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.

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.)

A report from the U.S. Government Accountability Office (GAO) found that the number of injuries are often under-counted. In addition, the severity of symptoms is underestimated. For example, some states only require that injured athletes be removed from play for the rest of the day… and yet, a study by the Children’s National Medical Center in Washington found that more than 80% of students who experienced a concussion reported a significant worsening of symptoms over the first four weeks after attempting to return to school academics. (From article in USA Today.)

The primary federal program directed specifically at preventing concussion in high school sports is Heads Up: Concussion in Youth Sports, a program of the Center for Disease Control and Prevention (CDC). This program provides information for coaches, trainers, athletes, and parents, including information about how long a child should sit on the sidelines after concussion. For example:

“Several factors may affect decisions about when it is safe for an athlete to participate in sports again, which are referred to as return-to-play decisions. For example, research has shown that athletes who have sustained one concussion are at increased risk of sustaining another concussion. An athlete who sustains a repeat concussion before the brain recovers from the first—within hours, days, or weeks—may recover more slowly or may have increased likelihood of long-term consequences. Research has also shown that children and adolescents are more likely than adults to sustain a concussion and take longer to recover from one, although the reasons for this difference remain unclear.” (from the GAO report)

What is clear is that concussion–more precisely known as mild traumatic brain injury (MTBI)–is more common than estimated, more damaging to young brains than most people think, and not as respected as it should be. What we’ve learned from studying adult athletes is that repeated mild head trauma can lead to permanent and debilitating brain injury, including early dementia and death.  No one encourages young people to get injured, but there is a strong culture encouraging kids to get back in the game, and to play through the pain. The government’s report is the first step in making sure everyone is aware of the potential severity of every head injury.

(For more information about brain injury, visit HensonFuerst dedicated web page:  HensonFuerst TBI page.)