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Six Years After: Concussion Risk Management Still A Work In Progress

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It is hard believe that it has now been six years since I gave the keynote address at the National Sports Concussion Summit in Marina del Rey, California. Harder, yet to think we have been leading this charge since 2000.

In that speech (a full copy of which you can view by clicking here), I offered some suggestions on how each of us — whether we be parent, coach, official, athletic trainer, clinician, current or former professional athlete, sports safety equipment manufacturer, whether we were there representing a local youth sports program, the national governing body of a sport, or a professional sports league, could work together as a team to protect our country's most precious human resource — our children — against catastrophic injury or death from sudden impact syndrome or the serious, life-altering consequences of multiple concussions. 

Note that my focus was on second impact syndrome and the effect of multiple concussions. I wasn't talking then about total head trauma - a concept popularized by MomsTEAM's concussion expert emeritus, Dr. Robert Cantu - or discussing the effect of repetitive subconcussive hits, or what is now commonly being referred to repetitive head impacts, or RHI.  It wasn't until two years later that researchers at Purdue stumbled upon, literally, evidence that high school football players who had not been diagnosed with concussion neverless suffered similar short-term neurocognitive impairment from the cumulative effects of RHI.  As anyone who has been following the subject of sports-related head injuries knows, the concern about RHI has continue to grow exponentially over the past four years, as researchers have used ever more sensitive and sophisticated imaging techniques such as diffusion tensor imaging (DTI) and fMRI to identify short-, medium, and long-term effects on the brain of RHI.

In assessing progress on such important health and safety matters as head injuries, childhood obesity, and physical activity, issuing report cards seems to be all the rage, so in assessing which of my suggestions have been adopted, to what extent, and how much more work we need to do, I'm going to assign grades as well, recognizing that they are just my personal opinion as to the degree of progress.

Safety-conscious parents

As I told the audience that day in April 2008, one which included such luminaries as super sports agent Leigh Steinberg and representatives of the National Football League, the story of how I became a sports safety activist, with a particular interest in concussions is one that is likely familiar to those of longtime readers of MomsTEAM.  

As the mother of triplet sons, I had always taken a keen interest in their safety. I suspected then, and I suspect now, that all parents would say, if asked, that they put their kids' safety first — whether it is playing organized sports, at home, or riding their bike in the neighborhood. Some parents — particularly mothers, who have been the guardians of children at play since the dawn of day — not only talk that talk, but walk the walk, and are very protective.

I admit that, when it came to my sons' safety — and the safety of their teammates, I fell — and still fall — at that end of the spectrum, because I feel that, while life always involves some degree of risk, childhood should be a time when it is our responsibility as parents to minimize those risks and make it one of our highest priorities.

Not a whole lot has changed in six years.

While there were then, and are now, lots of very protective parents, at the other end of the spectrum, there are still some parents who are, sad to say, willing to sacrifice their child's safety and — in the case of concussions, their long term health — at the altar of a winning performance, a touchdown scored, a scholarship won, a pro contract inked, not just fathers, but mothers, too (for proof, one only has to watch the recent reality television show, "Friday Night Tykes.").

Many parents admit that they allow their children to play in such circumstances even though they know about the potential for adverse long-term health consequences, like major depression and permanent cognitive impairment.

Where I think we have started to make progress is with the large group of parents in the middle, who want to protect their children from long term injury but simply didn't know their role and what to expect of their "teammates" — the coach, the ATC, the team doctor, the athletic director.  Fewer parents still think that concussions only occur with a loss of consciousness and/or that it isn't dangerous to play with a concussion. More parents are becoming educated about the risks head injuries - whether of the diagnosed concussion variety or the result of repetitive impacts - and the steps that can and are being taken to minimize those risks. 

In part, of course, the increased public awareness of the issue is the result of relentless, saturation media coverage of the issue (I have a whole bookshelf of concussion books and DVDs).  Studies are also showing that the enactment of Lystedt laws in 48 states and the District of Columbia (all since May 2009, a year after my speech), which require that parents receive at least some minimal head injury information as a prerequisite for their child's sports participation, is increasing awareness.

I would also like to think that MomsTEAM's continued efforts to educate parents about concussion risk management and our PBS documentary, "The Smartest Team: Making High School Football Safer," which aired on over 300 stations last fall and which will be broadcast on almost all 387 stations in the fall of 2014, has played a role in increasing awareness. 

Yet we still have work to do.

Grade: B-

Culture of resistance

In 2008, I commented that "Too many young athletes — from 9-year old cheerleaders to star middies on high school Lacrosse teams — are still failing to self-report their symptoms to the coach, sideline medical staff, their friends or even their parents, forcing clinicians to try to manage concussions somewhat in the dark."

I noted that "Kids fail to self-report because, too often, they are told by their parents, but far more often by their coaches, and, more subtly, by the very culture of sports itself, that they should remain silent:

  • to avoid jeopardizing their spot in the starting lineup
  • being labeled a "sissy" by their coach and/ or their parents
  • to demonstrate to the coach and their teammates that they can "take a hit like a man"
  • to show that they can be as tough as their professional heroes
  • believing that the glory of individual and team success, the promise of a college scholarship, or the lure of a lucrative professional career is somehow worth the risk of lifetime impairment."

I noted that such silence can, as we all know, be deadly.