How Well Do Football Helmets Protect Players from Concussions?

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

One of the most common questions that I get from parents is “How well will my child’s helmet protect against concussion?”

The elusive answer appears to have been provided at the 2014 American Academy of Neurology’s annual meeting. In a study co-authored by Frank Conidi, MD, DO, MS, director of the Florida Center for Headache and Sports Neurology, Assistant Clinical Professor of Neurology at Florida State University College of Medicine, the standard drop test was modified to measure linear and rotational responses in crash test dummies to repeated 12 mile-per-hour impacts.

Conidi, who is also the vice chair of the American Academy of Neurology’s Sports Neurology Section, and his colleagues conducted 330 tests to measure how well 10 popular football helmet designs protected against traumatic brain injury, including: Adams a2000, Rawlings Quantum, Riddell 360, Riddell Revolution, Riddell Revolution Speed, Riddell VSR4, Schutt Air Advantage, Schutt DNA Pro+, Xenith X1 and Xenith X2.

They found that helmets do protect the player from massive injuries like skull fractures in the range of 70 to 80 percent but provide little to no protection against concussion in the range of 10 to 15 percent.

Why is that? While the helmet does its job in disbursing the impact of a hard hit across the helmet to greatly reduce the risk of a skull fracture at one specific site, a helmet cannot stop the brain from shaking inside the skull, thus providing little to no protection against a concussion.

In fact, the team of scientists found that football helmets, on average, reduce the risk of traumatic brain injury by only 20 percent compared to not wearing a helmet. Added to these statistics, Conidi says, “Alarmingly, those that offered the least protection are among the most popular on the field.”

One of the best tools we have available is neurocognitive baseline testing. With the beginning of the school year upon us, please remember to get your child baseline tested. Headfirst Concussion Care offers free ImPACT® baseline testing. Please call 1-855-748-4868 (SIT-IT-OUT) or visit us online to arrange your child’s appointment.

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Fall Sports are a Great Time to Learn About Concussion Symptoms

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

Fall sports are right around the corner, which means doctors will see an uptick in the number of traumatic brain injuries.

Here are a few tips for parents to keep their kids safe throughout the season:

#1 – Get educated on concussions and mild traumatic brain injury. Learn what the symptoms are so if your child is experiencing some difficulties, you‘ll be able to identify the problem.  Common symptoms following a concussion are:
•    Physical – headache, dizziness, balance problems, fatigue, light and noise sensitivity
•    Cognitive – problems concentrating or remembering information, feeling foggy, and feeling slowed down
•    Emotional – feeling more irritable or sad, feeling more nervous or feeling more overwhelmed
•    Sleep – feeling drowsy, sleeping to little or too much, and trouble falling asleep

#2 – Talk with your kids about concussions. Let them know about the symptoms and that they should tell their coach and yourself if they aren’t feeling well after a game or practice

#3 – Focus on the goal of why your child is playing sports. Great goals include:
•    the importance of team work
•    discipline (especially if that effort can be translated into the classroom)
•    making friends and getting some exercise.

Keep it in perspective that most of children are not focused on the pros – they’re in sports for the sheer love of playing. If your child is injured, please take a conservative approach and wait until he or she is completely healed (without the above-listed symptoms) before returning to competitive athletic competition.

#4. Familiarize yourself with Maryland law regarding concussion. Every state now has concussion laws regulating traumatic brain injuries in youth sports. These laws generally have three major components: to educate parents, coaches and players about concussions; to remove the athlete from play if he or she is suspected of having a concussion; and to ensure the child is cleared by a medical provider to return to play.

#5. Familiarize yourself with the policies of your child’s school and team. Make sure that your son or daughter gets baseline neuro-cognitive testing in the unfortunate event they do sustain an injury. Doctors can look back and see what your child’s performance was like prior to the sports season.

