Staying Ahead on Head Safety

July 6, 2015

By Rob Kaminski
MHSAA benchmarks editor

Three stacks of concussion-related material offered precious little space on MHSAA Executive Director Jack Roberts’ desk, and perhaps consumed even more room in his head as he tried to wrap his mind around the seemingly daily “latest and greatest” documents outlining signs, detection and return-to-play elements involving head trauma.

Without a doubt, the scene is quite similar on any given day in the offices of his cohorts across the country as school sports leaders are faced with the daunting, dizzying task of devising plans to address concerns aimed at the health of their games.

Lawmakers, rules makers, medical experts and the court of public opinion all want the same thing for student-athletes: a reduction in the chances of head-related injuries. And they all are perfectly willing to offer instant fixes to those in charge.

They often expect those in Roberts’ position to analyze, digest and create action plans as soon as possible without considering the research and resources it will take to get there.

“All parties involved want the same thing. We all want to provide the safest environment for educational athletics through protocols and practices that will offer the most minimal risk of injury,” Roberts said. “But, this can’t be accomplished through unfunded mandates which would stifle the already struggling athletic budgets in many schools.

“Changes have to occur through training and education, orchestrated through state offices and executed locally. And, it takes time to research the best and most effective means. There is so much information, and so many devices in the field today that those in athletic leadership roles almost have to have a medical background as well.”

For instance, there are documents which list as few as five symptoms for concussions, and those listing as many as 15. There are sideline detection methods which purport to take 20 minutes and those which claim to determine concussions in 20 seconds. There are as many return-to-play protocols as there are state associations.

Increasingly, state high school associations are seeking opinions and expertise from local medical personnel. In March, in one of many such meetings, Roberts and other MHSAA staff welcomed several from the Michigan Department of Health and Human Services to their office to discuss sideline detection methods and return-to-play issues.

“There are two areas that concerned us most,” Roberts said. “One, sideline detection of head injuries is inconsistent across the state in terms of both results and resources. Two, we need methods which generate immediate reports and permanent records.”

As the group which convened in March discussed the topic, potential hurdles and new perspectives on sideline management came to the forefront.

On the money and manpower front, who would be responsible for administering sideline tools? Most ideally they would need to be overseen by medical personnel rather than coaches or team managers.

From a perspective standpoint, an interesting view was volleyed out to the group: could sideline detection actually speed up a student’s return to play rather than slow it down? Current protocol prescribes that if competition continues while an athlete is withheld for an apparent concussion, that athlete may not be returned to competition that day but is subject to the return-to-play protocol. And, clearance may not be on the same date on which the athlete was removed from play. Only an M.D., D.O., Physician’s Assistant or Nurse Practitioner may clear the individual to return to activity. With immediate sideline detection, are parties more vulnerable should a student pass immediate tests, only to have undetected effects of the incident increase over time?

“The group shed a different light on the various scenarios, which was a primary purpose for the meeting,” Roberts said. “As one can see, there are so many variables to consider when attempting to determine the next plausible and practical steps toward minimizing and detecting head injuries.

“Further, we have to take into consideration practice sessions as well as competitions, and all sports, not just select sports.”

Adding to the challenge is simply the nature of athletics. Competitors at any level are just that: competitive. Often, students – or their parents – will attempt to hide symptoms or be reluctant to come forward with injuries, particularly head injuries which can’t be seen.

In more cases, perhaps the symptoms simply are not recognized, which is why education is paramount. 

First, association leaders have to tackle the due diligence of researching issues and potential solutions to situations currently threatening the well-being of scholastic sports. Considering that some 1,620,000 results are offered when “sideline concussion detection tools” is typed into a search engine, this is a laborious and continual chore.

Such information then needs to be packaged and presented to leaders at the local levels – athletic directors – to pass on to coaches, the individuals who have as much or more influence on students that perhaps any other adults, including parents in some cases.

This is why MHSAA rules meetings, Coaches Advancement Program sessions and other statewide forums continue to bang the drum on health and safety issues; to make sure the messages and procedures reach the student-athletes.

And, it’s why the MHSAA is asking coaches and ADs to be accountable in verifying that the plans in place are being carried out.

