Concerns about concussions in high school football

Concussion awareness is raising concerns about the safety of football for high schoolers.- JR

Awareness of the seriousness of concussions has been at the forefront of recent discussions involving the dangers of playing football.

Earlier this year, the NFL settled a class-action lawsuit with more than 5,000 ex-players who asserted that the league willfully hid information about the dangers of concussions.

While many hailed that as progress, high school coaches wonder if the risks involved with concussions will affect the numbers of participants in the future.

“As a high school coach, my big worry is that parents start moving kids away from the game,” Steele coach Scott Lehnhoff said. “We’re going to do everything we can to make sure protocols are followed and kids aren’t going back until it’s completely safe for them.”

The University Interscholastic League, which governs most high school sports in Texas, has a “return-to-play” protocol in which an athlete who has been diagnosed with a concussion must get a doctor’s approval before returning to play.

“If something looks like a possible concussion, then we get him out of there and make sure there are no coaches jumping in and saying, ‘Get him back in there,’” Highlands coach Juan Morales said.

But what more can be done?

Some things are already in place. Players are penalized for leading with their helmets. Helmet-to-helmet contact is also flagged as a penalty. Therefore, players are being taught not to lead with the heads.

“We need to try to take the head out of the game as much as possible,” Lehnhoff said. “As a coach in the past, maybe if a kid tackled with his head, you didn’t say anything, but now you are going to say something.”

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Banning headers in soccer won't prevent concussions

A study shows that banning headers in soccer won't solve the concussion problem.

While many experts have called for a ban on "heading" the ball in youth soccer because they believe it is a leading cause of concussions, a new study suggests the body contact that often occurs during such play is to blame for most brain injuries.

So banning headers among high school players would not reduce concussion rates as much as enforcing existing rules on rough play would, the researchers added.

Heading the ball "is very much at the heart of soccer culture," explained study author R. Dawn Comstock, a faculty member in the department of epidemiology with the Colorado School of Public Health at the University of Colorado in Aurora. "And, yes, we found that heading is the activity in soccer during which most concussions occur among both boys and girls," she added.

"But if you look closely, it's not generally the impact of the ball to the head that leads to concussion. The vast majority of the time it's the athlete-to-athlete contact that happens during [heading] that causes the concussion. One player's head hitting another player's head, or a shoulder-to-head [collision]. That's the problem. Not the ball," Comstock explained.

"So, yes, if you eliminate heading in soccer you would definitely reduce concussions," Comstock acknowledged. "But soccer is not actually a full-contact sport. And there are rules of the game that already exist that penalize the kind of dangerous out-of-position contested heading that results in athlete-to-athlete contact."

So, she suggested, "if you just enforce these rules you would dramatically reduce aggressive body contact, and dramatically lower the concussion rate, without having to change the culture of the sport by eliminating heading itself."

The findings are published in the July 13 online edition of the journal JAMA Pediatrics.

Soccer's popularity among U.S. high school students has grown enormously in recent years. Today, almost 800,000 teens play the sport in the United States, compared with the mere 50,000 (exclusively male) students who played back in 1970, according to the report.

An analysis of data collected between 2005 and 2014 showed that today, girls actually face a higher risk for soccer concussions than boys: 4.5 concussions for every 10,000 practice or game exposures, compared with just 2.8 concussions per 10,000 exposures among boys.

Heading is the most concussion-prone activity, accounting for more than 30 percent of all concussions among boys, and more than 25 percent among girls, the investigators reported.

However, 78 percent and 62 percent of heading-related concussions among boys and girls, respectively, were attributed to body-on-body contact between players, rather than head contact with the ball, the study said.

"Based on this evidence, I would say that if soccer officials are going to allow the sport to become increasingly aggressive then, yes, please ban heading," said Comstock. "But be clear that what's causing concussions is not the ball. It's athlete contact."

But Robert Stern, a professor of neurology, and neurosurgery and anatomy and neurobiology at Boston University School of Medicine, argued that the current study "really misses the point."

"I'm a soccer fan and a major supporter of youth athletics of all different types," he said. "And we must keep in mind the incredible benefits of youth sports, including sports that result in a lot of injuries. But I do completely support those who want to eliminate heading in soccer at a young age, because the intense focus we've been having on the so-called 'concussion crisis' in recent years misses the much bigger issue: What happens to brains when they are exposed to repetitive hits to the head?" Stern said.

