As the NFL Turns...

Interesting that a new study on retired NFL players with a history of 3+ concussions, conducted independent of the NFL, found different results than the NFL found in their studies.

Guskiewicz and colleagues found that

retired NFL players who had at least three concussions during their careers had triple the risk of clinical depression as those who had no concussions... Those who recalled one or two concussions were 1 1/2 times more likely to be diagnosed with depression

On the other hand, the NFL found that concussed players returning to play in the same game showed :

Fewer initial signs and symptoms than those removed from play. Return to play does not involve a significant risk of a second injury either in the same game or during the season. The current decision-making of NFL team physicians seems appropriate for return to the game after a concussion, when the player has become asymptomatic and does not have memory or cognitive problems.

...but for players sustaining concussions requiring more than 1-week removal from the game:

only 1.6% involved a prolonged postconcussion syndrome. They recovered from symptoms and had a consistent return to play in the NFL.

It doesn't take a neuropsychologist to realize that something is wrong here....

On the right track

Hopefully, the NFL will get it right with their new concussion management rules:

Neuropsychological baseline testing will be required for all NFL players beginning this season, using a standardized test to establish an individual functional baseline. Neuropsychological testing is one tool a physician can use to assist in the management of MTBI. It cannot be used by itself to make clinical decisions. For players removed from games due to concussions, repeat testing will be done during the season to track recovery and to help decide when they can return to play. These players also will be re-tested against their baseline performance the following season at training camp.

Maybe they can follow the guidelines of Australian Rugby:

..."He has a concussion that is being monitored and will return to training dependent on when his headaches go away. You have to wait until your headaches go away, you have got normal concentration and your appetite returns and all of those symptoms go away."

New worry for parents?

It seems that "helmet boxing" has become a popular backyard sport (see YouTube), but it is anything but "safe" simply because helmets are in use:

To play, each individual dons a helmet with a face mask, along with a pair of gloves, and then each hits each other in the head until someone passes out, a helmet gets knocked off, or someone simply throws in the towel.

The linked article points out that while the American Academy of Pediatrics has no "official stance" on helmet boxing, they do

consider it to be on the "same playing field as regular boxing," which has been deemed unsafe for "young children with developing brains."

Concussions during childhood are now being recognized as mor ethan one-time benign incidents, as seen by this blogger's recent post:

...because it’s not yet known how such head injuries will manifest themselves in today’s athletes 15 to 20 years from now.

Every now and then...

we get some good press on concussion. A recent article in the Baltimore Sun talks about the "hidden" nature of concussion, and how not enough information is know where it is needed most:

"When someone gets injured and goes to a pediatrician or the emergency room, the information they get is wildly variable and the symptoms may not be recognized as a concussion."

As for why concussions go unreported:

"It goes back to [the fact] we don't have a certified athletic trainer in every school, at every game and practice. It's fallen into the hands of the coach, and it's not their expertise."

Global Retrograde Amnesia

Here is a strange case of a high school girl who fell and hit her head playing soccer in a non-contact situation. After what sounds more like a moderate-to-severe TBI, neuroimaging was negative but she experienced complete retrograde amnesia for all information prior to her injury.

She returned to school and soccer, with headaches and some academic difficulties, but is going on a 4-year college soccer sholarship next year that she earned "before coaches knew about her accident."

Who is making the decisions here?

A high school lacrosse player is ok'd to return to play 3 days after sustaining a concussion, and just 10 minutes before the game. After playing, he says:

"I didn't feel it during the game but now I'm starting to feel it..."

The player said he wasn't concerned about the concussion during the game.

"You can't put that stuff into your head before a game, I was just zoning it out and just played."

Perfect... just ignore the symptoms and focus on the game. Great example for the need to educate players, coaches, and parents, especially when there are limited sports medicine personnel involved.

Excellent diagnostics

Amazing... a catcher takes a direct hit from a baseball in the forehead, is "dazed and stunned", is later suffering from headaches, and this is a repeat of a similar incident from last year in which he did suffer a concussion, yet the coach states:

"He’s hurting right now. He took quite a shot. He’s fortunate he didn’t get a concussion. He has swollen eyes and some severe headaches."

This high-school baseball coach is clearly unable to accurately identify symptoms and severity of concussion, as headache clearly means something.

Very real dangers

Youth athletes are even more vulnerable after concussion than adults, as seen in this unfortunate case of a teen rugby player who returned to play too soon after a concussion.

Getting started

Back in October 2006, ESPN aired an episode of Outside the Lines on the controversy regarding how the NFL is managing concussions in their players. Other concussion-related press included the link between Andre Waters' suicide and depression and concussion.

HBO aired a segment on the long term effects of concussion last night (May 14th) on Real Sports, and interviewed Chris Nowinski, author of Head Games.

Hopefully, there will be some positive outcome from an upcoming NFL summit on concussion headed by the new Comissioner, but only time will tell.

I've been e-mailing students from a class on TBI and Concussion since the semester ended, and thought this would be a better way to communicate updates to them and anyone else interested. Keep posted...