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ReplyDeleteThe sight of a head injury is gruesome, especially after seeing a similar injury arise from Tua last week. Watching the tackle, Tua had a slight rotation in his head as its posterior portion was slammed down to make contact with the grass. As we know, the brainstem meets the spinal cord with its most inferior portion, the medulla oblongata, in the foramen magnum. In the medulla oblongata, there are structures known as pyramids that carry motor fibers from the motor cortex to the peripheral nervous system (Hogg, Basinger 2022). With such a forceful impact, could it be possible that some of that energy was transmitted into the medulla oblongata causing uncontrollable firing of some of these motor neurons, almost like a reflex response? Or a more plausible explanation, is this unconscious state we witnessed an innate protective measure after damage to such an important structure?
As Tua recovers, we must be on high alert and monitor other possible effects that could arise from this injury. This includes damage to cranial nerves that emerge from this area like IX, X, and XI which are glossopharyngeal, vagus, and accessory respectfully (Hogg, Basinger 2022).
Basinger H, Hogg JP. Neuroanatomy, Brainstem. (Updated 2022 Jul 6). Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544297/
This hit on Tua Tagovailoa during Thursday night football could be the result of second impact syndrome(SIS). Second impact syndrome is the result of a second head trauma before the first trauma has healed completely (Foris, 2022). The first injury makes the person more susceptible to a second. This is part of the reason why the concussion protocol was established. The previous week when Tua was tackled and his head hit the ground with significant force giving a clear mechanism for a possible concussion he should have been admitted to the concussion protocol. He proceeds to stand up and shake his head and attempts to join the huddle but displayed a loss of gross motor skills falling back to the ground. It was described as a back injury by the medical staff, so he was able to return to the same game. This was a failure by his medical staff to protect him from himself. It is debatable if the concussion Thursday would still occur if there was any protocol initiated. But what is not debatable is the head shaking, loss of gross motor skills, and needing to be held up by his lineman should have triggered more protocols and protection than it did for Tua. I hope he has a speedy recovery.
ReplyDeleteForis, L., Todd, M., & Chester, D. (2022). Second impact syndrome - statpearls - NCBI bookshelf. National Library of Medicine . Retrieved September 30, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK448119/
From the moment I saw the play on Thursday of Tua Tagovailoa and his previous injury, I was curious to know why he had been cleared to return to play. Going back to where you state that the brain is difficult to assess making it hard to diagnose and understand the severity of the injury—I almost wonder why in this case, the first injury was not assessed properly. In an article by the American College of Sports Medicine et al., state the importance for the team physician to know the complications of a concussion and the protocol for Return-to-Play decision. There is an agreement within the protocol that communicates any athlete to have significant, persistent, or worsening symptoms should not return to play. So going back to his first injury, only four days prior to the second injury, it is clear to determine gross motor instability. He was unable to properly walk and kept stumbling which should have raised immediate flags but instead, he returned to play in the second quarter. I believe the safest action would have been to hold Tua out, and the team physician to assess and evaluate the player better prior to clearing him—preventing this second head injury leading to the fencing reflex.
ReplyDeleteConcussion (Mild Traumatic Brain Injury) and the Team Physician: A Consensus Statement*. Medicine & Science in Sports & Exercise: February 2006 - Volume 38 - Issue 2 - p 395-399
doi: 10.1249/01.mss.0000202025.48774.31
When I saw this injury happen on the field I immediately thought about who let him be in this vulnerable situation in the first place. Not even a week earlier he hit his head so hard he could barely walk. The team then released a statement that he “did not sustain a concussion” from this initial hit a week earlier. I think there are some serious ethical issues coming to the forefront in the aftermath of such a traumatizing injury.
ReplyDeleteI believe that the Dolphins team doctors were not acting with non-malfeacence in mind. Allowing a player to return to the game moments after not being able to walk is not acting in limiting the harm to the player. There is also a question of justice when it comes to the leagues so called “concussion protocol”. These decisions whether to let a player play have huge implications on the teams chances to win and set a precedent for how other teams handle such injuries. And lastly, even though I do not know the exact conversation that was had between the doctors and Tua, I am skeptical of the amount of autonomy that was given to Tua during these injuries as there is tremendous amounts of pressure and financial incentive to “tough it out” and play. I think this injury will have an number of rippling effects throughout the NFL.
As we continue this situation it will be interesting to see what the investigation into this incident will shed light on. As of now, the doctor who consulted on this injury and okayed him being able to play has been fired.
Belson, Ken, et al. “Doctor Who Examined Tagovailoa Is Dismissed; N.F.L. Assessing Concussion Rules.” The New York Times, The New York Times, 1 Oct. 2022, https://www.nytimes.com/2022/10/01/sports/football/tua-tagovailoa-doctor-fired.html.
The NFL is a money driven league and even with implementation of independent doctors, we are still seeing players returning to play after suffering hard collisions. Following Thursday nights game between the Dolphins and the Bengals, the NFL players association fired the independent doctor who allowed Tua Tagovailoa to return to the game versus the Bills the Sunday night game prior. Having experienced multiple concussions in high school, the return to activity protocol was one week abstaining from contact and a second reevaluation before being cleared to participate. Interestingly, high school athletes take a much longer time to recover from head injuries compared to NFL players. In fact NFL players do not see neuropsychological effects after one week while high school athletes will have prolonged neuropsychological effects lasting greater than a week (Pellman et al., 2006).
ReplyDeletePellman, E. J., Lovell, M. R., Viano, D. C., & Casson, I. R. (2006). Concussion in professional football: recovery of NFL and high school athletes assessed by computerized neuropsychological testing--Part 12. Neurosurgery, 58(2), 263–274. https://doi.org/10.1227/01.NEU.0000200272.56192.62