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Dr David Hartman on Head Injuries

 
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Q&A: Dr David Hartman on Head Injuries (824 Posts)
Topic Comment
Snowboarding Helmets
On 2/19/2006 Dr. Dave wrote in from United States  (24.13.nnn.nnn)

The specs for snowboarding helmets are very similar to skateboard helmets, with similar head coverage. I recommend them for anyone who is skateboarding in a cold climate, since they are better insulated, but still vented.


I snowboard and, for the first few years, strange as it seems, hadn't worn a helmet, thinking that as a green and blue run beginner, I was not going to run into situations that would put my head in danger. That changed after talking to a snow-pro at Whistler a few years ago. He told me that most of the very serious head injuries in snowboarding are not because the boarder flew off a cliff or didn't see a tree coming, but rather because an experienced boarder was hit in the head by a flying, unleashed board, or because they were smashed into by a little kid, flailing amateur or hotdogging racer. So the injuries were coming from completely unpredictable sources. From then on I never went on the slopes without a helmet. And for you Canada snowboarders, Whistler/Blackcomb does NOT require board leashes.. . .

Dr. Dave

 
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head wraps
On 2/19/2006 snoball wrote in from United States  (65.35.nnn.nnn)

Someone mentioned using snowboarding helmets and I've wondered about them myself. I noticed though that in this Olympics bordercross, their helmets look like motorcycle helmets but I don't know if they are. Even if you don't use a full face like that, are snowboarders helmets - that look an awful lot like skaters helmets - better built than skaters helmets? Or do they just have some thermal lining 'in addition to..'? I've snowboarded without a helmet ( and not very well I'll add ) and caught a heel edge bringing the ground up to the back of my head pretty quick and man that hurt!! I just wondered if the snowboard helmets would be a good compromise between skate helmets and going full face ( which most skaters I know don't want to do because they're not downhilling )?

Brain injuries suck kids. Really.

 
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Hockey Helmet
On 2/17/2006 David wrote in from United States  (69.150.nnn.nnn)

Ryan is now wearing his full face hockey helmet. I warned him that it would take some time to get used to it. Initially, he was indeed frustrated. However, after several days, he loves it. As previously mentioned, he was initially also worried about the reaction from his friends and other observers. Most, if not all of his friends think it is pretty cool. Maybe not from the helmet per se but maybe more that he was willing to climb back up on the horse after a pretty serious accident. Ryan says that it does not hinder him in any significant way and that, actually, it gives him some additional security to try things that he otherwise wouldn't because he knows the risks have been drastically reduced. I laugh because we don't have to worry about him eating the board again, we only need to worry about broken bones.

With regard to the last post, I'm not confused between the tech and the downhill. I know that this site is more suited to the downhill enthusiast but it appears that almost all types of boarder's post here. I also know, from this site and others, that eating a board or cement or a post can happen regardless of your board interests. This site is wonderful and has been the source of a great volume of information. You should be very proud of it and the message that you folks are communicating.

In the meantime, I'll watch Ryan skate and I will sleep very well. We have found a way to keep him going in a sport that he loves(among others). He continues to heal(his teeth are stabilized and straight and the surrounding bone and gums are filling in nicely) but we still have another month or so of close monitoring. I know from the responses that a hockey helmet is not the ideal choice but the ideal choice has yet to make it to market. Maybe someone from this site could work towards that end. That being a tech skateboard helmet that could be, if desired, fitted with a full face mask.

 
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Tech Skating in a full face?
On 2/12/2006 Mike P wrote in from United States  (129.210.nnn.nnn)

David, I would like to strongly recomend that you reconsider making your son wear a hockey helmet. I am definately an advocate of helmet use, following a bad fall I had downhilling in the Oakland hills. I always wear my snell shell when speedboarding, and a regular bucket for everything else (sliding, street and park.) Your son is not going to be able to skate in a hockey helmet. It would be like requesting a tenis player to wear one. There are undoubtably facial injuries that are part of the risk of the sport. Nobody knows that better than your son, and he is not stupid, and does not want to eat his board again. If he does not want to wear the helmet though, it's not just that he will look stupid, it's that he knows he won't be able to skate in it. I cannot even imagine trying to street or park skate in a full face helmet.

