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Head games: Science fights back against concussions

Second in a two-part series on changing attitudes to concussions in sports
football decal
Members of the Handsworth Royals senior football team square off against the West Vancouver Highlanders during a high school league game last season. The Royals played the entire 2015 season wearing protective decals on their helmets designed by a team from Simon Fraser University. photo by Paul McGrath, North Shore News

The sporting world’s concussion crisis, which seemingly grows and changes every week with a new shocking story, has taken up permanent residence in the mind of Jay Prepchuk, head coach of the senior football team at North Vancouver’s Handsworth secondary. 

“Every day, every second that I step on the football field I think about it and worry about it,” he told the North Shore News during a recent interview. “I just lose sleep over it sometimes, just making sure that the kids are well protected and taken care of.”

That attitude is a welcome change. For decades concussions in sports, particularly at the professional level, were just another part of the fun. Announcers laughed about a player getting his “bell rung” and staggering back to the bench. Many Canadians who are becoming parents now grew up watching Don Cherry’s popular Rock’Em Sock’Em Hockey videos. Re-watching the first video, released in 1989, offers a glimpse into the prevailing attitudes of the time.

“OK folks, let’s just sit back and enjoy!” Cherry belts while introducing his “favourite part” of the video, the Hit List. Over the next four minutes and 40 seconds viewers are treated to shots of dozens of hockey hits, several of which result in players being unable to get up. The camera lingers on a few players who are completely motionless lying on the ice.

“Boy, weren’t those beauty hits. Thanks for watchin’!” Cherry bellows at the end of the segment, flashing his trademarked thumbs up.

Few people, however, would find such replays entertaining now considering what the world has learned about head injuries. The movie Concussion, starring Will Smith, is the latest instance of the crisis going mainstream, but the call for change has been growing for more than a decade. In 2012 beloved football player Junior Seau added his name to the list of former NFL stars who committed suicide by shooting themselves in the chest so that their brains could be preserved and examined for signs of permanent damage from concussions. Last year Seau was inducted, posthumously, into the Pro Football Hall of Fame.

The concussion horror stories are impossible to ignore for anyone who has at least a passing interest in sports.

Research studies are coming fast and furious now too, the latest of which, published in February’s edition of the Canadian Medical Association Journal, found that adults who suffer a concussion are three times more likely to die by suicide than the rest of the population.

Football and hockey, popular sports that emphasize aggressive physical contact, are two of the sports that now spend the most time under the microscope. Jay Prepchuk knows that – it keeps him up at night.

But maybe, due to a new innovation, Prepchuk is sleeping a little better these days. At the start of the 2015 football season the Handsworth Royals added a seemingly simple piece of equipment to their helmets – a pair of decals, each approximately one millimetre thick and sporting the Handsworth logo – as part of a trial set up by researchers at Simon Fraser University. With those decals on their helmets the senior Royals went through an entire season of games and practices without a single concussion. It was the first time that the team had gone an entire season without a concussion during Prepchuk’s time as head coach, which started in 2003. Most years two or three players got concussions, sometimes more. But in 2015: zero. “It was amazing,” said Prepchuk.

Daniel Abram
Daniel Abram shows off a Handsworth football helmet bearing the decal that he and his team at Simon Fraser University designed. The Handsworth senior team wore the decals for the entire 2015 season and did not suffer a single concussion. photo supplied, Simon Fraser University

• • •

Concussions may be big news these days but that doesn’t mean athletes, coaches, parents, league officials or even doctors are being equipped with the latest information to deal with the problem.     

“It’s the Wild West out there,” said Linda Drake, a chiropractor and homeopathic physician who specializes in treating concussions at The Foundation for Integrated Health in North Vancouver. “There’s a lack of education on the parent’s part, and kids are lying (about their symptoms so they can stay in the game), and coaches are just going along with it.”

Help may be on the way, though, as scientific researchers are stepping into the void to devise products, protocols and tests to help take the guesswork out of concussion prevention, diagnosis and treatment.

For the SFU team led by Daniel Abram, a postdoctoral fellow in the School of Mechatronics Systems Engineering, an interest in concussions began six year ago with a simple inquiry: how are helmets designed and how do they protect the head? What they found was disturbing.

“In the last 50 years they have been designing helmets only for compression,” said Abram. “And then they test it and certify for compression as well. Yet compression is only half of the problem when it comes to head injuries. The other half is sharp twisting.”

Compression force is the result of straight-on contact, but sharp twisting is just as dangerous when it comes to head injuries. Hits almost never occur straight on, there is always rotation of the head.

“They have done research on this matter and they’ve found that the human brain is way more sensitive to sharp twisting than to compression,” said Abram. “It makes sense because the membrane of the brain is one million times more sensitive to shear force than compression force. You can see that once you are dealing with rotation it causes a lot of shearing force to the brain, which is very dangerous.”

Abram’s team set out to change how helmets react to hits. They built their own testing facility complete with dummy heads, finely tuned sensors and high-speed cameras. What they came up with is Brainshield, a thin decal made up of four micro-engineered layers that divert the impact of a hit to the helmet, reducing the rotation of the head.

