(This post is a letter I sent to the State of Connecticut’s Children’s Committee on March 6, 2014)

Why are our most vulnerable children by being coached by adults with the least knowledge of concussion? 

Based on medical science and longer recovery rates for younger children, trained coaches are needed to coach elementary and middle school aged athletes. My sons suffered their first concussions on school grounds in 6th and 7th grade.

From my experience, many kids have their first concussion while they are middle school age playing youth sports, not in high school sports. These early mismanaged concussions set a poor framework for further concussions in high school. Connecticut needs to enact a law for all schools (all ages) to record head injuries to learn the scope of this issue and set policy based on sound data.

But there is solution available now that will turn this tide… Concussion education which is simple, effective and free

In 8 minutes, here is the motivation, education and the tool YOU CAN USE to help any child or adult with a possible concussion.

I also want to share with you the article below where YET another state has a bill to address youth sport coach concussion issue. Connecticut has a choice to be with the leaders or the followers on this issue.

Please don’t let two years of work to enact youth sport concussion laws go to waste? We will be back next year and the year after until Connecticut protects its youngest and most vulnerable athletes.

The CDC coach’s training only takes 20 minutes. A brain injury can last a lifetime. 

Please join the other states leading the way for children’s safety and enact youth sport concussion training for coaches.

Thank you,

Katherine Snedaker, MSW

Virginia Bill Could Require Youth Coaches to Get Training for Concussions

If a child gets a concussion while playing on a public school team, the coach has to pull the player from the game and he or she can’t come back until cleared by a doctor. But for recreational leagues, there are no guidelines. So, if a child suffers a brain injury while playing, there’s no set way to deal with it.

“There’s no reason kids should be more safe playing for school then they are playing for rec league,” said parent Wendy Etz.

The General Assembly is trying to change that. A new bill could require coaches to get training on concussions.

“I think it’s important for coaches to know, because they’re often the first line of defensive if you will,” said Anne McDonnell of the Brain Injury Association of Virginia.

McDonnell lobbied law makers in 2010 to change the rules for public schools, and she thinks it’s about time the same happens for rec leagues.

If the law passes, coaches will be trained to identify when a hard fall is something more serious—like a concussion.

“Well, obviously no one wants the children to be injured, and I think this would help people detect the injuries quicker and maybe prevent a long-term injury or disability,” said Robert Hodges of the Chesterfield Basketball League.

This means parents might have to pay more, but most of them say they wouldn’t mind.

“I played high school and college sports, so to make sure that they are safe, that’s going to be priority number one for me absolutely. Money wouldn’t be a problem,” said parent James Hargrove.

Lawmakers are still working on the bill. If both chambers agree, they’ll vote before session ends.

http://www.wric.com/story/24823463/new-bill-could-require-youth-coaches-to-get-concussion-training

Good Afternoon Representative Urban, Senator Bartolomeo, Representative Betts and Senator Linares and the distinguished members of the Children’s Committee,

For the record, my name is Katherine Price Snedaker, and have a Masters Degree in Social Work and live in Norwalk, CT. I am speaking today as a parent and the founder for PinkConcussions.com – an organization which focusing on female concussions – and SportsCAPP.com – a youth sport concussion educational organization.

I am here to testify in support of HB 5113, AN ACT CONCERNING YOUTH ATHLETICS AND CONCUSSIONS. But before I continue, I want to take this chance to show you how powerful, simple and free concussion education is right now. I have listed below three websites which will take you in total 9 minutes to view. In 9 minutes I believe I can motivate, educate and prepare you to help any child or adult who has a possible concussion.

Why http://www.theguardian.com/sport/video/2013/dec/13/concussion-sport-death-ben-robinson-video

What you need to know http://brain101.orcasinc.com/5000/

How to be prepared http://www4.parinc.com/products/Product.aspx?ProductID=CRR_APP

From a personal and professional prospective, concussions have changed my life. In and out of sports, I have suffered many concussions. Based on my double digit concussion history, I was accepted in BU CTE Legacy Study 2 years ago and on my death my brain will studied for signs of CTE.

As a mother, watching as my two sons’ lives affected by concussions. Despite having three sons for years in youth sports, the only concussion education I ever had was from an article in US Lacrosse magazine, yet that one article motivated me to take the correct steps to have my son checked by a doctor when he was concussed at school recess. One son now 14 suffered two concussions, my other son now 17 has suffered ten concussions – one at school recess, two on the school bus, two in youth sports. He was a straight A student – a few years of perfect scores on the CMTs – and in a matter of hours, was reduced to a child who couldn’t read more than two lines of text. One night when he was healing from the first concussion, I asked if he wanted chicken or steak for dinner, he started to cry and said he didn’t know how to decide. Now as junior, he is back in honors classes but cannot still suffers with weekly headaches and issues with executive functioning. Just a few minutes of concussion education, a article, a flyer and iPhone app can make the difference in how a parent responds to their child’s possible head injury.

As youth sports coach for boys for five years, I just didn’t see head injuries on the field. But after concussion education and with the free PAR CRR app designed by Dr. Gerry Gioia on my iPhone, in one year alone, I pulled at five youth players from games as a parent and as a coach, and assessed they needed to “sit it out and see a doctor.” All five players I pulled were later diagnosed by their MDs with concussions, and that is how I was convinced that sideline concussion education really works.

Now as mental health expert in concussion field, I attend the NFL’s Concussion Health & Safety Meetings and have spoken to Commissioner Roger Goodell, and the CEOs of US Lacrosse, US Hockey, Little League, USA Cheer, and American Youth Soccer. These leaders are very aware of need for safer sports and the liability issues of concussions facing youth sport. Some organizations have already educated all their coaches and others are preparing to move in that direction as time and resources allow. I also was invited the Institute of Medicine present to them on the effects of concussions on youth athletes and their families. This committee issued the IOM federal report on youth sport concussions this past fall. Through these experiences, I have been able to view concussions from a national prospective, and I truly believe:

  1. Concussion Education must be expanded horizontally from middle and high schools coaches to include students, parents and school staff on concussion facts and the consequences of not reporting head injuries. Education must be mandatory for parents. I know from years of experience, parents do not attend concussion events unless they are required for their children to play a sport.
  2. Concussion Education must be expanded vertically down from the high school to youth sports which include elementary and middle school age students, coaches, parents include youth sports organizations in a non-prescriptive way. This is not the huge burden it is made out to be. There is a free 20 minute course on the CDC website for coaches to take at home and print a certificate which can be given to their sports team. The CDC has free flyers for sports teams to use for parent and athletes.
  3. Communication must be improved between coaches, school nurses, athletic trainers, parents and medical providers. Again this is possible with free technology available today for Connecticut schools and sports leagues – it must be smart-phone based, real-time, tracable and be FERPA and HIPAA Compliance.
  4. Data must be collected at local, regional, state levels on all student-athlete injuries to evaluate the effects of the current law, any changes to the law, and for research to direct future policy. Our current data is weak on all aspects of concussions. Data is essential and I believe the key to collecting data is streamlined, app-based, paper-free, smart-phone apps.

So much has changed in the six years, I have been studying concussions. As this science is in its infancy, I would urge the committee to pass law that is flexible as I believe many the “facts” of today will need to be modified in the future. Connecticut led the way in the first round of concussion legislation in 2010, and will return to the leadership role when this bill becomes law in 2014. Thank you for your time.