You may be confused by the reports of facial injuries on this site. Most of them are from downhill (this is, after all the Northern California Downhill Skateboarding Association.) If I speedboarded in just a bucket, I would lose a lot of skin off my face. Catching a skate in the face is not that common. Possible, but not common enough to warrant a helmet that makes skating nearly impossible.

 
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Thanks Paul
On 2/12/2006 Dr. Dave wrote in from United States  (24.13.nnn.nnn)

Paul, thanks for the props. I think every helmet wearer has the potential to save lives - their own and anyone they convince to follow suit. Definitely good karma, either way.


Any readers have the experience of putting someone in a helmet, and finding out later they walked away from a header?

Dr. David

 
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This whole forum
On 2/10/2006 Paul Howard wrote in from United States  (64.5.nnn.nnn)

I haven't really followed this forum because I'm a helmet wearer already (full face Gyro for slalom and regular helmet for skateparks). I just want to say "Thanks" for doing this forum and am glad to see it. Adios-Paul

 
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The Road to Snell is Paved with Good Intentions
On 2/4/2006 Dr. Dave wrote in from United States  (24.13.nnn.nnn)

Snell allows up to 300 g's in a multiple strike accident. This is considered to be a dangerous amount of force transmitted to the brain, and there are concerns that a single impact standard that is "softer" i.g., lets fewer g forces into the brain is safer than a "harder" multi-impact helmet. Some of the newer testing suggests that non-snell helmets may be safer.

This is from www.motorcyclistonline.com. "Dr. Jim Newman, an actual rocket scientist and highly respected head-impact expert—he was once a Snell Foundation director—puts it this way: "If you want to create a realistic helmet standard, you don't go bashing helmets onto hemispherical steel balls. And you certainly don't do it twice.

"Over the last 30 years," continues Newman, "we've come to the realization that people falling off motorcycles hardly ever, ever hit their head in the same place twice. So we have helmets that are designed to withstand two hits at the same site. But in doing so, we have severely, severely compromised their ability to take one hit and absorb energy properly.

"The consequence is, when you have one hit at one site in an accident situation, two things happen: One, you don't fully utilize the energy-absorbing material that's available. And two, you generate higher G loading on the head than you need to. "What's happened to Snell over the years is that in order to make what's perceived as a better helmet, they kept raising the impact energy. What they should have been doing, in my view, is lowering the allowable G force.

"In my opinion, Snell should keep a 10-foot drop [in its testing]. But tell the manufacturers, 'OK, 300 Gs is not going to cut it anymore. Next year you're going to have to get down to 250. And the next year, 200. And the year after that, 185.'"

 
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Teeth
On 2/4/2006 RyanR wrote in from United States  (65.19.nnn.nnn)

David,
I know all about knocking out teeth. Last year I was doing some downhill racing and on my last run, my rear left wheel fell off going about 40mph. I was wearing knee and elbow pads. Gloves and a helmet, but the one place that hit the pavement was my face. I would still have my front 3 1/2 teeth if I would've had a full face helmet.

So on that note...Does anyone have any suggestions for a good Snell/DOT rated full face helmet. I have been looking at quite a few helmets for downhill racing but haven't had much luck. Dr.GoFast and Icaro helmets are not Snell approved and for the Timeship Racing Series they require a Snell approved helmet.

I have looked at some Motocross helmets but I am really looking for something with a face sheild and good peripheral vision. Please let me know if anyone has an idea.

Thanks.

Also, I read something about Snell testing not being right for skateboarding. What would that be about. Is CPSC certified enough?

 
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Blake
On 2/4/2006 RyanR wrote in from United States  (65.19.nnn.nnn)

Check out SKATEBOARDSAFETY.COM. There might be some info there or maybe some links you could use.

 
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Full Face Solution
On 1/26/2006 David wrote in from United States  (69.150.nnn.nnn)

Thanks for the replies everyone. Dr. Dave, there was no negotiation regarding the helmet and full face mask. The injuries were very bad but he is healing. He even looks the same except for the braces(which he was getting anyway). I don't ever want to see that again and, therefore, there was zero room for discussion.

