Concussion diagnosis still not foolproof

2015-09-17 10:10:15 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.

Browns' quarterback Josh McCown suffered a concussion on this play. Browns' quarterback Josh McCown suffered a concussion on this play.

With the recent news of Browns' quarterback Josh McCown suffering a concussion in the season opener against the New York Jets, I wanted to discuss the difficulty in diagnosing concussions.

It's especially a challenge in the college and high school settings where staffs - and budgets - are significantly smaller.

To make matters worse, players avoid concussion protocols, even popping right back up and dodging officials, because any sign of head injury means they're coming out of the game.

Yesterday I visited in studio and spoke with 1590 WAKR morning show host Ray Horner about this topic. Several rule changes in football have been implemented recently to help make the game safer, and I have seen an improvement in tackling techniques on the field.

But, we really won't know for another 10 to 15 years if we're affecting the game in a positive way.

Below is an audio file and transcript of our discussion.



HORNER: In our studio is our good friend, Dr. Joe Congeni from Sports Medicine Center at Akron Children's Hospital. Joe, I guess we gotta start off with the Cleveland Browns and our quarterback diving into the end zone.

trying to do the right thing; trying to get us a score, but we've got one quarterback with a bad elbow over there and Josh gets knocked out with a concussion.

They said he was up and he even drove himself home when they got back. Talk about this.

DR. CONGENI: Wow. I didn't see that one. We are very careful with our concussed, uh, high school athletes to make sure they're not driving if they are over 16 because it does affect your reaction time and cognitive function to some extent.

We haven't talked about concussion in a while ... so, you know, there's been a lot of debate in a few areas related to the McCown thing.

No. 1, the independent neurologic are on the sidelines and in the booth looking for abnormal behavior patterns that might say, "Hey, this person needs checked," because many athletes are not gonna say, "Hey, check me."

Dr. Joe Congeni Dr. Joe Congeni

And so, you're looking for abnormal behavior patterns. The problem is if you're in the college setting, which we are, or the high school setting even more, uh, you don't have that luxury.

And so, you're trying to watch 40 people walk around on the sidelines, you know, 35, 40 kids and it's hard to pick up on some of those patterns. And, it's to take a little of the fun out of covering, as it's a little bit harder to tell.

And then, we really don't even know with a lot of the rules changes we've made we're affecting things in a positive way. We might not know for 5 or 10 years.

HORNER: Well, what they were saying as well, and it's interesting you brought that up, is a lot of these players now, they're getting dinged, they're jumping right back up or they're staying away from those people because they don't want to go through the protocol of possibly having to come out.

They were talking about it all weekend, where some of these guys get knocked down. They immediately pop up and they go running back because they don't want to have a doctor looking at them.

DR. CONGENI: Right.

HORNER: Because that means they're coming out of the game.

DR. CONGENI: They're coming out of the game. They go to the locker room. They have the evaluation. You know that there is now some objectivity to the evaluations, but much of it is still clinical.

You know, "How do you feel?" balance testing, cognitive testing, do the months in reverse order. , starting with the month of, uh, September, tell me the months in reverse order. Uh, listen to, you know, 5 objects that I'm gonna tell you and remember them in 3 minutes.

You know, so those are some of the types of cognitive tests that we do in the high school setting still. And, it's not an exact science and it's very difficult to do it. And so, seeking out those people that are having the concussions is the hard part.

And then, on top of all that, and they're very, very rare -- I'll stress again, very, very rare -- but in Northeast Ohio we had an incident on Friday night. I'm not sure if you heard about that at Hubbard High School. I was out in Youngstown Friday night.

Out that direction, it was Ashtabula ... I believe, and Hubbard, and a young man had a brain bleed and was rushed by life flight to Metro General Hospital in Cleveland.

HORNER: Wow. That's awful.

DR. CONGENI: Yeah. ...

HORNER: And this was after a pop, right?

DR. CONGENI: It was after a hit, but there is a lot of discussion about whether that's a totally different thing because it doesn't present like a concussion at all.

There's a lot of people looking into might those people have weak spots in the brain or born with issues that would predispose them to a hit that would actually lead to bleeding and swelling in the brain.

Remember, the vast majority concussions that we see, there's no bleeding in the brain. There's no swelling in the brain. That's a different issue.

Some people used to think it was kinda a cumulative thing that maybe after a couple blows you were more prone to that kind of injury. Now, there's some evidence that maybe, uh, that person may just be more prone to having a brain bleed.

But, it's not the same thing. Concussion, brain bleed are not the same.

By the way, Ray, the young man from Hubbard is said to be doing very well. The surgery went well. Last I read, he was still in the ICU, but even a family statement came out and said that he came through the surgery and is doing very well up in Cleveland. So, that's good news.

HORNER: It is. ... Dr. Joe Congeni, Sports Medicine Center at Akron Children's Hospital, joining us in studio.

Joe, one thing I can say in paying attention to the football that I watched over the weekend, and I know we talk about concussions and football being violent, but I do notice now we're really, you know, 3 to 5 years in this of really pressing the issue, that I noticed a lot of the hits are now shoulders. They're doing a much better job and staying away from the helmet-to-helmet and head-on contact that we used to see a lot more 3 to 5 years ago.

DR. CONGENI: I think you may be right. Trying even at the youth level, I see the other side of it, is to teach to not use the helmet and the head as a battering ram or as a tool to bring people down. Maybe some of that's coming through.

So again, like I said earlier, you know we really don't know until years down the road we are making this significantly safer. In 5 or 10 or 15 years is gonna be when we get the answers.

Okay, Ray, have a great week.

HORNER: You too. Dr. Joe Congeni, Sports Medicine Center at Akron Children's Hospital.

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