Concussions Part 2: Equipment Safety, Concussions in Youth, & Reducing Second Impact Syndrome

last
week
on educational forum
leading experts and former athletes discussed the current concussion crisis
happening in professional sports
this week we examine the role that equipment plays
the affects of concussions in youth
and steps we can take to reduce the prevalence of concussions in second
impact syndrome
I'm holly vietzke and this is the massachusetts school of law educational
forum
one of the issues that frequently arises when discussing the increase in diagnosed
concussions
is the safety of the equipment
players are unquestionably bigger stronger and faster now
chris nowinski a former professional wrestler and collegiate football player
notes in his book head games that since nineteen twenty the average force
generated by an offensive lineman has more than doubled
has the equipment kept pace
or have the advances in equipment given players a false sense that they are
safer
with all the improved equipment
it creates more impact
and you know there's a debate going back and forth between
you know whether
uh... better equipment in
in you know greater impacts can have the same effect or whether you know less
equipment less you know
equipment can create a situation where the players are actually
you know technically
hitting the right way
and not you know leading with their head and not creating the
you know high impact car crash type uh...
hits that are
that you see every week
you know uh... i think they're doing a lot right now i think uh... you know there's
definitely a
an increased focus on
uh... player safety right now
you know with the penalties a that are being
uh... instituted and with the
the focus on
you know reducing the
high impact
hits the helmet to helmet hits the head hits
you know i think uh...
you know some rules changes could
could possibly do that you know
until the rule changes are instituted and you see what the affect is you know
sometimes
you know some rules you know have adverse effect so you know you have to
you have to try different things and see what's what's working ah... and i think
a lot of it starts from you know the youth
and high school level too and teaching the right techniques
uh... of hitting and playing the game to
you know to not lead with the head and and go for the helmet to helmet
hits
equipment plays a role one of the hats I wear is as a
vice president of NOCSAE which certifies football helmets and other athletic
equipment and there's no doubt that
helmets are better today than they were ten years ago and ten years ago they
were better than twenty years ago
but helmets don't prevent the majority of concussions and probably never will
because they do a quite a good job
with regard to those focal linear forces
like a stick over your head
and they do a quite poor job of attenuating the forces of rotatory
impacts likes snapping your head
from a blow to the side of the head
this is a normal nerve cell
you have the dendrites you have the nerve cell and you have the axon
and the signal arrives at the nerve cell it's transmitted to it
it's transmitted along the axon and then with neuro transmitters
they are released
that then
propagates the message onto the next neuron in the chain
when you have
a concussive injury
you have this metabolic chaotic event
where the potassium that normally is inside the cell
goes outside the cell
so it goes from the inside to the outside extracellular space
when these
ions rush out of the cell
it allows the positively charged calcium ions to replace them inside the cell
but these calcium ions shut down the a_t_p_ which is the energy pump
that's needed to pump
them out
and pump
the potassium
back in
um so it leads to this metabolic dysfunction
and it's at this stage that the cell is alive but the cell is not functional
functioning
and if you stress it either physically or cognitively you can tip the balance
and cause this cell to die
and that's why the hallmark of concussion management
is physical and cognitive rest until symptoms have cleared
or at least gotten a great deal better
and then in... with most concussions after a period of time
uh... the
the potassium ions will get pumped back inside the calcium ions will get pumped out the
neuro transmitters will be put back on
so after a period of time you have a normal functioning situation
and there's no demonstrable injury that can be demonstrated
and
so no matter how much they're improved
they're they're not gonna
dramatically
decrease the most injurious of all excellerated forces the x the rotational
ones
so i think it's great to keep working
to build a better helmet
and i i don't think any of that work should ever slow down
and i think it's great
uh... educating that new helmets are better than old helmets and let's uh uh
definitely recondition helmets frequently and eliminate uh helmets
that have been in the market for ten years period
uh but I don't think helmets are the solution they're great for eliminating skull
fracture
uh... they're great for reducing the incidence of acute intracranial bleeds the
subdural
but they haven't done much for concussions
it depends on how you use the equipment
to determine how much it helps against concussion
i would say for decades we made
better helmets meaning they fit better
and uh...
