Adrian Coxson Retires

Mondio

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I'm wondering who is neurologists and doctors were? Still grading concussions huh? We stopped doing that a few years ago because it was just an arbitrary assignment with no bearing or impact on outcomes
 
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HardRightEdge

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I'm wondering who is neurologists and doctors were? Still grading concussions huh? We stopped doing that a few years ago because it was just an arbitrary assignment with no bearing or impact on outcomes
"We"? Does that mean you're a MD?

The NFL doesn't use the grading system in it's protocols...it's a symptoms-based evaluation process with a set of milestones. Since Coxson said it's been recommended by two neurologists that he retire, I doubt that both fell back to an antiquated methodology. It may be a case of miscommunication, or somebody trying to communicate with Coxson in some kind of understandable short hand.
 

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"We"? Does that mean you're a MD?

The NFL doesn't use the grading system in it's protocols...it's a symptoms-based evaluation process with a set of milestones. Since Coxson said it's been recommended by two neurologists that he retire, I doubt that both fell back to an antiquated methodology. It may be a case of miscommunication, or somebody trying to communicate with Coxson in some kind of understandable short hand.
If you don't mind me asking, what do you do for a living HRE?
 

Mondio

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I'm just a guy on the internet. I have no doubt they took the situation seriously, but no we don't grade them anymore because we were grading on scales that weren't relevant to anything. We thought we knew, but we didn't. We may again someday, but as of now, I don't know anybody up on their concussion protocols that are talking about grades so I commented.

Anyway, I hope he heals up and moves on. Football is fun, it's not worth being mentally debilitated the rest of your life.
 

Joe Nor Cal Packer

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I'm just a guy on the internet. I have no doubt they took the situation seriously, but no we don't grade them anymore because we were grading on scales that weren't relevant to anything. We thought we knew, but we didn't. We may again someday, but as of now, I don't know anybody up on their concussion protocols that are talking about grades so I commented.

Anyway, I hope he heals up and moves on. Football is fun, it's not worth being mentally debilitated the rest of your life.
Yeah gotta give the young man credit for making what for a football player is a tough decision. I have no doubt though, that he did make the right decision. All the best to him and his family.
 

AKCheese

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The NFL may not use the grading system but it's not at all hard to believe that the young man's doctor explained that "what you have used to be considered a blah blah blah grade concussion" in order to put his injury in perspective ....next
 

Mondio

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The NFL may not use the grading system but it's not at all hard to believe that the young man's doctor explained that "what you have used to be considered a blah blah blah grade concussion" in order to put his injury in perspective ....next
Using a grading scale that nobody uses unless they are not up to date on concussion protocols is useless. I'd imagine it's not all too hard to believe that saying, "what you have here is a brain injury severe enough that another blow could leave you lifeless" would be enough perspective....next
 

Joe Nor Cal Packer

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Using a grading scale that nobody uses unless they are not up to date on concussion protocols is useless. I'd imagine it's not all too hard to believe that saying, "what you have here is a brain injury severe enough that another blow could leave you lifeless" would be enough perspective....next
Yeah we don't use rating systems with out physicians to decide a course of treatment, right? In this case I'm sure the considered opinion of two neurologists to get the #$%& out of football or risk death or permanent disability was all the young man needed.
 

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It's still a step up from "you hit your head really really hard and if it happens again your brain will turn to tapioca"
 

AKCheese

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Hey when Mondio gets his license to practice medicine he should use whatever terminology he wants to
 

Mondio

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You still don't get it? It's not about what "I" prefer or the NFL. It's how it is. If your'e still grading concussions, you're not up to speed on treating a concussed athlete. And I may just have a license, or I may just be a guy on the internet. I don't care what you think of me, it doesn't change what I've said.

Just pointing out they aren't graded, for some reason people choose to take offense to that?
 

Mondio

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so you have a group of researchers that aren't up to date either. Nice :) They might want to catch up to the rest of the athletic world
 

Mondio

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anyway don't take my word for it.

National Association of Athletic Trainers ( you know the guys that run out on to the field and take care of the athletes) NATA,
http://www.nata.org/sites/default/files/Concussion_Management_Position_Statement.pdf
Association position statement on the management of sport-related concussion ....Concussion-grading scales should not be used...

AAN (American Academy of Neurology) had this to say
https://www.aan.com/uploadedFiles/W...nt/6_Sports_Concussion_Toolkit/guidelines.pdf
We've moved away from the concussion grading systems we first established ....

