Roar Rookie
Joined January 2014
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The pursuit of performance enhancement in professional sport delivers some delicious ironies. Take for instance recent excitement about technologies to boost the brains of…
Sorry for the confusion Barry, I wasn’t trying to say that an MRI can be done “there and then” on the field (agreed that would be pretty difficult!). Not sure why Fitzy is so reluctant. I was just reinforcing that the acute symptoms of concussion tend to reflect a “functional” disturbance in the brain, rather than “structural” damage. A concussed person can display a number of functional problems whilst still having a relatively “normal” looking MRI. Similarly, down the track a person who experienced multiple concussions may exhibit a number of cognitive/behavioural/emotional impairments and yet have a relatively normal looking MRI… But as you say – see your doctor.
Regarding the UCLA team – certainly aware of this but a little concerned that they are over-reaching. At the moment, CTE can still only be confirmed post-mortem.
Cheers.
What the NRL can learn from the NFL
I agree Barry that it can be difficult to disentangle the precise causes of long term cognitive impairment.
An MRI may be useful for diagnosing brain deterioration (called atrophy), but this tends to be down the track and i’s worth remembering that when a person gets a concussion, they get a disturbance of brain function (that is, they may lose consciousness, have amnesia etc). In most cases, if you did an MRI there and then, their brain would actually look “normal”.
And unfortunately an MRI is not much use in trying to determine if a person has chronic traumatic encephalopathy (CTE). CTE is the particular form of brain disease that some former NFL players have been diagnosed with. Importantly, CTE can currently only be diagnosed once a person has died.
I would encourage anyone who is a mad keen NRL fan to read the link to this case study. It describes the neuropsychological evaluation of a recently retired NRL player. It is worth noting that he had a history of multiple concussions (at least 10) and that an MRI did indeed show evidence of brain atrophy that was attributed to these concussions…
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784794/
Cheers.
What the NRL can learn from the NFL
Yeah the 90% figure is an interesting one. It’s not really to do with the “severity” of concussions. Rather it likely has something to do with the fact that the most recent guidelines on concussion from the “Concussion in Sport Group” (known as the Zurich Consensus Statement – this forms the basis of the AFL and NRL concussion guidelines) says that:
T”he majority (80–90%) of concussions resolve in a short (7–10 day) period”.
What happens every 7 days? Footy! !! And it is certainly in the interests of the AFL and NRL to have the best players on the park each week.
Interesting to note that the Zurich Consensus Statement is co-authored by researchers linked to the AFL and the International Rugby Board…
Cheers.
What the NRL can learn from the NFL
Agreed on the need to take player welfare seriously, Pat. Regarding the actual incidence of concussion in Australian collision sports vs American football – well it is a little slippery.
Both the AFL and NRL claim that the rate of concussion is 5-7 per team per season. There is some research from the 1990’s that suggests the concussion rate in rugby league is a little higher than that – but y’know that’s from the 90’s!
A recent article in the British Journal of Sports Medicine included the claim that:
“Although the exact incidence of sport-related concussion is unknown, epidemiological studies suggest that football codes played in Australia (eg, Australian Football (AF) and Rugby League (RL)) have a 10-fold to 15-fold higher rate of concussion than does American football.”
It is worth noting that two of the authors of that paper also co-authored the AFL’s concussion guidelines (and one was a former Collingwood team doctor).
The AFL puts out an annual injury report detailing injury incidence. Incredibly it claims that only 1.1 concussion per team per season occurs. Why so low? Well, they only counted a concussion if it resulted in the player missing a week of football! What’s worrying about that is there’s evidence to say 92% of AFL don’t miss a week after being diagnosed with concussion (see Makdissi, 2009).
Cheers.
What the NRL can learn from the NFL
Thanks for the article. You touch on a couple of points about concussion:
“The NRL has been so far open to implementing changes to concussion policy to assist the well-being of players.”
It’s interesting to note how the NRL adopted it’s current concussion guidelines. Rather than conduct an independent review, the NRL’s Chief Medical Officer essentially consulted with members of the AFL’s concussion committee, and adopted the AFL’s guidelines almost word for word (albeit a little later than the AFL).
“It is of paramount importance that this continues to be updated with investments being made in researching both current and former player’s health and well-being to ensure the players we love can continue playing the game they love, and still enjoy a life after football.”
I agree, but of course this research should be independent. The NFL developed its own concussion committee who published research funded by the NFL in journals that were edited by researchers connected to the NFL. Unsurprisingly, these articles largely found that there was no problem with concussion in the NFL and that players could return to play on the same day. See: http://theconversation.com/nfl-settlement-fails-to-address-impact-of-collision-sports-17686
“Seeing a player returned to the field after suffering a massive blow to the head was once seen as a sign of courage. I’m not claiming that these players aren’t courageous. I’m claiming the league has a duty of care to ensure that this courage doesn’t override safety.”
Unfortunately the Chief Medical Officer of the NRL has stated publicly (at the 2013 Concussion in Football conference hosted by the AFL) that he has reported several instances where the concussion management policies were breached by team medical staff or trainers. In each instance a report was compiled for NRL management, however to date no team has been sanctioned for breaching the concussion management guidelines. I wrote a short article about this here, in case you’re interested. If the NRL wants to make a stand it should fine clubs who breach the NRL’s concussion rules: http://theconversation.com/is-the-nrl-enforcing-its-own-concussion-rules-13093
You might also be interested in the “baseline concussion testing” that NRL players are required to undergo. All teams must use the neuropsych testing product that is owned by a Melbourne based company, CogState. The AFL also requires all teams to use this product. There are a number of conflicts of interest that people should be aware of, some of which are detailed here, fyi:
http://theconversation.com/sport-concussion-guidelines-rife-with-conflicts-of-interest-13103
Cheers.
What the NRL can learn from the NFL
I remember watching The Wonder Years when I was at school. There is an episode where Kevin Arnold gets picked for the high school baseball team despite being terrible at the try-outs. Nobody, including Kevin, can figure out why he never gets cut from the team, but the coach continues to persist with him. It turns out that Kevin’s father, Jack, saved the coach’s life while they were army buddies in Korea.
My question is “Whose life did Geoff Marsh save in Korea?”?
How did Marsh get picked over White?