 

Katherine Snedaker

Additional Material The Children’s Committee requested I submit:

 

If you are a coach and want a training course, here is a excellent 20 min one that generates a certificate with your name at the end:

http://www.cdc.gov/concussion/HeadsUp/Training/index.html

Research I recommended for the committee:

Example #1

While this study is over a year old, I believe the data is still very valid and plays into everything that was discussed at the public hearing yesterday.

http://consumer.healthday.com/head-and-neck-information-17/head-injury-news-344/parents-may-be-taking-concussion-symptoms-too-lightly-survey-669524.html#.UxBkYn5hxMQ.gmail

Parents May Be Taking Concussion Symptoms Too Lightly: Survey

Many don’t seek medical evaluation for children or themselves after head injuries

FRIDAY, Oct. 12, 2012 (HealthDay News) — Only half of U.S. adults who thought they or their children might have a concussion sought medical treatment, a finding that suggests many people do not understand the seriousness of a potential concussion, a new survey finds.

Not thinking the symptoms were serious enough or assuming they just had a headache were the main reasons people did not seek treatment for their own possible concussions. Three in five parents cited the same reasons for not taking children with head injuries to a doctor.

Seven of 10 respondents incorrectly identified symptoms of concussion, according to the American Osteopathic Association’s online survey of more than 1,300 people. The findings were presented at an AOA meeting held in San Diego this week.

Only about one in four children suffered a possible concussion while playing either a school-related or non-school-related sport. The survey also found that children who suffer a head injury while playing sports may be more likely to be evaluated by a medical professional than those who are injured at home.

More than eight in 10 parents in the survey said their children were evaluated by a medical professional, coach or event personnel after they suffered a head injury while playing sports.

Men were more likely than women to report that they had suffered a concussion at some time in their life. Men and respondents aged 18 to 29, however, were most likely to say they did not seek treatment after a head injury because they did not believe the symptoms were serious enough.

About 40 percent of adults said they had suffered a concussion playing sports, making sports the most common cause of concussion in adults. About 30 percent of adults said they had suffered a concussion as the result of accidents at home and away from home.

People of all ages need to understand the seriousness of head injuries and see a doctor if they suspect a concussion, said Dr. Jeffrey Bytomski, an osteopathic family physician and head medical team physician at Duke University Medical Center in Durham, N.C.

“People don’t seem to realize how serious a bump or blow to the head can be,” Bytomski said in an AOA news release. “It might not seem that serious at the time because they didn’t lose consciousness or bleed, but this could be a traumatic brain injury and needs to be evaluated by a medical professional.”

Symptoms of concussion can include: pain in area of the head injury, dizziness, nausea or vomiting, confusion or inability to focus, and slurred or incoherent speech.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Example #2

A series of studies released Feb 27 that finds that despite a youth-sports concussion law and extensive coach education about concussions, 69 percent of student athletes surveyed in Washington State still played with concussion symptoms.

High school athletics coaches in Washington State are now receiving substantial concussion education and are demonstrating good knowledge about concussions, but little impact is being felt on the proportion of athletes playing with concussive symptoms, according to the two studies published in the American Journal of Sports Medicine.

Among the 778 athletes surveyed in a second study released today, 40 percent reported that their coach was not aware of their concussion.

Below you’ll find a press release detailing the studies.

FOR IMMEDIATE RELEASE

New studies indicate concussion education for high school coaches is not making student athletes safer

Seattle, February 25, 2014 – Washington State’s Zackery Lystedt law is helping to educate high school athletics coaches about concussions, but new research finds that 69 percent of student athletes that were surveyed still played with concussion symptoms.

High school athletics coaches in Washington State are now receiving substantial concussion education and are demonstrating good knowledge about concussions, but little impact is being felt on the proportion of athletes playing with concussive symptoms, according to two studies published this month in the American Journal of Sports Medicine.

The first study, released February 7, surveyed 270 coaches from a random sample of public high school football, girls’ soccer, and boys’ soccer in Washington State. Nearly all answered concussion knowledge questions correctly and the majority said they felt very comfortable deciding whether an athlete needed further concussion evaluation.

However, among the 778 athletes surveyed in a second study released today, 40 percent reported that their coach was not aware of their concussion, and 69 percent of the athletes reported they played with concussion symptoms.

Only one third of athletes who had experienced symptoms consistent with concussions reported receiving a concussion diagnosis.

Washington’s law is named for Zackery Lystedt who in 2006 suffered a brain injury following his return to a middle school football game after sustaining a concussion. He and his family, along with medical personnel, lobbied the state extensively for a law to protect young athletes in all sports from returning to play too soon.

“Six years after the passage of the nation’s first concussion law, educating coaches about concussions does not appear to be strongly associated with the coaches’ awareness of concussions.  Too many  athletes are still playing with concussion symptoms,” explained the studies’ principal investigator Frederick Rivara, MD, MPH, professor and vice chair of the Department of Pediatrics, and division chief for General Pediatrics at the University of Washington.

The studies also identify a crucial gap in knowledge for parents and athletes. Under the law, parents and athletes are required to sign a form alerting them to the dangers of concussions. The majority of coaches reported that they provided athletes with at least some instruction on concussions, including reading materials, videos or websites, but nearly one-third reported not providing athletes with any additional information.

For parents, the education they received from coaches was even less: Nearly 60 percent of coaches reported not providing parents with any additional concussion education, other than asking them to sign the legally required form.

“Given that concussions are difficult to diagnose, and often require either an athlete or a parent to report symptoms, educating these groups is an essential part of preventing athletes from playing with symptoms and risking a second potentially serious brain injury,” Rivara said.

“The Lystedt law was designed to improve identification of athletes with concussion and thus prevent athletes from continuing to play with concussive symptoms, risking further injury. Perhaps someday we can design laws that prevent concussion, but this would likely require different methodology, such as rule changes,” explained study author Sara P. Chrisman, MD, MPH, acting assistant professor in the Department of Anesthesiology and Pain Medicine Department of Adolescent Medicine Seattle Children’s Hospital.

Now that Mississippi has passed a youth concussion law, all U.S. states have a law aimed at preventing youth brain injuries in sports.

To learn more about the law in Washington and its requirements, as well as the laws across the country, visit http://lawatlas.org/preview?dataset=sc-reboot.

The articles, “The Effect of Coach Education on Reporting of Concussions Among High School Athletes After Passage of a Concussion Law” and “Implementation of Concussion Legislation and Extent of Concussion education for Athletes, Parents, and Coaches in Washington State,” are available online through the journal: http://ajs.sagepub.com/.

This research was funded by a grant from the Robert Wood Johnson Foundation’s Public Health Law Research program. For more information on the project and its findings, visit:http://publichealthlawresearch.org/project/evaluation-law-mandating-reporting-concussions-high-school-athletes

Example #3

Effectiveness of a State’s Youth-Concussion Law Studied http://blogs.edweek.org/edweek/schooled_in_sports/2014/02/paper_evaluates_effectiveness_of_washington_states_youth-concussion_law.html via @educationweek

Effectiveness of a State’s Youth-Concussion Law Studied

BRYAN TOPOREK FEB 18, 2014

Now that Mississippi Gov. Phil Bryant has signed his state’s youth-concussion legislation into law, every state has some form of youth-concussion legislation.

Are those laws actually changing behaviors? That’s what a new paper published online earlier this month in The American Journal of Sports Medicinesought to determine.

For the paper, the authors surveyed 270 public high school football, girls’ soccer, and boys’ soccer coaches in Washington state—the first state to implement youth-concussion legislation (the Zackery Lystedt Law)—from 2012 to 2013. They asked coaches about the amount of required concussion education for coaches, parents, and athletes, and also evaluated the coaches’ knowledge of concussions.

All but three of the coaches said they were required to undergo concussion education (98.9 percent), and 198 were unable to coach until completing such training (74.4 percent). Of the 264 coaches who answered a question about the frequency of their concussion education, 248 said they had to complete it annually (93.9 percent).

