UNIVERSITY PARK, Pa. -- Fifteen years ago Penn State tight end Bob Stephenson was tackled by Michigan safety Daydrion Taylor, resulting in what some have called the hardest hit in college football history -- ending their gridiron careers. "Thirty-two years of watching college football in the press box, I have never seen a hit like that," declares Steve Jones, the Nittany Lions' play-by-play announcer.
Stephenson and Taylor were both knocked unconscious for nearly two minutes after colliding helmet to helmet. Each diagnosed with a concussion, they both chose to stay off the field permanently after recovering. The Big Ten Network aired a program in November commemorating the anniversary, including interviews with Stephenson and Taylor reflecting on that fateful play at Beaver Stadium on Nov. 8, 1997.
Strides made in concussion research in the past few years emphasize the importance of giving a traumatic brain injury enough time to heal. Because of these findings, high school and collegiate football leagues as well as the NFL are taking concussions much more seriously than they have in the past. After a player sustains any head injury, many leagues require a doctor to sign off before he or she is allowed back on the field. That includes not only football but other contact sports, such as ice hockey, lacrosse and rugby as well.
Advancing research
In May 2012 Penn State opened the Center for Sport Concussion Research and Service in Rec Hall. The new center has two main goals: to advance research in sport-related concussions and to provide services to local collegiate and child athletes by performing baseline assessments, which can help diagnose a concussion.
The center includes a virtual-reality facility that allows the researchers to document athletes' cognitive and motor abilities.
"We, at Penn State, are the first to use virtual-reality technology to study the cognitive and motor effects of concussions on athletes," says Semyon Slobounov, director of the center. This technology is paired with brain imaging capabilities, like an fMRI (functional magnetic resonance imaging) and an EEG (electroencephalograph), so that the researchers can examine alterations in brain structure and function of an athlete who has received a concussion.
Slobounov, who is also a professor of kinesiology and of orthopedics and medical rehabilitation, is joined in the center by Wayne Sebastianelli, M.D., Penn State's director of athletic medicine. The two have worked together for many years, building toward the center that exists today.
Katie Finelli also is an integral member of the team. As the research and services coordinator for the center, she manages all testing in addition to handling communication between the center and its patients and their medical doctors.
"Our research has allowed us to work closely with the athletic teams for a number of years at the University," Finelli says. "This hard work and dedication has led us to a testing protocol that we can now offer as a service that is able to detect and monitor residual brain and functional abnormalities that are often missed with conventional clinical assessment techniques. This protocol takes a much closer look in areas including EEG readings, balance, memory retrieval, navigation and reaction time. We are fortunate to work closely with medical practitioners that care for student athletes as well as community members that could benefit from our center."
Along with Slobounov, Sebastianelli and Finelli, many graduate students help run the center.
Setting a baseline
In a study published in December 2011, Slobounov and colleagues reported that testing athletes for concussions may induce mental fatigue, whether or not the subject has a head injury.
"Testing for a long period of time can induce fatigue," Slobounov explains. "But at the same time, fatigue is a symptom of concussion. How do you rule out fatigue if you get fatigued while taking the test?"
This is where baseline testing comes in. If an athlete is tested at the beginning of the season, the center will then have a standard to compare to if the athlete sustains any head injuries. After a concussion, the center will provide the athlete's physician with both pre-concussion and post-concussion data to help create a concussion management plan.
Knowing more about the health of an athlete who sustained a concussion will help determine when he or she is allowed back on the field. According to the American Association of Neurological Surgeons, concussed athletes who return to the field too quickly are three to six times more likely to get injured again in the same season.
Several medical problems can occur when an athlete with a traumatic brain injury is not allowed enough time to heal. Boxer's encephalopathy, identified in the early 20th century, today is recognized as affecting any person who repeatedly suffers blows to the head. It can cause dementia, speech problems and tremors -- symptoms that are very similar to both Alzheimer's and Parkinson's diseases.
Second-impact syndrome is a deadly second blow after a person has received one concussion and not fully healed. The second impact -- minutes, days or weeks after the first injury -- can cause nearly instant death.
Protecting future athletes
The concussion center's research is funded by grants from the National Institutes of Health (NIH) and NFL Charities. The NIH grant enables researchers to identify athletes at risk for traumatic brain injuries, while the grant from the NFL Charities focuses on concussions in children.
"There is controversy and discrepancy in the literature as to whether children suffering from mild traumatic brain injuries recover faster and have a better prognosis than young adults," Slobounov says. "A widespread belief among pediatric neurologists is that younger patients recover faster with fewer long-term residual neurocognitive and behavioral deficits due to 'plasticity' of the younger brain. However, this belief is at odds with the notion that trauma to a young brain may prevent typical development of brain networks."
Along with the baseline testing the center is offering for athletes, the researchers are examining child athletes (13 to 16 years old) and collegiate athletes (18 to 21 years) who have suffered concussions. Slobounov and his team hope to help form guidelines for when a child should be allowed to return to the field post-concussion.
For more information about concussion testing visit www.concussion.psu.edu.