Confronting concussions
Posted on Thursday, September 20, 2007
FAYETTEVILLE - Dinged in the helmet and feeling dizzy, Arkansas tailback Darren McFadden jogged off the field at Bryant-Denny Stadium in the fourth quarter last Saturday in Tuscaloosa, Ala.
Twenty years ago, maybe even 10 years ago, a trainer would have let McFadden shake the cobwebs out of his head before sending him back into the fray, especially if the game was as tight as Arkansas' shootout against Alabama.
But this is a new day regarding concussions in American sports.
Arkansas trainer Dean Weber, busy taking care of one injured Razorback, finished what he was doing, then hustled over to examine McFadden, the Arkansas star who already had barreled through Alabama for 195 yards and two touchdowns.
"Darren, what happened ?"Weber asked.
"Man, I'm just dizzy,"replied McFadden, who was seated on a bench.
Weber asked McFadden to stand up, watched the gifted junior rise, woozy and wobbling on his feet, then had him sit back down.
"He just couldn't get things back straight into focus,"Weber said. "But that's the only symptom he had. He wasn't nauseated. He didn't have memory loss. He didn't have all the classic symptoms that you have with a concussion."
Still, McFadden's dizziness was enough to make Weber rule him out of service for the rest of the game.
McFadden, who wanted to help the Razorbacks run out the clock with a 38-34 lead late in a game that Arkansas would lose 41-38, was obviously not pleased.
"It was real hard for me [because ] I wanted to go back in there,"McFadden said. "[Weber ] was telling me it was best not to. I wanted to get back in there real bad to help my team get a victory."
That kind of attitude from players has prompted many a coach to re-insert players, but Arkansas Coach Houston Nutt was not tempted.
He knew better.
"Concussions kind of scare me because I have experience personally with that with my daughter Haven,"Nutt said. "So, I'm more educated on that deal. "That's a dangerous, dangerous thing because you're talking about the brain. That's a tough deal, and you've got to make sure. The doctors know what they're talking about on that thing. Any slight other hit after that hit could be real severe. So I never would do that."
THE GUIDELINES The Centers for Disease Control and Prevention estimates about 2. 5 million sports- and recreation-related concussions occur each year in the United States, with the majority coming at the high school level. A traumatic force applied to the head or upper body that causes the brain to shake inside the skull is the usual cause of a concussion.
The University of Pittsburgh Medical Center, one of the nation's leaders in concussion research, defines a concussion as when a blow of that type "causes a change in mental status, such as loss of consciousness, amnesia, disorientation, confusion or mental fogginess."
Athletes have been knocked silly since the advent of sports. In the not-too-distant past, the diagnosis and treatment of concussions was mostly guesswork.
"They're taking it a whole lot different than when we were here in '77,"Nutt said after a rash of concussions struck Arkansas during fall camp. "We'd have taken an aspirin and gotten right back on the field with Coach [Lou ] Holtz."
That's clearly not the case these days, as recent studies have shown that a second concussion, one that typically can be even more severe than the first, is more likely to take place if an athlete is rushed back into play before his symptoms clear up and his brain has had time to heal.
"There's been a lot more interest in the past 5 to 10 years with recognizing concussions and taking athletes out of service on a more standardized basis,"said Dr. Lee Archer of the Department of Neurology at the University of Arkansas for Medical Sciences.
Archer said concussions are generally graded on the spot in high-impact sports like football on three levels:
1. Resolution (of dizziness or loss of focus ) occurs in less than 15 minutes;
2. The symptoms last more than 15 minutes;
3. There is loss of consciousness involved. Using those guidelines, Mc-Fadden's concussion trickled just over the barrier into level 2. "I mean, later on, there's absolutely no symptoms,"Weber said of McFadden's concussion. "This is a half-hour after the game. "Could he have played if it had been earlier in the game ? Yeah. Did we make the right decision at the time ? Absolutely. I wouldn't change it."
AWARENESS SPREADING Concussions are the injury topic du jour in the NFL, and the discussion has steamrolled into the other levels of football, where the speed and impact of collisions that can cause concussions is on the rise. Weber said he dealt with six concussions during the Arkansas football team's fall camp. Among the Razorbacks slowed by concussions: defensive ends Adrian Davis and Chris Wade, tight end D. J. Williams, linebacker Tim Dial and offensive tackle Nate Garner.
An informal poll of SEC schools showed only one other team - Auburn - with as many as three concussions, but injury reporting varies from school to school.
Wade's concussion, a grade 3 blow on the concussion scale, was a bear wreaking havoc in his head. He was knocked out in practice one evening during fall camp and the next several days were agony.