In terms of the modalities in which concussion education was provided, 243 of 267 coaches engaged in at least two different forms (91.0 percent), ranging from written, video, PowerPoint, tests, or in-person sessions. More than 80 percent of the coaches (225 in total) utilized a video from the Washington Interscholastic Activities Association, and over 200 coaches took a test from the association (78.1 percent).

Athlete and parent education, on the other hand, was far less extensive than that of the coaches, according to the survey’s findings. Per the terms of the Lystedt Law, all parents and student-athletes must sign a concussion information form before the athlete is allowed to participate in sports. However, only 241 coaches said they required their athletes to sign the form (89.3 percent), while 218 of 263 said they required the same from parents (82.9 percent).

A number of coaches did not provide any further concussion education beyond the form, with 79 of 268 not doing so for athletes (29.5 percent) and 147 of 254 giving parents no additional information (57.9 percent). Of the coaches who did provide additional education, 96 only utilized one modality for athletes (35.8 percent), and 66 did the same for parents (26.0 percent).

In terms of the coaches’ scope of concussion experience and education, 96.2 percent said they were at least somewhat comfortable determining whether an athlete needed further concussion evaluation. Roughly 75 percent of coaches had at least one athlete sustain a concussion in the most recent season (from when they were surveyed), and 42.5 percent had anywhere from two to five athletes sustain a concussion. Just over half the coaches had heard of the term “graduated return to play,” which is the recommended step-by-step return process for any student-athlete who sustains a concussion.

Ultimately, the results “suggest that concussion education requirements for coaches are being closely followed by public high schools ” in the state, the authors conclude. They expressed concern about the limited extend of parent and athlete concussion education, but note vague language in the Lystedt Law itself likely played a role.

This paper represents the next major frontier in youth-concussion legislation. Now that every state has a law, it’s up to researchers to determine how effective each law is in terms of shaping behaviors.

If a law isn’t working as it should, it’s up to the state lawmakers and those responsible for enforcing each law to ensure that schools begin following the requirements more closely. Coaches, parents, and athletes also must shoulder the responsibility of demanding and following laws that keep student-athletes safe.

Katherine Price Snedaker,  MSW

203.984.0860
Katherine@PinkConcussions.com
@PinkConcussions
@SportsCAPP
Concussion Education Advocate
Concussion Mental Health Social Worker
Mom of Two Sons with Multiple Concussions
Founder, PinkConcussions.com
Founder, SportsCAPP.com
Founder, TheConcussionConference.com

Scroll down through the lines below until you see the one’s highlighted in red and see why most students with concussions would not qualify for a 504 plan. At the present time, general consensus is that most student concussions resolve in around a three week time frame. Note: everything known presently in the concussion world is subject to change.

SOURCE: Protecting Students With Disabilities

Frequently Asked Questions About Section 504 and the Education of Children with Disabilities

STUDENTS PROTECTED UNDER SECTION 504

Section 504 covers qualified students with disabilities who attend schools receiving Federal financial assistance. To be protected under Section 504, a student must be determined to: (1) have a physical or mental impairment that substantially limits one or more major life activities; or (2) have a record of such an impairment; or (3) be regarded as having such an impairment. Section 504 requires that school districts provide a free appropriate public education (FAPE) to qualified students in their jurisdictions who have a physical or mental impairment that substantially limits one or more major life activities.

12. What is a physical or mental impairment that substantially limits a major life activity?

The determination of whether a student has a physical or mental impairment that substantially limits a major life activity must be made on the basis of an individual inquiry. The Section 504 regulatory provision  at 34 C.F.R. 104.3(j)(2)(i) defines a physical or mental impairment as any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological; musculoskeletal; special sense organs; respiratory, including speech organs; cardiovascular; reproductive; digestive; genito-urinary; hemic and lymphatic; skin; and endocrine; or any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities. The regulatory provision does not set forth an exhaustive list of specific diseases and conditions that may constitute physical or mental impairments because of the difficulty of ensuring the comprehensiveness of such a list.

Major life activities, as defined in the Section 504 regulations at 34 C.F.R. 104.3(j)(2)(ii), include functions such as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working. This list is not exhaustive. Other functions can be major life activities for purposes of Section 504.  In the Amendments Act (see FAQ 1), Congress provided additional examples of general activities that are major life activities, including eating, sleeping, standing, lifting, bending, reading, concentrating, thinking, and communicating.  Congress also provided a non-exhaustive list of examples of “major bodily functions” that are major life activities, such as the functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions.  The Section 504 regulatory provision, though not as comprehensive as the Amendments Act, is still valid – the Section 504 regulatory provision’s list of examples of major life activities is not exclusive, and an activity or function not specifically listed in the Section 504 regulatory provision can nonetheless be a major life activity.

 

34. How should a recipient school district view a temporary impairment?

A temporary impairment does not constitute a disability for purposes of Section 504 unless its severity is such that it results in a substantial limitation of one or more major life activities for an extended period of time. The issue of whether a temporary impairment is substantial enough to be a disability must be resolved on a case-by-case basis, taking into consideration both the duration (or expected duration) of the impairment and the extent to which it actually limits a major life activity of the affected individual.

In the Amendments Act (see FAQ 1), Congress clarified that an individual is not “regarded as” an individual with a disability if the impairment is transitory and minor.  A transitory impairment is an impairment with an actual or expected duration of 6 months or less.

35.  Is an impairment that is episodic or in remission a disability under Section 504?

Yes, under certain circumstances.  In the Amendments Act (see FAQ 1), Congress clarified that an impairment that is episodic or in remission is a disability if it would substantially limit a major life activity when active.  A student with such an impairment is entitled to a free appropriate public education under Section 504.

40. What is the difference between a regular education intervention plan and a Section 504 plan?

A regular education intervention plan is appropriate for a student who does not have a disability or is not suspected of having a disability but may be facing challenges in school. School districts vary in how they address performance problems of regular education students. Some districts employ teams at individual schools, commonly referred to as “building teams.” These teams are designed to provide regular education classroom teachers with instructional support and strategies for helping students in need of assistance. These teams are typically composed of regular and special education teachers who provide ideas to classroom teachers on methods for helping students experiencing academic or behavioral problems. The team usually records its ideas in a written regular education intervention plan. The team meets with an affected student’s classroom teacher(s) and recommends strategies to address the student’s problems within the regular education environment. The team then follows the responsible teacher(s) to determine whether the student’s performance or behavior has improved. In addition to building teams, districts may utilize other regular education intervention methods, including before-school and after-school programs, tutoring programs, and mentoring programs.

 

Press Release

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

 

Contact:

Katherine Snedaker, MSW, PinkConcussions.com / 203-984-0860 PinkConcussions@gmail.com

Dr. Jimmy Sanderson, Clemson University / 864-656-3996 jsande6@clemson.edu

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
jsande6@clemson.edu
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 skateboarding?

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…

Good News…

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 ONEA 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. 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.
  • 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

Footnotes:

Wall Street Journal article, “Concussions on the Field, Repercussions in School, ” April 19,2013 http://online.wsj.com/article/SB10001424127887324108204579022770562136360.html

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.

CDC http://www.cdc.gov/concussion/pdf/TBI_Returning_to_School-a.pdf

National Children’s http://www.nationwidechildrens.org/concussions-in-the-classroom

From the American Academy of Pediatrics Clinical Report Sport-Related Concussion in Children and Adolescents http://pediatrics.aappublications.org/content/126/3/597.full

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 Parents

For Schools to set up a Concussion Management Team

For Teachers

 

 

For School Nurses

For Healthcare Providers

 

 

 

 

 

Training Videos available for free online

Video: BrainSTEPS Presents: Concussions in the Classroom – Return to Learning

Pennsylvania’sBrainSTEPS Brain Injury School Re-entry Program by Brenda Eagan Brown, Program Coordinator eaganbrown@biapa.org

Video: Concussion In Iowa: Return to Learn Webinar 

 

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.

