There's now significant education taking place for parents, coaches and officials on how to recognize the signs, symptoms and effects if a concussion. It's leading to better treatment. —Bart Thompson
SALT LAKE CITY — Jim McMahon isn't completely losing his mind, but he is noticing dementia-like symptoms, which he says are a product of concussions incurred on the playing field during his 14-year football career.
The former BYU and Chicago Bears quarterback told a Chicago television affiliate earlier this week that knowing what he knows now about the hits he took playing football, he wishes he'd have pursued baseball instead.
But University of Utah clinical neuropsychologist Dr. Angela Eastvold said concussions span multiple sports, including boxing and soccer among others, and also plague military veterans and individuals who suffer from autistic head-banging. The concussions aren't necessarily leading to long-term health problems down the road, however, it's how many and how often they occur, she said.
"A concussion in and of itself is not a serious injury, it does not cause permanent damage, but the problem is with repetitive concussions," Eastvold said. "Even a lighter blow the second time around can cause more severe damage."
Passing a certain "window of vulnerability," which is longer for younger and less-experienced athletes, is imperative before safely returning to game play, she said.
The Utah High School Activities Association has followed a strict concussion management policy for about four years, bolstered by a new Utah law in 2011. While there was some pushback at the onset, assistant director Bart Thompson said the club is now seeing marked benefits with increased reporting of concussions and education about the issue.
"Protecting students was incredibly important to us," he said.
The policy requires parents to provide consent prior to their kids' participation in school-sponsored athletic events and also play a role in helping students seek medical treatment and clearance following a bump to the head. Student athletes throughout the state of Utah are to be removed from play until such clearance can be provided by a qualified physician.
"It seems as though a lot of concussions were taking place where we were just saying, 'He got his bell rung and he's OK to play,'" Thompson said. "There's now significant education taking place for parents, coaches and officials on how to recognize the signs, symptoms and effects of a concussion. It's leading to better treatment."
The Utah law, and similar laws in 42 states, requires all public and private sports leagues, camps and clubs to enact and enforce concussion management policies.
Eastvold, a member of the Sports Neuropsychology Society and a neuropsychologist for the Real Salt Lake soccer players, said more conservative record-keeping will lead to a better understanding of the effects of repetitive concussions, including treatment of chronic traumatic encephalopathy, which is relatively new on the clinical scene.
The progressive degenerative brain disease isn't definitively diagnosed until after death, when brain tissues can be analyzed. Scientists, Eastvold said, are expecting more information in the next decade, as more is being learned about the disease from brain donations of dying NFL players.
Although she can't speak specifically to his case, Eastvold said the condition is likely what McMahon and a number of former NFL players suffer with, leading to symptoms of dementia — including gradual memory loss, aggression and anger outbursts, behavioral issues and depression. Chronic traumatic encephalopathy has also been blamed for an increased suicide rate among its sufferers.
McMahon has said he suffered four concussions while playing, but was never taken out of the game. He had to play to get paid, he told Fox's WFLD-TV.
The 53-year-old retiree is now part of a massive lawsuit in which more than 2,400 players are suing the NFL for the after-effects of concussions sustained in the game.
Helmet manufacturers are continually looking for technology that will make game play safer, Thompson said, adding that since he was a boy, football gear has lightened up tremendously.
"The way they are designed right now is to prevent a skull fracture and they do a great job at that, but rapidly stopping, even with a helmet on, can't protect the brain," he said. "They're just not designed to prevent concussion."
But all the pads and extra protection, Eastvold said, "can produce a false sense of safety."
"They are hitting harder now, so the force is greater," she said.
A concussion causes a contusion, or bruising on the brain, that causes all kinds of problems in delivery of what the brain can provide to the body.
Intentional and sometimes unintentional helmet-to-helmet contact in high school games in Utah, Thompson said, results in unnecessary roughness, a 15-yard penalty.
"There's no question they want to win," he said. "But it is written into the rules. We try to teach players that aggression can threaten safety, but it's not preventable."
The most common symptom of a concussion is headache, but effects can be physical, in terms of decreased balance and visual disturbances, or sensitivity to light and noise; cognitive, with confusion and memory problems; and cause issues with sleep, moodiness or irritability.
"Everyone can experience them in different degrees and for different periods of time," Eastvold said regarding symptoms. About 20 percent of individuals recover within a day's time, and more than 60 percent are back to normal after a week. Less than 3 percent, she said, experience symptoms of a concussion longer than a month.
McMahon said he does what he can to keep his mind active, but he still forgets people and conversations.
Anyone who suffers the degenerative disease can probably expect cognitive functioning to get worse over time, Eastvold said. Awareness of it, however, may prevent the condition for others.
"Any attention to anything that endangers a student, we think is good," Thompson said. "The more awareness there is, the more likely a parent is going to be to take care of the symptoms. Coaches and officials are watching for it. All of that helps provide a safer experience for the students."