they felt better
and therefore
the problem was even if they did protect better against force
athletes started using them as a weapon and as the point of contact and so if
you go back and watch go on you tube and watch old football clips from the fifties and
sixties and everyone tackled with their shoulder
especially when they added the helmet and then the face mask and then
got really good fit and went from suspension helmets to air pockets and all of that
athletes suddenly found out that the best way to knock somebody down is to hit 'em
with your forehead
and then we started doing that and not penalizing it and so therefore if you
played prior to the last couple years when we did start penalizing it you even
though you had the best helmets you were probably also receiving the most
brain trauma
because people were able to use their helmet and hit you in a way that never would
before
now that we realize this is a problem we are penalizing intentional hits
to the head which is
the most important thing we can do
and then helmet manufacturers are getting smarter
about focusing more on these
more not only concussions but milder hits and so
independent studies have shown the last generation of helmets are dramatically
better than prior generations
but there's a limit to how great they can be cuz you're still stopping
moving bodies and you still have brains floating in fluid slamming into skulls and
twisting around and no helmet will ever be able to fully
eliminate concussions
but they are a piece of the puzzle
but people have for too long put way too much faith in them
uh... and then if you look beyond helmets you know all the equipment has
really
made the games more dangerous hockey is finally having legitimate discussion
about that because
they started you know you basically
the thing that kept us all from
colliding into each other for
since the dawn of humanity has been the pain that came with it
and now that we've invented these really cool shoulder pads and elbow pads and all these other
things
we don't feel that pain
and so you combine a helmet with gigantic and you know titanium
shoulder pads and all that whatever they're putting in there
combined with really hard elbow pads especially the latest generation of
things in hockey
people it's more dangerous 'cause you could hit each other harder and so people are actually
moving away expecially in hockey from hard elbow pads bigger shoulder pads we're
starting to get some sense back into the fact that your
your body is there pain is there to tell you when things are wrong
and if we cover that up we're
making mistakes
doesn't the technology exist to make a safer helmet
i certainly hope not
I certainly hope they're not holding that back
uh... from the public I mean I think
growth has been made in in every generation as they go a lot of that
growth that's come in protections actually they've simply been making the helmets bigger
but also the materials inside are getting better
and so
I mean and technology is is ramping up very quickly and so
i wouldn't i would be surprised if there's
technology sitting out there that no one's applying that's gonna
solve this problem tomorrow but it's i think we can expect it to get better
every year
do mouth guards help at all
mouth guards help the
the oral uh... dentition for sure
uh... they protect your teeth
uh... i'm a strong advocate
therefore
of wearing them in collision sports
but they do precious little in reducing concussion
they're really only two
uh... theoretical
blows
that they may help in and that is a blow underneath your chin
that's directly up... so if you're wearing a cushion between your
upper and lower jaws you're going to reduce the forces
also a
blow right to the very point of the chin
drives the occipital condyles
of your jaw
back into the base of the skull
uh... mouth guards can attenuate those forces
but the great majority
of blows to the head in collision sports
are to the side to the top to the back to the face mask if you're wearing one
they're not to the point of the chin or under the chin in fact in football with your
face mask you really can't get to the point of the chin so
i don't think that um...
mouth gaurds should be viewed as protecting against concussion in any significant
way
helmets have the most potential for technological advances
that could reduce the severity of impact
so an obvious question becomes
why don't manufacturers develop a helmet that would better protect the head
in head games nowinsky addresses this very issue
one problem as he explained is that thirty five years ago there were
fourteen helmet manufacturers
today there are no more than six
what happened was that in nineteen seventy five a nineteen-year-old football
player injured in a game became a quadriplegic and sued the helmet
manufacturer
resulting in a three million dollar out of court settlement
this started a trend the costs of settlements eventually outweighed the
gross income of the entire helmet industry forcing most of the
manufacturers to go bankrupt or cease operations
another problem is that one of the leading helmet makers pays for the
right to be the official league helmet
so any improvements made by other manufacturers will have a very difficult
time making inroads into the n_f_l_
one such manufacturer located in lowell massachusetts has designed a helmet that
uses eighteen airbag like shock absorbers that reduces the risk of
concussions by as much as sixty percent
players using this helmet manufactured by xenith have reported a seventy percent
decrease in headaches
but as of a year ago the most recent data available
only one to two percent of n_f_l_ players were wearing a xenith helmet
and although players are allowed to wear whichever helmet they choose if they
were anything other than the n_f_l_ endorsed helmet they must cover up the
logo so it is not visible
requests for an interview with xenith went unanswered
news of professional athletes sustaining concussions surfaces it seems
at least weekly
during NFL and NHL playing seasons
in fact during the most recent n_f_l_ season there were at least three players
on the injury report for concussion in any given week
with several weeks listing as many as thirteen players
these are adults choosing to play sports for a living
as serious as the problem already is it becomes much more significant when
children are experiencing head trauma
according to a recent boston globe article approximately a hundred and
thirty six thousand concussions occur each year in high school
the concussions we've had I believe four
uh... and they're you know very
a strict about what you can do and what you can't do when you have a concussion
so basically ah... it's you know follow the the rules of the m_i_a_a follow what
the doctors are telling
uh... us about the kids um
you know and just hopefully try and get them back to health so that they can
come back but I mean
obviously the most important thing is is the students health
you know they have a life after high school you know this is not the end of the world
in boys hockey and mens hockey
these plays are faster and stronger than ever before and in the girls hockey it's no
different
they're faster and stronger at a different level
and you know the impact is much more severe
so um... they are working with equipment you know they're working with taking the hardness out of
shoulder pads and the hardness out of elbow pads
and uh
but there's still
always going to be that element 'cause that's a fast game
you're out there flying
you know and when you
when an incident happens it happens at high speed
is a child who suffers a concussion more at risk for second impact syndrome or
can that child
recover completely
given the amount of time between
concussions
I think that's a great question
uh... I believe that a child that's completely recovered from a concussion
and has had a
adequate period of time for their brain to heal is not at risk for second impact
syndrome
the people that are at risk for second impact syndrome are people where the brain
hasn't healed and it's still symptomatic
at any age
at any age and there's no magic one day one week
two weeks three weeks that
as long as the brain is still symptomatic and you're still healing it could be a
month or two months later
or after the initial insult
although most of them happen within a matter of a week or two
obviously getting a concussion is never
ideal
but is there any age that it's
the worst
to have a concussion
well i don't think there's a numerical age but i think there is a grouping
of ages where it's
uh... probably more injurious and we're much more worried about our youth with
developing brains
than we are with adults
adults have fully milinated brains
their heads are not disproportionately large compared with the rest of the body
and our necks hopefully if we're uh... athlete in sport are
well-developed
uh... that's not true of our youth our youth have brains that are much
uh... more easily injured because the myelin which is the coating of nerve fibers
um...