Note: From the Guardian website, the cap weighs less than 7 oz.

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. ”

 

Michael Oliver

Executive Director and General Counsel

NOCSAE®

11020 King St.,  Suite 215

Overland Park, KS 66210

913-888-1340

Fax 913-498-8817

 

“Commissioning research and establishing standards for athletic equipment, where feasible, and encouraging dissemination  of research findings on athletic equipment and sports injuries.”

 

NOCSAE Website

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 thatEach 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

www.PinkConcussions.com

www.SportsCAPP.com

203.984.0860

______________________________________________________________________________________________________

My letter to the schools involved

Dear School,

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.

 

Sincerely,

Katherine Snedaker

 

Katherine Price Snedaker MSW

www.PinkConcussions.com

www.SportsCAPP.com

203.984.0860

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.coman 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

http://www.cdc.gov/concussion/headsup/online_training.html

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.

Click for App

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).

About GE

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:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2140075/#i1062-6050-42-4-495-b1

This sentence in the 2007 study is marked with footnote referring to its source which is a 1991 study:

http://www.ncbi.nlm.nih.gov/pubmed/8680392

Abstract

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.

How to approach YOUR child’s team about their Concussion Policy by Katherine Snedaker

I have listed the 10 questions below which from a flyer by Gerard A. Gioia, Ph.D., a Pediatric Neuropsychologist, which Steve Stenersen, President of US Lacrosse, emailed to me yesterday. Steve and I were having one of our semi-annual talks about how to empower parents to ask their leagues about concussion policy. Steve Stenersen has been championing concussion education for years and we have been talking back and forth about concussions since I first learned about concussions from an article in US Lacrosse Magazine in 2008. I have had the honor of meeting Dr. Gioia at an NFL meeting this fall where I had a chance to talk to him one-on-one and then hear him present to the NFL Health and Safety Meeting.  I was very impressed with him and look forward to presenting with him in DC on Monday, Feb. 25, 2013.

Dr. Gioio’s list of ten questions are a great way to start a conversation about concussion policy, but I need to add some suggestions on how, when and where to approach your child’s sports organization which I will call TEAM for short. Prez will stand for the President of TEAM.

1. Email or call Prez, the President of TEAM and ask to set up a time to talk face to face about concussion education with him or her. Don’t ask the coach these questions before or after practice. This is a management issue FIRST. If you cannot meet in person, then set up a call. I do not recommend you blast off an email with these questions to Prez.

2. Before the meeting, check out the Info Link Page with links to national policy is for many youth sports. For example of your child plays football or lacrosse, check out what USA Football or US Lacrosse is suggesting to their teams.

3. Start the conversation with Prez with a thanks for all he/she does and say you are just trying “to help the kids” and add to the existing program which has offered your child (say something positive here).

4. Ask the questions in a friendly tone and don’t forget to smile.  BE NICE. Most youth organizations are run by volunteers who have jobs and families and they do so much without any thanks.

4. LISTEN to what Prez says in return and what the existing plans are to create a concussion policy. Most organizations start small with baby steps as not to rock the boat.

5. If you get a blank stare from Prez or a “no” to the questions below, you have three choices:

  1. Say ok, and just hope the conversation will generate some thought or future action. You sign your child up anyway for the sport, and then attend all practices and games and watch out for your child.
  2. You find another league or sport for your child which has a concussion policy. In a nice email, let Prez know why you have left TEAM and again offer thanks for the past years.
  3. You offer to help create the policy by researching some options. This is a really exciting way to contribute to your child’s sport and to the larger community

I am available by phone or email to help direct you and there are many resources available on my website. Here are the questions and don’t forget to smile when you ask them.

 
Source: Parents Taking Charge of the Youth Concussion Issue
Gerard A. Gioia, Ph.D. Pediatric Neuropsychologist
Director, Safe Concussion Outcome, Recovery & Education (SCORE) Program Children’s National Medical Center 

Ten Questions to Ask Youth Sports Organizations By Dr. Gioia

In whatever sport you and your child choose, to feel more comfortable and confident with your child’s participation as it relates to concussion risk, do your homework and ask questions of the league and its coaches about how they handle head safety. As a parent, you need to feel at ease that safety of the youth athletes is a priority. We encourage parents to ask these 10 questions.

  1. Does the league have a general policy in how they manage concussions?
  2. Does the league have access to healthcare professionals with knowledge and training in sport-related concussion?
  3. Are the coaches required to take a concussion education and training course?
  4. Who is responsible for the sideline concussion recognition and response to suspected concussions during practice and games?
  5. Do the coaches have readily available the tools – concussion signs & symptoms cards, clipboards, fact sheets, smartphone apps, etc. – during practice and games to guide proper recognition and response of a suspected concussion?
  6. Does the league provide concussion education for the parents, and what is the policy for informing parents of suspected concussions?
  7. What is the policy regarding allowing a player to return to play? [Correct answer – when an appropriate medical professional provides written clearance that the athlete is fully recovered and ready to return.]
  8. Does the league teach/ coach proper techniques (e.g., blocking and tackling in football, checking in hockey and lacrosse) in a way that are “head safe” by not putting the head in position to be struck? If the player does demonstrate unsafe technique during practice or a game, do the coaches re-instruct them with the proper technique/ method? Is head and neck strengthening taught?
  9. If a contact sport, are there limitations to the amount of contact? How often (# days per week, # minutes per practice) do you practice with live contact? Is that any different than past years?
  10. How amenable is the league/ team / coach to accepting feedback from parents about their child’s safety as it relates to head safety?

Almost 200 students turned out for the school dance for The Headbangers’ Ball – dance for Concussion Education, which made it one of our school’s largest dances ever. Boys and girls alike wore sport-themed shirts; and along with dancing all night, the kids were actually very willing to cooperate in the educational part of the event. By school tradition, each grade enjoys their refreshments in shifts in the hallway outside the dance.  As the kids lined up to eat, Katherine explain what they were to do to “obtain” their food. She pointed out the CDC posters that lined the hallways and told them before they could select their snacks from the table of goodies, they had to tell a parent volunteer one sign or symptom of a concussion. The kids read the posters and seemed to enjoy the process. At what other party can you say, “throw up” to an adult and then get a cookie? (Sorry, but they are middle schoolers and gross is cool to them).

Katherine then chatted with the kids in small groups as they ate their refreshments and answered their questions about concussions. As she suspected, the kids seemed to fall in two distinct groups – those who had had concussions and knew most of the facts, and those who had never had one and didn’t know anything about a concussion. What was surprising was the number of kids who had already had concussions for a dance of mostly 6th and 7th graders!

As parents’ cars lined the parking lots and kids prepared to leave the dance, they were handed a ticket to vote whether they learned something new about concussions. The exit poll results showed that 84% of kids voted that they learned something new about concussions at the dance. At the door, each child was handed a CDC info sheet on concussions and asked to hand them to their parent waiting in the car. Hopefully the hand to hand delivery helped avoid the dark hole which seems to appear in most middle school students’ book bags. To reinforce the information on Monday and to reached students who did not attend the dance, several students made morning announcements to the whole school with concussion facts and information.

The mix of education and fun seemed to work well and we can encourage other schools to do the same type of education/fun event around this important topic.

