Wisconsin's Lack of Concussion Oversight, Tracking Questioned

Copyright 2013 Madison Newspapers, Inc.
All Rights Reserved

October 9, 2013 Wednesday
ALL EDITION

THE CAP TIMES; Pg. 18

2254 words

TODD MILEWSKI , The Capital Times , [email protected]

Scott Rohlfing left Verona's football game at Madison La Follette feeling like his brain was going to bulge out of his eye sockets.

The senior offensive lineman and team captain doesn't remember much about the Sept. 12 game, but knows he took a pretty good hit to the helmet in the second quarter. He continued to play, but well into the second half, the pain was too much.

"I just could not stand it," Rohlfing said. "The lights were getting extremely bothering. At some point probably midway through the fourth quarter, I ended up just pulling the plug on it and talked to the trainer.

"I sat on the sideline with cotton balls in my ears and basically with my eyes closed and my head down, watching as much as I could just because the sound and lights were pretty intense."

Rohlfing was diagnosed with a concussion. His doctor ordered him to avoid electronics and school work. And state law forbid him from practicing or playing until he received written clearance from a health care provider.

Concussions, traumatic brain injuries that interfere with normal brain function like what Rohlfing suffered, are somewhat common and better diagnosed in high school sports now, and requirements are in place now to prevent further harm.

But at a time when the sports world is increasingly obsessed with numbers - from fantasy sports to "Moneyball" to ESPN's hiring of Nate Silver - data collection locally on concussions is haphazard and inconsistent. Those looking to find patterns or draw conclusions about how to address the top-reported injury in high school athletics have a difficult, if not impossible, task.

At no point was it required that Rohlfing's concussion be reported to any officials or organizations. Neither the state nor the Wisconsin Interscholastic Athletic Association, which governs high school sports statewide, requires concussions to be tracked.

Athletic trainers often keep figures for the individual schools at where they work, but there are no published statistics showing how schools in the Madison area and in Wisconsin compare year to year or to each other in how many concussions are suffered.

One local sports medicine expert called that a missed opportunity.

"We certainly have a better idea of what the concussion rate is than we did 10 or 15 years ago, but I think it's still a moving target. To really know in our area, it's tough," said Dr. Alison Brooks, a UW-Madison assistant professor in the sports medicine program.

"I could tell you how many clinic visits we've had, and we could tell you what the concussion rate was in the studies that we've done, but those are a part of research studies and when we quit doing the research studies, there is not any formal injury surveillance system in place that I'm aware of."

So far, the nation's concussion crisis, displayed perhaps most prominently in pro football, has not led to a push for more information on how many head injuries are being suffered locally.

Some states require schools to report head injuries, but in Wisconsin, the WIAA doesn't have the personnel resources to take the lead on collecting head injury data, deputy director Wade Labecki said. Besides, there are questions about how accurate figures compiled by school officials would be.

"It's easy to collect how many broken bones there are because ... it's visible on an X-ray and fixable with a cast," he said. "Now we're trying to ask either a lay person - a coach or an AD (athletic director) - to put down the number of concussions without the medical knowledge. Not every school has a medical trainer, so who's going to do that piece?"

One athletic trainer who frequently blogs at theconcussionblog.org on the issue said there is likely a more troubling reason the statistics aren't gathered.

"They don't want to know," said Dustin Fink, who works for a health care provider in central Illinois that contracts with high schools. "That's the simple answer. I'll flat out tell everybody that.

"The reason why it's not being collected at the high school level - or any other level, for that matter - is they don't want to know the true measure."

Bob Joers, the athletic director at Middleton High School, was curious how many concussions his athletes were suffering on a yearly basis, so in 2012, he asked the school's athletic trainer to compile the stats.

For the 2011-12 school year, there were 38. In 2012-13, 44 concussions were tallied.

Joers said he wanted to collect the data to be able to see whether efforts to educate parents, athletes and coaches on concussion signs and symptoms were effective.

"If there's a better way to address something, the way we're addressing the concussions or something, can we do that?" he said.

His counterparts at area schools report having the same access to figures: the athletic trainer keeps them. Other than using them for outside research studies, though, that's generally where the data stays.

John McKinley, the manager of outreach athletic training services at UW Health and an athletic trainer at Madison Memorial, said he hasn't noticed much of an outside push for data collection.

"I think there are means to do it," he said. "I think the question is what's the best way to do it, and what's the question that wants to be answered on the back end?"

The reasons for collecting the data, sports medicine practitioners say, are varied. On one hand, it provides a basis for determining whether positive change is happening.

"You have to identify what is the scope of the problem and whether there's a need to intervene," said Brooks, the UW sports medicine professor. "And of course if you do something to intervene, then you need some sort of proof that what you're doing to intervene is making a difference."

Fink, who said he started blogging out of frustration with the concussion crisis, said the numbers he kept showed that the high school football team he worked with had six concussions one season and 14 the next.

"I was able to discern that we had more hitting in practice and we had less substitutes in games, or we didn't have as many kids that (second) year so kids were exposed more," Fink said. "You can take the numbers and see why something would be occurring - level of competition, hours of practice, hitting in practice."

In Wisconsin, state and athletics officials have put the emphasis on education in their tackling of the concussion crisis as it relates to adolescents, who can be more vulnerable and take longer to heal from head injuries.

Wisconsin's concussion law, put in place last year, mandates youth sports organizers distribute concussion and head injury information sheets to coaches, athletes and parents.

The National Federation of State High School Associations and the federal Centers for Disease Control and Prevention offer free online concussion training courses. The WIAA's website includes information and a recommended five-step return-to-play procedure.

