The tragic metro north rail accident in the Bronx earlier this week will undoubtedly lead to law suits on behalf of the injured victims. But, the victims need to know that there are special Laws in New York which require that a Notice of Claim be filed within 90 days of the train accident against both Metro North and the MTA to preserve their right to comence a law suit. Unless this written notice of claim is filed, the victims will be precluded from suing for their injuries.
I was interviewed in an article appearing in today's Journal News regarding this train accident.
The following legislative update has been prepared by the Brain Injury Association of America (BIAA):
TBI Act Reauthorization 2013
The Brain Injury Association of America testified before the House Subcommittee on Health hearing "Examining Public Health Legislation to Help Local Communities" on November 20, 2013. The Subcommittee on Health is chaired by Rep. Pitts (R-PA) and Rep. Pallone (D-NJ) is the ranking member.
The TBI Act, H.R. 1098 was included with six other public health bills in the hearing. Dr. Drew Nagele, member of BIAA's board of directors testified on behalf of the TBI Act. BIAA is pleased to see the progress of the TBI Act in the House of Representatives. We ask you to contact your Senator's and urge him or her to introduce a companion bill in the Senate for H.R. 1098, the TBI Act.
Safe Kids Capitol Day
BIAA was invited to participate in the second annual Safe Kids Capitol Day hosted by the Congressional Kids Safety Caucus and Safe Kids Worldwide. The event promoted prevention of brain injury including wearing helmets and included concussion education. The Centers for Disease Control and Prevention (CDC) also participated in the Safe Kids Capitol Day.
The TBI Act, which BIAA advocates for provides funding to the CDC to conduct surveillance, prevention and public education programs on TBI. CDC provides free resources through the Heads Up Concussion Campaign for youth sports, schools, high school sports and practitionersBIAA is proud to partner with the CDC and to be a part of Safe Kids Capitol Day.
The following is the November 2013 legislative and policy update from the Brain Injury Assocation of America (BIAA):
TBI Act Reauthorization 2013
The Brain Injury Association of America along with the TBI Act stakeholders, National Association of State Head Injury Administrators (NASHIA) and National Disability Rights Network (NDRN), continue to work with Senate staff on reauthorization. The TBI Act should be introduced in the Senate this fall. National Conference on Youth Sports Safety BIAA was invited to participate in the first National Conference on Youth Sports Safety in Washington DC. The conference was led by Dr. David Satcher, the 16th U.S. Surgeon General. Dr Satcher is currently the Director of the Satcher Health Leadership Institute. The Protecting Athletes and Sports Safety (PASS) initiative seeks to initiate a sustained national conversation on changing the culture of sport so we can better protect our young athletes. PASS will continue to bring together the nation's thought leaders to take the discussion to the next level. Over the next two years, the conversation will lead to the development of a set of national guidelines that identify best practices proven to help 1) significantly reduce youth sports injuries including concussion and 2) provide parents with information they need to make good decisions about involving their children in youth sports. BIAA looks forward to working with PASS to make all sports safer for student athletes.
This week BIAA attended the Nondefense Discretionary (NDD) United Congressional Briefing. NDD United is a campaign of 3,200 national, state, and local organizations working to protect nondefense discretionary investments. As we enter into the next critical phase of budget negotiations, we are urging Congress to replace sequestration with a balanced approach to deficit reduction.
Future Care Coalition
BIAA continues to lead the Future Care Coalition with United Spinal Association meeting with the Office of Financial Management at the Centers for Medicare and Medicaid Services (CMS) to inform them of our concerns related to the Advanced Notice of Proposed Rule Making (ANPRM) for Medicare Secondary Payer Future Medicals. In the ANPRM, CMS proposed 7 options for a beneficiary to reimburse CMS for future medical costs. The Future Care Coalition believes there needs to be strong protections in place for the beneficiary in terms of access to care if CMS were to move forward with collecting future medical costs. The rule is currently at the Office of Management and Budget (OMB) where it is reviewed by OMB staff. BIAA and other members of the Future Care Coalition met with OMB staff to share our concerns about the ANPRM as they move through the review process. The coalition continues to meet with Congressional offices to build Champions on the hill related to this important issue. BIAA and members of the coalition met with staff in Reps. Jenkins (R-KS) and Kind (D-WI) and Sens. Kirk (R-IL) and Portman (R-OH) during the past week.
