Quick Hits

One catcher returns, another goes on the DL for concussion.  Carlos Santana of the Indians is scheduled to return from his stint on the DL for concussion while Angels Bobby Wilson was struck with a foul ball;

Bobby Wilson knew something was wrong when, while catching the second inning against the Seattle Mariners Monday night, he said he “felt like I could fall asleep right there behind home plate.”

Wilson took a foul ball off the facemask in the first and was replaced by John Hester in the bottom of the second. Tuesday, Wilson was put on the seven-day concussion disabled list and replaced on the roster by catcher Hank Conger, who was recalled from triple-A Salt Lake.

“It was the same feeling I had the last time,” said Wilson, who suffered a concussion in a plate collision with Yankees first baseman Mark Teixeira in his first big league start on April 23, 2010. “My face felt like it was on fire. I was drowsy, fatigued, in a fog.”

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NFL running back not thinking about future injury, nor should he.  Javid Best of the Detroit Lions Continue reading

New Hampshire Awaiting Signature

Governor John Lynch has a bill sitting on his desk that will put New Hampshire in line with the majority of states by enacting concussion legislation;

The bill, which has the support of the New Hampshire Interscholastic Athletic Association and others, would have school districts distribute information on the risk and nature of concussions to coaches, students, athletes and their parents.

Under the bill, a student athlete who shows symptoms of a concussion or who a coach, trainer or other suspects has sustained a concussion must be removed from the game or practice.

The student could return to practice or a game only with the permission of a heath care provider.

At first glance it appears that the bill is similar to that of Illinois, the signature would make New Hampshire the 36th state with legislation.

Add Kentucky to the List

Just before the second biggest day in the state this year (behind the UK/Louisville game) Kentucky becomes the 34th state (by our count) to enact some concussion legislation;

House Bill 281 is now law. Governor Steve Beshear signed the bill at Central High School in Louisville, a school rich in football history. The bill is designed to protect all student athletes in Kentucky who suffer a concussion.

It requires coaches, trainers and athletic directors to not only receive training on how to recognize a concussion but to also act in the best interest of the student’s health before allowing that student to play again.[…]

Neurologist Tad Seifert was at Central High for the signing. He says the second hit to a concussed head can be a life-changing blow, “speech, memory, motor skills, it would be very similar to somebody that’s had a devastating stroke” said Dr. Seifert.

It is worth noting that legislation is only a step in the process.  Having mandatory recognition for those involved with adolescent sports is a good beginning.  We all can do much more than the bare minimum, that being said, good job Kentucky.

Wisconsin Adds Youth Concussion Bill

Governor Scott Walker signed concussion legislation yesterday in Wisconsin;

Walker signed the youth concussion bill, which has the support of the National Football League, at Lambeau. The measure, which passed the Legislature with bipartisan support, requires that athletes who suffer apparent head injuries during games or practices be immediately removed and not allowed to resume playing without the written clearance of a health care provider who has examined them.

It also requires the state Department of Public Instruction, in conjunction with the Wisconsin Interscholastic Athletic Association, to develop guidelines and other information to educate coaches, athletes and parents about the risks of concussions and other head injuries.

Wisconsin becomes the 33rd state (by our records) with concussion legislation.

Home State has Concussion Education for Public

In Windsor, Colorado the Park District holds concussion education classes for the public three times a month; it is their part in raising awareness about the process of concussion.  This endeavor is in response to the Jake Sankenburg Act signed into law nearly a year ago in Colorado.  The Tribune serving the Greeley and surrounding area (did I mention that Colorado is the best place, EVER) wrote a story about the classes;

“Kids seem to be actually more susceptible to the problems with concussion than adults, which is kind of surprising because we tend to think of kids as being more plastic, meaning if that if they do incur an injury they tend to bounce back pretty quickly,” Kary said. “Actually, the opposite is true with concussions. I think it’s really imperative that we get the message out to parents to take this seriously because our generation was a bump in the head and kind of get back in the game and rub it off or shake it off.” Continue reading

That Light in the Distance Might Just be a Freight Train

It is still very early in the concussion issue – called an epidemic by the CDC – however this has not stopped people seeking damages against schools and institutions for perceived wrong doings.  These suits are based on the proper protection of the individual injured, you can see the multiple former NFL players filing suit for examples.  However, there are some that fly under the radar, well because they are not high paid athletes.

