Lori Shutter, MD, Has the Bengals’ Backs

Woman poses for photo

Photo of Lori Shutter, MD, by Dan Davenport / UC Academic Health Center Communications Services.

Look around Dr. Lori Shutter’s office on the UC Academic Health Center campus, and you won’t see any Bengal stripes. There are no NFL souvenirs or autographed posters on the walls. As an independent consultant to the Cincinnati Bengals, Dr. Shutter can’t afford to get swept up in the Who Dey spirit, even as the Bengals approach the playoffs this Saturday. “My priority is putting the players first, not the team,” Dr. Shutter says. “We want to take care of them. I can’t allow any bias to creep in.”

The Cincinnati Bengals turned to Dr. Shutter, Professor of Neurosurgery and Neurology and a neuro-intensivist with the Mayfield Clinic and the UC Gardner Neuroscience Institute, a division of UC Health, in 2009 during implementation of new rules that strengthened management of concussions. The NFL asked every team to designate an independent neuroscientist to evaluate any player who sustained a concussion — which is really a minor traumatic brain injury — and the Bengals selected Dr. Shutter.

The NFL’s concussion-management rules continue to evolve as researchers learn more about these injuries and their consequences. Most recently, after a concussive hit on Cleveland Browns quarterback Colt McCoy, the League adopted a rule requiring a certified athletic trainer to monitor each game from an upstairs booth, with access to video replay and communication to medical staffs for both teams. Although the NFL has a 10- to 15-minute standardized sideline assessment that can be performed on any player suspected of having a concussion, it appeared that the sideline evaluation of Mr. McCoy focused on a hand injury rather than a possible concussion.

“According to statements from the Cleveland Browns, they did not observe Mr. McCoy sustaining a blow to his head, and when he came to the sidelines he was only complaining of a hand problem,” Dr. Shutter says. “He was returned to play fairly quickly, which raised the concern that a full concussion assessment was not completed. Now there will be a trainer in the booth who will look down and monitor for hits that people at ground level may not see.”

If Dr. Shutter is not a Bengals fan per se (although she will be watching Saturday), she is impressed that the team always goes “one step beyond what the NFL recommends.” Even before the trainer-in-the-sky rule, the Bengals would have been unlikely to miss a concussive hit like the one suffered by Colt McCoy. “The Bengals have a large number of athletic trainers and athletic trainer assistants who are spread out along the sidelines, and they all have certain parts of the field that they watch,” Dr. Shutter explains. “They work very hard to not miss any injuries.”

Mr. McCoy’s injury prompted renewed calls for keeping an independent neurologist on the sidelines. Dr. Shutter says she understands the logic behind that argument but believes the athletic trainers, who know the players, are better suited to the task. “I don’t know the players’ personalities that well,” she says. “A player in the middle of the game has his adrenaline going and may be a different person than the one I see in the locker room on Tuesday. Because of that, an independent neurologist may not be the best person to make an independent sideline assessment, because we don’t normally see them in that hyper, revved-up adrenaline phase.”

Even as the NFL’s vigilance increases, researchers are learning more and more about what even the most experienced neurologist can’t see. Damage to the brain from repetitive head injuries is not showing up on standard tests such as CT scans and MRI’s, Dr. Shutter notes, which means the subtle changes are most likely happening at the cellular level. Doctors can identify those abnormalities when dissecting a brain after a patient’s death, but identifying them during life will require new kinds of tests. These tests potentially could quantify behavior, reaction time or blood flow to the brain.

The NFL’s interest in concussions spiked in recent years as researchers began finding evidence of chronic traumatic encephalopathy (CTE), characterized by microscopic protein deposits and other abnormalities in the brain, in former players who had died. In 2009 the league was further 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, revealed CTE. He was the first active player found to be suffering from the degenerative condition. In 2010, following the suicide (by hanging) of a 21-year-old junior lineman at the University of Pennsylvania, a brain autopsy revealed early stages of CTE.

CTE, Dr. Shutter says, is a disease that likely 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’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 will present “Play It Safe:  Injury Prevention Symposium,” which will include information about head injuries, June 15 at Drake Center.

Dr. Shutter says that families of school-age athletes need to be aware of the risks of concussions. 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.

— Cindy Starr

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