Concussions in youth hockey

Concussions in youth hockey are more likely to occur during illegal hits.

Concussions in youth ice hockey are as common as in youth football and soccer, and often occur when players break the rules of the game, a new study finds.

While the concussion rates in youth ice hockey are no greater than in other contact sports, more than 40 percent are caused by illegal hits, especially from behind, researchers said.

And younger players were at higher risk, according to the report.

"These findings highlight the importance of providing medical assistance, not only during ice hockey games, but also during practices, where more concussions occurred than expected," said Anthony Kontos, the study's lead author. Kontos is research director of the University of Pittsburgh Medical Center's Sports Medicine Concussion Program.

According to the USA Hockey Coaching Education Program, illegal moves include hitting from behind, crossing arms to hit a player in the neck and jumping on a player to push him into the wall.

Kontos suggested that training kids to obey the rules and enforcing penalties may reduce the number of concussions.

"Better enforcement of existing penalties for illegal hits -- especially those from behind when players are less able to protect themselves -- may help to limit concussions in youth ice hockey," he said.

The report was published online Jan. 8 in the journal Pediatrics.

For the study, the researchers followed nearly 400 ice hockey players aged 12 to 18 who took part in more than 23,000 games and practices during the 2012-13 and 2013-14 seasons.

There were 37 diagnosed concussions, all of which involved player-to-player contact, such as checking or collision. Illegal plays resulting in penalties accounted for 43 percent of the concussions, Kontos and colleagues found.

Concussions were three times more likely to happen during games than practices. However, ice hockey players were more likely to get a concussion during practice than kids in other sports practices, including football, the investigators found.

Most youth ice hockey concussions were suffered by players aged 12 to 14, rather than older players, the findings showed. This is in contrast to other youth sports, such as football, where concussion rates increase as players get older.

"Younger players may be at higher risk for concussion than older players, possibly due to unfamiliarity with checking and disparities in body size and strength, which highlights the need for concussion awareness and clinical care in this at-risk age group," Kontos said.

Symptoms of a concussion include severe headache, dizziness, blurred vision, sensitivity to light and, in severe cases, recurrent vomiting, the researchers said.

When a concussion occurs, the player should be taken out of the game and not be allowed to play again until all the symptoms are gone and a doctor has been consulted, Kontos added.

But if the symptoms are serious, such as a severe headache or recurrent vomiting or dizziness to the point of having trouble walking, then the player should go to the emergency room, he advised.

Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Nicklaus Children's Hospital in Miami, said kids should play sports for all the positive things the games can do for children.

"But follow the rules," he added.

"A lot of improvement is needed in terms of the players and how they play the game within the rules," Kuluz said. "Make sure your kid plays for a coach and a team that appreciates the seriousness of concussion."

Read more here

Study: Most NHL and Youth Hockey Helmets are Unsafe

A study shows that most helmets used in the NHL and by youth hockey players are not safe.

A new independent study has found that hockey players, ranging across the National Hockey League, or NHL to the youth leagues, are at the risk of concussion from hits during matches due to a lack of protection thanks to poor quality helmets.

The study, conducted by Virginia Polytechnic Institute and State University, tested 32 helmets available in the market on their ability to protect the players from concussion. The study aimed to rank the helmets on a scale of five stars. It was not funded by the NHL, cost $500,000 and took three years to complete.

According to the study, published publicly last Monday, none of the helmets got a 4-star or 5-star rating. Only one helmet, made by Warrior Sports, got a 3-star rating. Nine helmets failed to get even a single star, and the rest got a 1-star or 2-star rating.

"We don't think anybody should be playing in these helmets," Stefan Duma, the head of Virgina Tech’s biomedical engineering department said, as reported by ESPN.

Players wearing the poorly rated could be at risk of anywhere between six to eight concussions per season, the report claimed. The two most expensive helmets available in the market, made by Bauer and CCM, received just one star.

The report raises questions over the testing methods used to certify hockey helmets, as it claims all 32 helmets were approved by the Hockey Equipment Certification Council. The report raises questions as to whether more can be done to improve the safety standards of a sport played by millions in the United States.  

Steps are, however, being taken to reduce the risk of concussions. These include coaching players to avoid head-on clashes, safer techniques to tackle, avoiding fights, among others. 

"There will never be a perfect helmet that will prevent all concussions. It's about risk reduction. The reality is when you look at the bottom and the top helmets, you're talking about massive reductions in acceleration, over half. I think almost all biomechanical engineers would agree that that's a significant difference," Duma said.

Read more here

Brain imaging study of youth hockey players shows early markers for concussion damage.

