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NFL's Next Big Step in Monitoring Concussions Should Be Blood Test

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NFL's Next Big Step in Monitoring Concussions Should Be Blood Test
Associated Press
Percy Harvin being helped off the field after suffering a concussion in the divisional playoff game against the New Orleans Saints.

The NFL’s concussion epidemic has never been more evident than in 2013. Despite the decreased occurrence of concussions in the 2013 preseason and regular season, there were still 228 diagnosed concussions during that time, according to NFL senior vice president of health and safety policy, Jim Miller, per NFL.com's Khalil Garriott.

Even though the NFL made concerted efforts to decrease the frequency and severity of player concussions this past season—such as implementing the crown-of-helmet ban—it has become abundantly clear that improvements need to be made with their injury-prevention measures and diagnostic tools for concussions.

Fortunately, Swedish researchers recently developed a new and promising diagnostic test for brain injuries, as reported by HealthDay's Steven Reinberg (h/t WebMD.com).

It is a blood test that measures the quantity of a particular protein, total tau (T-tau), which elevates in peoples’ blood when they have suffered an acute brain injury.

If it’s found to be a valid and reliable test in further studies, it would be a dependable test—especially compared to field tests—for medical practitioners to use for diagnosing players with concussions and determining their prognoses (i.e. return-to-play times).

Lead researcher Dr. Pashtun Shahim, from the department of neurochemistry at Sahlgrenska University Hospital in Molndal, said:

We have a biomarker [indicator] that is elevated in the blood of players with a concussion. The level of T-tau within the first hour after concussion correlates with the number of days you have symptoms. We can use this biomarker to both diagnose concussion and to monitor the course of concussion until the patient is free of symptoms.

The ongoing discoveries of the long-term effects of repeated concussions necessitate improvements in objective-based diagnostic tests. Professional athletes are financially incentivized to play through injuries—not wanting to be seen as injury-prone during the next contract negotiations.

Therefore, football players are benefited by lying about symptoms they are experiencing when being evaluated for a concussion by medical personnel.

Currently, in the NFL, the most reliable tool for diagnosing and assessing a player’s concussion is baseline testing, such as the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT).

Unfortunately, like many tests, this one can be cheated.

Hypothetically, if a football player is worried that he will miss time in the season due to a concussion, he can purposely answer his questions slower than normal on the initial ImPact test at the beginning of the season.

Then, when he is tested after a suspected concussion, his “normal cognitive range” will be lower than it should be, and he could get a “passing grade” despite actually having a concussion.

A player trying to stay in the game after sustaining a head injury has been prevalent in the past. This could possibly have been the case in the recent divisional playoff game between the Seattle Seahawks and New Orleans Saints.

During that game, Percy Harvin suffered an illegal blow to the head by Saints safety Rafael Bush, and he was evaluated by medical staff. He was soon allowed to return to play.

Shortly thereafter, Harvin suffered another blow to the head, as described Nick Eaton of the The Seattle Post-Intelligencer: "Harvin walked back to the sideline under his own power, but looked visibly shaken, stumbling around a bit as trainers led him by the arm. Harvin was then taken back into the locker room to be examined for a head injury — again."

Following the second evaluation by the medical staff, Harvin was taken out of the game with a diagnosis of a concussion, as reported by NFL.com's Dan Hanzus.

The question that needs to be asked is whether or not Harvin had a concussion after the first serious blow to the head. If he did, his return to the game could have had major repercussions. This would include the occurrence of second impact syndrome, rapid brain swelling caused from a second concussion before the brain has healed from a prior injury. 

Although performing a blood test takes too long to be used to make in-game decisions, it should be used to rule out a concussion diagnosis for a player who is suspected of suffering a brain injury.

If a player is suspected of having a brain injury, he should be removed from the rest of the game and have the blood test performed to determine when he can return to practice or a future game.

This approach would have been helpful for many teams last season. This includes the Denver Broncos, who had to decide when it was safe for five-time Pro Bowl wide receiver Wes Welker to return to play following his first known concussion of the season on November 17, and his second concussion of the season on December 9.

The latter concussion forced the Denver Broncos to keep him out of play for five weeks.

Is it possible Welker was not ready to return after the first concussion in November? That is a very important question that the blood test could have helped answer, if it were available at that time.

With continued research and testing, this new blood test could help the NFL take a big step forward in making the game safer for its players. This test would take the guesswork out of diagnosing concussions, and give medical personnel the information they need to properly treat these athletes.

In addition to research and design for improved safety equipment—such as the NFL’s $10 million incentive program for helmet innovations— improved diagnostic testing of players could help the NFL address the concussion epidemic that has recently reached the public consciousness.

If this test is found to be valid and reliable in future studies, it will soon be an integral aspect of NFL injury reports, vernacular and culture.

 

Dave Pratt, DPT, is a licensed physical therapist focused on orthopedic and sports-related injuries. All information given is for educational purposes only.

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