Less Could Mean Less

There are times when it’s good to say, “less means more,” but in the case of contact sports, practices and competitions, the idea is for less to mean less. As in less time for collisions to occur yielding fewer injures.

It’s early yet, and one year does not constitute a large sample size, but the MHSAA Football Practice Policy instituted last August could be one step toward reducing head injuries.

Beginning this past football season, the number of practices with helmets, shoulder pads and full pads were limited to start the season, and preseason “collision” sessions were limited to one per day. During the season, such practices were limited to two per week, while the length of practices was also regulated.

Dr. Steven Broglio of the University of Michigan Neurosport department is conducting a three-year study of the Ann Arbor Gabriel Richard football program with the assistance of Richelle Williams to determine the “Effects of Concussion and Sub-Concussion.” The study began in 2013, one year prior to the new MHSAA guidelines.

Research in 2013 showed approximately 650 “impacts” per player.  In 2014, the number dropped to approximately 500 impacts per player. Impacts are defined as greater than 10 gs of acceleration. Williams stated that a slap on the back is 4 g, coughing is 3.5 g.  On average, a helmet hit is 25-45 g.  Concussions usually happen (roughly) between 80-150g. 

An encoder is embedded into each football athlete’s helmet which monitors head impacts and exactly where the impact is located. Williams sits at each practice and game and through a pager identifies the player’s number and impact from a hit of 90g or more. 

They are also looking at those who do not sustain an impact concussion, but rather sustain multiple head impacts and whether those multiple head impacts lead up to brain changes (measured through EEG). 

The initial findings, as submitted by the study team, indicated two reasons why there were fewer overall impacts from 2013 to 2014:  

Primary reason:  The MHSAA adoption that became effective in August 2014 with new limitations that were placed on “collision practices” and conditions that full pads could not be worn until the fifth day of team practice.

Secondary reason:  Fewer players evaluated in 2014 than 2013. 

Fit for a King?

Editor’s Note: There are many sideline detection tools on the market, as a quick Google on the topic will reveal. The following, the King-Devick test, is among the highly recommended tests, summarized here simply to provide an idea of the types of systems available and how they operate. The following is from King-Devick’s website.

The King-Devick Test is an objective remove-from-play sideline concussion screening test that can be administered by parents and coaches in minutes. The King-Devick Test is an accurate and reliable method for identifying athletes with head trauma and has particular relevance to: Football, Hockey, Soccer, Basketball, Lacrosse, Rugby, Baseball, Softball and Other Collision Activities.

King-Devick Test is an easy-to-administer test which is given on the sidelines of sporting events to aid in the detection of concussions in athletes. King-Devick Test (K-D Test) can help to objectively determine whether players should be removed from games. As a result, King-Devick Test can help prevent the serious consequences of repetitive concussions resulting from an athlete returning to play after a head injury.

How King-Devick Test Works

Concussions are a complex type of brain injury that is not visible on routine scans of the brain, yet are detectable when important aspects of brain function are measured. King-Devick Test (K-D Test) is a two-minute test that requires an athlete to read single digit numbers displayed on cards or on an iPad. After suspected head trauma, the athlete is given the test and if the time needed to complete the test is any longer than the athlete’s baseline test time, the athlete should be removed from play and should be evaluated by a licensed professional.

Remove-From-Play vs. Return-To-Play

Both remove-from-play and return-to-play decisions are crucial in concussion recovery. It is critical to remove a concussed athlete from play in order to prevent further damage. It is also extremely important to keep the athlete from returning to play until they have made a full recovery. There are tools to assist in making both remove-from-play and return-to-play decisions.

King-Devick Test for Remove-From-Play Decisions

  • Quick, objective sideline testing
  • Measures impairments of speech, language and other correlates of suboptimal brain function
  • Instant screening feedback in minutes
  • Administered by parents, coaches, athletic trainers and medical professionals in remove-from-play decisions
  • Neurocognitive Testing for Return-To-Play Decisions
  • Computerized concussion evaluation system (in the computer lab)
  • Measures verbal and visual memory, processing speed and reaction
  • Tracks recovery of cognitive processes following concussion
  • Assists clinicians in making return-to-play decisions

2023 Forsythe Award Celebrates Leinaar's 40 Years Dedicated to School Sports

By Geoff Kimmerly senior editor

March 8, 2023

Few people in Michigan have had a longer-lasting influence on the rules and policies of educational athletics than Frankfort’s Karen Leinaar, who has served in several roles locally, statewide and nationally over more than 40 years contributing to the school sports community.

