Increased concussion awareness helping student athletes

This article explains why concussion laws and increased concussion awareness are beneficial for student athletes.

A large increase in the number of U.S. school-age athletes receiving treatment for concussions is likely due to new laws and increased public awareness, a new study suggests.

Researchers examined data collected from privately insured 12- to 18-year-olds across the United States between 2006 and 2012 in order to assess the impact of concussion laws. Since 2009, all 50 states and the District of Columbia have enacted laws about concussion treatment.

In states where such laws were in place during the study period, there was a 92 percent increase in the number of young athletes receiving treatment for concussion. Even in states without such laws, there was a 75 percent increase in concussion treatment for student players, according to the researchers.

"There are two stories here," study senior author Steven Broglio, an associate professor at the University of Michigan School of Kinesiology and director of the NeuroSport Research Laboratory, said in a university news release.

"First, the legislation works. The other story is that broad awareness of an injury has an equally important effect. We found large increases in states without legislation, showing that just general knowledge plays a huge part."

The study was published online Dec. 22 in the journal JAMA Pediatrics.

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Helmet technology may help with concussions

Forbes recently published the following article explaining why current helmets cannot prevent concussions, but that new helmet technology may be able to help.

The veil of denial and misinformation that has clouded awareness of the long term dangers of athletic concussion has started to lift.  As the general public and especially families of collision sports athletes begin to realize the threat to a normal life posed by the heightened risk of Alzheimers, ALS, Parkinson’s, dementia, Chronic Traumatic Encepalopathy and depression that multiple concussions trigger–the search for solution becomes more intense. One focus in prevention is helmets. Athletes in football, baseball, hockey, field hockey, auto and horse racing all wear helmets.

There is a prevalent belief that those helmets play a major role in preventing concussion–they do not. Current helmets are primarily designed to prevent skull fracture. There obviously is some protective benefit–but the energy wave from a collision currently moves through the plastic and the liner of a helmet and enters the athlete’s head. Tate Technology, headed by CEO Jenny Tate Morgan, has devised a solution. Morgan comes from a family background in helmetry. Her grandfather, John Tate Riddell designed the first plastic helmet, and founded Riddell Football. Her father, also CEO of Riddell, co-ventured with Jack Welch and GE Plastics to use new polycarbonate materials on helmets in 1957. Riddell innovated a series of designs also used in military helmets.

Tate Technology assembled a scientific team of industry experts, engineers, PhD’s and MD’s along with a seasoned board of directors from Fortune 500 companies to find better solutions.  ”Advanced Concussion Technology” (ACT) is a solution which has gone through research, development and some testing. It uses a system of coils designed to dissipate energy and attenuate at the first point of impact. This is done through ”compression” instead of the energy flowing into “tension.” The energy wave moves directly into the head. The system of coil and compression in the helmet can reduce the impact of a hit by as much as half. This company is licensing the technology, which can adapt to any of the currently made helmets; it will not manufacture them itself.

I don’t pretend to be an engineer with in-depth knowledge of energy attentuation. But in lay terms, reducing the energy in a hit so it never penetrates the head and the brain, seems like a solution that could revolutionize helmetry. What works on sports helmets, can work on military, bicycle and motorcycle helmets. Tate’s ACT is ready to be installed in helmets now.

Kudos to those inventive individuals and companies that are trying to tackle a problem that is a largely undiagnosed public health epidemic. Otherwise, the number of concussions will continue to rise, and the trauma will manifest earlier than ever before. This is the result of larger, stronger, faster bodies colliding. It will be exciting to see how fast Jenny Morgan’s ACT technology can begin providing relief.I have always felt that once American corporations with engineering capacity worked on the helmet problem, progress would occur. In the same way neutraceutical and pharmaceutical solutions to brain damage have occurred. The race for solution is producing a variety of promising approaches, such as Prevacus nasal spray. In helmetry, Vicis Company has developed a helmet with impact absorbing filaments that also offers hope.

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Brain damage from mild concussions

This article explains how football players can have brain damage from milder concussions.

A new, enhanced MRI diagnostic approach was, for the first time, able to identify significant damage to the blood-brain barrier (BBB) of professional football players following "unreported" trauma or mild concussions. Published in the current issue of JAMA Neurology, this study could improve decision making on when an athlete should "return to play."

According to Prof. Alon Friedman, from the Ben-Gurion University Brain Imaging Research Center and discoverer of the new diagnostic, "until now, there wasn't a diagnostic capability to identify mild brain injury early after the trauma. In the NFL, other professional sports and especially school sports, concern has grown about the long-term neuropsychiatric consequences of repeated mild Traumatic Brain Injury (mTBI) and specifically sports-related concussive and sub-concussive head impacts."

