Concussion Concerns

hercegMuch has changed since I started graduate school in 1991 in pursuit of my PhD.  When I first chose to work in rehabilitation medicine, the Brain Injury Association of America was called the National Head Injury Foundation, and it was only in existence since 1980. It was established when Dr. Martin and Marilyn Price Spivack invited five family members and professionals to their home to discuss the need to form an organization to affect change for individuals with brain injury.  Since that time, research and treatment has resulted in tremendous improvement in the quality and life of people living with brain injury.  However, some changes have left me with considerable pause.

Most people today know about concussions (really brain injuries).  One can’t help but read about them or watch sports to actually witness concussions happening.  Over the last 15 or so years, incredible research has led to a greater awareness of what is a concussion and what are the associated symptoms.  Assessment of concussions has significantly changed as well. Nowadays, brief 20 minute computerized assessments have become the norm. Although these assessments were developed by well-intentioned Neuropsychologists, widespread availability, inadequate testing environments, and “consultants” have become the go-to people in for these evaluations.  With sincere respect to many great professionals I work with, from AT’s, to PTs, OT and MD’s, the bottom line is that the most qualified in this area are Neuropsychologists.  That does not mean others cannot work alongside Neuropsychologists, but that if a sports program does not have one involved, then there is no way it is providing the best service to its student-athletes. It is also a significant liability. I personally have witnessed high school AT’s administering in poor environments, with distractions, and unable to accurately provide instructions, or maintain control of students coming in and out of computer labs. Additionally, local MD’s have become certified in analyzing neurocognitive data by taking a 3 hour course. If I knew it was that easy, I would not have spent 5 years in graduate school and one year of residency!  I don’t fault those doing this as much as I place responsibility on the developers who have made this widely available.  You can even do it in your own kitchen now, just like you play XBox or Wii!

Additionally, many parents, former athletes, journalists, and attorneys have become self proclaimed “experts” in concussions.  Some do it for own self-promotion and fame, aka celebrity status, while for others it’s a new career choice.  Many disseminate information to the public stating they have “expertise.”  Lawyers teach not only concussion litigation but also teach brain anatomy.  Lawyers?   Really?    Other advocates proudly state that news outlets seek them for their “expertise” on medical, biomechanical, cognitive or behavioral changes or symptoms following concussions.  No matter the reasons, NO ONE, unless they have the proper training, education, AND state licensing should proclaim expertise in brain injury- which is what a concussion is. Perhaps if we referred to concussions more accurately as brain injuries, there would be less “experts.”  I don’t see the same happening for other ailments, illnesses, or diseases.  Different professionals also need to be aware of different areas of expertise and respect each other’s knowledge, since a multi disciplinary approach is best. However, I can’t help but sense the feeding frenzy people have to so that they are the “go-to” people in this matter.

I know it’s a stretch, but if I followed this example, then I could act like an expert in cardiology since I have certification in CPR.   Most would say that’s ludicrous, and I agree.  But this has to be the same approach to concussions.  A reporter may be an expert in writing or reporting about the subject; parent or advocate will have a expertise from their perspective, perhaps in dealing with academic issues for their child; a former athlete is an expert in reporting the symptoms and how life was altered; a lawyer is an expert from the legal end, etc.

We know more about concussions now than ever before, but the science continues to evolve, things continue to change rapidly, and for some reason there is an impatience by many to have all the information immediately. If not, many take to social media to question and/judge.  What we fail to realize is that our brains are so complex and different from person to person, that it’s quite impossible to have all the answers.  And one person cannot be giving the answers that are out there.   So we need to let the scientists study, the clinicians treat, the reporters write, the parents to remain vigilant, and athletes report the symptoms.  Each has their own experience, expertise and knowledge to bring to the discussion.  But the pursuit of fame and name recognition impacts many in this regard but they use the rationale that they are doing it for the greater good.

So as I look back and think about how the concussion and brain injury discussion has changed in 24 years, and I see how many “experts” there are, I can’t help but wonder, “Why in the heck did I spend all that time studying and obtaining a PhD?”  Since if seems as if nowadays everyone in the concussion world has one.


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