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
Answers from the Athletes
By
Rob Kaminski
MHSAA benchmarks editor
May 22, 2014
By Rob Kaminski
MHSAA benchmarks editor
MHSAA Student Advisory Council members were asked their opinions on several of the current issues facing the MHSAA Junior High/Middle School Committee and the MHSAA JH/MS Task Force. Students also shared experiences from their junior high/middle school days and from participation with non-school teams. Following is a sampling of responses:
Length of Contests and Seasons
Based on your junior high/middle school experiences, would you favor an increase in the number of contests/events that a junior high/middle school is allowed to play? Would you favor longer game times?
Kiersten Mead, Saginaw Swan Valley: “I personally don't believe that longer seasons are necessary. In middle school, student athletes are just starting to learn how to balance sports and school, so I think that the season time is already pretty reasonable.
“I do, however, believe that longer games would be really beneficial to all ages. It would allow more students to play and participate.”
Jonathan Perry, McBain Northern Michigan Christian: “When I was playing, I wish my season would have been longer, but it is at a reasonable length. It would be harder on parents having a middle school player and a high school player, but it would get you more ready for a high school-length schedule.
“The games are at a reasonable length also. The one benefit of having more games and longer games is that more kids get to play who otherwise might not if they had a shorter game or season.”
Connor Thomas, Marlette: “As a player, I would be totally in favor. If I were an adult, I would say no because of the traveling. As for the lengths of games, again, I’d favor it as a player. But with schools that have A and B teams for both grades, that could be a late night.”
Kristen Law, Bloomfield Hills Andover: “I really enjoyed playing in middle school, and I would have loved to be able to play more. Increasing the length of games might depend on the sport. For tennis, from what I remember, the matches were a shortened version of what we play in high school, and I thought they were appropriate given the level of the majority of the players that were competing.”
Zack Nine, Pinconning: “Based on my middle school sports experience, I would favor an increase in the number of contests and a longer game time. These changes would give athletes who do not get much playing time a chance to gain more experience. I also believe that more games and a longer game length would keep our youth in better shape and better prepare them for high school athletics through an easier transition.”
Mandy Paull, Cheboygan: “I think that middle school sports should be allowed to play more games, but I do not think that the length of games should be increased.”
Coby Ryan Manistique: “I would favor an increase in the number of contests. The seasons are quite short and go by too quickly, in my opinion.
“I would also favor longer game times. With this, more kids will get the opportunity to play, and it will also make the travel and the time invested more worthwhile.”
6th-Grade Participation
Is it time to also include 6th-graders at junior high/middle schools under MHSAA guidelines? Consider enrollments, sports and participation with 7th- and 8th-graders.
Eliza Beird, Holland Black River: “I would favor the addition of 6th-graders in all sports. This would allow for the possibility of two teams in some sports and it gets the kids playing with people they might be playing with for the rest of their high school careers.
“It is definitely easier to put 6th-graders with 7th- and 8th-graders at a smaller school because one grade usually won’t out-number another grade. In a big school, a bunch of 8th-graders will try out for the team because more go to a school. In larger schools, 6th-graders would have a chance to make only a 6th-grade team.
Hayden Smith, Hamilton: “I think it’s time for 6th-graders to be included, but not in all sports; just the non-contact ones. The various sizes of schools would make it easier for some to compete and harder for others, but it shouldn’t matter overall. All schools’ 6th-graders should be able to play. I think that would be a great experience for them.”
Mandy Paull, Cheboygan: “I think that 6th-grade students should be able to play middle school sports. Sports are a good way to initiate incoming elementary students to the middle school as well as provide a fun, constructive activity that they can participate in with their friends, and a way to make new ones as well.
“The 6th-grade athletes should only be mixed with the 7th and 8th grade in cross country and track, and have their own teams for sports like volleyball and basketball, just as the 7th- and 8th- graders do. Only non-contact sports should mix all grades.”
Connor Thomas, Marlette: “Coming from a smaller community, I think the MHSAA should include 6th-graders in only the schools that need them, such as small Class D schools. They should be allowed to play with 7th- and 8th-graders as long as the schools need them, and aren't bringing them up to have a ‘dream team.’ Enrollment has to be a factor; the schools should be struggling for numbers in order to have a 6th-grader on a team.”
Zack Nine, Pinconning: “I believe that 6th- graders should not be held accountable to MHSAA regulations. My opinion largely stems from the fact that not every school includes 6th grade as part of its middle school. I know mine does not. It would be difficult to regulate the participation of 6th-graders in some schools (because they're considered middle schoolers) while other schools cannot let their 6th-grade elementary students compete.”