Source: http://www.osteopathic.org/inside-aoa/news-and-publications/media-center/2012-news-releases/Pages/omed-2012-bumps-to-the-head-minor-concern-for-parents.aspx

FOR IMMEDIATE RELEASE
Oct. 9, 2012

American Osteopathic Association Survey Shows That Only Half of Respondents Who Thought They or Their Kids Had a Concussion Sought Out Medical Treatment

(SAN DIEGO) — Evidence of the long-term effects of head injuries to athletes has prompted the NFL to partner with the Centers for Disease Control and Prevention (CDC) to educate the public of the dangers of concussions through the Heads Up: Concussion in Youth Sports campaign. However, the seriousness of a potential concussion does not seem to resonate with the public. In fact, only half of all respondents to a recent online survey by the American Osteopathic Association (AOA) sought treatment and were diagnosed by a medical professional when they received a head injury and thought they might have a concussion.

The main reason people did not seek treatment for their own possible concussion was they did not think the symptoms were serious enough or thought that it was just a headache. Surprisingly, three in five parents gave these same reasons for not taking their children with head injuries  to a medical professional for treatment.

Better medical attention on the field? 

The survey reported that only about one in four children obtained a possible concussion while playing either a school sponsored or non-school sponsored sport. In addition, children injured while playing sports may have a greater chance of being evaluated by a medical professional than if the injury occurred at home. According to the survey, more than eight in 10 parents said their children were evaluated by a medical professional, coach or event personnel when they obtained a head injury during a sporting event.

As of September 2012, 39 states across the country have adopted youth concussion laws. Many of these laws call for the removal of a youth athlete who appears to have suffered a concussion from the game or practice at the time the injury occurs and requires the child be evaluated and cleared by a licensed health care professional before returning to play.

There are six states that have no pending legislation or youth concussion laws:

  • Arkansas
  • Georgia
  • Mississippi
  • Montana
  • Tennessee
  • South Carolina

Jeffrey R. Bytomski, DO, an osteopathic family physician and head medical team physician at Duke University Medical Center in Durham, N.C., believes that people of all ages need to be aware of the seriousness of head injuries and see a physician if they suspect a concussion.

“Sometimes people don’t seem to realize how serious a bump or blow to the head can be,” says Dr. Bytomski. “It might not seem that serious at the time because they didn’t lose consciousness or bleed, but this could be a traumatic brain injury and needs to be evaluated by a medical professional.”

Recognizing the signs

Even though the survey found that seven in 10 respondents were incorrectly identifying symptoms like “shortness of breath” and “hearing damage” as symptoms of concussion, they still reported feeling confident in their ability to recognize concussion symptoms. Actual symptoms could include any of the following:

  • Pain in area of head injury
  • Dizziness
  • Nausea or vomiting
  • Confusion or inability to focus
  • Slurred or incoherent speech

However, Dr. Bytomski worries that this confidence could be keeping them from seeking medical treatment.

“It is easy to rationalize and say ‘this is just a headache and I am not nauseous or vomiting so it can’t be a concussion,’” Dr. Bytomski observes. “However, they might be missing something that a physician will notice.”

Other survey results of note:

  • Men were more likely than women to report they ever had a concussion. However, along with respondents between the ages of 18 and 29, men were the most likely to say they did not seek treatment because they didn’t think symptoms were serious enough.
  • Four in 10 adult respondents said they received their concussions playing sports, making it the most commonly reported setting for this type of injury in grown-ups. This setting followed both in-home injuries and accidents outside the home where three in 10 respondents said they suffered concussions.

Concussion Resources

The AOA offers additional information about concussions, including a list of possible symptoms, advice on treatment and avoiding head injuries, atwww.osteopathic.org/concussion.

About the Survey

The survey results are being announced during the American Osteopathic Association’s (AOA) OMED 2012, the Osteopathic Medical Conference & Exposition. The conference, which began Oct. 7, will be held through Thursday, Oct. 11, at the San Diego Convention Center.

The survey was conducted from Aug. 14 to Aug. 16, 2012. A total of 1,303 respondents completed the online survey. A sample size of 1,303 has a margin of error of approximately ± 2.7 % at the 95% confidence level.

About the American Osteopathic Association

The American Osteopathic Association (AOA) proudly represents its professional family of more than 100,000 osteopathic physicians (DOs) and osteopathic medical students; promotes public health; encourages scientific research; serves as the primary certifying body for DOs; is the accrediting agency for osteopathic medical schools; and has federal authority to accredit hospitals and other health care facilities. More information on DOs/osteopathic medicine can be found atwww.osteopathic.org.

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Media Contacts:

Nicole Grady
(800) 621-1773, ext. 8038 (Toll free)
(312) 202-8038 (Office)
Mike Campea
(800) 621-1773, ext. 8043 (Toll free)
(312) 200-8043 (Office)
Twitter: @AOAforMedia

In the last few hours, there have been a number of reviews posted about Head Games, and for a good summary of the movie see the LA Times by Kenneth Turan. Rather than write this type of review, I wanted to offer my personal take on the film as a parent of a child with concussions and as concussion educator, and why I think parents should see Head Games.

In my work as a concussion educator, I have found there are two kinds of parents in this world: those who don’t think their child will get a concussion and those who guessed wrong. This movie has something to offer both types of parents.

I used to be that parent who never thought about concussions and the risk to my three boys, even though I personally have a long history of concussions. I would have thought why watch a movie on concussions? Do we next need a movie on the dangers of sledding or skateboarding? 

But now I know better after my son has suffered eight concussions; and sadly, I know if I had seen this movie years ago I would have made better choices as a parent when to allow him to return to sports. I also trusted helmets would protect him from further concussions.

What does this film offer the “un-experienced” parent? This film will help to educate parents who have not experienced concussions on why a child with possible head injury needs to see an MD, be watched for signs of concussion, and have a careful Return To Play plan. A parent’s (and a coach’s) response to pull a child out of a game or practice as soon as there is a possible injury is about the best line of defense available to try to mitigate a second blow and very serious consequences that can result.

The harsh reality right now is that there are no proven types of equipment to prevent concussions. There are no drugs or any specific medical procedures or equipment to help heal concussions. The only real defense right now is a parent’s response time and what steps a parent takes when his/her child sustains a head injury. The only way parents can respond quickly and effectively is by having the education they need as parents BEFORE they need it. BE PROACTIVE!

Is the film only for parents whose kids play sports? No, this movie is important for all parents because while it focuses on sports concussions, concussions can happen to any child in any activity– on the field, in the rink, in the bathroom, the kitchen or in the backyard. Outside of sports concussions, careless horseplay between kids, car accidents with new drivers, and teen alcohol-related accidents also play a large role in youth concussions.

Now what does the movie offer for the parents who know all to well the dangers and effects of concussions? The movie clearly shows the conflicts parents face in allowing their children – and we do make the decision – to let our kids continue to play certain risker sports – football, soccer, cheerleading, lacrosse, hockey, etc. As a parent who has watched her child suffer eight concussions it was hard to watch Headgames not because it is too graphic, but rather because for me it is too personal, so it took several viewings of the movie to really be able to get some distance.  I cried several times knowing exactly what it feels like to sit in that doctor’s waiting room, in front of his desk as he gives the news, in the MRI lab waiting for my child to emerge, and at home wondering when the symptoms will end and my child will be healed. It was painful but good to see the conflict on the big screen that sadly other parents experience too.

It was painful but reassuring to see other loving, educated parents struggling with the issue of safety and risk and allowing a kid to play the sport he/she loves.  It is that balance of risk and reward that is so hard to resolve over time. And as one of the experts in the movie reflects, “What is the level of respectable risk and reasonable reform?” Can we really make the sports our children play safer or their childhoods less risky; and if so, at what cost to their freedom and joy?