A brain imaging study of youth hockey players shows early markers for concussion damage.

James Hudziak, M.D., has two children who love ice hockey. His son skates for his college team and one of his daughters plays in high school.

As a pediatric neuropsychiatrist and director of the Vermont Center for Children, Youth and Families at the University of Vermont (UVM) College of Medicine, Hudziak believes in the benefits of ice hockey and other sports for kids. Athletic activities help a young person build organizational skills, improve motor and emotional control, reduce anxiety and boost confidence.

Now, though, Hudziak is looking into the potential dangers of ice hockey for young athletes. He and UVM colleagues Matthew Albaugh, Ph.D., Catherine Orr, Ph.D., and Richard Watts, Ph.D., have published a groundbreaking study in the February issue of TheJournal of Pediatrics that shows a relationship between concussions sustained by young ice hockey players and subtle changes in the cortex, the outer layer of the brain that controls higher-level reasoning and behavior.

Each year, more than 300,000 sports-related concussions (SRC) occur across all sports and all levels in the United States, according to a 2013 "Ice Hockey Summit II" report to which Hudziak and Boston University (BU) School of Medicine's Ann McKee, M.D., contributed. The report's authors advised the elimination of head hits from all levels of hockey, a change in body-checking policies and the elimination of fighting in all amateur and professional hockey. "Ice hockey SRC prevalence is high," the report states. "Hockey players compete at high speeds as they mature, risking injury from intentional and accidental collisions, body checks, illegal on-ice activity and fighting."

The UVM team used advanced imaging technology and cognitive testing to assess 29 Vermont ice hockey players between ages 14 and 23, some diagnosed with a sports-related concussion. As the severity of the athletes' concussion symptoms increased, the researchers found, the cortex got thinner in areas where it should be dense at those players' ages -- areas that relate to attention control, memory, and emotion regulation.

"We believe that injury to a developing brain may be more severe than injury to an adult brain," Hudziak says.

What the study indicates for the future health and function of an ice hockey player is unclear. The researchers hope to do further studies, ideally following the brains of these athletes over a couple of decades and factoring for their involvement and time in the sport as well as other influences, such as smoking and alcohol use.

"The concern is that what we are finding may be an early marker of brain damage," Albaugh says. "Years of playing contact sports and repeatedly getting your head knocked around probably isn't good for the brain, especially in young children whose brains are still maturing" he adds.

Their findings contribute to research into the consequences of brain injury in other sports, including the brain damage discovered in older professional football players by McKee, a neurology and pathology professor at BU and director of the "brain banks" in various centers of study for the university and the Veterans Administration. Her work was a cornerstone of "League of Denial: The NFL's Concussion Crisis," an investigative report by the public television program "Frontline" on the National Football League's response to players' brain trauma.

"It just adds to our information base about young athletes playing contact sports," McKee says of Hudziak's study. "It's a first step. It needs to be looked at longitudinally. We need to know if these athletes recover."

McKee says she wouldn't necessarily expect the brain changes in young hockey players to lead to chronic traumatic encephalopathy (CTE), a serious but uncommon disease that she found prevalent in retired NFL players. Instead, she expects that further study in the ice hockey arena will show that young players' brains can recover from early blows. Brains have a chance for rehabilitation after injury, she says.

"We're hopeful that these changes can be reversed," she says of the cortex thinning observed in Hudziak's study. "I would look at this as an opportunity to make a difference, and not a cause of irrevocable damage in these players."

Hudziak and his UVM colleagues would like to help the organizations running professional, collegiate, junior and youth hockey leagues make better decisions about how best to treat players' head injuries; how and when to return players to the ice after an injury; when to pull them from the sport entirely; and how to prevent injuries from occurring. Players and coaches at the national, college and youth levels of hockey have talked to Hudziak about his findings, he says.

In Hudziak's study, he and his colleagues cite research indicating "that cerebral concussion accounts for 15 to 22.2 percent of all reported injuries" in hockey.

The key challenges for them, says Hudziak, are that the definition of "concussion" is so slippery and reports of the incidence of concussions are inconsistent. Some people think a concussion happens when someone is hit in the head or gets dizzy; others think a person has to be "knocked out" to have a concussion.

His study focuses on the symptoms recorded after a diagnosed concussion. But Hudziak wonders whether lesser head injuries, what he calls sub-concussive events, could have as many or more consequences for the brain over time as a single major blow.

On the computer in his office, Hudziak shows a video of a professional hockey game during which a player gets body checked. It doesn't look like a very serious hit, though he's carried off the ice.

