By Colin Bock
Part I: Cases For
Throughout the years, many phenomenal athletic talents, such as Junior Seau of the NFL’s Chargers, have had the lives they loved turned upside-down. Because of these cases, enormous progress has been made since the Junior Seau story towards finding proper treatment of concussions. Unfortunately, student athletes continue to suffer from the effects of traumatic head injuries despite strict school protocols. A new Oregon Law (Senate Bill 1547) will change these protocols further, leaving athletic trainers, physicians, and researchers wondering if these changes will ultimately help or hurt the athletes the law is designed to help.
Part II: Charging up Chronic Traumatic Encephalopathy (CTE)
Imagine your head cascading into a puddle of turf pellets. Imagine an immense tidal wave slamming the side of your head into a rock and ridding you of your consciousness. These sensations almost always occur with every concussion or blow to the head. Just ask the loved ones of the late Chargers linebacker Junior Seau. Most likely, they’ll tell you that, “Although Seau never had a serious concussion, his continuous injuries to the head accumulated into what is known as CTE” (ESPN 2013). The NFL, like the state of Oregon, is grappling with a serious issue. Of course, times are different now than when Junior Seau ended his life because concussions are now less of a stigma.
Throughout his career, Junior Baul Seau Jr. made a name for himself thanks to his dynamic tackling ability. His room was lit from the blue light emanating from his television. This would be the only light in Seau’s brain— 20 years of tackling the likes of Randy Moss and Terrell Owens stripped Seau of his nearly all of his drive and internal consciousness. A lack of documented concussions made Seau’s condition seem better than it was— nobody could have imagined that Seau would lose all of his drive. It was his sister, Mary, who first noticed his deterioration. Mary began to notice the hot temperament and impulsive behavioral patterns commonly associated with Chronic Traumatic Encephalopathy. Weeping over the loss of her brother, Mary Seau claimed she noticed that, “gradually, [Junior] developed the deterioration of his brain and his ability to think logically.” (ESPN 2013). Remarkably, Seau’s symptoms went virtually unnoticed by league officials and fans during his hall of fame career.
Since the Junior Seau tragedy, the National Football League has been pressed to refine their concussion protocol. The new set of rules are aimed to meticulously evaluate potential concussions. As described by New York Times writer Agence France-Presse, “A player who stumbles or falls to the ground trying to stand, unrelated to an orthopedic injury, will be sent directly to the locker room for examination.” (France-Presse 2017). A well-respected newspaper company, the New York Times has brought groundbreaking stories to the surface. Their efforts to highlight new advancements in the NFL’s concussion protocol are sure to gain national attention. This refinement in the concussion protocol makes the era in which Seau played seem almost medieval.
Had Seau had the resources and highly-trained personnel throughout his illustrious career that current student-athletes have an abundance of, the concussion protocol for Seau would have been strictly enforced and could have potentially saved his life. Schools and employers use Junior Seau as a prime example when implementing their protocols. Many are still baffled by Seau’s untimely suicide, but it was his erratic pattern of behavior in the months leading up to his death that led the NFL to conduct an autopsy study on his brain. Had Seau not exhibited symptoms before his suicide— or had he not committed suicide at all— our awareness and understanding of concussions would be minimal, and our research technology would be subpar.
Of course, the loss of Seau is among the NFL’s most tragic. Many people still remember the plaintive interview Seau’s mother gave after learning about her son’s suicide. As any loving mother would, Mrs. Seau wept after her son’s suicide, pleading for the life of her son over her own. This tragedy inspired a massive change and laid the groundwork for further understanding of the root cause of traumatic brain disease. In the realm of concussion treatment and protocol, Seau’s suicide has sparked the greatest revolution in football history.
Part III: The Gray Approach
While “every single brain injury yields different individual reactions” (Gray 2018), these reactions are incredibly variable. As a concerned athletic trainer, Joel Gray describes the gold standard that Oregon Episcopal School (OES) sets for concussion treatment and rehabilitation. In his many years at OES, Gray describes his precise assessment technique of concussions. Among the most reliable is the ‘Sideline Concussion Assessment Test,’ also known as SCAT 3. Athletic trainers like Gray from around the area find great success in using this tool to supply a physician or other specialist with the necessary information to use as a baseline for making a formal diagnosis. With a seemingly-bright future in mind for concussion treatment and recognition, Gray plans to stick to his current routine that has yielded reliable results. Surely with athletic trainers such as Oregon Episcopal School’s Gray at the helm, concussions can be controlled— this is no longer Gray Matter for Oregon Episcopal School.
