Daily Archives: November 15, 2008

Lacrosse Injuries Update: Concussions Can Be Managed With “Pre-Participation” Neurological “Base Exam”


“…Another relatively new approach is a pre-participation neurological “base exam,” which gives doctors a picture of the athlete’s brain at the beginning of a season, so a comparison can be made should he or she sustain a concussion…”

concussion

“I have seen players who have had 20 documented concussions who are doing fine,” said Ruben Echemendia, president of the National Academy of Neuropsychology. “They’re doing fine across all the measurable standards we have. And I have seen players who have had two concussions, and it is time to call it a career. We have a more individualized approach based on science.”

 

“One of the things I see,” said Dr. Jeff Anderson of UConn’s medical staff, “is a player’s teammates will alert us. They’ll say, ‘Go talk to this guy, because he’s not right.’ “

http://www.courant.com/services/newspaper/printedition/sports/hc-concussion1114.artnov14,0,6491540,print.story 

They used to call it a “ding” or getting one’s “bell rung.” Football players, the toughest of the tough, would keep right on playing.

But mounting knowledge and awareness have greatly improved the managing of head injuries while also convincing players they must not take risks. A study by The New York Times found that at least 50 high school players in 20 states have died as a result of traumatic head injuries since 1997.

“One of the things I see,” said Dr. Jeff Anderson of UConn’s medical staff, “is a player’s teammates will alert us. They’ll say, ‘Go talk to this guy, because he’s not right.’ ”

The Center for Disease Control says there are more than 300,000 sports-related traumatic brain injuries in the United States each year, and there is fear that unreported cases number several times that amount.

Huskies quarterback Zach Frazer had a concussion before this season and sustained what has only been described as a head injury against Rutgers on Oct. 28. He has not played since but could return Saturday night against Syracuse. Anderson would not discuss the specifics of Frazer’s case.

Perhaps the most important change in the managing of head injuries is an individualized approach, since no two are the same. In the past, there was a blanket approach. A football player whose symptoms subsided within 24 hours might be allowed to play the next week, or a player whose symptoms disappeared within a few minutes might be allowed to re-enter the game.

“I have seen players who have had 20 documented concussions who are doing fine,” said Ruben Echemendia, president of the National Academy of Neuropsychology. “They’re doing fine across all the measurable standards we have. And I have seen players who have had two concussions, and it is time to call it a career. We have a more individualized approach based on science.”

Just two weeks ago, Echemendia, who began a concussion program at Penn State and now consults for several schools and also works with the NHL, recommended that a college player terminate his career. It’s a conversation Anderson has had, too.

“It is difficult, because it is not like, say, a heart condition, where you have a test and you can say, ‘I am not going to let you play, period,'” Anderson said. “But, ‘If I were your father, I would not let you play.’ That’s the way I usually say it.”

In recent years, several NFL players, including Troy Aikman and Steve Young, have retired after recurring problems with concussions. Mets outfielder Ryan Church missed much of last season because of lingering post-concussion syndrome.

“We had a player at Yale that we kept out a good four months,” said Dr. Peter Jokl, director of sports medicine at Yale-New Haven Hospital. “You don’t want to allow someone to play until you are sure all of his symptoms have cleared up.”

Another relatively new approach is a pre-participation neurological “base exam,” which gives doctors a picture of the athlete’s brain at the beginning of a season, so a comparison can be made should he or she sustain a concussion.

“A lot depends on what part of the brain has been injured,” Jokl said. “If that same area were to be injured again, it could lead to very serious problems, perhaps even death.”

Last month, Echemendia ran a symposium on sports-related head injuries in New York, where former NHL player Pat LaFontaine and former NFL player Mel Owens spoke about the need to stay vigilant in learning about concussions and finding better ways to manage them.

“They were clearly indicating, ‘I wish I knew then what I know now,'”Echemendia said.

Recent studies, including one by the University of North Carolina, developed possible ties between clinical depression and traumatic head injuries in former NFL players. When ex-linebacker John Grimsley died of an accidental gunshot wound last February, his wife allowed scientists to study his brain for the long-term effect of head injuries.

“There’s a lot we don’t know,” Echemendia said. “We have only been studying this for about 15 years. We don’t know exactly when it’s safe, on a scientific basis, to let someone return. We don’t have a good handle at this point on how many is too many. When should a player be retiring? We don’t have a good handle on the long-term impact. We need to see whether our management approaches make sense.”