John Boruk: And welcome into Raising a Champion. I'm your host John Boruk. With me, board certified physician for over 25 years now. Heads up the Mid-Atlantic Concussion Alliance, something that he founded back in 2010. He's got a wealth of information and something that a lot of parents are going to wanna know when it comes to brain injuries.

Dr. Vincent Shaler, thank you so much for coming. My pleasure, John. Yeah, absolutely. Let's just start at the very beginning 12 years ago you decided to form this alliance, the mid-Atlantic concussion alliance to, to, in terms of brain injury testing the diagnosis, treatment, concussion protocols, management, all of that.

What was your interest in that? What was the goal in getting that. . 

Dr. Vincent Schaller: So what was we realized, John, back in the urgent care world, which I did a lot of ER and urgent care work throughout my profession, and we realized that somewhere like around [00:01:00] 2000, 2005 in that window that we were our kind of what we were taught in medical school, we were taught in residency that if someone got knocked out completely, they have to be symptom free for four weeks if somebody got their bell wrong.

They have to be symptom free for two weeks. If somebody just got, possible concussion, they're having a little bit of headache, a little dizzy, they have to be symptom free for one week before you return back to sports. And we started realizing that we're having cases of athletes that were coming in, that they're having headaches, two weeks out, three weeks out, four weeks out.

And in the urgent care ER world, you would want to say, Okay, let's get you to see a neurologist to see what's going on. And get you tapped into whatever treatment plans are available back then, though as is today, a referral to a neurologist usually takes about eight to 12 weeks. So we had these folks in the waiting for eight to 12 weeks just to find out, what's the true diagnosis and what's the treatment plan.

[00:02:00] So during that time period, I had all these patients, like, when you're doing urgent care, you're open 365. So someone's having a headache and it gets worse on the weekend, or it gets worse when they go to a party, they go to a concert. They're coming back to the urgent care environment with that headache.

So we started realizing people are bouncing back on our service over and over again from a concussion and symptoms that were caused by it by having headache dizziness nausea. We started realizing that there had to be something better to try to get these folks access to evaluation and treatment.

Quicker than eight to 12 weeks. And in all fairness to my neurology friends they're very busy with a lot of complicated diagnosis like seizures, Parkinson's, ALS, Alzheimer's. So they truly have so much technology they have to absorb. And so many patients, they have to care for that.

They are stretched pretty thin. So eight to 12 weeks is not they're doing it's just that it's supply and. The reason why I got into concussions was because when I started realizing these patients are waiting there [00:03:00] was around, around 2005 or so students started coming in from the local high schools and colleges and they said, Hey, Dr.

Shaler, I got my bell wrong. Could you do an impact follow up test, a post-injury? And I said, What's an impact test? So then it was all within about six months. Over a dozen students came in a student athlete saying that can you please do my impact test? Can you please do my impact test?

And boy, that was like something I had never heard of before. So I figured out there must be some technology out there that I need to familiarize myself. So that led to me looking into the impact program. And then ended up when I did some research to see if it was a legitimate technology. I talked to some people already using it.

Talked to Dr. Berker at Colby College in in Maine. And he says, Oh yeah, in Maine they set up an entire statewide network. To do baseline testing with impact, and then if the kid's injured or the athlete's injured, bring 'em back in, do a post injury test. And so when Dr. Bergner said, Hey, thumbs up, we like the [00:04:00] program up here in Maine.

It's been running for about five years. I said, It's worth my while to go out to Pittsburgh University of Pittsburgh Medical Center and see what we can do to bring that technology to. Delaware and Southeastern PA. So that led me on my venture out to University Pittsburgh Medical Center.

Met Dr. Mickey Collins, Doc Dr. Mark Lowell. And they walked me through not only just what impact testing was, what it can do, what its limitations were, but they also introduced me to what's called a BOMBS exam of the SI motor exam. They also introduced me to, Prescription protocols that could be used for concussions, which was news to me.

I didn't realize that concussions could be treated with safe prescription protocol. And then they also introduced me to vestibular therapy which is the five stage that U P M C came up with. It's interesting that when I brought the U P M C five stage back to Delaware, It actually mirrors what the DIA had already put in place with a five stage return back to play.

So it's nice to see that it was starting to catch on as far as that kind of an [00:05:00] approach. And then they also talk about ocular therapy cuz sometimes when someone has, when a patient has concussions, they actually have a problem where their eyes are not tracking well, if they're not tracking well for moving targets, that's called gross motor skills.

Then that patient said a disadvantage going back the athletic. If they end up having a problem with ADEs, which is the ability to actually move from word to word across the page, up and down a computer screen, then they're gonna have academic problem. And if they have a fixations problem, they're gonna have fine motor skill problems.

So they broke all that down at pit and they said listen, Dr. Shaler, if you wanna get certified with our gang out here in Pittsburgh we'll certify you to then train other professionals back in Delaware, South Eastern pa. So it ended up being about a six month journey of caring for going through their courses outta Pittsburgh.

Rounding with Dr. Collins and Dr. Lowell with seeing their patients. It was fun seeing their patients because not only did they care for the local high school and college athletes, but amongst their patients were a lot of professional sports players. [00:06:00] So it was fun to actually hear stories, obviously.

Not HIPAA violation, but to hear stories about some of these athletes that came in and the people that they cared for were in nascar, they're MLB, NBA it was really a great experience. Anyway, so they said, Listen, Dr. Shower, while this training and coursework, you gotta go back to Delaware. You gotta care for 50 patients.

Start to finish. And then when you're done applying the UPMC protocols, applying the impact testing and learning how to use it and read it then we'll put you through two oral exams. You'll present all your cases and we'll see whether you have you've learned our technology and you can apply it.

So about a six month period of time, we saw about 50 patients back in in the urgent care world. . And we then ended up ended up passing my two oral exams got certified and at that point they, when I brought the the technologies back to I was my, my practice was in hoes in Delaware hoes in walk in medical care at that time when I brought it back the biggest challenge [00:07:00] was finding physical therapists that were willing to do or understood what's called vestibular rehab or the five stage recovery program.

