Tuesday, November 27, 2012

Head Games Review

Last week, I downloaded a copy of the video documentary Head Games. This film has received high praise from many in the film industry and the medical community. It shines a spotlit on the ever growing issue of concussions (mild traumatic brain injuries) in athletics today.

Much of the first half of the film is a thorough explanation about who some of the key people are in the country who are working to raise the of awareness this issue. During this time, the film describes the ongoing fight to bring a greater awareness of the seriousness of this injury into the public consciousness, especially with how that struggle was, and is continuing to be fought with the National Football League. The producers try to show how the NFL was working to keep the concussion issues covered up and likens the NFL's actions to a police officer at a crime scene telling everyone to "Keep moving, there is nothing to see here." As to whether or not they were also trying to hint that the NFL should be liable for some criminal misdoings, please draw your own conclusions.

After the film finishes with its history of the NFL, they spend time showing that this is not a problem that is exclusive to football. The producers tell about the prevalence of concussions in the National Hockey League, soccer, boxing, and other sports. They interview some victims of TBI who range from high school to retired professional athletes. All of interviewees tell the similar stories. They were so anxious to play, to not let the team down, that they were willing to risk sacrificing their future for a game. The interviewees also state that they were often making these decisions from an undereducated position. They then attempt to reinforce that if they knew what they do now, their decisions would likely have been different.

This is welcome and I am excited to see the advocacy for changing the attitudes about concussions in the public eye.  I have had too many confrontations and overly tense discussions with athletes and their parents when I decide to hold them out of competition because of a potential concussion.

The biggest criticism that I have with this film is that the lack of attention that is given to the often required academic accommodations for youth victims. This is such an important part of the recovery that is often being overlooked and even scorned by many school districts. I am lucky to work in a school district that understands the issue well and is willing to work with me to help accommodate the needs of their injured kids so well. (Many thanks to the school nurses, administration, and teaching staff at http://www.perry-lake.org.)  However, one does not have to work hard to find horror stories about how kids were treated by their peers and, in some instances, adults when they were recovering from a concussion.  Too many people do not understand that cognitive rest could be just as important in the recovery process as physical rest.

I understand that there are limiting factors such as time and money when making a film of this kind, but I saw no references that would have allowed viewers to go to a website like the CDC's (http://www.cdc.gov/concussions) to find more information. This is a very easy and inexpensive thing to add to any movie. To really make this easy, a QR code could have been added to the credits  to allow viewers to jump to a website with a listing of additional resources.

I know, I'm being a little picky here, but two things are motivating this small rant. The first is my educational background that always has me thinking about how to improve the use of technology to educate populations. (My thanks to Cleveland State University for that Masters degree in Educational Technologies; I hope I am putting their instruction to good use.)

The second reason is that the film has such a golden opportunity to educate that I think they just missed a chance to make it significantly better at little cost. Like I said, this might be a petty criticism, but I think it needed to be done in this film. There are many subtopics to concussions that need to be discussed. Further complicating the problem is that the data surrounding concussions, and all of its subtopics, is constantly evolving. The producers could easily make each of these subtopics into their own full length films if they wanted to give them the attention they deserve. I simply think that the follow up to this film could have been improved by giving convenient access to information that is continuously updated and relevant.

In closing, I highly recommend this film to anyone with an interest in youth athletics and I will probably show this film to my colleagues in a movie night. We may even try to make a continuing education discussion using the film as the centerpiece of our discussion. The film also serves as a notice for those that are still skeptical as to why this issue is so important. This film explains why the changes need to be made in the games we play before we end up losing them completely.



One small addendum:
I meant to include Dustin Fink's work at The Concussion Blog in the list of links of highly valuable resources. I can't state enough how much praise he deserves for the work he doing there.

Monday, November 12, 2012

Some Changes to Ohio's Wrestling Assessments

This past May, the OHSAA asked all of the state's master assessors to join them in Columbus for a meeting.  At this meeting various issues regarding the assessment program were discussed.  Chief amongst these complaints were the unauthorized changes that occasionally occurred to some kids' records after they were entered into the database by the assessors.

