People pose for a photo

Lori Shutter, MD, right, and at left with husband Michael Abney. Cycling photo by Mark Bowen.

To comply with a new National Football League protocol that requires an independent assessment of any player who has suffered a head injury, the Cincinnati Bengals have turned to Lori Shutter, M.D., a neuro-intensivist with the Mayfield Clinic and the UC Gardner Neuroscience Institute.

Last December, as part of a package of rules that strengthened concussion management, the NFL asked every team to designate an independent neuroscientist to evaluate any player who sustained a minor traumatic brain injury, or concussion. Dr. Shutter, an Associate Professor of Neurosurgery and Neurology at the UC College of Medicine and Director of Neurocritical Care at UCNI, said the new process complements the Bengals’ baseline testing with an additional assessment.

“My priority in this new role is to make sure that individual players are safe,” Dr. Shutter said this week.

“We nominated her based on her credentials, her experience and her training in working with head injuries,” said Paul Sparling, Head Athletic Trainer/Medical Coordinator for the Bengals. “We feel she’ll be a great asset in the evaluative process for our athletes who do suffer head injuries. She had actually played a role in the care of a former Bengals’ player who suffered a serious head injury as a result of non-football-related accident. So we were well aware of her expertise in this area. When we were asked to nominate someone for this position, she was one of the first people we thought of.”

Dr. Shutter noted that “the Bengals impressed me in that they had a good system in place prior to adding an independent neuroscientist.”

Indeed, although the league mandated in 2007 that all NFL teams provide a baseline neuro-psychological evaluation of their players, the Bengals began that process, Mr. Sparling said, in 2000 with Thomas Sullivan, PhD, a neuropsychologist. “We like to stay ahead of the curve and feel we’ve done a good job with that,” Mr. Sparling said. “We had used essentially a neutral person to assess our players with head trauma, concussions, in the form of Dr. Sullivan previously. Now we essentially have two independent specialists who will work in concert with each other.”

Dr. Shutter’s relationship with the Bengals continues the UCNI neurocritical care team’s efforts to educate the public about the risk of mild traumatic brain injury. UCNI held its first symposium about sports-related head injuries, “You Can’t Ice the Brain,” in April. The symposium provided a wealth of information about mild brain injury for its 175 registrants, who included athletic trainers, athletic directors, coaches, medical professionals, members of the ski patrol, and parents. Registrants were taught how to recognize and respond to a concussion or mild traumatic brain injury.

The issue has gained accelerating attention as scientists learn more about the long-term and cumulative effects of minor brain injuries. Researchers have found evidence of chronic traumatic encephalopathy (CTE), characterized by microscopic protein deposits and other abnormalities in the brain, in more than 20 NFL players who have died. The league was jolted when an autopsy of 26-year-old Chris Henry, the Bengals’ receiver who died after falling or jumping from the back of a truck last December, found that Mr. Henry suffered from CTE. He was the first active player found to be suffering from the degenerative condition.

NFL players are being encouraged to make plans to donate their brains, following their death, to a new center at Boston University that is studying the long-term effects of mild TBI. “This will allow scientists to see whether there is evidence, in a broad population, of the microscopic changes in the brain that we’ve seen in the more severe cases,” Dr. Shutter said. “It is probably a disease that falls along a continuum. The media reports about the most severe injuries, but this is probably a disease that also has mild aspects to it and is cumulative. So even if a player doesn’t have the most significant physical manifestation, he may have subtle changes suggesting injury to the brain.”

Dr. Shutter said families need to be aware of the risks of minor traumatic brain injuries She strongly supports ImPACT testing (Immediate Post-Concussion Assessment and Cognitive Testing), which helps ensure that a concussion is recognized so that the athlete does not return to play prematurely and risk further injury to the brain.

She believes that acquiring licensing for the test is worth the expense — institutional fees are $1 to $1.70 per athlete — and all school districts should purchase it for athletes in contact sports. The computerized, 20-minute test, which allows for objective assessment, establishes a baseline for each individual athlete’s neurological function, which can be used for comparison if the athlete suffers a blow to the head during practice or competition. Sideline testing, with which most athletic trainers are familiar, can supplement the ImPACT test, Dr. Shutter said.

On the horizon, but not yet available, are mechanical devices with the potential to objectively measure eye movements or fine-motor movements, which are slowed following head injury.

Among young male athletes, mild traumatic brain injuries occur most frequently in football, followed by wrestling, soccer, basketball, and baseball. Among female athletes, concussions occur most frequently in soccer, followed by basketball, softball, field hockey and volleyball.

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