Concussion in the National Football League: An Overview for Neurologists
Section snippets
Biomechanics
The biomechanical information was generated from studies performed under the auspices of the NFL MTBI Committee, with the assistance of Biokinetics and Associates (Ottawa, Canada). The data were collected using video analysis of a number of NFL head impacts, some resulting in an MTBI and some not resulting in MTBI. After video analysis, the impacts were reconstructed in the laboratory using Hybrid III test dummies (General Motors, Detroit, Michigan) [1].
Regarding impacts that resulted in
Epidemiology
The authors performed a 6-year clinical study of MTBI in the NFL. Data were collected prospectively. We collected complete injury data, initial clinical evaluation data, and follow-up clinical evaluation data for 787 MTBIs that occurred in preseason, regular, or playoff games for 6 seasons between 1996 and 2001. One hundred additional MTBIs from practice sessions were included in the database as well. Data were collected from forms filled out by team physicians and athletic trainers at the time
Concussion management guidelines
A number of practitioners have developed and promoted guidelines for the evaluation and management of concussion in sport [15], [16], [17], [18]. Based on the authors' experience in the NFL and our studies of concussion in the NFL, we do not believe that any of these guidelines are applicable or relevant to the NFL experience. The rationale for these guidelines is flawed. The authors of the guidelines indicate that the reasons why such guidelines are necessary include the prevention of second
Chronic traumatic encephalopathy
That there is a chronic traumatic encephalopathy (CTE) of boxers is not in doubt. The same, however, cannot be said about CTE of football players. There is an extensive medical literature documenting the clinical picture (ie, combinations of dysarthria, cerebellar dysfunction, extrapyramidal dysfunction, pyramidal dysfunction, cognitive-behavioral impairments), radiologic findings (ie, enlarged third and lateral ventricles, cerebral atrophy, cavum septum pellucidum) and distinctive
Summary
The authors' studies have yielded a great deal of data regarding the biomechanics of head injury and the clinical picture of MTBI in the NFL. The research has demonstrated the link between the effects of biomechanical forces on the brain and the clinical symptomatology of the concussed players. New insights into the mechanisms of injury are leading to new ways of protecting football players from the effects of MTBI. Our clinical data validate the effectiveness of the current NFL physician
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Cited by (24)
The King-Devick test and sports-related concussion: Study of a rapid visual screening tool in a collegiate cohort
2011, Journal of the Neurological SciencesCitation Excerpt :Younger athletes are particularly susceptible to third-party pressures to return to play preemptively, even before assessment [10–14]. Without the data from rapid screening tests to make proper decisions on the side lines, athletes may be at risk for chronic neurological symptoms and pathological changes that have been associated with concussion [15–30]. Concussion, defined by an impulse blow to the head or body that results in transient neurologic signs or symptoms, is largely the result of functional rather than structural injury to the brain [25].
Concussion in athletes: Information for team physicians on the neurologic evaluation
2010, Seminars in Spine SurgeryCitation Excerpt :For example, although recent clinical studies indicate that LOC is not the only factor influencing time to recovery, they also demonstrate that LOC is one of the significant risk factors for the development of post concussion syndrome, leading many experts in the field to agree with the guidelines that players with observed LOC on the day of the concussion are not good candidates for RTP on the day of the concussion.5,6,12 In addition, modern concussion management and the guidelines are in agreement that injured athletes should only be considered for return to play when the athlete is completely asymptomatic at rest and with exertion and has a normal neurological examination, including mental status.5,6,26 This does not mean that every athlete who meets these criteria should automatically be medically cleared to return to play; it means that athletes who are symptomatic and/or have abnormalities on neurological examination should not be considered for return to play at that time.
Overview of Traumatic Brain Injury (TBI)
2019, Traumatic Brain Injury: A Clinician’s Guide to Diagnosis, Management, and Rehabilitation: Second EditionInvestigation of the use of a mouthguard for decreasing the incidence and/or severity of sportrelated concussions
2016, Medecine Buccale Chirurgie BuccaleRight Brain: Concussion (film)
2016, Neurology
This work was supported in part by research sponsored by the NFL and NFL Charities.