Then, the video reverses to just a few minutes earlier in the game, when that same player collides with another and flips violently backwards, throwing off his helmet before his head hits the ice. That suggests the potential harm inside a person's skull that can occur from cumulative assault.

As Hudziak puts it, "The sum is greater than the individual parts."

That player flew into Burlington, Vt. to meet with Hudziak and his team, so they can learn more from his brain.

Ideally, Hudziak says, they want to apply their current study to female and male ice hockey players ages 8 to 14, then to college-age skaters of both genders and finally to retired professional hockey players. They'd like to compare their findings at each age group to nonathletes and to the same groups in soccer -- a sport typically involving less-severe head injuries.

"We don't have any sense that hockey's going to be worse than soccer," Hudziak points out.

Already, in a follow-up study, Hudziak's team has found more evidence of increased problems in the brains of athletes, compared with nonathletes. This work focuses on "hyperintensities," which look like little bright white spots on a brain image. His research suggests a higher volume of these bright spots may correlate with decreased thickness in the cortex.

"As a general rule of thumb, you're allowed one of these bright spots every 10 years of your life," Albaugh says.

So a 50-year-old should have about five of these bright spots. One of the college-age athletes in the study has 18 spots, Albaugh says. Hudziak now has to call some parents to tell them of the "clinically concerning findings" in their children's brain images.

Hudziak doesn't want to warn parents to keep their kids out of hockey or other team play. As the founder of the unique Vermont Family-Based Approach, which incorporates all aspects of a child's life to address emotional and behavioral problems, he prescribes hockey, soccer and other sports to help eliminate behavior, attention and psychological disorders. It is his hope that through brain training and health promotion the brain may recover.

"My goal is not to rid the world of these sports," Hudziak says. "My goal is to make these sports safer, so that more people can play them."

Read more here

Increase in concussions seen in Ontario's children

A study showed that concussions in Ontario's children significantly increased between 2003 and 2010.

The number of children and youth treated for concussions in both emergency departments and physician's offices in Ontario increased significantly between 2003 and 2010, with falls, hockey and skating injuries identified as the leading causes of pediatric concussion, according to a new joint study out of York University and the Institute for Clinical Evaluative Sciences (ICES).

The study," A population-based study of pediatric emergency department and office visits for concussions from 2003 to 2010," published in the journal Paediatrics & Child Health, analyzed all visits related to a concussion by school-aged youth (three to 18 years) in Ontario from 2003 to 2010.

"This study is the first to examine pediatric concussions evaluated in both emergency departments and physicians' offices," says York University Professor Alison Macpherson, the study's lead author. "By examining all of the pediatric concussions evaluated in multiple facilities, we were able to minimize the issue of under-reporting and obtain a more accurate number of concussions treated in Ontario."

Between 2003 and 2010, researchers found a total of 88,688 pediatric concussions were treated in either an emergency department or a physician's office, and there was a significant trend in both locations. The total rate of concussions per 100,000 increased from 466.7 to 754.3 (for boys), and from 208.6 to 440.7 (for girls) during the study period. The numbers also showed that over time more children were being evaluated in physician's offices than emergency departments.

When the sources of concussion were broadly examined, falls were found to be the most common cause of concussion in an emergency department, representing 34 per cent of all emergency department visits, followed closely by exposure to force (25.5 per cent) and motor vehicle collisions (12.3 per cent). When specific causes were examined in more detail, hockey and skating -- common sports in North America -- were the most common causes of concussions that were treated in an emergency department.

"Our findings reinforced that falls in general are the most common cause of pediatric concussions, and that evidence-based prevention initiatives to help reduce the incidence of concussion are warranted -- particularly in sports and recreation programs," says senior scientist and chief science officer at ICES, Dr. Astrid Guttmann, the study's senior author. "Sports-related concussions can be minimized by taking preventive action, such as reducing body checking in hockey or wearing a helmet while cycling."

Macpherson says that future studies can attempt to differentiate between the true incidence of concussions and an increase in those seeking a health evaluation due to increased awareness of concussion and subsequent health consequences.

Read more here

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.

Read more here

One fifth of 7th-12th graders claim to have had traumatic brain injury

An interesting study shows that one out of five 7th through 12th graders said they have had traumatic brain injury during their lives.

One in five adolescents surveyed in Ontario said they have suffered a traumatic brain injury that left them unconscious for five minutes or required them to be hospitalized overnight, a statistic researchers in Toronto say is much higher than previously thought.

Sports such as ice hockey and soccer accounted for more than half the injuries, said Dr. Gabriela Ilie, lead author of the study and a post-doctoral fellow at St. Michael's Hospital.

