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
Championship Team Builder Ingalls Named WISL Honoree
By
Geoff Kimmerly
MHSAA.com senior editor
March 22, 2021
Krista Clement played for high-caliber basketball programs at St. Ignace High School and University of Michigan. Then, after a few years of teaching, she decided to start her own team.
In 2013, Clement founded Helper Helper – a digital platform that provides tracking and coordination for community service efforts across the country and counts the NCAA among partners.
At first, Clement’s team was a team of one – herself. But as she started to build the company, her thoughts turned to her high school coach Dorene Ingalls – one of the most successful team builders in MHSAA history.
“Although we aren’t playing basketball on the Helper team, so much of what I do was through what I’ve learned from Dorene’s leadership,” Clement said. “My attempt to create a culture on my team – similar to a Saints basketball team – has come from Dorene. I now find myself trying to connect with my team the way Dorene connected with me – making my teammates feel valued and inspired to put their best foot forward every day.”
Over the last 22 years, Ingalls has built one of the most respected high school basketball programs in Michigan and become one of the most successful coaches in MHSAA history. She also has been one of the state’s most impactful advocates for girls basketball, and a presence in her adopted hometown that literally earned her the title of “ambassador” from the local chamber of commerce.
To celebrate her many and continuing contributions, Ingalls has been named the 34th recipient of the MHSAA Women In Sports Leadership Award, presented annually by the MHSAA’s Representative Council to “women coaches, officials and athletic administrators affiliated with the MHSAA who show exemplary leadership capabilities and positive contributions to athletics.”
And as with Clement, those contributions continue impacting many long after graduation.
“To have the confidence to overcome when people say you can’t do something,” Ingalls said, boiling down what she’s hoped to pass on over two decades. “We still always are like the ‘Hoosiers’ coming down (to a state championship game) – we go with that flow a little bit. We’re not going under the radar too often, but usually we don’t have as many DI (college) people as the teams we play. We try to make sure (our athletes learn) that hard work, dedication, positive attitude and don’t ever give up, fight through your adversities and just keep going, keep going, keep going.
“I get letters from kids that went to boot camp that said, ‘Oh my gosh, the only way I survived this is because of our practices and our tryouts. All these other kids are stopping, and I keep going.’ … Other ones go on to be doctors and nurses in the field. That’s what it’s all about, when kids are fighting through stuff. If they have all-nighters, they can figure that out and they know they have that inner strength they haven’t tapped into yet, that willingness to keep going. I think that’s what high school sports are about – teaching them the skills they need in life, to fight through things, that you’re capable of more, you just have to sometimes dig deep, shake it off and step it on up. … It’s just kind of a thing that sticks with some of these kids, and when you see them or get invited to weddings or whatever, it has nothing to do with records or scoreboards. It’s continuing in their life, watching them have families and successes in careers – that’s when it’s fun.”
Ingalls has provided two decades of experiences on and off the court her Saints will never forget.
Through the end of this regular season, she has led the St. Ignace girls basketball varsity to a 464-80 record since taking over the program prior to the 1999 season. Her wins are the 18th-most among girls basketball coaches in MHSAA history, and she has led teams to five Finals championships and four runner-up finishes – or a championship game berth to conclude nearly half of those seasons as head coach. Her teams have reached at least the MHSAA Semifinals 11 times, and won 16 conference, 18 District and 14 Regional championships.
Ingalls also has served 20 years as a board member for the Basketball Coaches Association of Michigan (BCAM), including a three-year term as part of the executive board serving as president-elect, president and past president, and she continues to serve as chairperson of the Miss Basketball Award committee. She also has served on the MHSAA Basketball Committee.
“Dorene is someone who has been passionate for years about providing opportunities for young women,” MHSAA Executive Director Mark Uyl said. “That's easily seen in the work she's put in not just with her program but as a strong voice of leadership for the Basketball Coaches Association of Michigan. She's been one of the strongest advocates for girls basketball in our state over the last 20 years.”
There’s some necessary context behind all of those on-court win-loss numbers. St. Ignace has only about 200 students and generally plays in Division 3 (or formerly Class C) or Division 4 – yet during the regular season the Saints frequently line up games against much larger opponents from all over the state. They’ve had their share of stars, especially for such a small schools, but the success is also a testament to how Ingalls works to find specific roles for as many players as possible – whether it’s for a minute here or there to grab a rebound or get a steal, many play at least some little part in keeping the team moving forward.
And the memories made off the court have meant just as much, if not more.
Clement, who became the Upper Peninsula’s first Miss Basketball Award winner in 2003 and then a four-year captain at U-M, recalled how much she and her teammates laughed with their coach and how Ingalls has a talent for connecting with her players.
“Her record by itself could garner consideration for this award, but that is not the primary reason I write this letter,” wrote St. Ignace superintendent Don Gustafson in nominating Ingalls for the WISL Award. His daughter Linnie played for Ingalls four seasons before graduating in 2018.
“She teaches basketball, but she teaches much more than basketball. The characteristics that Dorene models for the athletes who have played under her tutelage are dedication, perseverance, teamwork and life lessons, to name a few. The players she has coached in the past stay connected with Dorene long after that graduate, as (she) continues to provide guidance and advice even after the student athlete’s playing days have concluded.”
Like many families, cancer has impacted the Ingalls – both she and her husband Doug lost their mothers to the disease when those women were only in their 50s. St. Ignace’s trips to East Lansing, or Grand Rapids to play at Calvin College, or last year to Detroit to play in the Motor City Roundball Classic, included trips to medical facilities.
