Third in a series of three
Dr. James Stevens has worked with the Fort Wayne Neurological Center for 26 years and has extensively studied concussions since 1992. He is a nationally recognized expert in the field who once served as a consultant to help the National Football League develop guidelines for dealing with concussions.
The News-Sentinel met with Dr. Stevens to get his views on the evolution of concussion care.
N-S: What do you tell athletes when they come to see you with concussion symptoms?
James Stevens: There's such a small percentage of you who are going to end up being professional athletes, but whatever you do, for the rest of your life you're going to need your brain. You need to protect it. The thing where we've been able to make great strides over the past 10-15 years is just having the trainers and coaches recognize it and getting buy-in from the athletes. It's not 100 percent yet, but it's much better than it used to be.
N-S: It's not where it needs to be yet, but we seem to be getting more kids reporting on teammates who may have symptoms.
Stevens: Obviously it's an attention grabber. It's sexy when it's the NFL and those people, but the real people we need to get to are all the grade school, middle school and high school athletes, because the numbers are huge as far as the number of kids who are participating and have the probability of sustaining a concussion. It needs to be handled correctly because these kids are going to need their brains to function.
N-S: One of the theories is that teens who are doing something full-tilt without regard to their bodies may be as likely to suffer concussions in the backyard as on the football field.
Stevens: I've got skateboarders, soccer players or hockey players and volleyball players, basketball players. I see a lot of different athletes who have suffered it. The message, which is a good one, is that you get out of that environment and don't return until you are asymptomatic and we test you before this all happens and after it all happens. Then we test you as you go through these progressions of exertion to see if you remain asymptomatic.
N-S: Baseline testing, including ImPACT Testing (Immediate Post-Concussion Assessment and Cognitive Testing), has to be the biggest progression in the last five years.
Stevens: It's great, and there are all different kinds of models out there, but they all do essentially the same thing. They all will test memory, coordination, the ability to focus on things, and look for any focal neurologic abnormality and report symptoms that are very important.
N-S: Where can parents send their kids to have them take a baseline test?
Stevens: I think a lot of trainers at the schools have access. The most popular one around here is the ImPACT test, but (there are) a lot of different tests. When I started this in the early '90s with the Komets, I had our neuropsychologist go in there and do the full boat examination of every one of them before the season. Then we had a baseline if they got injured to see what was going on. There were objective measures that we could say, "Uh-oh, you're in trouble." The mindset back then was, "Oh, I think I'm OK, I can go back out," and the real problem was getting the second concussion right after the first one. That's when I see the longer-lasting issues with athletes. It's just critical to get them removed from the environment once they've had the concussion.
N-S: How much has the recent NFL settlement decision with former players affected the study of concussions?
Stevens: The media and the public aren't going to let this go. Chronic traumatic encephalopathy is real. It's so sad when you read stories like (Jim) McMahon, (Dave) Duerson or (Junior) Seau. The force of the impact has really gone up in this sport because of the speed and strength of the athletes. It's thought that the average hit in football is about 60 Gs of force. If you are playing on the line, they average 30-40 Gs, but it happens 40 times a game. They have demonstrated that a 90 G force to the head is predictive that you are going to get a concussion.
They are trying to develop the better mousetrap to reduce the likelihood of concussions. There are a lot of different products out there right now, and all of them have theoretical possibilities, but none of them have been definitively proven that they are reducing concussions. They are using materials such as Kevlar to helmets that compress upon impact and chinstraps that won't pop off. A lot of different ideas are being used. We just have to, over time and research, be able to prove that these can make a difference.
N-S: What do you think of these new helmets?
Stevens: They are a first step. They are trying to address the issue. The data is not there yet to say that they make a significant difference or not, but I think they are all worth a try and it's imperative that the manufacturer and the team that gets them keep track and keep an objective log on how many concussions they have in a season, etc. In the end, that's the only way we're really going to know if this made a difference. Certainly, they try and reduce the likelihood of them by technique and other things, but still you have big strong people running very fast and having collisions because that's what football is.
N-S: Someone suggested that part of the reason for the increase in concussions is the evolution of the passing game so there are players running farther and building up momentum before hits. What do you think?
Stevens: The impacts are even greater. I think that has a part of it. The size of athletes has a part of it. One of my good friends, he played in the NFL for a short period of time and his dad played for the New York Giants. I look at them, and they weren't a whole lot bigger than me. I think the equipment was such that they didn't take chances doing crazy diving tackles and other things. It's totally a different physical prototype that is playing this game today.
N-S: Everybody seems so hopeful for something definitively positive, but they need to remain objective.
Stevens: Science is the only way we're going to be able to do this, and we need people who are attempting to find answers to be rigorous in how they are deploying this equipment and how they are following along to measure the impact. We need to do this both in the research labs and on the playing field. To date, we've had a lot of ideas, but we haven't had that definitive study that we saw the incidents of concussions the season before and what we've got now by implementing some of these things.
N-S: High schools seem to be buying in, but they don't have the finances, whereas colleges have the finances, but they don't want to be experimented on.
Stevens: Let me tell you what's going to happen. The people who run those universities, they see what happened in the NFL and the legal ramifications from that. They know there are going to be significant legal ramifications coming from it if they don't make an effort to reduce concussion and subsequent sequelae from long-term concussions so you end up having long-term problems. I have had athletes come through here, and I followed them for five years, who could not hold a job. They had problems concentrating, and before that was not the case.
N-S: What would you tell parents whose kid wants to play football?
Stevens: It's interesting that on a national level they have seen an 11 percent decline in participation in youth football over the last two or three years. You know a lot of parents are saying, "Let's find something else to do." If they want to play football, I think it's imperative — and I think a lot of parents do — that they have discussions with the coaches about this, they are aware of it, that the rules are set and you let the child know that if they have any of this happens you are to tell your coach, your trainer and you are off. It's like car accidents in that we can't avoid (them) all the time, but can you reduce the likelihood of bad things happening? It's like using your safety belt or having better cars that we drive so the likelihood of a bad outcome is less. Public awareness is the first step, and now they are on the second step of trying to define what measures can be taken with the game and the equipment to reduce the incidents of that happening.
A couple of weeks ago, Coach (Mike) Ditka was in town, and I spoke to him about this, and he said, "Listen, we all kind of know that when we sign up for the game. We all know the risk." And I said, "Did you really? Did you really know back then that a Dave Duerson was going to happen?" They don't think along those lines.
Certainly, it's a major, major issue, and the thrust needs to be at a young age to educate. And hopefully there will be additional funds. I think the NFL, the National Hockey League, professional soccer, they should all be in on this and say "hey, we need to do what we can to make our sports safer."
N-S: What's the main point of current concussion research?
Stevens: To have any child who is in an athletic program have basic instructions on concussions — the symptoms and signs — and know when to talk to their coaches and trainers. You've only got one brain to take you through this life, so you want to protect it and to never forget that message.