For Release: Monday, November 2, 2013
Launch of International Study of Male Athletes and Concussions
Study of Female Concussions Launches 2nd Study, to explore Male Athletes’ Experiences with Concussions
Dr. Jimmy Sanderson, Clemson University / 864-656-3996 firstname.lastname@example.org
Norwalk, CT – Media attention and public interest in sports concussion injuries has been increasing at a rapid rate. As a result, it is important for researchers and concussion advocates to enhance research efforts on this very important topic. To provide some insight on female concussions, we launched a research study in October 2013, which focused on female athletes from all sports, and their past and present experiences with concussions. Via social media tweets & posts about the study, 652 women contacted us to participate. Of the 597 women who were eligible to participate and sent a link to the survey, 538 women completed the forty question online survey. This research study was also was designed to explore female verses male athletes’ experiences with reporting concussions, another salient avenue in the concussions dialogue, as many athletes do not report concussions willingly or are mis-diagnosed.
Now we are recruiting for a NEW IBR approved study of male athletes and their experiences with concussions in conjunction with our recent efforts to recruit female athletes to discuss their concussion experiences.
This research aims to explore reasons why male/female athletes would report or not report concussions and examine potential gender differences that can inform the athletic, medical, and academic communities.
Current and former male athletes are eligible for this study which will be conducted by researchers from Clemson University with the advocacy group, Pink Concussions. For this study, male athletes, age 18 and over, who are willing to participate can sign up now at PinkConcussions.com. Participants will be emailed a link to a twenty-minute online survey about their experiences with sports and non-sport concussions and reporting concussions.
The research also will investigate male/female athletes’ willingness to have genetic testing that may show links to the repair and recovery of brain cells after concussion. After finishing the survey, participants in the study can opt for an additional study and consider submitting DNA collected by a cheek swab to be tested for variants at the Apolipoprotein E (APOE) gene. Testing for certain genes has previously documented an association between specific genetic factors and outcomes from injuries such as concussion.
Apolipoprotein E is a protein that is important in the repair and recovery of brain cells that have been damaged due to concussion. The clinical studies point to a relationship between certain genetic signatures and poorer overall concussion response. While additional evidence is needed to better understand the relationship between APOE status and concussion outcomes, the American Academy of Neurology introduced APOE testing into concussion management guidelines this year.
This research will be beneficial in shedding light on and male female athletes’ experiences with concussions and reporting concussions. We hope the results of this research will help further concussion research by focusing on the communicative element present in this issue, and the results of the study will be helpful for athletes, parents, administrators, physicians, and advocates.
Co-Researchers in this study are Dr. Jimmy Sanderson and Dr. Melinda Weathers in the Department of Communication Studies at Clemson University, along with Ms. Katherine Snedaker, MSW, of PinkConcussions.com.
# # #
For more information about this study, help in recruiting athletes or to participate in the study, please fill the contact form at PinkConcussions.com or contact:Dr. Jimmy Sanderson Clemson University email@example.com 864-656-3996 Katherine Snedaker PinkConcussions.com PinkConcussions@gmail.com 203-984-0860
*Not a reason to not play the game, but THE reason to be an educated parent, player, coach and school.
About halfway through the fourth quarter in Saturday’s 60-6 loss to Arizona Lutheran Academy, Charles Youvella fell hard on his head. He eventually collapsed a couple of plays later. He died Monday at the hospital of a traumatic brain injury, reported the Arizona Interscholastic Association. And so another face add to the 2013 collection of dead boys from head injuries from football (see below).
Could he have died from a head injury while texting & driving?
Could he have died falling, while on drugs, climbing to spray paint his tag on a highway bridge?
Yes, Charles Youvella (pictured with his little brother) could have died doing a number of risky things that teenage boys can chose to do in their free time. The question is, was he more at risk playing football than partaking in other activities that night?
The best estimate is that 20-25% of youth concussions occur in organized sports. This leaves the other 80% of head injuries outside of organized sports, and not broken down by cause in any meaningful way to compare against playing football.
But what upsets me in the media coverage is the following quote by Charles’ coach…
On the news video attached to the story of Charles Youvella, the football coach is interviewed and says, “There are a lot of unknowns. We, People, Everyone that I have talked to has never seen anything like this. So we don’t exactly know what happened. “ http://www.abc15.com/dpp/news/region_northern_az/other/charles-youvella-update-hopi-high-football-player-dies-after-game-injury
ATTENTION — FOOTBALL COACHES, PLAYERS & PARENTS – KIDS CAN DIE PLAYING FOOTBALL… IT HAS HAPPENED BEFORE.
The expression of sheer surprise is echoed over and over again when a youth football player dies. HOW COULD THIS HAVE HAPPENED?!? A person can die a lot of ways – driving a car, jumping out of a plane, cleaning a gun. Tragedy happens. But the utter surprise that football can be a cause of death in youth players is a sign we need to have more education for parents, and need to start now with the parents of elementary age children.
I think football parents should sign waivers that they understand the risks in football for fatal injuries, sign off that they have been educated about concussions, sign off that they are aware of the medical care that is available on the field for practices and games, and sign off that they understand what insurance coverage a school has if there is a need for catastrophic medical care.
Could anything have been done (from what little we know about head injuries) to help Charles? From this report, it appears at first glance nothing could have been done (except not to play football).
The injury came during the fourth quarter, when Arizona Lutheran held a big lead.
On that play, Youvella caught the ball between two defenders and was tackled, but the senior wide receiver/running back then quickly got back up.
“It was a clean tackle,” Wallace said. “There was no helmet to helmet. But Charles came down on his back and his head and (there was) a whiplash affect. But Charles jumped up like he always does and gave the ball to the ref. There were no signs of dizziness or anything like that. If he doesn’t feel right, he’ll motion to the sidelines, but he didn’t (motion to the sidelines) on that play.”
Two plays later, with 7:28 remaining in the fourth quarter, Wallace spotted his son on the ground.
“He (Youvella) was trying to get back up,” Wallace said. “He was responsive and wanted to get up. He was asking me to get him up, but I wanted him to lay still. He was asking his coach to get him up. But we said, ‘Let’s check you out.’ I know my son, and you could tell something was wrong.”
Youvella was then taken to St. Joseph’s Hospital and Medical Center, where, with family members surrounding him, he passed away. http://www.aia365.com/insiders/jgarcia/3719/youvella-s-father-son-was-larger-than-life
Would Charles have lived if he had not stayed in the game and instead was taken off the field after the hit to be checked?
Could a personal spotter (like those in the press boxes FOR EACH NFL PLAYER) have caught the whiplash movement and called the medical team right away?
Could Charles have raised his hand to be checked?
We don’t know if Charles was educated about concussion warning signs; but even with player education, is an impaired player with a brain injury capable to stop himself mid-game and seek help? How many high school teams even have personal spotters for players much less a medical team?
There is so much we don’t know. But what we do know is your child can die from head injuries playing football...THIS HAS HAPPENED BEFORE THIS YEAR FIVE TIMES. And how many more faces will it take for this reality to sink into the minds and hearts of football parents and coaches.
