by Publisher | Feb 9, 2011 | Research
The NCAA has an ongoing partnership with Jason Mihalik and his colleagues at the University of North Carolina’s Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center. The group regularly creates educational resources for the NCAA membership and is responsible for two influential studies on concussions (Cumulative Effects Associated with Recurrent Concussion in Collegiate Football Players: The NCAA Concussion Study and Acute Effects and Recovery Time Following Concussion in Collegiate Football Players: The NCAA Concussion Study), which led to the development of the NCAA concussion guidelines. The university recently received grants from the National Operating Committee on Standards for Athletic Equipment (NOCSAE) and the NFL to study the causes and consequences of concussions.
Question: What impacts do acceleration and location have on the severity of a concussion?
Mihalik: At this time, researchers do not have a strong understanding of these phenomena. We know that the greater the head acceleration, the greater the likelihood the collision impact has of inducing a sport-related concussion. Our own data are beginning to suggest that top-of-helmet impacts still occur with relative high frequency and a disproportionate number of concussions have resulted in athletes sustaining impacts to the top of the head, or by striking an opponent with the top of the head.
Q: Are there other factors (for example, biological) that can play a role in the severity of a concussion? How do you account for these unique characteristics when developing standards and best practices to avoid Traumatic Brain Injuries (TBIs)?
Mihalik: Excellent question. From some of the NCAA Injury Surveillance System data that has been published in the last few years, some reports suggest that females have a higher injury rate in competition than males (for example, women’s ice hockey vs. men’s ice hockey and even football). Could this be a function of cervical muscle strength? Is it a function of hormonal fluctuations experienced by females across the menstrual cycle? Is it a function of training athletes to be more aware of their surroundings?
For example, open bodychecking is not permitted in women’s ice hockey. Does this mean that when an incidental body collision occurs it’s more significant because they are not anticipating the collision compared to a male hockey player who expects to be bodychecked when he is in possession of the puck or a running back when he is holding onto the football? We’re still exploring the contributions of these factors on injuries but carrying these findings over to injury prevention interventions seems a logical next step.
Q: There have been several calls recently from New Mexico Sen. Tom Udall and others to create safer testing standards for football helmets. Udall in particular is concerned for youth players. Can age play a factor in the severity and lasting impact of a concussion?
Mihalik: Most certainly it can. Research has identified the young student-athlete to be a particularly vulnerable athlete for many reasons. First, their brains continue to develop into their early 20s. Research has supported the notion that younger athletes, all things being equal, typically require more time to recover from concussions than their adult counterparts.
If injured in their youth, the window of potential repeat injury is lengthened and, thus, the long-term complications of repeated head trauma (injurious or subconcussive) may have lasting effects on younger athletes into adulthood. We need to remember that children and adolescents are not “little adults” but rather individuals who represent an overwhelming population of football players in the United States.
Q: Will there ever be a safe helmet?
Mihalik: This question suggests that today’s helmets are not safe, and that is an incorrect stance to take at this time and, quite frankly, an unfair position to put helmet manufacturers in. We need to understand that the primary purpose of the modern hard-shell helmet is to prevent focal injuries (like cerebral hematomae and skull fractures), and it has done a good job of this. People forget that dozens of football players died each year playing football before the modern-era helmet was instituted in football. In fact, the NCAA was instituted because of such high numbers of deaths in the sport. We’ve come a long way in protecting our athletes with today’s helmets.
Can they be better? Of course. As technological advances continue, it can be expected that helmets would evolve and become more protective. Changes in helmet design have already emerged in the past few years. I think helmet manufacturers get a bad rap for not preventing concussions when, in reality, they very likely prevent a lot of concussions and, more to the immediate purpose of the helmet, prevent catastrophic brain injuries that resulted in many deaths in the past.