Traumatic brain injuries, such as concussions, were reported more often by males than females, by those with lower school grades and by those who used alcohol or cannabis in the previous 12 months, she said.

The study was to be published Wednesday (June 26) in theJournal of the American Medical Association.

Dr. Ilie said this is one of the first studies of traumatic brain injury to focus only on adolescents and to include all of their self-reported TBIs. Most previous studies based their reporting only on hospital records. Concussion is the most common form of traumatic brain injury.

The data used in the study were from the 2011 Ontario Student Drug Use and Health Survey (OSDUHS) developed by the Centre for Addiction and Mental Health. The survey, one of the longest ongoing school surveys in the world, contains responses from almost 9,000 students from Grades 7-12 in publicly funded schools across Ontario. The OSDUHS began as a drug use survey, but is now a broader study of adolescent health and well-being. For the first time in 2011, questions about traumatic brain injury were added to the survey.

"The questions about TBI were added to the OSDUHS because there were no current data on prevalence in the adolescent population," said Dr. Robert Mann, a senior scientist at CAMH and director of the OSDUHS. "Early research has indicated that there may be links between TBIs and mental health and substance use during adolescence -- we plan to study this in the near future."

The survey found that 20 per cent of adolescents in Ontario said they had had a traumatic brain injury in their lifetime. It found that 5.6 per cent of them had had such an injury in the past 12 months.

Dr. Ilie said this suggests the prevalence of TBI among young people is much higher than previously known, because many head injuries remain uncounted when they are not being reported to parents, teachers, sports coaches or health care workers. In Canada, 50 per cent of all injuries that kill and disable youth involve a TBI.

This new research found that 46.9 per cent of the TBIs reported by adolescent females occurred during sports (e.g., hockey, skate boarding); the figure was 63.5 per cent for males.

Students who reported drinking alcohol occasionally/frequently and those who reported using cannabis 10 or more times over the past 12 months had more than five times and more than three the odds, respectively, of acquiring a traumatic brain injury in the past 12 months than students who reported abstinence. The survey also showed that students who reported overall poor grades at school (below 60 per cent) had almost four times the odds of a lifetime acquired brain injury than students who reported grades at or above 90 per cent.

"Traumatic brain injury is preventable," said Dr. Ilie. "If we know who is more vulnerable, when and how these injuries are occurring, we can talk to students, coaches, and parents about it. We can take preventive action and find viable solutions to reduce their occurrence and long-term effects."

Brain injuries among adolescents are particularly concerning because their brains are still developing. There is growing evidence that people who have had one or more concussions are at greater risk of future concussions, and evidence that multiple brain injuries can result in lasting cognitive impairment, substance use, mental health and physical health harms.

Read more here

Inconsistent Criteria Used to Diagnose Concussions and Head Injuries

A new study shows that head injuries in sports and concussions are diagnosed subjectively due to the athlete's individual symptoms, and that the term concussion means different things to medical professionals as it does to those in sports.

In recent years it has become clear that athletes who experience repeated impacts to the head may be at risk of potentially serious neurological and psychiatric problems. But a study of sports programs at three major universities, published in the October 2Journal of Neurosurgery, finds that the way the injury commonly called concussion is usually diagnosed -- largely based on athletes' subjective symptoms -- varies greatly and may not be the best way to determine who is at risk for future problems. In addition, the way the term concussion is used in sports injuries may differ from how it is used in other medical contexts, potentially hindering communication about the factors most relevant to patient outcomes.

"The term 'concussion' means different things to different people, and it's not yet clear that the signs and symptoms we now use to make a diagnosis will ultimately prove to be the most important pieces of this complicated puzzle," says Ann-Christine Duhaime, MD, director of the Pediatric Brain Trauma Lab at Massachusetts General Hospital (MGH), who led the study. "Some patients who receive a diagnosis of concussion go on to have very few problems, and some who are not diagnosed because they have no immediate symptoms may have sustained a lot of force to the head with potentially serious consequences."

The current study is part of a larger investigation into the biomechanical basis of concussion and the effects of repeat impacts to the head, conducted over five years at Brown University, Dartmouth College and Virginia Tech. A total of 450 students -- members of all three schools' football teams, two women's and two men's ice hockey teams -- wore helmets equipped with instruments that measured the frequency, magnitude and location of head impacts experienced during practice sessions, scrimmages and games. Team trainers and physicians followed their standard procedures for assessing and diagnosing potential concussions and prescribing treatment.

