The NFL is playing catch-up to the NHL in keeping watch over players with concussions.
The NFL is putting together details of a plan that will have each of its teams consult an independent neurologist before a player who has suffered a concussion can return to action, according to a report in The New York Times.
The move follows a step made by the NHL and its players' association more than a decade ago in which independent neuropsychologists were identified in each of the NHL's 30 cities to assess players with head traumas.
"The NHL/NHLPA concussion program was jointly initiated during the 1997-98 season and was the first of its kind in professional sports," National Hockey League Players' Association spokesman Jonathan Weatherdon said. "Our program was also the first in professional sports to mandate baseline and postconcussion neuropsychological testing."
The concussion program mandates that each roster player undergo a standardized baseline series of neuropsychological tests during training camp. Following a concussion and once a player is non-symptomatic, the player completes a postconcussion neuropsychological test. All evidence, including symptoms, physical examination and neuropsych tests are used collectively to make a decision regarding return to play. Essentially, athletes do not return to action until they are symptom-free both at rest and with full activity.
"The NHL currently has in place - and has for a number of years now - a framework in which independent neuropsychologists consult with each team in assessing and interpreting each player's neuropsychological test results," NHL spokesman Gary Meagher said.
The next step is getting players to come forward about head injuries. Head injuries and concussions are "drastically underreported" by coaches and hockey officials, a London, Ont., symposium on violence in hockey heard this spring.
Laura Purcell, assistant professor in the division of emergency medicine, pediatrics and family medicine at the University of Western Ontario, said injury-surveillance studies revealed one in five serious hockey injuries involve concussions, from minor hockey to the NHL levels.
"These injuries are notoriously underreported," she said in an interview. "Either the athlete doesn't realize it and doesn't want to be taken out of the game or coaches don't realize it.
"In a British Columbia study, there was a rate of 0.6 to 0.8 [head]injuries per 1,000 game hours, according to official reports. But when athletes themselves were surveyed, it was more in the range of six to eight injuries. That [a tenfold difference]is a huge discrepancy from the official reports," Purcell said.
"There are still coaches who don't recognize concussion and how serious it is. For a lot of coaches, if a player is not knocked out they don't seek medical help. It's vitally important that a player be evaluated by a doctor, preferably one who has experience with concussions."
The importance of the medical personnel being independent of the team was not specifically surveyed, but Purcell said in a question-and-answer session, that there was pressure on team doctors to clear players to play after an injury. Pro sports leagues have been under fire for not paying sufficient attention to head injuries and concussions in the past. Decisions on when players who sustain concussions should return to play have, in the past, been made by doctors and trainers employed by the team, raising questions of possible conflicts of interest.
"If NHLPA members have concerns about the diagnosis of a concussion, the NHLPA's consulting physicians, Dr. John Rizos and Dr. Paul Comper, are available to members to arrange a second opinion from a concussion expert." Weatherdon said.
The NHL and NFL have worked together before on concussions. Two years ago, the two leagues sponsored a DVD-based educational program on sports concussions developed by the U.S. National Academy of Neuropsychology and the National Athletic Trainers' Association.