SECOND IMPACT SYNDROME: Sports Confront Consequences of Concussions

USA Today (Society for the Advancement of Education), May, 2000 by Jeffrey H. Tyler, Michael E. Nelson

The confidential settlement amount should provide the lifetime care required for Schultz. Experts have estimated that his lifetime care costs will exceed $12,000,000.

Many athletes and their parents do not grasp the risk of returning to sports while still suffering even mild concussion symptoms. Most concussions occur without a loss of consciousness, so players and their parents may not realize that a persistent headache indicates that the athlete's brain has not yet recovered from the first blow. The American Academy of Neurology and the Brain Injury Association have issued recommendations for return to play. The guidelines divide concussions into three types:

Grade I: No loss of consciousness; transient confusion; mental status abnormalities last less than 15 minutes. The athlete may play again that day if symptoms resolve within 15 minutes.

Grade II: No loss of consciousness; transient confusion; mental status abnormalities last more than 15 minutes. The athlete can play again only after he or she has been symptom-free for a full week.

Grade III: Any loss of consciousness, either for brief seconds or prolonged. An athlete who is unconscious for just a few seconds can resume play after a full week of no symptoms. If the loss of consciousness lasts several minutes or more, the waiting period is at least two weeks.

Researchers from the Henry Ford Health Systems, Detroit, Mich., have been working with the National Football League, National Hockey League, and National Collegiate Athletic Association to promote a new, more-individualized system to determine when an athlete who has suffered a concussion can safely return to competition. Currently, most physicians rely on various grading systems that rank symptoms and recommend varying lengths of symptom-free observation--ranging from 20 minutes to several weeks--before allowing an athlete to return to play.

According to Mark R. Lovell, head of the Ford Division of Neuropsychology, those guidelines no longer reflect the state of medical knowledge. "For years, our understanding of concussion has been modeled after boxing," thus placing the greatest weight on loss of consciousness. However, physicians have learned that "short-circuiting," which occurs when brain tissue slams against the inside of the skull, can often make itself known in a more gradual way. "We see players who weren't even close to being knocked out who later develop symptoms that suggest more severe concussions, and players who are knocked out who afterward have very little in the way of symptoms." The best way to tell if an athlete's mental processes have returned to normal, he argues, is to compare them with data from preseason tests of memory skills and reaction times.

Stephen Rice, a national expert on pediatric sports medicine at the Jersey Shore Medical Center in Neptune, NJ., argues that the best tool for preventing catastrophic brain injuries is seeing a doctor. In reviewing SIS incidents, he discovered there has never been a documented case of SIS when the injured player was referred to a physician after the first impact. According to Rice and other head injury experts, the referral of the concussion victim to a physician after first impact is an effective preventive measure.