Yesterday during the games I tweeted a couple of times eluding to the Zurich 2008 Statement on Sports Concussions. I use this as the current benchmark, because it is exactly that, CURRENT. Granted some people have expanded on Zurich, now a three-year old consensus statement – for example our protocol now adds a step between current 1 and 2 for return to play.
However, the Zurich Statement is the best we have. Arising from a group of international scientists it provides the best start in this ever-changing arena. In 2006 from Prague the group took out grading and the term “mild” from the concussion arena. In 2008 the group provided what most wanted to know a return to play guideline.
How does this all relate to the NFL? If you look at the statement closely you will find that there is an actual section that deals with entities like the NFL and return to play on the same day. It does not use the NFL specifically but looking at the section it is pretty logical to think that is what is meant (bolded is my emphasis);
4.2. Same day return to play
With adult athletes, in some settings, where there are team physicians experienced in concussion management and sufficient resources (e.g. access to neuropsychologists, consultants, neuroimaging) as well as access to immediate (i.e. sideline) neurocognitive assessment, RTP management may be more rapid. The RTP strategy must still follow the same basic management principles; namely, full clinical and cognitive recovery before consideration of RTP. This approach is supported by published guidelines, such as the American Academy of Neurology, US Team Physician Consensus Statement, and US National Athletic Trainers’ Association Position Statement.58–60 This issue was extensively discussed by the consensus panelists and it was acknowledged that there is evidence that some professional American football players are able to return to play more quickly, with even same day RTP supported by National Football League studies without a risk of recurrence or sequelae.61 There are data, however, demonstrating that at the collegiate and high school level, athletes allowed to RTP on the same day may demonstrate NP deficits post-injury that may not be evident on the sidelines and are more likely to have delayed onset of symptoms.62–68 It should be emphasized, however, that the young (<18 years) elite athlete should be treated more conservatively even though the resources may be the same as for an older professional athlete (see Section 6.1).
How many other sports have this? Hockey, sure. Any others? I would say no, perhaps there are more resources that I don’t commonly know about at other events. In the cases of highly trained professionals being avialable to younger athetles, the lower level players should be treated differently.
How about the resource cited (61)? It is a study authored by Elliot Pellman et al (Pellman EJ, Viano DC, Casson IR, et al. Concussion in professional football: players returning to the same game–part 7. Neurosurgery 2005;56:79–92.), Mark Lovell of UPMC is the et al above.
Pellman was the embattled head of the then NFL research committee on concussions who was removed after the truth came to light (SOURCE 2007 prior to the Zurich 2008 Statement);
In recent weeks and months, there has been a great deal of controversy directed to the National Football League concerning brain injuries in sports. Not long ago, it was revealed that Dr. Elliot Pellman, long-time chairman of the NFL’s research committee on concussions had misrepresented his credentials and qualifications according to the Baltimore Sun, ESPN and the New York Times. Yesterday, Dr. Pellman, a rheumatologist, resigned as chairman of the committee although surprisingly, he will remain a member of the committee.
Another co-author was Ira Casson, also heavily criticized for his work even by me;
The previous study run by Ira Casson, MD was a joke from the beginning and this one seems to much more transparent and studying the correct people.
So what is the moral of the story? Well take from what you want, but it seems very clear to me that when the best resource became available (Zurich 2008), there was such a concern for the NFL that a special section had to be put in to basically exclude them from sitting out. Again, a case of do as we say, not as we do; which I am OK with it if the NFL would just come out and say that, and explain why that is the case.
The Concussion Blog 
Dustin:
You always have good information but your English/spelling/grammar is so bad, that the material becomes unreadable and detracts from its credibility. You need an editor.
Unfortunately you are correct… I don’t have money for an editor… Sorry…
Got a prospective English Literature major right here! If needed, I’d be more than glad to go over and revise grammatical errors… Also, I’m still kind of lost on this memo that the NFL put out prior to the season regarding return-to-play policies with their players, does it have no credibility in it?
“Informed fans may remember that the NFL released a memo to all 32 NFL teams before this season that contained instructions on how to reinforce player safety in regards to concussions. They were instructed to not allow a player back in the game if they even suspected that he could have a concussion.”
http://sports.yahoo.com/nfl/news?slug=ycn-10377081
Feel free to edit my posts John…
I just found this blog and I am so glad to see it. My daughter recently suffered a concussion, and I shared our experiences with it on my own blog (www.itbeginsathome.com). She was out a total of seven weeks before returning to play soccer, and I am so glad she had that recovery time. It is really good to see the landscape of expectations changing, but sad that the issue is still so misunderstood by so many. Thank you for helping raise awareness. That was my primary goal in publishing my own experience, and I hope the lessons I learned from it will be useful to others.
Christine,
We have other “Parent Advocates” that submit articles for us to post to raise awareness. I am inviting you to submit any and all your thoughts for us to post.
Inadvertently hit post button before editing and completing my response. Dustin can you please delete my previous and shorter response? Thanks.
====================================================
There have been over 25 RTP guideliness, and they have been criticized for lacking a scientific foundation…
So why should we accept any present guidelines…that lack a scientific basis?
Are you aware of the basis of the 15 minute sit-out rule in an recent (1997) RTP guideline?
The ‘scientific basis’ was reported to be the 15 minute NFL football quarter…
Due to a history of conflicts of interests (COIs) emerging within the RTP concussion policy making, I am cautious about accepting expert panel perspectives that fail to support their personal viewpoints with unbiased and quality research.
I was fortunate to have an M.D. mentor who shared the following advice and related caution re expert panels and blue ribbon panels:
That COIs may be exhibited by members of expert panels and blue ribbon committees was recently voiced by a clinical professor of medicine at the SUNY Upstate Medical University Hospital located in Syracuse, NY. Anton Joachimpillai (2004) stated that:
From his clinical perspective derived from almost 50 years of practicing medicine, expert panels and blue ribbon committee findings should be both cautiously accepted and critically reviewed as he has frequently found that committee members promulgate self-serving, and thus biased interests (personal communication, March 9, 2004).
In addition, it seems logical that different objective and research based return to play guidelines be put in place for younger individuals due to the developing brains. RTP guidelines should not be a one size fits all athletes.
Dr. Brady once again finds information that supports what we have been saying all along. I am glad that someone much smarter than I has chimed in on this.
Dustin,
I don’t think it is a matter of “being smarter”–
From our perspective (my wife, Flo, and myself) there needs to be more critical thinking pertaining to accepting ‘new and improved’ information re sport concusion assessment and management due to a history of conflicts of interest present within the SRC field.
As the brain directly impacts physical, cognitive and emotional functioning…and ALL components of the brain may be damaged via a concussion or multiple concussions, then all 3 areas of brain functioning need to be adequately addressed in ALL assessment and management protocals.
We also think it is important to possess indepth comprehension of concussion history knowledge. Below are 2 references that some of your readers might find of value:
Evans, R. W. (1994). The postconcussive syndrome: 130 years of controversy. Seminars in Neurology, 14, 32–39.
Goldberg, D. (2009). Concussions, professional sports, and conflicts of interest: Why the National Football League’s current policies are bad for its (players’) health. HealthCare Ethics Committee Forum, 20(4), 337–355.