“Imagine a banana skin on the floor, and then you step on it,” said Abram. “What happens is that that banana skin causes the friction force between the sole of your shoes and the surface that you’re walking on to be reduced. That’s why you slip. Now imagine the same movement of slippage when you are dealing with Brainshield. There’s an impact – the helmet is hitting someone else’s helmet, or hitting a pole, any obstacle, any barrier – and what Brainshield does is by just allowing these layers to move on each other, they don’t allow the force to be applied freely to the helmet. They cause that slippage. That way it diverts the impact, disengaging the helmet’s outer shell from the impacting surface.”

The decals were tested on the SFU football team in 2014 with positive results – concussions dropped from 14 the previous year to four in 2014. That led Abram – who is now chief technology and operating officer at Shield-X Technology Inc., an SFU spin-off company established to develop and manufacture Brainshield – and his team to introduce Brainshield to a pair of high school teams in 2015, including Handsworth.

Abram’s team celebrated alongside the Handsworth coaching staff when the Royals went through the season without a concussion.

“We were ecstatic,” he said. The decals – which can be applied to any type of helmet ranging from biking to skiing to everything in between – are designed to shear right off in an intense impact. The Brainshield designers estimate that a player will go through at least a couple of pairs each season, depending on the level of contact the player encounters. Abram was delighted every time he saw a player come off the field with a damaged Brainshield. 

Handsworth helmets
A seemingly simple addition to Handsworth's football helmets - a pair of thin decals - may have played a hand in preventing concussions during the 2015 season. photo supplied, Simon Fraser University

“When I see that (the decal) is damaged I become more happy,” he said. “I see that it has worked. Instead of somebody’s head got damaged, Brainshield got damaged. It’s replaceable.”

A pair of Brainshield decals for one football helmet costs less than $25, and Abram is hoping to get 10 or 20 more high school teams wearing his product next season.

“We see it works. What we need is more teams to be involved and then that way we can have a larger pool of data and see how effective it is on average,” he said, adding that he’s hoping to make his endeavour a win-win situation in which his business thrives while also providing an invaluable safety feature for young athletes.

“Almost every part of the human body can be replaced but your brain,” he said. “You can have a new heart, new liver, new kidney, but you can’t transplant a brain. It’s you.”

• • •

Four months ago hockey mom Julia Gerbrecht lived out a scary moment that is all too familiar for many parents. Her 13-year-old son Adam was playing a game with a North Shore Winter Club bantam team when an opponent nailed him with a late hit, cross-checking him headfirst into the boards.

“You just get a sick feeling in your stomach,” said Julia. “I wasn’t sure, you’re never sure. Sometimes they get up and they’re good, and sometimes they shake their head a funny way and you think, this isn’t good.”

This was one of those times that was not good. On the ice, Adam (who had suffered a concussion two years earlier) felt a change in his body.

“I do remember falling to the ground and just lying there thinking something about me just didn’t feel right,” he said. “I got up and I went to go skate and start playing and my balance was just like – immediately I could feel a change in how I was skating.”

Adam quickly got off the ice and stayed on the bench for the rest of the game, a headache growing as the bright lights of the arena started to bother his eyes. A visit to a clinic led to a prescription of rest, but as the days wore on and the headache remained, the family decided they needed something more.

Adam Gerbrecht
Adam Gerbrecht completes a grip strength test while chiropractor Aleem Remtulla of The Foundation for Integrated Health looks on. The test is one of many used in the Foundation's return-to-play concussion protocol. photo by Paul McGrath, North Shore News

That’s when they headed to the Foundation for Integrated Health, one of two North Shore clinics – along with North Vancouver’s Trimetrics Physio – certified with Complete Concussion Management, a national research company that educates health-care practitioners on providing concussion programs and rehabilitation to athletes and concussed patients at clinics across Canada.

The core of the concussion management program is conducting comprehensive baseline tests on healthy athletes so that if they do suffer a head injury a practitioner can redo the tests until they are sure that the athlete is fully healed before they return to play.

The power of the system is that it takes the decision out of the hands of athletes, coaches, parents and even doctors and gives it to an objective set of tests.

“It’s not subjective, it’s completely objective,” said Drake, who runs the concussion management program at the foundation along with chiropractor Aleem Remtulla. “It’s the only way to make sure that a kid is protected not only from them lying and not understanding, but everyone else too who wants them to get back in the game because it’s the big game and yada yada yada.”

The gold standard for many doctors treating a concussion is rest and, if the athlete remains symptom-free for two weeks, it’s time to get back in the game. That’s not good enough, said Drake.

“If you don’t have that baseline and someone says, ‘Oh, yeah. Two weeks. You’re healed. Off you go,’ and they’re not healed … you’re playing Russian roulette with a loaded gun. Yay, they didn’t get hit for the first two months. But if they get clocked, (it’s) their second impact.”