Nevertheless, and despite the counter suggestions, I ordered a full face hockey helmet last night. My reasoning is that hockey players hit ice and boards at high rates of speed and are hit by pucks, sticks, etc. at even higher rates of speed. They have their cages rattled, no doubt, but they receive very little significant damage. These helmets are relatively light so his athleticism will be impaired in only a minor way and the vision is excellent.

In any event, this will get him back on a skateboard and I will be able to sleep at night. There is little, if any chance, that the board can penetrate the mask and when I look at his previous hockey helmet versus his previous skateboard helmet, I sleep even better.

I wholeheartedly agree with your comments about the culture. To those who think that Ryan's injuries were rare, I've learned through some research(some included postings from this site) that they are more frequent than you might know. I can not recommend strongly enough, that any skateboarder at least consider the full face mask, regardless of how good you think you are. Ryan is good enough that he has been approached by sponsors. It was just a freak accident and one that could, and does, happen to anyone who enjoys the board.

My sincere hope is that some pro will convince his sponsor to make a skateboard standard and skateboard looking helmet that can be fitted with a full face mask. I then hope that same pro will wear it in an effort to show that culture should at least consider common sense.

I apologize for the editorial but it is important for everyone to strongly consider the downside to this wonderful sport. It does get closer to the edge all the time and the risk and degree of serious injury must, by definition, increase proportionally. Believe me, and I know it's heavy and corny, but there is no parent that wants to see someone they care about hurt as bad as Ryan was and I will spread my message as long as I still see good kids on boards without proection.

Thanks for your help and patience.

 
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The Wind In Your Hair; Your Brains on the Ground
On 1/25/2006 Dr. Dave wrote in from United States  (68.251.nnn.nnn)

Blake:

I think those 'no-helmet' sites have a minor point. It's true that if you fall in a certain way in a helmet, you can sustain an injury you wouldn't get without a helmet. It's even more true that helmets save far more lives than they damage. As far as I know, every state that has repealed motorcycle helmet laws has seen increased head injury death rates.


Think what happens to a boarder if the board stops and he or she keeps going. Every bit of kinetic energy that was built up going forward is redirected into whamming your head into the ground. Even an inch of helmet padding can the difference between massive brain injury and walking away. Your skull is NOT a helmet! In fact, the front of the skull has a set of knife-like edges that can slice and dice your brain if it rams into it. The hard foam in a helmet can absorb 100's of g's.


Go to the Snell Foundation's website and take a look around, not to promote Snell, but just to get a feel for the scope of the injury. The "freedom" helmet sites just don't get it. Yes there are some trade-offs and yes,even some freak injuries from helmets, but wearing one is overwhelmingly safer than not wearing one. I would vote against a helmet "freedom" measure every time, both for brain-injury-related grounds as well as the fact that my taxes will be paying for that person's "free" choice to get bashed into a persistent vegetative state. Something to think about.

Dr. Dave

 
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A mouthful
On 1/25/2006 Dr. Dave wrote in from United States  (68.251.nnn.nnn)

David.

I'd go with a dual certified helmet, esp a BMX helmet, which looks pretty cool, and prevents snapped off teeth. Even BMX isn't the best for speedboarding, which is getting into motorcycle helmet territory.


As far as helmets not being 'part of the culture' well, I haven't seen anyone parading broken teeth as part of a culture either. And if your son watches the X-games, he knows that nobody goes up on the half-pipe without full pads and helmet.


You know, being a parent is a lot like what Holden Caulfield wanted to do in the book they made us read in school, 'The Catcher in the Rye." Your job is to watch the kids run around and pull them back only if they get too close to the cliff. Boarding is close to the cliff; it's not just an extreme sport because of marketing. It's an extreme sport because you can get hurt badly, even when you're pretty good. You can explain the logic and all of that to kids, but if they are under your care, sometimes the only thing you can do is say 'no helmet, no board.' I'm not going to tell you they'll thank you later. They may hold a grudge forever. But you'll sleep better.


Let us know what you guys decide.

Dr. Dave


I can't recommend hockey helmets because they are not certified for board-related sports and injuries.

