We have written extensively about the dangers of concussion–what doctors now refer to as “mild traumatic brain injury” or MTBI. So far, this has been a watershed year in how concussions are viewed. This year, we learned that a person who receives multiple concussions is at risk for developing Chronic Traumatic Encephalopathy (CTE), which leads to early dementia, depression, personality changes, and death.

We also learned this year that some cases of amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s Disease) may be due to head trauma, not disease process.

This is also the year that we found out that the number of head injuries in children’s sports have doubled or even quadrupled in the past 10 years. MTBI awareness has even reached that most hard-headed group, the National Football League, which has mandated that an educational poster about concussion be hung in every pro locker room.

As Dr. Senelick states:

Although the population of NFL players is important, there are only 1,900 active NFL players each season. There are more than 3 million children playing football at the youth level and 1.2 million more playing high school football. This doesn’t even begin to count the number of kids playing soccer (heading the ball) and hockey (body checking). We have to ask whether we are taking adequate steps to protect our children – to change not just the equipment but the rules so that we reduce the chances of the players experiencing traumatic brain injuries.

What does he suggest? The same things experts and investigators have been suggesting for years:

1. Change the rules of the games to make head injury less likely.
2. Change the equipment, helmets and the equipment that makes dangerous projectiles of balls and pucks.
3. Mandate certified trainers in schools and for all organized sports activities.
4. Change the culture, so that we value health over winning a game…especially when our children are young, their brains are developing, and the games will be forgotten by morning.

None of that will be easy. Think how difficult it is just to get people to use a seat belt in a car, or to wear a helmet while cycling. Dr. Senelick notes that in Idaho…

We have an increasing number of bear attacks because people foolishly approach a bear, thinking it is safe to get that close-up picture. I recently read the following analogy:  If people are in the ocean and hear someone yell “shark” they race out of the water. If someone yells “bear” in Yellowstone, everyone races to get a close-up photograph. They have not been properly educated on the dangers of close encounters with a bear.

The same is true for youth sports and brain injuries. There is a bear out there and people need to be educated and the rules need to be changed.

He ends his editorial with this sentence:  ”Our children are getting injured and dying — it is time to wake up.”  Given the traumatic head injuries we have seen, we agree.  The only thing more heartbreaking than seeing a child with a head injury is watching the agony of that child’s parents. No one gets over it…not the child, not the parents, not the grandparents, not the community. We owe it to…well, everyone to help protect our children from head injury.

If you want to learn more about concussion and other traumatic brain injuries, visit our website at www.lawmed.com. If you have questions, HensonFuerst has answers.

Our previous blogs on concussion:

Football Concussion Poster

Youth Concussion Rates Skyrocket

Metal Bat Controversy in Youth Baseball

Head Injury and Lou Gehrig’s Disease

To read Dr. Senelick’s full article, click here: Head Games and Youth Sports: Have We Gone Too Far?

To read a great Time magazine article, which has a link to a video of what football can do to the brain, click here:  The problem with football:  How to make it safer

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.

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

“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.

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/

The National Football League (NFL) has released its official, new poster, which clearly lists symptoms of concussion and potential long-term effects. In one section, the poster says that traumatic brain injury (TBI) can lead to “…problems with memory and communication, personality changes, as well as depression and the early onset of dementia.”  This is the most honest and blunt statement of the hazards of football by the NFL since, well…ever.

According to an article in the New York Times, players welcome the posters:

“That poster is shocking,” said Domonique Foxworth, a cornerback for the Baltimore Ravens. “It gives people facts before they take risks. But it’s not exactly a new revelation.”

Matt Birk, the Ravens’ center, said: “To put it out there in writing in locker rooms, at least it’s publicly acknowledging that, ‘Hey, this is real.’ There’s risks in everything you do, and this one is real. You can’t sweep it under the rug anymore.”

On the poster (which may or may not be different from what is said on the field), players are told that “playing through” a concussion could cause permanent brain damage. The advice is to report symptoms, get checked out by medical staff, and then take time to recover.

Although this is a great and long over-due first step, the New York Times reports that a lawyer for the NFL wrote a memo discrediting connections between football head trauma and long-term cognitive decline. The article continues:

The letter, obtained by The New York Times, explained, “We can point to the current state of uncertainty in scientific and medical understanding” on the subject to deny players’ claims that their neurological impairments are related to football.