And Dr. Collins did alert me, he says, Your hardest problem's gonna be when you. An athlete, a concussion patient with challenge in their eye movements in which you find abnormalities on the bombs exam, that you're actually gonna have a really hard time finding an ocular therapist or a vision therapist in your region because there aren't many of them available back in 2005.

So I said, Okay take the challenge. So we started actually seeing then create a concussion clinic on Fridays at my urgent care center, and that was back around 2000 and eight, nine or so. And then we ended up forming the Mac Alliance by 2010 when we realized that there was a growing need.

And so I started then getting other folks certified and learning the technologies and we. Our relationship over groups of physical therapy centers ended up lecturing to athletic trainers, lecturing to school nurses, occupational therapists, and we were [00:08:00] lecturing to doctors as well in the area 

John Boruk: But it essentially started from a really small group to where you now have a network of schools.

Organizations. I think even we've talked about how you've worked, you work with firehouses, because there's a profession where, it's high stress and there's instances where they can suffer brain injuries. So you, you've taken it from a really small pocket to now something that is grown by leaps and bound.

Dr. Vincent Schaller: Absolutely, John. Absolutely. The first responders were definitely some a group of folks that we focused in on and offered the baseline testing for. By the time we started reaching out to the first responders, we had access to a new technology, which is now eye tracking. And we still use impact testing, but to that we added a test called Cambridge Brain Science. The impact test is rigorous. So if he gave the impact test to a 50, 60 year old [00:09:00] patient that it's a little too rigorous for them to pull through. So we actually found another technology that worked better for adults called Cambridge Brain Science.

And then we started picking up some technologies, the one that we really picked up, we like for athletes now. Is an infrared eye scanner and it allows us to do an infrared scan in 10 seconds. On a young athlete if you can imagine trying to do a 30 minute computer based test, which is what impact is, if you can imagine doing that on, five, 600 athletes in a large high school that would be a major endeavor because you have to pull 'em aside 30 at a time out of practice or outta classroom to put 'em in a computer lab.

A neurocog test like impact or Cambridge Brain Science. We realized once this technology of infrared came out, we could literally have a line of students 10 seconds each to run their eyeballs around it. The tracking, see how their eyes are tracking with their when they're healthy baseline, and then we can follow the tracking.

After a potential injury, we realized we could funnel through. A hundred kids in an hour and allowed us to really do baselines quicker [00:10:00] and allowed us to share that information with the parents confidentially on a, on an encrypted link. Parents could then access that data and. Keep that data of their I their child's eye tracking for whether they were injured or not Later.

Share that with their primary care doctor with their specialists or  pediatrician

John Boruk:. So can anybody come to the Mac Alliance? Whether it's a, it's, it could be a club sport lacrosse club, sport a football middle school football team. Can anybody utilize your practices and your science and your technologies?

Dr. Vincent Schaller: Absolutely. That we have it set up so that they can come to Mac or they can come to our affiliates who had the technology to be able to do that ten second screen. And the reason why we're excited about it is because we've been providing baseline concussion testing to 24 private schools in Delaware, along with the Catholic schools in Delaware.

And we've been providing those impact baseline tests now for probably over a decade. And the biggest challenge we had using the impact [00:11:00] program. For about 10 years was that it was costly. You have to actually pay for each school cause impact doesn't let you share it amongst schools. And then you had to actually then make sure that each school had an IT person to open up the computer lab, this, the school nurse, to provide the data, the IT to provide the names of the athletes.

And so it took a lot of energy time to be able to baseline test all the students. But we did it for about a decade through all those 24 schools. Then what ended up happening was when we saw the infrared technology, We said, Hey, this is gonna be a lot easier to get this cooperation of the students, the teachers, and this nurses.

So we actually then went into the schools with one of our baseline coordinators, and we sent our baseline coordinator out to those 24 schools. Now he goes in and out in a half a day. Test all the athletes in that school. And the programs become so much more streamlined and quicker, and now it's easy for the student to do is if they do get injured, they know exactly where the, and for technologies available, and be able to go out and get them, get the retest to see how it compares to their baseline.

[00:12:00] Again, 10 seconds. And this is something that if a school really had the interest, they could put, it's a portable carry case. It was designed for the for military, but you can actually literally have this thing set up in a tent at a school, potentially 10 seconds, know whether you need to pull the athlete or not, or keep it, off in the locker room.

So it allows it to be portable in the field. If you know a school's that interested, if not though the cost, is something where they can just come in and get the post injury done, see if they have a concussion or not. If they do, then the diagnosis is made and they can be instructed how to move on to the proper care and treatment.

John Boruk: It's good. I think the awareness behind concussion treatment and the long term symptoms in the long term aftermath of repeated brain injury is now finally coming to the forefront. Maybe it's because we're seeing some of these NFL players from the seventies and eighties and what has happened to them because [00:13:00] all of, the testing and the technology and the advances weren't even there.

And it, it's almost sad because your brain is the one thing that you can't put staples in you, you can't, wrap it and put a cast on it and it's gonna repair itself. 

Dr. Vincent Schaller: That is so true. That is so true, John. Absolutely. And yet it, it seems like we've been lagging in this area of brain study and brain medicine and neurology as it pertains to athleticism and athletic events that we're finally starting to catch up.

We're finally to get to that point where guess what, Finally, time to start taking this seriously. It's finally. For athletic apparel makers out there to come up with an innovative helmet for football, lacrosse, whatever the sport may be. That now there that all of these things that have surfaced and come to the forefront, money's now going into that [00:14:00] where, for as long as I remember me playing sports, it wasn't really there.

We shared helmet. It's year after year in high school. Oh, he, Jimmy had that helmet last year. 

The first thing that fascinated me when I started getting involved learning about the technology was what, there were actually certain sports where the athletes did not have helmets.

For example the comparison of male lacrosse, female lacrosse, and the female lacrosse players had goggles, no helmet. And the male lacrosse players had helmets. And I was like, Don't they realize that women have a much higher rate of concussions than men do in the exact same type.

And you can look at soccer. When you look at soccer and the statistics. Female soccer athletes have, I, I think it's almost three times the number of concussion risk that a male athlete has, and that's soccer. So there is no helmet in soccer. But then when you transfer that over to lacrosse, why would you leave a female athlete playing lacrosse without a helmet?

