HBO’s Real Sports Features Concussion Crisis in Youth Football Players

Over the past three years, 17 high school football players have died after sustaining head injuries while playing. A similar situation in the NFL would have caused a national uproar, so how has this been allowed to happen to our youth?

Take a look at trailer for this riveting episode of HBO’s series Real Sports with Bryant Gumbel, which is airing several times on HBO through mid-December 2016, as well as On Demand. The episode as a whole explores why there are such inconsistencies in protecting professional athletes versus the youngest players.

How to Mismanage a Child’s Concussion

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

Lots of myths and misinformation exist about how parents and coaches can supervise the recovery of a child’s concussion. Some of the most common ones stem from advice that was given years ago. But better understanding of brain injuries and new imaging technology has changed how concussions are treated. Here’s what NOT to do when managing your child’s injury.

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1  — Waking Every Hour or Two
Decades ago, physicians and clinicians encouraged parents to wake up their concussed children frequently to monitor their mental status. However, with modern imaging and clinical evaluations, patients who have been cleared by a concussion specialist can sleep soundly. In fact, remaining asleep 12, 15 or even 20 hours following a head injury is actually helpful, restful, and promotes faster recovery.

2 — Return to the Game Too Soon
Most concussion laws in every state have a provision in which a child is removed from play when a concussion is suspected and can only be cleared to return by a concussion specialist. Unfortunately, clinicians will periodically encounter an overly ambitious parent wanting to return his or her child to play prior to making a full recovery from the concussion. Depending on the timing, this can be exceedingly dangerous. If it is too soon, the child may be in danger of secondary impact syndrome, which can be fatal.

3 — Keep Away from Friends and Electronic Devices
Socialization is an important part of adolescent development. Keeping a child completely isolated from friends and electronic devices can lead to a sense of isolation, and in some cases, even depression. Clinicians and parents need to be mindful of balancing remediation with a young person’s sensitive self-esteem.

4 — Promote Completely Inactivity and Darkened Rooms
Although some rest is thought to be useful from 48 to 72 hours after the head injury, extensive rest and inactivity in a dark room is actually thought to do more harm than good. The brain can actually have more difficulty to returning to normal activity following an extensive period of inactivity.

Be Cautious of New Products or Research That Promise to Prevent or Heal Concussions

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

Periodically when I’m seeing patients in our HeadFirst concussion clinics, parents will ask me about a different brain trauma-related studies that they’ve heard about. These questions range from studies about concussion-healing chocolate milk to eye tracking devices to the effectiveness of helmets and different sports bands preventing head injuries. Presently, NO concussion treatments have been approved by the United States Food and Drug Administration (FDA). Likewise, the FDA has yet to approve of any devices that prevent concussions in the first place. No helmets, no mouth guards, no sports band or other piece of technology in any way shape or form has been demonstrated to completely prevent concussions.

I typically advise parents to be extremely cautious with new research or technology, or with the promises of concussion treatment. Instead, parents should seek out a concussion specialist who has years of experience treating these injuries and utilizes multiple methods in their assessment, diagnosis, and treatment planning.

Refreshing Delicious Chocolate Milk

Can chocolate milk heal concussions? Don’t count on it.

Significant Head Trauma Can Occur with Repeated Hits, Not Just Concussions

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

CTE’s connection to football has been in the news for five years now, with a debate centered around whether the number of concussions will affect long-term health and well-being of those playing the sport. Likewise, I’m constantly asked by patients and parents what the future effect of this or future concussions will be on their health. A recent study released by researchers at the Boston University School of Medicine (such as Dr. Robert Cantu, Dr. Ann McKee, Chris Nowinski and others) will probably give moms and dads across America a moment of pause before starting a collision sport like football or hockey.

An answer may lie in a concept developed by these researchers called the Cumulative Head Impact Index (CHII). They found individuals who had more hits to their heads—regardless of whether they had a concussion or not, were significantly (i.e., not even close…a large statistic margin) more likely to experience later-life cognitive problems, apathy and depression. The caution here is that the sample size was only 93 individuals and the exposure was only to football.