Please make educated decisions about your child’s coaches – ask about your team’s concussion education. Make sure your school has funds for ATs at every practice/every game. Hire the best sideline medical care your school can afford. Overall, be educated consumer about your child involvement in the game of football.Boys who have died so far this year from football head injuries…
The IOM and the National Research Council formed an expert committee to review the science of sports-related concussions in youth from elementary school through young adulthood, as well as in military personnel and their dependents. The committee’s report recommends actions that can be taken by a range of audiences – including research funding agencies, legislatures, state and school superintendents and athletic directors, military organizations, and equipment manufacturers, as well as youth who participate in sports and their parents – to improve what is knows about concussions and to reduce their occurrence.
The report finds that while some existing studies provide useful information, much remains unknown about the extent of concussions in youth; how to diagnose, manage, and prevent concussions; and the short- and long-term consequences of concussions as well as repetitive head impacts that do not result in concussion symptoms.
Bad News… There is no mention of any funding.
Good News… Here is who sponsored the IOM Report:
Bad News? Here is who the IOM Committee recommends to lead the effort…
Interesting neither group helped sponsor the study?
NCAA is not well thought of by many concussion field. In March, I had a face to face conversation with Mark Emmert NCAA President where I asked about limiting full contact practice in the NCAA schools to match the NFL and Ivy Schools reduced schedule, and he told me there wasn’t enough evidence and there needed to be more studies before he felt he could act. I am wondering if the many lawsuits are helping to motivate him to move on something here?
I am going to contact the NFHS and ask how they see their role in the future. Here is what the NFHS said.
Good News… We now have a National Sports Concussion Coalition.
Bad News… This coalition was not mentioned in the IOM Report.
So in summary…
Good News... This week we do have two new reports – a very informative the IOM Concussion and Youth Sports Report with ideas and recommendations along with the new road map for schools in APP report on Concussions and Schools.
Bad News… There doesn’t seem to be any funding mentioned in either report to fund any of these recommendations.
It is great news that 49 States have passed some level of “Return To Play” (RTP) concussion laws. Now it is my hope is that everyone’s attention will turn to the process by which concussed students return to school aka “Return To Learn” (RTL). Of the 49 States with RTP Laws, less than 25% of these states have any explicit inclusion of academic supports.
Since I am interested in the wide range of school concussion management plans that exist, I have been researching and summarizing the best “Return To Learn” resources that are currently available online for free.
I wanted to share these suggestions for RTL language in this blog post for anyone working to proposed a bill to update their state’s current concussion laws. To suggest some language for this effort, I have researched how number of states have handled Return to Learn and spoken with a number of experts in the field.
Please note all footnotes and credits – I do not take credit for creating any of the language below, but I merely have organized other experts’ words into sections with links back to original sources to further educate anyone interested in the topic to update their state’s laws.
Please find this post divided into four sections:
1. Colorado State’s Suggestions for Best Practices concerning RTL – a basic, concise version of RTL that could be used for any state’s Return To Learn bill
2. Additional suggestions from my research which could be added RTL section for a RTL bill
3. Sources and Additional Documentation for RTL bills and the additional suggestions in Section 2
4. List of RTL Resources for Parents, Teachers, Administrators, Healthcare Providers and Free Training Videos
SECTION ONE: A Colorado’s Law – a concise version of suggestions for RTL Law
Here is Colorado State’s Suggestion for Best Practices, with my suggestion for additional language in red:
Suggested Best Practices for Colorado’s Schools for Return to Learn
Note: These guidelines are not required by Bill SB 11-040 but should be considered:
SB 11-040 does not speak to the school district’s role in this section. Best Practice suggests that school districts create a Multi-Disciplinary Team Approach to Concussion Management including:
- A seamless system of communication between school professionals, medical professionals and the family. Information must flow smoothly from within the school to outside the school so that the RETURN TO LEARN plan followed by RETURN TO PLAY decisions can be made safely.
- A seamless system of communication among school professionals. Information must flow smoothly between the school athletic departments and the academic departments to ensure appropriate physical and academic adjustments during the recovery.
Best Practice suggests that a school create a concussion management system that is adequate and consistent for any student, elementary through high school, who has sustained a concussion regardless of the setting or mechanism.
Best practice also recommends that a school district create a system in which a student may receive a more intensive assessment and intervention, if the concussion does not recover in a reasonable amount of time. This may include formal accommodations and/or modifications of curriculum.
Taken with one modification page 9 from this source:
SECTION TWO: Additional considerations which could be suggested to make a more robust RTL section for the CT bill
Here are some suggestions which could be included in RTL Bill:
1. Suggestion for Return to Learn to be completed BEFORE Return to Play
- In concussion management, both RTP and RTL are common and important terms, but they are not parallel processes. 2 Student athletes are STUDENTS first. It is suggested that Return To Learn goals of “full school day with no accommodations” should be achieved FIRST before athletic returning to play guidelines are commenced.
2. Suggestions for Schools to have a Concussion Management Plan (CMP) in place
- When a student returns to school following any injury, the school team’s responsibility is to (a) assess the needs, (b) design an intervention plan, (c) monitor the effectiveness of the plan, and (d) adjust and readjust until the student no longer has special needs resulting from the condition. Returning a student to school following a concussion is no different. 2 It is suggested A “Return to School” Program should be accurately planned so any needed accommodations for the student begin as soon as the student returns to school. This suggested “front-loading” of academic adjustments helps to avoid complications and prolonged recovery on the back end. The student will experience the ability to cognitively exert more and more each day, while flaring less and less symptoms.2
- During the recovery period, it is suggested that students should be monitored in an scheduled, concrete way by medical and academic staff in the school until the student is fully recovered. Concussion management plans will be different for each child and even for each concussion; and it is suggested any plan should be designed with that flexibility in mind. Note: Unlike Return to Play decisions, students don’t need to be “cleared” by a physician to return to school so doctor’s note and instructions may or may not be available in initial period of student’s return.
3. Suggestion for School Staff Training
- Because students physically look well, it is not uncommon for teachers and other school officials to underestimate the difficulties that a student is experiencing and may downplay the need for cognitive rest. Education of teachers, counselors, and school administrators regarding the cognitive effects that a concussion may have on a student is important. 5 Educators are encouraged to seek out concussion accommodation training through the many resources available on the web and through continuing education programs.
SECTION THREE: Documentation for updating Concussion Laws and the additional suggestion
Why does our state need to update our Concussion Law to Include RTL?
“A concussion is an academic injury, in the sense that it affects the capacity for learning,” said pediatric neuropsychologist Gerard Gioia at the Children’s National Medical Center in Washington. “There are rarely times in school when these concussion issues do not have some potential effect on a kid’s grades and academic pursuits.” 1
In the US, 48 States have now passed laws that call for physical rest following a concussion so called Return to Play Laws. In the rush to pass RTP laws, the student-athlete was viewed as an athlete first and less than 25% of these states has any explicit inclusion of academic supports in the RTP focused laws enacted from 2009-2013.7
In just the past few years, experts in the field of concussion have come to the realization that cognitive demands, much like physical demands, can worsen symptoms and can delay recovery (Majerske et al., 2008). 2
How can a Concussion affect Learning?