 
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face guard for skating
On 1/24/2006 herbn wrote in from United States  (205.188.nnn.nnn)

wow, that's got to be pretty rare.i used to just wear fullface helmets,but only on my rather serious DH bike excursions,no helmets otherwise, i used to say i 'd feel real silly breaking my jaw while wearing a helmet . I've increased helmet use,a regular lightweight giro for most biking. I think i'm gonna go fullface for downhill skating,but i think a fullface helmet would really be a hassle on tech level street riding,switch varial heelflip(for instance),inside a full face? i don't think the really serious helmet advocates on this page can even come remotely close to relating to this type of move and how a slightly bigger hole to look through doesn't help all that much, i know skaters that flip wheels graphic in,because a swirling spitfire graphic is to distracting.Sad to say the womans' kid who took out his teeth on a "simple kickflip" should probabely switch over to biking,or some other sport that's more condusive(sp?) to fullface helmet use.

 
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Full Face
On 1/23/2006 Shane Anderson wrote in from United States  (130.132.nnn.nnn)

A great place to start for data on helmets is: http://www.bhsi.org/helmetxx.htm

Many of the full-face helmets out there are intended for BMX (Bicycle Motocross) applications, but some are also dual certified to include Skateboarding specifically. The Bike standard is the CPSC standard and the Skate standard is ASTM F1492.

I have several helmets for different applications. All of mine are dual certified. I am starting to wear my full face helmet more and more often. I originally purchased it because I wedged a rock one night freeriding and skinned the hell out of my face. I used to laugh at people who couldn't get their face out of the way. No more.

I wear this:

http://us.st11.yimg.com/store1.yimg.com/I/hardheadedsports_1877_46634 Available here http://store.yahoo.com/hardheadedsports/pracespfubmx.html (I am not affiliated).

This helmet is dual certified and will withstand multiple impacts. I am not going to go into all of the reasons why I did not buy a Giro, just the main one... they did not have one that fit me at the time.

I have also started to wear a mouth guard. You know, the old mouthguards that they made you wear when playing football... The reason? One of the major causes of concussion is apparently blows to the jaw. It may save my teeth too, though that is not my main reason for wearing it.

Hope this isn't off topic, nor construed as a hijack. I'd like to hear what others are using, and their impressions as well as Dr. Dave's overall take on full face helmets. Thanks.

Respectfully,

Shane

 
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Follow-Up to Mouth Injury Below
On 1/23/2006 David wrote in from United States  (69.150.nnn.nnn)

I've now read many of the postings. It appears that a great many skateboarders are now considering, and even using, full face helmets. These appear to be designed for bikers, skiers, etc. but are stil being used. What about hockey helmets? They have to be light-weight and they must have great vision and ventilation. They are reasonably priced. Has anyone tried? Is there any reason that I shouldn't consider these for my son?

Thanks for any reply.

Very interesting site and one that I will definitely show my son. I'm guessing that he will see that maybe, just maybe, the culture regarding the use of helmets(with or without face shields) is definitely changing.

 
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Skateboard Mouth Injuries
On 1/23/2006 David wrote in from United States  (69.150.nnn.nnn)

My son is an experienced skateboarder. Over X-Mas, he was performing a simple kick-flip and sent the skateboard through his mouth. No details necessary other than he suffered major injuries to teeth and gums. I will not allow him back on a skateboard unless he has a helmet with a facemask. He says that it is not part of the culture but I assure him neither were full face hockey helemts not so very long ago. I can't seem to find any full face skateboard helmets. Any help from anyone? My son loves the sport and I want him to be able to participate but not at the risk of even further damage or worse.

 
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Anti Helmet websites
On 1/22/2006 Blake wrote in from United States  (216.223.nnn.nnn)

Dr Dave,
My skate injury research has lead me to stumble into a bunch of "helmets aren't important" websites and studies, many are related to bicycling and skiing but basically say that helmets might help a little with minor injuries, but really don't prevent serious ones and might make things worse by increasing risk-taking behavior from a false sense of secutity. On the surface these seem crazy, but they are fairly convincing and well written. The paint a picture of a helmet crazed society where people would be better off not wearing helmets and paying more attention to what they are doing. What are these folks up to? Who bennefits from less helmet use?