Helmet-Warning-Label

A football helmet’s health warning sticker is pictured between a U.S. flag and the number 55, in memory of former NFL player Junior Seau; new research suggests that the accumulation of subconcussive hits may have more significant long-term effects than concussions. (© Mike Blake / Reuters/REUTERS)

The next step is for medical providers and concussion specialists to help families begin to connect the dots throughout the developmental hurdles of a child’s life. For example, the health outcomes for two 7th grade beginning hockey players if they have a different history. One student may have fallen off a changing table as an infant and suffered a skull fracture, have been in a motor vehicle accident, and have fallen multiple times during winter sports, while the other 7th grader may not have suffered any head injuries or significant head trauma. Baseline neurocognitive testing like the ImPACT® test might look different on these two young students, and the outcome and recovery time of any current injuries sustained by each of them could be considerably different.

I’ve often said that kids can’t live in a bubble as much as parents are sometimes inclined to want to wrap their kids in bubble wrap. Young people—really, people of all ages—are going to be in car accidents, bike accidents, and slip and fall just going through life. Parents need to make their own unique, informed decision about how much additional risk of physical injury to which they want to expose their child, given his or her medical history and athletic abilities.

When Is the Right Age for a Child to Specialize in a Sport?

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

How many times have you seen parents running their kids from one sporting event to the next? Parents and kids feel the pressure to stay on the best team, with the best trainer, and the best coach to continue to progress in their sport.

At what age should a child or teen begin to specialize in a sport? Should kids go the route of gymnastics and figure skating and focus exclusively at an early age or should specialization be held off until high school or college when bodies and minds begin to fully form and develop?

An excellent article on the Steve Nash Basketball Blog addresses these questions and more.

Sports-Kids

Having been in the military, I had the benefit of having my children participate in school systems and sports programs up and down th
e Eastern seaboard. School systems and sports programs are not all the same. The culture within these communities created by principals, athletic directors, teachers, coaches, athletes and parents were a direct result of their collective focus and values.

As a psychologist, what I have found interesting is that the value system of sports and athletics tends to mirror one another. Within one community, children are not cut from a sports team – all children up to 9th grade may be able to try out and play on any team without getting cut. In the same community, children may not receive letter grades – or “competitive grades” – until the 8th grade.

Elsewhere, however, I’ve seen children cut from teams and competing for spots as early as 1st grade, when they also begin receiving competitive letter grades.

As with many things, the trick is in finding the right balance. Children in 1st grade cognitively can’t keep score and focus on the tasks of what they need to do on the field. What does a “D” in reading really mean to a first grader? A summary letter grade is an abstract concept that doesn’t teach very young children that they need to read more to improve their proficiency. The same applies to sports. An older child can understand the causes and consequences of a low letter grade, be it in academics or sports. But is waiting until 9th grade to be cut from a team too long to teach the lesson that life is competitive?

Another factor to consider are that traumatic brain injuries (concussions) will interrupt an athlete’s season and training. The type of community a child is living in and the focus of the coach, parents, athletic trainers, administrators, and other adults working, training and living with these young athletes can affect treatment outcomes in case of a concussion. Is your community one that is fostering hyper-competition that is focused on the top one percent or does it focus on age-appropriate health and well-being of all its children and how they all can benefit from athletic competition?

Is Discussion About Concussions in Youth Soccer Being “Gagged” by Officials at the Highest Level of the Sport?

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director
and Ann-Marie Sedor, HeadFirst Concussion Care Marketing

A recent story out of Louisville, Ky., is that US Youth Soccer is trying to “gag” its state officials from having public conversations about concussions in their sport. US Youth Soccer is the largest member of the United States Soccer Federation, the governing body for soccer in the United States, and has 3 million registered players between ages five and 19.

Unfortunately, leaders of US Youth Soccer have declined to discuss why the organization issued a memo encouraging soccer leaders not to talk to the media both generally and specifically concerning upcoming concussion stories. However, a statement on their website says they are not trying to ‘muzzle’ their membership but instead to create one singular communication channel to avoid inaccurate or conflicting information.

The president of the Kentucky Youth Soccer Association President said the request came from the United States Soccer Federation, their parent organization, and was sent out as a precaution because of the pending lawsuit filed in California that seeks only to change playing rules rather than monetary damages.

Soccer officials at the state level aren’t buying it. Oliver Barber, a lawyer who is chairman of the Kentucky Soccer Referee Association and a volunteer coach was quoted as saying “I don’t like US Youth Soccer telling us not to address such an important issue. We have a whole lot more work to do to keep players safe.”

Like many sports today, soccer administrators at all levels of the sport, including youth, high school, college, Olympic and pro, are experiencing pressure from parents, athletes, referees, and the community to address the issue of concussions. Over the past year or so, soccer officials have been struggling with rule changes such as whether or not to let players head the ball under the age of 14. Two of the top proponents of avoiding ball heading at a young age include former U.S. international soccer star and World Cup champion Brandi Chastain and Dr. Robert Cantu, a leading expert on head trauma in sports and a clinical professor of neurosurgery at Boston University School of Medicine.