kind of like the insulation on telephone wires it isn't fully formed
uh... so it's easier to disrupt
nerve tissue in a youth
youths have very large heads relative to the rest of their body
uh... and neck muscles are characteristically pretty weak as well
all that sets up
uh... a given force that may not be that much having a greater impact on the
brains of our youth so we're very much concerned about our youth as a group
uh…it takes less in the way of a force to produce a concussion and as a group
not an individual in every case but as a group they recover more slowly than do
adults
should i not let my children play hockey then
well i have very strong feelings uh...
based on thirty plus years of
seeing many many concussion patients my average week for me's now twenty five
to thirty concussion patients
plus the work that we've done
uh... at the center for the study of traumatic encephalopathy at BU and the
great work that ann mckee is involved with
thinking of teenagers already with incipient c_ t_ e_
thinking of individuals
from pop warner football that
lost entire school years because they couldn't
remember their classmates names for many months at a time
lost just about all the language they'd learned in and math
reflected in all of that I personally think
that collision sports
should not be participated in by individuals under the age of fourteen as
they're currently being played
the head trauma's gotta come out of them
the sports can be modified to be made much safer
with regard to head trauma
i don't think we have to give up playing the sports but I think that we have to give up
playing them as we are currently playing them
what is second impact syndrome
second impact syndrome
is an individual that's still symptomatic from initial brain injury
and because the most common athletic brain injury is concussion most of the
injuries were concussions
but not all of them some were subdural hematomas that were missed some were
brain contusions bruising of the brain
so the brain is injured
you have post concussion symptoms you have brain injury symptoms and then the
individual's subjected to another brain trauma sometimes very minor
and the brain loses its ability to control blood flow
it's a loss of auto regulation
blood flow rushes in the brain
pools because it can't get out fast enough
what you see is this dark area here
uh... within the ventricle which is largely filled with blood
an increases intracranial pressure
and sets up a scenario that's very unique to this condition where somebody
is
subjected to brain trauma
sometimes not all that dramatic
uh... may get up a little stunned
but within minutes
two three four five
goes from this alert conscious state to being comatose fixed dilated pupils
respiratory embarrassment due to brain herniation
and it's a life threatening condition
john lilley a scout for the toronto maple leafs admitted that a history of
concussions
does factor into his evaluations when he is scouting players
I mean it's something that we do
we do look at
uh... you know it's
uh... very serious uh... issue right now
in the game and if if a young man has has had a lot of concussions it's
certainly something that we look at
um it definitely is something that
you know it's a concern it just seems like again there's more and more
uh coming to light
so from the players' perspective it's
there's a real advantage to denying that you've had a concussion or trying to
get on the ice because you don't want that
stigma attached to you if you want to turn pro
yeah but in the same breath again uh...
you know it's you're talking about your head and your brain and it's not
something you can you can take lightly so i think that
i like the way it is now because it's okay to uh... to say you're you're hurt
and you know
it's like I was talking to somebody the other day
if you hurt your knee
doctor can look at your knee and see it's swollen and
decide you know you you have a tear or whatever your brain
is very hard to
to diagnose in a split second as to
to what's wrong so i i i think it's it's a good thing the uh...
the kids are
you know uh...
are saying they have concussions now
so that they don't play and uh... you know do further damage
beth adams is a rehabilitation specialist treating children with head injuries
many of them with second impact syndrome
unfortunately her practice is very busy and what are some of the more disturbing
cases you've seen
very disturbing case that i saw was a boy who was fifteen years old playing football
at the time of injury and he was unable to recognize friends and family
to participate in school for an entire year
so he had a case of amnesia where friends would have to walk him around
school and reacquaint him to others
he didn't know his family had to be reacquaint by pictures and it was a
horrific event for the family to have to go through this at such a young age
what's the rehabilitation process like
the rehabilitation process varies depending on the individual and the blow to the
head
uh... oftentimes it can be a couple of weeks and can be up to a couple of years
uh... it's very slow at times can be frustrating
uh... memory and every individual brain varies and so people get very
frustrated that it's not happening quick enough how often do they come in for
treatment
they come in about once a week
uh... for something called cognitive rehabilitation where we work on
strategies that sort of fill in the void of some of the parts of the brain that
were injured
so we help adapt some of the
uh... extensions of their memory in order to keep them in check on a weekly
basis so that they can remember
what they're doing on a day-to-day basis how pervasive and or serious do you
think this problem is
I think it's very serious i think we're taking it more seriously now
i think that over the years and as you I'm sure can recall many years ago
there were those that just shrugged it off you hear a lot of people continue to
say
shrug it off but i think with more
publicity
and people coming forward that we are taking more precautions on looking at
this seriously
how do concussions effect those children with pre-existing disorders and
disabilities
somebody with um
an example of a child with attention deficit disorder
oftentimes i'll hear a child or his parent come in and say
my ADHD is worse than ever and what'll what's going on with me is my
ADHD getting worse and what i'm
helping them understand is that the brain is so diffuse that wherever the
injury is
oftentimes it mimics ADHD and so people who feel racy or feel
distracted or poor judgment or very hyper can be exacerbated up to ten times
worse
and so uh... what i'm trying to do is help them understand that it's an
excaserbation of their already
symptoms
are children who suffer multiple concussions
over a shorter period of time more at risk than adults who might suffer more
than one concussion
what I see now with the kids is that it's really affecting schooling and so
i'm questioning myself as a clinician that
multiple concussions really are
uh...