And in the old days, the old school was they're not gonna hit as hard. They're not [00:15:00] gonna clobber each other like the guys do, so they don't need helmets. But that's nonsense because truly when it comes down to, and sports have risen into a very high skill level.

If you look at all the sports, whether you're training, working out, speed training whether you're a woman or a man playing a sport, if there's a helmet required for that sport both men and women should have the helmet. So I'm starting to see some clubs actually start initiating helmets in women's lacrosse, but that almost needs to be like across the board and in, in our lacrosse sport in the us. 

John Boruk: I came across on your website, concussion rates by sport.

I was shocked. Obviously number one's boy's football, that would seem obvious. , and boy's eyes. Hockey is number three. But you mentioned girl soccer. . Why? Why is there such a prevalent to concussion? And girls 

Dr. Vincent Schaller: soccer. The thing is, it's really fascinating is there's a kind of an anatomy explanation for men versus women athletes, and you'll see a lot of [00:16:00] research studies at the university saying, we should be paying attention to female concussions as much as male because they actually, in certain sports, there, there ends up being a higher frequency and that the analogy's interesting, and my wife likes the one explanation.

So the one explanation is that the male brain tends to have more fluid. Less gray matter and the female brain has less fluid, more gray matter. Now, there is an evolutionary point to this, not to be sexist, but the evolutionary point is that the guys that, you go back, into our, gather and hunter stage.

A guy who'd be a hunter back in, early times if he fell off a rocket, hit his head while hunting, if he had more fluid around his brain, he'd survive. If he had less fluid around his brain, he wouldn't survive so well. So it's almost the x y chromosome evolved over time where the guys have more fluid, less gray matter.

Now my wife loves that cuz she goes, that makes a lot of sense that men have less gray matter than women do. But when it comes to concussions, there's less fluid cushion. So for a [00:17:00] female brain, it literally can, with acceleration, the same force a male brain would experience would actually experience more bruising and more injury to the brain.

The second part, which is a little bit more obvious, is the structure of the male and female neck. And again, this is a generalization, this is not, every female neck, smaller than every male that, but notoriously just cuz of the presence, biologically of testosterone. And the male body, male muscles are larger.

That's the reason why. It's I always, when I lecture, playing sports the reason why there's separate male sports and female sports is men have an unfair advantage, especially af after puberty. They have a heck of a lot more testosterone than women have, and that helps make muscles quicker.

That's the whole reason why you'll see steroids being abused, to make the muscles grow stronger in an athlete. It's almost a anatomically, genetically unfair advantage men have over. And so that's actually the male neck has more thicker muscles than the female neck. It's pretty obvious if you line up, a hundred guys and a hundred ladies, and actually then their [00:18:00] support isn't there.

The shock absorber is not there. When the head takes a hit or goes through acceleration. Acceleration. The male brain has this heavy muscle muscular shock cushion around it where the female brain doesn't. So whether it. Less fluid around the brain, for the female brain and less, not as bulky muscles around the neck.

There is definitely a disparity in concussions of men versus women in, in similar sports. 

John Boruk: Yeah. It, but if you go down the list too, of all the activities that, that you can do at the high school level of football, hockey, So you even have cheerleading. You see these types of injuries, cheerleading?

Dr. Vincent Schaller: Absolutely. Ever since the first day I started doing the concussion centers with Mac. There wasn't, probably, wasn't a month or two, didn't pass, and a first cheerleader came in. And ever since then cheerleaders and gymnastics we have had plenty of gymnasts, female gymnasts, plenty of female cheerleaders.

And when a cheerleader comes in, I, first question is, are you a base or are you a flyer? Because cheerleading [00:19:00] isn't just, pompoms and you. Choreography. Cheerleading is literally stunts and gymnastics. And it's when I usually say, Are you a flyer? Are you a base? They smile and look at me and say, I'm a flyer.

And I'm like, Okay, what happened? And it's usually for the flyer, it's because they're making a pyramid or they're being held up by their peer and someone loses balance or something and they come crashing down. If it's a base, it's usually they're at the bottom of the pyramid and things come crashing down.

And bodies land on bodies and usually their head takes a kick or takes a head to head hit. So yeah, we've had some really impressive injuries and concussions with cheerleader. And these are not concussions that they're back in the week. I've treated cheerleaders that sometimes it's weeks or even months until they fully recover and that affects them, returning back to their sport and they're fully treatable.

The, I think the, what I'd really like the public to know and, the technology there, it's great. We want use that technology, the treatment plans and protocols through really well developed and we can. See [00:20:00] how severe the concussion is, followed every step of the way. And there's a clear progress that can be marked, until they're fully recovered.

And really is what's important is that people know what good concussion care looks like and know how to access the technologies and the treatment protocols that are out there. We, the first time I went to Pittsburgh, I said, when I sat down and watched them do the bombs exam and I watched them look at the impact tests, I said, Oh my God, you can measure.

You can actually measure the injury to the brain and how it's affecting the function of the brain. And Dr. Collins looked at me with a smirk and looked back and said, “Yeah, we can, now we can measure it.” And that's something unheard of from through my medical school and residency. It wasn't, you could measure anything.

What the public means to know is that concussions and especially the multiple small hits, we talk about the in certain sports. It does not show up on a, on an mri, it does not show up on a CAT scan. And the best way to explain that, so everyone kind of wrap their brain around it and pun intended, is that [00:21:00] the MRI is actually no different than being in a gross anatomy lab.

Like when I was back in medical school and slicing the brain and looking at, so the CAT scan and MRIs you take the brain like a loaf for bread and you slice it, you look for defects. And just by looking at it with the naked, oh, you can't see anything. And that's what the MRI and CAT scan. This is a microscopic change to the brain, especially multiple sub-concussive hits.

You're literally shaking the. and the fibers of the brain are being sheared and forces on the brain. When you shear fibers in the brain, you can't see that on an MRI or CAT scan, just like you couldn't see If you cut the brain like a loaf for bread in the lab, in the gross anatomy lab and look at, you can't see it.

And so back in if you look back when they first started discovering cte, it was Mike Webster Center for the Pittsburgh Steelers. , It was his team doctor Dr. Ba. Mike Webster's brain. 20, 30 times looking for some changes and he kept scratching and said, saying, I can't figure it out.