We have thousands of visits a month to treat head traumas.  I am often asked if sports are worth it. Absolutely! Kids learn leadership, companionship, competition, exercise, emotional balance, and many other values and benefits of sports. The primary danger with a head injury is returning too soon before the injury has had a chance to heal itself. Play it safe. And remember, when in doubt sit it out.

HeadFirst Concussion Care - Fall Sports - Concussions

Summertime is Fun But Watch for Risks

by Tony Doan, Psy.D.
HeadFirst Concussion Care Program Director

Each week in our concussion clinics, I am reminded about how seemly innocuous summertime activities can unexpectedly take a turn for the worse. Pool injuries are all too common, especially in older teens and young adults. Though their bodies have changed over the years, people in the late teens and early 20s can forget how much taller they are and more they weigh than in their youth.

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I recently saw a young women who had jumped into about four feet of water and landed on her head and neck. She needed to be flown out to a regional hospital that manages shock and trauma patients but, luckily, had no life-threatening injuries. Unfortunately, the hospital sent the patient home with instructions to wake up every couple of hours, which goes against concussion recovery guidelines for brain rest. So, our work on educating both the public and professionals goes on.

Another patient I recently treated was a man in his 60s who was playing baseball with his grandson and fell face-first against a tree — hard enough to sustain an eye injury and a concussion. After more than a year of treatment, he continues to have memory and balance problems.

The summer is a fantastic time to hang out by the water, play games in the yard. But, always be careful. Be aware of your surroundings. Frequently stay hydrated and make sure your loved ones around you are doing the same.

Concussion Concerns Raised Again in the World Cup Finals

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

Germany may have won the 2014 World Cup, but their team wasn’t immune to head injury. In Sunday’s final game when Germany won against Argentina, German midfielder Christoph Kramer was hit hard in the face with a shoulder charge and knocked right off his feet. He was slow to get up and clearly disoriented but continued playing for another 14 minutes before slumping and needing help off the field. Even then, Kramer had difficulty maintaining his balance and appeared dazed despite attempting to shrug off the injury.

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Hassan Ammar/AP Photo

For the International level and professional level, games committee members will need to change the rule to allow an immediate substitution for a suspected concussion that doesn’t count against a team’s three-substitute rule for the entire game. Coaches and doctors can then immediately recommend subs to relieve the injured players.

For college, high school, club and recreational athletes playing soccer, the hits and concussions seen over the course of the World Cup have been good learning lessons about concussions. For coaches, the World Cup injuries are clear examples of when a child needs to be removed from a game and be evaluated and cleared by a medical professional prior to returning to practice or games.

With the action of the World Cup being, quite literally, on the world’s stage, we hope concussions finally get the attention they deserve.

Online Resources for Concussion Recovery Include Webinars and Apps

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

The Defense and Veterans Brain Injury Center (DVBIC) is a great resource for anyone healing from a concussion. This week, the center released new treatment guidelines for both insomnia and mTBI. You can read more information on their press release at: dvbic.dcoe.mil/press/2014/new-clinical-recommendations-treat-sleep-problems-following-concussion-released.

The DVBIC website has a ton of information for servicemembers, veterans and medical providers as well as family members and friends of anyone recovering from a brain injury. All the details can be found at: dvbic.dcoe.mil.

For medical providers, an ongoing webinar series is offered. The one coming up this Thursday, July 10, from 1:00-2:30 pm (EDT), is titled “Do Helmets Prevent Concussion?” More information can be found at: dvbic.dcoe.mil/webinar/2014/Do-Helmets-Prevent-Concussion

If the webinars are a little too scientific for you, check out the 27 cool apps that are helpful for individuals recovering from mTBI at: dvbic.dcoe.mil/slideshow/27-life-changing-iphone-and-ipad-apps-people-brain-injury. Some are free apps, while others are paid, but all use today’s smartphone technology to simplify everyday life for people with brain injury.brain_injury_apps

These are just two examples of the tons of information that both the scientific community & medical providers, as well as patients and their caretakers, will find useful and educational regardless of your level of understanding of mTBI. Enjoy & I hope you all had a fantastic 4th of July.

