First "Concussion in Sports" Law

It is becoming standard practice for youth and high school sports programs to have policies and regulations when it comes to concussion protocols. Many high schools now require athletes and their parents to undergo “concussion education” before they are cleared to participate in their sport. This education includes the signs and symptoms of a concussion, the importance of self-reporting, and the dangers of playing with a concussion. Return to play guidelines are also covered so that if an individual sustains a concussion, they will be aware of the steps they have to go through in order to return to the sport. Recently, a law made this required.

In 2009, the state of Washington passed the Zackery LystedtLaw, the first “concussion in sports” law.

“The new law (House Bill 1824), known as the Zachery Lystedt Law, requires medical clearance of youth athletes suspected of sustaining a concussion, before sending them back in the game, practice or training." According to the Centers for Disease Control and Prevention, three actions should be included in every program in regards to concussion:

1.  Educate coaches, parents, and athletes
2. Remove athlete from play
3. Obtain permission to return to play

With these guidelines, “an athlete can only return to play or practice after at least 24 hours and with permission from a health care professional. That being said, the Athletic Trainer has the final authority on whether they believe an athlete should participate or not. More laws need to be implemented in regards to concussion to certify the safety of athletes everywhere. Too many athletes and parents are unaware of the risks that they are taking when playing with a concussion. The dangers are serious and real and should not be taken lightly. The “suck it up” attitude of athletes, parents, and coaches needs to be eradicated in order to ensure the safety of the athletes.

New programs for football leagues are being implemented to ensure that all coaches are being taught how to instruct players to tackle correctly. This training is available for youth, high school, and clinicians. The training includes correct tackling techniques and similar concussion training as described above. This program is called Heads Up. The program is a great way to teach these coaches, parents, and players how to prevent, recognize, and respond to a player that has a concussion.

For more information on concussion laws and policies, please visit: http://www.cdc.gov/concussion/policies.html

Breaking Boundaries in the Field

 

I believe that Dr. Shane Caswell is a very important researcher and scholar in regards to the subject of concussion and in the Athletic Training field in general. Dr. Mr. Caswell received his B.S. in Physical Education Teacher Certification and Athletic Training form the State University of New York at Brockport, an M.S. in Athletic Training, and his Ph.D. from Ohio University. Dr. Caswell is an Associate Professor of Athletic Training and founding Executive Director of the Sports Medicine Assessment,Research & Testing (SMART) Laboratory at George Mason University.

Dr. Caswell is the recipient of the Virginia Athletic Trainer’s Association Researcher of the Year Award and the George Mason University College of Education and Human Development Scholarly Achievement Award. He is a member of US Lacrosse Sport Science Safety Committee and is on the Editorial Boards for the Journal of Athletic Training, Injury Epidemiology, and the International Journal of Athletic Therapy and Training.

“His pioneering research is the first to combine video analysis with epidemiological data to identify the types of game play situations in which head injuries occur in girls’ and boys’ lacrosse. Findings from this work have contributed to rule changes designed to improve safety in boys’ and girls’ lacrosse nationwide”

His main topic of interest is youth sport safety and prevention and management of traumatic brain injury, or concussion. His extensive research on youth sport safety has accumulated to invaluable information.

He shares this information in a Vision Works presentation at George Mason University Prince William Campus.

Recently, Dr. Caswell has created a research project to improve how traumatic brain injuries are diagnosed and managed. He has teamed up with Emmanuel Petricoin, another George Mason University researcher, to test the hypothesis that a biomarker in saliva can determine if there is concussion activity in an individual.

I have had the opportunity to work with Dr. Mr. Caswell on this study doing data collection with the helmet sensors and video recordings for analysis. He is a pleasure to work with and has a brilliant mind. He has contributed to the Athletic Training field in many ways and is respected in the Sports Medicine community.

For more information on Dr. Shane Caswell and to see a collection of his published works, please visit: http://cehd.gmu.edu/people/faculty/scaswell/

Lawsuit on the NFL?

In an article found on CNN, former NFL players are suing the National Football League (NFL). Why would players sue the organization that they prided in? Because of their brains.

These NFL players are claiming that the NFL “knew as early as the 1920s of the harmful effects of concussions on players’ brains but concealed the information form players, coaches, trainers, and others until June 2010.” They expected the NFL to be up to date with this information and protect them from injury as much as possible. Blame on the NFL goes for failing to regulate guidelines for the league on this subject or have return-to-play standards for players with concussion. The NFL’s Brain Injury Committee claimed they had no knowledge “of a link between concussion and cognitive decline.” This statement is unlikely, some sources calling the situation “fraud”.

Studies from the NFL Committee on mild traumatic brain injury published findings that found “no evidence of worsening injury or chronic cumulative effects”. They also state that NFL players can return to play safely on the day of a concussion. This is reckless behavior (and asking for a lawsuit if you ask me). In high-school and youth leagues (and general well practice), Athletic Trainers are not permitted to clear a player to participate after a suspected concussion that same day. The player must wait until the next day to be cleared to participate. “It was not until June 2010 that the NFL acknowledged that concussions can lead to dementia, memory loss, CTE and related symptoms by publishing (a) warning to every player and team”.