Centers for Medicare and Medicaid DMEPOS Bidding Program
BIAA was invited to participate in a meeting with the Centers for Medicare and Medicaid (CMS) that was led by United Spinal Association and the Independence through Enhancement of Medicare and Medicaid (ITEM) Coalition which BIAA is a member of to educate CMS regarding the DMEPOS bidding program that provides wheelchairs to Medicare beneficiaries. Wheelchair suppliers also attended the meeting. Even though CMS has opened up the rules to allow non-contract suppliers to repair wheelchairs in addition to contract suppliers, there is no enforcement of non-contract suppliers making repairs for those that need them. The implementation of the bidding program is an added obstacle in ensuring affordable, quality coverage and access to critical medical equipment, supplies and related services to an already vulnerable population; seniors and people with disabilities that must rely on a smaller number of providers for their medical equipment.
The Brain Injury Association of New York State (BIANYS) has scheduled in new webinair, “Overview of Benefits for Veterans with Brain Injury” for Friday, November 22, 2013 from 1:00-2:15 p.m. EST. This webinar will provide an overview of benefits available to Veterans who have sustained a TBI, their families and caregivers. For more information and to register, click here
Concussions and traumatic brain injury occur as a result of the rapid movement of the brain within the skull. The brain floats within the skull cavity. When the brain moves forward or backward and rotates, it brushed up against the sharp ridges and protrusions of the skull.
A helmet may be effective in preventing or reducing the chances of a skull fracture or scalp laceration but despite misleading claims by helmet manufactuers, a football helmet or any other sporting helmet cannot protect against the shearing, brusing or tearing of brain tissue that takes place when the brain moves within the skull.
A paper presented at the recent meeting of the Amercian Academy of Pediatrics, National Conference in Orlando, Florida found that "neither any specific brand of football helmet nor custom mouth guards result in fewer concussions in kids who use them" The study authors conclueded, "Despite what manufacturers might claim, newer and more expensive eqipment many not reduce concussion risk."
The New York Times contains an interesting opinion column today, Time to Remove Coaches From Concussion Decisions, discussing the importance of letting health care professionals rather than players or coaches determine when an athlete should be removed from a game because of a suspected concussion.
Without a doubt, the decision to be removed or to return to play cannot be left to the athlete or the coach who are both vested with conflicts in their decision making and judgment on this important issue.
Here is some of the important opinions contained in the article:
"What sports has to do, though, is remove the coach and the player in deciding if an athlete can return from a blow to the head. Player and coach are driven by adrenaline and by impulse, and are not qualified in medical matters."
"No coach should make that decision with head injury, and no team physician either. Neurologists and other experts studying the brains of deceased soccer players and investigating former boxers, hockey and rugby players and equestrian riders have the same mantra. They would never attempt to fully diagnose on the field the repercussions of what is going on inside the skull of an injured player. A tiny bleed can lead to a clot, and it might take days to develop."
A presentation at the American Academy of Pediatrics demonstrated that children who had suffered brain injury or concussion were twice as likely to develop symptoms of depression as their peers.
“Wylie MC, Gjelsvik A, Linakis JG, Vivier P. Depression in Children Diagnosed with Brain Injury or Concussion. American Academy of Pediatrics Presentation. 2013.
For more details, click here.
The following editorial was published today in the Boston Globe:
NHL should get serious about violence and head trauma
Despite Having nothing to do with the actual sport of hockey, which at its best is a blend of grace and power on skates, fighting has become an inseparable part of the pro hockey experience. While other team sports are cracking down on on-field violence, the National Hockey League implicitly accepts fighting as a part of the sport — or, more cynically, a vehicle for riling up fans. But it’s time for the league to reassess the role of fistfights in its games, both for the safety of its players and the example they set for young athletes.
