Thursday, August 28, 2014

Head Impacts in Kids by Jillian Urban



How many of you have kids who play soccer, football, hockey, basketball? Have any of you had a concussion or know someone who has had a concussion, particularly a young athlete? Many of your may know that concussions are an important topic at the moment. Head injuries commonly occur in football, but they also occur in many other sports including soccer, lacrosse, cheerleading, and basketball. 

The Wake Forest University Center for Injury Biomechanics has been working with the Childress Institute for Pediatric Trauma for the past two years, going on our third. In that time, they have provided us with $500,000 to perform a pilot study to collect head impact data, as well as medical imaging data from 147 youth and high school athletes. We have collected data on thousands of head impacts and medical imaging data on a scale that has never been done before which led to a grant from the National Institutes of Health worth $3.5 million to continue this study for the next five years.The focus of our study is on football but there are many opportunities to study head injuries in other sports, helmeted and non-helmeted, as well as in boys and girls. 

Previous researchers, like myself, have studied professional and college football for the past 10 years. There are only 2,000 NFL players and 100,000 college football players. However, that is just the tip of the iceberg. There are approximately 1.3 million high school football athletes and 3.5 million youth athletes. What is so important about this age group is that we have a large number of youth athletes in the age group, but most importantly, there is a lot we don't know about this age group that is learning, growing, and developing so one of the questions we are asking is - what happens to the brain of a young athlete if they have had 100, 500, or even 1,000 impacts over the course of one football season?

We commonly think of exposure when we are talking about sun exposure. We can apply this concept to head impacts where the concussion is a single bad event, similar to a sun burn, and a season or lifetime of impacts is analogous to a lifetime in the sun. Much of the focus has been one really bad concussion over the past 10 years, however, the question at hand is what has a greater effect on the brain: the high impact concussion or a season or even lifetime of repetitive head impacts. 

We are studying this using two methods. Before, post-concussion, and after the football season we collect medical imaging and neurocognitive data. The kids participating in the study come in for an appointment at the hospital where we perform a computer-based test that measures how fast they think and how well they remember things. We collect medical imaging data including a magnetoencephalography scan, or MEG, which listens to their brain - specifically the magnetic activity of the brain and an MRI, which takes different types of pictures of the brain but with no radiation. These together allow us to measure the functional activity of the brain, along with the structure of the brain.

In between the pre- and post-season scan, they play football. We instrument the helmets of youth and high school football players with a sensor system that fits in the existing padding of the helmet. The sensor system sits on the crown of the head of the athlete and wirelessly transmits each head impact during all practices and games. We are measuring where they were hit on their head and the force or how hard they were hit in terms of Gs. We measure changes in the brain from the MRI and MEG and seeing if they correlate to the number and magnitude of impacts they have received.

We have found that many of our athletes are receiving a greater percentage of their head impact exposure during practices compared to games, which is what our players and coaches have direct control of through modifying practice drills and limiting the number of contact practices. Additionally, by studying two different groups with different league rules on contact practice, we have found that one league significantly reduced the head impact exposure of the athletes without affecting how hard they hit during games.  
The study has many opportunities to go beyond youth and high school football. There is a lot we do not know about female athletes and even non-helmeted sports such as soccer where we see a high incidence of concussion. The results of this study will help us to better understand how to reduce head impact exposure and ultimately keep our kids safe.  

- Jillian Urban, Wake Forest University Center for Injury Biomechanics

Friday, August 15, 2014

Concussions in Kids



Many of you have heard a lot of talk in the news lately about concussions and head injuries from kids playing sports. I’m personally invested in this issue because my wife Lisa and I lost our younger son, Matthew, after he sustained a traumatic brain injury during a high school football game in 2008. I’m professionally motivated by the issue as the executive director of the Childress Institute for Pediatric Trauma.

As your kids go back to school and sports this month, we wanted to give you facts about concussions to help kids continue to play it safe:
  • Young children and teens are more likely to get a concussion and can take longer to recover than adults 
  • Recognizing and responding properly to concussions when they first occur can help prevent further injury or even death 
  • Athletes who have had a concussion, at any point in their lives, have a greater chance of getting another concussion 
  • Traumatic brain injuries (TBI) or concussions are a contributing factor to 31 percent of all injury-related deaths in the U.S.
Although the NCAA and NFL have pledged millions of dollars to study college and youth sports safety, up until now the effects of sports on kids have been vastly understudied. Did you know that 70 percent of the U.S. football-playing population is younger than 14? The Childress Institute is in its third year of funding a long-running study of 9- to 12-year-olds to track the cumulative impact on the brain of head contact across multiple seasons. The good news is, people are paying attention and we can start to make a difference as we learn more.
  • Symptoms may appear mild, but the injury can lead to significant life-long impairment
  • Each year, U.S. emergency departments treat an estimated 175,000 sports-related TBIs for boys and girls 
  • During the last decade, emergency department visits for sports-related TBIs, among children and adolescents increased by 60 percent 
  • 62 percent of sports-related injuries occur during practice not games
Based on the research we do have, we can help prevent and reduce injuries:
  • Limit contact during sports practices (when appropriate for the sport) 
  • Change rules and/or ban or limit the use of certain drills or techniques to help reduce the chances of injury 
  • Check sports equipment often to make sure the equipment fits the athletes well, is in good condition, stored properly, and is repaired and replaced based on instructions from the equipment companies 
Action can help improve outcomes for kids:
  • Educate coaches, parents, athletic trainers and athletes – inform and educate coaches, athletes, and their parents and guardians about concussion through training and/or a concussion information sheet
  • Remove athlete from play – an athlete who is believed to have a concussion should be removed from play right away – “When in doubt, sit it out”
  • Obtain permission to return to play – an athlete can only return to play or practice after at least 24 hours AND with permission from a health care professional trained in concussion care
My best advice as a parent of children who played multiple sports is not to be afraid to go to practice and ask questions. You are your child’s best advocate, so the more you know the better off everyone is.