"I don't expect there to be a lot of concussions caused directly by heading a ball," stressed Stern, who also serves as the clinical core director of the university's Alzheimer's disease and CTE Center.

"But I'm talking about all the long-term consequences that come from 'sub-concussive' hits, absent any concussive symptoms. The repetitive brain trauma that comes with hitting the ball frequently with the head, causing changes to the white matter integrity of the brain, cognitive [mental] changes, and other alterations to brain functioning," he explained.

"And I would say that parents who struggle with trying to understand this issue need to ask one very important question: Does it make sense for us to allow for our young kids to participate in an activity that results in repetitive brain trauma?" he said. "Personally, I think children deserve to have adults protect their developing brains."

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Why students need to get enough sleep

This article explains why it is so important for young adults, especially students, need to get enough sleep.

Humans need sleep. Young adults especially need it, and more  of it if possible. While growth spurts may be over, teenaged brains are still developing, and they will not fully mature until a person’s mid-20s, at the least. While students are in school trying to expand their minds, the very structure of their brains is expanding at the same time. Young adults need to balance academics with their sleep, which actually aids in learning and development. It may often seem like these two activities are at odds with each other, but their correlation is important.

Young adults have odd sleeping schedules, and it is not completely their fault. Developing brains of adolescents are wired to go to sleep later. When combined with heavy collegiate workloads, freedom from parental restrictions and the atmosphere of the city that never sleeps, it is no wonder that NYU students often go to sleep extremely late. While late bedtimes alone can be troubling, affecting everything from throwing off our circadian rhythms to our immune systems, this issue is compounded during the winter time. Moreover, students from warmer regions with longer days and shorter nights may not be aware of the effects the winter can have on one’s system. By going to bed late, young adults exacerbate these effects, which can lead to medical issues.

Seasonal affective disorder — a form of depression caused by changes in seasons — is among the potential complications. It can be triggered by a variety of factors, including an unnatural sleep schedule and decreased exposure to light. Symptoms of seasonal affective disorder usually manifest during fall and winter, and deficient sleep during this period can make individuals more vulnerable to depression. Research indicates that going to bed late when the sun sets later is not necessarily problematic. An 11 a.m. wake-up time gives one plenty of sunlight to maintain proper Vitamin D levels and circadian rhythm. Going to bed late when the sun goes down early is a recipe for disaster, however, because an 11 a.m. wake-up time means five hours of sunlight at the most. Students should be wary of seasonal affective disorder and take sleep seriously. Depression in the middle of a semester can jeopardize both academics and social life.

In college, personal well-being is seldom prioritized. This should not be the case — sleep is an essential tool for physical and mental health. Sleeping in late for Palladium brunch rather than waking up to an early breakfast may seem preferable, but a balanced sleep schedule can literally make winter much brighter. Suspend late-night study sessions, close Netflix and go to sleep — your mind and body will be grateful.

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Having autism as an adult

This article explains the difficulties of autism after high school and entering the adult world.

Melanie Tyner-Wilson is facing one of her toughest battles yet. She wants nothing more than to help her son Jay Tyner-Wilson, who is a person with autism, land his first real job.

Public school provided opportunities for Jay to gain volunteer vocational experience. There, he discovered he enjoyed working with animals -- and school offered a repetitive, structured and routine environment. But Jay is 21 years old now and aged out of the school system in May.

"The challenge is now finding a job," says his mother. "That's the golden ticket that I'm trying to figure out."

Jay did not qualify for an official high school diploma, so the path to college or career is a tricky one. Melanie laments that many people with disabilities end up living in poverty unless they have families and other resources that can save and plan for them. With an ever-increasing number of students on the autism spectrum coming through the school pipeline, questions abound as to what they can do to build a life for themselves beyond school.

A new study at the University of Kentucky College of Education helps frame the conversation around this transition. The National Institute of Mental Health (NIMH) has awarded a $693,000 grant to College of Education Professor Lisa Ruble and a cross-disciplinary team of co-investigators at UK and Indiana University-Purdue University Indianapolis.

