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
Tomlin Sells Opportunity at Alma Mater
July 11, 2013
By Rob Kaminski
MHSAA benchmarks editor
Edward Tomlin had it all. Or, at least, everything he wanted when he left Central State University in Wilberforce, Ohio, to launch himself into the real world.
“I was in sales. My big thing in college was that I wanted a company car, and a laptop, and I wanted to travel. That was it,” Tomlin recalled on a cold February morning this winter. “Well, 25 pounds later, I realized, ‘You know what? This is not all it’s cracked up to be.’ It was a lot of fun for a guy coming right out of college, but it really wasn’t meaningful.”
The erstwhile traveler is now firmly entrenched in a first-floor office at Detroit’s Cass Technical High School, selling the most precious of all commodities: opportunity to student-athletes.
He recalls going into work one day during his prior life and thinking there must be something else to do.
A phone call to his mother was all it took.
“She said, ‘Well then, quit.’ And, I quit, that day,” Tomlin said. “It’s funny because my mom told me before I left college I should get certified to teach, and I said, ‘Nah, I’m going into sales.’”
Well, mother knows best. In Tomlin’s case, both his mother, Jacqueline, and his father, Kern, were lifetime educators.
And, now, so is he.
After beginning as a substitute teacher within a week after retiring his sales briefcase, he landed his first teaching gig at Detroit Crockett High School.
A solid golfer, Tomlin was never at a loss to find people seeking to fill out a foursome during his sales travels. So, he put that talent to use as the Crockett golf coach during that first year.
“I started to coach golf in the fall of 1994 and found that I enjoyed it,” Tomlin said. “Plus I got to hit my golf ball a little bit and show some kids that they could play.”
A year later, his coaching path took a duck-hook if ever there was one when he arrived at his alma mater, Cass Tech. It was then that one of his dad’s friends told Tomlin the Technicians needed help with girls volleyball.
“About all I knew was what I’d seen in the Olympics. So over the next three or four years I learned to coach volleyball, and we went from being a good program to a bad program,” Tomlin laughed, while adding that Cass Tech had just won an MHSAA Regional and had some solid individual talent when he stepped in.
“But, through MIVCA (the Michigan Interscholastic Volleyball Coaches Association), and some additional training and sports performance videos, I’ve turned into a better coach,” he added.
Such is Tomlin’s approach to administration. As he was trying to find his way during the early years, and continues to do to the present, he leaned on the network of people and resources available.
Tomlin had worked closely with long-time Cass Tech athletic director Robert Shannon, and early in his educational career was introduced to the Michigan Interscholastic Administrators Association by Doris Rogers, then AD at Crockett.
“I started going to MIAAA and taking leadership courses and training,” said Tomlin, now in his second year as Cass Tech’s AD. “It really opened up a side of interscholastic athletics that I had not been exposed to. Going to those conferences has really helped me to develop my philosophies and helped establish what we try to do here at Cass.”
There is so much more that he’d like to do, but like all ADs in the Detroit Public School League, there are time limitations.
“One of the things holding us back in the Detroit Public Schools is that our position has turned into a stipend position,” Tomlin said. “I’ve got five Algebra I classes, so I’m in class until 2 (p.m.) every day. The things that I really want to do with this program in terms of moving it forward by finding more sponsorships for new teams and facilities suffer a bit due to time.”
As such, much of the responsibilities placed on athletic directors at other schools statewide fall to the coaches in the PSL. Cass Tech has won two straight MHSAA Division 1 football titles, something other coaches at Cass aspire to do. But, warns Tomlin, there’s a price to pay.
“Everyone likes the end result of a state championship, but the support and the effort it takes to get there is totally on the coaches here. They deserve all the credit,” Tomlin said. “The coaches have huge tasks because, hey, your AD has five classes so you have to be really passionate about what you’re doing; if you’re not, this isn’t the job for you.”
Hiring the right coaches is paramount today, as expectations of parents and students seem to be at odds with reality.
“Parents’ and students’ expectations have changed so much. Everyone wants that scholarship, or this level of athlete, but are they willing to put in the work?” Tomlin said.
Tomlin knows a bit about parental expectations, and hopes to instill all he’s learned in daughter Montana (16) and son Chase (11) as they continue to enjoy athletic participation.
When it’s time, Tomlin might even try to sell them on a career in education, as his mother did to him years ago.
PHOTO: Detroit Cass Tech athletic director Edward Tomlin stands in his school's gymnasium. He returned to his alma mater as volleyball coach in 1995.
This is the fourth installment of a series, "Career Paths," focusing on the unsung contributions of athletic directors. See below for earlier installments.