[00:22:00] This guy's deteriorating in front of my eyes and his exam, gross motor exam, neuro exam's normal. His MRIs are negative. What am I missing? And what he was missing was on a microscopic scale. So it was only when Dr. Alou actually said, Wait a minute, there's something going on with, this is a young guy, shouldn't be, having all these neurological deficits and problems.

And he actually then did not only looked at it under micro. Actually then stained it and found that there was areas where the nerve fibers. Where the body put down scar tissue to try to repair those broken nerve fibers, and that's what led to the discovery of chronic traumatic encephalopathy and the scar tissue is taro.

He were able to actually stain taro again, invisible to MRIs, invisible to CAT scans, so when an actual athlete gets injured, throwing up on the field. It's taken to the ambulance, to the emergency room, brush, the emergency room, the CAT scan's done. They get anti nausea medicines, they get fluids and all, but he's that athlete.

He or she's throwing up because the brain's bruised and it's bruised in the way that's creating headaches, [00:23:00] nausea, dizziness CAT scan's negative. So the up until, more recently CAT scan's negative. Go home, You're fine. Just rest it off. Go see your primary care doctor on, on, on Monday. Just don't, lay low over the weekend.

That was the original plan. But the CAT scan only tells the ER doctors is there a bleed or not. Is there a fracture or not? Okay? Even if an MRI was done in the ER, it can only tell bleeder fracture. An MRI can tell you we have MS incident coincidentally of. So their job in the ER though, and it's all in all fairness to my ER friends and my brother is an ER doctor.

So in all fairness to him, their job to make sure you're not bleeding, you don't need to call a neurosurgeon, you don't need to rush in and do some sort of procedure to drain the blood. But when it comes to concussions, it's invisible to the ER staff. It's invisible to their imaging. And so unfortunately for years, people leave the ER going, My CAT scan's negative.

Maybe their PCP orders an MRI the next week. It's negative. I'm good. But the reality is that none of those technologies can actually see if the brain's been injured, if the brain is actually [00:24:00] struggling and not functioning well. The big problem, some really amazing research has come out in the last year.

They've actually taken all the concussions that were not properly. Evaluated and treated that went back to the sport before the concussion was cleared. They have a four time increased injury of the lower extremities, and the reason is because when you send someone back in without measuring their balances off their eye, trackings off, you put 'em back in the field.

They can't anticipate the opponent, the ball, whatever they're doing in that sport. They can't anticipate the speed coming at them. And so they literally end. Twisting their ankles running in other athletes. So there's a four time increased risk of knee injuries, ankle and leg injuries if you don't treat the concussion.

So it's not just the concern with another concussion on top of the first concussion and now they're out for the season. But it's also if you don't treat the concussion, they athletes vulnerable even for soft tissue injuries in the lower extremities, which would be. You have sprained ankles torn MCLs, torn acls, they're at a higher risk because their ability to [00:25:00] anticipate and perceive what's going on in the active field has been altered because of the concussion.

Cause the brain's aren't perceiving well and the motor skills are not on. 

John Boruk: And that's part of, the second impact syndrome?

 Dr. Vincent Schaller: That's correct. 

John Boruk: But that, that you guys also treat and is, which is really, it's it. The compounding, once you sustain that first concussion, if not treated correctly, and if not given enough time off and it, if symptoms are still lingering, that, and that's where I think that we've seen that professional athletes, so that is something that is probably.

Significant with what you guys do. 

Dr. Vincent Schaller: Absolutely. We’re fortunate, John, that the frequency is of second impact syndrome is low enough that it stays pretty much below the radar? It occurs about I think the CDC comes up with about 20 to 30 cases per year. and second impact syndrome is a, an unusual phenomenon, but unfortunately dangerous and deadly in that when the brain takes a [00:26:00] few hits and no one sees it as a concussion maybe the athlete just kinda’ shakes it off, that there's already a inflammatory process starting.

And so this could happen during practice. The day before the game. And the problem is that if no one recognizes it, the athlete doesn't recognize it. They weren't knocked out, they weren't clobbered in the head, They weren't vomiting, they weren't having the classic symptoms of a severe concussion.

Then the next day they could go back in the game, take one good hit, and then the cascade of inflammation. That inflammatory reaction cascade goes warp speed and unfortunately the brain suddenly swells. Now that you actually can see on a CAT scan when you have a second impact syndrome rushed into the.

They usually will present. The cases that I've been tracking and following and seeing in the research. The usual thing is that you have we'll there's a very well known case and published in the Inquire, I think it was 2018, and it was a young man named Nick Bond, and it's very public, so it's well known in [00:27:00] the the media.

Nick Bond was a young man who was from Springfield High. And he would, he played football, he played lacrosse, he played ice hockey. Very talented athlete. He was in his senior year and he was playing for the Wissahickon group on a private ice hockey league. And they had a long tournament on a weekend.

He's at the tournament. Nick's planned is hard out. His dad's the coach. And Nick Bond played the whole weekend and must have sustained certain hits that nobody was really aware of. And then Sunday after the tournament's over from the way the the story describes from the ER and from the media was that, he's packed his bags.

Him and dad are walking out in the parking lot and literally just, he says, Dad, don't feel good, and he just collapses. And you hear all these stories of second impact syndrome where an athlete walks up to the coach and goes, Coach, I don't feel really good. And they suddenly just pass out and hit the ground.

And what's happening at that moment in time is the brain is going through that chain reaction of a fast [00:28:00] swell. And when the brain swells, unfortunately the pressure builds you go unconscious. If the swelling continues as concerning as it sounds, the brain actually then pushes, It’s the brain stem down through the hole in the skull called the Formin Magnum, and that's called a herniation.

And the problem is when you take the brain and you swell it, and you push the brain stem down through the, it literally stops breathing, stops the heart. It literally is, it's a fatal outcome. In Nick's case, the ambulance was. 9-1-1 was alerted he was taken to Einstein Hospital. They recognized when a CAT scan, the brain was swelling, and they did do the procedure for second impact syndrome.

You remove half the skull and you hope that the, probably removing half of the skull. That the brain actually can blossom out and not swell and push the brain stem down. In his case Poor Neck was I think Brain Dead was by the next day or the two days later. And he passed away. We've seen second Impact Syndrome where they do remove half the skull [00:29:00] and they actually the patient survives.

