New research published in the February 2011 issue of the medical journal Neurosurgery revealed that high school athletes who had two or more concussions were more likely to report physical, emotional, and cognitive problems than those who had never had a concussion.

“It appears that youth athletes who sustain multiple concussions experience a variety of subtle effects, which may be possible precursors to the future onset of concussion-related difficulties,” the researchers write.

The study looked at 2,500 high school athletes in three states. The researchers found that the athletes with two or more concussions had symptom “clusters,” that affected the way they could think, their sense of physical well-being, and their sleep. For example, young athletes with multiple concussions were more likely to have memory problems, “foggy” thinking, headaches, dizziness, balance problems, and sleeping more or less than usual.

According to the press release for the journal:

Recent reports have highlighted the cognitive and psychological aftereffects of repeated concussions, including cases of chronic traumatic encephalopathy (CTE) and degenerative brain disease in retired football players and other athletes.

“As a result of these findings, there is concern that repeated concussions can result in brain pathology that leads not only to cognitive difficulties, but to serious emotional sequelae in later life,” wrote lead researcher Philip Schatz, Ph.D., of Saint Joseph’s University, Philadelphia, and the International Brain Research Foundation.

This is another link in the chain that relates even mild traumatic brain injury to long-term problems. At HensonFuerst, we take all cases of head trauma seriously. With teen sports, it is clear that we all need to be more vigilant about safety.

• Teens should be encouraged to report all instances of head injury, and should not return to play until cleared by a physician.
• Proper safety equipment should be mandatory for all sports.
• Trainers and parents should watch for signs of concussion, and make sure that teen athletes receive medical care.

When it comes to any head injury, the rule of thumb is: Better safe than sorry. Let’s all take care of growing brains. If you have any legal questions about head injuries, please feel free to visit our website at www.lawmed.com, or call one of the lawyers of HensonFuerst at 1-800-4LAW-MED.

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

It’s not everyday that the American Academy of Neurology (AAN) takes an official position on an ethical topic; they have released fewer than 2 dozen position statements in the last 20 years. But today, this organization of more than 22,500 neurologists and neuroscience professionals have gone public on a topic near to our hearts: Concussion in sports.

The organization’s recommendations (which cover all ages, not just professional athletes) are:

1. Any athlete who is suspected to have suffered a concussion should be removed from participation until he or she is evaluated by a physician with training in the evaluation and management of sports concussions

2. No athlete should be allowed to participate in sports if he or she is still experiencing symptoms from a concussion.

3. Following a concussion, a neurologist or physician with proper training should be consulted prior to clearing the athlete for return to participation.

4. A certified athletic trainer should be present at all sporting events, including practices, where athletes are at risk for concussion.

5. Education efforts should be maximized to improve the understanding of concussion by all athletes, parents, and coaches.

According to an Associated Press article in the News & Observer:

The doctors group recognizes it isn’t necessarily feasible. One official called it a gold standard to strive for.

“We understand completely that is undoable in today’s environment, but we think that is a correct way to organize our priorities,” said Dr. Jeffrey Kutcher, chairman of the academy’s sports neurology section. He said that if a certified athletic trainer is not available to a school, perhaps contact sports should be avoided.

The overall message is the same one we’ve been hearing all year: Concussions are serious medical conditions that need to be spotted and treated immediately.

In the past few months, we’ve learned that concussion rates are soaring for student athletes (Blog: Concussion Rates Soaring), and that the long-term effects of concussion are potentially devastating (Blog: Concussion Linked to Dementia). While the recommendations from the AAN may seem extreme, the goal is to raise awareness and to keep brains safe. Who can argue with that?

RESOURCES

The American Academy of Neurology’s Position Statement On Sports Concussion

Associated Press article in the News & Observer: Brain Doctors Issue Warning on Concussions

HensonFuerst Brain Injury page

I just read a fantastic editorial about head injury and concussion in youth sports, written by someone who knows and cares: Neurologist Richard C. Senelick, M.D., Medical Director of the Rehabilitation Institute of San Antonio. He is also a father and a grandfather, so this topic is more than just an abstract medical exercise to him.

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

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.

As temperatures rise, so do the number of head injuries, including traumatic brain injury and concussion, head lacerations, and skull fractures.

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!

Concussion is finally gaining respect as a serious injury. Doctors have begun calling it “mild traumatic brain injury,” which more fully and accurately defines what concussion really is. High schools and high school sports organizations have begun setting more stringent standards for evaluating a student athlete after a head injury–no matter how minor the injury may initially seem to be. And doctors are weighing in with guidelines for when the injured athlete can return to play.

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.

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.)

Young athletes are suffering more and more sports injuries, everything from brain injury to broken feet.  Of most concern is the increase in mild traumatic brain injury (MTBI), what used to be known as concussion.

According to an article from the University of California, San Diego Health System:

Sports concussions are especially problematic in those under 18 years of age because of “second-hit” or “second-impact” syndrome. If an athlete returns to play too soon and has not allowed the brain to fully heal, then a second blow to the head could result in a life-threatening situation.

There is an organization that has launched an educational campaign to raise awareness and promote prevention of injuries in young athletes. STOP Sports Injuries was created by a coalition of organizations, corporations, and medical professionals. (The all-volunteer medical steering committee includes Dr. David Martin of Wake Forest School of Medicine in Winston-Salem, NC.)

The website offers educational tools for parents, coaches, athletes, and healthcare providers…concussion and injury-specific information…and injury prevention resources for specific sports, including baseball, basketball, cheerleading, dance, running, soccer, and many others.

Check out the site: http://stopsportsinjuries.org. The brain you save could be your own… or your child’s.

HensonFuerst Attorneys remain committed to combating brain injury. We are proud supporters of the Brain Injury Association of North Carolina (BIANC). If someone you love has suffered a brain injury and you are wondering what to do next, give us a call. If you have legal questions, HensonFuerst has answers.

University of Michigan researchers have reported that a simple test that measures reaction time can help detect and diagnose concussion in athletes.

In the study, athletes were tested once at the beginning of their sport season—they had to catch a weighted cylinder dropped by their coach. Their reaction time was measured. Then, if one of those athletes received a concussion during the season, there reaction time was measured again several days after the injury.

The researchers discovered that athletes with concussion had a 15% longer reaction time. This demonstrates that concussion carries effects that linger even after the initial headache and dizziness go away. And it dovetails with recent suggestions we reported that athletes with concussion should remain sidelined for  at least three months. Such a simple test…and yet, if it is adopted by high school and college coaches, it may help save the brains of our young athletes.