Category Archives: College
By Tina Hilding, Voiland College of Engineering & Architecture
With increasing concern about concussions from sports, some players have started wearing electronic sensors to measure head impacts.
But a new study by Washington State University researchers has found that some of the sensors for non-helmeted sports are not fast enough to measure hard hits and don’t accurately measure what are thought to be the most serious, angular hits. They report on their work online in the journal Procedia Engineering (http://www.sciencedirect.com/science/article/pii/S1877705815014447).
“Concussions are a really challenging problem,’’ said Lloyd Smith, professor in the Voiland College’s School of Mechanical and Materials Engineering and director of WSU’s Sports Science Laboratory. “What we’re worried about is what’s going on with the brain, but we don’t have brain sensors that we can plug into. The closest thing is to see what is happening to the skull. That’s what these sensors are trying to do.
“The message is that you have to be careful with these sensors,” he said. “They may not work for every type of impact.’’
A ball is in the barrel of an air cannon before firing during testing in the lab.
The laboratory is the official baseball bat-testing facility for the NCAA and one of the premier labs in the nation for exploring the physics of bats, balls and, recently, the interplay of balls and the human head.
Most head-impact sensors have been developed within the past five years, and many college-level football teams have their players wear them. When a player receives a hard hit, the sensor records it and alerts trainers.
Researchers are also using data they’re collecting from the sensors to improve their understanding about sports-related head trauma. They have found that the helmeted sensors accurately measure hits.
Less commonly used are non-helmeted wireless sensors, which are affixed to headbands, mouth guards, adhesive patches or within an earpiece that the player can wear for sports like soccer, women’s lacrosse or softball.
In the study, the researchers attached the non-helmeted sensor to a head dummy. Using a pneumatic cannon, they fired lacrosse balls, soccer balls and softballs at it at different speeds. The researchers equipped the dummy with high-fidelity, wired accelerometers to collect data for comparison with feedback from the small, battery-powered sensor.
The researchers recorded 234 impacts, directing the balls at the dummy’s chin and forehead. Ball speeds were similar to those found in game conditions, although the softball was projected at speeds slower than seen in fast-pitch competition to avoid damaging the dummy. The soccer ball was only directed at the forehead.
The researchers found that the non-helmeted sensors aren’t able to accurately measure harder and faster hits, such as an impact from a hard-thrown softball. To measure the impact from a ball, the devices take a lot of measurements in rapid succession. The sensors were able to accurately see the hits from the softer, slower balls, but they couldn’t take data fast enough to keep up with the faster hits.
When the impact is harder, the sensor missed the peak acceleration, which would have the highest potential for causing a concussion.
“The harder the ball, the less correlation we found,’’ Smith said.
The researchers also found that the sensors did worse at measuring rotational than linear acceleration. Earlier work has found that most head injuries from sports come about from a hit that twists the head rather than a direct hit.
The researchers used a sensor with hardware specifications representative of most sensors of its kind. They are working with the sensor manufacturer and hope to do more studies that could lead to improvements. The manufacturer had no say in the study design or the interpretation of results.
“These sensors are one element in many ways to make sports safer,’’ said Smith. “I’m optimistic that people are taking these injuries more seriously, and I think it’s really encouraging in helping us better understand the effects and causes of concussions.’’
University of Pittsburgh Medical Center to Host Concussion Experts in Effort to Share Best Treatments, Practices
Nearly 30 leading, independent concussion clinicians and researchers from around the United States will convene at UPMC Oct. 15 and 16 with a unique purpose: to propose standard guidelines on the best practices, protocols and active therapies for treating concussions today, resulting in a white paper to be published in a medical journal and shared nationwide.
For the first time in the relatively infant science of concussion, U.S. experts are coming together to discuss what the UPMC organizers call Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion. Representatives from the National Institutes of Health and the U.S. Department of Defense, among others, also have been invited to participate.
“There’s a gaping need for a consistency of care for concussions across the country, if not the world. To try to fill that void, we’re thrilled to host a meeting of some of the greatest minds in concussion science and clinical care,” said Micky Collins, Ph.D., executive and clinical director of the UPMC Sports Medicine Concussion Program and the chairman of the conference to be held at the U.S. Steel Tower in Pittsburgh, headquarters to UPMC. “It is a privilege to bring together such a group, discuss the issues truly facing concussion health care today, and attempt to share with caregivers everywhere what we find to be the best evidence, science and practices in getting people better.”