Evidence is now emerging that repeated head trauma, of the type meted out by team “enforcers,” can lead to the same chronic traumatic encephalopathy that is striking football players. On the opening night of the NHL season, a fight resulted in a Montreal Canadiens player being knocked unconscious as his head hit the ice. A preseason fight resulted in a concussion and broken jaw for a rookie for the Buffalo Sabres.
Finally, some leaders within the sport are saying that enough is enough. At a conference on concussions recently, Michael Stuart, chief medical officer for USA Hockey and codirector of the Mayo Clinic Sports Medicine center, said it was time to ban all fighting.
Whether it is the upright blows to the head or the crashing of heads to the ice, Stuart said, “Those forces acting on the brain are alarmingly high.” Joining him in the call was Hall of Fame goalie Ken Dryden, who declared, “Science has responded to the game on the ice. Now it’s time for the game to respond to the science.”
The game should respond to the science with automatic ejections, suspensions, and major fines for players who fight on the ice. Fighting is banned in American collegiate hockey and in youth hockey leagues in North America. It is time for the professionals to follow suit.
The Brain Injury Association of America has announced a new webinair to explore the new Obama, health care legislation and its implications for those with traumatic brain injury entitled, “One Month Into Health Care Reform: An Update on Health Insurance Exchanges”
Participants will learn:
1. The status of how the new health insurance marketplace is operating
2. How individuals with brain injury fit into overall health care reform
3. What the changes mean for providers and consumers of brain injury benefits
Date and Time Fri, Oct 25, 2013 3:00 PM - 4:00 PM EDT
Panelists Peter Thomas, Principle The Powers Firm Theresa Morgan, Legislative Director The Powers Firm
Registration Register at this link
Webinar ID: 147-022-147
Audio Participants can use their computer's microphone and speakers (VoIP) or telephone. United States Toll: +1 (909) 259-0012 Access Code: 205-103-885 Audio PIN: Shown after joining the webinar
An individual's recovery months after a traumatic brain injury (TBI) is difficult to predict, and some of the variability in outcomes may be due to genetic differences according to an article published in the Journal of Neurotrauma.
The genes that regulate a person's inflammatory response to injury can impact clinical outcomes in TBI, according to the study. The article is available free on the Journal of Neurotrauma website by ciicking here.
Today's New York Times reports, Many Ex-Players Many Be Ineligible to Share in Concussion Settlement.
it is shameful that this settlement excludes players suffering the effects of the post concussion syndrome, complicated mild traumatic brain injury and cognitive, behavioral and emotional difficultes that do not impair all of their activities of daily living.
I am honored to have been consulted and quoted in this story. Click here.
I am honored that the Huffington Post has published the response of Shana De Caro, chair-elect of the traumatic brain injury litigation group and myself “Players and Public Lose While NFL Reigns Victorious,” to
Commissioner Goodell’s recent comments on the NFL settlement and the amazing expose on what the NFL knew and when they knew it which aired last night on PBS, Front Line documentary, “League of Denial”
A critical investigative report on what the NFL knew and when it knew it-The concussion crisis in professional football
A documentary produced by FRONTLINE which promises to be a critical analysis of the concussion crisis in the NFL is scheduled to be aired on Tuesday, October 8th, beginning at 9 PM, EST. The film entitled, “League
of Denial” has already received a great deal of publicity based upon the abrupt withdrawal of joint sponsorship by ESPN. News reports suggest that ESPN was pressured by senior NFL officials to end their association with this film.
In the film, FRONTLINE investigates the hidden story of the NFL’s response to head injuries. Through interviews with former players, scientists and other experts on the concussion issue, it examines what the NFL knew about the risks of such injuries, and when it knew it.
You can learn more and see previews by clicking here.
An article in USA Today, Hyperbaric chamber treatments did not help with mild TBI reports a study, published this week in the Journal of Head Trauma Rehabilitation, which reports that using hyperbaric oxygen therapy
does not improve the outcome in soldiers suffering from traumatic brain injuries. This study confirms an earlier study published in 2011 with similar results.