"We're trying to educate, and we're going to see the number of concussions go up through that education," the WIAA's Labecki said. "We don't want to scare people, we want to educate people. We know that there's going to be concussions; there's concussions every day in life.

"But we know we've got to pull you out. We know you've got to be symptom-free. And when you are and you're healthy, we can put you back in. Because we're worried about the second impact syndrome," he said. "We're worried about the kid getting another concussion while still suffering the first concussion. That's dangerous. Those are catastrophic."

New legislation centers on education and parental approval but doesn't address data collection. Assembly Bill 293 would require game officials to complete an online training program every three years. Assembly Bill 343 and Senate Bill 258 seek to streamline the parent and athlete signoff process by making them return a signed information sheet only once per school year instead of for every sport the athlete plays.

In other states, the education component of concussion policy is complemented by a collection of actual numbers of head injuries.

Starting in the 2011-12 school year, Massachusetts law required schools to report the number of students who suffered head injuries or suspected concussions during extracurricular athletic activities.

The Boston Globe reported in July, however, that compliance by schools has been poor, and the state was changing the way it asked for data.

In football-mad Texas, the University Interscholastic League keeps a count of football injuries reported weekly. That data has been used to institute a rule change to limit contact in football practice to 90 minutes per athlete, per week.

One measure of recent concussions in the Madison area and an eight-year national study both show significant jumps in the number reported.

Figures provided by UW Health of patients it treated in its sports medicine clinic showed the number of concussions to high school-aged athletes growing from 47 in 2010 to 144 in 2012. This is just one clinic, however; many of those who were injured saw their own doctors at other clinics.

Nationally, since the 2005-06 school year, Dr. Dawn Comstock has reported data on injuries suffered by high school athletes in the High School RIO (Reporting Information Online) study.

In it, certified athletic trainers enter data on injuries weekly, and researchers extrapolate the data to provide a national estimate.

It shows that concussions suffered by high school athletes in seven core sports - football, boys and girls soccer, volleyball, boys and girls basketball, wrestling, baseball and softball - jumped from 133,162 in the 2005-06 school year to 314,329 in 2012-13.

Concussions grew from making up 9 percent of the total number of injuries to 23 percent of high school athletics, although sports medicine providers are quick to point out it's actually the reporting that's increasing.

"There isn't anybody in the field that really is an expert that I know of that believes that there are more concussions today," said Dr. Robert Cantu, the co-founder of the Sports Legacy Institute, a Boston nonprofit that studies brain trauma in sports. "It's just better diagnosis."

The diagnosis has changed how the Rohlfing family approaches high school football.

After the La Follette game where he was injured, Scott came home and slept, as is recommended. He tried going to school the next day, but he said he was in "zombie mode" and had to return home to sleep some more.

Five days after the concussion, he was in a doctor's office doing neurocognitive testing to see how he was responding. The answer: He wasn't ready to get back to football.

The fog in his head finally lifted 11 days after the concussion and he passed his test, which cleared him to return to practice. That week, he went through the recommended steps for returning to game action: light exercise, then more strenuous running, then non-contact drills, then full practice and finally full clearance, with each level taking at least 24 hours.

Fifteen days after her son suffered the concussion, Sharon Rohlfing stood outside the fence at Middleton's Otto Breitenbach Stadium, waiting for her mother-in-law to join her under the Friday night lights. Scott was warming up with the team on the field.

"This is an important game," Sharon said, "because if he starts to get a headache and he chooses not to tell ..."

She stopped. What did she think would happen if the headaches returned in the rivalry game against Middleton?

"I'm hoping he's honest," she said.

During the game, Rohlfing was back to normal in a lot of ways. When Verona's defense was on the field, he prowled the sidelines, screaming "Let's go!" or "Wake up!" to his teammates.

Scott made some adjustments that have him using his hands and shoulders in blocking instead of his head and shoulders.

"It definitely made me think twice how I was playing and change a little bit that way," he said. "And it helps to put everything in perspective a little bit more."

Sharon won't be able to watch Scott's games the same way.

"I think every time he gets on that field," she said, "I'm going to have a little bit of worry."

So what is the proper level of fear to have?

Brooks, the UW assistant professor who also works with the Badgers women's hockey and men's soccer teams, said it's tough to know because the data being used in lawsuits - and being disseminated in the media - often represents the worst-case scenarios related to head trauma.

"Some of that fear is good and some is not appropriate," Brooks said. "But all the attention on some of the athletes who have had very severe outcomes, how as a parent would you not be worried and anxious for your child? But we don't have any good, longitudinal data to suggest that a high school kid who gets one, maybe even two concussions that are relatively mild and they're managed appropriately, there's no overwhelming evidence that that kid is going to go on to have a neurodegenerative brain disease."

Fink, who blogs about concussions and treats them as an athletic trainer, brings the issue back to the availability of data.

"Education, we're doing a great job there, great inroads," he said. "In terms of collecting the actual number of concussions, it doesn't matter what level, nobody really wants to know the true number because they're afraid of what they're going to find, to be honest with you.

"We need the true number to figure out if what we're doing is working. If we don't have a true number and we don't have a baseline, so to speak, how in the heck are we supposed to know if we're doing any good at all?"

MIKE DEVRIES/THE CAPITAL TIMES John McKinley, the athletic trainer at Madison Memorial and manager of outreach athletic training services at UW Health, says there are means to collect data on high school sports concussions but questions what purpose it would serve. Verona senior Scott Rohlfing (left) suffered a concussion in a Sept. 12 game, setting in motion a process in which he had to clear multiple steps in order to return to practice

October 10, 2013