“The effects of concussion on a student’s return-to-school experience are unique to each student. In most cases, a concussion will not significantly limit a student’s participation in school; however, in some cases, a concussion can affect multiple aspects of a student’s ability to participate, learn, and perform well in school. In turn, the experience of learning and engaging in academic activities that require concentration can actually cause a student’s concussion symptoms to reappear or worsen. Given this inter-relationship, and the way concussion effects can vary across students, academic adjustments need to be tailored to each student’s specific circumstances” 3
In concussion management, both RTP and RTL are common and important terms, but they are not parallel processes. 2
To date, there are no agreed upon formulas for return to learning (RTL). This is due largely to the fact that the return to school following concussion is an extremely individualized process 2
Students must receive academic accommodations that need to be adjusted by school personnel in collaboration with managing medical professional until full recovery. The school psychologist and/or the school nurse are uniquely poised to facilitate the transition of a student with a concussion from the medical setting back to the educational setting. 2
Since a concussion is a medical event, and its recovery spans the home and school setting for 3 or more weeks, the management of the concussion is best accomplished by a seamless system of communication and collaboration among parents, the school, and the healthcare providers. 2
This multidisciplinary team approach to concussion management lends itself to consensus decision-making. It is best practice that the concussed student always returns to school with a signed release of information in place allowing for two-way communication between the school and the healthcare provider. 2
Many athletes will report increased symptoms with cognitive activities after a concussion, which makes intuitive sense because the concussion is a functional rather than structural injury of the brain. Athletes with concussion often have difficulty attending school and focusing on schoolwork, taking tests, and trying to keep up with assignments, especially in math, science, and foreign-language classes. Reading, even for leisure, commonly worsens symptoms. 10
To prevent exacerbation of the athlete’s symptoms and allow for continued recovery, “cognitive rest” is recommended. This rest may include a temporary leave of absence from school, shortening of the athlete’s school day, reduction of workloads in school, and allowance of more time for the athlete to complete assignments or take tests. Taking standardized tests while recovering from a concussion should be discouraged, because lower-than-expected test scores may occur.5,97 Test scores obtained while the athlete is recovering from concussion are likely not representative of true ability. Communication with school nurses, administrators, and teachers to be sure they understand these recommendations is imperative. 10
How can a school professional help a student recovering from a concussion?
A school professional can best support a student’s return to school and recovery by understanding possible concussion effects and providing the student with needed accommodations and support. Understanding concussion symptoms can help the student and members of the team identify individual needs of the student, monitor changes, and with proper permission, take action when necessary. This will help facilitate a full recovery and discourage students from minimizing the symptoms due to embarrassment, shame, or pressure to return to activities. 3
After reintegration into school, a student should be allowed adequate time to make up assignments, and the overall volume of make-up work should be reduced. Because students physically look well, it is not uncommon for teachers and other school officials to underestimate the difficulties that a student is experiencing and may downplay the need for cognitive rest. Education of teachers, counselors, and school administrators regarding the cognitive effects that a concussion may have on a student is important.10
How should schools respond to instructions from Health Care Providers?
“The contents of a note received from a physician may differ amongst providers. Some physicians will give detailed descriptions of academic accommodations suited to a particular student and his or her concussion, which can be easily followed by educators. Others may provide little or no details about the concussion. In the latter instance, educators should still help to determine if the student needs academic assistance, and if so, in what form.” 3
Note: Unlike Return to Play decisions, students don’t need to be “cleared” by a physician to return to school so doctor’s note and instructions may or may not be available in initial period of student’s return.
Who determines when the Student returns to school?
It is common for emergency departments to suggest the student not return to school until they have either been seen or been cleared by the healthcare provider. This recommendation often leads to a student being out of school for up to 1 or more week(s) while awaiting an appointment with a doctor, which may not be reasonable or necessary. It is also common for a medical professional to suggest the student not return to school until they are symptom-free. While it is true that an athlete must be 100% symptom-free before RTP, they do not need to be 100% symptom-free to RTL. The student may return to school when symptoms are tolerable and manageable, as long as the school makes appropriate adjustments for the student (the key point is that the school must understand concussions and necessary accommodations in order for the student who is still exhibiting symptoms to return to learn) 2
The school psychologist and/or the school nurse are the most skilled professionals at the school to help advise the parent and doctor when it is best to return the student to school. However, as the ultimate decision often/usually falls upon the parent, parents can utilize symptoms to determine when to safely return their student to school. 2
- If symptoms prevent the student from concentrating on mental activity for even up to 10 minutes at a time, rest is required. The student should be kept home from school on total bed rest with no (or very limited) television, video games, texting, reading, homework, or driving. Parents should consult a healthcare professional if this state lasts longer than a few days. 2
- If symptoms allow the student to concentrate on mental activity for up to 20 minutes at a time, parents should still consider keeping their student home from school, but total bed rest may not be necessary. Between periods of resting and napping, the student may engage in light mental activity, such as light reading or television, as long as these activities do not provoke symptoms. 2
Making the determination that an athlete is ready to begin implementing the graduated return to activity protocol is a medical decision. However, the school’s Concussion Management Team plays a critical role in deciding to return a student to activity—both academics and athletics. Communication among all members of the team is crucial. The school-based members of the Concussion Management Team will never clear an athlete to begin implementing the graduated return to activity protocol without the approval of the athlete’s health care provider. However, the Concussion Management Team has the authority to prevent a student from beginning activity if signs, symptoms, or behaviors of the concussion are still apparent in the academic setting or during physical activity.9
Once the student is ready to return to school, providing academic accommodations (e.g., extended time for tests, reduction of make-up work, rest breaks) can prevent exacerbation of symptoms and lead to a quicker and more successful recovery.
What is considered Best Practices for a School’s Concussion Team?
When a student returns to school following any injury, the school team’s responsibility is to (a) assess the needs, (b) design an intervention plan, (c) monitor the effectiveness of the plan, and (d) adjust and readjust until the student no longer has special needs resulting from the condition. Returning a student to school following a concussion is no different. 2
For schools who use RTI, Principles of Response to Intervention (RTI) as applied to TBI: Source: Colorado Concussion 8
- Thoroughly understand and assess the problem
- Apply a prescriptive intervention – early intervention is recommended
- Assess whether the intervention is having it’s desired outcome – progress monitoring
- Adjust: re-assess, attempt another intervention, progress-monitor: Adjust
This chart from Nationwidechildrens.org shows of what to do if increasing cognitive demand worsens symptoms. 6
Decision-Making flow chart 4
1 Wall Street Journal article, “Concussions on the Field, Repercussions in School, ” April 19,2013 http://online.wsj.com/article/SB10001424127887324108204579022770562136360.html
2 National Association of School Psychologists ”Research-Based Practice - Return to Learning: Going Back to School Following a Concussion,“ By Karen McAvoy http://www.nasponline.org/publications/cq/40/6/return-to-learning.aspx
Majerske, C. W., Mikalik, J .P., Ren, D., Collins, M. W., Cmiolo Reddy, C., Lovell, M. R.,& Wagner, A. K. (2008). Concussion in sports: Postconcussive activity levels, symptoms, and neurocognitive performance. Journal of Athletic Training, 43(3), 265–274.
