Neuroclinic

Richard Perry/The New York Times
Preston Plevretes, right, who sustained brain damage during a college football game, at the hearing with his father, Ted.

Written By ALAN SCHWARZ, New York Times

In what could have been a fresh start for the N.F.L.’s committee on head injuries, its two new co-chairmen, making their first official remarks on concussions before a House Judiciary Committee panel on Monday in Manhattan, were heatedly rebuked by lawmakers for sounding “like the same old N.F.L.”

That characterization by Linda T. Sánchez, Democrat of California, was the most pointed comment toward Dr. Richard Ellenbogen and Dr. Hunt Batjer, the two new N.F.L. committee co-chairmen, whose predecessors resigned last fall amid questions of bias and poor science.

Although other witnesses Monday included two retired N.F.L. players, the mother of an injured college player and three other doctors, the gathering became a litmus test for the N.F.L.’s new leaders on the issue of head injuries.

At one point, Anthony D. Weiner, Democrat of New York, asked if anyone on the panel could speak about helmet technology and became visibly irked when no one — particularly Ellenbogen and Batjer — offered a word. Later, after those doctors explained that they might retain approaches and data from their predecessors, Weiner said, “You have years of an infected system here that your job is to some degree to mop up.”

At one juncture, Weiner said, “Your answer doesn’t leave me very comforted.” At another, he chided, “You’re in charge of the brains of these players!”

Batjer, the chairman of neurological surgery at Northwestern Memorial Hospital, said in an interview that the three-hour hearing was reasonable. Ellenbogen, the chief of neurological surgery at Harborview Medical Center in Seattle, said, “I took it to heart.”

Ellenbogen said of Weiner: “I hear him loud and clear, O.K.? I didn’t have any problem with that. I think he’s right on. The bottom line is we’re coming in new and we’ve got a lot to do.”

Since a similarly heated hearing before the House committee last October, the N.F.L. has made several substantive changes to its approach to brain injuries, including the use of independent neurologists for return-to-play decisions and the airing of public-service announcements.

Just last week, Commissioner Roger Goodell wrote to the governors of 44 states without explicit concussion guidelines for youth sports urging them to follow Washington State’s law, which Ellenbogen helped devise.

In March, Batjer and Ellenbogen replaced Dr. Ira Casson and Dr. David Viano on what the N.F.L. renamed its Head, Neck and Spine Committee, further distancing itself from the group’s controversial past.

Batjer opened the hearing by detailing the league’s redirection and its current goal to make all sports, not just football, safer for athletes of all ages.

Ellenbogen discussed the Washington law, a new league injury database and the N.F.L.’s interest in assessing the cognitive decline of retired players. He concluded by saying, “I can assure you that the N.F.L. will be the leader now in this area.”

Sánchez and Weiner, the only two members of the House committee present for most of the hearing, later pressed the doctors for details. When Weiner received no response to his general question about helmets, he said, “If no one here is qualified to talk about it, I guess in the future we could perhaps drill into this.”

The doctors’ responses often cited subcommittees and outside experts — at one point, Weiner interrupted sarcastically to say, “I appreciate this roll call, but do you remember my question?” — rather than the mind-set of Batjer and Ellenbogen themselves.

Weiner said in a subsequent interview that despite their being in the leadership positions only two months, he expected greater proactivity and assertiveness from the N.F.L. doctors.

“I was troubled by the idea that the N.F.L.’s new experts on head trauma would be so unprepared to answer even basic questions about helmets,” he said.

Sánchez focused on retired players, who studies — including one commissioned by the N.F.L. — indicate to be reporting dementia and other cognitive disease at several times the rate of the national population. When Batjer discussed how a fellow committee member could use data collected by Casson that outside experts strongly discredited, she wondered how the group’s new leadership could consider following the path of the old.

Sánchez said in an interview, “I know they’re relatively new, but they’re not young and naïve.”

She added later, “I can only cross my fingers and hope they’ll be a little more responsive to retired players and a little more willing to part with the N.F.L.’s older way of doing things.”

Other witnesses testified about their own areas of expertise.

The retired players Nolan Harrison, 41, and Corey Louchiey, 38, recalled pressure to ignore injuries and their current fears of future cognitive problems.

Charlotte Bingham, the associate vice chancellor of administration at Texas Tech University, detailed a well-publicized incident last year in which Coach Mike Leach responded to the concussion of a player, Adam James, by angrily sending him to a dark shed in which he had to stand for an entire practice. Leach was later fired.

