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
Lessons Passed Down the Coaching Tree
July 18, 2013
By Geoff Kimmerly
Second Half editor
Lessons, like legends, are meant to be passed from generation to generation.
And just as parents hand them down to their children who then do the same, coaches teach athletes the best of what they learned as athletes themselves. Some of those athletes then become coaches as well, and in turn, educate a next group of teenagers growing up in part through their participation in sports.
As we begin to turn our eyes toward another school year beginning next month, here are a few favorite lessons taught by four recent participants of the MHSAA’s Coaches Advancement Program – with back stories on how they learned those lessons themselves and explanations of why passing them on continues to be important.
We are family
Steve Brooks
Ypsilanti boys basketball
Bio: Brooks led the Ypsilanti High School program the last 10 seasons, guiding the Phoenix last winter to its first Regional championship since 1981. He has been selected as the first boys basketball coach for the newly-formed Ypsilanti Community Schools, a merger of the former Ypsilanti and Willow Run districts. Previously, he coached three seasons at Inkster and also led that program to the Quarterfinals.
Lesson learned: Brooks was in fourth grade when he and a friend happened to ride their bike past Flint Northern’s football practice field during one of coach Fred Crawford’s training sessions. The noise and excitement and especially the defensive coaches yelling first caught the kids’ attention; Brooks and his friend ended up watching through the fence until Crawford approached and asked if they’d like a closer look. “He said, ‘Hey, you’re going to be a Viking one day, aren’t ya?’ It was so simple. But it made an impression on me as a young man, the pride and tradition of going there,” Brooks said.
Brooks’ family later moved to a neighborhood in Flint Northwestern’s district. But when the school boundary was redrawn before his junior year – and he had his choice of staying or attending Northern – Brooks remembered saying he would be a Viking one day and made the switch. Building togetherness remains a major focus of Brooks’ Ypsilanti program today, 49 years after Crawford first invited him into Northern’s football family.
Lesson taught: “At any time, our players can come in and talk about personal things and feel like they can let stuff out and it won’t go further than the people it’s entrusted to,” Brooks said. Making a connection to players begins early through his middle school coaches and remains key to building that familial trust.
It’s a philosophy that goes to Brooks’ core. “When you’re starting to coach nephews and younger brothers of players you’ve had, it’s that same type of feeling and promoting of family,” Brooks said.
Do the right thing
Heather Prentice
Portage Northern competitive cheer
Bio: Prentice has coached Portage Northern the last eight seasons and guided the 2007 and 2008 teams to the MHSAA Finals. Total, she’s coached cheer since 1986, including previous tenures at Climax-Scotts and Laingsburg.
Lesson learned: Prentice learned more from what she felt her high school experience lacked. She loved cheering – but decided as a coach to take an active role in the lives of her athletes. “I’ve matured the older I’ve gotten, and I think what’s become more important the older I’ve gotten is putting more of the focus on what I want my kids to leave with,” Prentice said.
“I’m not a parent, and I’m a person in their lives for a very short time,” she added. “But it’s a very significant period in life, and I try to carry myself as I would want them to remember me.”
Lesson taught: To that end, Prentice focuses on mixing plenty of fun with the hard work and lessons she teaches. Integrity ranks high on that list.
She’ll point out during workouts that if an athlete does 23 jumping jacks instead of 25, only that girl will know. But cutting corners, if it continues, tends to catch up with a person.
The payoff is finding out those lessons have paid off.
“The great thing about coaching for so long is you get letters or emails back from kids; ‘I thought of you today when I was disciplining my 3-year-old child,’ things like that. Or, ‘I went in for a job interview and they asked for one of my qualities. And I said I have integrity. I do have integrity, and you taught me that.’ Those are the cool moments,” Prentice said. “They really did hear me; they did hear what I am saying.
Accept responsibility
Duane Enderle
Birch Run girls and boys soccer
Bio: Enderle has coached Birch Run’s girls program since its start, and this spring led the Panthers girls to the District Final for the second time during the program’s six-season history. He also coached the boys for four seasons before taking the last two off, but will return to their sideline this fall.
Lesson learned: Enderle was a sophomore starter on his South Hagerstown, Md., team during one of the first seasons under eventual longtime coach Mike Tesla. At one point that season, Enderle didn’t make a Saturday practice – and during the next Monday’s game never left the bench.
“I learned at an early age it doesn’t matter how good you are. There’s always a consequence,” Enderle said.
Lesson taught: He’s noticed the last few seasons, both on the high school and club soccer fields, a growing number of players unable to control their emotions. “They get yellow cards and come out of a game for 10 minutes, and if it’s one of the good players it ends up hurting the team,” Enderle said.
He said this year’s Birch Run team saw a different side of him as he pushed accountability a little bit harder. It’s a lesson that doesn’t lose significance, even as athletes change over the years and push boundaries in different ways.
“That’s the biggest thing I try to pass on to them, their own self-responsibility and accounting for all of their actions,” Enderle said. “Everything they do always has consequences.”
One for all
Kim Crum
Mattawan girls lacrosse
Bio: Crum is a 2002 Mattawan graduate and played three seasons for the highly-successful softball program led by coach Alicia Smith. Crum just finished her third season coaching the school’s girls lacrosse team after previously coaching the Kalamazoo United team for three seasons.
Lesson learned: Being part of a team is a full commitment to those teammates, something Crum works to instill in her players each spring. She learned that in part as an athlete under Smith – who last season led Mattawan to its second MHSAA championship in three seasons. “With a group of teenage girls, a group of any teenagers for that matter, they form cliques and opinions of people before they get (on a team),” Crum said. “When we were on that team, there were people that didn’t agree, didn’t get along. But when we set foot in practice, for a game, we were part of a team and it didn’t matter what happened outside of there during the day. I try to tell the kids that now.”
Lesson taught: Instead of finishing practices with “1-2-3-Wildcats,” the team’s mascot, Mattawan closes with “1-2-3-Family!” Crum’s emphasis on “team commitment” also has grown through working with her assistant Matt Stephens, the school’s football coach during the fall.
Playing a high school sport often means seeing those coaches and teammates as much or more than family during that three or fourth-month span. Some of Crum’s lacrosse players have played together in the past or together on other sports teams. But she and Stephens are quick to remind them that each team, each season, is a new group with new dynamics to learn.
“Every time we do something, we look at it as how it affects the group,” Crum said. “We have to figure out how each other work. ... Be patient. By the end, we’ll figure things out.”
PHOTO: Ypsilanti boys basketball coach Steve Brooks (far right) celebrates with his team this March after leading the Phoenix to its first Regional title since 1981. (Photo courtesy of Randy Castro, Ann Arbor Journal.)