The paper, published by researchers at Ben-Gurion University of the Negev (BGU) and Soroka University Medical Center, describes a new diagnostic approach using Magnetic Resonance Imaging (MRI) for detection and localization of vascular pathology and blood-brain barrier breakdown in football players.

The images from the Ben-Gurion University of the Negev JAMA Neurology study represent Blood-Brain Barrier (BBB) Permeability in Football Players (A) vs. a control group (B). The players in the pathological-BBB group (B) presented focal BBB lesions in different cortical regions including the temporal (player 4), frontal (player 5), and parietal (player 6) lobes. Both gray and white matter were involved.

"The goal of our study was to use our new method to visualize the extent and location of BBB dysfunction in football players using Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) on a Phillips 3-T Ingenia. Specifically, it generates more detailed brain maps showing brain regions with abnormal vasculature, or a 'leaky BBB.' "

Study participants included 16 football players from Israel's professional football team, Black Swarm, as well as 13 track and field athletes from Ben-Gurion University who served as controls. All underwent the newly developed MRI-based diagnostic.

The DCE-MRIs were given between games during the season and revealed significant damage.

Forty percent of the examined football players with unreported concussions had evidence of "leaky BBB" compared to 8.3 percent of the control athletes.

"The group of 29 volunteers was clearly differentiated into an intact-BBB group and a pathological-BBB group," Friedman explains. "This showed a clear association between football and increased risk for BBB pathology that we couldn't see before. In addition, high-BBB permeability was found in six players and in only one athlete from the control group."

Friedman also explains that not all the players showed pathology. This indicates that repeated, mild concussive events might impact some players differently than others. This level of diagnosis of individual players can provide the basis of more rational decision making on "return to play" for professionals as well amateurs of any age.

"Generally, players return to the game long before the brain's physical healing is complete, which could exacerbate the possibility of brain damage later in life," says Friedman.

A decade of research in the BGU Laboratory for Experimental Neurosurgery has shown that vascular pathology, and specifically dysfunction of the blood-brain barrier (BBB), plays a key role in brain dysfunction and degeneration, and may be an underlying cause of neurodegenerative complications after brain injuries.

The BBB is a highly selective permeable membrane that separates circulating blood from extracellular fluid. It protects the brain by preventing many dangerous substances from penetrating, and therefore is not meant to be damaged.

Medical researchers, including Friedman's group at BGU, are working to find ways to find drugs that will target the BBB and facilitate its repair, allowing for the prevention of Alzheimer's disease and other brain-related disease.

"Prof. Friedman has been able to conduct this breakthrough brain research using the state-of-the-art MRI machine donated as a result of contributions from American Associates, Ben-Gurion University of the Negev (AABGU)," explains Doron Krakow, AABGU executive vice president. "We believe that with continued support, Prof. Friedman and the DCE-MRI can help render more accurate and informed decisions by athletes and others exposed to mild concussions about when to resume activities."

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A parent's thoughts on concussions can hinder treatment and recovery

A study shows that a parent's misconceptions about concussions and treatment hinders treatment and recovery.

With football season in full swing, there's no shortage of talk about young players -- from high school down to the pee wee levels -- suffering from concussions. Yet many parents may lack knowledge about this mild traumatic brain injury, according to two studies to be presented Oct. 10 at a pre-conference symposium on pediatric sports medicine at the American Academy of Pediatrics (AAP) National Conference & Exhibition in San Diego.

Nearly 175,000 children are treated in U.S. emergency rooms each year for concussions due to sports-related activities, according to the Centers for Disease Control and Prevention. Parental knowledge of the signs and symptoms of concussion and recognizing that this is a brain injury is important to ensure children are diagnosed in a timely manner and get appropriate treatment.

Two separate studies looked at parents' knowledge of concussion and common misconceptions. They will be presented as part of the Peds21 symposium, "1, 2, 3, Go! Sports in the World of Pediatrics -- Playing it Safe and Making it Fun!" in the San Diego Convention Center.

For the first abstract, titled "Parental Knowledge of Concussion," 511 parents of children ages 5-18 years who sought care at a pediatric emergency department within two weeks of their child suffering a head injury filled out a 24-item survey. They were asked questions about their demographics, their child's head injury, and general questions related to their knowledge of concussion and its treatment.

Results showed about half of parents correctly identified a concussion as a brain injury that could lead to symptoms such as headache or difficulty concentrating. No parental demographics (age, sex, education or prior history of sports participation) significantly predicted parents' knowledge about concussions.

The survey also indicated that almost all parents (92 percent) were aware that they should stop their child from playing and see a physician if they suspected a concussion. Yet only 26 percent were aware of guidelines on when their child could return to sports and school work.

"Our study showed that the vast majority of parents knew what to do if they suspected a concussion in their child and in most cases understood the clinical importance of this injury as a brain injury," said lead author Kirstin D. Weerdenburg, MD, FAAP, pediatric emergency medicine fellow at Hospital for Sick Children, Toronto, Ontario, Canada.

