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
Fund Helps Love for Comstock Live On
By
Pam Shebest
Special for MHSAA.com
August 21, 2018
COMSTOCK TOWNSHIP — Several years ago, Josh Whitfield and his sister, Mandy Hanson, were sitting around a bonfire just chatting when they touched on a subject that fired up the normally easy-going Comstock High School graduate.
Whitfield had started helping coach the girls soccer team and realized that to be involved in sports, Comstock athletes had to “pay to play.”
“It takes a lot to get him riled up, to get him angry or upset,” Hanson said. “He was talking about, ‘Can you believe it? You have to pay to play sports at Comstock.’
“I was like, that’s crazy. He was getting so upset talking about it. Some of these girls paid to play but then couldn’t afford the right equipment.”
Whitfield, a 2000 grad and four-year multi-sport athlete at Comstock, said he wished he had enough money to help out.
That opportunity would come out of the saddest of circumstances. But as his loved ones continue to heal from Whitfield’s untimely death in 2015, they’ve created an opportunity for his memory to impact the Comstock athletic community for years to come.
That May, while playing golf with friends, including Hanson’s husband Mike, Whitfield said he did not feel well and left the group on the second hole.
“Of course, the guys razzed him about it because it wasn’t like Josh to leave in the middle of a round of golf,” his sister said.
When Whitfield’s mother, Becky, called him at home later, he told her he was having trouble breathing. He called 9-1-1 and his dad, Vic, drove to his son’s house just as the EMTs arrived.
Whitfield did not survive, dying from a double lung collapse. He was just 33 years old.
Two of his buddies, Eric Stewart and Chad Howard, wanted to do something to keep Whitfield’s memory alive.
“We were all struggling a lot,” Stewart said. “Josh had an extremely tight-knit group of friends. It was really hard for a lot of us. We were talking about ways to spin positive out of grief.
“We were like, ‘What can we do to honor his memory, to keep his name alive?’
We thought it would mean something to his family. We knew it would mean something to Comstock, because Comstock is in a tough place right now.”
The buddies had the idea for a fundraiser to help a few Comstock athletes pay to play. They were hoping to raise at least $1,500 through an alumni soccer game.
They were stunned to raise $5,000.
‘Spinning positive out of grief’
Over three years, the group – which has gone from the two friends to a committee of 14 – has raised more than $52,000 and so far donated more than $27,000 of it to various athletic causes in Comstock.
“It started with Eric and Chad, who asked how they could help and wanted to set up an alumni soccer game to help offset the pay-to-play fees,” Comstock athletic director Justin Ansel said. “Initially, I wasn’t sure how big this would be or how sustainable this would be.
“Unfortunately, this entire thing was started by a tragedy. It’s a testament how, at Josh’s young age, how people rallied around him for this. It’s just special how the community comes together to remember Josh. We are thankful for what this organization does for our student-athletes.”
The fund has supplied about $5,000 for pay-to-play scholarships, helping more than 350 middle and high school athletes with activity fees and physical exam fees. But those have not been the group’s only focus.
“For example, someone might say I can’t pay the $75 for Rocket Football,” Stewart said. “We will approve that and send the check in to Rocket Football.
“We also do grants to teams and organizations focused on Comstock. We did Eastwood Little League through a $5,000 grant last year. We’re really excited to sponsor the First Day Shoe Fund. We bought all the kids in Comstock shoes. We know that a healthy lifestyle, teamwork, all are bred through athletics.”
This year, the group will have extra money available.
“As it happens, Comstock has a new superintendent this year in Jeff Thoenes,” Ansel said. “One of his first actions as superintendent was to remove our activity fee barrier so we no longer have this fee for the start of the 2018-19 school year.
“They still plan to fund things like athlete equipment, needs like shoes or shin guards along with a variety of other things.”
Without the pay-to-play expenditures, Stewart said, “Our goal now is to really push toward those youth athletic programs: AYSO, Little League, youth football, youth golf camps, soccer camps. We’re creating feeders to the high school that otherwise don’t really exist at Comstock.”
With Comstock’s entry a few years ago into the Berrien-Cass-St. Joseph Conference, teams travel more than 40 miles to many games. At first, the school transported athletes to the games, but parents took them home.
“Now the fund pays to bring kids home,” Stewart said. “Parents in poverty can’t drive that far to pick up their kids. That’s not OK, and we wanted to fix that.”
Continuing to grow
Once the original fund hit $5,000, Stewart and Howard did not want the sole responsibility of doling out the money.
“We said we need to vet this through a group of people,” Stewart said.
So they formed the non-profit Josh Whitfield Memorial Athletic Fund.
The board of directors is made up of Josh’s friends and family, and funds are distributed through the Comstock Community Center.
The committee sponsors three fundraisers each year: a golf outing, an alumni soccer game and a holiday party in December. It also accepts donations through its website (www.jwmaf.org).
The golf outing in June includes about “a quarter of the field with Whitfields,” Stewart said. “It’s always bittersweet when we get together for that reason, but I think it’s a good avenue to go through some of those things. Oftentimes it’s like a support group.”
The soccer tournament is set for Sept. 21 at the school.
“It started out as an alumni soccer game, and then we had people who weren’t alumni that wanted to play,” Hanson said. “We said of course.
“It’s just getting out there and having fun. Last year, the oldest was mid-40s and the youngest just graduated.”
Said Stewart: “We usually get about 50 who sign up. It’s a hoot. It’s a good time. Everybody’s getting older, but it’s fun to relive the glory days.”
The holiday party last December was held at Kalamazoo’s Tibbs Brewing Company, which donated a portion of the sales to the fund.
Hanson and brother Matt Whitfield are members of the committee, which meets once a month to review applications.
“A couple committee members work in Comstock schools, so they see what’s going on and they see a need,” Hanson said. “The committee generally takes a vote. If the applicant meets what we’ve set forth in the guidelines, then we do grant them the money.”
Applicants also can apply through the website, but must be connected to Comstock athletics.
All committee members are volunteers, with 100 percent of any money raised going into the fund.
Besides Stewart, Howard, Hanson and Matt Whitfield, board members are
Sara Howard, Alyssa Stewart, Rolly Taylor, Travis and Marie Law, Tyler and Shannon Howard, Loreen Hospodar, Katy Seward and Mason Everett.
“It is amazing,” Hanson said. “It’s truly an honor. I think to myself, my gosh, Josh would be so humbled to know that this is happening because of him.
“I think secretly he’s laughin’ and lovin’ it up there.”
Pam Shebest served as a sportswriter at the Kalamazoo Gazette from 1985-2009 after 11 years part-time with the Gazette while teaching French and English at White Pigeon High School. She can be reached at [email protected] with story ideas for Calhoun, Kalamazoo and Van Buren counties.
PHOTOS: (Top) Josh Whitfield in 2015, shortly before his death. (Top middle) Friend Eric Stewart, left, and Comstock athletic director Justin Ansel. (Middle) From top, Josh Whitfield playing wiffle ball, Josh and brother Matt Whitfield, and Josh and Stewart. (Below) Mandy Hanson, right, with daughter Madi. (Hanson photo by Pam Shebest; other photos submitted by Eric Stewart or Mandy Hanson.)