This is the latest study to test the hypothesis that using oxygen under high pressure to perfuse brain tissue promotes healing of damaged brain cells. In studies sponsored by the Pentagon and the Veterans Administration, this therapy has been found to be ineffective for treatment of traumatic brain injury.
The abstract submission site for the Tenth World Congress on Brain Injury is now open. The deadline for abstract submissions is October 11, 2013. To submit an abstract, click here.
Abstracts will be reviewed by the Congress’s International Scientific Committee, which will determine the most appropriate presentation format (oral presentation or poster) for each abstract accepted.
The 2014 abstract submission categories mirror the educational themes of the Congress as follows:
Neurotrauma – basic research
Neurotrauma – prevention and public health
Neurotrauma – case reports/clinical research
Neurotrauma – health services and outcomes
Technology – basic research
Technology – clinical research/applications
Neurorehabilitation – basic research
Neurorehabilitation – case reports/clinical research
Neurorehabilitation – activities and participation
Neurorehabilitation – public policy and advocacy
The Tenth World Congress on Brain Injury will take place in San Francisco, California on March 19 - 22, 2014.
The IBIA World Congress is the largest gathering of international professionals working in the field of brain injury. Delegates are comprised of physicians, psychologists and neuropsychologists, therapists, social workers, nurses, case managers, legal professionals, advocates and all others working in the field of brain injury.
The Tenth World Congress program will feature internationally recognized invited speakers, platform lectures, workshops, short oral presentations and poster sessions. The theme of the congress will be Neurotrauma, Technology, and Neurorehabilitation.
The aim of the Tenth World Congress is to provide an opportunity for establishing collegial relationships with international professionals focused on the care and/or service of persons with acquired brain injury and/or the science of brain injury research. State of the art research will be presented dealing with information spanning from basic science to clinical (coma to community) aspects of brain injury.
For more information, please click here.
Congress Location and Hotel
The 2014 IBIA Tenth World Congress on Brain Injury will be held on March 19 - 22, 2014, in San Francisco, California at the Hyatt Embarcadero Hotel.
The Brain Injury Association of New York State (BIANYS) is offering a free webinar: From the Desk of the School Nurse: How to Implement A Concussion Management Protocol.
Time and date: Wednesday, August 28, 2013, 11:00 a.m. - 12:15 p.m. (EDT)
Overview: The presenter, Patricia McLaughlin, RN, will focus on the importance of taking a multi-disciplinary team approach to concussion management and how best to implement a concussion management protocol in a school district setting. Patricia McLaughlin is a parent and a registered nurse with 25 years of experience. She is a current member of the staff at Albany Medical Center Coronary Care Unit. Mrs. McLaughlin also works as a full-time school nurse at Pine Bush Elementary School K-5, where she has been for 6 years.
For more information, please click here
The Brain Injury Association of America will present the 2014 Brain Injury Business Practice College at the Green Valley Ranch Resort and Spa in Las Vegas (Henderson), NV, January 21-23, 2014.
The 2014 College will offer sessions to enable rehabilitation executives, managers, and professionals to improve their business methods and metrics, and the Planning Committee has chosen Innovation as its theme. The full schedule will be posted on the BIAA website.
Today’s New York Times contains an interesting and important article on football helmets and the fact that they do not prevent players from sustaining a traumatic brain injury.
It is always an honor to be quoted in an article in the New York Times. Warning Labels on Helmets Combat Injury and Liability
The following legislative update on developments on traumatic brain injury in Washington has been prepared by the Brain Injury Association of America (BIAA):
Appropriations Bill Approved
The Senate Defense Appropriations Subcommittee approved a $594 billion fiscal 2014 Defense spending bill this week. In the bill there is a $60 million increase in Pentagon medical research efforts for traumatic brain injury and psychological health.
Committee Passes Reauthorization of the Workforce Investment Act, S. 1356
This week, the Health Education Labor and Pensions (HELP) Committee passed the reauthorization of the Workforce Investment Act (WIA). The WIA Reauthorization has been over due since 2003. The bill passed through committee by an 18-3 vote, and will now be considered by the full Senate.