having an impact on the kids and their learning now with adults with multiple
concussions
we do see that they have problems with work
for the athletes the professionals that try to get back in they are feeling
uh...
very foggy and they're not quite sure what's going on
but I believe that the children I'm seeing
i mean question that there's a lot going on more so
than the adults right now
could it be worse because their brain's still developing
children's brains are always developing uh...
and
for me
I I we know that children will continue on in future with college
hoping to graduate high school and for me the biggest concern that i have is
with the multiple concussions and with the impact of learning that we really
take a closer look at what these children are losing as they're going
forward with these concussions
now doctor robert cantu believes strongly that children under fourteen should
not play any kind of contact sports do you agree doctor robert cantu is
absolutely correct
again these children have a lot to lose when you're an adult you're playing
professional these are choices that you make
it now becomes your business your job uh... these children are being
i believe ill-prepared when they're very young
to know how to pull themselves out of a game
the coaches are trying to foster
the sort of sports uh... persona you know determination spunk
and what these kids are too young to understand is the importance
of the brain you know i can't happen to me syndrome
is really prevalent among all ages but for the children
they're just not mature enough to know that they've gotta pull out and they're
just going to keep going and and
i see these kids
uh... future really in jeopardy
and i think that under fourteen would be very safe to say absolutely no contact
sports
did you let your kids play
I
have um... been very fortunate that i've a son that
was too big to play pop warner and now is a high schooler he's in ninth grade
still not playing but because the
law the rules were written
that didn't allow him
it took the onus off of me but would i have
absolutely not
my sons when tom passed away at eight and ten were playing pop warner football
and um...
I went home that year after meeting the four co-directors uh...
and i approached the league about you know um... getting some training for their coaches
and they were'nt interested
I let the kids you know the kids had just lost their dad and when you're dealing with that
you're walking really on eggshells you know what do I do to to keep some stability to
keep you know to keep huh
things as uh... normal as i can for them so that they're not dealing with two they
really we're looking forward to playing that summer
and at that time i didn't know nearly as much about the disease as I know now
i don't let them play
anymore
because um... one because where i am in my area they're still very very
behind the times in terms of awareness about this they think they're aware
but they're not educated and so i think they think they're doing a very adequate
job of doing a better job of diagnosing concussions and whatnot
uh... i don't believe that to be the case and two because the level of disease
in my husband's brain was so significant at forty-five
that I uh
i have to believe my kids are probably more at risk and i'm just not willing to take a chance
other athletes however are not so quick to take that opportunity away from their
children
I have three girls uh...
and right now they're at a young age and and
hockey's a skill game at the level they're at there's no checking
obviously there's
instances where they can you know fall on the board and things like that but it doesn't
concern me uh...
i think you know as they get older it might become a little more of a concern
we have to be more cautious now with the knowledge that's starting to come out uh...
with concussions and and the side effects and
and things like that so that i would but it wouldn't
discourage uh... me from having them play hockey at all
it's gonna be up to them
uh... I'm here at the sports legacy institute event because
uh…I want to see changes made permanantly
so that when my son who is two years old decides to follow in dad's footsteps one
day
that he doesn't have to be subjected to
the mentality that i was subjected to
uh... and everybody else before me
that you know caused us to have all these problems now you know
uh... if if we would have only
had the knowledge and uh...
and been told the
consequences and the severity of having
these concussions and not addressing them seriously
i wouldn't be sitting here today and a lot of these people wouldn't be sitting here today and the
sports legacy institute probably wouldn't have to be here today
which is unfortunate you know
because the information's been there it just hadn't been given to us
i would discourage them
uh... more because it's a very tough business for the very
a minimal chance of being a success it can be the greatest business in the
world but it's very tough
the chances of getting hurt are very good the chances of being successful are very slim
i would insist that they a college education
and that they be realistic which is what I tell everybody
nothing wrong with pursuing your dreams whether it's being an NFL player
an actor in hollywood
or
a wrestler WWE as long as you're realistic and have a backup plan
fortunately for the student athletes
school athletic associations are taking this issue very seriously
in massachusetts the legislature recently passed a law designed to
prevent
the progression of concussions
the law which has several requirements
involves everyone involved in school sports from parents and volunteers
to the school nurse
one thing that the schools ave done differently I used to receive a call
on a monday from a parent saying oh my god my son or daughter has had a
concussion what do we do
i still receive those calls
but now what the schools are doing because of the concussion law since
summer of two thousand and ten
uh... in the state of massachusetts is that
when the child has a concussion they cannot return back until being
cleared by a physician the school nurse is also privy to it as is the trainer
but everybody come monday morning is more privy to the fact that the child
sustained a concussion so now oftentimes I'll receive a call
from the nurse
saying are there any accommodations that the child needs because we are familiar with the
fact that he has had a concussion
one thing that i just want to caution is with a concussion law
children are supposed to be seeing their pediatrician
uh...