On a personal note, last year I pledged to donate my brain to the BU CTE Study which is featured in this film. This movie shows the freezer and cutting board where my brain is “headed.” As I watched the doctor’s purple-gloved hands slice through another volunteer’s brain, I swallowed hard but even so, I am even more determined that my brain go to research when I saw what has already been discovered in the study. I want to be part of the solution even if it is just be donating my gray matter. Ironically, yesterday was day that had been scheduled for my two and half hours interview by a CTE lab researcher on my concussion history. In recalling the sports and non sports concussions I have experienced, I realized time and time again how I did not properly treat my concussions, and that may have over the years may have led to the place I am in now. I wish doctors knew then what many know now and I had seen a film like this years ago.

It this an earth shattering movie? It depends what a parent already knows about concussions. For those of us who live in the concussion world, Head Games reiterates what we already know.  If you had the privilege of seeing Chris Nowinski speak in person, you already are aware of much of the movie’s message. But if you haven’t seen Chris speak and if you don’t know much about concussions, I think you will leave the theater with a new prospective and a lot of unanswered questions.

Head Games raises concussion awareness and provides important information for parents: not all the information I want parents to know, but the topic cannot be covered in an hour and half by anyone.  And while no film is perfect, just the fact that it exists at all is amazing – that concussions are finally seen as important enough that a group of people spent time and money to make this first feature film.

To watch the film on iTunes:  http://bit.ly/OMNvj5 

To look for screening times at theaters:  http://headgamesthefilm.com/

National Federation of State High School Associations (NFHS) Sports Medicine Advisory Committee (SMAC)

The incidence of concussions in high school sports, including soccer, has been of interest and concern to the NFHS SMAC for many years. Increased knowledge, awareness, and public attention have produced major changes in management of concussions, and the NFHS SMAC continues to evaluate opportunities to improve safety and reduce concussion risks in all high school sports. The definition and methodology for initial assessments for return-to-play decisions have evolved over the last several years. Instruments such as neuropsychological and balance testing have aided researchers and clinicians to better serve our students who have suffered concussions.

The concept of padding the head to minimize the force delivered by a blow to the head has led to the development of several forms of headgear. Research has also shown that head injuries in soccer predominantly come from head-to-head, head-to-ground, head-to-goal post, and possibly ball-to-head on an inadvertent contact, instead of from the purposeful heading of the ball. Data on bio kinetic reduction in force are available and a published study in the field has suggested a decrease in self- reported concussion symptoms with use of such headgear.

At this time, the use of soccer headgear is permitted, but not required under the NFHS soccer rules. We know of no state that has chosen to require such use on a state-wide basis, though some schools or school districts may be doing so. Member state associations, school districts, schools, parents and students are free to make their own assessments regarding the advisability of soccer headgear.

The NFHS SMAC remains very interested in independent, valid research and empirical observations with respect to the effect of soccer headgear use on the incidence and severity of concussions and other injuries, and on the mode of play. At this time, the NFHS SMAC considers the current permissive rule to be reasonable, based on ongoing review and analysis of the existing data and collaboration and discussion with experts in the field.

The NFHS and other governing bodies tend to move cautiously with respect to equipment mandates, as unintended consequences (e.g. the possibility of more cervical injuries or increased aggressive play) are an ongoing concern. As additional research and information become available, the NFHS SMAC will continue to evaluate the situation, share the information with member state associations, and determine the advisability of a change in the current position. Risk management for our student athletes continues to be the primary goal and mission of the NFHS SMAC. We remain committed to that end.

Revised and Approved January 2012

Last week I had the pleasure of speaking for over an hour with Alan Goldberger about concussions and sport law.  His website states that ALAN S. GOLDBERGER is an attorney, speaker, and author. A nationally recognized authority on sports officiating and sports law, his practice is concentrated in the areas of sports law, business law, sports insurance defense, association law, and business and chancery litigation. He is a partner in the law firm of Brown Moskowitz & Kallen, P.C. located in Millburn, New Jersey. Among a long list of accomplishments as a lawyer in court, Alan is the author/coauthor of five books, including Sports Officiating: A Legal Guide, now in its second edition; and Sport, Physical Activity and the Law a college textbook now in its third edition.

What is missing from his impressive bio is how enjoyable and easy it is to talk to him. He is incredibly knowledgable on sports officiating and sports law: but unlike many lawyers I have met, I could talk to Alan like he was a regular guy in a conversation about sports safety like we were standing on a field before a game. Knowledge is great to have but the ability to pass knowledge along to others is a real gift. I really learned a lot from him about the important role the official plays in reducing concussion and injury risks to players during a game. I hope to have Alan up to Fairfield County to speak to teams, coaches and parents in the near future.

Rather than paraphrase Alan, I asked to re-blog some of his articles to share some of what I learned. Thank you, Alan.

For PDF click ASG.ARTICLE.NFOQ.YOURBESTFRIEND200809

Reprinted with permission of Alan Goldberger and the National Federation of State High School Associations.

 

Last week I had the pleasure of speaking for over an hour with Alan Goldberger about concussions and sport law.  His website states that ALAN S. GOLDBERGER is an attorney, speaker, and author. A nationally recognized authority on sports officiating and sports law, his practice is concentrated in the areas of sports law, business law, sports insurance defense, association law, and business and chancery litigation. He is a partner in the law firm of Brown Moskowitz & Kallen, P.C. located in Millburn, New Jersey. Among a long list of accomplishments as a lawyer in court, Alan is the author/coauthor of five books, including Sports Officiating: A Legal Guide, now in its second edition; and Sport, Physical Activity and the Law a college textbook now in its third edition.

What is missing from his impressive bio is how enjoyable and easy it is to talk to him. He is incredibly knowledgable on sports officiating and sports law: but unlike many lawyers I have met, I could talk to Alan like he was a regular guy in a conversation about sports safety like we were standing on a field before a game. Knowledge is great to have but the ability to pass knowledge along to others is a real gift. I really learned a lot from him about the important role the official plays in reducing concussion and injury risks to players during a game. I hope to have Alan up to Fairfield County to speak to teams, coaches and parents in the near future.

Rather than paraphrase Alan, I asked to re-blog some of his articles to share some of what I learned. Thank you, Alan.

For PDF  click ASG_ARTICLE_REFEREE_Law 2_11_ONUS

Reprinted with permission of Alan Goldbeger and Referee Magazine

 

            FOR IMMEDIATE RELEASE

9/5/12

 

NATIONAL FOOTBALL LEAGUE GRANTS

$30 MILLION IN UNRESTRICTED FUNDING TO THE

FOUNDATION FOR THE NATIONAL INSTITUTES OF HEALTH

FOR MEDICAL RESEARCH

 

Focus on Advancing Science and Medical Understanding

of Brain Injuries  

 

The National Football League will provide $30 million in funding for medical research to the Foundation for the National Institutes of Health (FNIH), NFL Commissioner ROGER GOODELL announced today.

The unrestricted gift is the NFL’s single-largest donation to any organization in the league’s 92-year history and will be overseen by The National Institutes of Health (NIH).

NIH, a component of the U.S. Department of Health and Human Services and one of the world’s foremost medical research centers, will administer the NFL funding and research designed to benefit athletes and the general population, including members of the military.

With this contribution, the NFL becomes the founding donor to a new Sports and Health Research Program, which will be conducted in collaboration with institutes and centers at the NIH. The FNIH hopes to welcome other donors, including additional sports organizations, to the collaboration.

Specific plans for the research will remain to be developed, but potential areas under discussion include accelerating the pace of discovery to support the most innovative and promising science of the brain, including: chronic traumatic encephalopathy (CTE); concussion management and treatment; and the understanding of the potential relationship between traumatic brain injury and late-life neurodegenerative disorders, especially Alzheimer’s disease.

