I didn’t want to disappoint him. He put a lot of faith in me.”
She said Smith also had an impact when she was a player. “He was so in your face in such a positive light. He wanted you to be successful, whether you had never touched a ball or had the ability to go on to play college ball. He was a spit-fire. He was so intense.
“He just exuded passion, at practice, at games. He had so much love for the game. That is something I’ve held onto because I too loved that game. To have someone like Smitty be so passionate and intense helped me become passionate and gave me the drive to be like that.”
Bill Buchmiller and Smith were partners for 40 years and he became godfather to Buchmiller’s children. In addition to guiding the Braves’ high school varsity, they served as American Legion coaches in the early stages of Gladstone’s program, worked together as Little League coaches and were softball teammates.
“He took a program from nothing to two state championships,” said Buchmiller. “He always encouraged the group. He may have broke them down a little bit but he always built them back up. He was a hard guy to get to know, but once you got to know him, he was a great guy.”
Smith used the knowledge he had gleaned from many years as a player and infused that into his players. “He just dwelled on the basics of softball. If you had to play small ball to win, that is what he played,” said Buchmiller.
“He covered all the different bases of softball. He stressed defense. He told (hitting coach) Al Verbrigghe, ‘You give me one run Al and we’ll win the ball game with my defense. Give me a run and we’ll manage somehow.’”
Theresa Shepeck, who joined Smith on the GHS staff in 2003, agreed with that assessment.
“Smitty always thought the short game was the way to go,” she said. “It was about bunting, not the long ball. You get a runner on one, you bunt her to two. You get somebody on three, then you suicide (bunt) her home.”
Shepeck said his players thrived on his various idiosyncrasies, such as finding tourney lodging in rather inexpensive motels and using a wad of cash to pay for the team’s rooms. “The kids just yukked it up,” she said with a laugh.
“He always put the kids first. If somebody made a mistake, it was never their fault; it is my (Smith’s) fault, the coaching staff’s fault. If one of us coaches made a mistake, he took that blame. It was always his fault, his responsibility,” said Shepeck.
The players appreciated how he used them in games and practices. “His philosophy was to put the best nine on the field, period,” she said. “He walked on a lot of toes, he had a lot of hurt feelings (of parents), but I think the kids respected that. Nobody ever doubted how they fit in. He was there to win.
“He was a little man (about 5-foot-6) but had a huge heart. He was all about the kids and the coaching staff. It was an honor to learn from him, to be in his presence, to be a mentor to the kids.”
Hughes agreed, noting “he had a way of figuring out what the team needs are and re-arranging the players (duties). He knew the players’ strengths and was always looking out for the entire team.”
Smith’s career record likely could have included more wins if he didn’t use the season’s first month to shuffle personnel while building for the postseason. It paid off when it counted the most as the Braves reached at least the Quarterfinal level each of his 11 seasons.
“He was definitely not afraid to experiment,” said Hughes. “He knew the rules of the game and he was always looking for more (from his players). He was an aggressive coach, and the girls who love the sport really grasped at that. He utilized every player on his roster.
“He didn’t have to say too much, but you always wanted to answer him and make him proud and prove to him that you can come through.”
Houle summed up Smith’s legacy when he said, “He was the person that put Gladstone High School on the map in high school activities. He will be dearly missed by so many. He touched so many lives.”
Denny Grall retired in 2012 after 39 years at the Escanaba Daily Press and four at the Green Bay Press-Gazette, plus 15 months for WLST radio in Escanaba; he served as the Daily Press sports editor from 1970-80 and again from 1984-2012. Grall was inducted into the Upper Peninsula Sports Hall of Fame in 2002 and serves as its executive secretary. E-mail him at [email protected] with story ideas for the Upper Peninsula.
PHOTOS: (Top) Gladstone High School softball manager Gerry Smith holds the Division 3 championship trophy after the Braves won the 2009 title in Battle Creek. Smith, who also led the Braves to the 2004 crown, died Oct. 15. (Middle) Smith talks with catcher Jordan Kowalski at a practice prior to the 2011 Division 3 Semifinals. (Photos courtesy of Escanaba Daily Press.)