2010 August 30th
It may seem like we keep banging the concussion drum, but this story doesn’t go away. According to new information published online today, the number of concussion-related hospital emergency visits for children ages 8-13 doubled between 1997 and 2007 (a 100% increase). For youth age 14-19, the increase was 200%, a 4-fold increase.
The cause of this increase isn’t clear, but the researchers note that most of the concussions happened as a result of sports, even though fewer kids participate in organized team sports. So…if fewer kids play organized team sports, but there are more concussions due to sports, what exactly is going on?
According to the experts, there are a few potential explanations:
- while there are fewer organized team sports, there are more sports activities available;
- organized sports today are even more competitive today than they were in 1997, which puts kids at higher risk;
- practice and play times have become more intense.
There is also the possibility that parents and coaches are more aware of the symptoms of concussion, and are therefore more likely to take an injured child to the hospital.
No matter the reason(s) for the increase, everyone agrees that action needs to be taken to bring these rates down. For example, there need to be clear, comprehensive, and age-appropriate return-to-play guidelines for all young athletes. In the future, we may also see use of MRI scans, balance tests, and neuropsychological testing to take the guesswork out of concussion diagnoses. Helmet use should be required in sports that currently have no helmet rules (such as for skiing)…and other equipment could be modified to reduce injury risk (for example, padding goalposts, or decreasing mass and air pressure of soccer balls).
For more information, see this story posted by NPR: http://www.npr.org/templates/story/story.php?storyId=129519808
The original medical journal article is available online: Pediatrics
The reference is:
“Emergency Department Visits for Concussion in Young Child Athletes,” by Lisa L. Bakhos, Gregory R. Lockhart, Richard Myers, and James G. Linakis. Pediatrics, online publication August 30, 2010.
2010 August 26th
The average cyclist crashes about every 4,500 miles. Kids? Seems like at least once a week. Wearing a helmet has been shown to prevent up to 75% of cyclists’ head injuries… and are required by law in the state of North Carolina for all cyclists under age 16.*
Here’s what you need to know about choosing and wearing a bicycle helmet.
WHAT TO LOOK FOR IN A HELMET
- Helmets must meet the U.S. Consumer Product Safety Commission standard. Look for one of the following stickers: CPSC sticker, or ASTM’s F1447 sticker, or Snell’s B-95 sticker. (CPSC and ASTM standards are identical; Snell’s is even tougher, but you’ll rarely see these.)
- Choose color with visibility in mind: white is still best, next in line come other bright colors that are easily seen by drivers.
- Choose a helmet that is totally smooth, with no points that can snag. A good helmet is designed to protect your head in case the worst possible event occurs: if you are hit by a car. It needs to be smooth to “glide” along pavement (instead of catching in a way that bends your neck), and to prevent any protrusion from catching under the bumper of a car.
- If you ride a mountain bike, look for models that offer protection from trailside hazards.
- If you have unusual needs–or if you simply want help with your helmet choice–ask for help at a specialized cycling store, which will have a wider range of products and the expertise to help. For example, there are helmets to fit unusually large heads…padding to fit unusually small heads…helmets with “ponytail ports” for people with long hair…helmets with no large top vents for people with sparse or no hair.
WHAT TO AVOID
Avoid anything that prevents you from wearing a helmet properly, or which violates the definition of a “good helmet” listed above. In particular:
- AVOID dark colors
- AVOID extreme aero shapes, which provide a convenient “lever” for knocking the helmet aside in a fall
- AVOID squared-off, ridged, ribbed, or spiked shapes
- AVOID helmets without a standards sticker on the inside
- AVOID helmets with thin straps (more likely to break)
- AVOID helmets that don’t allow good visibility
- AVOID helmets that don’t fit properly
- AVOID helmets with strap adjustments that are too complicated for comfortable, everyday use
WHEN TO REPLACE A HELMET
- For sure, if the last time you bought a helmet was before 1999, the last time the U.S. government updated safety standards.
- Replacement recommended every 5 years, but can go longer if you don’t ride often.
- For sure, if the helmet has a crack or dent.
- Recommended after any crash–some damage may not be visible.
- If your helmet shows bubbling or other signs of heat damage
HOW TO WEAR A HELMET
For a video on how to do a helmet fit test, click here: Helmet Fit Test Video
For an illustration of the right and wrong ways to wear a helmet, click here: “Do you know the right way to wear a helmet?” or here: “Easy Steps to Properly Fit a Bicycle Helmet”
- A helmet is properly worn level on the head–not tilted forward or backward.
