EMBARGOED FOR RELEASE 4 p.m. (EST), Tuesday, Dec. 21, 1999
CONTACT: Meredith Meyer (313) 876-2882
Current Concussion Guidelines Do Not Guarantee Player Safety,
Say Henry Ford Neuropsychologists
DETROIT --Concussion guidelines used by many sports teams -- including colleges and high schools -- to determine when a player can return to play have not been supported by research and do not adequately protect players.
This controversial opinion is outlined in a Contempo article that appears in the Dec. 21 issue of the Journal of the American Medical Association (JAMA). It is authored by Michael Collins, Ph.D., and Mark Lovell, Ph.D., of the Division of Neuropsychology at Henry Ford Health System in Detroit, and Doug Mckeag, M.D., a sports-medicine physician and chairman of the Department of Family Medicine at Indiana University School of Medicine.
Many teams currently follow concussion guidelines promoted by sports-medicine experts or by the American Academy of Neurology. The guidelines are designed to help the coach, athletic trainer or team physician assign a grade to the concussion based on symptoms and then follow a corresponding protocol as to how long the player should refrain from play.
For example, the Contempo describes a hockey player who receives an elbow to the face. Initially, he experiences confusion without loss of consciousness and passes a brief mental status evaluation. After 30 minutes he reports nausea and dizziness. He also performs poorly on the memory component of a mental status evaluation.
According to American Academy of Neurology guidelines, this athlete experienced a grade 1 concussion and would have been allowed to return to the game within 15 to 20 minutes. The authors contend this situation may place the athlete at risk because the effects of his concussion were not initially apparent.
"Currently, no research exists to support the specific grades of concussion and related return-to-play recommendations," Collins said. "Concussions affect every player differently. Uniform guidelines do not take into account varying symptoms and differing vulnerabilities to neurological injury for players of different ages."
Collins continued: "Part of the challenge is that, historically, concussion has been difficult to measure. MRI and CT scans are not typically sensitive enough to measure the effects of concussion. Also, a concussion does not always involve loss of consciousness and sometimes the symptoms take minutes or hours to manifest."
In a related article published this month in the Clinical Journal of Sport Medicine, Lovell, Collins and McKeag demonstrated that brief loss of consciousness is not an indicator of how someone will recover following concussion. This finding questions the makeup of all existing guidelines because they base severity of injury on loss of consciousness. Collins and Lovell are continuing to study the importance of other symptoms of concussion including confusion and memory loss.
To develop scientific return-to-play guidelines, Collins and Lovell currently are conducting a study of high school, college and professional athletes. They administer a 30-minute battery of written and verbal neuropsychological tests to these athletes to establish preseason baseline readings. If a player later experiences a concussion during the season, he is retested and does not return to play until he has returned to his baseline level of function. Thus, each return-to-play decision is based upon individual factors.
The battery of neuropsychological tests was developed by Dr. Lovell for the Pittsburgh Steelers. A similar program to help guide return-to-play decisions is now being used by the National Football League and the National Hockey League under Dr. Lovell's direction.
Dr. Collins led a study published in the Sept. 8 issue of JAMA that was the first of its kind to determine long-term effects of concussions on athletes' neuropsychological activity, which for example includes memory, problem solving, speed of information processing and fine motor speed.
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