High School Head Injuries - John Ferszt & Austin Priebe

Context

Reference to a current Michigan bill or law that relates in some way to your proposal:

http://www.legislature.mi.gov/documents/2011-2012/publicact/pdf/2012-PA-0343.pdf

Why this proposal will make a difference in the lives of students of all ages across Michigan, or a significant subgroup (by age, background, economic status, and/or region, etc.) of students in Michigan:

Our proposal will make a difference in Michigan as it will create a healthier environment to compete in high school athletics. Not only will the sport be safier, the measures taken in the event of a concussion will be much more streamlined, allowing a strict protocal to be made. From this, athletes will only be able to enter back into their respective sport once the necessary protocal has been completed.

How and where did you learn about the issues underlying your proposal?

Being John and I both played high school sports, namely, hockey and baseball, we were exposed to the hard hitting nature of sports and many of our friends incurred concussions. This issue has only become more serious as kids get bigger, faster, and stronger as the years go by.

How has your service activity influenced your thinking about this proposal?

We currently have our service activity scheduled but have not had the opportunity to be exposed to the issue just yet.

Link to your media artifact(s) giving background on the issue:

https://docs.google.com/a/umich.edu/document/d/1zCDR3wPoDQwfCbKVeWtkbBxStyXM1R-EUykBZo-e3Rw/edit?usp=sharing

Consultations

Talk directly with at least 3 real live people who have special knowledge about this topic or the impact your proposal would have, and summarize their comments. These may include people appearing in your media artifact (video, podcast, etc.).

CONSULTATION 1: John Ciecko is a certified athletic trainer for Bloomfield Hill High School in Michigan. During this consultation we wanted to gather more information about the salience of this problem at the High School level. One important takeaway from the interview was that he confirmed our hypothesis that the concussion issue at the high school level of athletics is less prevalent than at the pro level of sports because of the simple fact that the athletes weigh significantly less and are much slower. John also mentioned that trainers are not allowed to diagnose concussions or medically clear players with concussions. This makes us believe that there is not an issue with bias playing a role in determining whether a player plays or not because an independent doctor is always making the call. Lastly, John spoke of the fact that he believes a good start to increasing player safety at contact sporting events in Michigan is to require that a certified Athletic trainer be present at every sporting event, which is currently not the case.

CONSULTATION 2: Nicole Ferszt is a pediatrician at Chicago University Hospital. She specializes in learning disabilities among children and does a great deal of research on the effects of certain activities on the brain of a child. Like most of the medical community, Nicole confirmed that repeated trauma to a growing brain can lead to many long-term consequences, such as impulsive behavior, reduced cognitive capability and others. One of the highlights of the interview was when nicole noted that damages to a growing brain are in many cases, 100% irreversible. In this regard, she used the example of lead poisoning in children saying that she couldn’t prescribe anything to reverse the damages caused by lead to a child’s brain but she can do a great deal to stop the situation from worsening. This lead us to believe that preventative and precautionary measures can indeed make a difference in helping reduce the harmful effects that come from concussions and contact sports.

CONSULTATION 3: Kiff Hamp is an owner of the Detroit Lions. He did not agree to comment on the concussion issue. However, he did confirm that the contact sports and concussions issue is not something we can ignore anymore. One of the biggest takeaways from this consultation was when he explained the amount of medical resources that are available to pro-football players. When we compared this to the resources that high school athletes have, where some schools don’t have certified trainers present, it’s easy to see where the high school level can improve on this issue. After this consultation, we were further convinced that availability of medical resources and education on the issue are two excellent solutions to making a positive impact and reducing the number of concussions in high school sports statewide.

 

Prospectus:

Describe the specific issue or problem, being sure to provide sufficient context so that someone less familiar with the issue has a sense of the bigger picture, but know that your focus here is on a more detailed spelling out of the specific problem or issue that you’ve identified. (250 words minimum)

https://docs.google.com/a/umich.edu/document/d/1ljgd26Y992Adm9wa2qk_583xfccYzKXQkRkk7CWdl1o/edit?usp=sharing

Potential Solutions:

Describe three reasonable, feasible potential solutions or approaches that would help address this problem.

SOLUTION 1:

It is no surprise that the research done looking into head injuries and contact sports in High School is not as thorough as research done on the professional level. Our first solution involves us using a pilot program to get a sense of what is the greatest cause of head injuries at the High School level. According to the MHSAA, 6 students per high school will suffer a head injury every year. With this in mind, it is important that we work to identify the biggest cause of these injuries and work to mitigate the risks that come with injuries such as concussions. That is why we are proposing a policy that would allow us to adjust the rules in a select few districts that would give the state of Michigan a better idea of the root cause of head injuries at the High School level.