"The study also highlights that a physician visit shortly after the injury is important to confirm the diagnosis for parents and to inform parents of return to play/learn guidelines to ensure a proper recovery and prevent a second concussion while the brain is still healing," Dr. Weerdenburg said.

The authors of the second abstract, "Parental Misconceptions Regarding Sports-Related Concussion," also surveyed parents to assess their knowledge of concussions. The online survey was completed by two groups -- 214 parents whose children were evaluated at a sports medicine clinic for musculoskeletal or mild traumatic brain injuries (group 1) and 250 parents of students at a local private school (group 2).

The survey included questions that gauged their knowledge of and attitudes about concussions as well as demographic information.

The majority of parents in both groups did well overall but had several misconceptions:

• About 70 percent in group 1 and 49 percent in group 2 incorrectly believed that brain imaging (CT/MRI scans) can be used to diagnose concussion.
• About 55 percent in group 1 and 52 percent in group 2 did not know that "bell ringer or ding" is synonymous with concussion.
• Reduced breathing rate was incorrectly identified as a symptom by 25 percent and 29 percent, respectively.
• Difficulty speaking was incorrectly identified as a symptom by 75 percent and 79 percent, respectively.

"Our study highlights the fact that many parents are still in need of education regarding concussion identification and post-injury evaluation. Even those highly educated parents were prone to misconceptions," said senior author Tracy Zaslow, MD, FAAP, medical director of the sports medicine and concussion program at Children's Orthopaedic Center, Children's Hospital Los Angeles. "False perceptions such as the ones pinpointed by our study may impact when medical care is sought after concussion and lead to less than optimal home care."

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Athletes worsen after recovering from concussion and returning to exercise

A study showed that athletes who have recovered from a concussion can worsen after returning to exercise.

Athletes who seem to have recovered from a concussion may actually show a subtle worsening in a particular mental ability after they return to exercise, a small study suggests.

The findings come from a study of 19 high school athletes who suffered a concussion and then got medical clearance to return to physical activity -- most often football, although a few were on soccer, wrestling or volleyball teams.

Researchers found that for 12 of those athletes, a particular mental ability that had been improving post-concussion reversed course once they were up and moving again.

Specifically, the athletes' ability to simultaneously walk and do simple mental tasks "regressed," the researchers report in the journal Medicine & Science in Sports & Exercise.

In real-life terms, that means walking down the street while talking to a friend would be a bit harder, explained Li-Shan Chou, one of the researchers on the study.

The shift would be too subtle for a person to actually notice, said Chou, a professor of human physiology at the University of Oregon in Eugene.

But he and his colleagues were able to detect the regression in lab tests where the athletes walked while performing basic mental tasks -- like listening to a spoken word, then saying whether it was a high or low pitch.

What does it all mean? That's not clear, said Kenneth Podell, a concussion expert who was not involved in the study.

For one, since the study group was so small, the findings need to be replicated in larger studies to know whether they are "real," according to Podell, co-director of the Houston Methodist Concussion Center in Texas.

He also questioned how the athletes could show an improvement in their test performance early on, when they were "most concussed," but then worsen after all their other signs and symptoms had improved.

Chou agreed that the implications of his findings are unclear. For now, he said the study highlights the importance of giving concussions time to heal.

"Have patience, and give the brain time to recover," Chou added.

According to the American Academy of Neurology (AAN), more than 1 million athletes in the United States suffer a concussion each year.

Concussion symptoms include headache, dizziness, nausea, ringing in the ears, fatigue and confusion -- though these problems may not become noticeable until hours after the jolt to the head. And contrary to popular belief, concussions usually do not cause unconsciousness.

When athletes are recovering from a concussion, the "standard of care" is to gradually return them to physical activity before they can get back on the field, Podell said.

In fact, all 50 states and the District of Columbia now have some kind of law on youth concussions, protecting athletes from returning to the playing fields too soon.

But there is no "set timeline" for safe return to play, according to the AAN. And judging recovery is subjective, Chou said, because it involves asking patients how they feel.

The current findings are based on 19 high school athletes who were periodically assessed for two months after sustaining a concussion. All returned to physical activity, with medical clearance, during that time.

Chou's team found that once they were active again, 12 of the athletes showed some reversal in their ability to walk and perform mental tasks simultaneously. The problem showed up as a subtle change in their walking speed or balance.

Still, Podell said, it's not clear what to make of that. Even if the athletes' gait did regress when they first started physical activity, it might have been "fine" by the time they got back into their sport, he noted.

"The take-away for parents is, the return from concussion is complex, and the best clinical practice calls for a slow and gradual return to activity under the guidance of professionals," Podell said.

But it's not only physical activity that matters, he added. Concussed kids should also take a break from mental stress and only gradually return to schoolwork.

