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

Longtime Taylor AD, Game Official Ristovski Chose Athletics as Way to Give Back

By Doug Donnelly
Special for

February 20, 2024

There is a basketball court 5,000 miles from Sterling Heights with “MHL” painted on the center court.

Greater DetroitIt’s not the name of a local basketball league in the village where it is located – Siricino, Macedonia. Instead, it stands for Madison, Haleigh and Lola, the three daughters of longtime Michigan basketball coach, referee and athletic director Loren Ristovski.

“My dad loved going back (to Macedonia),” said Madison Ristovski. “He’s probably gone every summer since about 2017. His whole family still lives there. He loved going and visiting and seeing everyone.

“It was always a goal of his to give back to where he came from. He and Mom donated to the village to build a soccer field and basketball court with lights and everything. It was a pretty big deal. It’s something he wanted to do for them back home. We were very proud he did that.”

Loren Ristovski, athletic director for Taylor schools, died earlier this month while on leave to have surgery on his foot. It was a shock to his family, friends, and the Taylor community.

“It was a heavy blow,” said Matt Joseph, girls basketball coach at Utica Ford and a longtime friend of the Ristovski family. “It was like getting kicked in the gut. Basketball was his passion. Next to his family, basketball was definitely No. 1. He loved the game and all the intricacies of it. He loved seeing kids excel.”

Loren Ristovski heads an all-family officiating crew with Lola and his brother Dean Ristovski.Ristovski emigrated from Macedonia to Michigan when he was 9. He went to high school at Hamtramck St. Florian, where he excelled at basketball. He went to Wayne State University to get a degree in criminal justice and had plans to become a lawyer.

Before he could take the Law School Admission Test, however, basketball came calling.

“He started coaching at Henry Ford High School and Fuhrmann Middle School,” Madison said. “Once he realized how much he enjoyed coaching, he decided to go into education. He stayed the entire time. He never went to law school.”

Loren Ristovski became the head coach at Harper Woods but gave that up when his daughters were ready to start playing in high school.

“He gave up coaching varsity at Harper Woods so he could be at every one of my games,” Madison said.

He also coached them as youngsters, often teaming with Joseph to coach an AAU team.

“I met him when Madison was 5,” Joseph said. “He and I decided to put our daughters in the same parks and recreation team, and next thing you know we were coaching AAU.”

With Ristovski’s tutoring, Madison, Haleigh, and Lola all excelled at the game, each playing Division I college basketball after standout careers at Grosse Pointe Woods University Liggett. In 2012, Liggett reached the Class C Final with all three starting. They combined for 55 of Liggett’s 57 points in the championship game, with Madison scoring 42 after earlier that week receiving the Miss Basketball Award.

Lola and Haleigh played at the University of Detroit Mercy, and Madison played at the University of Michigan. Today, Haleigh lives on the west side of the state and plays recreational basketball. Lola is a referee in the Catholic High School League as well as for the Division II Great Lakes Intercollegiate Athletic Conference, and also works area Division III college games.

Madison is a teacher and the varsity girls basketball coach at Sterling Heights Stevenson.

“He taught us the game when we were very, very young,” Madison said. “We grew up in the gym with him and watched him coach his team. He coached me my whole life. He was very instrumental – he taught us all those things you need to become an athlete, and more importantly the things you need to do to succeed in life.”

Her dad is the reason she became a coach.

The daughters’ initials “MHL” glow on the court the family funded in Macedonia.“Watching my dad coach and seeing the impact he had on his high school athletes and even the kids in our church community – it inspired me to want to coach as well and give back like he did,” she said. “I watched him with my teammates and the impact he had on them. I thought it would be so cool if I could do the same for others.”

Loren Ristovski left a legacy at Taylor, too. School officials recounted several stories of how he balanced athletic budgets with the needs of student-athletes. He would lead fundraising efforts, created the Bitty Ball program for youth basketball players and cheerleaders and helped students become certified officials – and then would hire them to officiate games.

“He didn’t say no,” said Taylor boys basketball coach Chris Simons. “We made it work. We didn’t go out and ask people for a bunch of money. We would just do it. We all pulled together and made it work. Loren did everything he could to make things as pretty and presentable as he could with the budget we had.”

Ristovski also put on summer camps at both Taylor and at the Joe Dumars Fieldhouse in Sterling Heights, where he lived. He commuted about an hour to Taylor every day.

“He loved Taylor,” Madison said. “He loved who he worked with and the students. He included us, too. My mom would run the ticket table or do the scoreboard clock. I don’t know how many times I sold tickets for volleyball tournaments with him. He loved his people and loved having us there with him.”

Loren Ristovski, who played professional basketball in Europe during the late 1980s, ran well over 20 marathons in his life, including the Boston Marathon. He was a registered MHSAA official for 16 years, and in the weeks before his passing he refereed a varsity game in Rochester with his daughter, Lola.

“He looked at basketball, I think, differently than other people do,” Madison said. “He saw it as a way to have relationships with other people, to help people achieve their goals and to find meaningful relationships with others. It was more than just a game to him.”

Doug DonnellyDoug Donnelly has served as a sports and news reporter and city editor over 25 years, writing for the Daily Chief-Union in Upper Sandusky, Ohio from 1992-1995, the Monroe Evening News from 1995-2012 and the Adrian Daily Telegram since 2013. He's also written a book on high school basketball in Monroe County and compiles record books for various schools in southeast Michigan. E-mail him at [email protected] with story ideas for Jackson, Washtenaw, Hillsdale, Lenawee and Monroe counties.

PHOTOS (Top) Loren Ristovski, far left, and wife Svetlana support their lineup of Division I basketball-playing daughters – from left: Madison, Haleigh and Lola. (Middle) Loren Ristovski heads an all-family officiating crew with Lola and his brother Dean Ristovski. (Below) The daughters’ initials “MHL” glow on the court the family funded in Macedonia. (Photos courtesy of Madison Ristovski.)