Faces of Public Health: Kevin Guskiewicz, MD
A look at laws intended to reduce youth sports-related concussions was a focus of the recent Public Health Law Research annual meeting. Public Health Law Research is a Robert Wood Johnson Foundation program at Temple University.
The issue is so critical that this year the MacArthur Foundation named a Kevin Guskiewicz, MD, a scientist involved in research to prevent catastrophic youth sports injuries as a MacArthur Fellow, which awards five-year, $500,000 grants to individuals “who show exceptional creativity in their work and the prospect for still more in the future.”
The 2011 fellows just began receiving their grant money last month, and Dr. Guskiewicz is one of several MacArthur Fellows whose works informs critical public health issues. NewPublicHealth will be speaking with these grant recipients over the next few months, and we begin that series with a conversation with Kevin Guskiewicz.
NewPublicHealth: Tell us about the scope of your work.
Dr. Guskiewicz: We’ve been studying recovery curves following concussions. We’re trying to better identify the best tools with which to assess concussions. More recently we’re trying to look at the biomechanics of concussion and the way in which youth athletes often lead with their head inappropriately. So they might predispose themselves to a concussion because they’re tackling incorrectly or hitting a soccer ball incorrectly or blocking incorrectly. I think we’ve done a good job of answering questions on what happens after they’ve had the injury. So now we want to try and focus on prevention.
NPH: How do you prevent concussions?
Dr. Guskiewicz: We think a lot of it has to do with neck strength. We’re beginning to look at prevention methods that might allow us to strengthen that neck muscular, to try to teach kids how to prepare to take a hit if they get one because we know that to take an ill-prepared hit, where they can’t brace the head and tense the neck muscles, that the forces to the brain are worse than they are if they’re prepared for it.
NPH: How much of what youth athletes do with their heads is instinctive versus trained?
Dr. Guskiewicz: That’s a great question. I was just out in Montana lecturing on this yesterday. I think that too much of it is instinctive, and the focus has gone away from the technique. I think that you need to learn the skill of preparing yourself to take a hit and if we don’t teach them at a young age, it may be too late to learn that skill to make the kind of corrections that are going to help protect them.
NPH: So, it may be an imperative to retrain many coaches, both professional and volunteer, on how best to train a child to maximize best performance but also prevent injury?
Dr. Guskiewicz: Yes, and that’s where a lot of the concussion laws are headed. I headed up our concussion law effort here in North Carolina, and it’s actually called the Gfeller-Waller Concussion Awareness Act, which was named after two high school football players who died in 2008, each with very different injuries. Both were brain-related injuries, but different in why they occurred. One was a return to play too early and he was still suffering from the effects of concussion. He had what we call second impact syndrome and died. The other boy, Matt Gfeller, he had a defective helmet. So I think there’s a lot of education needed. All the concussion laws [I’ve seen] are aimed at educating coaches, players, and parents, about concussion and how to prevent it. That includes “no same day return to play,” so players can’t return to play once they’ve been determined they’ve had a concussion. And another feature is that they must be cleared by a physician or clinician trained in the management of concussion.
There are now over 30 states in the U.S. that have concussion laws and another probably ten that are pending, but we need to now begin to study the effectiveness of the laws.
NPH: What are some model practices you’d like to see that could help reduce injuries and deaths?
Dr. Guskiewicz: There needs to be a program that focuses on education and appropriate equipment. And then we need the policymakers to begin looking at the rules to make sure they are being enforced, and whether there are rules that might protect kids better such as kickoffs. In the NFL the kickoff rule was changed this past year [from the 30 yard line to the 35 yard line] to reduce the number of collisions that take place on kickoff, and by making that change we’ve effectively reduced the number of concussions that occur on that one play. We know that in youth football that’s the most dangerous play for a brain injury. We see a disproportionate number of catastrophic brain injuries on kickoff and punts than we do any other play, and so I think they should consider modifying the way the game is played.
NPH: What are some basic tenets that you’d like to see every state have in terms of laws that would best protect youth athletes?
Dr. Guskiewicz: Mandatory disclaimers by parents, coaches and athletes, and a requirement to read a fact sheet. In North Carolina, there’s a fact sheet that they have to sign off that on that they understand the dangers of not reporting symptoms, they understand what the symptoms are, that they’re wearing safe equipment— it becomes a checklist. There needs to be something like that in place so that everyone in society is playing a role and bearing some of the responsibility. And we also need to increase what schools and youth leagues are required to do in terms of safety equipment. I think that too many of these leagues— middle schools, high schools—they don’t refurbish their equipment in the right way, and they don’t have the funds unfortunately to buy equipment that is new. We know that the newer helmets are better, and so I think that there needs to be something aimed at equipment safety. And, as I’ve said already, I think the rules need to be looked at, to see if there are rules that could be changed.
And it’s not just football injuries. We have to be focusing on multiple sports and are prepared to handle these and what can we have in place to ensure that a kid doesn’t end up with a catastrophic injury. That’s the goal: what can be put in place to ensure that we can reduce the number of these catastrophic injuries.
NPH: And how will you be using your MacArthur grant?
Dr. Guskiewicz: We are developing a program that will allow us to look at behavior modification, such as putting accelerometers in youth helmets and seeing if we can show youth athletes how they’re leading inappropriately with the head and to try to retrain them so that we can try to prevent those injuries.
And we’re also using the grant to work with the military on concussions that are caused by blast injuries. We validated a lot of the measures to assess concussion and so the military is turning to the sports medicine community. We’re trying to see if we can help them quickly and effectivelyidentify injury extent and recovery times so that the soldier can be sent to the appropriate place for care.