Will a helmet ever be able to prevent all concussions? Would a car ever be able to come to a complete stop on a dime without any of the passengers feeling the urge to move forward? In essence, the brain within the skull is the passenger and the head/skull arrives at a full stop very quickly. Can a helmet ever prevent the brain from striking the inside of the skull?
Q: So, is the real issue the abrupt nature of the stop? Could momentum cause the brain to hit the inside of the skull and cause a TBI even if the hit didn’t occur to the head?
Mihalik: This is certainly a common mechanism of injury. Certainly an impact directly to the head is more likely to stop it suddenly, but impulsive (indirect) blows are also very capable of causing a concussion. In fact, this mechanism of injury has been highlighted in the Concussion in Sport consensus statements. Concussion is a very common and real injury that motor-vehicle accidents victims sustain, often due to the violent whiplash mechanisms they experience during their accident.
Q: Are football players able to change their behavior to better protect themselves from TBIs? What effect has your research had on North Carolina student-athletes?
Mihalik: Players can do a lot of things to protect themselves from TBI while playing. For starters, they can heighten their awareness of where they are on the field and where their opponents are. In so doing, they can better prepare for oncoming body collisions. They can be well-conditioned to withstand the physical rigors of extended athletic participation. They can employ safe tackling techniques and not lead with the head.
Q: Your lab recently received a grant from the NFL and NOCSAE. How will you use these funds?
Mihalik: The NOCSAE funds were awarded to begin exploring the differences between girls and boys hockey players and to begin exploring how aspects of muscle strength and anticipation differ between the sexes. The NFL Charities funding will continue to support the Center for the Study of Retired Athletes and Dr. Kevin Guskiewicz’s ongoing work with retired professional football players.
Jason Mihalik is an assistant professor in the department of exercise and sport science at the University of North Carolina.
by Publisher | Oct 21, 2010 | Featured, TV Coverage
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Just this week the NFL is starting to suspend players for vicious head hits. It’s a problem that starts in high school. The number of student athletes suffering head injuries is on the rise. 7s Richard Lemus has more about this Concussion Concern.
WSVN — It’s these violent helmet to helmet hits which prompted the NFL to punish players with hefty fines. From pro football to high school soccer, there are 100s of Youtube videos showing bone crunching hits on the field.
15-year-old David Goldstein knows firsthand how that feels.
David Goldstein: “A ball was rocketed at my head. I was dizzy and in a lot of pain.”
He got his first concussion playing soccer at age 12. His second came after a head to head collision with another player.
David Goldstein: “I was in a lot of pain, seeing stars.”
Both times David went right back in the game. Then in January during the district final against rival Gulliver Prep…
David Goldstein: “I’m thrown into the game and it’s the most important game I’ve ever played in my life.”
Another head to head collision video shows David stumbling across the field holding his head again. He continued playing, but after the game he collapsed.
David Goldstein: “Just thinking about how much it hurt was unbelievable. I couldn’t move I was in so much pain.”
Dr. Gillian Hotz: “We’re really worried now about the young and developing brains, so multiple hits of this type on the brain will really play havoc later on in life.”
Dr. Gillian Hotz of the concussion program at UM says, scientists are starting to realize even one hit can cause brain damage later in life.
Coach Mo Blake deals with injured student athletes at Ransom Everglades. He knows the tremendous pressure they’re under to perform.
Mo Blake: “If they are trying to mask the injury or say ‘I’m OK just give me a couple minutes,’ that’s where we as the coaches, adults and trainers have to really look out what’s best for the kid.”
That’s why school adminstrators at Ransom have implemented the Impact Test for all student athletes.
Claude Grubair: “You take it to get a baseline of where you are under your normal condition, and then you take the post-injury test.”
The Impact Test uses words and shapes to test a student’s memory, mental speed and reflexes. Following a head injury, the student repeats the test if there are any changes in thought pattern any red flags at, all the child is sent for medical treatment right away.
Dr. Gillian Hotz: “We’re able to take a look at the baseline testing and the repeated testing and take a look at the differences and make the proper recommendations.”