"Just because a student-athlete is ready to exercise does not mean they are 100-percent ready for a full load at school," Podell said.

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Age and brand of football helmet do not influence concussion risk

A recent study shows that both the brand and age of a football helmet do not change the risk of concussion for high school students.

A University of Wisconsin study suggests there is no difference in concussion risk for high school football players based on different brands or ages of helmets, according to a release.

The study involved 2,081 football players at 34 high schools in Wisconsin during the 2012 and 2013 football seasons, according to the release. Players completed a pre-season demographic and injury questionnaire, and sport-related concussions were recorded throughout the year.

A total of 206 players, about 9 percent, sustained a total of 211 SRCs during the study, officials said. During the study, players wore Riddell, Schutt and Xenith helmets.

The study also found that custom-fitted mouth guards increased SRC risk by 60 percent compared to generic guards; the rate of SRC was nearly seven times higher during competition than practice and four times higher during full-contact practice than no-contact practice; and age, BMI, grade in school or competition level was not associated with an increased risk of SRC.

Another important finding was that players who sustained an SRC during the previous 12 months were almost twice as likely to sustain another one compared to players with a history of SRC, according to the release.

“This was surprising because we found that the increased risk exists even when controlling for the players’ use of protective equipment, years of football experience and player characteristics, such as their grade in school and competition level,” said Tim McGuine, UW sports medicine researcher and co-author of the study. “These results highlight the need for medical providers to document a history of SRC in young football players and for more education among parents, coaches and the players about the increased concussion risk in these individuals.”

The researchers said other than learning appropriate tackling and other on-field techniques, properly maintained and fitted helmets remain one of the most important ways to prevent skull fractures and scalp lacerations in football players.

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Top-of-head concussions are more severe

A study claims that concussions on the top of a person's head have a higher level of severity than other concussions.

As we head into the start of the new school year, many young people will begin signing up for the football team. Though team sports are a great way for kids to boost their self-esteem and increase physical activity, there are certain risks involved with contact sports, including concussions. Now, a recent study from the American Academy of Pediatrics investigates how the location of impact could affect concussion severity.

Prior to this study, published in the journal Pediatrics, very little research had focused on how location of impact on the head could yield differentconcussion outcomes.

According to the Centers for Disease Control and Prevention (CDC), a concussion is a traumatic brain injury(TBI) that is the result of a bump, blow or jolt to the head that can change how the brain normally works.

To investigate further, researchers used data from the National High School Sports-Related Injury Surveillance Study to calculate rates and circumstances of concussions that occurred during football as a result of player-to-player collisions.

The team observed that most concussions of this type (44.7%) occurred on the front of the head, while 22.3% occurred on the side of the head. Based on where the impact occurred, the number and type of symptoms, symptom resolution time, and length of time before returning to play did not vary significantly.

But the data revealed that more football players whose concussions resulted from top-of-head impacts lost consciousness than those whose impacts were located elsewhere on the head.

In detail, 8% of players with top-of-head concussions experienced loss of consciousness, compared with only 3.5% of those with impacts on other areas.

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Only a doctor can determine when an athlete can return post-concussion

This article claims that only doctors can help determine when a player returns to play post-concussion.

An editorial published today in The Lancet Neurology calls for sports authorities to take into consideration the long term neurological problems that repeated concussions can cause.

Cerebral concussion is the most common form of sports-related traumatic brain injury (TBI), and the long-term effects of repeated concussions may include dementia, amyotrophic lateral sclerosis, and other neurological disorders, say the journal editors.

However, what is perhaps more concerning, is that even when the symptoms of concussion are delayed, or if they come and go quickly, neurological damage can remain without detection. This can lead to footballers, such as Uruguayan defender Álvaro Pereira during the 2014 FIFA World Cup, overruling doctors' advice to be substituted and returning to play after sustaining a head injury.

The journal editors argue that the decision for players to return to a game after sustaining a concussion should be made only by healthcare professionals, and "should surely be taken out of the hands of those with a vested interest in the player's performance."

According to the journal editors, "Many sporting organisations now acknowledge the potentially serious consequences of mild TBI and have drawn up new protocols to protect athletes who sustain a head injury'. However FIFPro, the world players' union, has called for an investigation of concussion protocols and return-to-play standards following Pereira's injury."

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Do doctors have an obligation to protect athletes from concussions?

This article discusses if doctors have an ethical obligation to teach and protect athletes from concussions.

The American Academy of Neurology (AAN), the largest professional association of neurologists and a leading authority on sports concussion, is releasing a new position paper that states doctors have an ethical obligation to educate and protect athletes from sports concussion and clear them to play only when the athlete is medically ready, standing firm against objections from players, parents or coaches. The statement is published in the July 9, 2014, online issue of Neurology®, the medical journal of the AAN, and is being released ahead of The Sports Concussion Conference, July 11-13, 2014, in Chicago, where the AAN will share the latest scientific advances in diagnosing and treating sports concussion.