and
the families are taking the children to the pediatrician
but where I'm finding a little bit of a breakdown is that although as
comprehensive as the pediatrician is
uh and wants to be for the child there are some pediatricians that are out
there that are clearing the child to return
and i've had children return as early as three days because they're not
displaying symptoms of a concussion
gone are the days where the symptom concussion has to be vomiting
or has to be dizziness
they can be subtle but if the pediatrician isn't aware of it
the child is cleared to return
and they go back to the playing field a week later and this is incredibly dangerous so
what i'd like to see happen is
that we have more resources for those that are able to clear the child
with the knowledge of brain injury
could it also be sometimes that the child is not being as forthright
as he or she could be absolutely and those children if they want to play on
that following game and they're the starter they're not going to share a lot of
information but there are subtle
neuro cognitive assessments that can be done for the children to see if they're
having any uh... distraction attention issues
other issues of cognition that might be problematic that a physician may not be
able to pick up as subtle as they are because
of their lack of
education
with concussions per se
the entity in charge of implementing and enforcing the new law
is the department of public health
although it is quite a large undertaking the department is officially making it
as easy as possible for everyone involved
doctor lauren smith is the medical director of the d_p_ h_ and the person
ultimately responsible for ensuring compliance with the law
well the department has a responsibility for turning the law into regulations
and then supporting schools as they implement them
and when did you first start taking notice of head injuries and concussions in
school sports
the department has been interested in this for awhile our data has shown us that
unfortunately
head injuries in sports isn't rare
so several years ago the department got a group together to really focus on
concussions in sports
and over the past years actually has
distributed
thousands of heads up concussion kits that we get through the c_d_c_ worked with key
stakeholders like the brain injury
uh... association so we really have been thinking about this for a while even
before the law was passed
and what have you been doing to implement the law have you been visiting
schools
implementing it is a is a lot of uh different steps uh the first thing
we needed to do was to
identify training
that was mandated as part of the law and this is training for parents and students as
well as school athletic staff nd others
and the rationale for that really is to make sure that everyone is on the same
page
understands what the
consequences of concussion can be
uh... especially if you don't acknowledge it and recognize it early
but also really just to understand what are the signs and symptoms
concussion can be subtle and so a lot of people weren't aware that some of the thing's
really could be signs of concussion what's involved in the training and who takes
place is it a class is it
a long course
the training we decided we really wanted to make sure it was easy
and accessible to people and ideally we wanted it to be free
so there are two trainings that we identified that had all of the key
components what we wanted people to know
one of those is through the c_d_c_ the centers for disease control has a
website devoted to concussion
uh... issues uh... and so there's training for
parents students coaches and others as well as a host of other materials which
are great
the other is also excellent and that's the national federation of high school
sports
they have an online training
again it's
and hits all high points of what we want people now
so these coaches and trainers and parents do they
they go in and take
almost like an online course and who certifies that they've taken it there's
two ways of doing that one would be uh...
for example you can get a certificate that prints out you know with the
after you completed the course
uh... the other thing that we wanted to make sure that people not had the
opportunity to do because not everyone has access to computers
is there's uh materials for parents and students and coaches
on the website the cdc website and so people could print that off
hand it out distribute it
uh... we've had uh... coaches and athletic directors hand them out at the preseason
meeting for the
football team players and the parents and then
they just know who came to the meeting and take that attendance and know that everyone got
the material
this seems relatively low cost to implement
or is there are there other expenses involved the training piece should be low-cost uh... i
think
really a most of it is
we've tried very hard to incorporate the regulations that we've put in place into
what we hope people are already doing
uh... because we know that people that the schools don't have
a lot of extra funds or any extra funds
to implement this so we've tried to be sensitive to them
how many
student athletes in massachusetts suffer diagnosed concussions each year
that's a good question uh we don't have good data on the diagnosis of concussion what we
do have is data from a survey of students
which showed us that about eighteen percent said that they had
had an injury to the head during sports that caused a number of symptoms that
could be consistent
with concussion
now whether or not they were diagnosed with it we don't know but that was
eighteen percent
which is a lot of kids
despite the good intentions behind the law it has its critics
a recent boston globe article reported that some school officials complain that
the law burdens districts
by requiring more documentation and paper work
initially there was some apprehension as i think anytime schools are asked to do
something new or in addition to their already
pretty full agenda that they're responsible for there
could be a little bit of anxiety about that
uh... but i think we've worked really hard with
school groups with
the a massachusetts interscholastic athletic association as well as others to
try allay those fears but especially to make people understand or make sure that
people understand
what the regulations actually do
we've had um...
several calls before you know at the end of the summer you know as school was
starting so that people could call in ask questions
does this work would this comply
and what i found
and i'm not surprised at all is that the coaches the athletic directors they want to
do
what's good and what's right for the kids and what's the ultimate goal of the
legislation
the ultimate goal is to keep
students safe
what we know is that if you have a concussion and you go back to sports
before
uh... you're fully healed and you have the athletic activity associated with
that and if
you have another injury
you're much more likely to have a severe injury the next time or even a
catastrophic one that could be fatal
so the idea really is to make sure that kids have enough time to heal
um so that they're not in the position of having one of those really terrible outcomes
well i think the most important thing that coaches in schools can do
is to have a concussion management plan in place
at all levels
and most importantly for the coach the athletic director uh... is that
if they don't have a certified athletic trainer as part of their staff if they
don't have employed
uh... team physicians as part of their staff
um...