The most personal testimony came from Tammy Plevretes, whose son, Preston, was seriously injured while playing football for La Salle University in 2005. Contending that the university did not follow proper procedures for handling concussions, the family settled a lawsuit against La Salle last fall for $7.5 million.

Preston Plevretes, who watched Monday’s hearing from the audience, sustained permanent neurological injuries and almost five years later can barely speak or walk.

“This is not a broken arm or a broken leg,” Tammy Plevretes said through tears. “This is a broken life.”

Later, while one of the N.F.L. co-chairmen spoke about league policies, Weiner noticed Preston Plevretes’s father, Ted, gingerly hoisting his 24-year-old son out of his seat. Weiner watched as Preston struggled up the stairs and disappeared behind a door, then returned his stare to the doctors.

Jeff Curry/Associated Press

Professionals, like the Arizona Cardinals’ Kurt Warner, have begun to ease the stigma of concussions with more informed statements to the news media and by sitting out after head injuries.

By ALAN SCHWARZ

Originally published: December 10, 2009

A little less crack! accompanies the televised collisions between National Football League behemoths these days. Players are tackling as hard as ever. But broadcasters are toning down the glorification of the sport’s inherent violence.

“I would say in our place, since this story has taken on a greater and greater prominence, we’ve taken action to take out the sound effects on promos and highlights of punishing hits,” said Dick Ebersol, chairman of NBC Universal Sports.

NBC, a broadcast partner of the N.F.L., is hardly alone in its shift toward greater sensitivity over brain trauma among football players. This fall, from the airwaves of sports talk radio to the broadcast booths at games to doctors’ offices, the language of brain injuries has taken an abrupt turn from silly to serious.

Game announcers have replaced words like “warrior” and “toughness” with “injury” and “dementia.” Among Fox pregame analysts, the former New York Giants star Michael Strahan described ex-teammates in their 40s taking Alzheimer’s medication, after which the Hall of Fame quarterback Terry Bradshaw denounced the N.F.L. for dawdling on the issue. Recent brain injuries to some of the most high-profile players in college and professional football — along with a House Judiciary Committee hearing that compelled the N.F.L. to adopt sweeping new safety policies in the middle of its season — have forced announcers to explain why players are suddenly sitting out with concussions their predecessors played through.

“This season has really opened my eyes — everything that’s happening, whether it’s Congress or what’s being reported in the newspapers,” said Cris Collinsworth, the NBC analyst, who has devoted several minutes each game to somber discussion of brain injuries. “The correlation of playing with a concussion and being tough is a culture we have to change within the game and in our society.”

Dr. Gerry Gioia, the chief of pediatric neuropsychology at Children’s National Medical Center in Washington, said he had noticed a drastic turn in the words teenagers were using to discuss their concussions.

For the first time, he said, they were regularly using phrases that were once gridiron blasphemy, like, “It’s not just an ankle,” “Ten or 15 years from now” and “Maybe I shouldn’t go back.”

“It’s almost a new age of discussion now,” Gioia said. “Kids are parroting what they see on TV, during the football games and on ESPN. They’re hearing intelligent talk about how serious concussions are.”

The change isn’t universal. The Fox pregame host Curt Menefee still casually refers to concussions as “dings.” During the House hearing on Oct. 28, Representative Ted Poe, Republican of Texas, rued “the end of football as we know it.” On Seattle news station KOMO, Eric Johnson narrated a segment in which he celebrated the “bone-crushing action” of “heat-seeking football machines,” who had their worlds rocked but soldiered on: “Now that’s a football player!” he exclaimed.

They were 9 years old.

Yet many announcers are more like Daryl Johnston, a former Dallas Cowboys fullback who for Fox called Philadelphia Eagles games in which running back Brian Westbrook sat out because of post-concussion syndrome and wide receiver DeSean Jackson was knocked out of the game with a brain injury. Johnston said he has made sure not to use the words “ding” or “he got his bell rung,” but to approach the injury more soberly: “There should be no bravado — with the players, or with us,” Johnston said.

When there is — the most glaring example coming when the Pittsburgh Steelers’ Hines Ward brazenly criticized his teammate Ben Roethlisberger for sitting out a big game because of a concussion — talk-radio phone lines have buzzed as never before, said Mike Greenberg, co-host of ESPN Radio’s “Mike & Mike in the Morning” show. He said that all the concussion news this season has catalyzed several spirited offshoot debates, like the conflicts of interest among team-employed doctors and the pressures on players to hide their concussions.

“As this is more often discussed, parents are going to listen and say, ‘Why don’t we have this level of safety for my son?’ ” Greenberg said.

“Everyone is talking about this, so why aren’t we doing all these things for our kids?”

