OA Update: Injury Prevention, Athletic Performance and Orthopedic Procedures

NFL Players Cheating on Concussion Baseline Tests?

CBS Sports and ESPN today reported that some NFL players think it's a smart idea to cheat on their baseline concussion tests. Why? Players are concerned that being sidelined by a concussion will hurt their livelihood. The reality is that by cheating on their concussion baseline test, NFL players are potentially planting the seed for long-term concussion consequences. Concussion experts point to conditions such chronic traumatic encephalopathy that is caused by repeated head trauma as cause for concern. Chronic traumatic encephalopathy is linked to depression, dementia and occasional suicide among more than a dozen deceased NFL players, according to the New York Times.

Concussion Management

Avoiding Long Term Consequences of Repeated Head Trauma

The long-term consequences of repeated head trauma are only now being fully realized. Witness the February 17, 2011 suicide of Dave Duerson, a retired Chicago Bears defensive back. Prior to his death, Duerson believed that he was suffering from chronic traumatic encephalopathy, a degenerative disease likely caused by repeated head trauma. Chronic traumatic encephalopathy is linked to depression, dementia and occasional suicide among more than a dozen deceased NFL players, according to the New York Times. Prior to shooting himself in the chest, Duerson sent family members text messages asking that his brain tissue be examined post mortem for the condition.

Former NFL players like Duerson did not benefit from the recent heightened awareness around the seriousness of concussive brain injuries. Players often complained of “having their bell rung,” but if they were not rendered unconscious, they may not have received appropriate treatment for the injury.

“One of the greatest fallacies is that a concussion only occurs after loss of consciousness,” said Dr. William Heinz, a concussion management and sports medicine specialist at OA Centers for Orthopaeidcs. “In reality loss of consciousness occurs in less than 10% of all concussions.” As a result, a significant number of concussions still go undiagnosed, resulting in the potential for longer-term problems to develop in our younger athletes.

Physical and Cognitive Rest Required to Avoid Long Term Concussion Problems

Recovering from a concussion requires both physical and cognitive rest. And while keeping a high school player off the field is one thing, asking them to rest their brains is another. Cognitive recover protocols include refraining from activities that are taxing on the brain, such as computer work, texting and driving.

“With physiological and cognitive testing, we are able to determine when an athlete can go back to school as well as return to the field,” said Dr. Heinz, a concussion expert. “If a young athlete tries to push through symptoms, that athlete risks prolonging the injury with the potential for longer term problems and second impact syndrome, a condition in which the brain swells rapidly and catastrophically after a person suffers a second concussion before effects from an earlier one have subsided.”

Concussion Management in Maine

7,207 Maine High School Athletes Received Baseline Neurocognitive Concussion Tests in 2010

When Boston Red Sox pitcher Josh Becket sustained a concussion in spring training this past winter, fans knew about it. The same could be said for Minnesota Vikings quarterback, Brett Farve, as the media reported extensively on his season-ending brain injury this past December. But what can be said of the hundreds, if not thousands, of Maine high school athletes sustaining concussions each year?

Thanks to the Maine Concussion Management Initiative (MCMI), the awareness and identification of mild traumatic brain injury among high school athletes has risen dramatically over the past two years. In fact, the 55 Maine high schools participating in MCMI’s program performed 7,207 baseline neurocognitive concussion tests on student athletes during 2010. Among those athletes, 737 athletes or 10.2% of participants were re-tested during the season after incurring a suspected concussion.

Founded in 2009, MCMI’s primary goal is to educate coaches, parents, trainers and students about concussions and to increase awareness about the seriousness of these injuries. The nonprofit organization also seeks to standardize concussion management throughout the state. Establishing neurocognitive testing in all 155 high schools in Maine is an important component of that goal.

Neurocognitive testing is an objective measure for determining both the nature and extent of an athlete’s concussion. The ImPACT neurocognitive test used by MCMI's concussion experts establishes baseline  brain function by measuring verbal and visual memory, visual motor speed, reaction time and impulse control at a time when the athlete is free of concussion. Then, if a  concussion is sustained during the season, the athlete is tested on ImPact to determine the extent of impairment and when it is safe to return to activities.

The ImPACT Clinical Report above shows the baseline concussion symptom score for an athlete on August 18, 2010. In January 2011, this same athlete experienced a head injury. She was tested on January 10, and a concussion was confirmed. A subsequent test on January 17 shows that the athlete was still experiencing concussion symptoms. After another 10 days of rest and recovery, the athlete was tested and cleared to play on January 27, 2011.

 “Prior to neurocognitive testing, concussion management was inconsistent and poorly defined,” said Dr. William Heinz, co-founder of MCMI and a sports medicine physician at OA Centers for Orthopaedics. “Neurocognitive testing of the kind supported by MCMI, coupled with gradual return to play guidelines as recommended by the Zurich Conference on Concussion Management, assure that our young athletes are fully recovered from concussions prior to resuming full academic and athletic activity.”

With a concussion diagnosis, athletes are placed on a rest and recovery protocol designed to speed their recovery based upon their individual symptoms. The cornerstone of concussion management is physical and cognitive rest until symptoms resolve and then a graded program of exertion prior to medical clearance and return to play. This always means that an athlete refrains from immediate return to an athletic contest, and it often entails missing school and refraining from computer, television and texting activity. The athlete is re-tested every 7-10 days until such time as their concussion symptom score and neurocognitive function returns to normal.