Several recent developments demonstrate increasing recognition of the serious potential consequences of concussion, and commitment to minimize those consequences through appropriate treatment of concussion:
Physicians have an ethical obligation to become knowledgeable about concussion.
On June 9, 2014 the American Academy of Neurology, the largest professional association of neurologists, released a position paper stating that doctors have an ethical obligationto educate and protect athletes from sports concussion and clear them to play only when the athlete is medically ready, standing firm against objections from players, athletes and coaches. The statement declares that sports concussion “is a major issue in the world of health care” and requires more attention from physicians. Read More
On January 23, 2014 the Defense and Veterans Brain Injury Center released new clinical recommendations with a standardized approach for concussion recovery. Included in the recommendations for managing concussion symptoms is a first of its kind five-stage approach for return to activity following a concussion. Detailed “do”s and “do not”s are specified for each stage. Movement from stage to stage is determined by scores on a simple twenty-two item “neurobehavioral symptom inventory” included in the recommendations. Read More
In August, 2013, the NFL announced that it had reached a $765 million dollar settlement of claims by more than 4,500 players alleging that they were suffering from long-term consequences of concussions that the NFL had known about for years, hid from players, and failed to minimize by establishing appropriate protocols for return to play. The alleged cover-up by the NFL, with co-conspirators in the medical community, was recently the subject of an extensively researched PBS Frontline special titled “League of Denial.”
By settling the players’ claims early in the litigation it appeared that the league would avoid further examination of what the league knew and when it knew about the long-term effects of concussion. However, several recent developments indicate that these issues will likely be examined further. The judge overseeing the litigation has appointed a “special master” to make recommendations concerning the settlement and the Brain Injury Association of America has petitioned to intervene in the litigation to make sure that the settlement takes proper account of the
“progressive physical, psychiatric and cognitive disease processes that are caused and/or accelerated by brain injury, but may not manifest in clinically significant symptoms on initial presentation.”
On June 4, 2013, Vermont’s Governor Peter Shumlin signed a bill that imposes greater requirements on schools to protect student athletes from the potentially serious consequences of concussions in sports, especially from multiple concussions.
Under prior law, coaches were required to keep athletes who they had “reason to believe” had sustained a concussion out of play until cleared to return by a qualified health professional. The new law imposes a similar requirement on a coach or health care provider who “knows or should know” that the athlete has sustained a concussion. Read More
The “BRAIN” initiative, which stands for Brain Research through Advancing Innovative Neurotechnologies, is already underway at the National Institute of Health (NIH). And, on April 2, 2013 President Obama announced that his 2014 budget will include $110 million in funding to advance the initiative, which supports human brain research that could be used to treat a range of neurological conditions, including traumatic brain injury (TBI).
I expect the additional funds to elevate the project’s urgency, as it would be a joint effort of the National Institutes of Health, the Defense Advanced Research Projects Agency (DARPA) and the National Science Foundation along with other private and public entities. If this initiative goes forward, it also promises to augment work already underway at other research centers throughout the country.
