I was very lucky to be sent the dissertation from Don Brady, PhD, PsyD, NCSP he wrote in 2004 titled; A Preliminary Investigation of Active and Retired NFL Players’ Knowledge of Concussion. This read has been extremely enlightening and I consider this piece, written in 2004, ahead of its time. It is a shame that some could not see what Brady saw 7 years ago.
Here are some excerpts I have recently thought about;
On page 93 of his work you can find a warning from Dr. Cantu from 1997, yes 1997;
A concussion warning notice that Cantu (1997) has proposed for football may also be applied to participation in all sports. More specifically, Cantu has advocated for the placement of essential information about concussion—symptoms and risk factors–on all football helmets. The neurosurgeon’s suggested message follows:
Warning – playing football may result in a CONCUSSION, which no helmets can prevent. Symptoms include: confusion, dizziness, headache, loss of consciousness or memory, or nausea. If you have these symptoms immediately stop playing and report them to your coach, trainer, or parents. Do not return to a game or practice until all your symptoms go and you receive medical clearance. “Ignoring this warning may lead to another and more serious or fatal brain injury” (p. 84).
How about how concussions are handled differently in sports, even though they are seen as the same injury. Brady, on page 102, looks into the difference between boxing and football, and a question that had never crossed my mind – yet makes perfect sense;
Perhaps football could take guidance from boxing, another sport in which concussions are a concern. Certain state boxing laws mandate the removal from the ring, for a significant period of time, of a boxer who has been knocked out. Rhode Island boxing statutes forbid a knocked out boxer from resuming participation for 70 days (Title 41 Sports, Racing & Athletes, 2004). Oregon boxing statutes require that a boxer who sustained a knockout be made medically ineligible to return to the ring for 60 days (Oregon Boxing & Wrestling commission, 2004). It appears ironic that two athletes, participating in their respective sports within the same state, have significantly differing criteria for returning to competition: An NFL player who loses and regains consciousness during a game may subsequently return to the field to play, while a boxer who loses and regains consciousness has a mandated removal from participation for an extended period of time.
There is nothing more that needs exposure than any conflict of interest when making decision and recommendations. To use Irv Muchnick’s tag line, it would be like tobacco companies providing research monies and recommendations about its use. Here are two excerpts about conflicts, from page 101 and 106 respectively;
At the opposite end of the same continuum, failure to provide acceptable health care services is also unethical. This particular concern has long been raised within the sports field and in particular by the National Football League Players Association (NFLPA) (Moore, 1982). In a 1982 article, the sports medicine coordinator for the NFLPA advocated for “improved medical care that he thinks is lacking in the injury world of professional football” (p.162). Moore (1982) also pointed out the existence of apparent COIs existing for team physicians and athletic trainers via conflicts in their dual roles of “allegiance to their team owners and the best interests of their patients”(p.162). Huizenga (1994), a former team physician for the Oakland Raiders, voiced similar perspectives pertaining to these two medically related concerns.
Recent support for the existence of sports-related clinician bias may be found in Kelly and O’Shanick’s (2003) discussion of the formulation of the 1997 AAN concussion management guidelines. The presenters shared that the Quality Standards Subcommittee of the American Academy of Neurology–which devised these concussion management guidelines–included NFL team physicians. These team physicians reportedly influenced the committee’s decision that determined that a timeframe of 15 minutes was ample time for an athlete to “sit out” after sustaining an initial concussion. This recommended timeframe was reportedly not based on empirical evidence but was arbitrarily and directly related to the 15 minute quarter of a football game, so that an athlete would be able to return to play in the same game he sustained the initial concussion, if the symptoms resolved” (Kelly & O ‘Shanick, 2003).
Finally an excerpt about testing and its future, I remind you this was written in 2004, this appears on pages 93 and 94;
In neuropsychological-related research pertaining to brain injury, cognitive functions have received more attention than physical and emotional/behavioral effects (Lezak, 1995, p. 21). Lezak further noted that brain damage rarely affects just one of these systems as the disruptive effects of most brain lesions usually involve all three categories. Lovell (1999) also pointed out the potential for diverse presenting symptomology when he offered suggestions for evaluating an athlete’s cerebral concussion. While acknowledging common adverse effects of concussion on information processing speed, attention, and memory, the neuropsychologist also emphasized the need to be vigilant and look for other presenting symptoms “as each individual athlete may display a slightly different pattern of impairment” (p. 210). As data needs to be collected in categories beyond cognitive skills to more adequately evaluate all potential areas of dysfunction and more accurately assess and determine if a person has functionally recovered their preconcussion level of abilities, the need to be watchful for multiple symptoms of concussions appears to further necessitate a comprehensive assessment conducted by an interdisciplinary team.
Given the extensive number of potential concussion effects, preconcussion baseline and postconcussion data should be obtained beyond the generally assessed cognitive functions to more precisely determine the multiple effects of a concussion (Brady, 1989, 1999, 2002). For example, since concussions may affect an athlete’s visual information processing skills, baseline and postconcussion data pertaining to vision should be obtained, as players are at risk for the occurrence of ocular and visual dysfunctions as a result of brain injury (Heitger, Anderson, Jones, Dalrymple-Alford, Framptom, & Ardagh, 2004; Suchoff, Kapoor, Waxman, & Ference, 1999). Concussions may adversely impact visual functioning by significantly reducing the efficiency of a person’s visual system (L. Savedoff, personal communication, May 12, 1999). Moreover, routine optometric assessments of persons who experience a brain injury have also been advocated (Cohen & Rein, 1992). Pre- and post- concussion personality testing should also be considered in order to compare data for potential psychosocial changes (Prigatano, 1992; Putukian & Echemendia, 2003; Brady, 2002) and the possible emergence of psychotic and psychotic-like disorders (Fujii & Ahmed, 2002; Sachdev & Smith, 2001; Zhang & Sachdev, 2003), which may occur after a person sustains a traumatic brain injury.
I was pretty much dumbfounded to read all this information (full disclosure I have not read in-depth) that Brady presented back SEVEN years ago; even four years before the information began to finally get though to the general public. I cannot republish the dissertation in full, but Don does comment here from time to time, you can ask him.
The Concussion Blog 