During the study period more than 486,000 head impacts were recorded in participating athletes. Concussions were diagnosed in 44 participants, four of whom were diagnosed a second time for a total of 48 diagnosed concussions. A specific impact could be associated with the concussion 31 times, but no clearly associated impact was identified in the other 17 instances. The most commonly reported symptoms were mental cloudiness, headache and dizziness, and only one athlete lost consciousness. An immediate diagnosis was made only six times, and many of the athletes did not begin experiencing symptoms until several hours after the game. Although measured head impacts in those diagnosed with concussions tended to be higher, some concussion-associated impacts had considerably less measured acceleration/deceleration of the head. The authors note that the injuries reported in this study contrast with those usually seen in patients diagnosed with concussion in emergency departments, in whom a single, clearly identified head impact is typically associated with immediate changes in consciousness.

The authors add that developing strategies to prevent and manage short- and long-term consequences of head injuries requires accurate tools to determine which patients have sustained impacts that may affect the brain in significant ways, and that currently used criteria based on reported symptoms may be unreliable predictors of actual injury to the brain. They propose that replacing the single term 'concussion' with the concept of a concussion spectrum may be useful in determining the range of factors that can influence patient outcomes.

"A lot of work is needed before we can understand to what extent patients' reported symptoms -- compared to such factors as the actual force imparted to the brain, previous head injuries and genetic background -- influence the eventual consequences of repeated head impacts, consequences that may vary from patient to patient," says Duhaime, who is director of Pediatric Neurosurgery at MassGeneral Hospital for Children, director of Neurosurgical Trauma and Intensive Care in the MGH Department of Neurosurgery, and the Nicholas T. Zervas Professor of Neurosurgery at Harvard Medical School. "For now, however, it's sensible to err on the side of safety, realizing that more specific answers will take more time and research."

Read more here

How To Prevent Sports Concussions Among Children

A great article from the New York Times discusses ways to prevents concussions in children by sport.

This fall, about three million children younger than 14 are playing organized tackle football in the United States. Is that a good thing?

For many parents and coaches, that means three million children are getting some pretty serious exercise, hanging out with old friends and making new ones, and unplugging from technology, for a few hours at least.

I see those positives. Yet if it were my call, those millions would be playing touch football instead. Many would be learning the fundamentals of tackling and other football skills. But they would not be playing tackle football until they turned 14.

The reason is simple. Tackle football is too dangerous for youngsters. Exposure to head trauma is too risky. What we know about football and the vulnerabilities of children’s brains leads me to this conclusion. More worrisome is what we don’t know. How will the hits absorbed by a 9-year-old today be felt at 30, or 50?

I’ve been treating young athletes for concussions and other head trauma for four decades. In an average year, I’ll meet with patients to discuss their concussion symptoms 1,500 times or more. I’ve treated children for concussions in any sport you can name, and a few you wouldn’t think of. I’ve seen pole-vaulters, BMX riders and tennis players. Not that long ago, I treated a young man injured playing Ultimate Frisbee.

I’m not in favor of abolishing any sport for children, football included. Sports have too much to offer young people. There is nothing like being part of a Little League team or competing as a swimmer, tennis player or golfer to promote perseverance, sportsmanship, fair play, to keep fighting until the last point in the match or the last out. These are traits that carry us through life’s challenges.

In light of what we now know about concussions and the brains of children, though, many sports should be fine-tuned. But many parents and coaches are satisfied with the rules as they are. They like seeing youngsters in helmets and pads, and watching them slide headfirst into second base. The closer the peewee games resemble those of the professionals, the happier we are. It’s natural for a parent or a coach. Even a neurosurgeon.

But children are not adults. Their bodies are still maturing. Their vulnerabilities to head trauma are far greater.

A child’s brain and head are disproportionately large for the rest of the body, especially through the first five to eight years of life. And a child’s weak neck cannot brace for a hit the way an adult’s can. (Think of a bobblehead doll.) A child’s cranium at 4 is about 90 percent the size an adult’s. That’s important to a discussion of concussions and concussion risk.

We cannot eliminate head trauma from youth sports. What we can change is our mind-set so protecting the head and the brain is always a top consideration.

The guiding principle should be that no head trauma is good head trauma. Let’s re-examine youth sports and take steps to keep young athletes safe. I would like to see these changes written into the rules across the country.

SOCCER Many parents and coaches are surprised to learn that soccer is not among the safer sports for head trauma. It is actually one of the riskiest. In 2010, more high school soccer players sustained concussions than did athletes in basketball, baseball, wrestling and softball combined, according to the Center for Injury Research and Policy in Columbus, Ohio.