That’s a Red Card!

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

Most of the globe is currently watching the World Cup and although football gets the lion’s share of the headlines about concussions, the June 19 soccer game between Uruguay and England is sure to land FIFA in some hot water. During the second half of the match, Álvaro Pereira, one of the stars of Uruguay’s national team, laid unconscious (below) on the field after taking a knee to the head. He fell to the turf and took at least 15 seconds before he showed any signs of consciousness.

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Richard Heathcote / Getty Images

It was clear to everyone—the players, the referee, the TV commentators—that Pereira was unconscious. At this stage, there’s no further diagnosis necessary. You will often read that doctors disagree about when to diagnosis a concussion or mild traumatic brain injury but once there is a loss of consciousness all doctors agree that a concussion or mTBI has occurred.

Pereira should not have been let back onto the field. His coach, his team physician and the FIFA physician all should have stopped him. But Pereira insisted on returning to play for the remainder of the game over the objections of his team’s doctor, while FIFA doctors didn’t even examine him until after the game was over.

Sure, any player would be upset but irritability and mild aggression are normal responses following a head trauma. Pereira should have been lead off the field and if the team didn’t get him off the field, they should have been issued a yellow card.

FIFA needs to do more in terms of educating international coaches, players, fans, and their medical staff. Mr. Pereira was cleared an hour after the game by FIFA physicians as being apparently concussion free; no return to normal cognitive activity and no return-to-play protocols needed. That’s a red card!

Keeping It Simple is the Best Medicine

by Daniel Pokrifka, ATC/L
HeadFirst Concussion Care Program Administrator

No matter the type or severity of an injury or illness, the basics of healing are the same: A good night’s sleep, a warm bowl of chicken soup, a walk in crisp, clean air, and a cup of tea can heal all your troubles…or so, Grandma used to say. Well, Grandma now has some science to back her up, even when it comes to recovering from a concussion.

Your Brain Needs Time to Rest
The National Sleep Foundation recommends that adults get seven to nine hours of sleep per night for optimal mental health. The brain needs this time to perform the necessary function of memory consolidation and other essential processing. Without this, one’s mental faculties suffer. While healing from a brain injury, your brain needs more rest to perform these essential functions as well as promoting further healing from the injury. This increase in sleep is only recommended for the few days after the injury. Beyond this, a return to a normal sleep pattern is recommended to allow the body to adjust back to the normal circadian rhythm.

Feed Your Body Well for a Balanced Mind
The human body relies on healthy foods for optimal functioning, growth and healing. A regular diet rich in nutrients not only fuels the body for daily activity, but also it fuels the brain. Daily intake of good foods can also avert long-term problems with depression and anxiety that can arise with a prolonged injury. Colorful fruits and vegetables that are high in antioxidants are also especially good for strengthening blood vessel walls, including those in your brain.

Regular Exercise Promotes Faster Healing
Regular exercise boosts your good cholesterol and reduces your bad cholesterol, both of which keep your blood flowing smoothly and promote healing. Light exercise or therapy after an injury helps reduce pain, increase range of motion, and rebuild healthy muscle tissue. Gentle exercise after a concussion also elevates your brain’s secretion of serotonin, which can make you feel happier and more relaxed. This acts as a natural combatant against post-injury depression and anxiety.

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Water is the Source of Life
Proper hydration helps all body process to function properly. Without it your body cannot begin the process of healing. Clear, nonalcoholic and non-caffeinated drinks are best. For variety, add a squeeze of lemon or lime, or drink seltzer water. There is no magic number for the amount of water to consume but don’t wait until you’re thirsty — at that point, you’ll already be on the the way to dehydration.

While a concussion is a complicated injury, healing from it doesn’t have to be. Taking steps that include rest, nutrition, hydration and gentle movement will help heal your brain faster. With all the complexities of medicine it’s nice to know sometimes simple is best.