"This funding will allow us to find ways to help reduce or eliminate the disconnect from needed services that often occurs when students with Autism Spectrum Disorder (ASD) complete school," Ruble says.

Melanie says her son is a person with multiple skills that would be of value to an employer, but who would need additional support.

"The powerful thing about this study is that it brings national attention to it beyond just some parent like me saying 'oh dear, my poor child,'" she says. "It is exciting because when something gets researched, it gets attention and it counts. It formalizes things and forces people to begin to pay more attention in this area. We have all kinds of people like my son Jay in the far reaches of this state and we need to figure out how we are going to meet their needs and give them a quality of life."

The study will further the research team's previous work with an intervention called the "Collaborative Model for Promoting Competence and Success" (COMPASS) for young children with ASD. COMPASS is a parent-teacher consultation model that has been shown to empower teachers, families, and above all, students, by improving educational outcomes.

While the work with COMPASS has been successful for young students, it will need to be adapted, based on stakeholder input, for students nearing adulthood and preparing to complete high school. Once adopted, it will be tested in a randomized controlled study of 32 participants. Additional variables to help understand factors that explain optimal and poor outcomes will be obtained.

Jay has been receiving services at the UK College of Education ever since he was a pre-school student at the college's Early Childhood Lab. He participates in services offered through the college's CASPER center such as social skills training and small group programs. Through the years, Jay has had the opportunity to interact with many of the college's faculty and students.

"UK is conducting research and training all these people who are going into careers to help those with autism," Ruble says. "It is uplifting because I know every student who goes through these programs helps raise the state and nation's capacity to provide services to children and adults with ASD. We need to continue to keep doing better."

Melanie is involved with the Autism Society of the Bluegrass, which is a caregiver support and advocacy group. She has had an opportunity to meet many individuals on the autism continuum. These individuals have a wide range of abilities -- some attend college, but many struggle to find employment.

"While many on the continuum have achieved postsecondary education and/or employment, there continues to be a significant number that struggle," she says. "The challenge is how we are going to plan and get what we need for these individuals."

For now, Jay is putting in lots of volunteer hours in pursuit of "the good life."

"I'm doing the same thing any parent would want for their child," his mother says. "We want to make sure our children are okay after we are gone. With Jay, it's a more involved, complicated plan. I think it's possible. I have got to figure out as a parent how to do it.

"It's been really humbling to be on this journey with my son, and it's probably the hardest thing I have ever done in life. It's also an honor because he's just an amazing person and has taught me so much as a parent."

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Importance of getting enough sleep

This article explains the importance of people getting enough sleep each night.

Studies conducted by the National Sleep Foundation reported that around 70 sleep disorders disturbed 40 million Americans between 1999-2004. Therefore, it may come as no surprise that college students have adapted a disorder of their own, commonly known as the "pull-an-all-nighter" syndrome. This disorder haunts those in hopes of remembering material that is impossible due to lack of sleep.

Did anyone attempt studying until 4 a.m for that 8 a.m biology midterm last week? Think about how much information you actually remembered from cramming and what went out the window once entering the testing center.

Now, think about the correlation between sleep and memory. It is actually impossible for one to properly remember and process information learned without adequate sleep. So how can one maximize sleep time and still be a college student? By finding balance.

“There is a lot of pressure on college kids nowadays,” said Francesca Johnson, junior in psychology. “...it’s hard to keep a balance.”

Well, what happens when balance isn’t found?

“Some short-term physical consequences are a slower metabolism and weakened immune system, on top of your body simply being physically tired,” stressed Carina Hanson, senior in kinesiology and health.

Sleep deprivation causes irritability, affects judgements and can make one feel drunk or hungover by not allowing complete rejuvenation from daily stress. It is also associated with obesity and increased obesity risks. 

Averaging less than 6 hours of sleep a night doesn’t give the body enough time to finish all of the phases of sleep.

Someone who has had a good night’s sleep will pass through the five stages of sleep cycle every 90 - 110 minutes. The National Sleep Foundation recommends seven to nine hours per night for college students, and each stage is vital to every individual’s overall health.

"The more sleep you get, the more you feel in control of your life and your body,” said Johnson. 

