Tuesday, September 29, 2009
Usually, being Tim Tebow is a good thing: starting quarterback for the top ranked college football team in the country and poster child for the reincarnation of Chip Hilton. But while the Claire Bee goodness and kindness remain, it has been a tough week. It began with the H1N1 influenza infection requiring some isolation from his teammates and it ended with a blow to the head, being carted off the field and a night spent in the hospital with a concussion.
The diagnosis is of a concussion is relatively easy. The hard part of the medical care is predicting when the patient will be able to return to the field of play. Once upon a time, not to long ago, the ability to count fingers on the sideline and roughly guess what month it was allowed a player back into the game. Fortunately, medical research has been able to demonstrate the downside to playing with a brain that hasn’t healed fully.
A concussion can be defined as a minor traumatic brain injury that leads to transient loss of brain function. There may or may not be loss of consciousness but the ability to process data can be altered. A patient may have minimal symptoms and complain only of difficulty concentrating, sleeping or irritability. Alternatively, a patient may have significant difficulty with confusion, disorientation, headache, vomiting and memory loss. Medical care may include just observation until the patient returns to normal function. Alternatively, depending upon the symptoms, imaging with a CT scan may be required to make certain no bleeding has occurred within the brain.
With most concussions, the treatment is time to allow the brain to heal. But most people are in a rush to return to their daily activities and athletes are especially motivated to return to practice and competition. The problem with early return is that the brain doesn’t like being rushed and it may not be able to tolerate another, even trivial injury. Second impact syndrome worries sports medicine people and parents alike, where a second injury can cause swelling of brain tissue, increased pressure within the skull and imminent death. The current thinking is that a healed brain is less likely to be a victim of such a catastrophe.
The question becomes: when is the brain healed? And the answer is there is no good answer. Arbitrary guidelines were generated decades ago by well meaning physicians who understood that time was needed to protect the brain but there was little knowledge as to how long. Even now, with computer testing to measure reaction times and emotional stability, the return to play decision is often based on art of medicine.
The return to activity not only includes playing a game but also includes practice and potentially other non contact activities like running or weight lifting, where brain blood flow can be altered. When activity can be added is a mutual decision between player, coach and team doctor or trainer. (And for high school students, a parent is added to the mix).
For Tom Tebow, the return to stardom may wait a week, a month or a season. Only his brain will know when the time is right. It will be up to people around him to listen and allow him back into the game.