The other day I was asked in a radio interview what I thought were the biggest recent developments in concussion safety, and what I saw happening in the near future to protect our kids from the dangers of brain injury in contact and collision sports. Here are the five developments that I view as the most significant, and a seven-point "wish list" for what I hope to see in the not too distant future to make such sports even safer:
1. Concussion safety laws. This one, pardon the pun, is a no-brainer. The passage of strong youth sports concussion safety laws by 40 states and the District of Columbia [1] over the past two years promises to do more than anything that has ever been done to improve the safety of contact and collision sports. Each law contains three components that MomsTeam and I have long been advocating: First, that the education of parents and athletes about concussion safety before every season [2] be made mandatory if the child is to play. Second, that athletes suspected of concussion be immediately removed from the game or practice (as all current expert guidelines provide), and, third, that they not be allowed to return to the game or practice field until a health care professional with concussion training and expertise gives the okay.
Such laws will go a long way to protecting against athletes, not only from death from second impact syndrome [3] (uncontrolled bleeding in the brain from a blow to the head before the brain has fully healed from an earlier injury) such as in the well-publicized cases of Ryan Dougherty of New Jersey, Jake Snellenberg in Colorado and Matthew Gfeller in North Carolina, but permanent disability, like that suffered by Zack Lystedt [4], which inspired the first of such laws in Washington State two years ago.
To parents, coaches, administrators, legislators, and governors in the other states, some which have weak concussion safety laws (Idaho, Vermont, and Wyoming), and some where legislation is pending or about to be reintroduced, but especially in the six states where no concussion safety bills whatsoever have even been introduced (Arkansas, Georgia, Kentucky, Mississippi, Montana and West Virginia), I ask, what are you waiting for? Help enact a law in your state now! We owe to it the kids.
2. Exciting new technology: Athough we are a long way off from seeing helmets or other equipment that can prevent all concussions, and, frankly, that day may never come, there is a lot of exciting new technology coming on the market.
Helmet sensors
The latest product to hit the market is the ShockboxTM wireless impact sensors [5] from Impakt Protective.* Once attached to a player's helmet (a hockey version is available now, versions for football, lacrosse, and ski and snowboard helmets will be introduced in 2012) a sensor measures the G-Force of a hit to the helmet from any direction, and then sends the data wirelessly via Bluetooth to the athletic trainer, coach or parent's smart phone to alert them when the athlete suffers a traumatic head impact that may be concussive so they can be removed from the game or practice for evaluation on the sideline using standard concussion assessment tools, such as the Standardized Assessment of Concussion [6], Sports Concussion Assessment Tool (SCAT2) [7] or King-Devick test [8].
It essentially gives parents, trainers, coaches and team doctors a set of electronic of eyes with which to watch out for concussions that might otherwise go undetected, either because the signs [9]were too subtle to be seen by officials, coaches, athletic trainers, team doctors or parents on the sports sideline, or because the player, out of a desire to stay in the game, [9]failed to self-report [10] experiencing concussion symptoms such as headache or dizziness that warrant, at the very least, further evaluation.
Another is Battle Sports Science's Impact Indicator [11],* a football chinstrap that flashes red when a force is transmitted to the head that may be enough to cause a concussion, alerting game officials and sideline personnel to check an athlete for signs or symptoms of concussion (even if they haven't observed any signs and/or the athlete hasn't self-reported experiencing any symptoms). Chinstraps are now available for football helmets, and versions for hockey and lacrosse - two sports with high concussion rates [12] - will be in stores soon.
Smart phone apps
In addition, there are now five concussion apps for smart phones on the market for parents and coaches:
For a review by the MomsTeam staff of the new concussion apps, click here. [17]
3. Exciting old technology with a new use: another tool that is being added to the concussion toolbox to help in the sideline assessment of concussion is the King-Devick test, a 25-year old test of rapid eye movements that two studies at the University of Pennsylvania, one of kick boxers and mixed martial arts athletes [18] and a second more recent one of college athletes at Penn, [8] show can be used to help identify athletes that may have suffered a concussion and warrant further evaluation away from the sports sideline. As with the Impact Indicator, the King-Devick won't prevent concussions, but, used in conjunction with other assessment tools in use on the sports sideline (e.g. SCAT2 [7], Balance Error Scoring System [19]), Post-Concussion Symptom Scale [9]), identify athletes who should be referred for further evaluation. And, speaking of old technology with a new use, a new campaign called BeUnstoppable [20], a collaboration between Chicago-based Healthy-TXT and the STOP Sports Injuries Campaign (of which MomsTeam is a proud member), is using text mesages - which studies show are the best way to reach kids these days - to educate parents and kids. Subscribers are sent free text messages on simple text messages about concussions, sports performance, injury prevention, and motivational tips from leading sports medicine experts and professional athletes.
4. New rules and stricter enforcement of existing rules: Not only is the NFL more strictly enforcing the ban on intentional helmet-to-helmet tackling of defenseless wide receivers, but the NHL is finally tightening substantially its rules against head shots, although it is too bad implementation came only after a concussion sidelined its biggest star, Sydney Crosby from January to November 2011. Two recent rule changes are particularly noteworthy: first, the Ivy League's reduction of the number of full-contact practices [21] in football, which came in response to recent studies by researchers at Purdue and Boston University showing that the cumulative effect of blows that aren't enough to result in concussion may be doing short-term and, unfortunately, long-term damage, including CTE [22], and, second, the adoption [23] by USA Hockey in June 2011 of what it calls its Progressive Checking Skill Development Policy, which tightens the standard of play for intimidation hits in the legal body checking age categories, and only allows, beginning in the 2011-12 season, legal body checking in games at the Bantam age level (ages 13-14).
I don't have a crystal ball, but, based on where we have come, I believe, or at least hope, the future will bring the following improvements in concussion safety:
* MomsTeam sponsor.
1. Meehan WP, d'Hemecourt P, Collins C, Comstock RD, Assessment and Management of Sport-Related Concussions in United States High Schools. Am. J. Sports Med. 2011;20(10)(published online on October 3, 2011 ahead of print) as dol:10.1177/0363546511423503 (accessed October 3, 2011).
Updated and revised October 2, 2012
Links:
[1] https://www.momsteam.com/node/3015
[2] https://www.momsteam.com/node/1459
[3] https://www.momsteam.com/node/208
[4] https://www.momsteam.com/node/3134
[5] http://impaktprotective.com/
[6] https://www.momsteam.com/node/215
[7] https://www.momsteam.com/node/1335
[8] https://www.momsteam.com/node/3776
[9] https://www.momsteam.com/node/149
[10] https://www.momsteam.com/node/2987
[11] https://www.momsteam.com/node/3890
[12] https://www.momsteam.com/node/3094
[13] http://www4.parinc.com/Products/Product.aspx?ProductID=CRR_APP
[14] http://itunes.apple.com/us/app/concussion/id418559920?mt=8
[15] http://itunes.apple.com/us/app/play-it-safe-concussion-assessment/id441786934?mt=8
[16] http://impacttest.com/imcat
[17] https://www.momsteam.com/node/5131
[18] https://www.momsteam.com/node/3290
[19] https://www.momsteam.com/node/221
[20] https://www.momsteam.com/node/3982
[21] https://www.momsteam.com/node/3583
[22] https://www.momsteam.com/node/3289
[23] https://www.momsteam.com/node/3284
[24] https://www.momsteam.com/node/128
[25] https://www.momsteam.com/node/3935
[26] https://www.momsteam.com/node/3843
[27] https://www.momsteam.com/node/3858
[28] https://www.momsteam.com/node/3341
[29] https://www.momsteam.com/node/305