Coach Blake says the impact test leaves nothing to chance if a student tries to cover up an injury. The test tells the truth something coaches are glad to have.
Mo Blake: “To not use this tool I think would be detrimental to the student athletes.”
David wishes he had the impact test after his first concussion.
David Goldstein: “If I had that support and that knowledge before my situation would have been a lot better.”
That’s why he is now behind a massive effort to get the impact test into more schools.
David Goldstein: “The initiative now is to raise enough money to provide impact testing for all the public schools in Miami-Dade County with athletic programs.”
Months later David has been cleared to go back to the game he loves.
David Goldstein: “Having all of this behind me gives me the confidence to go back on the soccer field.”
Knowing the impact test and his doctor’s support lowers his concussion concern.
Richard Lemus: “Congress is considering a bill that would establish standards for student athletes who get concussions.”
FOR MORE INFORMATION:
Dr. Gillian Hotz
UHealth Sports Medicine
Tel: (305) 243-3000
http://uhealthsportsmedicine.com/conditions-and-treatment/concussion
by Publisher | Oct 11, 2010 | News Coverage, Print Coverage
University of Miami program targets concussions in young athletes
If your high school son or daughter gets knocked in the head on the playing field anywhere in Miami-Dade, chances are Dr. Gillian Hotz and her colleague Dr. Kester Nedd will soon be on your speed dial.
The two have teamed up to spread the word on concussions and push for high school athletes to be tested before an injury occurs, thus establishing a baseline that will help determine treatment and assess their recovery.
At the start of the 2009 school year, Hotz said she was seeing three to four young athletes a week at the clinic at the University of Miami Hospital. This year, she’s seeing about 14 or 15 kids a week who have head injuries from playing football, soccer and other sports.
It’s not that the sports have become more dangerous. On the contrary, sports equipment is improving, said Vincent Scavo, who spent 17 years in the Miami-Dade County Schools system as an athletic trainer.
“What’s happening now is we’re educating people better,” Scavo said. “The way we handled equipment years ago was we gave the athlete a helmet and said, `Go play.’ Now, we’re conscious of how we fit the helmet. . . . That’s so important today. The hitting is unbelievable — even at the high school level.”
Scavo’s son Alec is a senior and defensive lineman on the football team at Christopher Columbus High School.
Hotz and Scavo, now the director of Sports Medicine Services at the University of Miami Miller School of Medicine, attribute the increase in clinic visits to better awareness and education. Teachers and coaches have been trained to identify concussion symptoms, which include headaches, dizziness and vision problems.
“A few years ago people had a headache or some type of concussion symptom and they would ignore it and say they are fine,” Scavo said. “We realize now that’s not the way to go. Concussions are dangerous. Athletes don’t want to come out of the game. That’s why it’s so important that athletic trainers deal with athletes and teachers to educate the athlete and say, `It’s OK, you have a problem, we’ll get you better.’ ”
But more needs to be done.
Along with The Miami Project to Cure Paralysis, Ransom Everglades in Coconut Grove has teamed with the UM to increase awareness of concussions in sports and raise money to help schools in Miami-Dade adopt ImPACT testing. The goal is to get a baseline reading for all public high school football players next year.
So far, Ransom, Miami Palmetto Senior High, G. Holmes Braddock Senior High and Terra Environmental Research Institute offer ImPACT baseline testing for its student athletes. Colleges and the NFL also use the program.
“ImPACT is an amazing tool, a positive step forward,” said Cheryl Golden, instructional supervisor for Miami-Dade County Public Schools. “Head injuries are an enigma to parents, coaches and kids. It’s not like a broken bone that you can X-ray. With a concussion you don’t have physical proof and that’s what makes ImPACT so valuable.”
Students are tested by answering questions in a computer program; the questions revolve around memory, reflex and timed situations. The ImPACT materials can cost about $600 per school.