Gray attributes his understanding of the brain and traumatic brain injuries to his years of experience. Gray believes that although he possesses the experience necessary to diagnose an athlete with a concussion, he would be “more comfortable sticking with the original protocol” (Gray, 2018). He is a great example of professionalism and consistency, qualities necessary for the proper assessment of an injury as severe as a concussion. Yet, despite his extensive experience in the field of brain injuries, he feels more comfortable continuing his prior role as a rehabilitation expert and an initial set of eyes. As Gray summarized it, “while I understand the process of recovering from a traumatic brain injury and [how it] has had great success when determining whether or not an athlete is concussed, having the proper certification is essential to appropriately apply a treatment protocol” (Gray, 2018).
Part IV: “Who’s liable?” (Senate Bill 1547)
Despite Mark Meek’s fiery passion for helping athletes, the legislative floor was brown and drab to go along with a chilly February morning. Clean cut and well groomed, Democrat Mark Meek stood out during his heated protest to Oregon’s New Law. The law enables any professional— whether it be an athletic trainer or licensed physician— to diagnose an athlete with a concussion or traumatic brain injury (Oregon.live, 2018). A proud father, Meek empathizes with the notion of losing a child to concussions. Doctors, politicians, and athletic trainers alike attribute their commitment to family and the well-being of people to their tales.
Upon first glance, pediatrician Laura Lynn Cooley, MD, says she believes [the law] is more “about who can be sued” and “who is liable for a poor outcome” (Cooley, 2018). Whereas Joel Gray is a reserved member of his community seeking out little in the form of praise or criticism, Laura Lynn Cooley is extremely outgoing, yet incredibly succinct. I gained a strong sense of professionalism and know-how from Cooley. As it pertains to the newly-passed Senate Bill #1547 and its provision that allows for athletic trainers and personnel to legally diagnose an athlete with a concussion, Cooley believes that there are “definitely pros and cons” (Cooley, 2018). As experienced and professional as athletic trainers and team staff like Joel Gray are, the pressure to make the right decision is often overbearing. Gray told me firsthand about the struggles of making the right call with a compromised viewpoint. Physicians such as Cooley are legally obligated to make an unbiased decision that best fosters the student-athlete’s rehabilitation. As both a mother and a pediatrician, it is no surprise that Cooley cares deeply for the lives of children. Doctors and parents like Cooley are the key resources in a child’s recovery from a traumatic brain injury.
It just so happens that throughout preschool, I was friends with Cooley’s son. Despite the trouble we caused at her house, Cooley never drifted from her mild temperament. Cooley’s strong devotion to helping children has guided her throughout her career. Despite her mild temper and direct manner, Cooley expressed concern regarding the diagnosis of concussions by athletic trainers. Cooley believes that “while this law opens doors for children living in poverty, it may not be the best move for children with access to proper health care” (Cooley, 2018). Cooley highlights the immense pressure placed on athletic trainers and weighs every side. As Cooley explained her beliefs further, it became more and more clear that what she ultimately cares about is what’s best for the athlete.
“I really try to do my best and help the athletes however possible,” Joel quietly claims. “I just want to do what’s best for the student” (Gray, 2018). Gray describes the school’s decision to uphold the current protocol as the only feasible option, due in large part to the potential for insurmountable pressure that could be placed on athletic personnel to authorize an athlete’s return to play. While employed at a previous job, Joel recalls witnessing a football player tumble to the ground after light contact to the head and neck area. Because the athlete was cleared to practice the next day, the athlete collapsed after a simple tackle and later died in the hospital. Ultimately traumatized by this event, Gray believes that “From that moment on, I came to understand how scary concussions can really be” (Gray, 2018). Gray is just like Cooley— they both believe that kids deserve to have the opportunity to be kids. Without the threat of life-altering injuries, this vision can become a reality.