Thank you, Bill Baker.

The longtime teacher, coach, principal and superintendent during a career that stretched across multiple schools – including Leinaar’s growing up, Delton Kellogg – made an impression on the standout multi-sport athlete before she graduated from high school in 1977. Baker’s philosophy and work led Leinaar to study education at Michigan State University and then brought her back as Delton’s athletic director to begin four decades of making the same impact on children in her hometown and eventually in hometowns all over Michigan and beyond.

Baker died in 2009, but not before continuing to mentor Leinaar through many good times and tough ones.

“The man had two daughters that I grew up with, his wife was a teacher, and he demonstrated to all of us – he never missed an event – that we were important to him. That even though we weren’t his kids, we were his kids and athletics was a way to help kids become better people – and for some kids it was the only thing that they had positive in their life,” Leinaar said. “And he made it known just to that individual kid how important their participation was and their involvement, and how that helped them become the person that they were.

“That to me was such an example of how to help people be good people, that I just took that role on.”

It’s a role in which she continues to serve. Leinaar began her career as an athletic administrator in 1982, and as the interim athletic director currently at Frankfort High School is serving her fifth district in that position. Since June 2019, she also has served as executive director of the Michigan Interscholastic Athletic Administrators Association (MIAAA), the professional organization for school sports administrators in the state with a membership of nearly 700.

Leinaar accepts the MHSAA's Women In Sports Leadership Award in 1998. To recognize that longtime and continuing impact, Leinaar has been named the 2023 honoree for the Michigan High School Athletic Association’s Charles E. Forsythe Award.

The annual award is in its 46th year and named after former MHSAA Executive Director Charles E. Forsythe, the Association's first full-time and longest-serving chief executive. Forsythe Award recipients are selected each year by the MHSAA Representative Council, based on an individual's outstanding contributions to the interscholastic athletics community.

Leinaar also served 22 years on the MHSAA’s Representative Council and a four-year term from 2009-13 on the Board of Directors for the National Federation of State High School Associations (NFHS), and just last week was named to the 2023 class of the National Interscholastic Athletic Administrators Association (NIAAA) Hall of Fame.

“It is impossible even to estimate the number of students, coaches, administrators and others who have been affected by the work Karen Leinaar has done to make school sports the best they can be – not only in her communities, but across Michigan and throughout the country,” MHSAA Executive Director Mark Uyl said. “There are few who have equaled her dedication and her support and promotion of the ideals of school-based sports. She has always placed an emphasis on being in the room, on the field or at the arena, actively participating in her leadership roles, and our programs are better for it.”

Leinaar first served as athletic director at Delton Kellogg for nearly 17 years, from March 1982 through October 1998. She spent three years at Gaylord, then 8½ at Benzie Central before taking over at Bear Lake in November 2010 and spending the next decade organizing athletic programs for students in grades 5-12 before retiring in January 2021. She came out of retirement to return to the athletic director’s chair this past fall as interim AD at Frankfort. She has completed nearly four years as MIAAA executive director, moving into that position after previously serving nine years as an assistant to the executive.

Leinaar began her service on the Representative Council in Fall 1999 and completed her last term as a statewide at-large representative at the Fall 2021 meeting.

She has been honored several times for her contributions. She received the MHSAA’s Women In Sports Leadership Award in 1998, a Citation from the NFHS in 2000, and she was named MIAAA Athletic Director of the Year in 2001. She received an MHSAA’s Allen W. Bush Award in 2014 – recognition given for work done generally behind the scenes and with little attention.

“This is the top of the mountain, per se. This one does mean so much,” Leinaar said of the Forsythe Award. “The names that are associated with this over the years, I never thought I’d be put in that group.”

Leinaar remains a continuous source of support at a multitude of MHSAA championship events, and during her time on Council was one of the most frequent representatives handing out trophies and medals to champions and runners-up at Finals events. She began while athletic director at Delton Kellogg hosting the MHSAA Volleyball Finals in Class B and Class C and continues to assist with those championships now played at Kellogg Arena in Battle Creek.