4 National Children’s http://www.nationwidechildrens.org/concussions-in-the-classroom
5 From the American Academy of Pediatrics Clinical Report Sport-Related Concussion in Children and Adolescents http://pediatrics.aappublications.org/content/126/3/597.full
6 Nationwide Children’s Hospital, “An Educator’s Guide to Concussions in the Classroom” http://www.nationwidechildrens.org/concussions-in-the-classroom chart
7 Gerry Gioia’s Presentation for The Institute of Medicine https://docs.google.com/viewer?url=http%3A%2F%2Fwww.iom.edu%2F~%2Fmedia%2FFiles%2FActivity%2520Files%2FChildren%2FSports-Related-Concussion%2F4%2520Gioia%25202.pdf
8 Colorado Kids with Brain injuries https://docs.google.com/viewer?url=http%3A%2F%2Fcokidswithbraininjury.com%2Fckwbi%2Fwp-content%2Fuploads%2F2009%2F11%2FPrinciplesofRTI.pdf
9 Oregon Concussion Awareness and Management Program https://docs.google.com/viewer?url=http%3A%2F%2Fwww.ohsu.edu%2Fxd%2Foutreach%2Fprograms%2Fthinkfirst%2Fupload%2Focampguide.pdf
10 PEDIATRICS Vol. 126 No. 3, September 1, 2010 pp. 597 -615 (doi: 10.1542/peds.2010-2005) http://pediatrics.aappublications.org/content/126/3/597.full
SECTION FOUR: List of Resources for Parents, Teachers, Administrators and Free Training Videos
For Schools to set up a Concussion Management Team
- COLORADO DEPARTMENT OF EDUCATION CONCUSSION MANAGEMENT GUIDELINES Authored by: Karen McAvoy, PsyD and Kristina Werther, LCSW
- BrainSTEPS PA’s State Concussion Program
- Gerry Gioia’s Presentation for The Institute of Medicine
- Colorado’s REAP Program
- Traumatic Brain Injury Networking Team: TBI Identification Protocal
- Colorado’s Kids with Brain injury: Principals of RTI
- PEDIATRIC ANNALS 41:9 | SEPTEMBER 2012: Importance of ‘Return-to-Learn’ in Pediatric and Adolescent Concussion Christina L. Master, MD; Gerard A. Gioia, PhD; John J. Leddy, MD; and Matthew F. Grady, MD
- Nationwide Children’s Org: An Educator’s Guide to Concussions in the Classroom
- McAvoy, K. (2009). REAP the benefits of good concussion management. Centennial, CO: Rocky Mountain Sports Medicine Institute Center for Concussion
- Colorado’s REAP Program
- Traumatic Brain Injury Networking Team: Educators and Professional Manual
- PA’s BrainSTEPS
- Nationwide Children’s Org: An Educator’s Guide to Concussions in the Classroom
For School Nurses
For Healthcare Providers
Training Videos available for free online
Pennsylvania’sBrainSTEPS Brain Injury School Re-entry Program by Brenda Eagan Brown, Program Coordinator firstname.lastname@example.org
Guardian Caps are being used on middle school and elementary students as young as third graders who playing tackle football in my area. Now Guardian only began shipping product in the Spring 2012, and so there is only one year of experience using these caps on high school age students. Before research is even begun on a large scale to test what effect this cap has on high school players, the product is now being worn on more vulnerable brains and smaller bodies of kids as young as third grade.
I wonder how these parents would feel if they were at an amusement park and their 8 year old child was offered an unproven safety device to wear on a roller coaster. They would be assured that other kids said the device felt good when they used it, but there was no scientific research that stated the device definitely worked or whether it caused any harm. Would parents agree to try an unproven safety device to see if it helped? And what about using their child as a test case? I believe it is rather frowned on to experiment with children as subjects.
What is the Guardian Cap?
- Soft-shell football helmet cover
- Reduces impact up to 33%
- One-size fits all
- Lightweight (<7oz)
From an mail from Mike Oliver, Executive Director and General Counsel of NOCSAE, to me on this topic:
“There is another potential confounder to the question and debate regarding the addition of things to helmets, whether external or internal, and that is the significance of the increase in total helmet weight, particularly with regard to youth football players. NOCSAE has been working diligently to identify effective criteria that would allow us to create a football helmet standard unique to the youth player, and even with the best objective experts in the country, the only near consensus we have been able to develop is that there should be a limit to the mass of a helmet worn by young football players outside of scholastic or academic based programs such as middle school, junior high or high school regulated by the various state athletic activities associations.
From an investigation recently concluded by our technical director, we know that the average weight for a youth football helmet with face mask is 1600 grams or 56 ounces, and can be as light as 38 ounces. Any item or combination of items weighing 6 ounces and added to a youth helmet can increase the mass by almost 20%. If someone wants to sell a product that can add as much as 20% to the weight of a helmet for a youth player, they should be required to demonstrate with peer reviewed science that such added weight increases the level of protection in a measurable way AND does not increase the risk of injury. ”
Executive Director and General Counsel
11020 King St., Suite 215
Overland Park, KS 66210
“Commissioning research and establishing standards for athletic equipment, where feasible, and encouraging dissemination of research findings on athletic equipment and sports injuries.”
Dustin Fink Of The Concussion Blog reposted my blog on Guardian Cap from today, with his own thoughts and additions. Then Mike Oliver, Executive Director and General Counsel of NOCSAE, commented on our mutual blog on the liability issue.
From Mike Oliver in reference to Dustin’s and my blog post
You have done an excellent job identifying and clarifying the issues associated with helmets and helmet add-on products.
As with most national and international equipment safety standards, the NOCSAE helmet standards are design neutral.That simply means that the standards define performance and function, and leave the decision as to how to achieve those ends to engineers and other experts most familiar with material design.
A typical football helmet involves very complicated interactions between the rigid exterior shell and the interior energy absorbing material, which relationship includes how much the shell flexes on impact, where and to what extent those flexing forces are transmitted to the padding underneath, and how the flexing of the shell itself acts as an energy absorbent component to the entire system.
Because even minor changes to any of those components can result in measurable performance changes (good or bad) in the system, NOCSAE standards mandate that such changes to a model require a separate and independent set of certification data when the manufacturer makes even minor changes in those components.
If a manufacturer had chosen to incorporate an external similar to the Guardian Cap into any of its models, it would have been required under our standards to develop and establish compliance with the standards for that new model, and would have been required to give that model a different name to distinguish it from others.
This is true even if the change or addition was an improvement to the helmet performance. That new testing data could encompass over 6000 separate impacts across 200 to 225 sample helmets, depending upon the total quantity of that helmet model being manufactured.
I did recently received a statement from Riddell indicating that “Each helmet and face mask model is certified by the manufacturer to meet NOCSAE performance standards. The manufacturer certification is void if the helmet or face mask is modified in any way. Riddell recommends against the use of any third party aftermarket accessories that alter the fit, form or function of the helmet or face mask as such modifications void the NOCSAE certification and render the helmet or face mask illegal for most organized play.
“Hey, mom, we have these new igloo caps in football and they reduced concussions by 80%,” reported a 5th grade, first-time football player to his mom in a local town in Fairfield County.