As it pertains to other schools around the greater Portland area, having a complementary treatment option, albeit from an often unlicensed professional, can be beneficial. Cost-effective, experienced, and loyal to his or her respective student body, an athletic trainer may well suffice as someone capable of diagnosing concussions. On the other hand, impartiality can come into question. Dr. Cooley clearly understands a parent’s desire to return his or her young athlete to a game. Cooley remained modeset when talking about her experiences, yet often alluded to her comfort in making difficult decisions due to her lack of involvement with the institution itself. On the other hand, athletic trainers, who are paid by schools, will determine the fate of an athlete under this new law. Coming from Gray, someone who has seen it all in decades of hands-on experience, the potential for failure remains too significant. In the case of Gray, being able to stick to a similar protocol is beneficial. For schools lacking resources, this law has the potential to jeopardize the health of student-athletes.
Among the opposition to the new law is Mark Meek. Speaking from personal experience, Meek attempted to convince Oregon legislators not to pass the concussion bill. Although the focus of the bill is to make concussion treatment more accessible, “it does the exact opposite” (Meek, 2018) according to Meek. Much like Dr. Cooley, Meek characterizes treating concussions as “a broken bone” (Meek, 2018). Meek passionately states the fact that the state views “a broken arm as a more serious injury than a concussion” (Meek, 2018). Whereas “a broken bone requires treatment by a medical professional [or specialist]” (Meek, 2018), a more serious injury, according to Meek, that has a negligible amount of understanding is being dismissed. Meek sees the volatility in the concussion treatment process whereas a respectable amount of lawmakers don’t. Meek bluntly suggests the idea that the new concussion bill would undermine the understanding of the rehabilitation process.
Treating a broken bone as a more severe injury than a concussion is appalling to many, but opponents are concerned that Oregon lawmakers fail to understand the colossal impact this law has. Treating the loss of function within the brain as a minor issue fails to paint the picture of the damage caused by traumatic brain injuries. “There’s definitely a dark cloud surrounding the issue of concussions,” says Cooley. “What’s vital is that the kids receive appropriate treatment for an injury we know next to nothing about” (Cooley, 2018). Doctors are grappling with understanding this complex issue. The consensus opinion among medical professionals is that concussions need to be understood.
Something Cooley feels that she’s been able to pride herself on is her integrity. A mother of two boys, Cooley uses her life experiences when probing key health issues. “We may not know much, but the stories we accumulate are meaningful” (Cooley, 2018). Clearly, concussions aren’t all black and white— they’re more complex than determining whether or not a kid simply has a concussion. Take it from someone like Cooley: the thought of her children sustaining a serious head injury is a miserable one. This surely is the case for any concerned parent— seeing his or her child unconscious on the floor is a dreary and horrible thought, unfortunately.
Unfortunately, All of Meek’s impassioned pleading was for naught; the new Concussion Law passed, enabling athletic trainers and personnel to officially diagnose a player with a concussion and determine their return to play date. With the passing of the new law, Meek sees the potential of an athlete returning prematurely as overwhelming. “Sports teach children how to make and keep lifelong friendships. All of that is thrown out the door when the child returns to play and suffers a catastrophic concussion” (Meek, 2018).
Meek vividly remembers the near tragedy of Max Conradt, a Eugene quarterback. “In the fall of 2001, high school quarterback Max Conradt sustained a concussion during a game. With no medical confirmation that his first concussion had cleared [the protocol], Max started in the next game. He collapsed at halftime due to massive bleeding in his brain even though no remarkable hits were observed. Three critical brain surgeries saved his life, but he continued in a coma for three months.” (cbirt, 2018). Because of improper implementation of the concussion protocol, Conradt found himself living in a special house in Eugene for people with severe brain injuries. (cbirt, 2018). Meek reminisces on Conradt’s near-death experience, claiming the new law would allow for similar situations to occur and that “this new law clearly undermines Max’s law” (Meek, 2018). Traumatized by this endeavor, Meek hopes to never bear witness to a similar situation. Meek implies that the new law would negate all progress made since Max’s concussion.