She also hosted Competitive Cheer Finals at Delton Kellogg in 1996 and 1997, Ski Finals while at Gaylord, and many more championship events across the Lower Peninsula. She continues to assist at the MHSAA’s Lower Peninsula Cross Country and Track & Field Finals.

After attending Delton Kellogg High School, Leinaar earned a bachelor’s degree in physical education, health and recreation, with a minor in driver education, from MSU in 1982. She completed a master’s in athletic administration from Western Michigan University in 1994.

Leinaar has been a member for 40 years of both the MIAAA and NIAAA, and has served as chairperson of the MIAAA Annual Conference and awards chairperson for both the state and national bodies. She’s also served as chairperson of the MIAAA’s Exemplary Athletic Program.

Past recipients of the Charles E. Forsythe Award 

1978 - Brick Fowler, Port Huron; Paul Smarks, Warren 
1979 - Earl Messner, Reed City; Howard Beatty, Saginaw 
1980 - Max Carey, Freesoil 
1981 - Steven Sluka, Grand Haven; Samuel Madden, Detroit
1982 - Ernest Buckholz, Mt. Clemens; T. Arthur Treloar, Petoskey
1983 - Leroy Dues, Detroit; Richard Maher, Sturgis 
1984 - William Hart, Marquette; Donald Stamats, Caro
1985 - John Cotton, Farmington; Robert James, Warren 
1986 - William Robinson, Detroit; Irving Soderland, Norway 
1987 - Jack Streidl, Plainwell; Wayne Hellenga, Decatur 
1988 - Jack Johnson, Dearborn; Alan Williams, North Adams
1989 - Walter Bazylewicz, Berkley; Dennis Kiley, Jackson 
1990 - Webster Morrison, Pickford; Herbert Quade, Benton Harbor 
1991 - Clifford Buckmaster, Petoskey; Donald Domke, Northville 
1992 - William Maskill, Kalamazoo; Thomas G. McShannock, Muskegon 
1993 - Roy A. Allen Jr., Detroit; John Duncan, Cedarville 
1994 - Kermit Ambrose, Royal Oak 
1995 - Bob Perry, Lowell 
1996 - Charles H. Jones, Royal Oak 
1997 - Michael A. Foster, Richland; Robert G. Grimes, Battle Creek 
1998 - Lofton C. Greene, River Rouge; Joseph J. Todey, Essexville 
1999 - Bernie Larson, Battle Creek 
2000 - Blake Hagman, Kalamazoo; Jerry Cvengros, Escanaba 
2001 - Norm Johnson, Bangor; George Lovich, Canton 
2002 - John Fundukian, Novi 
2003 - Ken Semelsberger, Port Huron
2004 - Marco Marcet, Frankenmuth
2005 - Jim Feldkamp, Troy
2006 - Dan McShannock, Midland; Dail Prucka, Monroe
2007 - Keith Eldred, Williamston; Tom Hickman, Spring Lake
2008 - Jamie Gent, Haslett; William Newkirk, Sanford Meridian
2009 - Paul Ellinger, Cheboygan
2010 - Rudy Godefroidt, Hemlock; Mike Boyd, Waterford
2011 - Eric C. Federico, Trenton
2012 - Bill Mick, Midland
2013 - Jim Gilmore, Tecumseh; Dave Hutton, Grandville
2014 - Dan Flynn, Escanaba

2015 - Hugh Matson, Saginaw
2016 - Gary Hice, Petoskey; Gina Mazzolini, Lansing
2017 - Chuck Nurek, Rochester Hills
2018 - Gary Ellis, Allegan
2019 - Jim Derocher, Negaunee; Fredrick J. Smith, Stevensville
2020 - Michael Garvey, Lawton
2021 - Leroy Hackley Jr., Byron Center; Patti Tibaldi, Traverse City
2022 - Bruce Horsch, Houghton

PHOTOS (Top) Karen Leinaar, left, awards the 2022 Division 4 volleyball finalist trophy to Indian River Inland Lakes coach Nicole Moore. (Middle) Leinaar accepts the MHSAA's Women In Sports Leadership Award in 1998.