Group Makes Strides in Concussion Studies
Dr. Rick Greenwald, founder and president of Simbex, holds a football helmet with a HIT system installed inside as he stands next to a test dummy head at the company's Lebanon facility yesterday.
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Research engineer Eric Wyan calibrates sensors for a new impact alert sytem that will be cheaper than the current HIT system at Simbex in Lebanon yesterday.
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Engineering technician Stephen Lefebvre assembles a HIT system for a football helmet at Simbex in Lebanon yesterday.
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At a recent Dover High School Board meeting, board member Paul Butler, a retired physician, proposed the district drop football.
Citing concerns about the long-term effect of concussions, Butler told Foster’s Daily Democrat, “I think it’s the moral thing to do, the ethical thing to do to try to stop football at Dover High School and throughout Dover.” That kind of talk concerns Dr. Rick Greenwald. The founder and president of Simbex in Lebanon, Greenwald is an entrepreneur and biomedical engineer with more than 15 years experience in research and development in sports and orthopedic biomechanics.
While sharing concerns over the safety of all players in contact and collision sports, Greenwald is quick to call for the need for measured steps and responses.
“There’s a lot of information and misinformation about what is the current state of the science in this area. We must be careful in our interpretation,” Greenwald said.
“We have to let the science evolve and make sure we apply that science to new rules and regulations.” The Dover School Board later released a statement saying that Dr. Butler’s comments were his reaction to various studies he’s read and is not the opinion of the board itself. It said termination of the high school football program isn’t on the agenda at this time.
Working with Simbex’ groundbreaking Head Impact Telemetry (HIT) System, a biofeedback device that monitors how often, how hard and where players’ heads are impacted when they take a hit on the football field, Greenwald and his colleagues have made remarkable discoveries. But it is how those advances are first understood and then incorporated that has Greenwald’s attention.
“We’ve been doing this now for nine years,” Greenwald said. “And we have recorded more than 2 million head impacts.” “We’re learning about what defines head impact exposure in different sports and for different age groups. For example one of the things we’ve found is that high school kids hit harder than we thought. But still less hard overall than many players at the Division I collegiate level.” What Greenwald makes clear is that their technology is not a diagnostic tool for concussions, but rather it gives medical professionals key information about how hard and where the impacts occurred that they might not have seen and which the athlete often does not report.
It is also used as an educational tool allowing the players to see how and where they are hitting, which has already helped to change tackling technique from youth level all the way up to the professional ranks.
Another positive coming out of these types of studies is that there are now new rules governing how much hitting is done at practice, including Pop Warner and the Ivy League. Obviously, less hitting means less chance for head injuries, along with other serious injuries caused by the nature of the game.
“The idea is to get the head out of the game,” Greenwald said. “It was never the intent to use the head as a weapon. This new era of awareness for kids, parents and coaches about this issue has become a very important tool for prevention.” And that goes for the monitoring of head impacts, where that data is used to better protect athletes from too many hits.
“We need to be cognizant of the science and the data and how the research plays out over time,” said Greenwald, who has two sons playing sports at Hanover High. “Parents and kids need to appreciate the results and weigh those against the potential risks of playing youth sports.
“We don’t know yet if playing (collision sports) in youth, high school or college has widespread long term effects. But we do know that professional players have shown a higher rate of cognitive, long-term issues compared to the general population.
“Does that transfer to kids who only play through high school or college?” A paper in the Journal of Neurology, led by Dartmouth researcher Dr. Tom McAllister, found that for a group of high school and college players, 80 percent of the athletes showed no significant cognitive effects compared with their baseline from taking hits during the course of the season when tested within a few weeks following the end of contact.
“What that showed was that over the short term, for the majority of players, there doesn’t appear to be a lasting impairment from playing a season of football,” Greenwald said.
“We clearly need to understand more about the 20 percent who did not return to baseline, and also significantly more about the effect of cumulative impacts over the course of multiple seasons.” But Greenwald is concerned about other issues besides the obvious athletic ones. Specifically, how quickly and how successfully can student-athletes return to class.
“In the same way coaches are trained to look for signs, we need to improve communication among administrators, teachers, coaches, athletic trainers and families to understand the effects (of concussions) on school, social and emotional performance as a result of a sports injury,” he said.
“Parents must be diligent to what the kids are saying after a practice or a game, especially after they have taken a significant impact.” The other critical component in making football safer is trying to make the helmet more protective. But as Greenwald points out, most helmets were never designed to prevent concussions because — as he emphasized, “We still don’t know exactly what causes concussions.
“Helmets do a great job for what they were designed to do: Prevent skull fractures and bleeding brains. Those have been virtually eliminated.” Newer helmet technology, Greenwald points out, reduce head acceleration, both linear and rotational, which inherently reduces the risk of concussion.
“Modern helmets perform better than older helmets in reducing the energy that is transferred to the head (during violent collisions),” he said.
Though football is in the crosshairs right now, all collision sports need to be considered, says Greenwald. What is true for football is true for soccer, lacrosse, ice hockey and field hockey.
Head impact can lead to concussions for boys or girls, as easily in football as in field hockey. Science is finding new ways to help deal with the effects of head injury, it just can’t know beforehand what type of hit will cause the injury and why one player is affected more severely than another.
But at least kids are talking, coaches are preaching and parents are listening.
Greenwald recently spent an hour teaching a psychology class at Hanover High. In an interesting anecdote, he relates that two years ago, only 30 percent of the class understood or were aware of many of the concussion issues in athletics. The last time he was in the classroom, almost 100 percent of the class was knowledgeable.
“This is a great start,” he said. “We are seeing more kids reporting injuries to their parents or their coaches. That is very positive.”
Don Mahler can be reached at firstname.lastname@example.org or 603-727-3225.