Most of that risk comes from one play: heading the ball. When two or more leap to direct the ball with their heads, a number of collisions can occur with heads, shoulders and elbows. From a neurological standpoint, nearly all are bad. About 90 percent of the patients I see with soccer head trauma and concussion are related to heading accidents.

It’s an easy call for me: take heading out of soccer until the players are 14.

ICE HOCKEY The progressive leadership of USA Hockey and Hockey Canada have done most of the heavy lifting in this sport. Hockey Canada outlawed checking to the head throughout amateur hockey. In 2011, USA Hockey approved a ban on body checking before the age of 13. I would extend the ban on body checking to 14. (The previous rule permitted body checking for players as young as 11.)

BASEBALL AND SOFTBALL Batting helmets are mandatory at every level of baseball, yet it’s surprising how little we do to ensure that they stay on. Some youth leagues around the country have mandated chin straps for years. All youth and high school leagues should require them.

In addition, headfirst slides should be eliminated. When a child’s head plows into an ankle or a shin, the leg always wins. Worse are home-plate collisions in which the head of the base runner can crash into the catcher’s hard shinguards.

FIELD HOCKEY AND GIRLS’ LACROSSE

I have heard that girls would be emboldened to play more aggressively if helmets were required in these sports, and that the net effect would be more injuries, not fewer. I say hold officials accountable for enforcing the rules, and that will not happen.

In lacrosse, some officials now favor something like a bike helmet to protect the top of the head. That is not good enough. When helmets that cover the entire head are required, fewer young women will sustain concussions.

Field hockey rules state that players should not raise their sticks above the knee. But that rule is broken in every game, often resulting in concussions, eye injuries, cuts, broken noses and more. Helmets are needed, although they do not have to be as robust as football helmets.

]I would expect resistance to these recommendations from parents of the 16,000 players in Pop Warner football’s tackle division for 5- to 7-year-olds, for example. But let’s begin the debate.

Read more here

Helmet sensor sends a mobile alert when athletes are at risk for concussion

A sensor in helmets can send an alert to parents and coaches when a player has possibly had a concussion.

When it announced it was donating $30 million to the NIH’s Neurology Institute earlier this month, the NFL made a big statement about its concern for the impact hard hits could have on players’ brain health.

The NFL is far from alone in its push to address head injuries in football and other sports. A movement over the past several years has spawned new research, collaborations and products, including one that’s getting traction helping high school and college sports teams monitor the hits their players sustain.

Impakt Protective Inc. is a Canadian company using sensors to help parents, coaches and athletic trainers identify hard hits that could potentially cause concussions. The company’s Shockbox sensor, powered by a rechargeable battery, is installed with an adhesive into a football or hockey player’s helmet. It measures linear and rotational acceleration and sends data about the forces being applied to players in real-time to a smartphone, laptop or tablet using Bluetooth technology. A mobile alert is triggered any time a player takes a hit above 50 G.

High school football players sustain about 100,000 diagnosed concussions per year, according to the Centers for Disease Control. Concussions occur when impact causes the brain to move violently and suddenly, resulting in a range of ambiguous symptoms including headache, dizziness, nausea or blurred vision. Kids who have concussions are more prone to catastrophic and long-term injuries, said Jonathan French, a neuropsychologist at University of Pittsburgh Medical Center Sports Medicine Concussion Clinic.

One thing worth noting is that the technology’s founders know its own shortcomings. “Concussions in sports has always been a problem and will always continue to be a problem,” Crossman said. “The need is that no one knows when they should start intervention.”

The problem with these kinds of sensors, according to French, who wasn’t familiar with Shockbox, is that there’s no universal threshold for head injury. “The second issue is that once sensor goes off, there’s still the need for a good sideline clinician who can do a thorough evaluation,” he said.

Shockbox doesn’t claim to be a concussion sensor; rather, it’s a tool to help coaches and parents avoid missed head injuries. “It’s kind of like CPR – everyone knows how to do it, but when someone needs it, everyone just looks around because they don’t know when they’re supposed to do it.”

And while some research has indicated that other factors aside from impact are at play in head injuries, Crossman said 50 G seemed like a logical place to start. “There’s a range that starts somewhere around 70-80 G and goes up to 100-110 G – that’s the area where there are most concussions,” he said. “We look at 50 G because in college level sports, 86 percent of hits are below 50 g. We’re looking for the exception cases.”

Shockbox, which is available in retail stores for use in football, hockey and snow sports, has gotten some traction. “We’ve only fully launched it about two to three months ago, and we sold out of our first manufacturing run.” It’s also the supplier of the East Coast Athletic Conference hockey league.