Jonathan Perry, McBain Northern Michigan Christian: “I think all sports should be included if 6th-graders were allowed to play. I think it’s more helpful to small schools, but wouldn’t limit it based on enrollment. I go to a small school; last year my school did not have enough kids for a 7th-grade team.”
Kiersten Mead, Saginaw Swan Valley: “I understand the monetary considerations schools may have with 6th-grade teams through the MHSAA, but I do believe that the MHSAA should start setting guidelines for the schools which see it as feasible. Middle schools don't have to go through the MHSAA, but I believe that by including 6th-graders, it may generate a positive reaction from member schools.
“I feel like as long as the coaches don't see a major physical disadvantage to it, then it would be okay for 6th-graders to participate with the 7th and 8th grade in all sports. Non-contact sports would most definitely be alright, because in high school, you compete against all ages anyways.
Coby Ryan Manistique: “I believe that it is time for 6th-graders to get the chance to participate in athletics, regardless of school size. By choice, a child should always be given the opportunity to be active, stay out of trouble, learn about teamwork and leadership, and build a foundation for fundamentals that will be used for the rest of their athletic careers. Many schools do not have locally run programs, and the MHSAA running it would give thousands more kids a chance to play.”
Kristen Law, Bloomfield Hills Andover: “When I was in 6th grade, I was competing against 7th- and 8th-graders (on community teams), and I probably would have been upset if I couldn't compete against them. Sixth-grade participation should definitely be allowed in non-contact sports, but I don't know too much about contact sports and the risk of injury to 6th-graders if it were to be allowed.
“I don't think the size of the school should determine whether or not 6th-graders can compete against 7th- and 8th-graders.”
Community and Club Sports
If you played community sports during your JH/MS years, how did the experience compare with school sports? If you could have played MHSAA-based sports in 6th grade, would you have done so?
Emileigh Ferguson, Bear Lake: “I played little league softball prior to middle school, until 5th grade. I prefer MHSAA sports over other kinds because they are more serious and organized. My school has basketball for 5th and 6th grade so we don’t play with middle school.”
Eliza Beird, Holland Black River: “I played soccer and basketball from Kindergarten through 6th grade and still play club sports. My outside-of-school sports tended to be a bit better.
“If there were MHSAA sports in 6th grade, I would have definitely played basketball. I already played with a bunch of girls from school so playing for my school would not have been much different. Plus it’s fun to play for my school. I probably would not have played soccer because the club team I was on at the time was quite a bit better than the school team.”
Hayden Smith, Hamilton: “In my experience (community sports) was somewhat similar, but still different. School sports weren't coached by parents anymore; the best players got to start. Also, it was different in that a lot of kids stopped playing; only the ones who really liked it kept playing. However, it was similar because there were always people (parents and kids) complaining about playing time. It was similar in that there was always a strong community at your back.
“If I could have played school sports earlier, I would have done so because of the aspect of representing my community and school. I think I still would have done the travel baseball stuff, but that is always in the summer.”
Mandy Paull, Cheboygan: “I played girls little league softball from 3rd to 5th grade, and house hockey from 1st grade to 9th. In middle school the sports were more serious and I enjoyed them much more. As a team we would dress up for our games, and we got to travel on a bus to away games. There was a much stronger bond and all the players were more serious. The teams were also better in middle school due to tryouts.
“I definitely would have played middle school sports in 6th grade as opposed to community teams.”
Jonathan Perry, McBain Northern Michigan Christian: “I did not notice a huge difference between community sports and school sports. The big difference in community sports is that you get a wide range of kids, not just the kids in your school. I like playing the school sports better because I knew that the kids I was playing with were who I would play high school sports with.
“I would have played school sports in 6th-grade or earlier if the option was there. A lot of community sports I played on (were) all about winning. The school team sports provide learning sessions for both sports and life. It's an extension of the classroom. I saw that more with school sports than community sports.”
Kiersten Mead, Saginaw Swan Valley: “I did not play anything prior to middle school, but in 6th grade I was a part of an AAU volleyball team since my school did not offer a 6th-grade team. I also bowled in leagues at a few different bowling alleys.
“I definitely would have played with my school versus community. We really didn't have a solid AAU program in our area so the school team was much more organized. I found that the volleyball teams through my school were much more beneficial to me. We practiced on a regular basis, and it was nice to play with girls that I was already friends with. We were able to grow more as a team and gain a greater sense of unity. I believe that my school team made me a better athlete as well.”
Kristen Law, Bloomfield Hills Andover: “I enjoyed being able to play sports with my friends in middle school, but I also liked the competitiveness of the community- based sports I participated in. The middle school sports atmosphere didn't feel as competitive.
“When I was in 6th grade, I played tennis on the middle school team, but it was not affiliated with the MHSAA.”