Prompted by Congress, the N.F.L. planned to run its first public service announcement regarding concussions during Thursday night’s Steelers-Browns game. The thrust of the message, which was approved by the Centers for Disease Control and Prevention, is a voice-over for players of all ages: “Don’t hide it — report it.”

Collinsworth said that he expects the N.F.L. to limit its comments on the short- and long-term effects of concussions — particularly now that the league is instituting safety policies that for years, and through this October, it insisted were unnecessary.

“When you have an open-ended liability issue that the N.F.L. has now, and there’s so much money at stake, it’s hard to get to the heart of the discussion and to what’s right to do,” Collinsworth said.

Of course, some young players still court catastrophe by playing through their concussions in the name of toughness; last week, one day after the N.F.L. decided that no player showing any significant sign of concussion could return to a game, several players at Tustin High School in California admitted they still wouldn’t tell a trainer if they got hurt.

But professionals have begun to ease the stigma of concussions with more informed statements to the news media. The Arizona Cardinals’ Kurt Warner explained with nuance how it was harder to sit out with a concussion than to play, but he had to anyway. At Eagles practice on Wednesday, Westbrook said of remaining injured, “I’m more concerned about how things will happen for me in the future, how having concussions now will affect me 20, 30 years from now.”

More subliminal messages will be harder to change. A coach who praises a player who returns from a concussion by calling him “tough” will be, perhaps inadvertently, calling those who remained injured less tough. When Eagles Coach Andy Reid said after Westbrook’s concussion that “I’m counting on he’ll be there” for the next game, however unintentionally he made it harder for the player to let him down.

As the language of concussions adapts to the new era, the messages will come from everywhere. Including the public.

“I’ve seen the light,” said Johnson, who received e-mail messages criticizing his glorification of hits by 9-year-olds. “I’d read some stuff before I did that spot, but you get a little carried away with the wow factor, and forget the life factor. That’s football, you know?”

Richard Sandomir contributed reporting.

Originally written by Janice Lloyd, USA TODAY

When high school athletes suffer concussions, as many as 40.5% return to action prematurely and set themselves up for more severe injuries, new research shows.
The study from the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, adds fuel to growing concerns about the long-term side effects of concussions. It also shines new light on inadequately trained personnel on the sidelines unprepared to make accurate diagnoses and informed decisions about sending players back on the field.

STUDENT ATHLETES: Trainers pushing for ‘athletic health care’ in high schools

“We find these numbers about athletes returning to play tremendously alarming,” says
Dawn Comstock, the study’s director of research.

Concussions account for almost one in 10 sports injuries, according to the Centers for Disease Control and Prevention, and for young people ages 15-24, sports are second only to motor vehicle accidents as the leading cause of brain injury. Comstock estimated that more than 130,000 concussions occurred in nine sports last year, adding that those are “conservative estimates” that will grow when she adds nine additional sports to her research this year.

About 3.8 million students competed in those sports. The most concussions occurred in football and boys’ and girls’ soccer.

The statistic most troubling to Comstock: 16% of football players reported returning to play the same day they lost consciousness. An athlete is advised not to return to play the same day after losing consciousness in guidelines created by an international panel of experts in 2004.

Young athletes, whose brains and skulls are immature, risk death or additional concussions by going back too soon. Recurrent concussions also have led to depression and early dementia, according to studies on retired NFL players. All concussions require evaluation by a medical doctor.

In rare instances, the danger of playing with a concussion can lead to death from second impact syndrome (SIS), a condition in which the brain swells, shutting down the brain stem and resulting in respiratory failure. In North Carolina last year, two high school football players died from SIS. Both returned to play within two days of getting a concussion. Three other football players died from brain injuries, and 14 high school football players died overall, says the Annual Survey of Football Injury Research.

The National Federation of State High School Associations has reviewed the new data from Comstock and is sending a revised concussion pamphlet to state federations before the end of the school year, says the federation’s Bob Colgate.

“We’re trying to keep this a front-burner issue,” Colgate says. “Kids are still getting in and playing with head injuries.”

The pamphlet is directed at coaches, the people most often responsible for the welfare of athletes, Colgate says.

Only 42% of high schools have athletic trainers. Kevin Guskiewicz, a former athletic trainer for the Pittsburgh Steelers, belongs to the National Athletic Trainers Association and is chair of the sports science department at the University of North Carolina.

“If we cannot put the appropriate medical personnel on the sidelines, such as certified athletic trainers, schools should consider dropping contact or high-risk sports,” he says. “People have said we’re overreacting, but if you’re involved in mismanagement of these kids and listen to their families, you quickly realize the importance of quality care.”