One such case in California was just settled and reading the article brings chills down my spine as an athletic trainer for adolescents; Continue reading

Dr. William Spangler on State Concussion Legislation

Mentioned before in the Nathan LaFayette post, the Chartis Insurance group is promoting awareness though a unique way; posting information from their sources on this blog.  Their endeavor is part of  a promotion for aHead of the Game®.  The Concussion Blog does not endorse this company or product, however their willingness to provide information will garner them some blog space.  Chartis is not paying this blog to post as we feel this information is educational in content.  Other companies are welcome to send along information as well; however not all material makes the blog, it is an owner/author decision.

State Concussion Legislation Continues to Change Youth Sports

By Dr. William Spangler

 

Injuries in sports are all too real. They can sometimes be dramatic and life-changing. But, nothing is perhaps as gripping and tragic as when an injury severely impacts the life of a young athlete and changes that child’s life forever. Concussions, especially repeated ones from sports and recreation activities, can have a devastating and lasting effect on a young person’s life.

Recognizing the need for some kind of oversight of youth sports, Continue reading

Mom Seeking Answers and Insight

There are great websites out there to visit to find information about injuries and concussions, I hope this is a good resource for all of you.  We are not the be-all-end-all rather just a piece of the puzzle when it comes to awareness.  There is a great site that is devoted to the Mom’s of the world called “Mom’s Team“, headed by Brooke de Lynch.  A serial emailer sent along a recent letter a concerned mom had about a concussion her son endured while playing tackle football – her son’s age… 8;

The following is a redacted version of a letter one mom of a concussed young football player recently sent to her state legislators in a Midwestern state:

Dear _________________:

As the mother of an eight-year-old who sustained a concussion during bantam football practice, I believe it is essential for the provisions of our state’s youth sports concussion safety law to be applied to all children participating in contact and collision sports held on school grounds. The injuries which occurred on my son’s team of approximately 25 third- and fourth-graders clearly demonstrate that concussion information is necessary for these players, their parents, and their coaches.

The letter is very compelling and articulate, it is worth the jump and read Continue reading

Collecting Concussion Data: Massachusetts

As part of the concussion legislation put in place in the state of Massachusetts, the public middle and high schools must report all head injuries/concussions to the state Department of Public Health.  Although plans have not been set for the actual purpose of the data collection, it can provide a snapshot of what high schools are dealing with.  As Lisa Kocian of the Boston Globe wrote;

Football and soccer players from 26 area high schools suffered more than 300 head injuries last fall, the first time athletic departments were required to collect data under the state’s new concussion law, according to a Globe survey.

Football players accounted for 207 of the injuries found in the survey, exceeding the totals on soccer teams at most schools. Girls’ soccer programs reported nearly twice as many head injuries as boys’ soccer teams, 85 compared with 46.

The sample set of data has been put in graphical form, click on the link above to see it.  The average injury reports Continue reading

Youth Football Going Forward: Hruby

Patrick Hruby is not new to this blog, as he was highlighted with his commentary on brain trauma and football back in 2010.  His newest article has been out about 24 hours and it has provoked quite the response from many different locations, mostly silence.  There are articles that come out that see like a lightning rod for comments, “End Game: Brain Trauma and the Future of Youth Football in America” has provided the opposite: silence.

It could be that the article appearing on Yahoo! Sports blog The Post Game has not been viewed enough to get a response; very unlikely as it was trumpeted around the Twitterverse by many people.  Rather, I believe, it may have caused many people to sit back and think.  Hruby looked at what Drew Rickerson and his mother Jean (founder/developer of sportsconcussions.org) went through in 2008;

No one had a clue. Not his coaches. Not his teammates. Not even his mother, looking on from her usual spot in the grandstand. On a foggy November night four years ago, Drew Rickerson found himself wandering around the sidelines of a football field in Sequim, Wash., a city of 6,600 on the state’s Olympic peninsula. He was 15 years old, playing quarterback for the Sequim High varsity football team in the final game of the regular season, a week away from the state playoffs. He also was struggling to speak, dazed and disoriented, hardly able to drink water.

Hruby traces the issue from the beginning of the injury to the trials and tribulation of the family eventually to what has been found since that time about the brain injury of concussion.

It is a very well written piece that shows the obvious dilemma that we currently face with youth football, yet we are very unprepared to talk about or even address; Continue reading

This is a Problem!

Opening up the email today I saw several articles sent in from various readers, a lot are very intriguing and wish I could comment on all of them, like the recent Grantland article about football collapsing, from the view of economists Tyler Cowen and Kevin Grier.  As you all know this blog is a hobby/devotion based upon free time away from job and family so I try to do my best.

