The TeamSafe® Report #28: Concussions: The Confusion Continues

The "Good News"

New research on concussions shows the occurrence of brain injuries to high school athletes across the country is dropping, especially during practices.
According to the OHSAA (Ohio) "football is safer than it’s ever been" and a high school coach says, "People are erring much more on the side of being safe than sorry.”
Another new study says, "There is a common perception that there's a direct causal link between youth contact sports, head injuries and downstream adverse effects like impaired cognitive ability and mental health," said lead author Adam Bohr, PhD. "We did not find that." "It is important to understand that the exposure of a typical youth participant may differ from cumulative exposure of former professional athletes and that the many benefits of youth sport participation should be weighed against the risks."

The "Bad News"

Could these injuries be prevented?

"She claimed the coaching staff at Hampton High School did two things wrong. The first thing, she said, was that they did not follow concussion protocol after Clark's first injury during practice back in August. 'We are alleging that had the proper concussion protocol been followed, Eric would not have been allowed to participate in the game two days later, until he was cleared by a medical professional,' Rogers said.The attorney also alleged that the school did not report the initial injury on the school's parent portal right after it happened on Aug. 27, and just posted the injury two days ago."
A former high school football player files concussion lawsuit against school district which alleges coach told player to keep playing after helmet-to-helmet hit. "'Man up, 'quit being a (expletive)' and 'get back out there.'” Yet the school district representative stated, “We’re definitely concerned about the safety of our students." “Our intent is to make sure our coaches have the training and certifications that will help them be more effective.”

Do High Schools report concussions to their state sports association?

Not in Oklahoma. "Tracking concussions from the standpoint of are they reporting those to us? No, they're not reporting those to us.”

Have coach's attitudes really changed?

In a recent D1 collegiate football game, the Tennessee quarterback "left the game during the second half after he took a substantial hit from a Georgia defender, resulting in a sack. Maurer suffered head trauma, but started yet again in Tennessee’s next game against Mississippi State on October 12." The announcer says, "He got blasted. He never saw the corner blitz coming."
But the head coach says, "Every play, there’s a lot of people running into each other, and they’re hitting their heads. I mean, I guess we could stop the game and evaluate everybody out there, but I don’t think we have time for that.”

The definition of concussion is still not clear.

"Variations in the definition of an injury and the definition of concussion make it challenging to compare studies and produce reliable incidence data.Variations in the definition of an injury and the definition of concussion make it challenging to compare studies and produce reliable incidence data."
"There is limited information about the proportion of concussions that are not captured by injury surveillance systems"

It's all in this paper.

This paper discusses the issue of the "skill" of reporting a concussion. Simply put, how does a coach or athlete "report" a concussion? What is documented? Where is it documented? How is it documented" To whom is the documentation sent?
The aforementioned paper also discusses concussion reporting and documentation and discusses additional reasons for lack of concussion data because it was not "observed" or a "diagnosis" of concussion was not made.
The bottom line is that without training and a system lots of concussions fall through the cracks and are never reported. The athlete is never examined and/or no follow-up examination or care is ever given.

This disturbing story alleges that the University of North Carolina lead by concussion expert Kevin Guskiewicz discovered extremely high rates of learning disorders in their football players and UNC doctors prescribed Adderall (ADHD stimulants) to many of these athletes. UNC did not disclose these findings in their concussion research.
These drugs affect baseline testing and post testing cognitive function. They allow the athlete to “power through” the time line the brain needs to recover. This allows the athlete return to play more quickly because they feel "OK" (like they do not need the rest and recovery time). They then "pass" the post test. All this happens in an accelerated time line.
This was used as "data" in UNC's research on concussions to show shorter recovery times.
Here is the rub. If the baseline testing occurred before the diagnosis of a learning disorder than the athlete would have reported no learning disorder before the baseline test. If they are diagnosed with a learning disorder sometime AFTER the baseline, this affects the results of the post test.
What if the learning disorder "symptoms" are really concussion symptoms, symptoms due to repetitive head trauma earlier in the athlete's career (youth, high school)?
For more, read Open Letter Requesting NCAA and Its Members to Release Data on Learning Disabilities