In the bill, the National Institute on Disability and Rehabilitation Research (NIDRR) will be moved to the Administration on Community Living (ACL) in the Department of Health and Human Services (HHS). NIDRR is renamed the National Institute on Disability and Independent Living Research (NIDILR). NIDILR is where the TBI
Model Systems are located. There are 16 TBI Model Systems throughout the United States that provide care and collect information on individuals with traumatic brain injury during the acute hospital stay and in the community after discharge.
Title V of WIA reauthorize the Rehabilitation Act, including vocational rehabilitation (VR) programs. According to the committee press release the updates to the Title V are aimed at making sure that young people with disabilities have increased preparation and opportunities for competitive, integrated employment. The bill requires state VR agencies, in conjunction with local educational agencies, to make "pre-employment transition services" available to students with disabilities. Updates to the bill also focus on creating better alignment of government programs at the national level that are focused on employment and independent living for people with disabilities.
Congressional Hearing on Human Brain Research
This week the House Committee on Science, Subcommittee on Research and Technology held a
hearing entitled the Frontiers of Human Brain Research. Witness included Dr. Story Landis, Director of National Institute of Neurological Disorders and Stroke at the National Institutes of Health, Michael McLoughlin, Deputy
Business Area Executive, Research and Exploratory Development at Applied Physics Laboratory at John Hopkins University, U.S. Air Force Master Sergeant Joseph Deslauriers Jr., Dr. Marcus Raichle, Professor of Radiology, Neurology, Neurobiology and Biomedical Engineering at Washington University, and Dr. Gene Robinson, Director at the Institute for Genomic Biology, Swanlund Chair, Center for Advanced Study Professor in Entomology and Neuroscience at the University of Illinois.
Congratulations and best wishes to Nicole Godaire who has been appointed the new executive director of The Brain Injury Association of Massachusetts (BIA-MA).
Ms. Godaire has served the association for the past eight years in multiple capacities, including her most recent position of assistant executive director and manager of education.
The BIA-MA is the state chartered affliate of the Brain Injury Association of America.
Huffington Post just published our thoughts on the proposed mediation of the NFL lawsuit.
The following webinairs are sponsored by the Brain Injury Association of America duing the month of July:
July 18, 2013, 3 p.m. ET, Mitch Rosenthal Memorial Webinar: Sexual Functioning after TBI
Angelle Sander, PhD, will discuss current research on sexuality following TBI.
Registration ends July 16, 2013, at 5 p.m. ET. Click here.
July 24, 2013, at 3 p.m. ET:
Discussion of the current status of implementation of the Patient Protection and Affordable Care Act and other legislative and regulatory actions affecting access to rehabilitative care for people with TBI.
Register for this webinar here:
July 31, 2013, 3 p.m. ET, Caregiver Education Series: Getting Things Done with Smart Apps
Michelle Ranae Wild will explore a number of productivity apps available to help after brain injury.
Registration ends July 29, 2013, at 5 p.m. ET. Click here.
I had the pleasure of viewing in preview, a new HBO documentary, The Crash Reel exploring the life and brain injury sustained by American snowboarding champion, Kevin Pearce which will debut on Monday, July
15th at 9 PM eastern time, 8 c on HBO.
As an advocate for persons with a brain injury, I appreciated the compassionate approach to the subject matter. The treatment of Kevin as a person with a brain injury, rather than a brain injured person is a very important message for members of the public. Kevin does not allow his brain injury to define who he is. He is an inspiration to anyone who has sustained a traumatic brain injury.
The stages of the film depicting Kevin’s journey are quite helpful to an understanding of the transitions that an individual and their family members go through following profound brain trauma.
This film will make a very important contribution to the understanding of traumatic brain injury in the minds of the public.
The filmmakers have launched a comprehensive traumatic brain injury awareness and outreach campaign called #LoveYourBrain and the Pearce family has started the Kevin Pearce Fund to support families and individuals
affected by traumatic brain injury and other challenges.
For more information on the documentary, visit their face book site.
Stroke is the fourth-leading cause of death in the United States and the number one cause of disability. According to the Centers for Disease Control, each year an estimated 795,000 people in this country experience a stroke. the No. 1 cause of adult disability?
