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Without Updated Tools, NFL Is Still Finding Concussions Too Late

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In September, Miami Dolphins quarterback Tua Tagovailoa was hit in two separate games over five days. He slammed his head on the turf so severely in each instances that they became a flash point for criticism of the N.F.L.’s, and the team’s, handling of concussions and prompted pro football to amend its policy regarding benching players after head hits.

But last week Tagovailoa took a 3rd hit, after which he gathered himself and played the following snap, an illustration of the difficulties that the league faces with its evolving concussion strategy.

In the sport against the Green Bay Packers, Tagovailoa was sacked from behind as he tried to shovel a pass out to a Dolphins receiver. His momentum swung him around, and Tagovailoa fell backward, his head smacking the sphere again. Tagovailoa didn’t display the plain lack of motor skills that he had within the previous instances — lack of consciousness, trouble standing, involuntary hand movements — but he threw three interceptions on three consecutive possessions within the second half of the Miami loss.

Not until Monday, the day after the sport, did Tagovailoa report concussion symptoms to team personnel, who placed him under league-mandated statement and out of play.

“I totally didn’t realize that Tua went through that,” Raheem Mostert, the Dolphins running back, said of the concussion. “Nevertheless it also type of made sense toward the tip of the sport. , I used to be asking myself within the huddle, like, ‘What are we doing? What’s happening?’”

The everlasting damage brought on by brain injuries to athletes can have devastating effects.

The N.F.L. and the players’ union said in a joint statement on Saturday that they’d reviewed the sport and that the play involving Tagovailoa didn’t immediately merit taking him out of the sport. “The review established that symptoms of a concussion were neither exhibited nor reported until the next day at which era the team medical personnel appropriately evaluated and placed Mr. Tagovailoa within the concussion protocol,” the league and union said.

The league mandates that almost 30 medical professionals are readily available for each game. They include athletic trainers and neurotrauma consultants on the sidelines and medical examiners scanning the sphere from press boxes so as to spot any potential head injuries that is perhaps missed below.

But concussions may cause much subtler symptoms, including headaches, sluggishness and difficulty sleeping, a few of which should not present immediately after a trauma. The absence of obvious symptoms makes the sort of easy diagnosis that’s urged within the N.F.L. difficult without the adoption of updated tools that may measure concussion symptoms with the next degree of specificity.

“Mainly, anything that your brain controls may be disrupted by a concussion,” said Dr. Uzma Samadani, a neurosurgeon who was an unaffiliated neurotrauma consultant for 4 years at Minnesota Vikings games and who developed an eye-tracking device to more definitively diagnose concussions. “Is it possible to make an objective assessment of somebody’s total capability of brain function on the sideline that rapidly? It’s very difficult.”

In recent weeks, the players themselves have been those alerting football staff to potential concussions. In early November, Los Angeles Rams quarterback Matthew Stafford reported the onset of concussion symptoms days after he was sacked 4 times in a loss to the Tampa Bay Buccaneers. He was placed in concussion protocols again that month after experiencing leg numbness that doctors couldn’t attribute to at least one particular injury.

In a Monday night game on Dec. 12, Recent England Patriots receiver Nelson Agholor frantically waved down a referee to stop play in order that his teammate DeVante Parker might be evaluated after successful. Parker had been lined as much as play the following down but was eventually diagnosed with a concussion.

“I can let you know there’s been a sea change during the last decade within the willingness and the understanding of players to talk up about their symptoms,” said Dr. Allen Sills, the N.F.L.’s chief medical officer. Around 40 percent of the league’s concussion evaluations involved some type of self-reporting, he added.

Sills noted that today’s players have “grown up with a concussion protocol,” often having had their high schools and colleges institute policy changes. “They’re far more acquainted with and have a much greater understanding of the protocols and players than possibly a generation ago,” he said.

While self-reporting symptoms may be key to diagnosing concussions, studies have found that players may be reluctant to talk up for quite a lot of reasons. Those include the chance of going against football’s next-man-up culture and the lack of compensation in a sport without guaranteed contracts.

The N.F.L. uses a series of physical and cognitive exams to evaluate players for concussions, but experts in brain injuries say that there stays no objective tool to discover a concussion. Elite athletes, even with diminished mobility, can often handle the physical tests designed to gauge their balance and motor skills.

“Unfortunately, even today with all of our technology, we don’t have a blood test or an X-ray scan or an M.R.I. scan to reliably diagnose concussion. We’re still very reliant upon self-report of symptoms and identification of symptoms as type of the cornerstone of our diagnosis,” Sills said.

Still, as science evolves, other diagnostic tools are gaining wider acceptance outside of football in evaluating concussions. Dr. Nsini Umoh, a traumatic brain injury program director on the National Institute of Neurological Disorders and Stroke, points to CT scans and the Banyan Brain Trauma Indicator test — a blood test that measures two proteins that appear in instances of brain bleeding — as advancements which are gaining common usage.

The N.F.L. has partnered with the Canadian Football League since 2015 on recent testing and funds concussion research through various initiatives but has yet to adopt any of the brand new tools. “Before we’ll put a tool as a part of our concussion protocol, we and the Players’ Association together have to be convinced that it’s going to enhance our diagnostic accuracy because players don’t want false positives,” Sills said.

The league and its players’ union must jointly comply with adopt changes to the concussion protocol, including recent diagnostic tools. Advocacy from players has been key in certain changes to the policy previously.

The N.F.L.P.A.’s lobbying prompted the 2012 addition of independent neurological evaluators on the sidelines and in booths, and the union has pushed for using higher helmets and searched for methods to raised review back-of-head hits.

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