Girl Heading Soccer Ball - 2

A number of studies have shown that soccer players have developed CTE (chronic traumatic encephalopathy) and experience cognitive changes from frequent heading of the ball. The damage occurs, not as a result of a single concussive injury (although these injuries also occur in soccer), but as a number of cumulative hits in which the brain moves. These hits are called subconcussive trauma, and while scientists don’t have a handle on the defined threshold before injury appears, there is clear evidence in their research that heading the ball over time produces structural changes which can be observed in neuroimaging.

As soccer administrators in the United States continue to formulate rule changes to protect our children and protect the integrity of the game, parents can and should continue to be their child’s best advocate with regards to safety.

Parents can:

What’s Missing in Youth Concussion Laws

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

A recent Fox Sports article discusses the youth concussion laws that have passed in all 50 states and the District of Columbia, but it also highlights some key elements that were missed.

Over the past five years, each state has modeled their laws after the State of Washington law in 2009, also known as “The Zackery Lystedt Law” after a high school athlete who suffered a life-changing concussion (pictured below, pre-injury and today, with his father).Zackery-Lystedt

Unfortunately, only 21 states have implemented all four key components of Washington’s law, which is considered the gold standard by many professionals:

1. REMOVAL FROM PLAY
This is pretty basic. The science and medical reasons for asking a child or athlete to leave a game or practice when a concussion is suspected is in place so a second and potentially more dangerous concussion does not occur. As of today’s writing, neither Illinois nor Wyoming requires the removal of an athlete from play in such a scenario. Arizona and South Carolina allow an athlete to return to play the same day if cleared by a physician.

When a child is suspected of having a concussion, it is a good idea to at least wait 24 to 48 hours after the injury to ensure that symptoms do not develop. Here at HeadFirst, as many as 40% of our patients develop symptoms one to two days after their injury.

2. EDUCATION
Fortunately, this is not as opposed as it was just three or four years ago. Coaches now realize the importance of receiving education about how to evaluate and treat a head injury. New York law requires not only coaches but also nurses, athletic trainers, and teachers to receive training on concussion and concussion management.

But New York is the exception and there are many states that don’t require education about concussion. Researchers and scientists also still need to do much in this area. Studies have not been completed on what coaches and athletic trainers know prior to training and what type of training is effective.

3. PARENTAL CONSENT
This is quite a basic component of the law which requires student athletes and parents to sign an informed consent stating they understand the dangers of the sport and that a concussion or traumatic brain injury is one of the risks involved in the sport.

4. MEDICAL CLEARANCE
Only 30 states have this element as part of their laws requiring clearance by a trained concussion healthcare provider prior to injured athletes’ return to play. Many laws and training programs also do not specify what training a concussion specialist needs or requires.

Even though these elements are a good first step, they’re still not enough to protect our children. A carefully designed return-to-learn plan is just as important in concussion recovery since academic demands can slow brain healing. Unfortunately, only two states—Nebraska and Virginia—have return-to-learn elements within their concussion guidelines. These procedures require a school to be notified if a student has sustained a concussion and then to give that student accommodations due to the injury.

Some states have even made unsuccessful attempts to add supplementary requirements to their concussion laws.

Oklahoma tried to add a section to their law that would mandate suspensions and punishments on coaches and athletic trainers who didn’t follow concussion guidelines.

Massachusetts attempted to add required neurocognitive baseline testing for all high school students.

And, Maryland tried to add a requirement of helmet sensors on high schoolers’ helmets before basic scientific research had been completed on the sensors or the meaning of a positive or negative sensor result.

HeadFirst-Doc-is-In

A number research studies continue to suggest the negative effects of alcohol (and other recreational drug use) after brain injury.

Alcohol is a neurotoxin — meaning alcohol kills brain cells — exacerbating the effects of a concussion. There is no recommended safe amount of alcohol or recreational drug use after a concussion. Even moderate amounts of alcohol for people with a concussion have been associated with increased deficits in memory, attention and balance.

Additionally, heavy pre-injury alcohol consumption is associated with poorer health outcomes and substance abuse post-injury. Many concussion patients report they are more sensitive to the effects of alcohol after injury. Even a small amount of alcohol after a concussion can impair judgment and increase the risk of a fall (and subsequent head injury).