Did you know that approximately 20 percent of strokes occur in people younger than age 55, and over the past decade?
But, prompt action can greatly reduce the risk of severe disability and death following a stroke. It is important to recognize the signs of a stroke and get the victim to a hospital so that prompt treatment can be instituted. There is now an accepted FDA approved medication known as TPA, a clot busting drug which if administered within the first several hours following a stroke can lead to full recovery.
If you see any one of these "Five Sudden, Severe Symptoms," call 911 -- regardless of the victim's age.
• Sudden numbness or weakness of the face, arm or leg on one side of the body.
• Sudden confusion, trouble speaking or understanding.
• Sudden trouble seeing on one side.
• Sudden, severe difficulty walking, dizziness, loss of balance or coordination.
• Sudden, severe headache with no known cause.
It is important to emphasize the words "sudden" and "severe" and the number "one." Any of these symptoms can occur in a mild, fleeting way and not be worrisome, but if any one of them comes on suddenly and is quite severe, it could signal the onset of a stroke, which increasingly is described as a "brain attack," because like a heart attack, a stroke requires immediate action to improve the odds against disability and death.
The medical profession has a saying, Time is brain. The crucial element is time. Rapid transport to a hospital and followed by rapid administration of the clot busting drug greatly improves the chances for a better outcome.
The Court ordered mediation of the lawsuit brought by players against the NFL alleging the league’s fraudulent concealment of the risks associated with concussions was discussed in today’s USA Today, on line edition, Judge orders mediation on NFL concussion suits
I am honored to have been quoted in this article concerning my views on the dangers that a mediated settlement will have in perpetuating the long standing conspiracy by the National Football League and its partners to
hide the dangers and long term consequences of concussions.
Here is a portion of what I said,
Michael Kaplen, questioned whether a settlement – and the confidentially that could entail -- would be in the public interest.
"I'm not so sure it is the right solution to this issue …. The facts surrounding this case are so important not only to the players involved in the case but to everybody else who has an interest in the issue of sports concussions," Kaplen said.
"These facts need to be set forth in the public arena. They can't be hid under the rug in exchange for payment of money. And that's what I'm afraid is going to happen."
Kaplen added, "This impacts any child that's playing any type of sport … the parents, the coaches, the school systems who have looked to the NFL as their model. It goes to college athletic programs, and the implications are just huge. It's like if the tobacco companies settled cases before all the (court) discovery took place, we wouldn't know what they knew, when they knew it and how they hid information."
The American Academy of Neurology (AAN), has launched a new app called "Concussion QuickCheck", to help coaches, athletic trainers, parents and athletes quickly evaluate if someone may have a concussion and needs to seek medical assistance.
The app, which is available for iPad, IOS (Apple), Android, and mobile, was developed in partnership with the Academy’s updated guideline for diagnosing and evaluating sports concussion.
Key information and tools in the "Concussion Quick Check" app include:
Common signs of concussion
Symptoms of concussion
Things the athlete may tell you
What to do if an athlete has a head injury during a game
What to do if it appears the athlete has a concussion
When an athlete should return to the game
Help finding a neurologist near you (GPS capability)
Help finding state laws on concussion
Learn more by clicking here.
Traumatic brain injury in the elderly is explored in a special edition of NeuroRehabilitation: An Interdisciplinary Journal. The guest editor of this collection of articles is the well-known expert in the field of neuropsychology and traumatic brain injury, Wayne A. Gordon, PhD., Vice Chair of the Department of Rehabilitation Medicine at Mount Sinai School of Medicine in New York.
The articles in this special edition address the following subject matters:
A comparison of cognitive function of individuals diagnosed with dementia and a history of TBI with those with dementia and no history of TBI;
Factors related to death following TBI in the elderly based upon medical chart review of individuals 55 years and older who died one to four years after moderate or severe TBI, and compared these to matched living patients;
Characteristics of the inpatient rehabilitation treatments received by individuals with a TBI who were above the age of 65 when they received their injury;
Use of The Brief Test of Adult Cognition by Telephone (BTACT) to screen elderly patients for TBI;
Review of the literature on age-specific factors that are related to successful outcomes in the elderly who sustain a TBI.