Zachary Liad a case up in Washington. Caused the Zachary Liad law, which was that any concussion must be cleared by a medical professional before they get back. Not just, mom or dad saying, Hey, you have a headache. Get back in. Or the coach saying, Hey, you have a headache, get back in. And Zach Liad situation, he was in a coma for nine months, but he didn't die and he survived.

Enough so they could put the skull piece back on when he recovered. But it took years for recovery for him to be able to start walking again. And Zach is verbal but his cognition is severely challenged by the injury to his brain. So he's a case of a survivor, but a very debilitated young man.

That's much so the laws were made in Washington State and his name Nick Bond, unfortunately, is one of the second impact syndromes that did not. And they weren't able to get quick enough to remove the surgical procedure in order to protect his brain and allow him to survive that episode.

John Boruk: Yeah. So you wanna bring [00:30:00] awareness to really any school that has any type of physical activity. And you were three years into the Mac Alliance and that you're not only just seeing concussions with athletes, but also any everyday students that were participating in gym class, right?

Dr. Vincent Schaller: Any type of activity? Absolutely. So when we did the baseline testing for the private and Catholic schools in Delaware, we said this is how it's gonna go down. We're not just taking athletes that are participating in sports. We're gonna do every sixth grader and we're gonna do every ninth grader.

In all the schools every year. So what happens is when they become seventh graders, they've already been baseline tested. Eighth grade, once they get to high school, if they're still playing sports, they get ninth grade. That covers all the gym injuries falling down the stairs. We even had a a brother and sister that were screened and they were in a car accident, and so then they came into our center knowing they had been baseline tested for impact in school.

They were in the backseat of. That got rear ended and both sustained significant concussions. But because we had the baseline from school, we were [00:31:00] able to quickly make the comparison and immediately identify a concussion was present and start the treatment program. 

John Boruk: But what type of instruction do you give to, let's say an elementary school that may just have a school nurse and certainly isn't, doesn't have the awareness, the training, or the education in treating or even recognizing concussions?

What do you say? I'm, Because you have a kid. . Ha. You know that goes through and has a concussion. He'll probably tell a nurse or his mom later that night, He's My head doesn't feel good. And that's probably gonna be the extent of. So Correct. What did they do? What did they do to ensure that this is going to follow the proper protocols?

Dr. Vincent Schaller: Excellent question, John. So what we tried to do is for the last 10th years, going on 11 years, we have been educating school nurses. Parents, coaches, athletes themselves to try to raise the awareness of what it feels like if you have [00:32:00] a concussion and what it looks like if somebody else has a concussion.

So it's really a team sport when it comes to identifying a concussion. So we've had lectures, though, it's with school nurses where we not only explain to them when over the, and there's really some really good. CDC information available online that we share and share the link with our students and our parents and the school nurses.

And it's called A Heads Up. The Heads Up handout that the CDC gives out. Really great one page read, quick read, but talks about, if your students more agitated, if your child's more agitated look for if they're sleeping more look for if they're not eating nauseous look for if their grades are dropping in school.

So it gives a really good list of things to look out for concussion. But it's exactly right if we don't identify it. And if the student themselves says, Hey I heard that. If you get nauseated or if you're, you're having bad headaches or if you're dizzy, it could be a concussion.

So when they learned and were educated that then they can go to their parents and say, Hey, I'm having these symptoms. I think I'm a, I got clock pretty good [00:33:00] at the game on or at the practice, this week. But it's really all about education. But the key is educate the referees. Educate the coaches, educate the trainers.

The trainers have a lot of good education coming from their college training and all, but educate the doctors in the community. You know what good concussion care looks like. And even if the doctor doesn't provide that concussion care, they know what it looks like.

They know to refer their patient off to the proper center. And it's not a matter of trying to bypass how primary care has been doing concussion care, All these. But to allow the primary care doctors to know that the technology's there, they can use the technology or they can make sure they refer their patient to a location in the area that has that technology to be able to make the diagnosis, get the therapy started and get rolling with.

And when you do concussion care properly you, you get all the evaluation front. You see how the eyes are tracking on the first. You do a cognitive test on the first visits, see where they're starting with their ability for memory and processing. You even do a [00:34:00] balancing test on the first visit to make sure their balance hasn't been thrown off, and then every visit they follow, they're literally gonna have a test done.

Repeat it again. Recheck the balance. And the most rewarding thing treating concussions is actually watching somebody whose memory scores were like 5% and 10% on the first visit. And three weeks later, after some good vestibular therapy, Oh, they're cruising. Like 80, 90. And you say to the student, Wow, you were like five and 10% on the first visit.

What kind of student are you in school? And they'll be like, I'm straight A's. And then when they're all recovered, you're up to 95, 90 9% and you can really pick it up. The other thing on some of the processing speeds, specifically on the impact program, when you repeat the impact each visit on a student, you actually will watch these two scores called Visual motor Speed and Reaction Time.

They're the processing speeds. And when they fully recover, when you see processing speeds that are like on full recovery, 99%. What's fascinating is that they tend to be that, those gifted athletes that have that it factor. And I'll look at these scores really high in full [00:35:00] recovery and I'll say, What sport do you play?

And then they tell me, I say, What? And oftentimes it's a skilled position, like a striker or a goalie ice hockey. It's like you could tell the almost a position by the reflexes are so sharp, so strong, so beautifully wire. That they're, when I actually follow in the recovery, I look at them and I go, Wow.

I said, ymust be really good at your sport. And they smile and nod their head. I once had an adult who had these scores that were like 99 and a hundred at the full recovery, and he was in a, he was rear-ended by a FedEx truck. And I'm looking at these scores and I'm looking at the patient and he's a very thin guy.

He's an IT program. And I said, Play any sports? And he said, No, never did. And I said, Darn, you got really high scores on your reaction time and on your visual motor speed. And I looked at him and I said. Do you do any gaming? And he went, looked at me and he went, Yeah. And I said, Do you like beat everybody in gaming?