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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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Teenagers need more sleep

This article explains that teenagers need more sleep, and not getting enough sleep can lead to health consequences.

Health experts say if you don't snooze, you lose. They say teenagers actually do need their beauty sleep.

'Let them sleep!' said the nations largest pediatrician group, the American Academy of Pediatrics. Studies have shown that only one in five teens get nine hours of sleep on school nights, the recommended amount.

The AAP is urging schools to start high school and middle school classes at 8:30 a.m. or later. Lack of sleep in adolescents is shown to increase risk for obesity, stroke and Type 2 diabetes. There is even an increase in anxiety and depression, which can lead to risk-taking behaviors.

The AAP said naps and caffeine only temporarily counteract the lack of sleep, but it's not enough.

"Kids who, for example, take a biology class at 7:20 in the morning, if you compare that group of kids to kids that take that class at 10, 11 or 1 and then you give them all the same standardized tests, as a group the kids that take that class later in the day perform better," said Chief of Division of Pediatric Sleep Medicine Heidi Connolly.

With much controversy surrounding later start times at schools, there may be a long road ahead for teen sleep.

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Pediatricians urge later school start time

This article explains why pediatricians are urging for later school start times for older kids in middle and high schools.

U.S. high schools and middle schools should start classes later in the morning to allow kids some much-needed sleep, a leading group of pediatricians is urging.

Ideally, the American Academy of Pediatrics says, the first bell should ring at 8:30 a.m. or later -- which is the case at only 15 percent of U.S. high schools right now.

At the very least, classes should start no earlier than 8 a.m., said Dr. Judith Owens, the lead author of a new academy policy statement on school start times.

The recommendations, published in the academy's journal Pediatrics, are based on research showing that U.S. kids are sleep-deprived, which has consequences for their health, school performance and safety.

"This is an important issue," said Dr. Marcel Deray, a Florida sleep specialist who wasn't involved in the recommendations.

"I see a lot of teenagers who are tired and have problems in school because they have to get up so early," said Deray, who directs the Sleep Disorders Center at Miami Children's Hospital. "Some kids are getting up at 5 a.m., 6 a.m."

Many people think the answer is for kids to just get to bed earlier, Owens noted. But it's not that easy, she said, because biology has other plans.

Around puberty, the body's natural sleep-wake cycle shifts, and it's actually hard for teenagers to fall asleep earlier than 11 p.m.

"Teenagers' bodies release melatonin later than (adults') do," Deray explained, referring to a hormone the brain secretes in the evening to induce drowsiness.

"The other issue," Owens said, "is that teenagers' sleep needs are greater than many people think. They need nine to nine-and-a-half hours."

Yet, 43 percent of U.S. public high schools start classes before 8 a.m., according to the U.S. Department of Education. Middle schools, meanwhile, typically start classes at 8 a.m. -- with about 20 percent starting earlier than that.

"And that's the first bell," Owens said. "That's not even counting the commute time."

So in areas where kids take the school bus, the actual school day could begin before sunrise.

According to Owens, U.S. high schools started bumping up start times back in the 1950s and '60s, mainly to space out bus runs. Many school districts start high schools and middle schools first, then circle buses back to pick up elementary school kids.

One option would be to flip elementary and high school start times, but parents often oppose that -- since young children could be standing at bus stops in the early-morning dark, or have no one at home after school. Another option -- running more buses -- would be expensive.

Transportation is not the only obstacle, according to the National Sleep Foundation, which supports pushing back school start times. Some other arguments are that sports and extracurricular activities would end too late; teenagers would have no time for after-school jobs; and a later start could conflict with working parents' schedules.

Owens acknowledged the logistical challenges, and said parents and school staff sometimes oppose later start times. As an example, she said the Fairfax County, Va., school district has been debating the issue for years. Four options, including one with a 9:15 a.m. high school start, will be put to a vote this fall.

Some districts have found "creative solutions" to certain obstacles -- like having high school students switch from school buses to public ones, according to the academy.

Deray thinks tackling the practical challenges is worthwhile. He said studies have linked kids' sleep deprivation not only to poorer school performance, but also to higher rates of car accidents, obesity and depression.

In a recent study of eight U.S. high schools that delayed their start times, researchers found improvements in kids' grades, attendance and car crash rates.

