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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
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'Always just a phone call away'
March 30, 2012
By the time Charles Schwedler joined the Bullock Creek school district nearly 19 years ago, Bill Mick had moved on to other educational roles in the Midland area.
They had never worked together. They didn’t know each other from a previous experience. Schwedler, now his district’s Superintendent, had never worked with either of Mick’s children.
The only connection they shared was an interest in the success of Bullock Creek’s students.
“Bill has always been just a phone call away for anything that I have needed from the day I arrived in Bullock Creek,” Schwedler wrote in his letter of recommendation for this year’s MHSAA Charles B. Forsythe Award. “That may not sound all that unusual except for the fact that he really has never had a reason to help me. … Bill intuitively knew that if I succeeded, kids would have a better shot at succeeding. No hidden agenda; just what’s best for kids.”
For more than four decades, Mick contributed to high school athletics as a coach, administrator and then mentor to those who followed him in those roles. That drive, which has continued after Mick’s official retirement from education, made him this year’s recipient of the MHSAA’s highest honor.
The Forsythe Award is in its 35th year and is named after former MHSAA Executive Director Charles E. Forsythe, the Association's first full-time and longest-serving chief executive. Forsythe Award recipients are selected each year by the MHSAA Representative Council, based on an individual's outstanding contribution to the interscholastic athletics community. Mick received the award during halftime of Saturday’s Class B Boys Basketball Final at Michigan State’s Breslin Center.
“I think it’s just being around athletic directors, particularly the new or younger athletic directors, that keeps the juices flowing, so to speak,” Mick said. “It goes both ways. I think I have experiences I can share with people that can help them. And it sounds trite, but it’s the truth: Their enthusiasm makes them flow faster.”
Mick began his career at Bullock Creek Public Schools from 1963-76, first as a science and physical education teacher and later as a counselor and Guidance Department head. He then moved to Midland Public Schools, serving as a counselor at Midland High and then Counseling Department Head at Midland Dow until becoming the district’s Coordinator of Health, Physical Education and Athletics from 1985-97. Mick finished his educational career as a part-time counselor at Midland’s Windover High School from 1997-2002 and then again at Bullock Creek High School from 2002-03.
Among his various contributions to athletics, Mick served on the MHSAA Representative Council for three years and in a number of roles with the Michigan Interscholastic Athletic Administrators Association (MIAAA) over 24 years. He coached cross country, track, football and basketball, and has served as an instructor in the MHSAA Coaches Advancement Program.
He remains part of the committee that organizes the MIAAA’s annual statewide conference, and also makes a trip to the MHSAA office once a year to assist in a conference for new athletic directors. He passes on lessons from the challenges he's faced over the years, with an eye on new ones that continue to crop up.
“The whole electronic media thing, things happen so much quicker. There is so much more with the Internet, and that’s probably the biggest change I can see since I got started,” Mick said. “(And) the role of the AD now is so much more complex, and we don’t see as many fulltime ADs. They have other responsibilities and obligations, so much on their plates – probably more than we had on our plates when we were ADs.”
Mick has received multiple honors from the MIAAA, including the State Award of Merit in 2002 and Distinguished Service Award in 2008. He also received the MHSAA’s Al Bush Award in 1998 for his many contributions to the association, and the Midland Area Community Foundation’s Lloyd Osborn Award in 1997 for his service to youth and athletics in that community. He was inducted into the Midland County Sports Hall of Fame in 1998.
Mick also was an MHSAA Track Finals meet manager for three years and served as executive secretary of the Mid-Michigan B league for five.
“Bill Mick contributed to high school athletics in a number of mentorship capacities during his career, and he remained engaged in that service after his retirement,” said MHSAA Executive Director John E. “Jack” Roberts. “Through his work with the MHSAA and MIAAA, Bill has provided valuable training to the next generation of leaders. We’re proud to honor Bill Mick with the Forsythe Award.”
A Tawas High School and Albion College graduate, Mick also received a master’s degree from Central Michigan University and did post-graduate work at Saginaw Valley State University.
His father and brothers all were superintendents and his mother was a teacher. His wife Mary Lou was an elementary school counselor for Midland Schools, and together they still attend a number of Battle Creek basketball games – where they now watch the children of those they taught, counseled and mentored.
They have two sons who are both doctors, one living in California and the other in Maine.
Past recipients of the Charles E. Forsythe Award are:
1978 - Brick Fowler, Port Huron; Paul Smarks, Warren
1979 - Earl Messner, Reed City; Howard Beatty, Saginaw
1980 - Max Carey, Freesoil
1981 - Steven Sluka, Grand Haven; Samuel Madden, Detroit
1982 - Ernest Buckholz, Mt. Clemens; T. Arthur Treloar, Petoskey
1983 - Leroy Dues, Detroit; Richard Maher, Sturgis
1984 - William Hart, Marquette; Donald Stamats, Caro
1985 - John Cotton, Farmington; Robert James, Warren
1986 - William Robinson, Detroit; Irving Soderland, Norway
1987 - Jack Streidl, Plainwell; Wayne Hellenga, Decatur
1988 - Jack Johnson, Dearborn; Alan Williams, North Adams
1989 - Walter Bazylewicz, Berkley; Dennis Kiley, Jackson
1990 - Webster Morrison, Pickford; Herbert Quade, Benton Harbor
1991 - Clifford Buckmaster, Petoskey; Donald Domke, Northville
1992 - William Maskill, Kalamazoo; Thomas G. McShannock, Muskegon
1993 - Roy A. Allen Jr., Detroit; John Duncan, Cedarville
1994 - Kermit Ambrose, Royal Oak
1995 - Bob Perry, Lowell
1996 - Charles H. Jones, Royal Oak
1997 - Michael A. Foster, Richland; Robert G. Grimes, Battle Creek
1998 - Lofton C. Greene, River Rouge; Joseph J. Todey, Essexville
1999 - Bernie Larson, Battle Creek
2000 - Blake Hagman, Kalamazoo; Jerry Cvengros, Escanaba
2001 - Norm Johnson, Bangor; George Lovich, Canton
2002 - John Fundukian, Novi
2003 - Ken Semelsberger, Port Huron
2004 – Marco Marcet, Frankenmuth
2005 – Jim Feldkamp, Troy
2006 – Dan McShannock, Midland; Dail Prucka, Monroe
2007 – Keith Eldred, Williamston; Tom Hickman, Spring Lake
2008 – Jamie Gent, Haslett; William Newkirk, Sanford-Meridian
2009 – Paul Ellinger, Cheboygan
2010 – Rudy Godefroidt, Hemlock; Mike Boyd, Waterford
2011 – Eric C. Federico, Trenton
PHOTO: Midland's Bill Mick (right) receives the Charles B. Forsythe Award from MHSAA Representative Council president James Derocher during halftime of the Class B Final.