Two weeks ago a local paper ran a very misleading article concerning Guardian Caps in which the Guardian Cap was called “concussion caps” multiple times and the caps were “concussion prevention.” The reporter continued to summarize their use as ”It is probably overstatement to suggest the difference is getting hit by a truck as opposed to getting hit by a pillow.“
Over the last two years, I have had “communications” with Guardian Caps about the way in the past they have marketed this product with sometimes less than factual detail, and so I called Guardian about this article. My concern was that now the flawed newspaper article was on the internet and would be googled and read by some parents as fact. Guardian said they did not supply any information to this reporter and they agreed it was poorly written piece, but there was nothing they could do about it.
The Guardian site now has a clear warning in the footer of every page; ”*No helmet, practice apparatus, or helmet pad can prevent or eliminate the risk of concussions or other serious head injuries while playing sports. Researchers have not reached an agreement on how the results of impact absorption tests relate to concussions. No conclusions about a reduction of risk or severity of concussive injury should be drawn from impact absorption tests.”
Under the Science & Facts section of their website, Guardian has just one quote in the “What Experts are saying section,” with no author mentioned here other than the source is a October 10, 2012 blog post from “McGill University Physics Professor Review “Newton’s Cradle: Colliding Football Helmets: Physics 101″ ; and below the quote, Guardian has posted, ”This is an individual’s opinion and has not been substantiated by any scientific study.”
Guardian stated there was nothing they could do about the article so I then wondered what the high schools mentioned in the article knew of the issues around Guardian so I decided to contact those schools. I wanted to know if schools understood the limitations and the possible liability issues around using an add-on product and if they had notified the parents and the student athletes. I emailed the schools – see my original email and all source documents with links are below (thanks to several people on this list who reviewed and helped me with this effort).
My first concern was if the schools know Guardian Caps does not have scientific research to support that it can prevent or reduce concussion. No helmet or device attached to a helmet can prevent a concussion at this point in time. I supplied the schools with a number of advisories by NOCSAE have been issued on these products. Links below.
My second concern was regarding the potential liability to the school district by attaching this product (which is called a 3rd party add-on) to the football helmet. By using the Guardian Cap, schools may possibly void the helmet manufacture’s warranty and void the NOCSEA certification. I provided the schools the NOCSAE advisory that had been issued on these types of “3rd party add” products. This is an issue in Colorado and some Colorado schools who have been using the Guardian Caps since 2012, are considering banning its use.
What I discovered in contacting the schools is not only are high school students now wearing these caps, but in some places Guardian Caps are being used on middle school and elementary students as young as third graders who playing tackle football. Guardian only began shipping product in the Spring 2012, and so there is only one year of experience using these caps on high school age students. Before research is even begun on a large scale to test what effect this cap has on high school players, the product is now being worn on more vulnerable brains and smaller bodies of kids as young as third grade.
I wonder how these parents would feel if they were at an amusement park and their child was offered an unproven safety device to wear on a roller coaster. They would be assured that other kids said the device felt good when they used it, but there was no scientific research that stated the device definitely worked or whether it caused any harm. Would parents agree to try an unproven safety device to see if it helped? And what about using their child as a test case? I believe it is rather frowned on to experiment with children as subjects.
In 2009, I bought my 6th grade son who had suffered two concussions a $250 “concussion proof” helmet for lacrosse to “protect him against concussions” as the sales clerk promised this new helmet would do. He lasted twenty minutes in a practice before illegal hit sent him backwards and he hit his head on the ground for his third concussion. I sent my son back into a contact sport thinking he was protected. Based on the marketing language on the box and the sales clerk, I made a decision to let my son play. Marketing is not the same as scientific research.
I believe that parents and children using the Guardian Cap should be notified by their schools in writing and sign-off they understand the limitations and liabilities surrounding this product.
From my experience, these schools have staff who promote and believe in concussion education, and I believe the staff ordered these caps in an effort to help, not hurt kids. But have these caps been oversold to coaches and parents as “concussion caps” as the article states? And there is also concern from some ATs and experts in the concussion field that children will be less likely to report concussion symptoms because they believe they are protected or believe it would be wimpy to report if they have on something meant to reduce concussions. Will parents will be less likely to take their children to doctors if they believe this covering can protect their child’s brain? What about possible neck and spine injuries as helmets with the caps collide? The answers are unknown. It will remain to be seen whether this product helps, hurts or has no impact in this informal experiment with these athletes, some of whom are only 8 years old.
Katherine Price Snedaker, MSW
My letter to the schools involved
I am writing to you because I am concerned about the Guardian Caps helmet covers, which per an article in the Stamford Advocate, your football team is currently using as a “safety device” in practice. In addition to being a parent of two sons who have suffered concussions, I am also concussion educator who has spoken locally and nationally on various concussions issues, including recently presenting at Institute of Medicine(IOM)/National Research Council (NRC) on concussions in youth sports (see my bio below). I had the honor of speaking at your school last spring to two upper school Psychology classes on the topic of concussions and was very impressed with your students. I have spoken to your AT and other staff in the past and have been impressed by your concussion policies.
However, after reading the flawed article about Guardian Caps in the Stamford Advocate, http://www.stamfordadvocate.com/sports/article/Concussion-caps-making-the-scene-at-HS-football-4776651.php I felt it was important to share with you the following information concerns safety and liability issues. I know from experience that liability is an important issue to address in a school as my father was superintendent of schools for 29 years and a private school headmaster for 8 years. I am also working with the press to write a follow-up story to correct serious errors in this story.
My first concern with this product is that athletes or parents might falsely believe that this product can help prevent or reduce concussions. No helmet or device attached to a helmet can prevent a concussion at this point in time, and this “safety” device does not have scientific research to support that it can prevent or reduce concussions. A number of advisories have been issued on these products including:
• June 2012 NOCSAE “warns parents and athletes about protective equipment concussion claims” http://nocsae.org/wp-content/uploads/2012/10/NOCSAE-Consumer-Warning-News-Release-06-15-12.pdf
• 2012 NFHS Statement on these products “has not been able to form a definitive conclusion as to whether a number of such products are, on balance, beneficial or detrimental”: http://ciacsports.com/site/?p=1534
• NY Attorney General issues concussion alert including use of concussion “safety” products: http://online.wsj.com/article/APbecd319ec23e42c4bc79b826f600d2fa.html
• Guardian Cap after the NOCSAE http://www.nfl.com/news/story/0ap1000000223873/article/guardian-cap-caught-in-catch22-after-nocsae-statemen
The leaders in the concussion community have been following claims made by the company which makes Guardian Caps, beginning before its first delivery in April 2012. There have been issues with the company and sales representatives making claims about the caps which were not substantiated by any research, which over the last year, Guardian has tried to rectify. The Guardian site now has a clear warning in the footer of every page; ”*No helmet, practice apparatus, or helmet pad can prevent or eliminate the risk of concussions or other serious head injuries while playing sports. Researchers have not reached an agreement on how the results of impact absorption tests relate to concussions. No conclusions about a reduction of risk or severity of concussive injury should be drawn from impact absorption tests.”
In their science section on their website, after one researcher explains how the cap might work, they post this warning, “This is an individual’s opinion and has not been substantiated by any scientific study.”
