Posted by: mdegeorge | April 25, 2011

Weekly Diagnosis: April 25

It’s been a busy week of playoff action ranging from the scintillating (read: NHL) to the largely predictable (read: NBA). In between (and thanks in large part to the extra few days bought by my delays) we found a few stories to profile, including awkward teens and NFL players doing what they each do best: getting hurt and failing tests, respectively.

Study says concussion down time up

A study released by the Canadian Medical Association Journal April 15 found that the recuperation time for concussions was on the rise from 1997 to 2004. The incidence of concussions per player hour varied widely from year to year, but the overall time spent on the sidelines showed a steady increase over that period. The report, one of the most comprehensive of its time, analyzed 559 concussions over that seven-year span.

Beyond that, there’s not a whole lot to glean from the report until a little context is provided by their next planned  study slated to analyze similar data from 2005 to present. The study did categorize concussions by number for player, with 70 percent recognized with their first concussion and eight percent on their third or more. The study also includes a large amount of gray area dating from times in which knowledge of concussion detection and prevention were lacking and protocols were severely lax.

The study does little more than provide a baseline for the next round of data analysis and investigation that will come sometime in the next year. With that data, it won’t be a surprise to see more concussions and more time on the sidelines, indicative of greater awareness and stricter protocol. That study, much like the current one, won’t be the smoking gun that says NHL players are dirtier or harder-hitting than ever before, as some of us expect when we click on these surveys. But like so much of the info coming out of the ongoing concussion situations, it’s a start.

Football drill sergeant of the year goes too…

In one of the countless, meaningless postseason awards banquets in the world of college football, Iowa Hawkeyes head coach Kirk Ferentz stepped to the podium April 19 to hand out a new award. It was an award he conceived of a few months ago in late January – you know, right around when his university was embroiled in a scandal that included allegedly overworking players until 13 of them landed in a hospital with rhabdomyolysis, a condition that can be caused by overexertion and can lead to severe kidney and other systemic problems.

The man at the center of that controversy was the center of attention at the Polk County I-Club Tuesday when it came time to present the inaugural award. That person was Iowa strength and conditioning coach Chris Doyle, who led the doomed workout. If only he pushed one of the kids until they died, he might be up for assistant coach of the decade.

Doyle has been cleared by a university investigation of an wrongdoing in the incident, which nonetheless has marred the reign of Ferentz (who as you might recall was away on a recruiting trip, letting the mice play until a bakers’ dozen needed round-the-clock IVs). The entire ordeal still looks quite shady, and to editorialize a bit, the award appears as more of a thank you for helping beat the rap than for hard work. I’m sure there’s more to come from this story. We can only hope that something isn’t a tragic repeat of January’s workouts.

Smells like tween spirit

Teens are awkward. It’s a fact many of us know through experience that is a bit too first-hand for comfort. But New York Times health blogger Gretchen Reynolds noticed that while a certain amount of clumsiness was understood, concrete academic research was surprisingly divided on the matter. Previous studies suggested that teens, or more specifically tweens between the  of 10 and 12 in the early stages of pubertal growth, may be more prone to injuries, while others suggest that susceptibility is the price to pay for being more advanced at athletic tasks than their pre-pubescent counterparts.

Reynolds uncovered a study conducted by the Cincinnati Children’s Hospital Medical Center and the Ohio State University that indicates the gawkiness is more than just suddenly big feet and gangly legs. The study, which used infrared sensors to track movement of nine- to 11-year-olds in physical tasks, shows profound differences in their proprioception, the orientation of their bodies, from adults. The difference suggests a lag time in the underlying neurological perception of the limits and capabilities of their growing bodies, including a shift of motor control from subcortical regions to higher cortical regions, that accounts for the ungainliness.

The article suggests an interesting test for this phase:

Chalk one of the child’s fingers and have him leap as high as he or she can from the floor, marking the wall with the chalk. Then have him drop from a one-foot box and leap up immediately after touching the floor. “A well-coordinated kid will leap higher after dropping from the box,” Dr. [Timothy] Hewett [a senior of the Ohio State studey] said. An adolescent in the midst of his or her awkward stage probably will not.

I guess when the band members aren’t there to take the tests…

It was bound to happen that this story would hit the wire eventually. Increased scrutiny of concussions means more strict protocols to follow and higher stakes for failure. With the implementation of baseline testing for neurological function, it’s not shock that some (possibly already concussed) idiot would put two and two together to think that intentionally flunking the baseline tests could get them back on the field faster by make their concussed performance on the sidelines look not that bad.

That’s exactly what one concussion specialist who has treated current and former NFL players says is a somewhat common practice. Dr. Daniel Amen revealed that some of his former patients, names of whom he could not disclose citing doctor-patient confidentiality restrictions, had confessed fudging their baseline tests in an effort to get back on the field quicker.

This type of deceit doesn’t just involved answering questions wrong in the cognitive or concentration portions of the exam. It also includes masking the physical manifestations of a head injury through the use of drugs such Attention Deficit Hyperactivity Disorder drug Ritalin, which can temporarily fool tests such as the SPECT (Single Photon Emission Computed Tomography) test used by Amen and other specialists.

The story includes various concussion anecdotes about concussion screening past and present, including this exchange between New York Giants vice president of medical services Ronnie Barnes and head coach Bill Parcells in regards to quarterback Jeff Hostetler’s in-game concussion during Super Bowl XXV in 1991 as told by Barnes: “I said, ‘He doesn’t know his name.’ [Parcells] said, ‘Well, tell him his name.’”

Amen does manage to hit on a seminal point in the problem when discussing the issue of concussion testing evasion:

Players are smart. They know that if they have a concussion and score badly that, ‘I’m going to be taken out. It’s going to affect my livelihood.’” I’ve had a number of players tell me they purposely do bad on the testing to start so if they get a concussion it doesn’t affect them. We need to educate them that this is a really dumb idea, that it’s the rest of their life that they’re playing with.

Article of the Week: The Drew Fernandez story

Courtesy of The Concussion Blog and Project Brain Wave, this story chronicles the travails of a mother trying to gain understanding and accommodation for her son, Drew, a high school football player suffering the repercussions of a freshman-year head injury. The long and winding path of rigorous testing, medications and divides between the medical and psychological dimensions of his recovery, which has run the gamut of symptoms from memory loss to debilitating migraines, is startling and frustrating. It’s a story of the side we rarely see with professional athletes, like struggling with school work, compounded with the normally excruciating social push-and-pull of trying to be a normal teenager.

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