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.

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.

Now that the Fourth of July weekend is upon us, many families will be spending every spare minute around the pool or at the beach. Most of us have fond memories of those “Hey, watch me dive” days from our childhood. I remember one summer when my cousin slipped while running around the edge of the pool and split his lip on the concrete… and another year when my teenage friend nearly drowned after body surfing in the dark.

In hindsight, it is obvious that we were all pretty lucky that our injuries weren’t worse than that. Those memories just as easily could have been tragic. Head and neck injuries can result in brain injury, paralysis, coma, or death.

Today’s summer advice is about water safety, so that our kids have fond summer memories, too.

Ocean Play

According to Hoag Hospital’s Project Wipeout, most injuries in the ocean are caused by the powerful surge and pull of waves. Serious injuries can occur in a number of ways:

“When your body tumbles in the waves, gets thrown by the waves to the ocean floor or when your head spears into the sand; your head can be forced down onto your shoulders, pushed forward into your chest or pushed backward further than it can naturally extend. And once spinal cord damage is sustained, little can be done to medically repair it. The result is severe pain, paralysis, the inability to breathe on your own or even death.” (Project Wipeout)

• Don’t jump off piers or jetties.
• Don’t enter the ocean alone.
• When body-boarding, hold the board so it extends past your head–if  a board is held closer, a wave can flip the board backward toward the head and neck.
• Make sure you know where sandbars are before riding surf.
• Don’t enter the ocean drunk.

Swimming Pool Play

According to LiveStrong.com, supervision at the pool is the number-one safety rule:

“One-on-one adult supervision is recommended for children. If supervising a child, you are too far away if you are unable to reach the child with an outstretched arm. Young children under 7 and non-swimmers should wear a PFD, personal flotation device, when in water at or above chest height. Flotation toys are not intended to prevent drowning. Implement the buddy system for everyone. Good swimmers and adults alike should never swim alone.” (LiveStrong.com)

Diving

• Don’t dive in less than 9 feet of water. A good rule of thumb is if there is no diving board, diving is not allowed. That means no diving into the shallow end of a pool, or into an above-ground pool.
• If you can’t see the bottom, don’t dive. You never know when there might be submerged items in your dive path.
• Don’t dive into unfamiliar waters…even if others are diving.
• Get training before doing back dives or fancy dives, or diving from diving blocks.
• Don’t try to dive through or over objects.
• Never dive from pool structures, such as slides or ladders… or from retaining walls, rooftops, balconies, or fences.
• Don’t dive drunk or under the influence of drugs.
• Don’t dive alone.

Sliding

• Don’t let anyone slide head-first…even adults.
• One slider on the slide at a time.
• Slide only if the water in the landing area is free of objects or other people.
• The landing area in front of a slide should have a minimum depth of 5 feet.

To read our other Summer Safety Tips…

Tip #1: Heat Illness.

Tip #2: Summer Auto Wrecks.

Tip #3: Medications that Don’t Mix with Heat.

RESOURCES

Lifesaving Resources, Inc. Spinal Injuries in the Aquatic Environment; Part 1: Prevention. (Gerald M. Dworkin, reprinted from 1987 Parks & Recreation. (http://www.lifesaving.com)

Hoag Hospital’s Project Wipeout. A nonprofit hospital’s program to save lives and prevent injuries at the beach. (http://www.hoaghospital.org/ProjectWipeout/AboutProjectWipeout.html)

Christopher & Dana Reeve Foundation’s Summer Safety Checklist. (http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.5283099/k.6B65/Summer_Safety_Checklist.htm)

LiveStrong.com. ( http://www.livestrong.com/article/124389-private-swimming-pool-safety/#ixzz0sTuyKsvE)

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.)

People who sustain a head injury sometimes end up with a vision problem called “vertical heterophoria syndrome,” or VHS, in which the eyes go out of alignment with each other.  This causes many different symptoms related to eye strain, sense of balance, and the ability to see straight. Symptoms include dizziness, headaches, light sensitivity, double vision, difficulty ready, motion sickness, poor coordination, drifting while walking, lightheadedness, nausea, etc.  These symptoms can greatly reduce quality of life, and can be a challenge for doctors to treat successfully.

The Michigan researchers discovered that when people with VHS were fitted with special glasses that realigned the images so that they appeared in line again, symptoms were reduced by more than 70 percent. (April 2010 issue of Physical Medicine and Rehabilitation)

“Treatment [of traumatic brain injury] involves a multifaceted approach, including physical therapy, occupational therapy and multiple medications, and can take years to complete,” says Jennifer E. Doble, M.D., a physiatrist at St. Joseph Mercy Hospital, Ann Arbor.  ”Prismatic lens treatment seems to allow the other therapies to be effective more quickly. And as a result, patients get better quicker, reducing the time and cost of caring for this patient population.” (press release, PR Newswire)

We can get behind anything that helps brain injured people get better faster!

The attorneys of HensonFuerst remain committed to helping people with brain injury. We’ll keep you informed of other medical breakthroughs on our HensonFuerst brain injury webpage.

“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.”

The first week of May, it was announced that athletes at all Big Ten colleges will be required to undergo education about the symptoms of MTBI.

On May 9, 2010, Dylan Steigers died of a football-related head injury. He walked off the field after a scrimmage, vomited–a sign of concussion–then taken to the hospital. He died of subdural hematoma (bleeding on the brain). His death will surely be remembered and cited often as yet another reminder of how serious every head injury can be. (OregonLive)

At HensonFuerst, we are highly attuned to the dangers of brain trauma.  Every day we see clients whose lives have been changed forever after an accident. We support the principle of brain injury education for athletes, coaches, parents, and college administration officials.  The more we all understand about the signs and symptoms of brain injury, the more we respect the seriousness of even “mild” concussions, the more we encourage wellness over performance, the fewer disabled athletes will require a lifetime of special care.

We hope that the responsibility for recognizing when an athlete may be unfit to play is given to those who have the appropriate medical training. We say this because it was reported that “students will sign a waiver acknowledging their responsibility to be an active participant in their care.” (Dr. Jeffrey Kutcher, as reported on AnnArbor.com.)

Yes, it is important that athletes report their symptoms honestly–without fear of mockery or reprisals–but people who have a brain injury can be confused, forgetful, and disoriented. If the intention of this waiver is to get athletes to become more aware, that’s wonderful, but we hope that it is not used as a way to shield the colleges from their responsibility to protect the students.

HensonFuerst is a proud supporter of the Brain Injury Association of North Carolina (BIANC).