that anybody suspected of having a concussion
needs to be
pulled out of play pulled out of game
play and or practice and cleared only by somebody with that proper expertise
for a coach to
suspect a concussion he's gonna have to have concussion education himself and the
same goes for the player and the same goes for the parent
are there consequences for schools that don't comply
the law gave us the authority to impose penalties or consequences we have at
this point chosen
not to take
uh... the penalty approach because as i said we really are finding that people
want to do the right thing with
with this so we're really providing technical assistance uh we're developing
model guidelines and policies
so that schools can have those to use
uh... really we've been asking um
developing frequently asked questions because people had a lot of uh...
questions that they wanted to know me put that on line so our focus really has
been supporting schools to do it
um... theoretically we could develop penalties but that's not been how we've
approached it so far
while the law is a very important step in addressing the concussion problem
everyone working on this issue agrees that more education is also critical
education is the easiest thing in the world to accomplish it doesn't you know
it doesn't take a great deal
um... but the hardest thing i think because you know dr cantu and chris nowinski have
put together the most phenomenal concussion clinic that i i i mean i can't
imagine a better one and in fact the feedback from coaches who do attend they they
say this was the most worthwhile training i've ever been to and i would
encourage other players you know and coaches to come and you come back
the discouraging thing is there's thirty five people in the room people don't
recognize their need for the information
and i understand that because i you know three years ago i say this all the time
three years ago if you had said please come out there's an education you know there's a
concussion clinic i wouldn't have gone out i mean evenings are hectic i've got
three kids and putting dinner on the table we've got homework i wouldn't have gone
because i didn't know what i didn't know
and um... you know now that i you know i'd say now
that i know what i know i wish
once people are exposed to it they realize they say now i would get everybody
i know here
uh... the challenge is to
get people to understand how important this information is and
how big the gap is
between their knowledge level and what they fully need to understand to do a
better job of of protecting their child
the sports legacy institute has programs that they're implementing to do with
education
uh... we want to get the word out there
that these programs are available I think parents need to become more aware
and need to educate themselves uh... i think that
they probably have over the years been relying on coaches and trainers uh for
this kind of information and in many cases those coaches and trainers don't even have it
the parents need to take that on themselves and really understand what's going on and
then we need to do a better job of educating coaches and trainers making
sure that they get special training on this that they're aware that they know
what to do they know where to turn to
it's we haven't put any criteria in place or any specific requirements for
somebody to be a coach or a trainer um... in the in the for the smaller kids
and uh we need to have
some better programs for them
I think it's just very important that
parents really understand
the impact of their child's concussion
i've seen a number of
families in my office
that although their child is the number one priority the bigger picture
is they want the scholarship they want the child to do their best they want the
child to be that trophy child and i think that parents need to understand
that whenever there's an issue
um no matter how small it is that the parents if if there is two parents
to come together on the benefit of that child to say we need to stand our
ground and say absolutely no return to play until we're comfortable that he or
she has returned to somewhat normal baseline
and i don't see that enough out there I see parents arguing with one
I see um
I see a lot of dads saying it's okay for him to return i know it's okay to
return i would have returned if this were me and i think that
the kids who are coming out now are more apt to say wait a minute
because of the concussion laws and what we're teaching so if i can impress upon
anything it's to know your child and it's to really be aware and
if they need to be pulled it's okay to be pulled
where the parents have to divulge if the child's had a concussion before
is there a lot of information available for the parents because a lot of people
don't realize that a simple headache can be a result of a concussion well that's an
excellent point and that's why we're pairing uh... that with the training
piece so ideally people have
been trained to understand what can
a concussion can really look like
but the way the questions are asked really has a child ever had a head
injury
have they ever had these kind of symptoms and if so you when did that
happen and how long did it last
so we're trying to
to get at that until you know really everyone understands what a
concussion is
but we feel like that's important information
for the coaches and the athletic staff to have so they know
who they need to look out for
can't the trainer or coach overrule the parent
they can overrule the parent to a degree but when you're talking about children
you can
team shop
um you know this can follow you if you're in a more structured
um sport absolutely then the trainer can follow but there are parents who
will
team shop until they get the answer that they want and they'll pull their child from the
school
so you think not just coaches and trainers but maybe all pediatricians
should be
trained in concussion awareness
absolutely i think it's critical we're going to see more and more and with the concussion
law
these children will have to have a go to to return to sports so somebody is going to have to
answer these questions
there's a lot that parents should do and most of it they are not doing
and uh... you know one of our goals is to really turn parents into advocates
for their own kids you know they're advocates for so many things but they
really
don't pay attention when it comes to sports and the environment that coaches create
now we know you know and i'm a firm believer that coaches are out there cuz
they care about the kids they want them to succeed
but they also don't like people telling them what to do they don't like restrictions and because
they're mostly volunteers they don't have the time to invest to learn this information
so um... what parents should be paying attention to is
you know it's a long list are there coaches educated on concussions at a
minimum are they doing the c_d_c_'s online certification which is thirty
minutes and free if they're not
you shouldn't be sending your kid there because there's no reason they shouldn't be
doing that
you know there are larger ways to to uh...