My second concern is regarding the potential liability to your school district by attaching this product (which is called a 3rd party add-on) to the football helmet. By using the Guardian Cap, schools may void the helmet manufacture’s warranty and void the NOCSEA certification. Please consult with your legal team to see your district is comfortable with the use and possible consequences of using this 3rd party add-on.Please see helmet companies’ response below.
• The August 2013 Nocsae advisory on 3rd party add-ons: http://nocsae.org/wp-content/uploads/2013/08/NOCSAE-Add-on-Fact-Statement-8-7.pd
Some Colorado schools have been using the Guardian Caps since 2012 and are considering banning its use. From http://www.denverpost.com/ci_23772337/guardian-cap-controversial-ruling-may-mean-end-use :
After a Denver Post story last week, about the growing use of the Guardian Cap, the National Operating Committee on Standards for Athletic Equipment issued a statement that read, in part: “The addition of after-market items by anyone that changes or alters the protective system by adding or deleting protective padding to the inside or outside of the helmet, or which changes or alters the geometry of the shell or adds mass to the helmet, whether temporary or permanent, voids the certification of compliance with the NOCSAE standard.”
Soon after, CHSAA issued a news release, warning coaches and athletic directors “considering the use of third party add-on accessories (at practices) to work through their risk managers and attorneys. The liability that schools face can be affected by the use of these accessories.”
I would be more than happy to meet with you and anyone else to discuss these issues. While I cannot give legal advice, I am a national expert on the topic of concussions and I can provide some background and sources to help you in making a decision regarding the use of Guardian Caps.
Katherine Price Snedaker MSW
Schutt Helmets’ Position
In this statement to Moms’ Team, Schutt Helmet specifically advises purchasers of its helmets “alterations, additions or component deletions or removals you make to the helmet may void [its] warranty and could adversely affect the protective capabilities of the helmet.”http://www.momsteam.com/nocsae-ruling-third-party-helmet-add-ons-generates-controversy?page=0%2C3 .
Robert Erb, CEO of Schutt, said that while “We work with a number of inventors and outside companies to help them understand helmet impact dynamics, we do not certify or approve the use of third party products in our helmets. We make the best protective gear and prefer that nothing be added or subtracted from the manufactured product. When it leaves our facility, it is fully compliant with NOCSAE and other regulatory bodies, and it is fully insured and warranted. A company that seeks to alter the helmet in any way needs to do its own certification under NOCSAE standards and needs to fund its own insurance. This is no different than after-market automotive or electronic enhancements.” http://www.momsteam.com/nocsae-ruling-third-party-helmet-add-ons-generates-controversy?page=0%2C3#ixzz2dx9N0bgO
My work in the Concussion Field
In February 2013, I was asked to present in Washington to the Institute of Medicine (IOM)/National Research Council (NRC) Commission on “sports-related concussions in youth” on the topic of the concerns of parents with respect to sports-related concussions in youth, as well as the issues and challenges faced by the families of concussed players. As a medical social worker, I have helped guide the recovery process for over hundred children with concussions and their families as they re-entered school and team sports. I have also co-founded and consulted with several CT concussion clinics in Fairfield County and have run support groups for kids with Post Concussive Syndrome.
Since 2008, I have been working as concussion educator for youth sports via SportsCAPP (Sports Concussion Aware and Prepared Program) through public speaking, social media and consulting in the NY Metro Area. Our Youth to Youth Program, MIND YOUR MELON, takes high school athletes who have healed from concussions to speak to groups of middle and high school students. This program benefits middle school kids as they learn about concussions as well as help the athletes find a positive way to share and view their concussions. I have run a number concussion education events for the community and educational programs for schools and camps. Launched in 2010, SportsCAPP.com, an education hub website, created to deal with the loop hole in the Connecticut Concussion Law to help recreational teams, town leagues and private schools use free resources to create concussion policy and bring awareness into their programs for players, coaches and parents. TeamConcussion.org was created in 2010, to be a social media/web create a variety of support groups for teens with concussions to connect with other “healed” teens thru Twitter, Facebook, Instagram. In 2013, PinkConcussions.com was created an info hub for research, resources & answers for female concussions from sports, accident, abuse or military service.
With the CDC 20 minute training course and The Concussion Recognition & Response™ APP on your phone, you can be ahead of most youth coaches and truly make a difference. I used this app four times in the Spring 2011 Season to pull four children from lax and soccer games. All four were determined later by their doctors as having suffered concussions. I made a difference by keeping these kids from returning to play and you can do the same.
1. Heads Up Online Training Course
Get prepared for the new season in less than 20 minutes
Click here for the course – at the end print the certificate for your records
Heads Up: Concussion in Youth Sports is a free, online CDC course available to coaches, parents, and others trying to keep athletes safe from concussion. It features interviews with leading experts, dynamic graphics and interactive exercises, and compelling storytelling to help you recognize a concussion and know how to respond if you think that your athlete might have a concussion. Once you complete the training and quiz, you can print out a certificate, making it easy to show your league or school you are ready for the season.
What You Will Learn:
- Understand a concussion and the potential consequences of this injury,
- Recognize concussion signs and symptoms and how to respond,
- Learn about steps for returning to activity (play and school) after a concussion, and
- Focus on reducing risks and being prepared to try to help athletes safe season-to-season.
We can help athletes stay active and healthy by knowing the facts about concussion and when it is safe for athletes to return to play.
The training requires Adobe Flash and Adobe PDF Reader installed on your computer. It has been tested on the following browsers with Adobe Flash installed: Internet Explorer, Safari, Firefox. Please do not close/refresh your browser as this will restart the course. If you need to exit the training, you will be returned to the beginning of the course.
2. Great App to have on your Smart phone – everything you need to know/do when a kid gets head injury for FREE.
The Concussion Recognition & Response™ APP is a tool that helps coaches and parents recognize whether an individual is exhibiting/reporting the signs and symptoms of a suspected concussion. The app allows a coach or parent to respond quickly and appropriately to this potentially serious medical situation.
In less than 5 minutes, the user can complete a checklist of possible signs and/or symptoms to determine whether to remove the child from play and the need for further medical examination. The app allows users to record pertinent information regarding a child with a suspected concussion and share that information via e-mail with health care professionals; it also provides a system for post-injury follow-up.
With answers to Frequently Asked Questions for parents and coaches, this tool is an invaluable guide for learning about concussions. This FREE app is available at the Apple® App StoreSM and the Android Market.
For your iPhone®, iPad®, iPod® Touch, Android™ device or tablet!
GE, NFL & Leading Healthcare Experts Team up to Accelerate Concussion Research, Diagnosis & Treatment
$40 million research program aims to increase accuracy of traumatic brain injury diagnosis
GE, NFL, Under Armour also launch $20 million open innovation challenge to find and fund ideas to develop new solutions to diagnose and protect against traumatic brain injury
March 11, 2013 01:00 PM Eastern Daylight Time
NEW YORK–(BUSINESS WIRE)–(NYSE: GE) – GE and the NFL today announced the Head Health Initiative, a four-year, $60 million collaboration to speed diagnosis and improve treatment for mild traumatic brain injury. The goal of the research and innovation program, guided by healthcare experts, is to improve the safety of athletes, members of the military and society overall.
