Monday, May 14, 2012

New Study Looks at Head Impacts in Youth Football

We neuropathologists, and society as a whole, has spent a lot of time over the last couple of years rethinking the long-term effects brain damage causes by repeated concussive and subconcussive blows to the heads of professional and college football players. But what about the 3.5 million kids in American who play below the high school level? Dr. Peter Cummings today sent me a link to a report regarding groundbreaking research being done at Virginia Tech in which impact-measurement instruments were placed on 7 and 8-year-old football players. Data was collected on more than 750 hits to the head over the course of the season.

Lead researcher, Stefan Duma, a professor of Biomedical Engineering, reports that some head impacts in youth football are equal in force to some of the bigger hits he sees at the college level.  The average kid received 107 head impacts during the course of the season. This is few than seen in high school (which averages about 500 per season) and college (which amounts to about 1000 per season.). But what about the magnitude of these hits? The median impact was 15 g's. In Duma's study, there were 38 impacts that were 40 g or greater (almost all of which occurred during practice.) Six impacts were over 80 g's, which starts to get into the range of risk for concussion. “Nobody expected to see hits of this magnitude,” says Duma, who speculates that once players start seeing hits of 30 g's above, there is a risk for cumulative injury.

Here's the video report from reporter Stone Philips. The interviews with the parents of these youth players perplexed me. All of the parents featured found the results concerning, but none expressed any thoughts about having their child switch to another sport.


Forensic Pathology Blog said...

Hey Brian,

It was a pretty interesting show. One issue I have with it is that the investigators say 'no child had a concussion', but the investigators never tested the kids, so how do we know?? Kids of this age group might not complain of 'adult' concussion symptoms. A concussion in kids may manifest as cranky behavior, fatigue, hyperactivity, difficulty with waking up in the a.m., and difficulty paying attention in school. As we all know, there are within the norm of child behavior so diagnosing concussion in this age group is very difficult. The problems associated with the diagnosis make it hard to follow these kids and observe outcomes. We just don't know anything about concussion in this age group. Interesting stuff.

Anonymous said...

You mentioned that neuropathologists (and society) as a whole have been looking at this issue intently. I see some serious lag time with these discussions at the annual sports physical exam for my child despite the fact that I live in a zone where the high schools actively participate in formal concussion study assessments. While it might be easy to look at those junior league football parents and be amazed by their failure to consider another sport, I think we should all be a looking a little more critically and be much more concerned about the lack of formal guidance around this entire topic of discussion by the American Academy of Pediatrics. I am frustrated with an offering of H1N1 vaccination in July when I should be hearing something said to my athlete about protocols for hydration, head injury, and second impact syndrome reviewed. Perhaps this is because my athlete is a soccer defender and not a linebacker but that is what makes this issue even more irritating. The participating high school study groups could and should be offered wired headgear for this athletic group as well especially if they are formally providing pre and post-concussion assessments for study. Then we would know the level of G's soccer players are getting when some have required multiple follow-up assessments before their clearance to return to seasonal play. ...And what about those discussions on concussion biomarkers developed by the Army that were previously referenced???...No soccer or lacrosse headgear prototype available? Then have the engineering department get them up and running in Fall 2012/Spring 2013. If you can manage DBS then you can put wires in monitoring devices for other high risk/high impact sports.
So as we all sit patiently on the American sidelines for one academic institution to measure one area of interest and another academic powerhouse to look at another, we as parents realize our kids are the subjects of experiments that quite frankly deserve to be better designed to answer more than one very selective question. Furthermore, the Surgeon General should be equally engaged in promptly and clearly formulating such important questions and reviewing and revisiting them regularly. I signed those releases but I did so expecting these experiments to be designed such that my children's participation answered real questions in real time not to authorize the same lame research game to be played on a different field for decades more debate. We are clearly at the point where all this head injury and impact data can be collected at the same least at the high school level.

Sadly when you look closely at the context, goals, and execution of some of the brain research going on today you can't help but be disturbed and at a loss to ask why.

What is a threat to our national security?? Adding any of our 3.5 million children/young adult athletes or uncounted young SERVICEMEN prematurely to the cognitive decline now considered an epidemic at the other end of the age spectrum. A timeline shifting? Tau tangles in 18 year olds making them look like 50 year olds. No, parents signing those consents aren't ignorant, they are just not aware. How could they be?

Forensic Pathology Blog states: "We just don't know anything about concussion in this age group". Plenty of CAT scans and MRI scans are ordered on young American athletes and plenty of ER work-ups for concussion tell me we should surely have something in pediatric neurology to go on by now in 2012. Hard to follow? It is not that parents don't come back for follow-up; they usually need a note to resume P.E. or sports. Is this a problem to be addressed by American Pediatrics, American Neurology, the CDC or the NIH?

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