We will never solve the concussion problem in sports until players understand that a brain injury can last a life time. But, what we do know is that we cannot rely upon the player to be truthful and accurately report their symptoms. Therefore, we must have longer minimum times that a player is not permitted to return to play following a suspected concussion.
At the annual meeting of the Pediatric Academic Society held in Washington, D.C., a survey was revealed which found that even though young athletes said that they understood the dangers of a head injury, 53% said they would “always or sometimes continue to play with a headache sustained from an injury.” Just 54% said they would “always or sometimes report symptoms of a concussion to their coach.”
Among the surveyed players, 30 reported suffering a concussion and 82 reported having concussion symptoms and risks explained to them. The majority of the high school athletes indicated that they understood that headaches, dizziness, difficulty with memory, difficulty concentrating and light and sound sensitivity were all risk factors for a concussion after a high-impact hit.
The National Basketball Association has released its new concussion policy statement and it leaves a lot to be desired.
Although the policy provides for a series of steps to determine when a player can return to play following a concussion, there is no required minimum amount of time to keep a player out of play, other than preventing him from returning to play on the same day that the injury takes place.
The statement also requires baseline neuropsychological testing of all players before the start of the season and requires a return to baseline before they are permitted to return to play, but as we know, return to base line in and of itself cannot be used as the sole criteria for clearing an athlete following a concussion. Concussions are more complicated than just completing a series of computer questions. Things can and do get worse for those injured by a concussion in the days and weeks following the initial injury even though the player, may return to baseline.
From reading the NBA policy, they seem only to be concerned with brain injury symptoms caused by exertion. What about mood changes, personality changes, behavior changes, memory functions, concentration difficulties, sleep problems, loss of sleep, sensitivity to bright light and sound and the list goes on and on? Shouldn’t they also be considered before a player is permitted to return to play?
Here is the reported National Basketball Association Concussion Policy:
The National Basketball Association Concussion Policy is designed to maximize the neurological health of NBA players by providing a framework of education and clinical management. The policy was created under the core principle that each concussion, and each athlete, is unique. Optimum medical care depends on an individualized and comprehensive approach to concussion management.
1. Education: Every player and coach receives concussion education prior to the beginning of each season. Topics include information on the underlying mechanism of concussion, common and uncommon presentations of concussion, appropriate management strategies and possible complications or long-term manifestations of the injury.
2. Baseline Testing: Prior to each season, each player will undergo testing of baseline brain function, via a neurological and cognitive assessment.
3. Evaluation and Management:
a. If a player is suspected of having a concussion, or exhibits the signs or symptoms of concussion, they will be removed from participation and undergo evaluation by the medical staff in a quiet, distraction-free environment conducive to conducting a neurological evaluation.
b. If a player is diagnosed with concussion, he will not return to participation on that same day.
c. A player that is diagnosed with concussion should have their physical and cognitive exertion limited as much as possible while they are still experiencing symptoms of concussion.
4. Return to Participation Decisions:
a. Once a player is diagnosed with a concussion he is then held out of all activity until he is symptom-free at rest and until he has no appreciable difference from his baseline neurological exam and his baseline score on the computerized cognitive assessment test.
b. The concussed player may not return to participation until he is asymptomatic at rest and has successfully completed the NBA concussion return-to-participation exertion protocol.
5. Return to Participation Protocol:
a. The return to participation protocol involves several steps of increasing exertion — from a stationary bike, to jogging, to agility work, to non-contact team drills.
b. With each step, a player must be symptom free to move to the next step. If a player is not symptom free after a step, he stops until he is symptom free and begins again at the previous step of the protocol (i.e., the last step he passed without any symptoms).
c. While the final return-to participation decision is to be made by the player’s team physician, the team physician must discuss the return-to-participation process and decision with Dr. Jeffrey Kutcher, the Director of the NBA’s Concussion Program, prior to the player being cleared for full participation in NBA Basketball.
d. It’s important to note that there is no timeframe to complete the protocol. Each injury and player is different and recovery time can vary in each case.