AMSSM (American Medical Society for Sports Medicine)
http://www.amssm.org/concussions-getting-your-head-out-of-the-game-va-3.html
Previous grading scales used symptoms at the time of the concussion to determine the severity of the concussion. New guidelines now suggest that we not grade concussions at all and that we only determine that a concussion has occurred. The reasoning for this lies in newer research that shows symptoms at the time of the initial injury do not correlate with the severity of the injury and recovery time. Additionally, grading does not change our treatments as resting until symptoms have resolved is the initial treatment regardless of the injury.

Maybe something from UW Health?
http://www.uwhealth.org/sports-medicine/clinic/concussion/11486
In the past, health professionals used a variety of classification/grading systems to define concussion. These have been determined to be obsolete. It is now known that the severity of a concussion can only be determined after the symptoms have resolved.
 

JBlood

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so you have a group of researchers that aren't up to date either. Nice :) They might want to catch up to the rest of the athletic world
The point is: loss of consciousness may indeed have long term consequences; and may be an important factor in the treatment of concussive brain injury. And, as you point out, guidelines for treatment change, and research such as this study done in Texas adds important information. Current head injury protocols consider all concussions as serious injury, which is appropriate. That doesn't mean that some are not more serious than others. We are really in the infancy of determining the effects of injury at the cellular and molecular levels in the brain. Once those are figured out, there will be better treatment protocols based on the seriousness of the injury. You can be sure that the "athletic world" will constantly be chasing the "research world" in the medical field.
 

Mondio

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by and large, the "research world" is only using grades, which are still entirely arbitrary as you can connect any level of importance or weight whatever symptom you'd like, however you'd like, because they have zero impact on predicting outcomes, dictating treatment, or how that concussed individual is going to, or what treatment they will respond to, to simplyl quantify some symptoms that they noted. and they won't even translate to other researchers by their giving of some grade. The breakdown of catagories should be given in the methods for any study and again, leave the need for a meaningless grade out like everyone else.

Not even sure why these guys did use that language in their study other then all they did was look at older data. and obviously some concussions are more severe than others, that wasn't my point. The point was, we don't grade them because what we used to think were important, didn't seem to have much impact on outcomes or predicting them. and as I said previously, I"m sure we may grade them again, once we have something besides arbitrary importance placed on things that may or many not mean anything in the long run.
 
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HardRightEdge

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anyway don't take my word for it.

National Association of Athletic Trainers ( you know the guys that run out on to the field and take care of the athletes) NATA,
http://www.nata.org/sites/default/files/Concussion_Management_Position_Statement.pdf


AAN (American Academy of Neurology) had this to say
https://www.aan.com/uploadedFiles/W...nt/6_Sports_Concussion_Toolkit/guidelines.pdf


AMSSM (American Medical Society for Sports Medicine)
http://www.amssm.org/concussions-getting-your-head-out-of-the-game-va-3.html


Maybe something from UW Health?
http://www.uwhealth.org/sports-medicine/clinic/concussion/11486
No argument there. The guy who came up with the grading scale commented as far back as 2011 that the scale was obsolete.

My issue with your original comment is that you implausibly assumed two neurologists and two other doctors, a total of four it would appear, are somehow unaware of the current science without entertaining more plausible possibilites. I probably would not have commented at all had not it been for that particularly annoying "we".
 
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Mondio

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you'd be surprised how many are unaware, and if all 4 were really didn't know, I might find a new team to treat my concussion :) I made that comment fully aware that patients often hear things we don't say and fill in blanks when they see fit and there is a very good chance no doctor graded any concussion.

anyway, it was made more so that people realized we don't grade concussions. The only way to ascertain how bad it was, is to wait and see when they recover. It doesn't change any treatment protocols or return to play to give it any arbitrary grade. when they recover, I guess you could grade it then, but a lot of good it will do you. I think after 6 weeks and not being cleared, you can probably figure out, it was worse than others.
 

JBlood

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The only way to ascertain how bad it was, is to wait and see when they recover.
Yes, we're in a situation where all concussive injury is treated the same, and that's precisely because of the relative ignorance of the injury.
Most fractures, in comparison, have classifications based on injury patterns. Each pattern may require vastly differing treatment--from nonoperative to complex operative--which are designed to give the best possible outcome. Varying levels of brain injury due to concussion do not have those classifications as of yet, since little is known about what is going on in the brain at the cellular and molecular levels.
A study that confirms that a significant period of unconsciousness is associated with long term cognitive deficit would seem suggest an important subclass of injury. What exactly the treatment should be for it is another story.
Ultimately, there will be methods available to immediately determine the extent of brain injury at the molecular level, which will likely lead to more detailed classification and treatment.

It's likely the neuroscientists involved in all of this are up to date on the subject.
 

Mondio

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You'd be surprised how many "experts" aren't and that crosses all disciplines
 

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