“It’s tough for these schools, they don’t have resources,” Hotz said. “They are doing the best they can. Some of these programs in rural parks don’t have a trainer. It’s a dad or a neighbor that’s a coach. If a kid’s really not right, he’s got to be seen, he’s got to be followed, and the school has to play a role in that. They are the gatekeeper.”
David Goldstein, 15, has become one such gatekeeper.
In September, the Ransom 10th-grader addressed representatives from The Miami Project, joining with speaker Marc Buonoconti, a Citadel University football player who was paralyzed during a game in 1985.
Goldstein introduced his school to the work done at the UM clinic after he suffered his third head injury in four years while playing soccer in January.
“I struggled with my situation for a long time. I found doctors Hotz and Nedd here at the Sports Medical Center and they helped me out,” Goldstein said.
The first step in his rehabilitation was ImPACT’s 30-minute computerized test to gauge his motor skills and to determine how serious his head injury was.
“My mental skills were nowhere near what they should have been,” Goldstein said. “They helped me out by finally getting me on medicine. I had a timeline of what to do when and how to come back from the injury. They introduced me to concussion testing.”
Quite a difference from months earlier. After Goldstein’s accident on the field, he practiced the next day.
“I got into the car after and collapsed under the pain,” he said. “I couldn’t move. I went to a couple neurologists who said I should never play soccer again,” he said.
“I’ve played since I was 4. To think I couldn’t play again devastated me. I thought I would wait it out but after three to four months I was having so much pain I had to sleep through a couple periods of school a day,” Goldstein said.
His mission now: Make baseline testing the norm at all schools by the 2011-2012 year.
For a 10-year period ending in 2007, the American Academy of Pediatrics tracked emergency room visits for concussion in children ages 8 to 13 and for teenagers who are all involved in organized sports. Emergency room visits among the younger group doubled and increased by more than 200 percent among the teens. More than 500,000 visits were reported for the combined groups.
Part of the reason for the increase, Nedd says, is the evolution of awareness and treatment. Concussions, and the push for baseline testing of student athletes, has received national attention.
Nedd acknowledged that injuries can’t be completely avoided in contact sports like boxing and football.
“The real issue is the long-term impact on people’s lives. Can they return to work? At school, can they perform at a level that will be deemed acceptable? The interpersonal relationships. When you look at pro athletes and the problems they have, a lot of time they have unrecognizable head injuries they received in junior high and high school. Even mild head injuries affect personality.”
The formative pre-teen and teen years can be most critical, Nedd said.
“Some of the ills we have in society may have a basis in an injury to the brain at an early age.”
Nicholas Johnson, a 10th-grade defensive end at Coral Gables High, sits on an examination table inside the University of Miami Hospital on a recent Tuesday afternoon.
The preceding Wednesday, he suffered a head injury during a football game.
“One of the players on the other team hit me helmet to helmet at least six times,” said Johnson, 15.
He wasn’t overly concerned during the excitement of the game, he said. “I got up, didn’t think much of it and went back to the huddle. It didn’t bother me until I got home that night.”
Thursday, his vision blurred, he couldn’t concentrate on a test in sixth period and his head started to hurt.
That first night, his mother recommended that Nicholas check in with Coral Gables’ athletic trainer, who prescribed immediate rest and set up an appointment for Nicholas at the UM clinic to undergo testing.
“I was glad to see they are very conscientious and were paying close attention to what’s happening with him,” said his mother, Doris Johnson.
Lacking a baseline score, the doctors ran Nicholas through a series of tests, both paper and pencil question-and-answer, and neurological tests of motor skills.
The verdict? An inner ear injury. No football until further tests show a return to normalcy.
“I’m upset because tomorrow is one of our biggest games against Columbus and I can’t play,” Nicholas said.
It could be worse.
“Some families freak out,” Hotz said. “I’ve had 200-pound kids crying that they are out of football. If they reach baseline, with no symptoms, we’ll clear them. But every kid, every hit is different.”