He goes, Yeah, no one wants to play with me cause I'm so good at it. They're, his reflexes and his world were in were [00:36:00] shown in gaming and being able to have that quick, rapid response. But it was funny that I worked my way around looking at the final result. And I can almost tell this person has that wiring of, in his case, gaming.

But you'll see in the athletes, it's like when you'll get these high scores. 

John Boruk: It's almost like genetic testing for the brain. You can determine what might, may I be good at, surely. How is my brain, quote unquote wired for. Absolutely. That's, it's, that's amazing. So let's get into the use side of things because you And I'm sure parents or administrators would probably ask you, So what should be the age standard?

I think I, I read 67% of concussions happen with a blow against another opponent. Am I correct when playing? Or is it contact with the ground? 

Dr. Vincent Schaller: It can be any sort of acceleration. Acceleration force. So for example we've had fa, we've had patients. Believe it or not, have had concussions in tennis. [00:37:00] 

And it wasn't the ball hitting their head, it was literally just falling to the ground, trying to make that play. We've had even volleyball's the same situation. It could be a hit to the head on a volleyball when they're going after the ball, or it could just be falling down on the ground trying to get it.

But the key here is that, and I think the trickiest part to, to educate everyone about is you do not have to hit your head. Okay? So when you see an athlete with an. And they don't have a concussion. They don't have a cut. I don't see any blood. They don't have any swelling. They're not reaching further.

Their ear got hit the ground or hit head to head on another athlete. You do not have to have any injury to the head itself. All you need is the body. It's the body to go through an acceleration injury. And then all of a sudden when the brain stops, whether it's the ground, the air, whatever it's doing, when the skull stops and brain.

It's really to think about. It's all about momentum. So the biggest concussions that are missed are just somebody who a week later says, I have these horrible head. Do you remember hitting your head? No. We do [00:38:00] the violence exam. It's grossly abnormal. We do the cognitive testing, it's grossly abnormal. And then we have to really think about what did they, what happened to them in the last week.

But if you think about it, whether it's a car accident with the brain moving fast, 50, 60 miles an hour, whether it's an athlete running down the field, okay. At, 15, 20 miles an hour, and there's a sudden stoppage. So picture two athletes once tackled again, football, okay? The helmet's protecting that brain, right?

But it's not stopping the momentum. The momentum force. The shift and force. So this, you gotta, that's why the kickoffs, you see some of the worst concussions in kickoffs because you got these guys running down the field. A hundred yards full top speed cuz they want to level that guy that gets the ball or hit him hard enough.

The ball's fumble and even better, they, they might get a make a score out of it, but you have this person running top speed after one person get standing, still getting the ball, even if they tackle them properly. Even if their head doesn't hit the ground, it's that shearing sudden force. Their brain goes from being in the inside that helmet.

The skull’s brain goes from being zero [00:39:00] miles per hour to pop the sudden hip. And so even if their head doesn't slam the ground or don't have a helmet to helmet, that truly could end up being a concussive episode. And the trainer and the coach would be looking, it looks like a clean hit, wasn't a helmet to helmet hit, but even in just that force, that sheer force that, that, that allows it, The obvious ones are head to head soccer.

Okay. Two soccer players go up for a ball, and whether their head hits the ball or their heads hit each other trying to get the ball, that's a, an obvious big one. You wanna double check those athletes, make sure they're okay. And football, it's clearly, obviously it's the helmet to. Or you pound the guy into the ground and helmet goes down into the ground.

But even just like I said, a kickoff and the running clean hit, that could be a concussion just because, purely cuz of the force in car accidents, you don't have to hit your head on the steering wheel. Okay? The airbags go out beautifully, but you were just sitting at a stoplight and rear-ended by a, a truck going 50 miles an hour.

And you know that is gonna cause a concussion even if there's not a single. Brewers are cut on your head. It's the acceleration, [00:40:00] deceleration force. So the biggest challenge is detecting a concussion when there's not a clear head to head hit. Detecting a concussion when there's not a clear head to, to, we'll call the court and basketball, you don't see the head hit the court in basketball.

That can't be a concussion. But the reality is if two athletes are going after the ball and they're coming from the other sides of the court and body hits body, no head hits head, it still could turn out to be a concussion. 

John Boruk: Yeah I'm sure parents and coaches, administrators are asking you your recommendations for when, let's just say tackling in Pop Warner football.

When should that, how long should we hold off on something like that and some of these other sports, How long should we hold off? Because. The brain is in the developmental stage until, I think, until your early twenties, correct? 

 So if somebody was asking your recommendation. What would you tell 'em? Should, they should little kids out there, third graders be practicing their tackling form [00:41:00] at such a young age. 

Dr. Vincent Schaller: Another excellent question. The reality is this, that for orthopedic purpose injury to growth plates, injury to, on a contact basis, you're looking at the bones aren't fully.

The growth plates aren't f change over from cartilage to bone until puberty and puberty can be at a different age for, for men and women. But the reality is that for orthopedic reasons, you shouldn't be tackling the brain outta the picture. Concussions outta the picture. You probably shouldn't be doing tackling at all until12 to 14 and that window, 12 to 14. When the growth plates are fully grown technically you could have a contact injury, football, soccer, lacrosse in a, less than 14 year old. It's where there's still cartilage and you could actually damage the growth plate.

You could actually change the length of a leg or an arm or something like that. And you can actually end up having a fracture of a growth plate, which could have long term repercussions. So if you just look. [00:42:00] Orthopedics 12 to fourteens that window where you wanna say, let's hold off on heading.

Let's hold off on colliding. It's a hard thing to. Private leagues and school leagues. And college leagues to follow because that's, you know what we naturally thought of when I was a kid growing up, you wanted to be wrestling at a young age, soccer at a young age, football at a young age. So that way when you got to high school, you had all the skill sets.

Okay. So that's where. Where I grew up. So to now be a concussion doctor saying, Okay, for orthopedic reasons and oh yes, for concussion reasons, we shouldn't be heading until 14, until puberty 14, 12 to 14. We shouldn't be, colliding and tackling checking in hockey. 

John Boruk: That's what they have pushed. You're talking about skating at a high speed and then your impact is suddenly stopped because you're now hitting an opponent. Absolutely. 

Dr. Vincent Schaller: Absolutely. And hockey's a great one where there's a good hit. You, I love watching hockey and follow, hockey [00:43:00] myself, love watching a game.