Sadly, that adds credence to the football league’s “chew ‘em up and spit ‘em out” reputation when it comes to players’ health. The problem is that if a player wrecks his knee, he loses his job…but if he wrecks his brain, he could lose his memory, his family, his entire sense of self. We’re glad to see that the posters provide solid medical information. Maybe, eventually, the message will sink in. The next step is to make sure players are respected for taking it slow after concussion.

To read the full New York Times story, click here: NFL Concussion Poster

Weeks of vacation and sultry weather make outdoor sports more popular, and whenever people get active, there are bound to be injuries. This week, the American Association of Neurological Surgeons (AANS) issued a reminder to enjoy summertime sports safely.

Over a one-year period from 2008 to 2009, the numbers of head injuries rose for nearly every sport (the single exception: Trampoline!). Heading the list (pun intended) are bicycling, water sports, baseball and softball. Cyclists suffered the most head injuries–more than 85,000 were reported in a single year, up from about 71,000. And the number water-related head injuries more than doubled, from 11,200 to than 28,700.

“By taking a minute or two to use your head, you can help prevent potentially life-altering and tragic consequences,” Dr. Gail Rosseau, a Chicago-area neurosurgeon and AANS spokeswoman, said in an association news release.

Surprising and Preventable Causes

When it comes to cycling, the AANS reports that at least part of the blame for the increase in injuries comes from–get this: use of cell phones! “Sidetracked cycling” is is as dangerous as “distracted driving.”

The AANS offers the following safety recommendations:

• To prevent biking accidents, the organization encourages riders to use helmets, obey traffic signals, avoid uneven surfaces, wear bright colors and reflectors at night, and avoid cell phone use.
• To increase water safety, AANS advocates for adult supervision of young children, careful diving in conjunction with accurate water-depth information, keeping gates locked around backyard pools, avoiding alcohol consumption during water-related activities, following posted instructions at public places, and enforcing a strict ban on potentially dangerous rough play.

And don’t forget that using cell phones while supervising young children around swimming pools could also be dangerous. If attention is needed, give attention. Of course, if you’re a glass-is-half-full kind of person, you could take the AANS report as a license to turn off the cell phone and enjoy your time outdoors. Summer, sports, and safety–that’s having it all!

This week, a press release from C.S. Mott Children’s Hospital (part of the University of Michigan Health System) reports on a recent poll, and talks about the next step in recognizing concussions: parents.

According to the article, two-thirds of parents of young athletes worry that their children will get a concussion while playing school sports, but 50% don’t know if their children’s school has a concussion policy. One-third of parents are unaware of the dangers of repeated concussions, which can include permanent brain injury, early dementia, or even death.

Experts believe that a young athlete who suffers a concussion should not return to play for at least two weeks, and some brain injury specialists believe that injured players should sit on the sidelines for three full months to give the brain a chance to heal.

It can be difficult to diagnose a potential concussion on the field. Contrary to popular belief, most concussions do not result in a loss of consciousness…and symptoms may not occur for several hours after the injury. Young athletes may not recognize that they are hurt, or they may be afraid to mention symptoms for fear of losing playing time or of disappointing a coach or a parent.

What parents should know

Parent involvement in guarding against repeat concussions is critical.  Any time you suspect that your child has received a head injury, watch for these common signs and symptoms of concussion:

• confusion
• loss of memory (amnesia)
• headache
• dizziness
• a sensation of the world spinning (vertigo)
• imbalance
• lack of awareness of surroundings
• nausea and vomiting

If these symptoms appear after a head injury, consult a medical professional promptly for a full evaluation. Don’t allow a coach to pressure your child into playing before he or she has recovered. When in doubt, talk with a doctor.

For more information, click here:   “Concussion in Sports” from the Centers for Disease Control and Prevention (CDC)

To read the full C.S. Mott Children’s Hospital press release, click here: “Parents Ill-Prepared to Reduce Kids’ Concussions Risks”

If you have legal questions about concussion and brain injury, go to the HensonFuerst dedicated Brain Injury page. At HensonFuerst, if you have questions, we have answers.

The sport?  Cheerleading.  And compounding the tragedy of injury is the fact that only 20-25 states list high school cheerleading as a sport… the NCAA doesn’t recognize cheering as a championship sport… and unless the number has changed since December 2009, only 3 colleges consider cheering a sport–none in North Carolina. (Statistics from Journal of Athletic Training 2009)

Call a Sport a Sport.