The white paper is intended to make scientific, clinical and therapy recommendations for otherhealth care providers to replicate and researchers to study further.
Over the past decade, there have been summits and conferences abroad where participants agreed upon definitions, evaluations and on-field protocols, but this marks the inaugural U.S. meeting focused strictly on active therapies, treatments and best clinical practices for concussions.
“Never before has evidence-based science and clinical experience been brought to bear in advancing concussion treatment like we’re attempting here,” said Anthony Kontos, Ph.D., research director for the UPMC Concussion Program, associate professor in theUniversity of Pittsburgh Department of Orthopaedic Surgery, and co-director of the meeting. “We believe that this meeting will bring together cutting-edge research knowledge and clinical approaches to this injury that will blaze a trail for concussion treatment moving forward.”
The invitees cut across academic, scientific and health care environments. Among those expected to attend are Julian Bailes, M.D., NorthShore University Health System (Chicago) and chairman of the medical advisory board for Pop Warner Football, and retired Gen. Peter Chiarelli, former U.S. Army vice chief of staff and an outspoken leader in research and treatment for traumatic brain injury (TBI), mild TBI such as concussion, and post-traumatic stress.
“There have been numerous advances in our understanding of concussion treatment, and this conference should facilitate the implementation of best practices to make participation in all sports safe,” Dr. Bailes said.
“I am honored to be among this group of leading concussion clinicians and researchers for a meeting that will be a critical step forward in the standard of care for concussions,” Gen. Chiarelli said. “A published consensus statement on concussion treatment will give every patient the opportunity to receive the best care, no matter where they are injured. It’s time to put aside our differences, collaborate and work together for the sake of patients everywhere.”
Added conference co-director David Okonkwo, M.D., Ph.D., professor of neurological surgery and clinical director of the Brain Trauma Research Center at the Pitt School of Medicine: “It is high time to assemble neurosurgeons, neurologists, neuropsychologists, emergency medicine physicians, physiatrists, athletic trainers, physical therapists and all the multidisciplinary health care professionals who are the primary caregivers to people, and not just athletes, troubled by concussions. Let’s effect change and improve outcomes now and for the future.”
UPMC received support to host this meeting because it is aligned with Pittsburgh’s long-standing place at the center of the field: the first sports-medicine concussion program to open its doors (2000), a leading institution in concussion research and innovation, and a model clinic with successful assessment, treatment and outcomes amid its nearly 18,000 concussion-patient visits yearly.
“We are fortunate that we have this opportunity to carry out this idea of spreading better care practices and ultimately helping so many,” Dr. Collins said. “We are looking forward to a wide-ranging, stimulating discussion that is overdue, and we feel our science, innovation and clinical experience make us well suited to serve as hosts.”
The two-day meeting is fully funded by a grant from the NFL Foundation.
“Because of the vital nature of the concussion conversation, it’s critical to support leading institutions in the country, like UPMC, that are promoting science in an effort to advance treatment, evidence and clinical experience,” said Charlotte Jones Anderson, chair of the NFL Foundation and executive vice president of the Dallas Cowboys. “The NFL Foundation is dedicated to improving the health and safety of sports, youth football and the communities in which we live, and we look forward to learning from the experts who will meet in October to further that mission.”
The conference will conclude with a panel discussion and media availability that is expected to be streamed live.
(Editor’s Note: What follows is a brief excerpt of an article written by attorney Richard C. Giller of Polsinelli PC that appeared in the August 2015 Concussion Litigation Alert. For the rest of the article and numerous others, please subscribe at http://concussionpolicyandthelaw.com/subscribe/)
On June 10, 2014, Adrian Arrington, the lead plaintiff in a concussion class action lawsuit filed against the National Collegiate Athletic Association, fired his attorney claiming that he never approved a proposed $75 million settlement of the case. Mr. Arrington has reportedly also asked the judge overseeing the litigation to reject the proposed settlement. Arrington, a former strong safety and captain of the Eastern Illinois University football team, claims in his September 2011 lawsuit that he was forced to stop playing football because of health issues including “numerous and repeated concussions” he suffered during his college playing days. Arrington claims that the five concussions set forth in his complaint, as well as other head injuries sustained playing college football, resulted in serious medical issues including memory loss, seizures and headaches, all of which cut short his football career. The plaintiffs in the NCAA concussion case claim that the organization knew about but disregarded information concerning the long-term effects of concussions and other forms of head trauma on athletes, and that the Association ignored studies involving the link between the frequency and severity of concussions and certain types of sports.