But it’s got some competition. Riddell, which makes the official helmet of the NFL, has a sensor-embedded helmet that allows for sideline monitoring on on-the-field impact, and the NFL is alsoreportedly testing BAE Systems’ helmet sensors developed for the Army.

Starting next spring, the Shockbox sensors will be part of similar smart helmets for football and hockey. But Crossman said the company will continue to focus primarily on youth and college sports, as high school teams often have one athletic trainer covering multiple schools, or maybe student trainers, and have more of a need for this technology.

Crossman wants people to know that Impakt isn’t smoke and mirrors, and that it underpins a lot of its work with research. But he also wants to make sure people understand the purpose of his product. “Brain-Pad just got slapped by the FTC for making false concussion claims – we’re very wary of that,” he said. “We are not a concussion censor. We just want to help them identify when a hit is too hard.”

Read more here

An expert argues that the rules in youth's sports need to change in order to prevent concussions. He believes this will better reduce concussions than helmets can.

Imagine ice hockey without body checking and football with less hitting. What might sound blasphemous to hockey and football fans and players could protect youngsters from potentially deadly concussions.

L. Syd Johnson, an assistant professor at Michigan Technological University who has studied the disastrous effects of concussions in professional sports, argues that the time has come for major changes in hockey and football.

"Helmets don't really help," Johnson says. "A concussion occurs when your skull goes one way and your brain the other. Helmets help with skull fractures, but they don't help for concussions, though players still think they do."

Johnson favors banning fighting in hockey, which is accepted in the NHL and North American junior leagues but illegal in European and Olympic hockey. The Canadian Academy of Sports and Exercise has called for a ban on body checking in all levels of minor hockey, she points out.

Johnson acknowledges that 100 percent of hits can never be taken out of football, but they can be can be lessened, she says.

"I'm most interested in changes in the way hockey and football are played for the recreational and junior players who won't make professional leagues," Johnson says. "Youth are a neglected population of players when it comes to studying the effects of concussions. Nobody really knows the long-term consequences, nobody has studied them."

Johnson's research also taps into the culture of sports, she says. Fighting in hockey, for example, is celebrated in venues like Don Cherry's twenty-volume video series, "Rock 'Em, Sock 'Em Hockey," that focuses on fisticuffs and body checking.

"As adults, we need to protect kids from injury," she says. "Sports are valuable. They help fight obesity, for example. But there are ethical implications. What's important in sports? What are we teaching kids?"

Johnson says that players in sports need to be respected as humans, not merely replaceable beings for our entertainment.

Read more here

Head Impacts in Sports May Reduce Learning in College Athletes

A new study suggests that head impacts experienced during contact sports such as football and hockey may worsen some college athletes' ability to acquire new information. The research is published in the May 16, 2012, online issue of Neurology®, the medical journal of the American Academy of Neurology.

The study involved college athletes at three Division I schools and compared 214 athletes in contact sports to 45 athletes in non-contact sports such as track, crew and Nordic skiing at the beginning and at the end of their seasons. The contact sport athletes wore special helmets that recorded the acceleration speed and other data at the time of any head impact.

The contact sport athletes experienced an average of 469 head impacts during the season. Athletes were not included in the study if they were diagnosed with a concussion during the season.

All of the athletes took tests of thinking and memory skills before and after the season. A total of 45 contact sport athletes and 55 non-contact sport athletes from one of the schools also took an additional set of tests of concentration, working memory and other skills.

"The good news is that overall there were few differences in the test results between the athletes in contact sports and the athletes in non-contact sports," said study author Thomas W. McAllister, MD, of The Geisel School of Medicine at Dartmouth in Lebanon, N.H. "But we did find that a higher percentage of the contact sport athletes had lower scores than would have been predicted after the season on a measure of new learning than the non-contact sport athletes."

A total of 22 percent of the contact sport athletes performed worse than expected on the test of new learning, compared to four percent of the non-contact sport athletes.

McAllister noted that the study did not find differences in test results between the two groups of athletes at the beginning of the season, suggesting that the cumulative head impacts that contact athletes had incurred over many previous seasons did not result in reduced thinking and memory skills in the overall group.

"These results are somewhat reassuring, given the recent heightened concern about the potential negative effects of these sports," he said. "Nevertheless, the findings do suggest that repetitive head impacts may have a negative effect on some athletes."

McAllister said it's possible that some people may be genetically more sensitive to head impacts.

The study was supported by the National Institutes of Health and the National Operating Committee on Standards for Athletic Equipment.

