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
Jack Roberts, on Tom Rashid: One More Call
By
John E. (Jack) Roberts
MHSAA Executive Director, 1986-2018
December 9, 2021
More than a decade ago, with his knowledge, I placed in my “Will & Instructions Upon Death” that Tom Rashid was to be the one and only person to speak at my funeral or memorial service. A short number of years later, Tom told me that I was to do the same for him. Obviously, we knew that we could not both keep our promise to the other. But I must say, if Tom does not actually show up for my funeral, that will be the first time he has not kept a promise to me.
I understand there will be a time in the future, when the weather warms and COVID wanes, when school administrators across Michigan can gather in force to show their respects to Tom, and when I will provide the eulogy that Tom asked of me. But Tom’s recent death reminds us how uncertain life can be and suggests that I say some things now, before it’s too late.
Tom was the unparalleled master of award presentations; and for more than a dozen years he wrote and delivered polished praise on award recipients at the annual conference of the Michigan Interscholastic Athletic Administrators Association. My tribute now isn’t an awards presentation or hall-of-fame induction, so I won’t recount the particulars of Tom’s career; but what you will see here is the importance of Tom’s life … the themes that distinguish him from any other person I’ve known.
Tom comes from a large, complicated and compassionate family of parents, aunts, uncles, brothers, sisters, nephews and nieces who mourn his loss at levels few of us can fathom. Over the years, and for many years, he was the caretaker for several family members; and he was generous with all of them. My hope for each family member now – and for many days, weeks and months to come – is that you are at peace. Tom’s pain is over; and his place in eternity is secure. Tom purchased a reserved seat.
Tom often joked that his only good habit was prayer. That’s not really true, of course. But for as long as I’ve known Tom, he talked to God many times a day; and I’ve always had the feeling that he talked to God the same way he talked to us: bluntly, forcefully, passionately, honestly, loudly, making very plain what he had on his mind.
Tom was a rigorous practitioner of his devout Catholic faith; and, the God whom Tom believed in is a big God … the president, general manager and head coach of a huge, diverse team whose game plan is a large, loving Gospel of limitless parameters and possibilities. I have no doubt that, both in times of need and not, members of the Roberts family – including both my parents, my sister, my wife and our children and grandchildren – have been specific in his petitions to God. I have no doubt that Tom’s daily prayers included many of you, and your loved ones as well.
In addition to Tom’s immediate family is the even larger and even more complicated family Tom developed through a long, illustrious career in Michigan school sports administration: a full 25 years with the Archdiocese of Detroit, until 2003, when I invited him to join me at the MHSAA office in East Lansing.
During my 32 years as the executive director of the MHSAA, I never saw another like Tom … never, anywhere. He talked to anybody, anytime of the day or night, about any question or problem they might have. Usually, Tom didn’t need to give me notes reviewing his telephone conversations. From my adjacent office, and given his forceful voice, I could hear Tom’s every word, very clearly.
Tom had the ability to anticipate what I might need and take care of it without my asking. It is no exaggeration to say that Tom would do anything for me. For example, Tom’s reluctance to travel and his fear of flying are well known to many of you. I believe the one and only time that Tom flew in an airplane was in 2003, when I ordered him to fly to Texas so that he might receive the highest award of the National High School Coaches Association. He had never flown before; he has never flown since.
Most remarkable was not merely Tom’s unselfish, unlimited, legendary availability to athletic administrators at any hour of the day or night, nor his experienced, learned grasp of the subject matter in answering their calls. What was more remarkable was his effort to help school administrators through their hard times. On many occasions these callers had made an error of commission or omission. They had made a mistake or an oversight; and Tom was supremely compassionate in guiding them through the local fallout from disappointed athletes and disgruntled adults. Secure in himself and our mission to be servant-leaders, Tom very often shared or completely shouldered unjustified blame so others would not. He gave cover to countless local school administrators every year of his MHSAA career so that those administrators might survive and even thrive in their careers.
Among my remarkably loyal MHSAA staff, Tom still stands out. And he earned the enduring loyalty of those with whom he worked. I think especially of his successor at the Archdiocese of Detroit, Vic Michaels: I doubt that more than two days ever passed between their almost daily telephone conversations … usually in the morning … for the full 15 years that my office was next to Tom’s at the MHSAA. I have never, ever been witness to anything like that; and I know there is no one in our good work who misses our dear colleague more than Vic.
But most remarkable of all was Tom’s ability to turn an adversary into an ally. He could have a knock-down, drag-out argument with a person one day, and by the next day, and for years to come, that person was Tom’s greatest advocate and admirer.
Well … maybe second-greatest advocate and admirer. Because no one in athletic administration – no one – loved Tom more than I. And no one in our work told him this more than I did.
I have written often about my admiration and affection for Tom. I have spoken both publicly and privately of it, on many occasions. But let me say it one more time, here, as we celebrate his life, and mourn our loss …
Tom and I provide proof that opposites attract, and we tag-teamed MHSAA’s leadership. One of us was very outgoing and vocal, the other more reserved and reticent. One of us was loud, the other more subdued. One of us was more comfortable on the phone, the other with the pen. One of us had no idea what to do with apostrophes, while the other would put them in the correct places. One of us was more spontaneous and extemporaneous, the other a more detailed planner and measurer of consequences. One of us hated to travel, the other sent messages to him from distant oceans and continents every year on Christmas or New Year’s Day to thank him for his life and service. But in our hearts, where one’s core values are harbored, we were almost identical twins.
I doubt that any two people who were side-by-side in the workplace for 15 years expressed their gratitude for each other more than we did, nor any two co-workers who said “I love you” to one another as often as we did. We each felt in deep debt to the other for myriad gifts and gestures that improved our careers and our lives.
Over the years, Tom and I developed the strategy of making one more telephone call before we made a final decision in a difficult matter … making one more call that sometimes made a difference in the controversial decision we had to make or in how that decision was accepted by those it affected. Tom loved to be the one to make those calls. And, sometimes, that “one more call” made all the difference.
Throughout my adult life, whenever I’ve attended a funeral or memorial service, I’ve found myself asking what it is I should learn and try to emulate from the life of the deceased. If you should find your mind and heart doing anything like that now, may I suggest these two answers.
First, Tom’s life and death remind us that we should not delay a single day in telling those with whom we work that we appreciate them and are grateful for what they do. And, if it is true and you are able, say you love them. Tom did this more often than anyone I’ve known.
And the second message is this. Tom’s life stands for faithfulness … faithfulness to his God, faithfulness to his family, faithfulness to his colleagues and friends, and faithfulness to his work and the mission of not just amateur athletics, but particularly school-operated, educational athletics. His was a steadfast faithfulness, never-a-day-off faithfulness, you-come-first faithfulness.
So Tom, my dear friend, once again I say, “I love you.”
And, “Rest in peace, Tom. God knows, you rarely rested in life.”
I would give anything for just one more call.