To learn more about recognizing concussions in your young athlete, visit the CDC’s concussion website. You can learn more about my family’s personal story with sports-related traumatic brain injuries by visiting MattGfellerFoundation.org. We hope you will all help kids play it safe this fall.

 

Wednesday, August 6, 2014

Accidents Happen by Ty Dillon



I used to really enjoy riding my dirt bike. 

My brother and I have a track behind our house that has some cool jumps, curves, bends, and hills. We would ride almost every weekend around the track and in the woods, doing tricks and revving up our motors as high as they would go. We are racers, and super competitive in almost everything we do – whether it’s a foot race to the car, or on the race track, Austin and I are competing.

I had to force myself to stop riding my dirt bike about three years ago when I got into two serious accidents. They weren’t life threatening, and I’m thankful to be able to walk away, but sometimes I think back on how lucky I was to be wearing the proper equipment during my accident.

I had a very deep cut in my leg that was several inches long when a piece of the dirt bike pierced my leg. It could have been a lot more serious if it had hit one of the major arteries. I don’t remember a lot of pain in my leg, just being in shock.

Then, I broke my two major bones in my lower leg, my fibula and tibia. Both obviously very important bones in my body to be able to race each weekend. After that accident, I made a pretty difficult decision to give up dirt bike riding.

Racing has been a huge part of my life in the past 10 years. It’s been around me for my entire life, but since I began racing on a regular basis when I was 12, I realize that I sometimes have to give things up that I really enjoy doing. I look back to the accidents that I was involved in and how it kept me out of a race car for a long time. Thankfully, doctors today are equipped with medical treatments that healed my leg quickly, and I was able to get back to racing quicker. I was even able to get back into our Richard Childress Racing ARCA Series car in 2011 and win the series championship.

Overall, I’m a believer in living life to its fullest, making the most of everything you are given, and live life with no regrets. I’ve learned a lot since hurting my leg a few years ago and spent a lot of time in-and-out of doctor’s offices. It’s hard not to ride my dirt bike anymore, but racing in the Nationwide Series this season in the No. 3 car is important. We’re focused on winning another championship and my health is an important factor in doing so.

My grandparents started the Childress Institute for Pediatric Trauma in 2008. The Institute’s goal is to help seriously injured kids get the best treatment possible when they need it the most across the U.S. I’m lucky to live in a place that has great EMS and a high level of medical care available 24 hours a day so that when I was injured as a child, I had a great outcome. Not everyone has that fast access.

In racing, it takes speed, technology, talent and great equipment. The same is true for helping injured kids get the best care in an emergency. In the race to save more injured kids, the Institute is helping improve those odds.

Wednesday, July 30, 2014

Saving Kids Worldwide



One of the leading causes of death worldwide is injury to children, especially between 1-14 years of age. Most people are unaware that injury should be considered a disease. There is so much awareness of the benefits of immunization to prevent childhood disease but injury continues unabated. Action to prevent injury and death will save the lives of children and reduce the disability that results.

Worldwide, the challenge is the “burden of injury” which creates a significant economic and social impact upon the family, community and society. The effect upon the family is significant: absence of the child from school, loss of employment by the parent, reduction in income for the family who must care for the child and isolation of the family from the community. After a child steps upon a landmine or plays with unexploded ordinance, the mobility of the child is eliminated after an amputation of an extremity. In many cultures the family is shunned by the community. The “burden” affects the entire community that is responsible to provide a safe environment for the child. Surgeons can prevent death, improve the quality of life and provide a chance for rehabilitation following disability from injury.

Nevertheless, about 10% of the injuries to children worldwide challenge the best surgeons and health care systems. We rely upon a team of people to help save children once they are injured. It takes a system that includes response at the point of injury, acute treatment and a commitment to rehabilitation, to prevent the death of the child and restore them to health. The initial response time has impact upon the outcome. It is imperative that we prepare the first responder and the Emergency Medical System to save the life of the child and to provide transfer to an appropriate level of trauma care.

Sudden events that result in injuries, such as earthquakes, riots or political conflicts, create a challenge for all levels of the system. It takes a long time before you have a response by emergency services, so the bystander and local team need to be able to initiate emergency care while providing transfer to a facility for acute treatment. In the United States, only 10% of injured children have access to a verified pediatric trauma center, so that means 90% receive acute care in general hospital facilities.

The big question is “how do we take care of these kids no matter where they are in the world?” After 10 years of war in Iraq and Afghanistan, the approach to care for the injured child changed. This knowledge and experience affects the system of care and the approach to treatment that makes a difference to children. Better prevention, acute care and rehabilitation will improve the quality of life for the community.

A community has the opportunity to learn from the global experience with injury or to share them with colleagues throughout the world. The convenience and accessibility of using web-based technology can share life-saving ideas quickly. We now can provide access to new surgical techniques and to accelerate practical application in a matter of weeks, instead of years. As an example, The Childress Institute for Pediatric Trauma creates web symposia to provide cutting-edge practice to medical professionals in 33 countries over the past two years.

The timely transfer of pediatric trauma care knowledge is saving the lives of injured children worldwide. The challenge to provide contemporary trauma care to the worldwide community is worthy of our efforts. 

- MartinR. Eichelberger, M.D., Professor of Surgery and of Pediatrics at George Washington University, Children’s National Medical Center in Washington D.C.