And I hate to say it was a concussion, doctor. When I see a good hit, I'm like, Normally, before I became specialize in concussions, a good hit, I'm like, Yes, this is great. And, or a fight even. You're thinking, and now I'm a concussion specialist. I'm like, wait a minute, okay, they're gonna fight.

Someone's gonna win by causing a concussion than the other person. And I. Maybe that's not such a good idea. . Yeah. But the sports guy me is like, Oh, this is great. This is gonna change the momentum of the game and we're gonna see how this game goes. But in no reality ice hockey is high speed on skates.

It really is. And you don't have to see the helmets clash on the athletes. You just have to see two bodies hit and that's an acceleration. It almost seems and I know this would be really hard at private leagues and rec leagues, but it almost seems like when we get to the point where we have high schools and colleges and all that, there should be a spotter.

And I think, it. Maybe as a professional, a parent or someone in the community that has a medical background that [00:44:00] just spots and just, it doesn't have to be the team doctor who's running out to take care of the injured ankle and the trainer that runs out for the shoulder and when they run out in the field to check on an athlete.

But almost like a spotter has a medical background, be a nurse, or a doctor, nurse practitioner, a PA that can literally just keep an eye on and just. That collision looked like it could be a concussion. Yeah. And the NHL 

John Boruk: And pulled 'em aside, and the NHL did that where they had those spotters and they would essentially tell you, you've gotta remove this person from, the surroundings.

 Not just take 'em off the ice it's surroundings and put 'em in an area where there's no lights and there's no sound. Is that really the first step when you think that somebody has sustained a significant brain? 

Dr. Vincent Schaller: I think because be it's actually smoother than that.

So if you can actually detect a suspected concussion out in the ice, two athletes clo each other, but they get back up, they shake it off, they keep playing, and the spotters has pull them off. [00:45:00] You do not have to knock 'em outta the game. You pull them off. And we have the technology like the ten second infrared eye track, and you can pull 'em off the ice, take 'em back to the locker room for five minutes.

Do the eye tracking thing and if it's abnormal statistically abnormal for their age group, then you know they're done for the game. They're done for the day, comes back completely normal. You do a quick bombs exam on top of the infrared eyes are tracking beautifully, no wiggling to the eyes on tracking back on the ice.

And so you literally could we have the technology to say it looked like a horrible hit, but hey, this. This guy's. Okay, This lady's okay. Send. I'm back onto the ice. So it just, being pulled doesn't mean you're done for the day. Now when you get pulled and the data's abnormal, you're done for the day. Yeah.

And then you have to report to the doctor who's gonna care for the concussion, the trainer who's gonna get you through the vestibular therapy and all. How much does this 

John Boruk: Technology. What would cost a school to have the proper technology that you're talking about, the infrared technology, where you can make that determination in 10 seconds.

Is this something that. That a school board would look at saying, There's no way we can afford this. Because if you're talking about [00:46:00] preserving the lives and the integrity of your administration, your athletic conference, whatever the case may be. , isn't this 

Dr. Vincent Schaller: worth it? ? The technology ranges from it, it ranges between 5,000 and 10,000 for a device.

Okay. So it, it does have a cost to it and that might be prohibitive to a certain program or budget. But the nice thing with the technology is that it can be administered by anybody. So that's the best part. So if the school could invest $5,000 in Fred device and it could be administered by anybody and that's another trainer can keep staying on the field, taking care of the other athletes, literally a Just an administrator or an assistant coach could take 'em back, run it, and then what happens, the way we have it set up at Mac Alliance is that gets automatically read.

It goes into a queue and it's read by a medical provider on call who then reaches back to the family or to the coach and says this is an abnormality. We need to keep them out and get them to see a doctor. So it's a kind of thing where we've actually not only [00:47:00] taken the in for technology into the field like we did with the 24 Catholic and private schools, but when those kids get.

And they go to get an infrared. And it doesn't have to be an infr at the school. If it's, the technology's not in the school just yet. They can go to one of our centers, get the infrared red. A provider's gonna read that and say, This is a confirmed concussion. Let's do this, and this. Or further diagnosis. Let's get 'em to a into the treatment plan. 

John Boruk: How many schools would you say have that technology in place right 

Dr. Vincent Schaller: I'm aware of about it. It's about half a dozen in this area. And I think Malvin Prep has the device and all, so there are some schools out there that have it. Okay.

We've tried to make sure that we have a device in the Mac lines downstate in Delaware and have, we have two devices in upstate that they would be able to just call those centers. Cuz when we, when they do get the information by email, they hit the encrypt, the encrypted connector, they can get to download the information, but that email says, here is the link to the local sites that your student could go.

Yeah, so most of these sites are open, at least five days a week. Some [00:48:00] of are open seven days a week. Real quickly 

John Boruk: If none of these technologies out there, let's just say you're talking about high school football and, yeah, there's athletic trainers on each side, but yet you're a parent of a child and you saw your child take a hit like that and you go, Forget it.

What’s the first steps that parent should do with that kid? 

Dr. Vincent Schaller: So the parent should reach out to a concussion specialist in their area. And that's where the education comes important. They have to make sure that concussion specialist is using the latest technologies. So make sure that the concussion specialist is also utilizing the latest treatments.

For example, the old go home and, curl in a ball in a dark room. That's not the right way to treat a concussion anymore. I knew from the gang out of Pittsburgh back in 2005 that you want them walking. Yeah, they may have sunglasses and a baseball hat on, but you want 'em walking, you want 'em outside, you want 'em moving.

So we've learned that motion and movement's very important, but what's also important is that you don't delay. You get them into a vestibular recovery program, which literally is they go to a physical [00:49:00] therapy center and I'm happy to. Almost every physical therapy center in this area is equipped with people trained how to do vestibular work.

Whether it's NovaCare at Phoenix Pivot. I've trained and worked with all of them over the last 10 years, and they'll literally bring in concussion protocol. Got it. And they start, that's the strategy and it's a stage one through five. By stage one, you're just walking on, you're actually on a elope or on a stationary bike, and you're doing all these balancing exercise on balls and all by stage five, when you're ready to get back on the field, you're running 30 minutes on the treadmill without headaches, without symptoms, your balance is still good.

