The League

Dr. Matthew Prowler
Resident Psychiatrist

Dr. Matthew Prowler

Resident Psychiatrist at The Hospital of the University of Pennsylvania

Depressing Conclusions


For a sport that was historically played with no helmets or with the equivalent of a burlap sack as headgear, the last 15 years in the NFL represent a veritable scientific revolution when it comes to head trauma. In 1994, Paul Tagliabue founded the league's 'mild traumatic brain injury committee.' Many ex-players began speaking publicly about their experiences with head trauma and several books were written about the NFL's 'concussion crisis.'

However, it was a more recent tragedy that may have focused the most attention on what has undoubtedly been a long-standing problem. When ex-player Andre Waters, considered one of the hardest-hitting defensive backs in NFL history, committed suicide in 2006, post-mortem pathology showed that Waters' brain had degenerated into that of an 85-year-old man with signs of early stage Alzheimer's disease.

While it is accepted that cognitive and mood changes can result from head trauma, there is still great uncertainty within the medical field about how to define brain injury and even greater about how to treat it.

The June issue of The American Journal of Psychiatry examines the psychological effects of mild traumatic brain injury (TBI). TBI severity is graded as 'mild to severe' based on duration and intensity of the loss of consciousness and / or amnesia after a head injury. While many patients improve after a concussion - it is estimated that half of patients recover fully within one month and that 80-90% recover by 6-12 months post injury - others suffer harmful consequences. As head injuries usually affect the frontal and temporal lobes of the brain, common neuropsychological symptoms include irritability, mood swings, apathy, as well as memory and cognitive deficits.

While there has been some success with antidepressants or cognitive-enhancing medications to treat post-concussive symptoms, there is no clear-cut cure, or even FDA approved drug for this indication. The best intervention remains the prevention of head injury in the first place.

And to this end, current commissioner Roger Goodell has initiated some laudatory rule changes. In 2007, he made baseline neuropsychological tests mandatory for all players, so that there would be objective data points with which to compare after a TBI incident. Also, more effort has gone into testing helmet design and instituting rules to prevent unnecessary injuries due to spearing of players with head-down tackles.

But any fan can tell you that the penalizing of these hits remains imperfect at best. And big hits remain an undeniable part of the game and reliable ESPN highlight fodder. So ... 'Are you ready for some football?'... without the brutal head-on force that leaves strong men laying unconscious on the field? Fan distaste for the aftermath, along with scientific advances, would create the impetus for more preventive changes.

By Dr. Matthew Prowler  |  June 10, 2009; 12:49 PM ET  | Category:  Concussions , Dr. Matthew Prowler , Medical Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati  
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