 
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Mea culpa? Or youra culpa?
On 1/20/2006 Adam wrote in from United States  (198.144.nnn.nnn)

JBH, Very good point.. change made.

Thanks for the good idea. Many off-topic posts have been removed from this forum over the years, but I sometimes made an exception when a mod wasn't able to catch them before DrD responded and a thread ensued. Now DrD will no longer be responding to off-topic posts and mods will simply remove them.

 
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Mea culpa? Or youra culpa?
On 1/20/2006 JBH wrote in from United States  (165.134.nnn.nnn)

Adam, when I posted my knee question that was removed, I was unaware of this forum's change to a focus strictly on head injuries and protection, um, therefrom. I admit I was a bit curious as to why Shane A. mentioned that a post about his toe was removed, but I had read back a page or two and saw that Lenny had posted (and received an answer about) "turf toe," so I figured maybe Shane had just asked a really gnarly toe question. ;-)

However, I bet I'm not the only person who wasn't aware of the "head-only" focus--which is not made clear by the "link" title, which is simply "Dr. Dave's Corner," (and which it has been for some time now, I believe?). So Adam, unless you want similar "off-topic" posts to continue to be made in error (?), would you please consider changing the title of the forum on the link so it more clearly indicates the "head" focus? You do it for Chaput, Cliff, Hackett/Olson and Yandall--why not for Dr. Dave?

 
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Forum topic: Head Injuries
On 1/20/2006 Adam wrote in from United States  (198.144.nnn.nnn)

From the webmaster..

Dr. D has been with us for going on 4-years now and has been an invaluable resource by helping Ncdsa.com members better understand the seriousness of brain injuries and the importance of helmet use. While he has, on occasion, graciously replied to off-topic questions, it was not, and is not, the aim of this forum to attempt to delve into such topics.

Effective immediately, any off-topic post will simply be removed without notification. My hope is that this will re-focus the forum on its intended goal, namely skateboarding related head injuries. Thanks, Dr. Dave, and thanks to our members for their understanding.

 
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Pro-Tec "SXP" foam?
On 1/20/2006 Jonathan Harms wrote in from United States  (165.134.nnn.nnn)

I've got two questions for you, Dr. Dave. I'll post them in two separate posts.

The first is about helmets. After reading that the "hard foam" type of helmet offered better protection about two years ago, I bought and have been wearing an inexpensive "hard foam" helmet with the Kryptonics brand name on it. It's lightweight and comfortable, and I have no complaints, except that the fabric liner on the foam is coming off. But every now & then I check to see what's new in helmet-land, and today I decided to check the Pro-Tec Web site at www.pro-tec.net.

I'm wondering if you or others can comment about the "SXP" foam (Surface activated eXpanded Polypropylene) that Pro-Tec is using. How do you think it compares to the "hard foam" (is it expanded polystyrene?) that seems to be the standard?

In this case, I'm thinking of it more for ramp/pool/park riding, but perhaps also for slalom. I may eventually go full-face for slalom, but would like to hear your opinion on the Pro-Tec nonetheless. Thanks.

 
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No Helmet Horrorshow
On 1/19/2006 Dr. Dave wrote in from United States  (24.13.nnn.nnn)

Dee,

It's tough to convince teens that helmets are necessary. They are all immortal, of course. . . What does your son say about the X-gamers, who are all close to his age and padded to the max? Some kids listen to logic, but most say 'it won't happen to me.' I think the best thing you can do is say 'if it's good enough for the X-games its good enough for you,' and let the argument stop there. It only takes one unprotected fall to bash your brains out, literally. You might want to ask him how he would feel if he *does survive something like that and is strapped to a wheelchair the rest of his life? But in the short-run a black-and-white 'no-helmet-I repossess your board' rule may be the way to go.

I wrote an article about skateboard injuries for the defunct 'International Longboarder' a couple of years ago. If you send me an email, I'll shoot it to you.

You too Blake, send me your email at drdavidhartman@hotmail.com and I'll send you a copy. Contact the Snell Foundation http://www.smf.org/ for other helmet related information. While there's some dispute about whether Snell's standards are the best for boarders, you can get a lot of useful information there.

