<p>The National Football League’s settlement of a lawsuit by former players concerning the lifetime impact of head impacts and concussion on the brain has brought a set of issues that are never far from the spotlight — and are not confined to football or sports — onto the stage again. Drs. Neha Raukar and Michelle Mellion share their thoughts on many of the issues the settlement raised.</p><p>&nbsp;</p>

I commend the NFL, the media, and state and federal lawmakers on their efforts to heighten concussion awareness with the public. The $765 million the NFL settled on for the “concussion lawsuit” by all accounts is a very small price to pay to make this headache go away, especially given the large sums of money the NFL has at its disposal. After everyone takes their cut, and the money is divided up, how much will the athletes actually get?

Had the NFL spent the time and done their research, they would have discovered that the science behind the link between concussions and some of these alleged long-term effects is tenuous, at best. Also unknown is the effect of the timing of the hits. Is it the hits received as an adult or those sustained as a kid that leads to these potential long-term effects? Would the NFL have been solely and totally responsible for the current state of these athletes?

By the NFL settling, the athletes will see some financial remuneration in their lifetime which I'm sure was part of the impetus for settling quickly, but the NFL may be opening themselves up to more scientifically questionable lawsuits.

In the wake of this settlement, companies will prey on the fears of parents everywhere with their “concussion-proof” helmets and accessories. As a society, before we make laws, create and market safety products, or settle lawsuits, we should be very clear on the science behind the hype. It is admirable that the NFL funds and supports such concussion research. We all must work together to protect athletes of all ages. Scientists should find the answers to the questions, and those with deep pockets should fund quality research. I hope that this settlement is not viewed as an admission of guilt but as a call to action.

Dr. Neha Raukar
Assistant Professor of Emergency Medicine
Director, Division of Sports Medicine, Lifespan

Despite increased awareness of concussion, there are still gaps in the recognition and understanding of the long-term effects of this potentially debilitating injury. Awareness of concussion and its immediate management are well-known to the public, especially those serving in our armed forces, coaches supervising contact sports, parents and players involved in high-risk activities. The media and many organizations have been successful in providing education to promote awareness and appropriate intervention. However, understanding and treating the more chronic manifestations of concussion have proven more challenging. Caregivers must know the subtle signs of persistent dysfunction related to concussion, or the diagnosis and opportunities for early intervention may be missed.

Individuals who have suffered a concussion can experience confusion, dizziness, sleep disturbances, headaches, and difficulty concentrating — otherwise known as post-concussive syndrome (PCS). These symptoms, easily recognizable as a result of the head injury in the immediate post-concussive period, can last for days, weeks, months, or even years, despite clearance to return to sports or work. Approval to return to normal activities may imply complete resolution of the event but many concussive symptoms persist or become pronounced in the setting of more routine activities.

The continuation of concussive symptoms may lead to other issues such as depression, persistent headaches (possibly due to the overuse of medications), and continued difficulties with memory and thought processing. Most of these problems can be effectively and successfully managed with appropriate support and treatment. Awareness and education are the critical for recognizing these persistent symptoms.

Dr. Michelle Mellion
Assistant Professor of Neurology
Director, Clinical Neurophysiology Fellowship
Rhode Island Hospital

(Adapted from a commentary that also appeared in the Brain Injury Association of Rhode Island newsletter)

Editors: Drs. Raukar and Mellion and their colleagues will be part of a free public panel discussion of concussions at 6 p.m. Thursday, Oct. 24, 2013, at the Alpert Medical School, 220 Richmond Street in Providence. It will be the inaugural talk in the Brainpower series sponsored by the Norman Prince Neuroscience Institute.