The AAN position statement calls for doctors to safeguard the future mental and physical health of athletes as a top priority, especially regarding return-to-play decision-making. Physicians also must educate patients and their families about the dangers of concussion in all relevant sports, according to the statement.

The Academy has spent several years analyzing all of the available research and ethical issues to develop this official position paper, which corresponds with the AAN's guideline on sports concussion.

"With nearly four million sports-related concussions in the US each year, it is imperative doctors are educated and protect these athletes who may have sustained a concussion," said lead author Matthew P. Kirschen, MD, PhD, a neurologist with The Children's Hospital of Philadelphia and a member of the American Academy of Neurology. "Concussions can have devastating effects such as short-term impairments in athletes' cognitive and athletic performance. Repeat concussions have been linked to long-term impairments in brain function, such as problems with learning, memory and behavior."

The statement also:

• Supports wider use of baseline cognitive testing

• Recommends that concussion evaluation and management training be added to neurology residency programs

• Suggests the development of a national concussion registry with mandatory reporting, which may help to document more rigorously the incidence and recurrence of concussion at all levels of play

Ethically, the statement concludes that physicians caring for athletes during and after a sports-related concussion should have adequate training and experience in the recognition and evaluation of both the existence and severity of potential brain injury.

"These strategies could help identify the threshold at which the number and severity of head injuries leads to irreversible brain injury. They may also help to clarify how concussion risk varies with factors like age, gender, puberty stage and ethnicity so athletes and parents can make informed decisions about playing contact sports," said Kirschen.

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Study: Concussions take longer to heal from than previously believed

A study analysed people's cerebrospinal fluid to show that it takes longer to heal from concussions than previously believed.

Scientists at the Sahlgrenska Academy, University of Gothenburg, have shown that analysis of the cerebrospinal fluid after concussion can be used to determine the magnitude of brain injury and to follow its course. The studies show that recovery from concussion takes much longer time than previously known, and this may be of major significance for athletes of all ages in return to play considerations.

Sanna Neselius is a scientist at the Sahlgrenska Academy and member of the medical commission of the Swedish Boxing Federation. Her previous studies have shown that amateur boxing causes damage to nerve cells, that can take more than two weeks to heal. This discovery led to her being offered a place in the International Olympic Committee's expert group for boxing-related head injuries.

Sanna Neselius has now defended her doctoral thesis at the Sahlgrenska Academy, in which she shows that sports-related concussion heals much slower than previously known.

Four months recovery

"It has previously been believed that concussion heals in 7-10 days, and the Swedish Boxing Federation has decided the rest period to be of one month after a concussion, in order to be on the safe side. But our studies show that a concussion, such as may be experienced after being knocked out, can take more than four months to heal," says Sanna Neselius, who is herself a former boxer.

Further, the results show that repetitive head trauma in boxing, damages nerve cells in the brain, even though the boxer may not show any concussion symptoms.

Prevent resuming too early

Concussion is one of the most common sports-related injuries, and more athletes experience it every year. In recent years, focus has been directed on the effects of repeated concussions, in which athletes in such sports as ice hockey may be affected by long-term effects.

The cerebrospinal fluid samples analysed by Sanna Neselius and her colleagues can be followed until normalization and thereby be a valuable tool to prevent athletes resuming sport too early.

"The assessment today is often based on physical symptoms, neuropsychological tests, and the neurological examination of the athlete. Our studies show that these tests are not sensitive enough, nor can we rely on the athletes self-reported lack of symptoms. Concussion symptoms usually pass after a few days, but the neurological damage may still be present," says Sanna Neselius.

Safe rehabilitation

She continues: "The first sample is recommended to be taken 10-14 days after the concussion. This allows us to see the magnitude of the injury, and gives an idea of how long the healing process will be. I hope that brain injury markers in the cerebrospinal fluid, and hopefully also later in blood, can be used at all levels in all sports. By this we can use individual measurements to plan and guarantee safe rehabilitation."

Sanna Neselius points out that the brains of children and adolescents are more sensitive and require longer time to heal.

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Study: Concussion rates double in high schoolers

A study claims that rates of concussions have doubled between 2005 and 2012 for high school athletes.

The rate of concussions in U.S. high school athletes more than doubled between 2005 and 2012, new research shows.

The trend probably reflects an increased awareness and more legislation governing concussions in student athletes, and not more danger in sports, the study authors noted.

"The bottom line is that rates have gone up," said lead researcher Dr. Joseph Rosenthal, an assistant professor of physical medicine and rehabilitation at Ohio State University. "We don't know the exact reason. This was an observational study, so I can't say for sure, but I believe what is explaining the increase is the increased awareness, not that sports are more dangerous. It's just that the concussions are being recognized more, which is good news."