A second impact coming before a previous concussion is fully healed is where the danger really starts, said Drake, citing the example of teenager Rowan Stringer, a high school rugby player in Ottawa who hid concussion symptoms from her coaches and parents. Stringer died after taking a big hit in a game just four days after a hit that likely gave her a concussion.  

“Her friend was begging her to go see someone the day before she went and played in this game and died,” said Drake, adding that stories like this reinforce the notion that the return-to-play decision must be taken out of the hands of players, parents and coaches. “When you’ve got a kid’s brain on the line, it doesn’t matter what the parent says, the coach says, anyone says – it’s what the testing says.”

Adam started to feel better after his first session at the Foundation for Integrated Health. Practitioners immediately went to work getting his eyes tracking again, a key first step in recovery. The practitioners at the clinic don’t rely simply on rest, said Drake. Instead, they slowly ramp up activity at levels that don’t trigger any symptoms.

“The headaches started to go away after the first couple of sessions,” said Adam, who returned to game action about a month after sustaining the injury. After another month he went back to the clinic to do baseline testing, information that now travels with him on a tag attached to his hockey bag. As part of the Complete Concussion Management system, Adam can locate clinics across Canada if he takes a hit while on a road trip and the practitioners will be able to access his baseline test scores immediately.

concussion tests
Athletes who go to The Foundation for Integrated Health - a clinic affiliated with the nation-wide Complete Concussion Management program - must complete several tests before being cleared to play following a concussion. photo by Paul McGrath, North Shore News

“My brother got a concussion when he was in a hockey tournament, and that could very well happen to me,” said Adam. “I travel quite a bit for hockey. If you’re in (a new) place you’re kind of scrambling a bit. ‘Oh, do I go to a doctor?’ Now that I have this, I know where to go.”

Having that baseline information gives extra peace of mind to mom Julia as well.

“More than anything it gives you reassurance that they’re ready to go back,” she said. “You don’t know otherwise – it’s in their heads. It’s not like a wound or a sprain – you have no way of knowing.”

• • •

Handsworth’s concussion-free football season is generating buzz. A BBC camera crew came to the school in January as part of a documentary on concussions.

Prepchuk, a highly regarded coach who just took the B.C. provincial team to Las Vegas for an all-star tournament, is heavily invested in keeping the sport safe and prosperous.

“Everything we do on the football field is based around safe football,” he said. “With all the benefits you get from being on a team and understanding the importance of teamwork and ... working really hard to attain a common goal with a group of guys that have to work together, football is a game like no other.”

The Handsworth team will be wearing the Brainshield decals again next season. Everyone involved in the sport, however, knows that nothing can guarantee safety. In fact, the Handsworth junior team wore the decals in 2015 and two of their players suffered concussions.

Jay Prepchuk
Handsworth head coach Jay Prepchuk talks strategy with quarterback Sam Tholl during a high school league game in 2015. photo by Paul McGrath, North Shore News

The makers of Brainshield know it isn’t a cure, but rather one more safety feature in a growing arsenal that includes rule changes, equipment changes and increased awareness of concussion issues.

“This type of technology shouldn’t give the impression to players that ‘Oh, now I can hit harder,’” said Abram. “It’s kind of like seatbelts for your car. You want to have it, but you’re hoping that you never use that. But it’s there for you when everything else fails. You can’t say, ‘Hey, I have a seatbelt on so I can go 150 km/h and hit the wall.’ It’s just there to add one more layer of protection for you.”

More help is likely on the way right here in the Lower Mainland. For the past two years, researchers at the University of British Columbia have followed several volunteer players on the UBC football team who wore impact sensors, known as the xPatch, taped behind their ears during games and practices. Researchers are still analyzing the data and will release preliminary results this spring. The hope is that the technology will become reliable enough that one day all players might be outfitted with sensors that could instantly alert team officials to potentially harmful impacts.

Anything that makes sport safer and keeps children active is welcome news for Drake. The alternative solution – children sitting all day, parked in front of a screen – is potentially just as harmful. “No one wants to keep kids home on the couch,” she said. “We all want our kids to go out and enjoy sports.”

Adam Gerbrecht is back enjoying hockey. The dream of every young player is to make it to the NHL, but Adam admits he’s got more attainable goals now. He wants to play hockey at a college or university while studying design. He already has a passion for it. “I enjoy designing layouts of houses, exteriors of houses,” he said.

Adam Gerbrecht
North Shore Winter Club hockey player Adam Gerbrecht goes through a balance test with Aleem Remtulla of the Foundation for Integrated Health. Gerbrecht, 13, wants to play hockey in university while studying design. photo by Paul McGrath, North Shore News

His mom worries about what head injuries could do to those dreams. “I don’t worry about the hockey as much, I worry about school,” said Julia. She’s happy to have Adam on a concussion program now, though, so that they’ll know that whenever he’s on the ice he’s as ready as he’ll ever be. That way, when it comes time for the next phase of his life, he’ll be free to design his own future.

“He’ll need a lot of brain cells for that,” she said.

 

You can find Part 1 of our two-part concussion series here.