For example, for one district we can impose stricter in-game policies that would prevent athletes from taking certain actions that have higher risks of resulting in a head injury. In another district, we can call for mandatory concussion awareness programs that would focus on informing athletes of the causes of head injuries and the potential side-effects of repeated head trauma for young-adults. It is our hope that by implementing such a pilot policy program, we can be more thorough in our quest for finding an answer to this issue. By tweaking rules and regulations at a district level, we can more clearly identify exactly what type of policy is more beneficial in preventing student athletes from suffering major head injuries. In a nutshell, This solution would involve utilizing both solutions 2 and 3 we are proposing, but utilizing these solutions in a manner that would allow us to collect more vital information on this issue.

 

SOLUTION 2:

There has been extensive research already done to identify the harmful side effects of repeated head trauma. One of the biggest side effects we have identified in our research on the topic is CTE. CTE has demonstrated the capability to affect a person’s personality, making some patients demonstrate impulsivity, explosive temper, and physically violent behavior. Knowing this, it seems to be common sense that the state should implement stricter athletic guidelines designed to keep student athletes from suffering multiple concussions in a year. Such a policy would entail a minimum of 2 weeks out for athletes the suffer concussions (suggested timeline to fully heal is 1 week). Also, Athletes that suffer concussions must be cleared by an independent doctor before returning to practice or playing in a game to ensure the athlete has fully healed. This policy would also set stricter in-game rules and regulations for contact sports.    For example, for football, any contact where one player leads with the crown of the helmet would be illegal. Once committed by a player, the player would miss the remainder of the game. Another rule would be that referees has the ability to temporarily send a player, who is demonstrating signs of a concussion, to the sideline. This rule would also involve training high school referees in identifying early signs of concussions, enabling there to be an unbiased opinion present intended to make sure players are not put in danger and playing while concussed. By creating policy that makes a deliberate effort to keep concussions from happening and concussed players from playing, we believe we can significantly reduce the current rate of head injuries reported by the MHSAA (6 per school per year) and begin reducing the fears associated with young student athletes suffering from CTE.

SOLUTION 3:

While there is protocol in place to to prevent athletes from entering back into their respective sports before it’s safe, our third solution is to create a number of different ways students must be tested. Currently the only way in Michigan to decide if it is safe for a student to enter back into their sport is for a health professional to grant them access through an examination. However, our solution couples an examination from a health professional with imPACT (Immediate Post-Concussion Assessment and Cognitive Testing) baseline testing. imPACT testing has two categories: baseline and post-injury testing.

Baseline testing “refers to the neurocognitive testing under normal conditions before injury, typically conducted in pre-season. The baseline test provides a snapshot of how one’s brain functions in normal, everyday circumstances.” The post-injury testing is where “composite scores are then compared to the baseline scores acquired earlier before a concussion injury affected brain function. Therefore, concussion baseline testing only becomes of value if, and when, post-testing is utilized after a concussion injury.”

Through this solution the students are even more protected as they still have the face-to-face interaction with a health professional who understands each player and their past history. However, by incorporating imPACT testing, healthcare professionals will be able to double-check their work with data from thousands of other tests taken to better understand how the student being tested equates to thousands of other tests. Ultimately, coupling the assessment of a healthcare professional with imPACT testing, students are better taken care of with the possibility of entering back into their respective sport too soon decreasing.

  Reaction or advice from a Topic Coordinator:
  1. Our first meeting was with Professor Stanzler which was great for idea generation and ensuring we are approaching the problem correctly. During this meeting we shared our solution of imPACT testing along with a few modifications to the current rules of high school football. Professor Stanzler brought some critical information to the table, and that was we should hold a pilot program in two districts with differing rule changes in each. This would help us compare the results from one to the other, and better understand which plan is working better. He also mentioned he thought our idea of imPACT testing was great, the one concern he had was the cost of it which we further looked into after our meeting. We found buying a single or just a few tests can be very expensive; however, if bundling them, the cost per test is greatly reduced, becoming much more feasible.

  2. Our second meeting was with Professor Fahy. He was of great help in bringing our proposal to the next level after implementing Professor Stanzler’s ideas. During this meeting, Professor Fahy helped us couple our our idea of imPACT testing with rule changes in high school football. His idea proved to be novel because as we thought about it further, this solution takes advantage of the controlled environment of a football game through rule changes, but also has the ability to collect meaningful data if an unfortunate injury were to occur. Moreover, by utilizing imPACT testing, players better enter back into the game once they are fully healed and the results of their post-concussion test is back up to the level it was at during baseline testing. His idea created great value for us and we feel this is a very persuasive argument we make.

 

Research process:

During our research process we relied heavily on professionals who are deeply involved with sports, and more specifically high school sports. Not only were the individuals we consulted surrounded by the world of head injuries, they were able to point us to other contacts and information that could benefit our proposal. Besides individuals who were exposed to head injuries, we also talked to an Orthopedic Surgeon who had the opportunity to be at every high school hockey game for a particular high school for 7 straight years. While head injuries aren't his expertise, he was in many cases the first indivudal to the incident being he was on the bench as the team doctor. He told us he always errored on the side of caution and would not let the athlete enter back into the competition if they showed any sign of a concussion. He believes head injuries aren't taken as seriously as they should because they the athletes are still physically able to compete. One dead end we came upon was when we tried to get in touch with a non-profit who focuses on helping moms understand the complications of head injuries and the precautionary measures that should be taken if they see signs of one. We were unable to get in contact with the company which was unfortunate as we were looking forward to their insight. Overall, our main strategy was to gain insight from industry professionals and leverage them to get in contact with others who could provide value to our proposal.