Later school starts are just one way to help sleepy kids, however. Deray offered parents some tips.

"All electronic devices should be turned off an hour or two before bed," he said. "The blue light from them suppresses melatonin production."

He also advised avoiding physical and mental stimulation close to bedtime -- which means exercise and homework should be done earlier in the evening. And while teenagers love to sleep till noon on weekends, that will only further disturb their sleep/wake cycle. Deray said kids should get up by 9 a.m. on weekends and get plenty of morning sunlight.

He acknowledged, though, that all of that is easier said than done.

Owens agreed. "One of the issues is that kids are overscheduled," she said. "Don't give them so many things to do that they can't get to bed before midnight."

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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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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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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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Study: Later school start times are beneficial for adolescents

A study shows that later school start times result in improved sleep quality and a better overall mood in adolescents.

Julie Boergers, Ph.D., a psychologist and sleep expert from the Bradley Hasbro Children's Research Center, recently led a study linking later school start times to improved sleep and mood in teens. The article, titled "Later School Start Time is Associated with Improved Sleep and Daytime Functioning in Adolescents," appears in the current issue of the Journal of Developmental & Behavioral Pediatrics.

"Sleep deprivation is epidemic amongadolescents, with potentially serious impacts on mental and physical health, safety and learning. Early high school start times contribute to this problem," said Boergers. "Most teenagers undergo a biological shift to a later sleep-wake cycle, which can make early school start times particularly challenging. In this study, we looked at whether a relatively modest, temporary delay in school start time would change students' sleep patterns, sleepiness, mood and caffeine use."

Boergers' team administered the School Sleep Habits Survey to boarding students attending an independent high school both before and after their school start time was experimentally delayed from 8 to 8:25 a.m. during the winter term.

The delay in school start time was associated with a significant (29 minute) increase in sleep duration on school nights, with the percentage of students receiving eight or more hours of sleep on a school night jumping from 18 to 44 percent. The research found that younger students and those sleeping less at the start of the study were most likely to benefit from the schedule change. And once the earlier start time was reinstituted during the spring term, teens reverted back to their original sleep levels.

Daytime sleepiness, depressed mood and caffeine use were all significantly reduced after the delay in school start time. The later school start time had no effect on the number of hours students spent doing homework, playing sports or engaging in extracurricular activities.

Boergers, who is also co-director of the Pediatric Sleep Disorders Clinic at Hasbro Children's Hospital, said that these findings have important implications for public policy. "The results of this study add to a growing body of research demonstrating important health benefits of later school start times for adolescents," she said. "If we more closely align school schedules with adolescents' circadian rhythms and sleepneeds, we will have students who are more alert, happier, better prepared to learn, and aren't dependent on caffeine and energy drinks just to stay awake in class."

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Study: Teenagers who go to sleep late have lower grades

A study shows that teenagers with late bedtimes have lower grades than those who go to sleep earlier.

Teens with late bedtimes during the school year and schooldays that start early have lower academic performance and are at risk for later emotional distress. A new study in the Journal of Adolescent Health provides further evidence for a growing body of research that supports a movement to delay school start times for adolescents.

"Going to bed after 11:30 pm, particularly in younger adolescents, predicted worse cumulative grade point average (GPA) at high school graduation and more emotional distress in the college years and beyond," said the study's lead author Lauren D. Asarnow, MA, a doctoral student in the department of psychology at the University of California, Berkeley.

The study gathered data on sleep and the number of hours slept from 2,700 teens age 13 to 18 participating in the National Longitudinal Study of Adolescent Health in two cohorts, one in 1995, the second in 1996. In 2001-2002, as respondents aged, data on academic performance and self-reported emotional health were collected for longitudinal comparison. The overall goal of the study was to examine the relationship between the sleep/circadian patterns of high school adolescents in a nationally representative sample, their overall academic performance in high school and rates of emotional distress reported post graduation.

For both high school cohorts, 23 percent of participants reported going to bed at 11:15 pm or later. By the time these teens reached graduation and college age, late school year bedtimes in high school predicted both lower cumulative GPA at graduation and more emotional distress between age 18 and 26. The researchers noted previous research found that adolescents who prefer late activities and bedtimes (a pattern of behavior often referred to as an evening circadian preference) were tested in the morning; they performed worse on cognitive tasks.

