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Players may try to beat concussion tests
As the NFL prepares to enact tougher concussion rules for the 2011 season — provided there is one — a brain-imaging expert warns that the league should be on guard for shady player head games.
Dr. Daniel Amen, who has treated current and former players for post-concussion symptoms, said some of his clients have confessed to fudging the initial baseline tests administered by NFL teams. By doing so, Amen said those players are seeking quicker clearance to return from any future head injuries they might suffer.
Amen is prevented from disclosing names because of patient-doctor confidentiality.
Baseline testing is the crux of the NFL's new "go/no-go" concussion policy. Any player who suffers a head injury must now pass a six- to eight-minute test that measures such elements as cognitive thinking, memory, concentration and balance. Those results are then compared to how the player scored in the preseason to determine clearance for an in-game return.
"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,' " Amen said. "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."
Another potential form of cheating is the use of Ritalin to pass a concussion test. The drug, which is intended for those suffering from attention deficit hyperactivity disorder (ADHD), changes brain chemistry and may serve as a short-term mask for concussion symptoms.
A story at beyondchron.com anonymously quotes one concussion expert as saying that NFL players are already using Ritalin for this purpose.
"Ritalin will work," Amen said. "It helps boost activity to the front part of the brain. In my mind, it's not the first thing I would do to rehabilitate a concussion but it would be on the list of things to do.
"Clearly, it's not approved by the NFL or a smart thing to do and try to cheat the test."
A mental health practitioner and founder of the Amen Clinic, Amen began treating brain-damaged retired NFL players in the late 1990s. One of his recent clients is FOX Sports NFL analyst Terry Bradshaw, who recently revealed that he is feeling the effects of concussions suffered during his playing days with the Pittsburgh Steelers in the 1970s and 1980s.
"I’ve had this horrible concentration problem for a while now," Bradshaw wrote last week in a story for FOXSports.com after going public with his medical issue. "It’s obvious that my brain isn’t what it used to be."
Amen conducts a nuclear imaging test known as a SPECT (Single Photon Emission Computed Tomography) that provides a detailed look at the brain’s blood-flow activity and any possible damage incurred. Amen also offers individual suggestions to promote healing such as supplements, change of diet, and physical and mental activity.
Although the validity of his work has come under scrutiny from some members of the scientific community, Amen did have a study of 100 former and current NFL players covering 27 teams and all positions published earlier this year by the Journal of Neuropsychiatry and Clinical Neurosciences. Amen's self-funded research showed consistent maligned brain function among players compared to the regular populace.
Amen said the number of concussions and length of time playing football even before reaching the NFL "didn't seem to matter" in regards to the level of brain damage.
"That was a huge surprise for us," Amen said. "But I remember what (ex-boxing champion) Joe Louis once said: 'It's not the big hits that make you demented. It's the thousands of little hits that are the problem.'"
The NFL held a media conference call earlier this week with members of the league's player safety advisory panel and head, neck and spine committee to explain upcoming changes in concussion diagnosis and treatment. The push for a standardized in-game test stemmed from a request by NFL commissioner Roger Goodell and the aftermath of Philadelphia's 2010 season-opener against Green Bay. Two Eagles players who had suffered concussions — linebacker Stewart Bradley, who stumbled off the field, and quarterback Kevin Kolb — were allowed to briefly return before being pulled.
"What we want to promote is that if we're not certain whether a player sustained a concussion, if there's any question, then that player ought to sit and be evaluated through this checklist," said New York Giants vice president of medical services Ronnie Barnes, who is a member of the head, neck and spine committee. "We can then make a proper determination about whether they can return to play."
Barnes, though, admits it remains "difficult" to determine precisely when a player should be cleared to return with no elevated risk of further brain trauma. Amen recalled when renowned neuropathologist Bennet Omalu suggested to the NFL's previous concussion committee that affected players should be barred from returning for at least two months.
"The people on the concussion committee just hated him," Amen said. "But think about it: your brain is a heck of a lot more important than your shoulder. But if you have a shoulder injury, you may very well be out two, three, four months. We need to know if your brain is really back at its baseline before we subject you to a second potential concussion that could put your mental health at stake."
The NFL is trying to find those answers. The league has provided medical grants for concussion research — Amen has applied for one — and is working with universities and outside agencies. One of them is the U.S. defense department, which is seeking better ways to treat soldiers who suffer head trauma.
One thing that has already changed is the concussion culture. And it's not just football. Major League Baseball recently instituted a seven-day disabled list for players believed to have suffered concussions and implemented standard testing protocol. The Pittsburgh Penguins have held out star forward Sidney Crosby since he suffered a concussion on Jan. 5.
The NFL's recent efforts to better address the problem have trickled down to youth sports. Eleven states have instituted mandatory diagnosis and treatment protocols with legislation pending in 21 more states and the District of Columbia.
Barnes said more players are now more willing to admit concussion symptoms. Other players are coming forward as well if they believe a teammate is affected, he said.
This is a far cry from when Barnes first entered the league with the Giants in 1980. Barnes recalled telling then-coach Bill Parcells that quarterback Jeff Hostetler had suffered an in-game concussion during Super Bowl XXV in January 1991.
"I said, 'He doesn't know his name,'" Barnes recalled. "[Parcells] said, 'Well, tell him his name.' "
"When I began, if the player wasn't knocked out and he knew his name and could make some recall, we let them go back," Barnes said. "I don't think we had the respect for it because the (medical) literature just wasn't there. We've seen a vast movement from that perspective."
Barnes believes there will be even more movement in the future.
"We do know that we have just scratched the surface (of concussion research)," he said.
Dr. Daniel Amen and Ronnie Barnes were interviewed by Alex Marvez and Rich Gannon on Sirius NFL Radio, Channel 124.
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