HOWEVER, once in a while there are articles that I must find time for; hopefully good, but in this case a complete head scratcher.  I would like to thank a fellow athletic trainer, Brett Gustman, from Virginia for sending this my way.

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If your doctor tells you that because your heart is exposed to greater danger due to some factor, he would suggest that you not eat Big Mac’s any more; would you listen to him/her?  How bout your doctor told you that going jogging on a broken ankle is a bad idea; would you listen?

How about a doctor telling you Continue reading

SLI “Hit Count” Initiative

Sports Legacy Institute did in fact release their white paper today; it simply brings to the surface something that they along with others have been saying with more frequency.  Their initiative to create a Hit Count is a bold step and on that is welcomed, especially in light of the very current research from Purdue.

You can find the article on the SLI website (here) or you can read the final white paper .pdf here; there is a very good background for this idea and the simple yet powerful citation of research already performed in this area.  Their idea is mapped out very well, again the devil will be in the details as it all begins to be sorted out;

There are technological and monetary limitations to a pure Hit Count, as Hit Count systems currently are only sold for helmeted sports, and there are costs involved.  A Hit Count is not as simple as a pitch count, where coaches only need a pencil and paper.

However, hits to the head can be accurately estimated, and methods can be developed to approximate the brain trauma exposure during games and during practice based on known variables, like position.  With these estimations, rule changes and practice guidelines can be provided to ensure few, if any, athletes exceed a proposed limit. Continue reading

White Paper

Sometime today Sports Legacy Institute (SLI), headed by Dr. Robert Cantu and Chris Nowinski are going to release a “white paper” that will “plan to spread successful NFL policy changes to all youth sports,”  this according to Irvin Muchnick via his blog Concussion Inc.

What is a white paper?  Glad you asked it is important for context (via Wikipedia);

A white paper is an authoritative report or guide that helps solve a problem. White papers are used to educate readers and help people make decisions, and may be a consultation as to the details of new legislation. The publishing of a white paper signifies a clear intention on the part of a government to pass new law. White Papers are a ” … tool of participatory democracy … not [an] unalterable policy commitment.[1] “White Papers have tried to perform the dual role of presenting firm government policies while at the same time inviting opinions upon them.”

It is mentioned that along with SLI, Boston University’s Center for the Study of Chronic Traumatic Encephelopathy (headed by Dr. Ann McKee) will be in the white paper as well.

I will be interested to see what exactly they are Continue reading

Show Critiques (CNN and ESPN)

Yesterday there were two important shows that aired.  One on ESPN, the Outside the Lines presentation on helmets and the other was a documentary by CNN and Dr. Sanjay Gupta.

CNN and Dr. Sanjay Gupta presented an hour-long look into the concussion issue, mainly at the high school level.  Although the main press is with the professionals, the time spent at the high school was a HUGE KEY to making this documentary a success.  Like we have been posting on this blog for the past 18+ months the real issue with concussions begin at or earlier than high school.  This is not only because there are obviously more participants at the HS level, but it is also where kids are learning and learning how to learn.  In short the high school level is where the brain is functioning the hardest.

The presentation was excellent, it not only provided the current (subjectivity) but exploding (CTE) issues in the concussion discussion, but exposed a real solution to the issue. Continue reading

Colorado’s “Jake Snakenberg Act”

The concussion legislation in Colorado went into full effect recently and in this case, a seven year-old, it has paid dividends;

“Two concussions and a scar right here,” said Dylan, pointing to his forehead.

Dylan suffered his first concussion playing football this past summer. He says he suffered another concussion when he ran into the dishwasher at his home.

“I was chasing my brother,” said Dylan.

His mother, Alex Hearn, admits she didn’t understand the full implications of concussions till it happened to her son.

“I think people don’t take it as seriously as they probably need to,” said Alex Hearn.

The new measures Continue reading

Good Idea, but Take Care of Own First

I get why its being done.  In fact I agree with the principle behind the letters to the states, however it is tough to ask for someone to do something that you yourself have a difficult time doing/policing.  The NFL and NCAA sent out letters to 19 Governors asking them to consider concussion legislation (via USAToday);

NFL Commissioner Roger Goodell and NCAA President Mark Emmert are urging 19 governors to support legislation this year aimed at cutting down on concussions in youth football.

Goodell and Emmert sent letters Thursday to governors of states — such as Florida, Ohio and Wisconsin — they said do not have something akin to Washington state’s “Zackery Lystedt Law,” named for a middle school football player who sustained brain damage after he got a concussion and returned to play.