The study was published recently in The American Journal of Sports Medicine.

Concussions are usually due to a blow to the head, often in sports such as football or ice hockey, but they also occur in other sports.

The researchers analyzed data from a sample of 100 U.S. high schools that have one or more certified athletic trainers on staff.

Rosenthal's team found that the concussion rate increased from 0.23 to 0.51 concussions for every 1,000 athlete exposures. An athletic exposure is defined as a single athlete participating in one competition or a practice.

From 2005 through 2012, just over 4,000 concussions occurred in seven sports. These included football, soccer, volleyball, basketball, wrestling, baseball and softball.

Five of those sports had increases that were statistically significant. These included football, boys' basketball, boys' wrestling, boys' baseball and girls' softball. High school football had the highest rates of concussion, according to the study.

Increased awareness is probably behind the higher numbers, agreed Steven Broglio, an athletic trainer and director of the Neurosport Research Lab, at the University of Michigan in Ann Arbor. He is also chair of the National Athletic Trainers' Association position statement on the management of sport-related concussion.

"I'm not entirely surprised at this uptick," said Broglio. More concussions are being recognized due to a number of factors, including increased media coverage on the dangers of concussions and position statements about concussion management from organizations such as his, he added.

Another recent study suggested that awareness about the dangers of concussions is higher. Researchers from Children's Hospital Colorado tracked the compliance of high school athletes who suffered from concussions and how well they followed the return-to-play guidelines.

The researchers found that half of the athletes they tracked were compliant in 2007, but by 2013, 80 percent were. Those findings were presented at the recent annual meeting of the American Society for Sports Medicine in New Orleans.

All 50 states and the District of Columbia have some kind of law designed to protect young athletes from returning to play too soon after a concussion. Experts agree that children who have a concussion need evaluation by a health care professional and need to be cleared before they can return to sports.

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Vision tests may help spot concussions

Research shows that a vision testing on the sidelines at games can help determine if a player has had a concussion or not. Caution if the athlete has a reading disorder. JR

A simple vision test given on the sidelines can help identify athletes who've suffered a concussion, a new study finds.

Researchers found that the test -- known as the King-Devick, or K-D -- was able to detect 79 percent of concussions among college athletes who were followed over a season. When the results were combined with those of two other screening tests, all of the concussions were caught.

The findings were released Wednesday by the American Academy of Neurology (AAN), ahead of its annual meeting this spring.

Experts said the study bolsters evidence that the K-D is a reliable way to help spot athletes' head injuries -- though the test, by itself, is not enough.

"People have been looking for quick, on-the-field screening tests," said Steven Broglio, an athletic trainer and director of the NeuroSport Research Laboratory at the University of Michigan in Ann Arbor.

The new findings suggest the K-D is "one option," said Broglio, who was not involved in the study. "But it's not definitive, and you wouldn't want to rely on this alone," he added.

The K-D takes a minute or two, and it can be given by an athletic trainer, coach or even a parent right on the sidelines. It requires test-takers to read a few rows of single-digit numbers that are unevenly spaced, as quickly and accurately as possible. If they are slower to finish than they were on their "baseline" test -- taken before the season starts -- that's a potential sign of a concussion.

There are other sideline screening tests already in use, including ones that test balance and short-term memory.

But the K-D test "fills a gap" by looking for vision-related problems, explained study co-author Dr. Steven Galleta, chair of neurology at NYU Langone Medical Center in New York City.

Concussions can cause a wide range of symptoms that are often subtle at first. Symptoms like worsening headache, dizziness, nausea, fatigue and confusion might not become obvious until hours after the knock to the head. Plus, even when athletes are suffering immediate problems, they might not tell anyone.

"Some athletes don't recognize the symptoms, and some try to hide them because they want to stay in the game," Galleta said.

A number of professional groups, such as the AAN and National Athletic Trainers' Association, say that athletes who've potentially suffered a concussion should be taken out of the game or practice immediately.

For the new study, Galleta and his colleagues followed 217 athletes at the University of Florida -- including male football players, and female lacrosse and soccer players.

At the start of the season, they all took the K-D, as well as two other sideline screening tests: the BESS, which measures balance; and the SAC, which measures abilities such as short-term memory (asking the athlete to memorize and recall five words) and "orientation" (asking the player to name the day, month and year).

Over one season, 30 athletes were diagnosed with a concussion. And when the researchers looked at their sideline test results, 79 percent showed slower times on the K-D, compared with their pre-season performance. Adding the SAC and BESS results improved the detection rate to 100 percent.

Part of the appeal of the K-D is its simplicity; it can be used by "laypeople," including coaches and parents, Galleta noted. That raises the question of whether it can be used in high school and youth sports -- where there is often no athletic trainer or other health professional on the sidelines.

