There was a story on National Public Radio (NPR) today about the growing concern over concussion in youth sports. This is a topic that has been in the news (and in our own blogs) this entire year, and it shows no sign of going away. Thank heaven! The more voices that join the chorus of concern, the healthier our children will be now, and in the future.

According to the story, concussions are now the second most common injury in kids’ sports. And due to more sports opportunities and a greater emphasis on performance, the hits are not only more frequent, but harder than ever before. On the scientific side, we now know that concussion is not a simple, benign bump on the head. As described by NPR:

Concussions used to be described as a brain bruise, but doctors now like to say that it’s a problem with the brain’s function, a problem that can’t be detected by MRI or CT scan. When the brain suddenly slams to a stop, the brain’s neurons all fire at once. That surge of energy temporarily messes up the brain’s electrical and chemical signal system, making it hard to think straight.

After kids suffers a concussion, doctors recommend that they rest their brains as well as their bodies. They are sidelined from sports until cleared by a doctor, and they need to cut back on everything that requires complex thought including playing a musical instrument and even texting. Once their brains are healed, kids are asked to ease slowly back into their usual routine.

…some schools are trying to do a better job of monitoring student athletes by taking a page from the NFL’s playbook. Last year, Churchill High School in Potomac, Md., started assessing student athletes’ memory and reaction time with the online ImPACT test, the same test used in the NFL, to see how their brains work.

“If there’s a potential concussion and they retest, we look for abnormalities,” says Dave Kelley, the athletic director at Churchill. “If they perform poorly on memorization or don’t react as quickly, that may show signs of a brain injury.” Kelley has benched eight or nine students in the past 18 months whose second tests suggested a concussion. [from the NPR story]

These measures sometimes seem like overkill to parents and coaches who grew up in a time when athletes were encouraged to “walk off” the pain and disorientation of a concussion. But studies have shown that concussions—especially multiple concussions—greatly increase the risk of permanent brain damage. In the long run, concussions may even lead to premature dementia and even death.

The brain injury attorneys of HensonFuerst believe that there’s no such thing as “too much” concern about kids’ concussions. A child has one brain to last a lifetime…how crazy is it to risk permanent injury for the sake of a game?

RESOURCES

To read or listen to the NPR story, click here: NPR Concussion Story

To read our blogs about concussion and other brain injury topics, click here: HensonFuerst TBI blog

You can also read more about traumatic brain injury on our dedicated web page: HensonFuerst TBI website.  If you have questions, HensonFuerst has answers.

Also, the U.S. Centers for Disease Control and Prevention (CDC) has developed a concussion awareness campaign called “Heads Up Youth Sports.” To see the Heads Up informational poster, click here: Heads Up Concussion Poster

This week, two articles published in the medical journal Pediatrics highlight the extremely high cost of motorcycle wrecks for youths ages 12 to 20.

The first study, “Youth Motorcycle-Related Hospitalizations and Traumatic Brain Injuries in the United States in 2006,” showed that the number of motorcycle deaths and injuries are increasing for children and young adults. Between 1999 and 2006, there was an 88% increase in motorcycle-related deaths. Among young motorcycle riders who are in a crash, one-third sustain a traumatic brain injury (TBI). Those with TBI were more likely to be discharged to a rehabilitation facility (instead of home), and 24% had long-term TBI-related disability.

The second study, “Youth Motorcycle-Related Brain Injury by State Helmet Law Type: United States, 2005-2007,” examined how differing helmet laws affect rates of brain injury and death among motorcycle riders ages 12 to 20. The researchers found something unexpected: States that have a youth-specific helmet law have an increased risk of  TBI that required hospitalization, disability, and death. States with a specific <21 law have 38% higher rates of serious TBI than states with universal helmet laws.

What might account for this counterintuitive finding? Perhaps universal helmet laws make adults more likely to remember their child’s helmet when they put on their own. Or it may be that adults who regularly use helmets themselves pay more attention to other aspects of safety while driving a motorcycle. The study just examined the numbers…it didn’t provide answers. However, the study’s authors declare:

Advocates for repealing universal helmet laws often assert that this retains their desire for choice while protecting young adults. This assertion is dubious; with consistent evidence of increased death and serious injury to young adults and minors who are supposed to be protected.

We agree. We have seen first-hand the devastation of traumatic brain injury caused by crashes involving motorcycles. We represent people who have had their lives destroyed by motorcycle wrecks. There is no good reason to subject a young person to risks they cannot control, and which carry such a potentially high price tag.

To read the full studies, click on the titles below:

“Youth Motorcycle-Related Hospitalizations and Traumatic Brain Injuries in the United States in 2006″ [Weiss, et al. Pediatrics, November 15, 2010]

“Youth Motorcycle-Related Brain Injury by State Helmet Law Type: United States, 2005-2007″ [Weiss, et al. Pediatrics, November 15, 2010]

To read more about traumatic brain injury and/or motorcycle wrecks, see our dedicated pages at www.lawmed.com. If you have questions, HensonFuerst has answers.

You know that feeling of dragging your body around in a North Carolina heatwave? Feeling sluggish and fatigued and just plain drained? (Yes, I’m happy it’s finally autumn.) But what if that feeling didn’t go away when the weather broke?

That’s what happened to Marilyn Berger, a contributor to The New York Times. As she describes in a fascinating article, Ms. Berger’s story started May with a fall from her bike. She landed on grass, but her helmet got crunched. By July, during the worst of the summer’s heat wave (and about two months after the fall), Ms. Berger was dragging along like the rest of us. Well, not quite like the rest of us. Her symptoms didn’t stop when the temperature dropped.

To make her awful and riveting story much shorter than it deserves, it turns out that the bike fall caused more than just a damaged helmet–her brain was injured, too. The diagnosis was a subdural hematoma, the type of blood clot thought to have killed actress Natasha Richardson last year.  She nearly died, and was saved only by the fact that a house guest was around to discover her in bed, incoherent.  She had brain surgery; she lived to tell the story.

Ms. Berger tells the story much better, with poignancy and clarity. There are two morals to this story. The first, which Ms. Berger leaves unspoken, is that all head injuries should be taken seriously. The second is that when a brain is injured, a brain can’t recognize the injury. Ms. Berger’s foot had been dragging, she weaved when she walked, she felt tired–the brain can concoct all kinds of reasons for the physical changes. Like extreme summer heat.

Which brings us back to moral number one: All falls need to be taken seriously. Especially because we may not always recognize the most serious of symptoms.

Please read the entire article. You’ll never look at a simple fall the same way again. Click this link:  The New York Times: “The Calm Before the Brain Injury Was Discovered”

To learn more about the effects of traumatic brain injury, see our website:  HensonFuerst Brain Injury page

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

For girls and young women, one sport accounts for more than 65% of of all high school catastrophic injuries, and more than 70% of all collegiate catastrophic injuries. (For the record, “catastrophic injuries” are life changing events, including traumatic brain injury, paralysis, and death.)  Less severe injuries are also common–each year, this sport sends more than 25,000 female students to hospital emergency rooms.

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.)