The initiative includes a four-year, $40 million research and development program to evaluate and develop next generation imaging technologies to improve diagnosis that would allow for targeting treatment therapy for patients with mild traumatic brain injury. In addition the NFL, GE and Under Armour launched a two-year open innovation challenge to invest up to $20 million in research and technology to better understand, diagnose and protect against mild traumatic brain injury.
GE Chairman and CEO Jeff Immelt said, “GE is a leader in developing sophisticated diagnostic imaging technology, but for all the advances in science our knowledge of the brain is far behind that of nearly every other organ in the body. With this initiative, we will advance our research and apply our learning to sports-related concussions, brain injuries suffered by members of the military and neurodegenerative diseases such as Alzheimer’s and Parkinson’s. Advancing brain science will help families everywhere.”
NFL Commissioner Roger Goodell said, “Jeff and I have had many conversations over the years about business and the game we both love – football. The future of our great game is bright. The NFL has made tremendous progress in making the game safer and more exciting. But we know we have more work to do. Our collaboration with GE and Under Armour and the launch of the innovation challenges puts us on an accelerated path to progress with experienced scientists, academics and entrepreneurs dedicated to developing game-changing technologies that will benefit athletes, the military and all members of society.”
Research to Map Brain Imaging Biomarkers
The research will take a whole brain approach to determine the key Magnetic Resonance Imaging (MRI) biomarkers for potential diagnosis, outcome prediction, and therapy management for patients with mild traumatic brain injury. The research study will be guided by an advisory board consisting of a cross-disciplinary team of medical professionals from various institutions. Among those participating:
1. Dr. Thomas McAllister is the Millennium Professor of Psychiatry and Neurology, Director of the Section of Neuropsychiatry and Vice Chair for Neuroscience Research for the Department of Psychiatry at the Geisel School of Medicine at Dartmouth. He has recently been named chair of the Department of Psychiatry and the Albert Eugene Sterne Professor of Clinical Psychiatry at Indiana University School of Medicine. He will begin his duties in the summer of 2013.
2. Dr. Richard Ellenbogen is Chief of the Division of Neurosurgery and Fellowship Director of Neurological Surgery at Seattle Children’s Hospital. He is the co-chair of the NFL Head, Neck and Spine Committee.
3. Dr. Russell Lonser is the Chair of The Ohio State University Wexner Medical Center Department of Neurological Surgery, head of the NFL’s Research Subcommittee and a member of the NFL’s Head, Neck and Spine Medical Committee.
4. Dr. Geoffrey Manley is the Chief of Neurosurgery at San Francisco General Hospital and Professor of Neurosurgery at the University of California San Francisco (UCSF).
5. Dr. Pratik Mukherjee is an Attending Neuroradiologist and an Associate Professor of Radiology and Biomedical Imaging, Bioengineering and Therapeutic at the University of California San Francisco (UCSF).
6. Lieutenant Colonel Gerald York, is an Active Duty radiologist with a Certificate of Added Qualification (CAQ) in neuroradiology serving at Brooke Army Medical Center in Houston, TX. He has expertise in interpretation of CT and MRI of the brain, spinal cord, and head-neck disorders, including many acute, subacute and chronic traumatic brain injury patients.
7. Colonel Jamie Grimes is the National Director of the Defense and Veterans Brain Injury Center. As national director, COL Grimes oversees all aspects of the organization’s mission: to serve active duty military and veterans with traumatic brain injury through state-of-the-art medical care and care coordination and through innovative clinical research and educational programs.
8. Dr. Larry Leverenz is the Clinical Professor in the Department of Health and Kinesiology and Director of Athletic Training Education at Purdue University. He has served professionally as a member of the National Athletic Trainers’ Association Education Council and as president of the Commission on Accreditation of Allied Health Education Programs. Currently, he is the President of the World Federation of Athletic Training & Therapy.
9. Dr. Teena Shetty is a Neurologist at Hospital for Special Surgery and is triple board-certified in neurology, neuromuscular medicine, and electrodiagnostic medicine.
10. Dr. Brian Hainline is the Chief Medical Officer at the NCAA. He is a leading sports medicine advocate with more than two decades’ experience most recently as the chief medical officer of the United States Tennis Association (USTA).
Open Innovation Challenge to Study and Prevent Traumatic Brain Injury
In addition to the research program, the NFL is partnering with GE and Under Armour to launch the Head Health Challenge, which has two focus areas that seek new solutions for understanding mild traumatic brain injury. The organizations are pledging to find and fund ideas that accelerate solutions for brain protection. The challenge fund could invest up to $20 million.
Sue Siegel, CEO of GE healthymagination, said, “GE is investing in research and development to fast-track advancement in head health. Through our research collaboration and open innovation challenge, we hope to stimulate the broader ecosystem of scientists, engineers, mathematicians, computer scientists, entrepreneurs, and innovators worldwide to bring their talents to this effort and accelerate the current understanding of brain trauma and improve diagnostic tools.”
Kevin Plank, founder and CEO of Under Armour said, “As longstanding partners of the NFL, we recognize the magnitude of this initiative, and the impact it will have for athletes at all levels. Under Armour was founded upon the pillar of making all athletes better through the relentless pursuit of innovation. We take great pride in supporting this effort to reward new ideas and breakthrough concepts in this space, particularly as it applies to protecting athletes and influencing positive change in sports.”
Dr. Geoff Manley, professor and vice-chair of the Department of Neurological Surgery at UCSF and Chief of Neurotrauma at San Francisco General Hospital, said, “Traumatic brain injury is one of the greatest unmet medical needs of our time. Every 20 seconds someone in the United States sustains a brain injury. A better understanding of the molecular, physiological, and behavioral/biomechanical changes that occur shortly after a traumatic event is needed to reliably diagnose the types of changes that are difficult to identify using current technologies.”
Challenge I: Methods for Diagnosis and Prognosis of Mild Traumatic Brain Injuries
Starting today, GE and the NFL are inviting proposals for technologies and imaging biomarkers that address identification and management of subclinical and mild traumatic brain injury. Multiple cash awards with a cumulative total value of up to $10 million will be made, along with the possibility of future partnership and collaboration with GE. Entries are being immediately accepted at www.NFLGEBrainChallenge.com. Specific focus areas for this challenge include:
- Development and validation of imaging and/or sensor based biomarkers that can aid in the diagnosis and prognosis of mild traumatic brain injury events. These include imaging biomarkers of brain structure, connectivity, function, cognition, neuroinflammation, and molecular markers.
- Development of new technologies that are more sensitive to small contusions and injuries that are missed by current technologies; and assessing the long-term chronic impact of these events.
- Improved algorithms for the quantification and visualization of markers of brain injury severity and longitudinal change.
- Algorithms and tools that link imaging data to clinical, cognitive, and biomechanical data.
- Models of individual risk and long-term prognosis and clinical decision support tools using population studies.
- Robust methods for triaging acute stage events and developing “Return to Play” guidelines using physiological, molecular, electrical or physical changes in brain or body functions.
