Is it my imagination, or is the NFL cleaning up its act? I watched Super Bowl XLV (or 45 for those of us using the regular numbering system) last night, keeping an eye out for the kinds of hits that have made headlines lately — and resulted in players being sidelined. I also sorta kinda kept an eye on Aaron Rodgers, whose concussions during the season caused lots of people to question whether or not he’d play.
When all was said and done, the Packers had won handily over the Steelers, and Rodgers was named MVP… which is great news if you’re looking for evidence that concussion isn’t an immediate disqualifier for the rest of the season. Or that having one or more concussions in a season makes you more susceptible to further brain trauma.
A lot of people have a lot of different perspectives. Dr. Mitchel Berger, a member the National Football League’s Head, Neck and Spine Medical Committee and chairman of the department of neurological surgery at the University of California, San Francisco School of Medicine, said of Rodgers after a season of multiple concussions:
“I think his risk is not that significant or greater than if he hadn’t had any this season,” Berger said. “Having had an event a month or six weeks ago, he’s essentially back to baseline, otherwise he wouldn’t have been cleared to play. Once we clear a player to go back, based on the guidelines, that player is clear to go and really doesn’t have any increased risk.” (Read more: http://www.foxnews.com/health/2011/02/04/concussions-affect-aaron-rodgers-super-bowl-performance/#ixzz1DH4yugP8)
Some would disagree, of course, including those who think that anyone with a concussion needs to sit out an extended period of time. Dr. Bennett Omalu is such a person. He’s got a very different take on how to handle concussions among football players.
Dr. Bennet I. Omalu, the pioneering sport-forensic pathologist who first linked brain damage to tackle football nine years ago, warns that players are dangerously mishandled still—despite official claims this season of “safer” play through rule changes and “concussion management” for the injured.
. . .
Omalu maintains that every concussed football player needs isolation from physical and mental stimulation followed by lengthy rest, further shielding—as he testified one year ago for the House Judiciary Committee. “Two weeks is insufficient time for the recovery of (cerebral) membrane and micro-skeletal injuries caused by concussions. The absence of symptoms does not mean that the brain has healed,” Omalu, chief medical examiner of San Joaquin County, Calif., told congressional members on Feb. 1, 2010.
Two experts, two completely different opinions. Who’s right? Who can tell? But Aaron Rodgers looked much better last night, than he did after he got clocked back in December.
I suppose time will tell, over the long run, if the concussions have impacted Rodgers. For now, though, the Vince Lombardi Trophy is back in Green Bay, and Rodgers is MVP. A multiply concussed MVP, which probably feels like very good news to the NFL. See? Even players who get their bell rung a bunch of times in the season can still outperform the crowd.
Hm.
Well, anyway, I kind of got sidetracked with this whole Super Bowl business. The “much better” topic I wanted to discuss was how much better — and I mean noticeably better — I’ve been in the past few months. I’ve been taking on some pretty significant challenges at work as well as at home, and I’ve been branching out into new areas of my life, meeting new people, doing new things. And enjoying myself. During halftime last night, I was on the phone with a friend who’s going into the hospital for surgery today, and they remarked at how much better I’ve been doing. Noticeably. I told them it was kind of hard for me to remember how things were before, but they echoed my sense that going back and dredging up past evidence of impairment was not the best use of time.
“Just enjoy it,” they told me. “You’ve earned it.”
And earned it, I have. It’s kind of amazing to me, but I really have made good progress. I’m clearer now, I’m more confident, more focused, more settled. I’m also a lot more stable. The emotions have either chilled out a good deal, or I’ve figured out how to manage my responses to them. I still have my moments, of course, but all in all, I’ve really managed to get my act together in some fundamental ways. There are still times when I don’t recognize myself or people around me — there are times when people who obviously know me come up to me and start talking, and I have no idea who they are. But I hang in there and interact with them as though I know them, and in a few minutes, I figure out who they are. So long as I don’t let things throw me, and I just hang in there, I can make progress — good progress.
Well, speaking of progress, it’s time to get on with my day.
This is better. Much, much better.
Broken Brain - Brilliant Mind 
Just in
PHILADELPHIA – A simple test performed at the sideline of sporting events can accurately detect concussions in athletes, according to study by researchers at the University of Pennsylvania School of Medicine. Current sideline tests can leave a wide amount a brain function untested following concussion. Penn researchers showed that this simple test adds to current methods and accurately and reliably identified athletes with head trauma. The study appears online now in Neurology.
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Demo Card from the King-Devick test. Credit: King-Devick Test. (Click to view larger version and more images of the test cards..)
Related Links
Penn Comprehensive Neuroscience Center
Penn Neurology
University of Pennsylvania School of Medicine
University of Pennsylvania Health System
The one-minute test involves the athlete reading single digit numbers displayed on index-sized cards. Any increase (worsening) in the time needed to complete the test suggests a concussion has occurred, particularly if the delay is greater than five seconds compared to the individual’s baseline test time.
The test, called the King-Devick test, captures impairments of eye movement, attention, language and other symptoms of impaired brain function. It looks at saccadic and other types of eye movements that are frequently abnormal following a concussion.
“This rapid screening test provides an effective way to detect early signs of concussion, which can improve outcomes and hopefully prevent repetitive concussions,” said the study’s senior author, Laura Balcer, MD, MSCE, Professor of Neurology, Ophthalmology and Epidemiology at the University of Pennsylvania School of Medicine. “If validated in future studies, this test has the potential to become a standard sideline test for athletes.”
While more extensive testing can best capture post-concussion syndrome symptoms, and these tests may be influenced by other factors such as intellectual ability or depression, tests of rapid number naming such as the King-Devick test are objective and capture many aspects of function. This may help coaches and athletic trainers determine whether players should be removed from games or not.
As emphasized by the study’s lead author, Kristin Galetta, MS, “Concussion is a complex type of brain injury that is not visible on the routine scans we do of the brain, yet is detectable when we measure important aspects of brain function, such as vision. The K-D test is only one test on the sidelines, though, and the diagnosis of concussion requires a combination of tests and input of medical professionals.”
In a study of 39 boxers and MMA fighters, post-fight time test scores were significantly higher (worse) for those who had head trauma during their matches (59.1 ± 7.4 vs 41.0 ± 6.7 seconds, p < 0.0001). Among those with head trauma, fighters who lost consciousness had even higher post-fight scores compared to those who didn’t lose consciousness (65.5 ± 2.9 vs 52.7 ± 2.9 seconds, p < 0.0001). Test times improved by more than a second on average for participants who did not have head trauma, while average times for those who suffered head trauma worsened by 11.1 seconds. Fighters who lost consciousness were 18 seconds slower on the test after their bouts.
The study was funded by a grant from the National Eye Institute.
A follow-up study, looking prospectively at college athletes at the University of Pennsylvania, is examining changes in athlete test scores over the course of a season, reliability of retest or tests conducted by different testers such as athletic trainers, and establish test norms and expected ranges of pre-competition scores for this age group. It will also provide large-scale results to further evaluate the effectiveness of the test to identify closed head injury and concussions accurately.
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