Studies are currently testing the K-D's usefulness for kids as young as 6, said Dr. Laura Balcer, a professor of neurology at NYU Langone who also worked on the study.

But regardless of what the K-D or other screening test shows on the sidelines, Balcer said there is "no substitute" for parents' judgment. If they notice any potential signs of concussion after a game or practice, they should take their child to the doctor immediately, she said.

"Parents know their kids best," Broglio agreed. "If you notice a change in their behavior, it's probably worth it to have them evaluated."

According to the U.S. Centers for Disease Control and Prevention, more than 173,000 U.S. children and teens land in the ER each year because of a concussion suffered during sports or recreational activities, like bike riding.

But the overall number -- including kids not seen in the ER -- is probably much larger: the CDC estimates that across age groups, up to 3.8 million Americans sustain a sports-related concussion each year.

In general, experts say kids with concussions should be symptom-free and get a doctor's OK before returning to sports. The biggest concern is that, if they sustain another knock to the head while they are still recovering from the first concussion, they could suffer so-called second-impact syndrome -- which can cause potentially fatal bleeding inside the skull and brain swelling.

The data and conclusions of research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

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The difference between concussions in high school and in professional sports

This article explains the difference between concussions in high school sports and concussions in professional sports.

No sports enthusiast will ever forget the goal line collision between Pittsburgh Steelers' Le'Veon Bell and Baltimore Ravens' Jimmy Smith or when Detroit Tigers Catcher Alex Avila was drilled by David Ross of the Boston Red Sox.

Both of these plays caused two serious concussions and both of these athletes returned to play about a week later.

But that's professional sports.

When a high school athlete suffers a severe concussion, it could take weeks before they are back on the field. That's for multiple reasons.

"They too have to go through certain criteria, just like our high school athletes do. However, they are being monitored 24/7. Seven days a week, 365 days a year by the medical staff. They have somebody with them pretty much at all times," said Mike Casselman, HealthWorks.

In high school, it's a different story.

"Though we have athletic trainers there on a daily basis, there might be a day or two gap where the communication isn't there," Casselman added.

The issue of 'chronic encephalipathy' in many NFL players has been receiving a great deal of media attention. In the cases of retired players, it appears most had long careers in the NFL after playing in both high school and college.

In most cases, they played football for more than 20 years and suffered multiple concussions in addition to hundreds of other blows to the head.

But its not just football players that can receive a concussion and its not just from helmet to helmet impact.

"It can be by whip lash. It could be from a quick fall," said Frank Moore, Marion County Athletic Director. "Football would be one you would think. But soccer has a lot of concussions, along with basketball."

Casselman agreed.

"I'm telling you. A big one is cheerleading. People might not think that. It's very competitive in this area. You have the bases that are catching the flyers. They take an elbow, they take a knee," Casselman said.

While many professional athletes blame concussions for their memory loss and depression, little is known about the long term effects concussions can have on high school athletes.

"No concussion is the same and you need to take a very serious approach if they have any of the signs and symptoms," Moore said.

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Head impacts lead to lower test scores

A new study shows that non-concussion head impacts can result in lower test scores and brain changes over time.

Repeated blows to the head during a season of contact sports may cause changes in the brain's white matter and affect cognitive abilities even if none of the impacts resulted in a concussion, according to a study published today in the journalNeurology.

Using a form of magnetic resonance imaging, or MRI, researchers at the Indiana University School of Medicine and the Geisel School of Medicine at Dartmouth College found significant differences in brain white matter of varsity football and hockey players compared with a group of noncontact-sport athletes following one season of competition. White matter is composed primarily of axons, the long fibers that transmit signals between neurons.

"The contact sports and noncontact-sports groups differed, and the number of times the contact sports participants were hit, and the magnitude of the hits they sustained, were correlated with changes in the white matter measures," said Thomas W. McAllister, M.D., chair of the IU Department of Psychiatry.

"In addition, there was a group of contact sports athletes who didn't do as well as predicted on tests of learning and memory at the end of the season, and we found that the amount of change in the white matter measures was greater in this group," Dr. McAllister said.

The study was conducted while Dr. McAllister was Millennium Professor of Psychiatry at Dartmouth.

"This study raises the question of whether we should look not only at concussions but also the number of times athletes receive blows to the head and the magnitude of those blows, whether or not they are diagnosed with a concussion," Dr. McAllister said.

Two groups of Dartmouth athletes were studied: 80 football and ice hockey players in the contact sports group, and 79 athletes drawn from such noncontact sports as track, crew and Nordic skiing. The football and hockey players wore helmets equipped with accelerometers, which enabled the researchers to compile the number and severity of impacts to their heads. Players who sustained a concussion during the season were not included in the analysis.