In addition to brain research, funding also will be dedicated to other important health areas such as: sudden cardiac death in young athletes; heat and hydration-related illness; chronic degenerative joint disease as a result of athletic injuries; the transition from acute to chronic pain; and the detection and health effects of performance enhancing substances, including human growth hormone.

“We hope this grant will help accelerate the medical community’s pursuit of pioneering research to enhance the health of athletes past, present and future,” said Goodell. “This research will extend beyond the NFL playing field and benefit athletes at all levels and others, including members of our military.”

“We are grateful for the NFL’s generosity,” says Dr. Stephanie James, FNIH acting executive director and CEO. “The research to be funded by this donation will accelerate scientific discovery that will benefit athletes and the general public alike.”

Dissemination of funding from this grant will be governed by federal law and policy applicable to NIH-funded research.   In accordance with NIH policy, NIH funding recipients will be urged to disseminate the results of research to optimize the value of the science to the research community and the public.  The NFL will have no early or special access to scientific study data. 

About the Foundation for the NIH

Established by the United States Congress to support the mission of the NIH – improving health through scientific discovery in the search for cure – the Foundation for the NIH is a leader in identifying and addressing complex scientific and health issues. The Foundation is a non-profit, 501(c)(3) charitable organization that raises private-sector funds for a broad portfolio of unique programs that complement and enhance the NIH priorities and activities. For additional information about the Foundation for the NIH, visit www.fnih.org.

About the NIH

NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

About the NFL’s health and safety programs

Throughout its history, the NFL has made the health and safety of its players a priority and its reach extends to football and sports at all levels. At the youth level, partnerships with USA Football and the Centers for Disease Control and Prevention help parents, coaches, clinicians and athletes understand the signs and symptoms of possible head injuries.  The league also collaborates with state legislatures to push for passage of youth concussion laws. Through funding for medical studies, collaboration with the military on their research 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. For more information, please visit www.nflevolution.com.

 

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FOR IMMEDIATE RELEASE

8/30/2012

U.S. ARMY AND NATIONAL FOOTBALL LEAGUE ANNOUNCE JOINT HEALTH AND WELLNESS INITIATIVE

Players & Soldiers Encouraged To Seek Help if They or Their Teammate/Battle Buddy Are Affected by a Head Injury

WEST POINT, NEW YORK — The U.S. Army and the National Football League launched today a long-term initiative to enhance the health of its soldiers and players by sharing information, providing education and engaging in discussion on concussion and health-related issues that affect both organizations.

The multi-faceted initiative, built upon the mutual respect shared by the two organizations, is designed to promote help-seeking behaviors and empower soldiers and players to maintain healthier minds on the playing field and battlefield. The initiative includes event-based programs, websites and social media that will foster peer-to-peer opportunities to share information, lessons learned and tips on how to recognize, prevent and manage concussions and reduce the stigma associated with reporting brain injuries or asking for help with health issues.

GENERAL RAYMOND T. ODIERNO, Army Chief of Staff, and NFL COMMISSIONER ROGER GOODELL made the announcement at The United States Military Academy at West Point as part of a panel discussion that included former NFL players and soldiers, as well as leading medical professionals.  The discussion took place in front of an audience of nearly 200 West Point Cadets, underscoring the NFL and Army’s intention to promote healthy behaviors to younger and older generations alike.

This was the third such discussion between the two organizations. Current and former players met this offseason at The Pentagon with soldiers and Marines who have experience with the injury.

In a letter announcing the initiative to soldiers and current and former NFL players, General Odierno and Goodell said:  “Our organizations share common traits: pride and passion, dedication and determination, and an enduring belief in the power of team. On a personal level, there is mutual respect, appreciation and admiration between Soldiers and Players. While the execution of our crafts is fundamentally different, these traits make America’s Soldiers and NFL Players who they are and the best at what they do. With this initiative, we are seeking to integrate the uncompromising devotion to win with a need to address traumatic brain injuries with the necessary care, consideration, and commitment to prevention that these injuries require.”

Among the initiative’s tactics:

·         New interactive websites: the NFL launched today a website dedicated to this initiative– www.NFL.com/military. As an extension of NFL.com, this site provides service members with both exclusive access to football news and the most up-to-date information on brain injuries. In addition, a new site www.army.mil/tbi will serve as the Army’s first-ever centralized hub of information on traumatic brain injury for soldiers.

·         Event-based forums that will bring players and soldiers together at NFL team facilities and Army bases across the country to share experiences and reinforce the need for care.

·         PSAs and social media interactions designed to increase awareness and promote help-seeking behaviors in each organization.

·         Development of a peer-to-peer program that matches recently retired NFL players with soldiers transitioning out of the Army.

·         Sharing of medical research and information between the NFL and Army.

General Odierno and Goodell stressed the need for soldiers and players to seek help if they may be suffering from a head injury and also to get medical attention for a teammate or soldier who may need assistance.

“We know that this mission cannot be accomplished alone,” they wrote in the letter. “It is a shared responsibility. A concussion is a brain injury that is not always easily recognizable to the untrained eye. We want to encourage and empower Soldiers and players to take an active role in the education and prevention process. We all have a crucial role in making sure a brain injury is properly identified and treated.

“By coming together in this historic effort, we are combining and strengthening our forces,” the letter concludes. “As we continue to focus our efforts on encouraging safer environments, we will continue to celebrate the spirit of competition and determination that define our two organizations. Working together, we will ensure longer careers and healthier lives. Working together, we all become stronger.  And working together, we have the power to make a real difference.  We hope you will join us.”

 

#    #    #

 

Concussions:  Introduction of Overlapping Concussion Syndrome

A 13 year old female soccer player collides with another player falls and hits her head on the ground.  She immediately appears dazed and confused.  She reports a severe global headache and mild photophobia.  Her coach appropriately suspects concussion and removes her from the game.  Her parents then take her to the emergency room where over the next couple hours she improves slightly.  She is diagnosed with a concussion and sent home to rest and follow up with her primary care physician.  Follow up with her primary care doctor occurs two days later where she demonstrates continued improvement with a mild headache, dizziness, and fatigue.  She is advised to rest the remainder of the week and stay out of school.  She follows the instructions and in a week reports she is doing well, therefore her parents allow her to return to school.  Since she is doing well in school, she is allowed to return to soccer activities.

Sound familiar?  This scenario is estimated to occur 150,000 times per year nationally for athlete’s ages14-18 years old (Bakhos, Lockhart et al. 2010).

Two weeks following her concussion, she was playing soccer again.  During a game she jumps for a header and hits her head on another player’s head and immediately has a return of her symptoms.  Again, she is taken out of the game and again she is diagnosed with a concussion.  Unfortunately, now her symptoms are more severe and the duration significantly longer.  Due to the severity of her symptoms she misses a significant portion of the school year and ultimately has to receive tutoring over the summer to catch up and stay with her grade.  It was noted upon further questioning that she really was never back to normal after the first concussion.  Although her headache, dizziness, and photophobia resolved, she still had subtle symptoms such as mild fatigue, difficulty concentrating in class, and homework taking longer to complete.

Sound familiar? If not think again.  Although the numbers are unknown, this scenario occurs quite frequently.  I personally have seen this scenario on a weekly basis.  What is happening here is another concussion occurs on the tail end of a concussion where complete resolution has not yet occurred.  Unfortunately, when this occurs the symptoms are often amplified and prolonged.

The medical literature is very aware of Second Impact Syndrome (SIS) where a second blow on top of a previous head injury with continuing symptoms leads to a loss of regulation of cerebral blood flow resulting in brain swelling and herniation commonly resulting in death.  Second impact syndrome although catastrophic, is very rare, with estimates of less than 1 case per year (Thomas, Haas et al. 2011).