While “recognition” might seem like a minor point, it has major ramifications for safety.  A “sport,” performed competitively and for entertainment, requires strict guidelines to ensure the safety of athletes. In 1980, when cheering was still primarily about leading the crowd in cheers, there were fewer than 5,000 emergency room visits. Today, cheering involves highly skilled gymnastics (as well as being tossed in the air and trusting that someone will be there to catch you).

Without the sanction of being a sport, cheerleaders often have to practice in areas that make injuries more likely, such as an asphalt parking lot or a team member’s backyard.  A “sport” requires coaches to have a certain level of training and certification; a “sport” puts limits on the risks required of the participants; and a “sport” makes training and safety an integral part of practice and performance. Unfortunately, in most schools, cheering lacks safety, limits, and trained coaches.

Gimme an A-C-T-I-O-N.

One of cheering biggest and most vocal supporters is Frederick O. Mueller, Ph.D., Director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill (UNC-CH). The group’s 26th annual report devotes a special section to cheerleading injuries, which describes the current state of cheering as a sport, details specific catastrophic injuries and how they occurred, and suggests sample guidelines that could help prevent cheerleading injuries. As quoted from the report (available here):

“Is cheerleading an activity that leads the spectators in cheers or is it a sport? If the answer is to entertain the crowd and to be in competition with other cheerleading squads, then there must be safety guidelines initiated. The authors of this research question why it is called cheerleading, when competitive cheer has nothing to do with leading the crowds at athletic events in cheering for the athletic teams on the playing field. Following are a list of sample guidelines that may help prevent cheerleading injuries:

1. Cheerleaders should have medical examinations before they are allowed to participate. Included would be a complete medical history.
2. Cheerleaders should be trained by a qualified coach with training in gymnastics and partner stunting. This person should also be trained in the proper methods for spotting and other safety factors.
3. Cheerleaders should be exposed to proper conditioning programs and trained in proper spotting techniques.
4. Cheerleaders should receive proper training before attempting gymnastic and partner type stunts and should not attempt stunts they are not capable of completing. A qualification system demonstrating mastery of stunts is recommended.
5. Coaches should supervise all practice sessions in a safe facility.
6. Mini-trampolines and flips or falls off of pyramids and shoulders should be prohibited.
7. Pyramids over two high should not be performed. Two high pyramids should not be performed without mats and other safety precautions.
8. If it is not possible to have a physician or certified athletic trainer at games and practice sessions, emergency procedures must be provided. The emergency procedure should be in writing and available to all staff and athletes.
9. There should be continued research concerning safety in cheerleading.
10. When a cheerleader has experienced or shown signs of head trauma (loss of consciousness, visual disturbances, headache, inability to walk correctly, obvious disorientation, memory loss) she/he should receive immediate medical attention and should not be allowed to practice or cheer without permission from a physician.
11. Cheerleading coaches should have some type of safety certification. The American Association of Cheerleading Coaches and Advisors offers this certification.
12. The NFHS should make cheerleading a sport, which will place cheerleading under the same restrictions and safety rules as all other high school sports. The NCAA should follow this same recommendation.”

HensonFuerst commends the research and activist efforts of Dr. Mueller and his team. We represent the interests of far too many children and young adults whose lives have been shattered due to head trauma or other catastrophic injury. There are few things in life as heartbreaking as broken potential. We agree that it is time to let recognition and regulations catch up to this fast-moving, physically demanding sport. Yes, sport. Let’s at least make an effort to stop the hemorrhage of young, enthusiastic lives.

To report a cheerleading injury to make statistical reporting more accurate, go to www.cheerinjuryreport.com, sponsored by the National Cheer Safety Foundation. For more information about traumatic brain injury, or to request a legal consultation for a cheer injury, visit our dedicated web page. If you have questions, HensonFuerst has answers.

(Related and interesting articles can be found here: Flying without a net: Cheer injuries on rise. MSNBC and Cheerleading is leading cause of catastrophic injury in young women, ScienceDaily.)

“Nearly 30,000 veterans have suffered some kind of traumatic brain injury in the wars in Afghanistan and Iraq – an estimated 2,000 of them severe enough to put warriors into comas or leave them with severe disabilities. Yet eight years into the wars, testimony before Congress shows veterans still suffer yawning gaps in coverage for what has become the conflicts’ signature wound.”   (News & Observer, 5/23/2010)

“…part of Pittman’s brain has gone dormant, and on most days, he can’t think straight. He leaves the room and forgets what he was searching for. He gets migraines so piercing that his right eye wanders. Anger comes easily, inspiring rages that sometimes have his wife terrified for herself and the couple’s 3-year-old daughter.”