Sports concussion lawsuits trigger a number of important cultural, medical and legal issues. However, the focus of this article will be on one of the more pedestrian topics; i.e., whether insurance coverage is available to the NCAA to help offset the tens or hundreds of millions of dollars in defense and indemnity payments arising out of these types of claims. It has been reported that that the NCAA and several of its insurers have reached settlement agreements concerning coverage for concussion lawsuits and that the NCAA is engaged in negotiations with other insurers on a defense cost sharing agreement for the concussion cases. Despite this progress, several insurance companies are contesting coverage based upon a number of issues and this article will analyze the merits of the coverage positions staked out by some insurance carriers.
The NCAA Concussion Litigation and Proposed Settlement
Underlying Concussion Litigation
Arrington’s lawsuit against the NCAA was filed in federal court in Chicago and became the first of a number of concussion lawsuits filed against the Association. In fact, over the last few years there have been over a dozen additional proposed class action concussion cases filed across the country naming the NCAA as a defendant. In December 2013, the actions pending at the time were consolidated into a single multi-district litigation (MDL), which is currently pending in the United States District Court for the Northern District of Illinois.
The NCAA MDL includes claims for negligence, fraudulent concealment, unjust enrichment and medical monitoring, and alleges that the Association breached certain duties purportedly owed to college athletes by not taking steps to prevent head injuries despite purportedly knowing how severe the repercussions might be for an athlete who suffers a concussion. In addition to allegations that the NCAA withheld information from athletes regarding the long-term effects of concussions, the MDL plaintiffs also allege that the NCAA failed to properly train coaches and athletic trainers in how to identify concussion symptoms or to implement proper coaching methods for determining whether an athlete has suffered a concussion or when and for how long a player should refrain from athletic activities after suffering a concussion.
The MDL plaintiffs further allege that the NCAA failed to implement regulations to minimize or reduce activities which were likely to lead to concussions and head trauma, such as failing to implement proper tackling techniques in football, for example, or reducing the number of headers a soccer player is involved with during practice, among other claims. Finally, the concussion MDL alleges that the NCAA failed to implement standard “return-to-play” guidelines in each of the sanctioned sports with respect to athletes who sustained head trauma.
Proposed Settlement in the Underlying Concussion Litigation
In 2014, the parties to the NCAA MDL reached a preliminary $75 million settlement of the medical monitoring portion of the litigation. Pursuant to the proposed settlement, a $70 million common fund would be established for the creation of a medical monitoring program and the NCAA would contribute an additional $5 million over the next ten years to fund research regarding the prevention, treatment, and effects of concussions. The proposed settlement class includes “all persons who played an NCAA-sanctioned sport at an NCAA member institution at any time through the date of Preliminary Approval.” To characterize that class as being “broad” would be an understatement. The settlement class is not limited to any particular sport or any level of competition and is estimated to encompass over four million current and former college athletes. Instead, it apparently includes any athlete who played any sanctioned sport for any length of time at any NCAA member institution.
According to the Association’s website, “The NCAA and its insurance carriers will pay $70M to fund a medical monitoring program that will provide medical evaluations to qualifying class members over a period of 50 years. The medical monitoring program will be overseen by a medical science committee composed of four leading experts in the management and treatment of concussions, including NCAA Chief Medical Officer, Brian Hainline.” The Association’s website also notes that “the medical monitoring program will in some measure be funded through the NCAA’s insurance carriers.” The website explains that under the terms of the proposed settlement, “certain of the NCAA’s insurers have agreed to pay a portion of the Settlement Amount. If those insurers …
(For the rest of the summary with more details about the parties and claims, please subscribe to Concussion Litigation Reporter.)