"Headaches, a lot of dizziness, big old migraines, things like that,"Wade said. "Sometimes you just feel like you want to throw up."
D. J. Williams reported similar symptoms after suffering a concussion the same week.
"Headaches all the time, feeling sick to your stomach, can't focus in the meeting room,"Williams said to describe the aftereffects he felt.
Nausea, headaches and lack of focus are all standard symptoms of the higher grade of concussion.
"This is a brain injury,"Weber said. "This is an organ in the body, an extremely important organ. This is not a'dinger,' this is not 'you got your bell rung,' it is not a 'smoked globe.'"
Veteran Arkansas State trainer Ron Carroll advocates a high-tech, preventive approach to go with the usual finger-in-front-of-the face, question-and-answer session that typically follows a potential concussion-causing impact.
The Indians' helmet supplier is Riddell and almost every player on the team wears the Revolution helmet, a newer model that covers the jawline and is designed to distribute the impact of a head blow more evenly.
Riddell also offers a computer software program used by the NFL and select major-college programs in which impactrecording chips in the helmet can signal severe head shots to a computer and track them as they occur. That way, Carroll said, trainers can know if a player has sustained a possible concussion even if he shows no outward symptoms.
While the Indians can't afford the $ 60, 000 to 80, 000 for the entire system, Carroll said, the program will in the future spring for the special sensor helmets $ 1, 000 at a time after a player receives a concussion. "How do you put a price tag on preventing a repeat concussion ?"Carroll asked. The Razorbacks offer different models of helmets from a couple of companies, and they also refresh their stock of helmets every season to upgrade to the newest models.
IMPACT'S IMPACT Data compiled by UPMC reveals that 34 percent of college football players have had one concussion, and that 20 percent have incurred multiple concussions. And if a player hasn't successfully recuperated from one concussion, they are at greater risk of suffering a second, and likely more debilitating concussion if they are rushed back into full contact, the UPMC studies have shown.
"I know the penalties for [coming back before the brain has healed ],"said Wade, who sat out about a week before returning on a limited basis. "If I were to go out here and and risk myself, I could get another concussion."
The advancement in knowledge of concussions has altered their treatment.
Now players are given time for plenty of rest, sometimes including excused absences from classes and team meetings.
"The best thing you can do to help [a concussion ] heal is to do nothing,"Weber said. "Sometimes we excuse kids from going to class. [Going to class ] is going to make it worse. It'll make it last longer.
"Don't go to your meetings. Stay in bed.... And no, you can't ride a [stationary ] bike. You have to rest this thing, rest your brain."
Arkansas and Arkansas State both use a cognitive test to help determine when their athletes have recovered from concussions. The software, developed by the University of Pittsburgh, is called ImPACT (Immediate Postconcussion Assessment of Cognitive Testing ).
ImPACT users can conduct preseason computer evaluations, which take about 30 minutes, to "establish baseline data about each athlete,"according to the UPMC Web site.
Then, if a player suffers a concussion, he can undergo the evaluation every few days to determine when his brain functions return to normal, signaling his readiness to return to the playing field.
"It's state of the art,"Weber said. "The NFL is hot on this thing right now. But the ImPACT testing is just a part of the puzzle."
Arkansas' Garner took the Im-PACT test twice during his week of missed practices. On the first try, Garner thought he had done well, but the results proved otherwise.
"I had less than 1 percent on reaction time, they told me,"Garner said.
Garner's second attempt was in line with his baseline scores, allowing him to hit the practice field again. "I felt a lot better when I took it [the second time ],"he said. "I came out and didn't have a headache."The Razorbacks have used the ImPACT system to determine when their athletes were suited to return, and for different players the missed practice time varies. "Some guys take three days, some guys take two, some guys take a week or 10 days,"Weber said. "What's the difference ? I don't know. It's a brain injury and you must let it heal."
McFadden did not need to take the ImPACT test to determine his readiness to return to full-pad work. His symptoms were waning by game's end on Saturday. During postgame interviews, he said he "wasn't real dizzy, just a slight headache."The training staff supplied him with some Aleve and within minutes of taking off on the team flight back to Fayetteville, he was doing even better. "I slept a little bit on the plane, maybe slept about the first 10 or 15 minutes of the plane ride, then I felt like I was all the way back to good,"McFadden said. Could McFadden have returned to the Alabama game for the final series ? He says he was willing to go back in, of course, but Weber never wavered in the decision to play it safe, keeping a hand on McFadden's shoulder pads as they watched the final minutes from the sideline. "I understand completely why I was held up,"McFadden said.
Information for this article was contributed by Todd Traub of the Arkansas Democrat-Gazette.
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