In the never ending saga of concussions
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02-27-2013, 04:05 PM
Join Date: Sep 2004
Location: North of the Tank
NFL to use iPads to expand in-game concussion testing
The mandatory postinjury sideline concussion assessment tool, instituted for the 2012 season along with a baseline test done during physicals at the start of preseason, will now be used in app form by all 32 teams, a method that was tried by a handful of teams in a pilot program last season. The hope is that being able to compare the results of a baseline test and a postinjury test side by side in real time will speed diagnosis and help doctors and trainers recognize when a player should be removed from a game. The league also plans to have independent neurological consultants on the sideline during each game to assist the team physician in diagnosing and treating players.
The players union, which had pushed strongly for independent doctors to be on the sideline, said it was encouraged by the technological advance the new test represented, but it still had questions about how much power the independent consultants would have to make decisions about players. The union wants the independent sideline concussion experts to have almost exclusive authority in detecting concussions and administering tests, in part because it believes team doctors are often busy attending to other injured players, while the concussion experts are there for one reason.
The postinjury test is quick — it takes about six to eight minutes — and shares many elements with the baseline test to allow a comparison that might indicate a decline in function. Both include a section on the players’ concussion history and a 24-symptom checklist; players are asked to score themselves on a scale of 1 to 6 in categories like dizziness, confusion, irritability and sleep problems. Both note any abnormal pupil reaction or neck pain. There is a balance test and a concentration test, in which players, who are usually brought to the locker room to be evaluated, are asked to say the months of the year in reverse order, to recite a string of numbers backward and to remember a collection of words three times. Then they are asked to recall them again, without warning, at least five minutes later. The words and sequence of numbers may be changed from test to test, so players cannot memorize them from a previous test to mask concussion symptoms — a fact that has annoyed players, according to Dr. Margot Putukian, the director of athletic medicine at Princeton University Health Services and a member of the N.F.L.’s Head, Neck and Spine Committee.
On the postinjury tests, there is one different element: a series of five questions designed to test orientation and glean how confused a player might be at that moment. They are: Where are we? What quarter is it right now? Who scored last in the practice or game? Did we win the last game? Those questions, known as Maddocks questions, were developed in the 1990s by an Australian doctor who worked with players in Australian rules football.
The tests are far from perfect tools for diagnosing concussions. Some doctors are concerned the N.F.L. tests are trying to reduce concussion evaluation to ticking items off a checklist, a problem Putukian acknowledged, emphasizing the importance of having doctors familiar with the players evaluate them. ...
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