Ask a Doctor: Concussions and the NFL

Once in a while we get a special guest blog here at NYaT and today is one of those times. This one comes from Cynthia Brown, MD. Cynthia was formerly a practicing Neurologist for over 20 years at Fallon Clinic as well as President of the Medical Staff  at St. Vincent Hospital at Worcester Medical Center. She now works for an EBSCO subsidiary, DynaMed (from the website: DynaMed is a clinical reference tool created by physicians for physicians and other health care professionals for use primarily at the 'point-of-care'.); In her free time, Cynthia now lives in Ipswich, Massachusetts and is an active localvore, full-contact bird watcher, eco-traveler, rower, gardener, mother, and lover of old Jews telling jokes. We asked to her to give us a little background on concussions and her advice for the NFL as this is a hot topic right now. Here is what Cynthia had to say:
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The American Academy of Neurology Guidelines for the management of concussion in sports is in the process of revision, so the official date on this is 1997. The old guidelines were somewhat more lax than is current practice and allowed for players to return to the "contest" is they had their "bells rung" (AAN wording!).

One of the leading world authorities on this subject is Dr. Cantu who arrived at the grades of head injury. He and a committee recently published guidelines for returning to play which are somewhat non-committal.

In my practice, I did not allow an player to return to play for 1 week after a head injury, even without a loss of consciousness. A second incident meant they were out for a month. A loss of consciousness kept them out for at least 2 weeks to a month.

The Massachusetts Medical Society recommendations are based on the AAN guidelines:

The athlete should have no symptoms (subjective findings as expressed by the player such as headache, feeling groggy, or foggy) or signs (objective findings that are seen by another observer, such as the player moving clumsily or appearing stunned or dazed) of a concussion. Any amnesia (memory loss) is a critical warning sign. For example, you may notice the athlete repeatedly asking the same questions without remembering that he or she asked them, or without remembering the answers. If an athlete misses any of the
confusion/orientation or memory test questions, in addition to not returning to play, the player should seek emergency medical attention. He or she should not return to athletic activity for a minimum of five to seven days after all symptoms have disappeared and should be cleared first by a physician or certified athletic trainer. Rest is the only known method of treating concussions.

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I think that's a pretty definitive answer on how concussions should be handled. It will be interesting to see the next steps the NFL takes in this matter.