So they run you through that five stage. And that's something where some schools will try, the trainer will provide that five stage, but I find that the trainers are very busy in these schools. If done anything stretched amongst all the athletes in sports, it's a lot easier for that trainer to go, Hey, listen, go over to the physical therapy place.

You know they're gonna be able to run the five stage, five stages done. Doctor examines the patient this great on their neuro cog test with impact, or CBS does good on their balance test is good on their Obama. They're back to school and they're ready. They're back [00:50:00] to sports and ready to go. 

John Boruk: Yeah. And what I find interesting in talking to you previously is that even though this is your life work, this is now your area of expertise and what you study, that if your child or somebody has undergone as has suffered through a concussion, Doesn't mean they have to quit the sport.

Correct. Doesn't mean they have to quit the sport. Just make sure you go you go through the proper steps to make, to ensure that they're fully recovered. But that's what I like. You're not all about Yep. You're done. That's, you don't, that's not the directive that you take 

Dr. Vincent Schaller: That is the last resort.

If that situation occurs, it's the last resort. You're usually looking at an athlete who has had a series of concussions that have led to severe migraines, a series of concussions that have led to they're having, problems with balance, severe concussion that's leading problems where they're academically not doing what they were doing, before.

So there's a small subset of people, I'm happy to say, in , about [00:51:00] 12 years or so doing this on a heavy duty basis. The number of athletes, I've said, Listen, you gotta change your sport or stuck outta the sport. Out of 17,000 cases, we've treated maybe a dozen tops that I've actually asked.

So we're not, it's a small subset. Very good. Yeah. And that's an important message to send out to the community. When they see a concussion, doctor's gonna see their kid all, he's gonna have him out for weeks, And don't go to him. He's gonna end up keeping him out. And they'll probably tell my kid not to play.

No. The training that I came from University of Pittsburgh Medical Center, it's sports based, sports intended. It was to keep sports safe. It was not to attack any sport and say, this sport's not safe, or this sport's not doing it well, it's, listen, you get a concussion. No matter what the rules of the sport are right now, whether it's with and without a helmet, we don't care.

You guys are gonna make your decisions and figure out. But if you get ahead. Let's diagnose it, get you into the treatment. Let's go through all five stages. Let's get you back safely. If what I have, I've actually followed athletes from, I've been doing this long enough. I've [00:52:00] followed athletes who were in middle school.

I had a concussion or two, went to high school, had a concussion or two, and I got one man that's had three concussions in college. One was actually at a frat house when he slipped on the beer and hit his head. So it doesn't have to be sports. You know 

John Boruk: what, that could be top of the list. Now that may have just overtaken voice football.

I, because I that No we all have that story to share.

Dr. Vincent Schaller: but I have that same athlete still is playing sports because what he did was the concussions. Far enough apart that he made a full recovery on each one. Him and his family were very much aware of, Hey, we think you hit your head pretty hard. Let's go get you checked out.

And he's still playing sports as of today, so it's not a matter of, you go to a concussion doctor and you're gonna be flagged to leave a sport, after the first, second, or third concussion. We can't predict who after the. Multiple concussions is gonna end up having severe migraines that they're like, this isn't worth it anymore.

Or have problems with their vision so that they can't study when you go from middle school to high school to college. The demand on your eye tracking for [00:53:00] reading is dramatically increased. So if you've got a young athlete in high school whose eyes are just struggling to read through a page, when they go to college, it's gonna be hours of reading textbooks and fine print.

So if you don't treat that concussion in high school, it's not only a matter of the safety to get back to the sport. It's a matter of if you don't treat those visual change. They're gonna struggle in college and then the academics are effective. Yeah, so we're looking at the academic recovery success and the athletic recovery success.

Both are equally as important and we're, we love to send our patients back to sports. We. Bells and whistles at Mac. Once someone's cleared, Hey, you're done. Let's get you back to the sport. We like nothing more than that. So it's really important for people to understand that concussion specialists and concussion technology is not to, not the big boogie man that's gonna take you outta your game or make you, hey, if you have a bad concussion and you miss the playoff, it's no different than if you have a torn ACL or broken ankle and you're out for the season.

The brain is that important just because it's invisible. [00:54:00] Doesn't mean it's not an important injury. And I think since it's been invisible for decades, obviously invisible, that CTE occurred in its invisibility that we just need to pay attention to it and make sure that we take as seriously a concussion.

If it's a mild concussion, it's like a sprained ankle, get 'em back in a few weeks. If it's a severe concussion though and their eyes are not tracking well and they're having bad headaches and all, that's like an ACL. They might be out for the season, so the different grades of concussion might take a patient out, but you take 'em out for the amount of time for full recovery.

You don't just, drag it out and drag the recovery out. The recovery's aggressive. They would literally go to PT three days a week, hour of a very aggressive there. And I love it because the athletes used to being conditioned. So the five stage Pittsburgh protocols awesome, because you are gonna keep them conditioned.

So when they hit the fifth step, which could be in two weeks, four weeks, whatever, they're ready to hit the field. They, there's they're cardiovascular conditioned, and they even involve weightlifting and conditioning. We get to stage four and five. So [00:55:00] it really is geared around keeping that athlete fully conditioned so when they do return back to the sport, they don't look like, Wow, you really fell apart.

I think, And you lost all that hard work you lost with the conditioning preseason. Yeah. 

John Boruk: The bottom line though, is when you've seen. Some of these NFL players that have now suffering from ALS, Lou Gehrig's disease the bottom line is, The preservation for quality life.

Absolutely. That's really what comes out to, We could absolutely sit here and talk about this for another hour. We're gonna get you back on because this is something that I think you're gonna see the technology and it's just gonna continue to improve and how we track concussions, how we treat concussions.

And it's, it is something that, that starts at the moment that your. Starts to get active and it's out there and starts playing sports. Dr. Shaler, thank you so much. My pleasure. This has been good. My pleasure. Very informative. We in the show like we always do, we give you our inspirational quote of the show [00:56:00] this week.

Most people don't wanna be part of the process. They just want to be part of the outcome. But the process is where you figure. Who's worth being part of the outcome. All right. Thanks for joining us on Raising a Champion.