Harry Kerasidis M.D.

Brain Trauma

Two Low-Cost Ways to Avoid High-Cost Concussion Challenge

Concussion doctor gives keys to battling epidemic-like problem.

Posted Oct 06, 2015

 Harry Kerasidis, MD
Source: Source: Harry Kerasidis, MD

If a simple, low-cost solution provides an answer to a very costly, complicated problem, wouldn’t we consider it? In other words, when does something become a “no-brainer?” 

Consider sports concussions, as a case in point.

But first, imagine the potential human costs with concussions, particularly those that go undetected and lead to post-injury problems associated to more severe forms of mild traumatic brain injury (TBI). Brain injuries can degenerate affecting the cognitive performance executing language, reasoning, memory and self-control. Post-concussion syndrome and TBI troubles millions of people, and are serious conditions that are hard to diagnose. Therefore, many treatments are off-target, escalating the costs and frustration.

Then, there’s the harrowing Chronic Traumatic Encephalopathy (CTE) issue plaguing the NFL and ringing up a massive tab. 

For professional leagues, such as the NFL and NHL, a new positive trend is hiring personnel such as “concussion spotters,” athletic training staff, and medical specialists. Even The World Rugby Cup uses hawk-eye technology which is largely a video spotter technology. But for amateur athletes, these human resources exceed what the programs can provide — regardless of how high the potential cost to the athlete.

By contrast, despite the millions of dollars spent on concussion-related problems, here are two surprisingly low-tech, and conveniently low-cost, sports concussion safety tips:

1. Establish a “Concussion Spotter.”

Whether bias or unbiased, I recommend having a “concussion spotter” who observes practices and games, monitoring for athletes for potential signs and symptoms of a concussion. However, I believe this individual can be given added responsibilities deserving a “concussion coordinator” title, serving at both team and league levels. I outline other responsibilities in “Concussionology” available now here. It’s also interesting to see the differences between how the NFL and NHL appoint their spotters.

However, there are “ethical” and “empowerment” questions to be answered. Although they don’t cost a dime, they can mean everything. Below I offer the questions, and my answers.

Ethic Question: Is it safer for the concussion coordinator to have a bias, or unbiased, view of how to handle concussion safety?

Using the NFL example, spotters are employed by the league. The NHL allows each team to employ spotters, and the only requirement is to agree to attend some training. The employment in both examples infer a possible conflict of interest. While this is progress, an unbiased viewpoint prevents “pay for play” decisions that benefit the team, not the individual’s health. Therefore, I think leagues should provide the implementation and monitoring, along with mandating team compliance. However, this viewpoint challenges all the parents out there who would argue their blood-line bias is what’s keeping their athletes’ safe.

Also, I like requiring certain levels of specialized concussion education. In this case, knowledge truly is power, including the ability to stop play in order to pull an athlete out of the game, which leads to the next question.

Empowerment Question: How much responsibility is too much to govern? (i.e. Allow Concussion Spotters to interrupt play of game by throwing concussion injury flag.)

The NFL now allows league-employed “spotters” serve as “officials” who may halt a game should they identify a player showing signs and symptoms of a possible concussion. I think this could lead to throwing a “green” health flag to stop play and address a concussion or other major health issue. However, who then governs these decisions? It would add a layer of complexity for sure, involving replays and subjective opinions of course. Nevertheless, if we can manage to find water on Mars, we should be able to figure this out too.

2. Use a Sideline Assessment App (on Smartphone).

What should be done when a spotter eyes a potentially concussion-inducing "big hit?” 

Regardless of rule changes, do not move an unconscious player. Give the athlete 15 seconds to awaken or call 911. If the athlete can make it to the sideline without assistance, wait for a few minutes before beginning to assess concussion risk. Using a smartphone app, like XLNTbrain Mobile, a number of tests can be administered to help gauge the severity of injury. This includes a unique Balance Test, among other simple ways to detect concussion. This data can be monitored and can also be helpful for medical professionals review.

Beyond the practical advantages of having this low-cost technology, using this method will help standardize sideline assessments. Using these tools will demonstrate the importance of having the data integrated and available on one platform that collects baseline scores along with sideline test results, symptom and recovery protocol monitoring.

While the NFL does some things that are helping others, they are also well-funded, and the rest of the athletic world must find a low-cost solution, like ours, that really makes brain sense. 

Set the Example

The world needs to see an NFL team doctor or athletic trainer properly administer a quick sideline assessment using a smartphone app. Fans are watching and would see that the league is using these smart, low-cost tools as well as establishing a set of best practices to be emulated.

About Harry Kerasidis, MD

Harry Kerasidis, M.D. is one of only a few neurologists in the world specializing in concussion detection and prevention. After 25 years treating hundreds of concussions, Dr. Kerasidis noticed most people were using protocols, information and tools that were out of date, limited or incomplete. So he created his own, now called XLNTbrain LLC, an online and mobile platform to provide everything necessary to help prevent, detect and protect student athletes from concussions.

His new book, "Concussionology: Redefining Sports Concussion Management for All Levels" is available here.

Dr. Kerasidis also founded Chesapeake Neurology Associates, serves as Medical Director at Calvert Memorial Hospital for the Center for Neuroscience, the hospital’s Sleep Disorders Center and Stroke Center.