What happened in this described case is not SIS, rather a much more common injury where a concussion occurs while the athlete is still symptomatic from a previous concussion.  This scenario often results in more severe symptoms that last longer.  I believe this scenario deserves proper terminology.  I have previously referred to this condition as Overlapping Concussion Syndrome (OCS).  Patients with overlapping concussion syndrome may also be labeled as post concussive syndrome.  Clinically these syndromes may be similar but there is a big difference as OCS can be prevented. In OCS there is a previous event, whether it was recognized or not.  The proper recognition and management of the first event is the opportunity to prevent OCS or some of those injuries labeled as PCS.

Overlapping concussion syndrome emphasizes the need to properly manage concussions.  We have to be diligent in following concussions to a resolution.  The difficulty is that some of the residual symptoms can be more difficult to detect and the clinician must be carefully looking for the more subtle signs of concussions.  These subtle signs may be seen in school performance, mild headaches, fatigue, personality changes, vestibular impairment, or neurocognitive testing changes, to name a few.  In addition, as the child feels better, there may be pressure to return to sporting activity that leads them to hide or underestimate these mild symptoms, making them even more difficult to detect.

As we move forward, we need to improve the detection of these subtle symptoms.  Neurocognitive testing is one of the mechanisms by which this is being done.  We are currently looking at vestibular measurements to help as well.  Some of our current research is in the area of eye motion and balance changes.  Still many of the subtle symptoms can be identified by the athlete, parents, and teachers.

I believe that if we remain diligent in the diagnosis of concussions and continue this diligence to the management of concussions, we will better prevent the more severe condition of OCS as well as the rare yet catastrophic SIS.

David Wang MD, MS

Medical Director

Concussion Program

Elite Sports Medicine

Connecticut Children’s Medical Center

 

References:

Bakhos, L. L., G. R. Lockhart, et al. (2010). “Emergency department visits for concussion in young child athletes.” Pediatrics 126(3): e550-556.

Thomas, M., T. S. Haas, et al. (2011). “Epidemiology of sudden death in young, competitive athletes due to blunt trauma.” Pediatrics 128(1): e1-8

 

Dave H. Wang, MD, MS

David is a sports medicine physician with over 15 years of specialized care for athletes of all abilities, from the novice to the Olympian. He has served as a team physician for the University of Minnesota for over a decade, which is also where he received his M.D. in 1989. Most recently he has been the director of the Sports Medicine department in a large multispecialty clinic in Minnesota where he has continued to work with non surgical techniques for musculoskeletal ailments as well as medical conditions affecting the athlete. He holds a Masters degree in Exercise Physiology and has interest and experience with sports performance issues. He is a former collegiate track athlete, who has accumulated a deep understanding of the specifics of most sports and their unique training regimes. In 2009 David and his family made the decision to move to Connecticut and join the outstanding staff at Elite Sports Medicine.

Ladies, u played sports, had concussions? Want to leave a legacy to those girls on the soccer fields today who may need our help?

I have pledged my brain to the BU CTE study = only 5% r female pledges.

Got Brains? Donate them! Leave a Legacy… I want a photo shoot Vogue Style on the front of SI of all the amazing sports stars who will pledge their brains!

I became concussion educator after suffering # of concussions. Once in the CTE study I started asking how many other females where involved.  They are not YET even studying how the female brain is different from the male brain (yes, there are differences). 5% is not enough and we need to change that now.

Got Brains? Donate them!  Leave a legacy.

Email me Katherine@SportsCAPP.com to join up –

Matt Chaney writes a response to a blog post on The Concussion Blog about my visit to the NFL

Change? Optimism for fundamental shift in football brutality? Right. What a joke. This woman was in fact PR-ed, snookered, bamboozled, and by some of the lamest in such trade, American football yaks, beginning with Dollar Roger Goodell.

 

Here is my response to his comment above…

No, I believe that Goodell and Hallenbeck are sincere about the changes they are making in youth football.

First, the NFL and I were talking about youth football – pre-high school – NOT PRO.

And don’t worry about me being from off the farm. I grew up with a step-father who worked in NYC advertising and I was a PR-Adv Major. I get it. The NFL has a concussion problem so on a different scale so does cheerleading, girls soccer, BMX biking, and so does teen drinking – But guess who offered to get a bunch of bloggers together and talk about it with top experts? Not the liquor companies? And I can hardly get a call back from local soccer leagues.

I have volunteered my time for four years doing concussion education that  NO one has really cared about until it was their kid who got hurt. Yeah, not too smart to work without pay, you got me there.  But there is no one paying for concussion educators to spread needed info. No drugs companies, no large hospital chains, no one. There is a line in the sand  – on one side are the people who think concussions won’t happen to their kids – on the other are those who guessed wrong.

When The NFL asked ME to come to them, I agreed and was given access to people, programs, and executives’ time to share what I thought about my experience with educating parents and kids and coaches. From Roger to Scott to Paul – I met and talked executives whose young kids now play sports. These dads want safer play and they are committed to spend money and time to change youth football and all youth sports. Someone has to lead the way, ANYONE? ANYONE? US Lacrosse has taken great steps for their players and program but we need more help as the scale of kids in youth sports is huge.

Last Friday night, I spoke with my youth speaker, Chris Coyne, to over 500 inner city kids and their families who came out of their depressed, high crime city to the local stadium for a awesome football pep rally (kids, babies, grandparents, and parents). They were such a great crowd and really listened to what we had to say. When I handed out CDC flyers after the event, almost every person thanked us for coming to share info with them.

Did I get paid? No. There is not money in this league for this kind of education. It cost me 6 hours away from my own kids, gas there and back in Friday night I-95 traffic, and I had to spend $100 of my own money to rent a sound system. Worth it? Yes. Do I need help? Yes. I need money to expand. Does what I do matter? Yes, because three kids have already had concussions there, and I hope they will now get appropriate medical care faster knowing what I taught. My real dream is that every team could have an AT on the field, but don’t get me started on that.

I didn’t grow up with football, my kids didn’t play – football is not part of my world – we were a lax family until my son had 7 concussion (only one lax). But what I saw in the stands of that city stadium were loving, devoted caring families who got out of work on a hot Friday night to gather around something they love. It provided their children with great coaches (role models) and an alternative to hanging out in the streets.

So say we ban football as evil and bad for kids – I do not think these kids are going to be playing tennis or sailing or going to sleep away camp. But if I can volunteer my time to make this youth sport experience (which is already pretty entrenched in the USA) as safe as possible for those kids, I am going to go. I also have volunteered my time for the last four years to talk to the inner city lacrosse team and they ran over and called me “the concussion lady.”

But what if someone will help – NFL, an auto part company – I don’t care as long as I believe they are sincere about YOUTH sports. I met fathers at the NFL and looked in their eyes – they are sincere about this. Are the pros someone else’s child? Yes, they deserve their say in court, but back to the kids who are NOW playing youth football as we argue on… we have to start somewhere.

The CDC started producing concussion flyers in 1996 – the year before my son was born. CDC flyers are not making it from their warehouse to your house.  And I am trying to be the local distribution system for CT people who don’t know they need this info. It’s a hard sell in a poor economy to ask people to pay for something they don’t think they need.

I don’t judge what people decide to do with their lives – My children do not ride bikes on public roads as it has been my experience that I have lost friends’ lives and various body parts to being hit on bikes by cars. Biking is terrible in my personal experience, but other people seem to love it and ride all over the place with their kids in tow. America is a beautiful place because we can make choices.

We all take risks. What kills me is seeing kids hurt in the concussion clinic every week – in football season and outside football season. The NFL and USA Football showed me that they are sincere about youth football and that is better than the sports who do nothing. Kids get concussions in life. Maybe football is taking the first step that will change the game. I want to be part of the solution and it beats being alone.