The athletes were administered a form of MRI test known as diffusion tensor imaging, which is used to measure the integrity of the white matter. They were also given the California Verbal Learning Test II, a measure of verbal learning and memory.

The study did not find "large-scale, systematic differences" in the brain scan measures at the end of the season, which the authors found "somewhat reassuring" and consistent with the fact that thousands of individuals have played contact sports for many years without developing progressive neurodegenerative disorders.

However, the results do suggest that some athletes may be more susceptible to repeated head impacts that do not involve concussions, although much more research would be necessary to determine how to identify those athletes.

More work would also be necessary to determine whether the effects of the head impacts are long-lasting or permanent, and whether they are cumulative.

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There's no such thing as a concussion-proof helmet

This article explains why parents should be weary of helmets claiming to be "concussion-proof"and what to do about concussions in their children.

Football season is upon us and many parents of young players may be swayed by helmets claiming to be "concussion-proof." There is no such thing, experts warn.

Some manufacturers are promoting aftermarket add-ons for football helmets – such as liners, bumpers, pads and electronic devices – that promise to reduce the risk of concussion. However, there is little research evaluating the effect of physical impact on young athletes, and risk-reduction claims about helmets designed for adult players may not be relevant to younger players, New York Attorney General Eric Scheiderman warned. 

“It’s important to remember that no helmet can fully prevent a concussion,” Schneiderman said, as he cautioned manufacturers against making claims they can't back up. “Ensuring that manufacturers don’t mislead the public and endanger young New Yorkers is a key concern for my office."

Head injuries, including concussions, can happen at any time on the field of play, regardless of the type of helmet being worn. False claims may give players and parents a false sense of security. Instead, parents, coaches and young football players should rely on a number of tips and strategies to help reduce the risk of head injury, including: learning and recognizing symptoms of a concussion; minimizing head-to-head hits on the field, and enforcing stronger and stricter penalties against such behavior.

What to do

Although the age, condition, type and fit of the helmet are important factors, reducing the risk of concussion is not “all about the helmet.” Schneiderman issued these tips to reduce the risk of concussion and head injury in youth football:

• Players, parents and coaches must be trained on the symptoms and risks of concussion.
   
• Recognizing the signs of concussion and removing a player immediately is extremely important.
   
• New York State law requires that players be removed from play until they are asymptomatic for a minimum of 24 hours and have written approval from their physician to return to play. Many other states have similar laws.
   
• The number of concussions can be significantly reduced with modifications to practice format and an emphasis on penalty enforcement.
   
• Reducing the number of hits is instrumental to reducing the risk of concussion because of the cumulative risk from repeated hits. Limit the amount of contact in practice and forbid drills that involve full-speed, head-on blocking and tackling that begins with players lined up more than three yards apart.
   
• Players need to be trained to focus on techniques that minimize head-to-head hits. Coaches and referees must strictly enforce penalties against such behavior.

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Updates to concussion guidelines

The American Academy of Neurology recently updated the 1997 concussion guidelines in effort to make football and other contact sports safer.

UPI reported on evidence-based guidelines for managing concussions that were published Monday in the journal Neurology that it said affect more than 1 million Americans each year.

Co-lead guidelines author Dr. Christopher C. Giza of the David Geffen School of Medicine and Mattel Children's Hospital at University of California, Los Angeles, said the new guidelines replaced the 1997 American Academy of Neurology guidelines on concussions.

"Among the most important recommendations the academy is making is that any athlete suspected of experiencing a concussion immediately be removed from play," Giza said in a statement.

"We've moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually. There is no set timeline for safe return to play."

Athletes of high school age and younger with a concussion should be managed more conservatively in regard to return to play, because they take longer to recover than college athletes.

PRNewswire published the full guidelines.

According to the guidelines:

* Among the sports in the studies evaluated, risk of concussion is greatest in football and rugby, followed by hockey and soccer. The risk of concussion for young women and girls is greatest in soccer and basketball.

* An athlete who has a history of one or more concussions is at greater risk for being diagnosed with another concussion.

* The first 10 days after a concussion appears to be the period of greatest risk for being diagnosed with another concussion.

* There is no clear evidence that one type of football helmet can better protect against concussion over another kind of helmet. Helmets should fit properly and be well maintained.

* Licensed health professionals trained in treating concussion should look for ongoing symptoms (especially headache and fogginess), history of concussions and younger age in the athlete. Each of these factors has been linked to a longer recovery after a concussion.

* Risk factors linked to chronic neurobehavioral impairment in professional athletes include prior concussion, longer exposure to the sport and having the ApoE4 gene.

* Concussion is a clinical diagnosis. Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis.

Signs and symptoms of a concussion include:

* Headache and sensitivity to light and sound

* Changes to reaction time, balance and coordination

* Changes in memory, judgment, speech and sleep

* Loss of consciousness or a "blackout" (happens in less than 10 percent of cases).

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