Although both the NFL and NCAA have outlined “guidelines” and mechanisms for concussions themselves, they do have a hard time enforcing them.  A quick glance at just this blog unearths some serious issues: Kris Dielman, Mike Vick, Huffgate, and Bonnergate just to highlight a few.  Just think how difficult that is for an entire state with more than one level and one sport to worry about.  The NCAA should be able to help, but even there they are “recommendations/guidelines”, there are no teeth to the rules.

Legislation is good, but only good for one reason in my opinion: awareness.  That is it, because there are ways to skirt the Continue reading

Wonderful Retrospective Article

Originally published August 11th, “Student athletes suffer the stings of concussions while lawmakers fail to help” written by Steve Jansen and Gus Garcia-Roberts (not their first) in the Miami New Times News shows examples of how missing concussions and not handling them correctly (from player to coach to parents to athletic trainers) can be very troubling.

Including in this piece are quotes from Dr. David Hovda, one of the leaders in concussion/brain trauma research from UCLA, as well as other lawmakers and parents.

I was previously unaware of the Village Voice Media research and findings; Continue reading

ATSNJ Survey

Below is an email from the ATSNJ that I feel needs to be posted to create more dialogue.  New Jersey, the ATSNJ and Eric Nussbaum have done a fine job of leading the way in this issue at the high school level.  Thanks for the note.

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Dustin,

From the Athletic Trainers Society of NJ, completed in November.

NJ was one of the first states to formally pass a concussion law in December of 2010.  Our concussion law accomplished several things.  a) directed our department of Education to develop a model concussion policy and instructed ALL districts to implement a formal concussion policy by September 1, 2011.  b) Mandated concussion education for all licensed athletic trainers in the state.  This makes us the only healthcare profession with mandated continuing education in concussion care, making athletic trainers concussion “experts”.

We had heard that many schools were having some issues formulating/implementing a formal program for their districts.  There were several questions that were not well-defined in the law or model policy put out by the DOE.  Key terms like: “trained in the management of concussion”, “asymptomatic”, “academic accommodations”, specific education and RTP guidelines were all issues that districts needed to consider for their policies.

The ATSNJ put together an online survey and sent it out to our secondary school ATs.  We had 110  secondary schools with an LAT respond to the survey.  (about a 33% return)

We conducted the survey to: a) see how many schools actually were implementing a board approved policy. b) find out if terms were being defined c) find out about consistent issues w/ policies d) determine what source of information schools were using to develop their programs d) determine who was responsible for education, notification, coordination and implementation of actual policy.

The highlights of the results were posted in our release, HERE;

  •     Only 63% of team physicians are “trained in the management of concussions”
  •     9% of respondents do not have a board approved concussion policy.
  •     27% of schools adopted a generic policy.
  •     84% of districts do not define “trained in the management of concussions” in their concussion policy.
  •     51% of districts do not define “asymptomatic” in their concussion policy.
  •     60% of districts do not define specific academic accommodations in their concussion policy.
  •     89% of school policies define “graduated return to play protocol”
  •     100% of districts utilized athletic trainers as the gatekeeper for the concussion management process

We also developed a policy check list that schools and parents could utilize to evaluate each schools policy.  We have posted suggestions for definitions and improving policies on our website, HERE.

We realize that development of a good working policy may take time and a little tweaking.  The ATSNJ wants to be a resource for parents and schools as they develop their individualized policies.

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Feedback is encouraged by commenting below.

Tuesday Quick Hits

The concussion news cycle seems to have slowed a bit over the past week.  Sure there has been plenty of newsworthy events, including cases of kids getting hurt, but the amount of news seen in the searches has dropped quite a bit recently.  I must say that over the past few weeks I have seen more and more “mainstream” outlets picking up on the awareness issue.  One such case is NPR and a story about products that have been popping up.  The title is a bit misleading as mouthguards are not discussed, it does take a look at the Battle Sports Science Impact Indicator;

Battle Sports Science CEO Chris Circo says his product does measure rotational movement as well as direct head impacts. Circo, who’s had five concussions and takes anti-seizure medication, says he knows how complex brain injuries are. In an interview, he is more circumspect than his trumpet-like email to the media.

“Does the Impact Indicator prevent concussions? Absolutely not,” Circo says. “Does it diagnose concussions? Absolutely not.”