Asarnow urged parents to help youngsters get to bed earlier and added that a teen's sleep behavior is highly modifiable with proper support. However, shifting a teen's bedtime from a late to an earlier hour can be hard, she added, in part because for 30 percent to 40 percent of teens, delayed bedtimes have a biological basis tied to the onset and progress of puberty. Furthermore, academic pressure, habits around technology use and the bedtimes of friends also influence a teen's choice to turn in or stay up late.

Timothy Monk, Ph.D., director of the Human Chronobiology Research Program at the University of Pittsburgh agreed that the need to rise very early for school can put students at risk for underperformance academically and for other problems tied to a lack of sleep. "An early school start time both limits the sleeping time of the student and asks him or her to learn at what is close to the nadir of their circadian cycle."

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Less concussions occur at higher altitudes in high school sports

An interesting study claims that the likelihood of a concussion in high school sports is lower at higher altitudes.

According to a recent study done by doctors at Cincinnati Children's Hospital Medical Center, high school athletes who play collision sports at higher altitudes are less likely to suffer from concussions than those who play at lower altitudes.

The doctors who were involved in the study recognized that prior research indicated that the volume and/or pressure of intracranial fluid, which acts as a cushion to protect the brain inside of the skull, is affected by one's altitude and that it may be associated with the likelihood and/or severity of a concussion. They hypothesized that when adjusting to higher altitudes, physiological responses increase intracranial fluid volume and these responses would provide a "tightened fit" which should help protect the brain from concussions like bubble wrap.

Data on concussions and more than 20 million athlete exposures were gathered between 2005 -2012 from nearly 500 high schools across the US. The data focused on concussion occurrence in a variety of sports including but not limited to boys' and girls' soccer, volleyball, basketball, cheerleading and boys' football and ice hockey. The altitude of the participating schools ranged from 7 to 6903 ft.

When concussion rates were examined relative to altitude, sequential elevations in altitude above sea level were associated with a reduction in concussion rates overall. Specifically, high school sports played at higher altitudes demonstrated a 31 percent reduction in the incidence of total reported concussions. Further analysis showed that concussion rates at increased altitude for football players were reduced by 30 percent for overall exposures, 27 percent for competition exposures and 28 percent for practice exposures.

Dr. Greg Myer, Director of Research, Sports Medicine, Cincinnati Children's Hospital Medical Center, says that "this research shows us that the physiological responses to altitude may be associated with a reduction in sports-related concussion rates, especially in collision sports."

He goes on to say that future research that focuses on other techniques that can optimize intracranial fluid volume (via jugular compression) will play an important role in the determination of the most effective approaches to prevent sport related concussion in athletes.

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Concussion symptoms the same for teens and adults

A study claims that concussions symptoms are at the same level of severity for teenagers and young adults.

Whether injured athletes are teens or young adults does not affect the severity of their concussion symptoms, according to a new study. However, differences may still exist in the concussion's aftermath, the researchers say.

Some previous research has raised concerns that high school-age athletes may suffer more severe symptoms after a concussion than college-age athletes, but this study found no evidence of that.

Related symptoms include headache, dizziness, nausea, fatigue, irritability, sleeping difficulties and problems with memory and concentration.

Vanderbilt University School of Medicine researchers compared concussion symptoms in 92 athletes aged 13 to 16 with those of 92 athletes aged 18 to 22. Both groups had 56 percent females and 44 percent males.

No significant differences occurred between the two groups in the number, duration or severity of concussion symptoms, according to the study published online Sept. 24 in the Journal of Neurosurgery: Pediatrics.

Some age-related differences may occur after sports-related concussion, the researchers said. They noted that previous research from the Vanderbilt Sports Concussion Center concluded that age-related differences exist in neurocognitive testing after sports-related concussion.

In evaluating sports-related concussion, it's important to separate different ways of assessing outcomes, study co-author Dr. Scott Zuckerman said in a journal news release. These methods include assessing symptoms, neurocognitive testing, balance problems, school performance and others.

