Since the NFL announced last Friday that it will have its doctors use an iPad app — created by X2 Biosystems — to help diagnose concussions during games, there has been a lot of interest in how the process will work.
The New York Times offered more details Wednesday with a deeper look at what the doctors will do once a player is suspected of suffering a concussions.
The postinjury test is quick –it takes about six to eight minutes — and shares many elements with the baseline test to allow a comparison that might indicate a decline in function. Both include a section on the players’ concussion history and a 24-symptom checklist; players are asked to score themselves on a scale of 1 to 6 in categories like dizziness, confusion, irritability and sleep problems. Both note any abnormal pupil reaction or neck pain. There is a balance test and a concentration test, in which players, who are usually brought to the locker room to be evaluated, are asked to say the months of the year in reverse order, to recite a string of numbers backward and to remember a collection of words three times. Then they are asked to recall them again, without warning, at least five minutes later. The words and sequence of numbers may be changed from test to test, so players cannot memorize them from a previous test to mask concussion symptoms — a fact that has annoyed players, according to Dr. Margot Putukian, the director of athletic medicine at Princeton University Health Services and a member of the N.F.L.’s Head, Neck and Spine Committee.
On the postinjury tests, there is one different element: a series of five questions designed to test orientation and glean how confused a player might be at that moment. They are: Where are we? What quarter is it right now? Who scored last in the practice or game? Did we win the last game? Those questions, known as Maddocks questions, were developed in the 1990s by an Australian doctor who worked with players in Australian rules football.
“What the application does, when you are evaluating the athlete, you actually see — as they are doing their word recall — his baseline,” said Putukian, who added that it was her understanding that team doctors would administer the tests. “He was able to remember 15 out of 15 words, and now he’s having trouble giving you five back right away? Maybe he’s only able to remember two? It gives you real-time information.”
While the NFL plans to have independent neurologists on the sidelines as well next season, the NFL Players Association wants to make sure those new doctors have the power to sideline a player.
The union wants the independent sideline concussion experts to have almost exclusive authority in detecting concussions and administering tests, in part because it believes team doctors are often busy attending to other injured players, while the concussion experts are there for one reason.
“If you’re busy and didn’t see the play, how do you know you need us?” said Dr. Thomas Mayer, the union’s medical director. “This is a big enough issue we need an extra set of eyes, an extra judgment.”
– Bill Bradley, contributing editor