Interviewer: It doesn't seem to be any rhyme or reason, I mean, I have followed athletes, there is a couple on the baseball team that I have followed that have suffered from concussions like you said just, it doesn't look like it's very bad, just a glancing blow to someone who is actually wearing a helmet, but knocked him off for the rest of the year. Why can they vary so much?
Dr. Maroon: Well, that's the multimillion dollar question then. Many scientists are trying to answer. We know that rotational injuries are much more prone to result in post-concussion syndrome than direct acceleration or deceleration.
So in boxing, for instance, if you, if a price fighter wants to knock out his opponent, where does he hit him? He hits him in the jaw and rotates his head so that there is a translational movement to the brain that results in an electrical and a metabolic shutdown. But why one is more prone than another, we really don't know that answer.
Interviewer: If you have one or once you have had a concussion, are more susceptible to getting them again?
Dr. Maroon: You are more susceptible if you are not managed appropriately the first time, meaning the NFL has instituted several criteria before you return to play. Number one, you have to become completely asymptomatic, no headache, no memory problems, no nausea. Number two, you have to asymptomatic with a gradation or a graduated progression of aerobic activity. From a stationary bike, lifting weights, running and then full aerobic activity, number two. And number three, you have to pass the impact neuropsychological, neurocognitive test that we developed, Mark Lovell, a neuropsychologist and I in Pittsburgh.
This is a 20 minute test that athletes are given as a baseline. If there is a concussion within 24 to 72 hours they are retested to make sure that they get back to baseline and we now of baseline five million kids with this test. So it really has become the standard of care, in terms of a neurocognitive test in contact sports. And we now have it, will in the next month or two available down to six year olds.
So it's been a major advance. But what I was getting to if you follow those criteria the implication of another concussion having longer lasting effects is reduced to the minimum. If you return still symptomatic then you are risking potentially very severe problems.