"It appears that symptoms may not be a prominent driver when assessing outcomes of younger versus older athletes. We hope that our study can add insight into the evaluation of youth athletes after sports-related concussion," Zuckerman said in the news release.

The author of an accompanying editorial, Dr. Ann-Christine Duhaime, noted that definitions of concussion are not uniform, its diagnosis is not standardized and it's extremely difficult to match all variable factors in a study of sports-related concussion in different age groups.

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Concussion recovery requires the brain to compensate

A study claims that increased brain activity a few weeks after a concussion shows that the brain compensated to help recover.

Concussion patients have irregular brain activity within the first 24 hours after their injury but increased levels of brain activity a few weeks later, which suggests that the brain may compensate for the injury during recovery, a new study reports.

Researchers used functional MRI to study the recovery of 12 high school football players with concussion and compared them to 12 uninjured teammates. The concussed players underwent brain scans at 13 hours and again seven weeks after their head injury, and the uninjured players had brain scans at the same time.

At 13 hours, the concussed athletes had typical symptoms such as decreased reaction time and reduced mental abilities. Their brain scans revealed decreased activity in certain areas of the right hemisphere of the brain. This suggests that their reduced mental abilities may be related to underactivation of attentional brain circuits, according to the researchers.

At seven weeks, the concussed players showed improvement in their mental abilities and normal reaction time. Brain scans at that time revealed that the concussed athletes had more activation in the brain's attentional circuits than the uninjured players.

"This hyperactivation may represent a compensatory brain response that mediates recovery," study lead author Thomas Hammeke, a professor of psychiatry and behavioral medicine at the Medical College of Wisconsin, said in a college news release. "This is the first study to demonstrate that reversal in activation patterns, and that reversal matches the progression of symptoms from the time of the injury through clinical recovery."

The study appears in the September issue of the Journal of the International Neuropsychological Society.

"Deciding when a concussed player should return to the playing field is currently an inexact science," study senior author Dr. Stephen Rao, director of the Schey Center for Cognitive Neuroimaging at the Cleveland Clinic, said in the news release. "Measuring changes in brain activity during the acute recovery period can provide a scientific basis for making this critical decision."

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Healthy diet and sleep help children learn

For children, success at school is influenced by a healthy diet and getting enough sleep.

Backing what many parents already believe, experts say that healthy eating and good sleep habits can help youngsters do well at school.

"Your brain can't work if you're not consuming enough calories, and in general that's not a problem," Krista Casazza, an assistant professor in the nutrition sciences department at the University of Alabama at Birmingham, said in a university news release. "But when kids go to school without eating breakfast, their [thinking and learning skills] can be affected."

Children should start the day with fruits, proteins and whole grains. They should avoid sugary cereals because they cause a sugar high followed by a crash.

"A balanced breakfast will fuel the body for a long period and help sustain their attention level through lunch, when they need to eat well again," Casazza said. "This will hold them until dinner, and they won't snack ravenously after school."

If their kids do need to eat something before dinner, parents can offer healthy choices such as yogurt, fruits and vegetables. Baked chips, in moderation, can be an option if children want "kid stuff." For a drink, give them water instead of soda.

Sleep is another important part of success at school.

"Children need a good night's sleep for their overall school performance," Kristin Avis, an associate professor in the pulmonary and sleep medicine division in the pediatrics department at UAB, said in the news release.

"Lack of sleep can lead to problems with attention and memory in the classroom, affect impulse control and mood regulation [and] lead to anxiety and even depression," she explained.

Children aged 6 to 12 should get nine hours sleep per night, as should teens aged 13 to 18. However, they typically average little more than seven hours per night, Avis said.

"Often parents think one night of sleep loss won't matter, but that's all it takes to affect them the next day," she said. "If they are chronically deprived, it can snowball and make matters worse."

Trying to catch up on lost sleep on the weekend can compound the problem.

"If kids sleep in Saturday, they have a hard time going to bed Saturday night; so they sleep in Sunday and have a hard time going to bed Sunday night. Monday morning they are tired, and it's hard to wake up for school. They struggle to get back on a good sleep schedule," Avis said.

Children and teens need a consistent bedtime seven days a week.

"It keeps their clock set so they can go to bed at a certain time, sleep well through night and wake up well rested the next morning," Avis said.

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