Concussion awareness has increased substantially over the last few years. Though they’ve always been a problem is sports, they often went unrecognized in the past. For example, the problems—including repetitive concussions and the long term consequences—have been well-known in boxing since the early 1900s, but there wasn’t much of a concern until it became a problem in tackle football, ice hockey and soccer.
How are you making a difference in the health field and what satisfaction do you get when helping others?
I’ve aimed to make a difference in the health field by being involved in, and helping to develop, the field of sports neurology for the past 30 years. My colleagues and I started the first sports neurology program in the country at the Hospital for Special Surgery and we went on to edit the first sports neurology textbook in 1989.
Today, it is much more common for physicians to become specialized in this field—there is now a sports neurology section under the American Academy of Neurology— and the field is receiving greater attention in the media and in circles outside of medicine.
This has really allowed me to make a difference and to help athletes at all levels—from kids playing Pop Warner football to college athletes to professionals. By serving as an adviser for various sports organizations, for example, I’ve been able to help make games safer and to reduce head injuries in players. On the more legislative side, I’ve served as an adviser for a variety of issues, such as, for example, assisting in the implementation of New York state concussion laws for scholastic athletes.
It has always been my hope to try and make contact collision sports as safe as possible and minimize the risk of brain and spinal cord injuries. It’s extremely gratifying to be able to help these players and advocate for safer sports for all athletes.
As a team physician for USA Boxing, how do you respond to boxers who, despite advice given them that would be a detriment for them, sometimes refuse to follow advice or just don’t listen and want to continue in a way that would be harmful to them?
As a physician caring for boxers, the health and safety of the boxer is paramount. If we determine he or she is experiencing untoward consequences from a particular bout or from simply having been fighting for years, it’s encouraged that they not continue. If you, as a physician, suspend a boxer, he or she is not allowed to box. Thankfully, the boxer usually does follow our advice.
Naturally, they may be upset, so I try to show them in a concrete way what we’re talking about. I’ll explain how this particular test was this way at one point and now it looks different, so they can see the evidence of neurological deterioration.
What is your stance on how the NFL is now handling concussions?
I believe the NFL is doing a good job. The rule changes the league has implemented have been particularly important. For example, changing where the kick-off occurs has undoubtedly reduced the number of concussions. Also, having unaffiliated neuro trauma consultants on the sidelines to assist the team physicians has made an impact on recognizing, documenting and managing concussions.
What’s also great is that the NFL has come forward to fund programs in various parts of the country that look at the long-term effects in players who’ve had numerous concussions over the course of their career.
Though not affiliated with the NFL, here at Burke Rehabilitation Center, we are currently launching a program called RACE—Retired Athletes Cognitive Evaluation—which will provide retired amateur and professional athletes from any sport (including football, boxing, soccer and lacrosse) with a comprehensive neurological examination as well as diagnosis and appropriate treatment. This is important because recent studies have speculated that Chronic Traumatic Encephalopathy (CTE) and other neurodegenerative disorders such as Alzheimer’s disease and Parkinson’s disease may be associated with repetitive concussive or sub-concussive blows to the head.
President Obama just hosted a Healthy Kids and Safe Sports Concussion Summit at the White House. How important is it to get the word out to kids at an early age and what steps do you feel must be taken to save kids from concussions and other brain related mishaps?
I was honored to be invited and to attend the summit at the White House. Having discussions at events like this highlights and brings continued attention to the importance of keeping kids safe while playing sports.
Getting the word out to kids, in particular, is extremely important. To start, we need to get a better idea of what the magnitude of the problem is, so we need better surveillance and epidemiology.
I think it’s also important that we level the playing field, so to speak, because there are disparities between different areas in the country in terms of access to athletic trainers. Inner city schools very often don’t have the same resources as affluent communities with larger budgets—and having athletic trainers is integral in recognizing and documenting concussions in student-athletes.
There also needs to be increased and continued education about the signs and symptoms of concussion. Along those same lines, having proper supervision of kids at a young age in order to prevent unnecessary trauma to the brain, such as heading the ball and excessive contact during football practices, is also important.
What is the most enjoyable part of your job?
For me, the most enjoyable part of the job is being able to help others and work towards preventing brain injuries in athletes at all levels of play. If a patient has sustained a severe brain injury, it’s a great feeling to be able to see them recover and reintegrate back into society. When they come back to visit or even when I’m out and run into someone and they say, “I was your patient!,” it’s just a remarkable feeling.
Along with helping patients on a daily basis, it’s been gratifying to have had the opportunity to work with some of the most talented athletes from all over the world and to be able to provide them with important medical care. Working with the US Olympic committee in the 1995 Pan-American games in Argentina was phenomenal. It was hard work, but it was extremely rewarding. One instance that comes to mind was with the cycling team. During a race, one rider fell and the whole team basically fell over him. They came into the clinic and we were all trying to take care of them and treat any injuries. Then, the team went back out there the next day and won the gold medal—now that’s what makes working in sports exciting.