to teach and to educate you know uh... we provide a lot of that through sports legacy institute
but at a minimum the free online stuff
is there a pre-season meeting for the athletes and the parents so that they
understand what's going on
especially now maybe we won't need it in ten years because everyone will get it by
then but now
no one gets it we're always walking into cold rooms where no one
you know i i
gave a talk to five hundred coaches in chicago
and i said okay how many coaches here have had first aid training
everyone's hand went up
how many coaches here
had CPR training everyone's hand went up
how many coaches here have had concussion training at any point in their career
three hands went up out of five hundred
like let's let's let's wake up here so it starts with education that needs to happen
um... then uh... you know you have to look at your your programs policies
does you know all the guidelines now say and it's now state law in over thirty states
no return to play
same day of a suspected concussion
required medical clearance to go back
does your league require that most laws don't actually touch the low the youngest
kids so if you have a seven-year-old out there playing a collision sport
you better be sure they have those policies in place and they're educated enough to
use them
does the program
commit to re a reduction of repetitive brain trauma 'cause we're realizing now
concussions aren't the only problem
every hit to head may be damaging and what we're certain of is every hit after a
concussion is really damaging and if we're only diagnosing ten percent of
concussions
we should not be opening the door to ninety percent of those kids taking another
hundred hits to the head every week
uh... and so uh... you know are the coaches hitting a lot in practice are
your soccer coaches paying attention at all to how many times kids are heading the
ball in practice
you know we have pitch counts in youth baseball to protect
athletes elbows
and we never ask a soccer coach or football coach to even consider counting
how often they hit your child in the head
so that should be a question parents ask they should be looking at
the equipment are they using newer helmets have they been reconditioned
that's that's part of it it's lower down the list but that's still part of it
um...
and you know there's there's there's more but
i think i would say at a minimum a minimum if your coaches have not been
certified an educated by the cdc
don't sign up your kids because
you know they could end up being one of those kids in our brain bank
just out of
ignorance
are there any other requirements of the regulation
uh... there are a few that i think will be important for people to know about
to begin with
parents have to
uh submit information at the beginning of the season
saying whether or not their child has ever had a head injury before uh... a
concussion and that's really important so that the certified athletic trainer the
coach the school nurse
can really know if this child is at risk once you've had a concussion you're at higher
risk of having a second concussion
and for some of our students who've had multiple concussions it really does
bring up the issue whether or not they should play a different position or
something else has to be modified to lower the risk of them having a
subsequent concussion so that's an important piece to start communication
um... the other piece is that if there's an injury that happens during a game or
a practice
coaches have to notify the parents and they have to do that directly they can't
just you know give the information to the student and say you know tell your parents
what happened so
and many schools are already doing that so that's another important piece
um
I guess the next piece really is that once a child or a student has
been pulled from practice or a game because there's a suspected concussion
they need to go back be evaluated
and have a full medical clearance before they can come back
the idea behind that really is to make sure again
that they're able to do what they need to do when they comeback
and they can't start playing they can't start their sports until they're
completely clear of symptoms and they've gone through what's called a graduated
return to play
that's where you start off really kind of slow you do a little bit of light
activity and then you
move it up
because many times
uh patients or athletes will experience symptoms
at some of these lower levels and then they have to go back and wait until
those symptoms resolve
uh so that's a really important
piece that people are going to have to get used to the kids have to go through this gradual
return to
to play
you know and just the other piece that hasn't been done before that i think is a really
important part of what we're doing is that there also needs to be
accommodations for the student at school if students have symptoms that really
persist for a while
then schools need to sort of help them and figure out a plan for making sure
they get back into the academics in the same way that they need a plan for
getting back into sports
we're taking it more seriously now
i think that
over the years and as you I'm sure can recall many years ago
there were those that just shrugged it off you hear a lot of people continue to say
shrug it off but i think with more publicity
and people coming forward that we are taking more precautions on looking at
this seriously
what kind of resources are there for families who might be looking for more
information on concussions or want to treat concussions
we have a few resources we have had
very limited resources uh…on a national level but i think here in massachusetts
we've got a few uh... spalding rehabilitation network
which is all over the state does provide outpatient rehab centers for a brain
injury for concussion rehab
um the brain injury association of massachusetts is one
um it's a state organization there is one in every state on a national level
can call up and ask for resources surrounding concussions support
groups and physicians uh... as well as myself concussions rehab specialist
uh... in salem massachusetts
happy to provide as many resources as needed or at least to be a go-to
person for those that aren't familiar with resources for the state concussion
rehab.com
groups like the alzheimer's association are probably
are probably providing support
but that's probably because a lot of these guys are being diagnosed with
alzheimer's disease and it's not really alzheimer's disease
and the alzheimer's association has great programs for them because
those kinds of programs can help support the families for this illness to
there needs to be something that's probably a little bit more specific and
a little bit more specialized because it's a little bit different to have
a great big guy who's
two hundred and fifty pounds
who's having these problems
and who's still physically probably still pretty healthy
as opposed to an elderly eighty five-year-old person who's
probably smaller and frailer and and has
different issues going on so we do need some more specialized programs for
these guys they're younger they're stronger they're bigger uh... and they have some some
special problems that need that families need support on
massachusetts new concussion law for schools promotes safety and well-being of
all our athletes