- The helmet should sit low on the forehead, one or two finger-widths above the eyebrows.
- The strap should be fit snugly–not loose, not too tight for comfort.
- Once on the head, try to move it with your hands. The helmet shouldn’t move more than an inch in any direction no matter how hard you try.
SPECIAL INFORMATION ABOUT HELMETS FOR KIDS
- Every child who rides alone or on the back of an adult’s bike needs a helmet. However, until a child reaches age 1 year, the neck muscles aren’t strong enough to support a helmet. If you have questions about riding with a toddler, talk with your child’s pediatrician about the best protection.
- Replace a helmet as often as you need to assure a good, safe fit. Consider a helmet at least as important as shoes.
- Some child helmets have several foam inserts of different thicknesses. These can be changed out to accommodate a growing head. (And the different thicknesses do NOT affect the protection offered by the helmet.)
- Teach your child that bike helmet is for biking or skating with in-line skates only. Skateboarding requires a different helmet.
- VERY IMPORTANT WARNING: A child SHOULD NOT wear a bike helmet on the playground. Children have died due to crush or strangulation when the helmet got caught on climbing equipment. For more information about this topic, click here: “Wear Bike Helmets On Bicycles – Not On Playgrounds”
HOW TO GET YOUR CHILD TO WEAR A HELMET
- Start by being a good role model: Wear a helmet yourself while riding!
- Make wearing a helmet a requirement right from the first day your child starts riding a 2-wheeler. If you make it an important rite of passage, it will feel more like something to be proud of. (Do you remember the day your training wheels were finally taken off? That kind of pride.)
- Explain why wearing a helmet is important.
- Talk with the parents of your child’s friends to let them know that you require your child to wear a helmet…and that you would like their help in applying that rule. This is a great opportunity to ask if they also require their children to wear helmets–kids are more likely to wear helmets if their friends also do.
- Point out cyclists wearing helmets as you’re driving, or if you watch bike races on television.
FAMOUS LAST WORDS…
From actual people who crashed:
- “I didn’t think I needed a helmet–I was only going about a mile.”
- “I don’t know what happened. The brakes locked on a turn and I flipped over the front wheel.”
- “I wasn’t expecting that rock to be there.”
* While your child’s brain depends on a helmet, don’t forget that your child depends on you and your healthy brain. The HensonFuerst traumatic brain injury team has seen too many people suffer permanent, catastrophic brain damage from bicycle accidents.
INFORMATION SOURCES:
Bicycle Helmet Safety Institute
U.S. Consumer Product Safety Commission
SafeKids USA
Insurance Institute for Highway Safety: Helmet Laws by State
ASTM International: Standards Worldwide
REI: How to Choose a Bicycle Helmet
National Highway Traffic Safety Administration
Wikipedia: Bicycle Helmet
2010 August 17th
“Tuesdays with Morrie” is the heartbreaking story of the final life lessons imparted by a beloved teacher dying of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. Today, the New York Times reports on an astonishing bit of science that expands the tragedy: Some people diagnosed with ALS may not have the disease. Concussions and other brain trauma may cause neurological decline and death in a way that mimics ALS.
“Doctors at the Veterans Affairs Medical Center in Bedford, Mass., and the Boston University School of Medicine, the primary researchers of brain damage among deceased National Football League players, said that markings in the spinal cords of two players and one boxer who also received a diagnosis of A.L.S. indicated that those men did not have A.L.S. at all. They had a different fatal disease, doctors said, caused by concussionlike trauma, that erodes the central nervous system in similar ways.” [from the New York Times article]
This is not to say that ALS does not exist…it simply highlights a new syndrome, a cascade of damage to the brain an nervous system that begins with trauma.
The researchers (in an article to be published tomorrow on the website for the Journal of Neuropathology & Experimental Neurology) refer specifically to athletes and men in combat, who suffer repeated head injury during their training and careers. Although Lou Gehrig is not specifically mentioned, the study raises questions about whether his eponymous disease actually caused his death. It may have been caused by his multiple head injuries. As recounted in the New York Times:
In 1924, during a postgame brawl with the Detroit Tigers, Gehrig swung at Ty Cobb and fell, hit his head on concrete, and was briefly knocked out. While playing first base against the Tigers in September 1930, Gehrig was hit in the face and knocked unconscious by a ground ball. He was knocked out again by an oncoming runner in 1935.
