A First Hand Account of Concussions in the NFL

Kris Jenkins offers a poignant first hand account of what its like to be a professional football player in the NFL dealing with concussions.  Definitely worth a serious read here.

The Importance of Prior Testing Scores

Students come routinely to be tested to determine if they have a condition that may warrant test accommodations by either their school/university or a testing agency.  Recently, a young man came to see me for testing before applying to take the LSAT (Law School Admission Test) examination.

We tested him in accord with the LSAT guidelines and requirements.  The LSAT is very specific about the tests they require to be administered and how the scores are reported; otherwise, the report is rejected.

As I reviewed the test scores with James, I recounted his IQ test scores.  At first, James was surprised I had administered an IQ test, though I explained the LSAT required this.  I told James he was bright and had a verbal intelligence score in the high average range and an overall score in the Average range because his attention (working memory) and processing speed were low (part of his condition warranting additional time on tests).  James was surprised.  He said that he had been tested before, and his IQ test scores were much higher.  I asked James if he could obtain the report.

A day later, James emailed me a pdf of his prior testing, and we were both astonished.  His verbal score went from 140 before to 110 now, a 30 point decline!  His overall score went from 122 to 102 now.

This decline was dramatic and somewhat concerning.  I reviewed James' scores, with his permission, with his psychiatrist.  We both agreed the most probable cause was the medication cocktail the psychiatrist had prescribed, but just to be safe, the psychiatrist asked a neurologist to examine James.  The psychiatrist is in the process of reviewing James' medications to see if some can be changed or reduced to minimize the cognitive effects, and a neurologic exam is being scheduled.

James' documented change in IQ is, itself, evidence of a condition warranting testing accommodations.  Still, the testing pointed out that James may be able to function much better if his medications can be adjusted to return him to his prior, higher functioning IQ.  Without the prior testing, we might have just concluded James had slow processing speed due to a learning disability.  With the prior testing, we see a 20 point IQ change that demands explanation and modification of his treatment.

Be sure to keep all copies of your prior testing--James' case illustrates the results may come in very handy one day.

Sport Science: NFL Concussions and helmet to hemet collisions

It may surprise you but approximately one quarter or more of the patients I examine are unsure if they have sustained a concussion.  Ninety percent of concussive injuries do NOT involve a loss of consciousness.  This past week, I examined a 10 year old who could not identify a specific incident in the game producing a concussion, but he reported one tackle that resulted in dizziness.  After the game he had a headache, and this increased with physical or mental activity.  Most probably, he did sustain a concussion.

This video provides an illustration of the forces that can result in a concussive injury without the player necessarily knowing which event actually produced the forces necessary to produce a concussion.

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THE A B C’s OF CONCUSSION

I spoke with a mother this week of her 14-year old daughter who wanted an urgent appointment—the same day—for a concussion evaluation after her daughter sustained a concussion playing soccer.  Unable to see the daughter the same day, the mother stated “She could die before tomorrow.”  I realized that the mother was confusing the acute, emergency assessment and evaluation with the second phase of evaluation and management which begins 24-48 hours after a concussion.  As I spoke with the mother, I learned her daughter had been evaluated in the acute phase, and was cleared from an acute threat such as a bleed to the brain.  (A bleed in the brain can occur hours, days and in some persons, usually the elderly, a week or so after an initial injury, but most often occurs soon after the concussion impact). 

Let’s review the ABC’s of concussion evaluation and management.

Acute Assessment:  This usually occurs on the field in sports or in the emergency room in other circumstances.  When an athlete has a possible concussion, the athletic trainer or team physician usually conducts an on-the-field acute assessment.  Some forms of assessment are the Acute Concussion Evaluation by Gioia and Collins, the Sport Concussion Assessment Tool-2 among others.  The first 24-48 hours are crucial for observation in order to prevent an acute, life threatening condition such as a bleed inside the head (hematoma).  A CT or MRI scan will rule this out.

NeuroBehavioral Evaluation:  After the acute phase, the concussed patient should be seen by a concussion specialist to assess the presence and severity of symptoms and guide the patient (and parent, if appropriate) on how to manage the symptoms to promote the fastest recovery possible.  Mismanagement can result in not only a prolonged recovery, but a worsening of symptoms.  This evaluation will usually consist of an interview, brief cognitive testing such as ImPACT, testing of balance and eye movements, and assessment of mood. 

Cessation or Resolution of Symptoms:  The patient is usually followed until the symptoms have largely resolved and the patient can be cleared to return to play and/or return to school.  This must follow a generally gradual path from little activity to increasing levels of activity until a return to normalcy without active symptoms is achieved.

            Management of concussion is critical for the player, athlete or patient to return to life as normal as quickly as possible and to prevent other serious, potentially life threatening complications such as Second Impact Syndrome.  We’ll discuss these issues later.