Con­cus­sions Draw­ing In­creased Scru­tiny

The Washington Post Sunday - - Sunday Morning On The Air - By Les Car­pen­ter

LOS AN­GE­LES — The night of the Dal­las Cow­boys’ sec­ond con­sec­u­tive NFC cham­pi­onship in Jan­uary 1994, Troy Aik­man was in a hospi­tal un­able to re­mem­ber what, if any­thing, he and his team­mates had ac­com­plished hours ear­lier.

A third-quar­ter hit had knocked the quar­ter­back’s brain against the sides of his skull. At a con­cus­sion sem­i­nar this past Fri­day morn­ing, Aik­man’s agent Leigh Stein­berg re­called visit­ing him in the hospi­tal that night and be­ing met with blank stares.

Stein­berg re­mem­bered Aik­man ask­ing, “Did I play a foot­ball game to­day?”

When Stein­berg said yes, Aik­man then asked if he played well. Stein­berg again said yes. Aik­man then won­dered if the Cow­boys had won. When told yes again, Aik­man asked what the win meant. Stein­berg told him he was go­ing to the Su­per Bowl.

“His face re­ally bright­ened then,” Stein­berg re­called.

Five min­utes later, Aik­man turned to Stein­berg and said, “Did I play a foot­ball game to­day?”

Stein­berg told this story at the sem­i­nar he put on along with the Los An­ge­les-based Sports Con­cus­sion In­sti­tute to il­lus­trate a fact that now seems star­tling. Af­ter a week of fog­gi­ness and feel­ing sick to his stom­ach, Aik­man played in the Su­per Bowl, ex­pos­ing him­self to a po­ten­tial blow that could have caused fur­ther head trauma and put him at risk for fu­ture de­bil­i­tat­ing prob­lems.

Sev­eral years ago, Stein­berg or­ga­nized a sem­i­nar to study con­cus­sions, but the sub­ject quickly died. Now in­ter­est has re­gen­er­ated af­ter re­cent sug­ges­tions that the deaths of for­mer NFL play­ers Mike Web­ster, An­dre Wa­ters and Terry Long might have been re­lated to con­cus­sions. Fri­day’s sem­i­nar drew sev­eral doc­tors who are con­sid­ered lead­ers in the field and who pre­sented new find­ings that ap­pear to show just how blows to a brain not healed from a pre­vi­ous con­cus­sion can cause ex­po­nen­tially more dam­age.

Mark Lovell, the di­rec­tor of the Sports Medicine Con­cus­sion Pro­gram at the Univer­sity of Pitts­burgh Med­i­cal Cen­ter, said es­ti­mates from the Cen­ters for Dis­ease Con­trol show there are 1.6 mil­lion to 3.8 mil­lion sports con­cus­sions a year. Other stud­ies of high school ath­letes sug­gest 70 per­cent of foot­ball play­ers re­ported con­cus­sion symp­toms but only 20 per­cent knew they had a con­cus­sion. It takes two weeks for 60 per­cent of high school ath­letes to re­cov­ery fully from a con­cus­sion, he said.

Sev­eral of the doc­tors wor­ried that too many of those kids are re­turn­ing to ac­tion sooner than that, which leaves the brain vul­ner­a­ble to an­other hit that could give the ath­lete headaches, dizzi­ness and tem­po­rary am­ne­sia for weeks and put him or her at a height­ened risk for con­di­tions such as Alzheimer’s and Parkin­son’s dis­eases.

The prob­lem is no one knows just how ex­ten­sive those risks are.

“This is the last fron­tier in med­i­cal re­search,” Stein­berg said. “We know ev­ery­thing about the knees and joints. But the brain is truly the last fron­tier.”

Com­pli­cat­ing such study, many of the doc­tors said, is the cur­rent sports cul­ture that de­mands play­ers get onto the field as soon as pos­si­ble. Sev­eral gave anec­do­tal ev­i­dence of high school ath­letes who tried to get back into soc­cer games or foot­ball games or play again within days of what ap­peared to be se­vere con­cus­sions.

The doc­tors urged all high schools and sports teams to adopt base­line test­ing, which re­quires ath­letes to look at a television mon­i­tor and re­spond to a se­ries of prompts. This gives a record of nor­mal brain ac­tiv­ity, so when a head in­jury oc­curs, the ath­lete can be tested again to de­ter­mine how much func­tion has been lost.

While many pro­fes­sional sports leagues do base­line test­ing, only a frac­tion of high schools do.

To il­lus­trate how tricky this re­search can be, sev­eral doc­tors said in­jured play­ers can fake their way through ba­sic tests for con­cus­sions by say­ing they feel fine, even as their heads are pound­ing. Only when more ex­ten­sive tests are given, forc­ing the pa­tient to re­mem­ber sim­ple facts and iden­tify ob­jects, can the true ex­tent of the in­jury be de­ter­mined.

Ben­net Omalu, a foren­sic pathol­o­gist who first made the link be­tween brain in­juries and the deaths of Wa­ters, Long and Web­ster, showed pic­tures of each player’s brain to demon­strate how nor­mal all three of the brains ap­peared. Only af­ter fur­ther ex­am­i­na­tion could the tell­tale signs of head trauma be iden­ti­fied.

The brain of Web­ster, who had sev­eral post-foot­ball health is­sues, showed de­men­tia “of­ten seen in an 80-year-old,” Omalu said.

Tech­nol­ogy is help­ing in study­ing brain is­sues. Some sci­en­tists have wired the hel­mets of col­lege foot­ball teams to study the force of im­pact on the brain.

There was a lot of dis­cus­sion about de­sign­ing new hel­mets, but many cited the prob­lem of hav­ing some­thing that is com­fort­able enough for a player to want to wear.

“Peo­ple are ap­palled when I tell them to put a used swim­suit on their kids, but they put on their kids’ heads any­thing that comes out of the equip­ment closet,” said J. Na­dine Gel­berg, the pres­i­dent of Get Charged, a com­pany that ex­am­ines sports tech­nol­ogy. “They don’t know what’s hap­pened to that hel­met.”


For­mer Dal­las quar­ter­back Troy Aik­man didn’t re­mem­ber play­ing in the 1994 NFC cham­pi­onship game be­cause of a blow to his head in the third quar­ter.

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