Specifically, Max’s law requires that “students suspected of sustaining a concussion must be evaluated by a properly trained medical professional,” and that a return to play may only occur when “all symptoms have resolved, at least one day has elapsed since the injury, and a medical release has been obtained” (cbirt, 2018) (italics mine). Meek also argues that the new concussion bill is a clear infringement of Max’s law, in that athletic trainers are nowhere near as well trained in the concussion field as physicians, for example, Laura Lynn Cooley. The concussion bill has been passed and Max’s Law is now obsolete. While it remains in practice, Max’s Law will likely be contradicted by the newly passed Senate Bill #1547. As the understanding of concussions increases, time will tell if the new bill is a resolution to a crippling dilemma.
But what about the athletic trainers? Most athletic trainers are sparsely educated in the field of medical diagnostics and are under heavy pressure to administer a player’s return to play by the athlete, team, and parents. To many people, concussions only impose a one week restriction from play at the most. Being able to acknowledge a full concussion recovery is vital so as to avoid advanced post-concussion symptoms and the development of Chronic Traumatic Encephalopathy. No matter who you consult, they’ll tell you it takes brains to save brains— that’s just how life works. We control our lives with our brains— preserving our brains means preserving our lives.
Perhaps the most telling piece of context is that the concussion protocol is only becoming more strict. As Cooley puts it, “as more and more people gain the ability to clear kids, the concussion protocol is bound to develop into a rigid, meticulous game” (Cooley 2018). Even specialists, Cooley claims, know “little to nothing” about concussions. In a grand sense, “it’s scary how little we know” (Cooley 2018). With even licensed medical professionals grappling with a dense issue, it becomes baffling to comprehend how unlicensed trainers with a compromised viewpoint are able to completely alter the landscape of head trauma.
Part V: OHSU, Boston University, and Forward Strides
Although our knowledge of concussions is still developing, with proper resources, for example, as Boston University’s concussion center or the OHSU Neurology Lab, the understanding of concussions by medical professionals will improve. According to professionals, these two institutions are the most prestigious and well-respected nationwide.
It was a frigid, windy day in downtown Portland. The Neurology Lab at OHSU seemed metallic and futuristic. The technology here is nowhere near obsolete. I was taken aback when I found out that the institution prides itself on having “subspecialty centers that offer specialized care for patients with a range of neurologic diseases including Alzheimer’s disease and related dementias, Parkinson’s disease and other movement disorders, multiple sclerosis, stroke, amyotrophic lateral sclerosis, neuromuscular diseases, epilepsy and brain tumors.” (OHSU, 2018). By adopting a broad focus, OHSU opens itself up to understand a multitude of different brain injuries, meaning their understanding of concussions could open the doors to understanding other conditions, such as tumors.
At Boston University’s World-Renowned Center for Concussion Research, eye-opening discoveries are being made. When I stumbled upon their practice, I was immediately immersed in their experience. Practical yet open-minded, Boston University’s team follows a precise procedure that designates every doctor or student to a specific role. The lead researchers take portions of the brain and do individual research as it pertains to the functionality within that region (Boston University, 2018). Research of this type, Joel Gray believes, will inspire a more concrete understanding of concussions and more centralized focus on concussion treatment. Who knows? If athletic trainers similar to Gray gain the necessary experience to understand and interpret concussions correctly, the new law may work.
Part VI: A New Opportunity
The central focus of Oregon’s new concussion bill is the accessibility to treatment for students statewide. Even physicians like Laura Lynn Cooley firmly believe in equal access to an appropriate concussion treatment plan. Regardless as to how one views the new concussion bill, the idea of devoting more attention to concussion research and helping foster the futures of other students is encouraging to professionals and specialists.
Regardless of who I spoke to and the places I visited, I gained a sense of devotion to the cause. I knew that these were the right brains to support researching brains. Not a single medically-trained interview subject demonstrated a sense of fear or disinterest. Most notably, Oregon Episcopal School’s Joel Gray remains practical and committed— demonstrating a sense of professionalism and expertise. Professionalism and commitment are two traits key for a concussion expert. Adding more perspective to a team of experts may enable Oregonians to capitalize on an opportunity to take a step forward. Oregon, unlike most other states, is taking a bold approach to concussion treatment.
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