Author contributions:

Overall, equal distribution of tasks was done between John and I. Our goal was to meet every week for at least 2 hours to talk about our proposal and the next steps. We conducted all of our work while together to ensure we were utilizing each of our intellectual capabilities while together. We have always felt the synergies of our thought processes compliment each other well, making it important no one person was tasked with doing a particular portion of our proposal alone. Moreover, we also felt it was important to be on the same page to ensure we were executing our strategy as planned, which is what led us to complete all the work while together.

 

===FORMAL PROPOSAL===

The sections below should comprise your final proposal language, submitted for consideration by your peers and potential inclusion in the MSC Platform.

Preambulatory clauses

These set up the PROBLEM, but not the solution.

WHEREAS.... It’s estimated 1 in 5 high school athletes participating in a contact sport will sustain a head injury during the season, whether that be the 65% who sustain it during competition of the other 35% who sustain it during practice in MIchigan

WHEREAS.... It is not mandated by the Michigan High School Athletic Association (MHSAA) for a trainer with concussion expertise to be at contact sport competitions

WHEREAS.... 33% of high school athletes who have a sports concussion report two or more in the same season

WHEREAS.... Current policies aim to only educate coaches, players, and parents, remove the athlete from play, and obtain permission from a health care professional

WHEREAS.... The frontal lobe areas of the brain are still developing during adolescent years causing concussions to stunt growth in that area

Operative clauses

These describe in detail, the solution you are proposing (not the problem itself; those should go in the "Whereas" clauses above).

THEREFORE BE IT RESOLVED....

1. MHSAA require a certified athletic trainer be at high impact high school sporting events to quicker and more accurately diagnose head injuries

2. imPACT (Immediate Post-Concussion Assessment and Cognitive Testing) be done for all high impact high school athletes before each season to create a baseline, after a potential head injury occurred, and at the end of the season

3. Two districts within the state implement different in-game policies where Bloomfield High Schools implement a one game suspension for targeting and the East Grand Rapids Public Schools give a referee the authority to take both individuals in a collision off the field to be assessed by a health care professionals

Counter-arguments:

What are three reasonable arguments against this proposal?

1. Because we are implementing in-game rules within two districts, there is the possibility for bias and critical decisions to be made in times that can dramatically hinder the likelihood of success for those teams. For example, if a referee suspends a team’s leading linebacker during a state semi-final game, the probability of winning the state championship the next game dramatically decreased for that team. From this example, the referee’s autonomy can dramatically affect a team.

2. The cost of implementing the imPACT testing program along with the compensation needed to pay an athletic trainer needs to come from somewhere. With already tight budgets, this increase in costs can be a difficult task to overcome.

3. The possibility for grassroots resistance rises. Because greater restrictions would be in place for football teams, players may become more cautious, potentially leading to a ‘less fun’ game to watch in the minds of diehard football fans. These greater restrictions not only could affect high school sports, but also college sports because those same players who are now more cautious bring their tendencies to the college level.

Costs and funding:

What will your proposal cost (in direct expenses, lost tax revenue, lost economic opportunity, and/or non-monetary costs)? How will you pay for your proposed legislation? Where will/could the funding for your proposal come from?  Who might object to dedicating resources to your proposal (competing interests)?  

The costs to implement our proposal arise from two areas: more hourly pay for athletic trainers and imPACT testing software. Athletic trainers would now need to attend all high impact sporting events. In the event of overlapping sports, there would potentially have to be another athletic trainer onboard which could be very costly. In regards to imPACT testing, the software needed is expensive. Each test can cost $10 or $20, or a school can buy a package of 500 baseline exams for $750. Clearly buying the package deal is the most cost-effective route; however, this cost for a school is large and can deter a school from implementing this program which has the best interest of the student athletes in mind. To pay for this cost, we would look to pull money away from the health department. We believe this is a good route as the data collected would then benefit the department and the education for the students. However, we believe we will receive pushback from the health department as their budget is thin already and they may think the money could be better spent on interactive projects which also enhance the learning of their students.

References:

http://fox17online.com/2017/08/08/mhsaa-concussions-drop-11-in-2nd-year-of-study-football-players-still-have-the-most/

 

http://www.headcasecompany.com/concussion_info/stats_on_concussions_sports

 

https://www.forbes.com/sites/tarahaelle/2017/07/26/is-football-worth-gambling-with-high-school-and-college-players-brains/#5fca99c112c6

 

http://www.makemynewspaper.com/designer/app/open

 

https://www.huffingtonpost.com/2012/02/28/concussions-may-effect-te_n_1307886.html

 

http://www.slate.com/articles/health_and_science/medical_examiner/2012/01/impact_and_other_concussion_tests_for_athletes_may_not_work_.html

 




 

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Total votes: 22

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