Read more here

Concussion patients are more likely to re-visit ERs

From hockey to horseback riding, a helmet could go a long way towards curbing the number of head injuries in Edmonton.

That’s according to research conducted at the University of Alberta.

It shows city folks who’ve suffered concussions from sports or recreational activities are likely to make return visits to the emergency room.

Dr. Donald Voaklander — a university professor and Director of the Alberta Centre for Injury Control and Research who funded the study — spent the better part of two years researching head injuries in Edmonton.

“Over an 11 year period, we had about 9,500 head injuries from sport and recreation activities,” Voaklander said.

The research shows that activities like hockey, rugby, driving ATVs and horseback riding are the top concussion causing activities in the city.

The study also showed that men under the age of 18 sustain a majority of the head trauma treated in Edmonton’s emergency rooms.

Voaklander worked with graduate student Andrew Harris to pore over several million emergency room records provided by Alberta Health Services for hospitals in the Edmonton region dating back to 1997.

“This study is unique because the data is gathered from the immediate community,” Harris said, noting that typically, this type of research focuses on professional sports and recreation concussions.

“These data are indicative of what is happening to the average Edmontonian,” Harris said.

The pair found that an Edmontonian who sustains a head injury is three times more likely to report back to the emergency department with another head injury. Those individuals are then six times more likely to return for a third visit.

“It confirmed our hypothesis that people with head injuries get more head injuries,” said Voaklander, noting that sometimes concussion symptoms don’t surface until hours after the time of the injury.

After sustaining a bump to the head, some people think that if they aren’t dizzy or don’t black out, they can get right back to it, Voaklander said, but that’s not the case.

“Even innocuous hits to the head still result in mild concussions,” said Voaklander, “While it might not prevent you from skating or whatever, it’s still a significant injury that needs to be managed like any other sprain, strain or broken bone.”

Edmontonians need to be more aware of the proper protective equipment when playing sports, said Voaklander, and refrain from behaving in ways that could make recreational activities more dangerous.

“You have to take head injuries seriously and if you’re doing high-risk activities, wear the gear, wear your protective equipment,” he said.

The research was recently published in the Clinical Journal of Sports Medicine.

Read more here

Study Claims that Kids' Concussion Symptoms Can Last a Year

Some children who suffer a concussion will display continued difficulties, such as attention and memory problems, for many months, a new study finds.

Concussions, also known as mild traumatic brain injury, are common in childhood, with more than 500,000 children and teens a year needing hospital treatment for these injuries, the researchers note.

"The results of the study suggest that the majority of kids who sustain mild traumatic brain injuries actually do quite well and don't have to have persistent symptoms after their injury," said lead researcher Keith Owen Yeates, director of Behavioral Health Services at Nationwide Children's Hospital in Columbus, Ohio.

"But, there is a small, but significant proportion of kids that do go on to have persistent symptoms after their injury, lasting as long as three to 12 months," he added.

The extent and duration of the symptoms appear to be related to the severity of the injury, and can affect quality of life and school performance, he said.

Kids shouldn't go back to play until their symptoms are gone, and the medical profession must fine-tune guidelines regarding permissible post-concussion activity, Yeates said.

The report was published in the March 5 online edition of Archives of Pediatrics & Adolescent Medicine.

For the study, Yeates' team compared almost 200 children and teens ages 8 to 15 who suffered a mild brain injury to about 100 similarly aged children who had a bone injury.

The researchers looked for symptoms of headache, fatigue, inattention and memory problems during the year after the injury.

They found children who suffered a mild brain injury were more likely to show these symptoms compared to other children. Also, the physical symptoms abated sooner in the concussed kids than the problems involving mental, or cognitive, functioning.

Moreover, these symptoms appeared worse in children who had lost consciousness or had abnormalities seen on brain scans, the investigators added.

It's not just football and hockey that pose a risk for student athletes. Soccer is the leading cause of sports-related concussions among high-school-age girls, the study pointed out.

Dr. Frederick Rivara, a professor and division chief of general pediatrics at the University of Washington in Seattle and author of an accompanying journal editorial, said concussions are taken more seriously by physicians, parents and coaches nowadays.

Sports are important for health, but care must be taken to protect youngsters from head injuries, Rivara said.

"If kids have symptoms of concussion they should be taken out of the game and shouldn't return to play without seeing a physician," he said.

Rivara said children should see a doctor after a concussion whether or not they lose consciousness.

"We have ignored these injuries, and we don't know enough about these injuries," he said. More research is needed about the consequences of concussions, he added.

Read more here