But, as advertised, it does help, says Circo. And despite Halstead’s fear, Circo insists Continue reading

Delaware Makes 32

Delaware Governor Jack Markell signed into law a concussion act for the state, the basic principle is “when in doubt, sit them out”.  The law mimics other states with concussion training for coaches as well as informed consent for parents and athletes.  The best part of Delaware’s law is that it extends to junior high school aged kids, not just high school.

Before a player returns to play they must be medically cleared, similar to other states and the NFHS.

List of states, HERE.

Comprehensive Article From LA Weekly

Kids are the reason there is so much buzz about concussions.  The professional player understands the risk and is getting paid to take those risks, kids are not.  The other more important reason is that a younger brain can be more adversely affected by an insult/concussion.  Steve Jansen and Gus Garcia-Roberts wrote an extensive and comprehensive article titled: Concussions Take a Terrible Toll on America’s Young Athletes.

Across the country, people have awakened to the sometimes irreversible damage of concussions, especially in high-impact professional sports. With much of the attention focused on the National Football and National Hockey leagues, Village Voice Media conducted a nationwide investigation into the consequences of concussion on youth athletes.

The article finds that there are some inherent gaps in the former and current systems for concussion recognition and return to play.  A lot of the confusion Continue reading

Louisiana Adopts Law

The state of Louisiana becomes the 31st to enact a law designed to protect athletes from concussions.  There are actually two separate bills signed recently, one deals with concussions the other the scope of who is “in charge” with the injury;

Under Roy’s bill, that provider can be anyone from a licensed doctor to an “official responsible for judging or supervising the athletic competition.” Under Cheek’s bill the provider must be a physician, a nurse practitioner, a licensed physician assistant who has been trained in neuropsychology or “concussion evaluation and management.”

Cheek’s law applies to all organized sports — whether in school or an independent league — from age 7 and up, but not professional sports.

The law will require parents, athletes and sports officials to become educated about concussions.

Good to see another section of the United States getting the word out, but I take umbrage with the fact that the licensed athletic trainer is not included on the list of healthcare providers, specifically.

Great Resource About Concussion Myths

Matt Chaney has been busy this summer with work, but he found some time to forward a bunch of links regarding concussions.  There were a lot dealing with the state laws and the mandates now in place across the sporting landscape, all with very valid opinions.  Some dealt with his area of expertise, steroid and PED detection.  However there was one that I must share with you; a link to a NASP Communique (National Association of School Psychologists)

The link was very resourceful but the gem was the attached .pdf that dealt with the myths we commonly hear with concussions.  Due to the rudeness of ripping off all the information below you will see the myths they took on, and for the actual facts please click on the .pdf link above;

Identifying Concussions

  • Professionals agree on the definition of a concussion.
  • A more accurate term for concussion is a head injury rather than a brain injury. Continue reading

Gov. Quinn FINNALY Set To Sign

The Illinois State Legislature has been working on the concussion bill since January, it has been held up along the way for a couple of amendments but has been sitting on the Governors desk since June 3rd (LINK).  Word is that the Governor is set to sign the bill today at a ceremony in Solider Field (the 30th total according to our records) putting into motion, what I have been trying to tell any school in Illinois that would listen, the requirements for concussions at the high school level.

This bill has remained relatively unchanged since I first posted about it in February; there are two Amendments that you can see in the first link.  In quick synopsis this bill/law will; Continue reading

Live From Princeton

Welcome to the continually updated live feed from the Athletic Trainers Society of New Jersey 2nd Annual Concussion Summit.  I would like to thank the ATSNJ in particular; John Furtado, Eric Nussbaum, and Mary Jane Rogers for the help in getting things set up.  We are at the Wyndham Princeton Forrestal Conference Center & Hotel in a stunning amphitheater, attendance is anticipated to be high.  I anticipate updating this post as soon as possible after each speaker.  Follow @concussionblog for updates.

6:25am CST: Crowd flowing in with provided breakfast in hand.

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6:33am CST: Jason Mihalik, PhD “Biomechanics of Concussion”;

  • Concussion is a FUNCTIONAL injury not structural injury
  • Brian injury a major public health concern (showing a pyramid with the head injuries on the bottom, unseen or caring on their own)
  • Things that feed into Traumatic Brain Injury:
  • Cognition, Concussion History, Postural Stability, Mechanism of Injury, Physical Exam, Symptomatology, Knowledge/Attitude
  • Injury Prevention (anticipation, infractions, play type, closing distance)
  • Kinds of impacts that cause concussion; research obviously done primarily on animals beginning in the pre 40’s.  The coup-contracoup model was found by using animal models
  • Research moved from animal models to human analogs; wax skulls/gelatinous brains Continue reading