This was an experience that I had dealt with last year when I performed an assessment on a young man only to have the information inadvertently deleted by another assessor.  This assessor thought that the young man's information was somehow a "leftover" from last year and never got deleted, for whatever reason.  While this was not a big deal and I was able to reenter the information very quickly, there were other instances around the state where changes were being made of a much more troublesome magnitude.

Therefore, beginning this year, once the data has been entered into the database by the assessor, only a master assessor can go back and edit the information.  If a mistake is made by the assessor, then they must contact a local master assessor and request the edit after providing a copy of the individual profile form that they recorded all the data on.  It is the hope of the OHSAA that this will limit some of the issues that we have seen in the past.

The coaches also made one request of the OHSAA to "close a loophole" in the rule.  The part of the rule the coaches had a problem with was that a kid could fail an initial hydration assessment and then try again two days later with the same general assessor (these are usually the schools' athletic trainers) without a second team there to make sure that everything is being done properly.  (Part of the previous rule required a minimum of two teams present to perform these assessments to limit cheating.  However, it was understood that for the one or two stragglers that couldn't make the assessment or failed the first assessment that the assessor could just do them individually.)

This year, the wrestler that fails their initial hydration test must go to another assessor for the test if the original assessor it that school's AT.  It is the hope of the coaches that by doing it this way, there is less chance for cheating.  This does not apply to the master assessors.

Finally, a rule that didn't change but was heavily reinforced by the OHSAA this year was requirement of 48 hours need to pass before a wrestler can retest following a failed hydration test.  There were many stories of kids who would fail the initial test in the morning and would then schedule an appointment with another local assessor later that day to retry and get the test done.  This was happening far too often because the assessor who did the first exam was not getting to enter the data immediately following the exam when a wrestler failed, if they entered it at all.  It was stressed to all the assessors that in the event if a failed hydration test, entering the data immediately is the only effective means of preventing a kid from getting retested within 48 hours of the initial test.  Hopefully, this emphasis will help to alleviate this problem.

In closing, if there are any questions from any Ohio general assessors, please feel free to ask your local master assessor first before contacting the OHSAA.  The OHSAA gets bombarded with questions that are easily answered by the master assessors and we can help to ease tis burden by following some common sense protocols like this.

Saturday, November 10, 2012

Heat Acclimatization Policy Comparison

A recent post on the Korey Stringer Institute/University of Connecticut's web site compares the heat acclimatization policies of all 50 states to that of their own recommendations.  Not surprisingly, most states did not comply with their guidelines.  What is interesting is that many southern states, where the heat lasts longer into the season and is more intense, have not complied with these guidelines.

For Ohio, where it affects me, I am aware that the Ohio High School Athletic Association considered these guidelines, but rejected them.  Their argument, from what we were told, is that our region of the country does not experience the same kinds of weather conditions as the southern states do.  I agree that we don't have the issues as far into the season since the temperatures usually moderate by the 3rd week of the season in early September, but these guidelines weren't meant to control practices after the start of the regular season.  These guidelines are meant to govern the two a day sessions that fill the first 2-3 weeks of practices.  During that time, we often do have temperatures that can be threatening.  But even this is not consistent.  The most common weather pattern is to have 1-3 days of hot temps followed by up to a week or more of moderate temps and occasionally even have some really cool days thrown in the mix.  Some years we never see a temperature above 80 with very low humidities.  To comply with these rules with the wide variance in local weather patterns would, at times, be difficult to explain.  Therefore, I think the better solution is to have a certified athletic trainer at every school that can make these recommendations based on their education and experience.  I would advocate for the OHSAA to mandate every school that fields a collision sport has a licensed AT on staff.  Currently, it stands as a "strong recommendation."

I guess I could be waiting a while van this one.
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