And Blake. Your personal helmet story made my day, because I have a good idea what might have happened if you hadn't worn it. Good job. . .

Dr. Dave

 
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son not wearing helmet
On 1/17/2006 dee barclay wrote in from United States  (66.190.nnn.nnn)

Dr. David, Please help me find info. to share with my son on why he is made to wear a helmet- injury pictures ect. This is a constant fight at our house because none of his "friends are made to wear helmets while skateboarding. Any help you could give would be great, I will not "cave" on the helmet issue and my son is a very bright young man so I feel with a little bit of scare tactics i will be able to convince him (and maybe his friends) that it is imperative to wear a helmet.

 
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Injury research
On 1/16/2006 Blake wrote in from United States  (216.223.nnn.nnn)

Dr. Dave,
I'm working on a skateboard safety equipment ad campaign (promoting its use, not selling it) for a graduate graphic design class. Do you have resources for good research that would include: number and type of injury, age of victim and whether they were wearing gear or not? I was planning to do this project anyway, but bouncing my helmeted head off the asphault while practicing gymnastics at the end of a slalom run this weekend really made me more committed to doing the project and seeing if I can make it a real campaign, not just for school.

 
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Better Helmet Tech is Possible
On 1/10/2006 Dr. Dave wrote in from United States  (24.13.nnn.nnn)

People. Here's some proof that better helmet technology can reduce concussions. The new helmets don't change recovery patterns if you actually have a concussion anyway, but it looks pretty sure that they make getting a concussion less likely in the first place. Let's hope the skateboard helmet makers get a clue from this research:

PITTSBURGH, Pennsylvania (AP) -- Newer helmet technology could reduce the risk of high school football players getting concussions, but not the severity of the injury, according to new research. A three-year study by the University of Pittsburgh Medical Center found that athletes who wore a helmet with more protection for the temporal area of the head and jaw had fewer concussions than those wearing a standard helmet, said university neuropsychologist Micky Collins, the study's principal investigator.


The study, published in the February edition of the scientific journal, Neurosurgery, looked at 2,141 high school football players from 2002 to 2004. Of those, 1,173 wore the improved helmet and 968 wore standard helmets through both the pre- and regular seasons.


The study, funded by helmet maker Riddell, is the first to look at whether helmet technology can reduce the severity or number of concussions, Collins said.


The study showed the annual concussion rate was 5.3 percent in athletes wearing the new Revolution helmet and 7.6 percent in the older version. Revolution wearers were 31 percent less likely to sustain the an injury, compared with wearers of standard helmets, the study showed. The Revolution helmet was introduced in 2002.


However, helmet type made no difference in the recovery time of athletes suffering from concussions, Collins said.


Investigators used a test developed by UPMC to check the athletes' reaction and memory skills before and after concussions.


Collins said 50 percent of the athletes who had concussions did not recover within one week, 30 percent did not recover within two weeks and 15 percent did not recover within three weeks.


This is crucial because reduced cognitive skills also hurt the athletes in the classroom, Collins said.


"There's no such thing as a concussion-proof helmet," Collins warned. "The biggest mistake anyone can make is saying, 'This kid has a concussion. Put him in this helmet and send him out there.' ... Any athlete who has a concussion and goes back to play too soon, that's when the risk levels are high."
Experts studying sports-related brain injuries welcomed the study.


"(It) supports what we have anecdotally been discovering over the past few years," said Kevin Guskiewicz, chairman of the Department of Exercise and Sport Science at the University of North Carolina at Chapel Hill.
Fewer concussions were reported among UNC players wearing Revolution helmets, he said.


Stefan Duma, director of the Center for Injury Biomechanics at Virginia Tech in Blacksburg, called the UPMC study "a critical aspect in improving player health."


Duma and Guskiewicz are involved in separate studies to measure the acceleration of football players' heads in real time by installing wireless transmitters in their players' helmets, both Revolution and standard.


Guskiewicz said he hopes studies like his and UPMC's help researchers to better protect the brain from sports related injuries.


"The exciting part is it indicates there are design factors that can be modified to reduce your risk of concussion," Duma said. "Just showing they have shown a reduced risk with design change, maybe they can change the design more and keep improving."

 
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