At the cancer center in East Lansing, the Saints inadvertently crossed paths with a St. Ignace resident undergoing treatment, and Dorene still is brought to tears retelling how they connected with that patient and were able to give her tickets to come watch them play that weekend. The Grand Rapids center was where Ingalls went through rehabilitation after suffering paralysis during childbirth in 2005; she remains partially paralyzed and uses a wheelchair.
Last season, before COVID-19 grounded the Saints’ chances to win another title, the team visited Karmanos Cancer Center in Detroit, including the room where one of the player’s mothers had fought for her life just a year before. That mother was part of the visit and, as Ingalls recalled, “to have that, and not the state championship, that’s probably more important. … That was pretty special. They’re learning the lessons that you’re hoping they do.”
This season’s team hasn’t enjoyed the “changing life” speeches that are part of usual bus trips, because right now the Saints aren’t taking buses to away games. But the pandemic has provided other opportunities – like when the team did workouts in the snow before full-contact practice was allowed to resume, or spent one practice performing skits for each other from the 1970s and 80s just to “break up the uncertainty and negativity.” Ingalls called it making the most of what you’ve got – and those are the memories she knows won’t be forgotten.
There has been recognition. She was inducted into the Upper Peninsula Sports Hall of Fame in 2016 and received the Michigan Sports Hall of Fame’s Treasure Award in 2017 – in addition to various Coach of the Year awards both for the Upper Peninsula and statewide over the years. She was named the Prep Person of the Year by the Detroit Free Press in 2011 and received BCAM's Tom Hursey Distinguished Service Award in 2018.
All are proud moments. But perhaps the proudest is another effort that keeps on building. Mining a connection to Lowell High School and its Pink Arrow cancer awareness games – St. Ignace alum Nate Fowler is Lowell’s superintendent – Ingalls hatched the annual Hooping for a Cure basketball game in 2009. Cedarville, Cheboygan and Mackinaw City have joined in the fundraising game since, and the event became a doubleheader this season with the girls and boys teams both playing.
The event raised a record $35,000+ in 2020, and more than $25,000 this season despite attendance restrictions. That brought the total to more than $245,000 – funds that at first were donated to the oncology department at Mackinac Straits Hospital in part for the purchase of specialized examining tables and chemotherapy treatment infusion recliners. Once the equipment needs were met and a new hospital – Mackinac Straits Health System – was built, the money went into a No Cancer Patient Left Behind fund that provides financial support for patients who have to travel outside of the area for further treatment.
“This benefit game and ensuing experiences for the team have taught us about being grateful for every day we do have and to have the courage to fight through adversity,” Ingalls said. “These vital lessons will carry on in all of us for a lifetime.
“In fact I recently received a photo from a former player sitting in one of the infusion chairs getting treatment for an autoimmune disease that really struck me deeply. Talk about full circle.”
Ingalls is a 1986 graduate of New Baltimore Anchor Bay High School, where she played basketball, volleyball and softball. She attended Lake Superior State University, earning a bachelor’s degree in geology in 1991, and she then moved to St. Ignace to begin six years as a geologist before starting a screen printing and embroidery business.
She had earned 10 letters playing four sports at LSSU – volleyball, basketball, softball and tennis – and soon after moving to St. Ignace she joined the Saints’ coaching ranks, first as a junior high and assistant junior varsity basketball coach in 1992-93, then junior varsity girls head coach from 1994-98 until she took over the varsity position. She also has coached softball and subvarsity boys basketball.
Ingalls and husband Doug have two sons, Jackson and Jonathan.
The first Women In Sports Leadership Award was presented in 1990.
Past recipients
1990 – Carol Seavoy, L’Anse
1991 – Diane Laffey, Harper Woods
1992 – Patricia Ashby, Scotts
1993 – Jo Lake, Grosse Pointe
1994 – Brenda Gatlin, Detroit
1995 – Jane Bennett, Ann Arbor
1996 – Cheryl Amos-Helmicki, Huntington Woods
1997 – Delores L. Elswick, Detroit
1998 – Karen S. Leinaar, Delton
1999 – Kathy McGee, Flint
2000 – Pat Richardson, Grass Lake
2001 – Suzanne Martin, East Lansing
2002 – Susan Barthold, Kentwood
2003 – Nancy Clark, Flint
2004 – Kathy Vruggink Westdorp, Grand Rapids
2005 – Barbara Redding, Capac
2006 – Melanie Miller, Lansing
2007 – Jan Sander, Warren Woods
2008 – Jane Bos, Grand Rapids
2009 – Gail Ganakas, Flint; Deb VanKuiken, Holly
2010 – Gina Mazzolini, Lansing
2011 – Ellen Pugh, West Branch; Patti Tibaldi, Traverse City
2012 – Janet Gillette, Comstock Park
2013 – Barbara Beckett, Traverse City
2014 – Teri Reyburn, DeWitt
2015 – Jean LaClair, Bronson
2016 – Betty Wroubel, Pontiac
2017 – Dottie Davis, Ann Arbor
2018 – Meg Seng, Ann Arbor
2019 – Kris Isom, Adrian
2020 – Nikki Norris, East Lansing
PHOTOS: (Top) St. Ignace girls basketball coach Dorene Ingalls embraces one of her players after their team finished Class C runner-up in 2014. (Middle) Ingalls talks things over with her team during a game at the Breslin Center. (Below) Ingalls coaches her team during a Semifinal win at Calvin College's Van Noord Arena in 2019.