students must submit a history of head injuries to the school nurse before
every season
parents players coaches school nurses volunteers trainers and others associated with
teams must participate in a concussion training program every year
any student who has suffered a head injury or suspected concussion during
practice or competition
must sit out the rest of the day and be cleared by a medical doctor before
returning to play
any head injuries suffered during the season outside of team activity must be
reported to a coach or specified school official
any student diagnosed with a concussion must have a plan for gradually resuming
athletic and academic activities
schools must report annual concussion statistics to the state
my biggest concern I think is that I went
for years
not understanding exactly what was wrong with my husband
and then when he was diagnosed
for years caring for him at home
before i finally couldn't care for him anymore and he went into an assisted
living facility
and i think that there are a lot of other families like that that are in the same
situation
um... they're not educated about what's going on and so they they need
for someone to actually reach out to them find them
provide some help and support to even
help them understand that this is actually an illness and a disease
and i don't think the NFL is taking that kind of action
i think they're kinda shying away from taking that step but
i think it's one that they really need to take there are families out there and
former players out there that are suffering and they don't even know what
they have they don't even know what's going on
a parent of a young child from day one
i would like to be out in front
and making sure that my child gets the best equipment the best
training and the best
education and I think that's what happens sometimes
people just put a child on a field and throw them a ball
and say go for it
and no one is
uh... aware of the pitfalls and
here we are today
we do know what can happen
so let's just go forward and
to the future
to be preventative
you know right now i'm in a stage where I'm just trying to deal with uh my husband's illness
it's too late for us but
if we can just all be preventative
take that and go with it in the future
you know it'll be a better sports community for all of us
you know maybe a few times when you i was a kid
did i ever maybe hit my head but i don't remember ever having the symptoms of a
concussion
but uh... until I played football
football was
the sport
that i got involved in
brought me
to concussions ha ha ha
part of the problem is that players may hesitate to report symptoms
they may believe their injuries are no big deal
or they'll try to tough it out return to the game for their team
there maybe pressure from parents other adults or other players to keep playing
don't let your athlete convince you that they're just fine or that they can
tough it out
emphasize to athletes and parents that playing with a concussion is dangerous
if a coach suspects a concussion in a young football player it's critical
that that player not return to
play or practice
if one of your players has a concussion their brain needs time to heal
a repeat concussion one that occurs in a short time period before the brain
recovers from the first can be very dangerous as it may slow recovery or
increase the chances of long term problems it could even be fatal
most people who suffer a concussion fully recover however returning to
sports and other regular activities too quickly can add weeks or months to an
individual's recovery time for
boys and girls who are in school concussions not only affect sports performance they affect school performance as
well
students may find they can't do their homework they can't concentrate or study because it prolongs
their symptoms just like a premature return to sports
exercising or activities that involve concentration such as studying working
on the computer and playing video games may cause concussion symptoms
such as headache or tiredness to reappear or get worse
after a concussion physical and cognitive activity such as studying
and learning should be carefully managed and monitored by a health care professionals
early on in my career like my rookie year I started to uh...
uh... bouts of vertigo
that I didn't
understand
why I was getting it it would
prolong itself for
periods of time where i just
just be completely incapacitated
and the coaches would just
put me in a
dark room and say
take a nap and
we'll see you after practice
so knowing now i know that i
probably was having residual effects and after having seen doctors know that
those
migraine headaches that i was experiencing were probably triggering those
episodes of vertigo
the good thing is is usually a concussion
isn't as bad as a second concussion
you know if you get a concussion and a couple days later you hit it again that's bad
so with all the new rules when somebody is even thought that they may be concussed
that in and we had a player go down and hit her head the other night in boxboro
and you the trainer come over and spent I'm gonna say a half an hour
with her evaluating her
her awareness whether she was confused and
and uh and it everybody's taking it so serious that you can get over that first concussion in a couple weeks
but if you get the second that's the one that'll linger on and the kid that got hurt last
year we found out she had hit her head previously in another game from another league
before it happened so
second hit is uh
is devastating
we are very supportive of
students engaging in sports
being an athlete doing sports is absolutely uh...
a key part of
being a a healthy adult and getting those
uh... developing those habits is important
so we want to be supportive of sports
initially there was some concern that omigosh you're trying to you know get rid of
sports and that's not the case at all we just want to make sure that students are
safe in doing it
i have three kids they all play sports every season so I understand the... the
importance of sports in kids lives and so we just want to make sure that kids
are able to do that in a healthy way
we got two concussions out of a game
i think three years ago in andover had a concussion last year and we lost a girl
half a year very
important player center in one of our lines had a concussion and was gone for half the season
so yeah it's always there
there's a lot of contact out there
you know there they can you can
make contact with somebody as long as you don't lower a shoulder
as long as you don't extend a hip you don't extend
if you bump into somebody it's incidental contact there's a lot of incidental contact
and it is very very rough
but as long as you don't expand on the hit it's not considered a check
so it's not like they're playing a game without
contact
there's still a lot of
there's still a lot of mucking it up especially in the corners
i'd like to thank all the guests for sharing their stories with us
while it may be too late for them to undo some of the damage it is not too
late to prevent the rest of us and our children from some of these injuries
take a moment to review the symptoms again and if you or your child is experiencing
any of these do not return to activities until being cleared by a trained
professional


from the massachusetts school of law
i'm holly vietxke and this is educational form