Even when the NFL had this information, “the NFL did not warn any past players, including the plaintiff, or the public of the ‘long-term brain injury caused by concussions’”. The article also states that “Chronic traumatic encephalopathy is a degenerative, dementia-like brain disease linked to repeated brain trauma. The disease has been found in the brains of 14 of 15 former NFL players studied at the Boston University School of Medicine Center for the Study of Traumatic Encephalopathy as of May (2011).”

The article provided above shares stories of former NFL players who committed suicide at ages 38-50. This complication with continuous impacts, called chronic traumatic encephalopathy (CTE), is a progressive degenerative disease which presently, can only be definitively diagnosed postmortem in individuals with a history of concussion and sub-concussive impacts. The signs and symptoms of CTE include gait disorders, speech slowing, extrapyramidal signs, mood disorders, paranoia, agitation, social withdrawal, poor judgment, and aggression. This disease is greatly found in individuals involved in boxing and is often called “punch drunk syndrome”. Since this condition is predominantly found in boxing, a sport that clearly involves repeated impacts, doesn’t that alarm the NFL that the hits in football can produce the same dangerous and deadly results that boxers have?

A documentary film called "Head Games" was even made in order to explain the dangers of this condition.

What are your thoughts on the situation with the NFL and what do you think the result will be in regards to the lawsuit?

The Impact of Impacts

Participating in contact sports comes with the risk of mild traumatic brain injury, commonly known as a concussion. The growing controversy of concussions in contact sports has expanded into a national concern. A lot of concern comes from second impact syndrome: “when an individual who has had one head injury receives a second head injury before the brain has recovered from the first head injury, the second injury is often called ‘second impact’. If the individual continues with their activity while concussed and sustains the second impact, the effect is often fatal. If the results are not fatal, the individual would be severely disabled.

More information on Second Impact Syndrome

With the absence of evidence-based data to diagnose a concussion, it is extremely difficult for the sports medicine staff to make decisions about traumatic brain injuries. If there is no definitive information to diagnose a first concussion, the likelihood of preventing second impact syndrome is low. Athletes’ lives should not lie on the low reliability of self-reporting and subjective tests.

When an athlete sustains a suspected concussion, a sideline evaluation is conducted. The athlete is then instructed to take a neuropsychological assessment, such as imPACT, SCAT, or CogSport. These results are compared to a baseline test that the athletes took pre-injury before the sports season. Many athletic organizations, especially high-schools, require this baseline testing at the start of the season so that test results can be compared to the post injury results.

Many concussions tend to be unreported or unrecognized because of the number of athletes to look after and the heightened pressures to “suck it up” and stay in the game. This issue is extremely important for our world in 2014 because of the emphasis on sports in today’s society. Individuals are starting sports earlier than ever before and the mentality to “push through the pain” is widely expected. This issue is important to discuss in order to spread awareness of the dangers of concussion and the significance of reporting injuries.

Multiple concussions and second-impact syndrome are dangerous injuries in the world of contact sports. It is important to spread awareness of these dangers to ensure the safety of athletes everywhere. When athletes are aware of the dangers, they are more likely to report their injuries. Many high-schools are implementing concussion education programs that require completion by the athletes as well as their parents before authorization to participate in sport. This will certify that the parents will know the symptoms of a concussion to make a better likelihood of nothing missed.  Also, new technology is being created and perfected that involves the use of accelerometers in helmets. This technology has been created to get more information on concussions immediately after they have occurred. Impact sensors have been an increasingly popular invention in the sports field to detect concussions instantly. These sensors have been tested in a number of locations on sports equipment. Prototypes that are being used in sports today include helmet sensors, attachable sensors, chinstrap sensors, and even sensors built into mouthguards. This means of impact sensing technology measures gravitational force and records other information, such as where the impact was located, and reports this information to a central database. A computer that stores all of the data will be located on the sidelines which would be accessible to the sports medicine team. An alarm will activate if a force from impact is detected and is considered dangerous enough to permit medical attention. This detection prevents athletes from playing with a concussion and keeps individuals from risk of further injury or death. Impact sensing technology can potentially assist with identifying dangerous head impacts and prevent athletes from putting themselves at a greater risk by continuing to participate after concussion.

We all must understand the importance of a definitive diagnosis of concussions.

Signs, symptoms, and more information on concussions can be found at:

http://www.cdc.gov/concussion/signs_symptoms.html

http://www.cdc.gov/TraumaticBrainInjury/index.html

Information on Impact Sensing Technology:

https://www.theshockbox.com/

http://www.engin.umich.edu/college/about/news/stories/2014/january/understanding-concussions-testing-head-impact-sensors

http://www.x2bio.com/x2_x_guard/

http://www.x2biosystems.com/