Changing the concussion culture in the NFL
Robert Harbaugh, M.D., ’78 has a unique vantage point as a member of an NFL subcommittee studying the long-term effects of concussions on professional football players. First, Harbaugh is a well published and highly regarded neurosurgeon who serves as director of the Penn State Institute of the Neurosciences and chair of the Department of Neurosurgery. That’s the professional part.
Second, he’s lived the experience of watching his own son play football, and has a 12-year-old transitioning from flag to tackle football. That’s the parent perspective. Third, Harbaugh himself played football in high school and college, and suffered three concussions along the way. That’s the personal piece.
All three reasons have enticed him to serve—unpaid, with no perks, no Super Bowl tickets, and no chance to mingle with football legends—as chair of this NFL subcommittee, which is part of a larger committee established by NFL Commissioner Roger Goodell to study head and spine injuries in football players. Harbaugh’s group is charged with developing a comprehensive database that will gather and analyze information over time to help determine what factors lead to acute and delayed neurological injuries in NFL players.
Why do some players who sustain repeated concussions live to age 80 and never have neurological problems, while other players with less documented episodes of head injury develop dementia symptoms by age 40? What factors put someone at high or low risk? Which blows are the most dangerous? What’s the contribution to the level of risk between practices versus actual game play?
Harbaugh hopes that answers to all these questions—and many more—can help make the sport safer for professional and amateur players alike. He and his subcommittee members—composed of medical experts in head injury and data analysis, along with NFL Players Association representatives and retired NFL players—are working together to determine exactly what data is needed and how it will be collected. “We need the perspective of players and the Players Association,” says Harbaugh. “From a scientific point of view, I feel pretty comfortable about what kind of data we need to collect. But we have to remember that this data is protected health information. In this case, the players are our patients. We need to do this in a way that players feel comfortable with the collection and how data is handled.”
“They need assurance that if they participate in this prospective study, it won’t jeopardize their playing careers.” As discussions have unfolded enters the league would undergo a comprehensive process that includes baseline neuropsychological testing, MRI imaging of the brain, a neurological examination and a detailed medical history.
Players may also be asked to provide tissue and blood samples, though no genetic profiling would be conducted until a player completes his career. Current NFL players would also be tested and entered into this extensive baseline study. “There are additional things we’d like to do,” says Harbaugh. Negotiations include the use of accelerometers—special devices imbedded in the helmet that can track the magnitude and types of blow to the head. This information can be coupled with film footage, as every single practice and game is filmed by the NFL. “Game exposure is a tiny fraction of the time that players are actually exposed to head injury,” says Harbaugh. “Much contact comes during the hours of practice, especially during football season.”
With such a rich collection of material, researchers could analyze data and seek patterns that may predict long-term problems. “It’s more than just blows to the head,” said Harbaugh. “This will help us sort out other factors and help us determine exactly what puts someone at high or low risk for acute or delayed neurological injury. “It will help us look at how we design protective equipment, tell us which blows are the most dangerous, and tell us what percentage of risk is generated from practice versus actual game play.”
It will take years to develop and see results from this database, but it is a critically important step in the right direction. In the past, for instance, football players learned to “tough it out.” A head injury wasn’t considered a concussion unless a player lost consciousness. Often, they were sent right back into a game.
– By Martha Phan