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Some comments on the recently released NBA concussion policy statement

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.

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