Those are the four incidents in which Gehrig’s being knocked unconscious was notable enough to be reported in newspapers. He most likely sustained other concussions that were never noticed or considered meaningful — for example, when he was hit in the head with a pitch during a 1933 game against Washington but continued playing — either in baseball or while serving as a halfback for Commerce High School in New York and later Columbia University.
This sure makes helmets look like a brilliant invention.
We’ve been writing a lot lately about the importance of recognizing concussion and allowing athletes–especially young athletes–time to heal. Playing through injury is no longer a sign of strength…now, it’s smarter to value brain over brawn.
2010 August 12th
On July 29, 2010, I wrote about the danger of metal bats in youth baseball. There are a growing number of head and brain injuries caused when baseballs hit by metal bats strike a pitcher in the head. Some players have been severely injured. One 16-year-old young man, Gunnar Sandberg, was nearly killed by a line drive. He was in a coma for three weeks.
Although there are no hard data linking metal bats to an increase in injuries, there are plenty of anecdotes. Plus, bat manufacturers are quick to try to sell metal bats based on superior performance, but seem to back off when it comes to injury. They say that “exit speeds” off metal bats are only about 6 mph greater than those for wooden bats. On the other hand, metal bats have a “trampoline effect,” which causes the bat to compress and bounce back when hitting a baseball, causing a faster hit. (Wood bats don’t compress as much because they’re not hollow.)
States are creating rules about the use of metal bats in grammar and high school sports. The latest is in California.
According to an article in today’s San Francisco Chronicle:
Assemblyman Jared Huffman will abandon a bill that would have temporarily banned metal baseball bats in school sports, after striking a deal with California high school sports officials that may lead to mandatory protective headgear for pitchers and other players.
New safety standards set by the California Interscholastic Federation (CIF) will ensure that non-wooden bats perform more like wooden bats, and that the bats cannot be tampered with to enhance their performance.
Most importantly, the CIF agreed to encourage infielders and coaches to wear protective headgear, and this may become mandatory within two years. In addition, the federation pledged to lobby its national leadership organization to set protective headgear standards.
HensonFuerst supports any measure that helps protect young athletes. Especially if the brain is protected. It bears repeating: Injured bones heal… injured brains are injured for life. Protective headgear may seem extreme, but there’s a whole generation of adults who grew up before bicycle helmets were required… now, wearing a helmet is second nature. This is a good idea, and we encourage federal safety standards for bats and head protection.
To read the full San Francisco Chronicle article: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/08/11/MNV51ESKG6.DTL#ixzz0wQNLi5I2
To read the original blog: http://www.lawmed.com/brain-injury/tbi-lawyer/more-injuries-from-metal-baseball-bats/
2010 August 6th
About four years ago, Texan Dianne Helms drove home after a night of partying and drinking. She crashed her Toyota Tundra into a culvert. Her body was tossed around in the car…her head went through the driver’s side window and smashed onto the pavement.
That’s how her year-long coma began.
That’s how she ended up in a wheelchair, unable to use her left arm or leg, unable to speak or even to pucker her lips enough to kiss her now 10-year-old daughter. Helms had “locked-in syndrome,” a condition in which a person can think, but can’t move or speak–nightmare of fear and frustration. She is now relearning the most basic of physical tasks, like how to eat and swallow, and how to go to the bathroom by herself.
The Houston Chronicle reports that with the help of a computer and a voice synthesizer, Helms is finally able to tell her story. And she doesn’t want anyone to end up in the same position she is in.
Over the past few months, Helms has continued giving her speech to teenagers, to adults – to anyone who will listen. She says warning others is her mission in life now. ”Maybe I was saved so I could save others,” she recently typed out on her laptop. [from The Houston Chronicle]
Helms feels tremendous guilt, for many things. For being a burden to her parents, who take care of her every need…and for not being fully there for her daughter.
Most people know that they shouldn’t drink and drive, but they never think that anything bad will happen to them. It’s the other guy, the one who isn’t “a good driver,” or who “can’t hold his liquor.” But impaired is impaired, and those who are most likely to get in a wreck are often those who think they are most capable.
Everyday, the lawyers of HensonFuerst see the victims of drunk drivers. These people end up in a wreck because they got in the way of an impaired driver–they had no choice in the matter, and they did everything right.
Broken bones can heal…cut skin can close and scar…but an injured brain is permanent. The brain doesn’t give second chances. Here’s hoping everyone hears Helms’ story and makes the smart choice: Don’t Drink and Drive.