Challenge II: The Mechanics of Injury: Innovative Approaches For Preventing And Identifying Brain Injuries
Launching in fall 2013, the NFL, Under Armour and GE will invite proposals for new materials and technologies that can protect the brain from traumatic injury and new tools for tracking head impacts in real time. Specific focus areas for this challenge include, but are not limited to:
Protection against Injury
- Materials or devices that can distribute the force of impact. These include smart materials or active polymers that are comfortable but can adapt to sudden impacts are highly desirable
- Systems to predict and initiate protective responses to prevent injury activation of adaptive padding at the focus of impact
Monitoring and Identifying Injury
- Systems that monitor and integrate directional and rotational impact forces. These systems should integrate information with imaging/diagnostic equipment
- Sensors to provide biofeedback to modify behaviors that predispose athletes to injury
- Systems that monitor biomechanical and physiological responses to detect injury
- Systems to efficiently collect, interpret and organize large quantities of real-time data
The winners of the challenges will be selected by a panel of external judges that include leading healthcare experts in brain research, imaging technologies, and advocates for advances in brain research. For Challenge I these individuals include:
1. Dr. William J. Heetderks is the Director of Extramural Science Programs at the National Institute of Biomedical Imaging and Bioengineering (NIBIB), NIH.
2. Dr. Walter Koroshetz is the Deputy Director of the National Institute of Neurological Disorders and Stroke (NINDS) at the NIH. Before joining NINDS, Dr. Koroshetz served as vice chair of the neurology service and director of stroke and neurointensive care services at Massachusetts General Hospital (MGH).
3. General Peter Chiarelli, USA (Ret.) is the Chief Executive Officer of One Mind for Research. He is a retired four-star General with 40 years of experience designing and implementing American defense policy for the U.S. Army and Department of Defense in peace and during combat operations.
4. Colonel Dallas Hack is the Director of the Combat Casualty Care Research Program and the Chair, Joint Program Committee 6 (Combat Casualty Care), US Army Medical Research and Materiel Command, Ft Detrick, MD, where he coordinates leading edge research focused on new techniques and products to save the lives and reduce morbidity of troops injured in the line of duty.
5. Dr. Geoff Manley is the Chief of Neurosurgery at San Francisco General Hospital and Professor of Neurosurgery at the University of California San Francisco (UCSF).
GE (NYSE: GE) works on things that matter. The best people and the best technologies taking on the toughest challenges. Finding solutions in energy, health and home, transportation and finance. Building, powering, moving and helping to cure the world. Not just imagining. Doing. GE works. For more information, visit the company’s website at www.ge.com.
About The National Football League
Throughout its history, the NFL has made the health and safety of its players a priority. This commitment extends to football played at all ages, as well as other sports. At the youth level, the NFL’s partnership with the Centers for Disease Control and Prevention and the League’s support for USA Football, including prominently their Heads Up Football initiative, helps parents, coaches, clinicians and athletes understand the signs and symptoms of possible head injuries. The league has successfully advocated for the passage of youth concussion laws in 42 states thus far. Through funding for medical studies, including a $30 million grant to the National Institutes of Health for medical research; collaboration with the military on research and recognizing and reporting potential head injuries; and the work of the NFL’s medical committees, the NFL is committed to supporting and advancing science that will have an impact far beyond football. With a continued emphasis on improved equipment, rules changes, and in-game policies, the NFL fosters a culture that promotes health and safety at every level of the game.
About Under Armour, Inc.
Under Armour® (NYSE: UA) is a leading developer, marketer, and distributor of branded performance apparel, footwear, and accessories. The Company’s products are sold worldwide and worn by athletes at all levels, from youth to professional, on playing fields around the globe. The Under Armour global headquarters is in Baltimore, Maryland, with European headquarters in Amsterdam’s Olympic Stadium, and additional offices in Denver, Hong Kong, Toronto, and Guangzhou, China. For further information, please visit the Company’s website at www.ua.com
There is statistic going around the press that has been concerning me. The basic quote goes like this…
“For young people ages 15 to 24 years old, sports are the second leading cause of traumatic brain injury, following only behind motor vehicle crashes.”
This sentence or a version of it is on many major network news websites and Congressman Udall’s site and most concussion sites but not the CDC site. As of last Saturday, NO ONE had a footnote or a source for such a bold, specific statement so I set out to see if I could find the source.
I found this exact sentence in this 2007 Study using google:
This sentence in the 2007 study is marked with footnote referring to its source which is a 1991 study:
The 1991 National Health Interview Survey was analysed to describe the incidence of mild and moderate brain injury in the United States. Data were collected from 46,761 households and weighted to reflect all non-institutionalized civilians. The report of one or more occurrences of head injury resulting in loss of consciousness in the previous 12 months was the main outcome measure. Each year an estimated 1.5 million non-institutionalized US civilians sustain a non-fatal brain injury that does not result in institutionalization, a rate of 618 per 100,000 person-years.
Motor vehicles were involved in 28% of the brain injuries, sports and physical activity were responsible for 20%, and assaults were responsible for 9%. Medical care was sought by 75% of those with brain injury; 14% were treated in clinics or offices, 35% were treated in emergency departments, and 25% were hospitalized. The risk of medically attended brain injury was highest among three subgroups: teens and young adults, males, and persons with low income who lived alone. The incidence of mild and moderate brain injury in the United States is substantial. The National Health Interview Survey is an important national source of current outpatient brain-injury data”
From my research on google, it seems this “fact” stems from this 1991 study which would make this information very dated in 2013, to be quoted without a source. I cannot get a copy of 1991 study yet but the study seems to be talking about adults in this sentence and the category is “sports and physical activity” which is also very broad. Also, this seems to be only using LOC – pre 2008 Zurich – as a factor and we now know that LOC only occurs in 10% of concussions.
I have asked someone I know at the CDC to look it into the matter for me. I hope someone proves me wrong and we do have valid, specific data like this but I believe we do not.
We must be honest how “limited in value” the stats are that we have. For example, any study pre-2008 Zurich concerning concussions would seem to be dated to me if LOC was used as the sole determination of concussion.
Why is this important? Because we must know why and where each age group is getting hurt so we can direct resources to educate and try to reduce concussion.
And even within concussions for a particular youth sport, I would like to see concussion numbers broken down by specifics as then one could target the issue at hand.
Did the child or teen get concussed…
- Playing in a game (with refs present)
- Participating in practice drill (coaches in charge of play)
- Fooling around in practice not following directions and rules (coach present but not watching)
- Pre/Post practice with no adult at all watching in locker room or parking lot.
I would also like to see a study that looks at the use of drugs and alcohol with teens and concussions. As I follow social media and concussions, I look at what teens are posting on social media sites (non Facebook sites) where parents do not monitor their posts. I see so many teens post about being drunk or high when they were concussed.
Hopefully better data is coming soon to help guide our efforts, resources, time and money.
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- Girls & young athletes more severe Concussions
- Connecticut Concussion Law of 2009
- How to help reduce risks of Concussions
- What Can I Do to Help Feel Better After a Concussion?
- Heading in Soccer: The Investigation Continues
- Hard Hits, Hard Numbers
- HeadStrongPlayer, A Program for Kids
- Concussions 101, a Primer for Kids and Parents
- YouTube posting of “Big Hits, Broken Dreams”
- Girls at greater risk from Concussions
- What is a Concussion?
- Teen Brain takes longer to heal
- Former NFL players sue over Concussions
- Welcome to the Sports CAPP Site
- Equipment Limitations part of Dr. Kutcher before US Senate Committee