This week, we'll see the release of the new movie "Concussion" — a drama about the connection between head trauma in NFL athletes and their later development of brain pathology. While we're all very familiar with concussion lingo – 'CTE', for example - I wanted to ask an expert to shed some light on this topic. Dr. Alex Strauss is a Board Certified psychiatrist and Partner at Centra, PC, a multidisciplinary practice in the greater Philadelphia Area. His practice focuses on concussion assessment and treatment.
Q: How did you get interested in concussion assessment and treatment?
In 2005, while in medical school, I traveled with a buddy to Arizona for spring training baseball. I was really impressed with Adam Greenberg and his play for the Cubs. Unfortunately, in his first major league at bat, he was hit in the head. I was amazed how one hit to the head was so detrimental to his career. Later I trained with the University of Pittsburgh Medical Center neuropsychologists who developed ImPACT testing (a computerized cognitive assessment test). I learned that 20 percent or so of athletes don't quickly recover from concussions. In studying the medical management of prolonged post-concussion syndrome, I quickly realized the impact of mental health on recovery and that the development of depression, anxiety and ADHD symptoms is common.
Q: What occurs when a player is taken back to the locker room for concussion assessment?
Typically the athlete has experienced either signs or symptoms associated with concussion. A tool such as the SCAT (Sports Concussion Assessment Tool) is then used to screen for a head injury. It's best if there is a baseline of the SCAT before injury, to be able to compare scores. The SCAT includes an assessment of past history, current responsiveness, awareness of game info (e.g who last scored), symptom evaluation (e.g. headache, nausea), cognitive assessment (e.g repeating numbers backwards and recall of words), and a neck, balance and coordination exam. A concussion diagnosis should be made based on the SCAT but also using the clinical judgment of the on-field assessor.
Q: What are some recent advances in concussion assessment and treatment?
One tool that is being utilized more and more is brief cognitive assessments such as the ImPACT test. That's a computerized test that allows for a baseline score (at the beginning of the season) and then can be measured again after an injury to see if there are any changes in cognitive function. A decrease in score may be one sign of concussion, and a player's score should return to baseline before return to play. One of the newest advances in concussion management is the speed at which we get students and athletes back to modified school and activities. In the past, players with post-concussion symptoms would be removed from life for weeks to months. But now, we can get people active again within days. Additionally for student-athletes, there is growing research on returning to learn following concussion, which is a wonderful addition to the more studied return to play.
Q: What are some recent advances in concussion prevention?
The most recent advances include modifying sports to help decrease the likelihood of head injury. For instance US soccer recently told players not to head the ball for ages 10 and under.
Q: Research in football shows that players experience not just knock-you-out hits, but 900-1,500 blows to the head a season. What effects do these more minor, but frequent, hits have?
I believe it's mixed at this point; however there are definitely some articles demonstrating that multiple minor blows can lead to problems. These hits are often deemed "subconcussive."
Q: If you were the lead NFL physician, what changes would you suggest to make the game safer?
I believe the NFL has done a lot in recent years to help, such as rule changes to help prevent people from leading with their head and hitting people in the head. Part of the problem is that athletes keep getting bigger, stronger and faster, leading to bigger impacts. Football like many other sports poses significant risk for injury while at the same time excellent experiences for many children and adults.
Q: If you had a son, would you let him play football?
I say 'no' at this point and have purposefully not exposed my son to football. In my work, I see the worst of the worst in terms of injury and recovery from concussion. I always remind my patients who are struggling with the difficult question of return to play after prolonged recovery, that they only have one brain so they have to keep it working well. However, I played high school football as a wide receiver and kickoff returner, and my personal experience in tackle football was fantastic for many reasons. Sometimes people need to follow their passion and play the games they love. Additionally, there are a lot of other risky activities and sports, so would I ban those as well? When it comes down to it, if my son had a passion for the game and asked me, I'm not sure how I'd answer that question.
Thanks to Dr. Strauss for sharing his expertise. Have an idea for an interview? Contact Dr. Whitman at firstname.lastname@example.org.