Among those testifying at Congressional hearings on the NFL and Concussion was Joseph Maroon, M.D., of the Department of Neurosurgery at the University of Pittsburgh Medical Center. The hearings were held in Detroit on January 4, 2010. Maroon is also the Team Neurosurgeon, The Pittsburgh Steelers and has been on the NFL _s Mild Traumatic Brain Injury (MTBI) Committee since it was created in 1994.
Maroon called the Congress’s attention to what advances in the way in the NFL treatment of concussion since 1994. He said in his prepared remarks:
Our committee was specifically charged in 1994 with initiating and supporting independent scientific research to further the understanding of the causes, diagnosis, treatment and prevention of concussion.
This work has involved research on helmet standards, injury data collection and analysis, and an ongoing study of the long _term effects of concussions on NFL players. As a result, the NFL in recent years has initiated educational and preventive measures, guidelines for the management of concussions, and rule changes to eliminate unnecessary hits that can lead to concussions. Since the formation of the committee in 1994, there has been a significant positive culture change in the NFL on the issue of concussions. I have personally witnessed this culture change among NFL teams and players and I am confident that it will continue in a positive direction.
Clearly there was insufficient culture change between 1994 and 2009, to make a significant difference, which is why the hearings in October of 2009 caused such a stir. Maroon commented on the changes since October:
I am here today to report on additional steps relating to concussions that the NFL has taken since the October 28 hearing. The long _running arc of improvement continues.
The NFL now has stricter return _to _play guidelines. It includes the addition of an independent neurological consultant for each team approved by the medical advisors of the NFL and the NFL Players Association. The 2009 statement on return to play says that a player who suffers a concussion should not return to play or practice on the same day if he shows any signs or symptoms of a concussion. It also states that once a player is removed for the duration of a practice or game, he should not be considered for return _to _play activities until he is fully asymptomatic, both at rest and after exertion, has a normal neurological examination, normal neuropsychological testing, and has been cleared to return by both his team physicians and the independent neurological consultant.
If you read the above statement carefully, it really makes no sense. If a player suffered a concussion, by definition if a player “suffers a concussion” he would show a sign or symptom of concussion. What Maroon left out, is sign or symptom of a concussion at what point. As a football fan, I understand the enormity of keeping a star player out of a game, potentially a playoff game, because he was knocked woozy on one play. But if you are going to provide a guideline, then provide it. If there is any return to play after a concussion in the same game, then you must clearly state at what point in time, 15 minutes, 30 minutes, a quarter of the game, the symptoms must have cleared.
My biggest quarrel with what Maroon states here is the abandonment of the stated time period of not returning if the player is found to have the “signs or symptoms of a concussion.” Most sport and concussion guidelines specific 7 days or longer period for the concussion that is still symptomatic for more than a short period of time after the original injury. The best part of the guidelines is putting that finite “no play” period because it required the serial follow-ups, that are the most sensitive determination of the severity of a concussion. Leaving the finite “no play” time period out, guts the guidelines.
Maroon did get it right when he addressed the most serious problem in implementing the any guidelines, changing the culture of the sideline, the locker room so that players aren’t short sighted or intimidated into not fully reporting concussions. He stated:
The 2009 statement also addresses the responsibility of the players. It states that players are encouraged to be candid with team medical staffs and fully disclose any signs or symptoms that either they themselves or their teammates are showing that may be associated with a concussion. The nature of concussions, which can be difficult to diagnose in the absence of loss of consciousness, places an important responsibility on players to put their health above competitive considerations. This is the policy of the league with respect to its teams _ medical decisions must override playing considerations _ and it is extremely important that the players commit to meeting that standard.
In December, the NFL, in conjunction with the Centers for Disease Control (CDC), produced a public service messaged directed primarily at young athletes and their parents and coaches on the importance of head injury awareness. The theme is _Take Head Injuries Out of Play _ and the message has been airing and will continue to air on NFL game telecasts throughout the playoffs. This PSA also was sent to a group of conference commissioners of college sports so that they could adapt for their use on
television and with their athletes.
According to Maroon, the NFL is trying to make a difference outside of its own games:
In addition, the NFL is working with the CDC and other organizations on educational material for young athletes and high school coaches, and to develop an overall certification program for coaches at those levels addressing player health and safety.
Further, John Madden, in his role as a special advisor to Commissioner Goodell, is chairing a committee of coaches that is exploring ways of providing players with a safer environment to reduce the risk of head trauma in practices.
All positive steps. The biggest step is the publicity that these hearings have created on one simple theme: Concussion can be serious.
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