Abstract and Introduction
Abstract
In 1994 the National Football League (NFL) initiated a comprehensive clinical and biomechanical research study of mild traumatic brain injury (TBI), a study that is ongoing. Data on mild TBIs sustained between 1996 and 2001 were collected and submitted by NFL team physicians and athletic trainers, and these data were analyzed by the NFL's Committee on Mild Traumatic Brain Injury. At the same time, analysis of game videos was performed for on-field mild TBIs to quantify the biomechanics involved and to develop means to improve the understanding of these injuries so that manufacturers could systematically improve and update their head protective equipment. The findings and analysis of the Committee have been presented in a series of articles in Neurosurgery.
Introduction
In 1992 Al Toon, who was a wide receiver for the New York Jets, was the first NFL player known to have retired because of postconcussion syndrome. The year after Mr. Toon's retirement, another player, Merrill Hoge of the Chicago Bears, retired because of the same problem. Commissioner Paul Tagliabue, team physicians, and many others raised questions: was this a new problem or a misdiagnosed or unrecognized one? Was this a statistical anomaly or the beginning of an epidemic?
It was decided that a rigorous, scientific approach was necessary to gather the data to answer these questions for this high-profile professional sports league. In 1994, Commissioner Tagliabue approved the creation of the NFL's Committee on Mild Traumatic Brain Injury. The Committee was composed of experts inside and outside the NFL. It was decided by the Committee that protection against in jury as well as collection and analysis of injury data would be critical to the success of their mission. For the study, a reportable mild TBI was defined as a traumatically induced alteration in brain function manifested by an alteration of awareness and consciousness, including but not limited to an LOC, a "ding," a sensation of being dazed or stunned, a sensation of "wooziness" or "fogginess," a seizure or amnesic period, and by symptoms commonly associated with postconcussion syndrome, including persistent headaches, vertigo, lightheadedness, loss of balance, unsteadiness, syncope, near-syncope, cognitive dysfunction, memory disturbances, hearing loss, tinnitus, blurred vision, diplopia, visual loss, personality change, drowsiness, lethargy, fatigue, and inability to perform usual daily activities. The research summarized here was developed, supervised, and completed in response to the stated goals of the NFL's Committee on Mild Traumatic Brain Injury.