National Football League Players Association Research Articles

The National Football League Concussion Protocol: A Review.

Sport-related concussion remains an area of high concern for contact sport athletes and their families, as well as for the medical and scientific communities. The National Football League (NFL), along with the NFL Players Association and experts in the field, has developed protocols for the detection and management of sport-related concussions. This article reviews the NFL's most recent concussion protocol including preseason education and baseline testing for players, concussion surveillance by gameday medical teams and neurotrauma consultants and athletic trainers, gameday concussion protocol and procedures, and return to participation guidelines.

Effectiveness and use of reverse transcriptase polymerase chain reaction point of care testing in a large-scale COVID-19 surveillance system.

BackgroundRapid COVID‐19 testing platforms can identify infected individuals at the point of care (POC), allowing immediate isolation of infected individuals and reducing the risk of transmission. While lab‐based nucleic acid amplification testing (NAAT) is often considered the gold standard to detect SARS‐CoV‐2 in the community, results typically take 2–7 days to return, rendering POC testing a critical diagnostic tool for infection control. The National Football League (NFL) and NFL Players Association deployed a new POC testing strategy using a newly available reverse transcriptase polymerase chain reaction (RT‐PCR) rapid test during the 2020 season, and evaluated diagnostic effectiveness compared to other available devices using real‐world population surveillance data.MethodsRT‐PCR POC test results were compared to NAAT results from same‐day samples by calculation of positive and negative concordance. Sensitivity analyses were performed for three subgroups: (1) individuals symptomatic at time of positive test; (2) individuals tested during the pilot phase of rollout; and (3) individuals tested daily.ResultsAmong 4989 same‐day POC/NAAT pairs, 4957 (99.4%) were concordant, with 93.1% positive concordance and 99.6% negative concordance. Based on adjudicated case status, the false negative rate was 0.2% and false positive rate was 2.9%. In 43 instances, the immediate turnaround of results by POC allowed isolation of infected individuals 1 day sooner than lab‐based testing. Positive/negative concordance in sensitivity analyses were relatively stable.ConclusionRT‐PCR POC testing provided timely results that were highly concordant with lab‐based NAAT in population surveillance. Expanded use of effective RT‐PCR POC can enable rapid isolation of infected individuals and reduce COVID‐19 infection in the community.

Mavacamten for hypertrophic cardiomyopathy: effectiveness and value.

DISCLOSURES: Funding for this summary was contributed by Arnold Ventures, The Donaghue Foundation, Harvard Pilgrim Health Care, and Kaiser Foundation Health Plan to the Institute for Clinical and Economic Review (ICER), an independent organization that evaluates the evidence on the value of health care interventions. ICER's annual policy summit is supported by dues from AbbVie, America's Health Insurance Plans, Anthem, Alnylam, AstraZeneca, Biogen, Blue Shield of CA, Boehringer-Ingelheim, Cambia Health Services, CVS, Editas, Evolve Pharmacy, Express Scripts, Genentech/Roche, GlaxoSmithKline, Harvard Pilgrim, Health Care Service Corporation, HealthFirst, Health Partners, Humana, Johnson & Johnson (Janssen), Kaiser Permanente, LEO Pharma, Mallinckrodt, Merck, Novartis, National Pharmaceutical Council, Pfizer, Premera, Prime Therapeutics, Regeneron, Sanofi, Sun Life Financial, uniQure, and United Healthcare. Beinfeld, Nhan, Rind, and Pearson are employed by ICER. Through their affiliated institutions, Wasfy, Walton, and Sarker received funding from ICER for the work described in this summary. Walton also reports consulting fees from Second City Outcomes Research. Wasfy reports personal fees from Biotronik and Pfizer; grants from National Institutes of Health, National Football League Players Association and American Heart Association; and travel support from American College of Cardiology. Sarker has nothing additional to disclose.

Design Considerations in the National Football League and National Football League Players Association Prescription Drug Monitoring Program: An Introduction and Overview.

Design Considerations in the National Football League and National Football League Players Association Prescription Drug Monitoring Program: An Introduction and Overview.

Observed Versus Expected COVID-19 Infections Among National Football League Players During the 2020 Season.

The National Football League (NFL) and National Football League Players Association implemented a set of strict protocols for the 2020 season with the intent to mitigate COVID-19 risk among players and staff. In that timeframe, the league's 32 teams completed 256 regular season games and several thousand meetings and practices. In parallel, community cases of COVID-19 were highly prevalent. We assess the risk of holding a 2020 NFL season by comparing community and player COVID-19 infections. We used county-level COVID-19 test data from each team to establish baseline distributions of infection rates expected to occur in a population similar in age and sex to NFL players. We used a binomial distribution to simulate expected infections in each community cohort and compared these findings with observed COVID-19 infections in players. Over a 5-month period (1 August 2020 to 2 January 2021), positive NFL player infections (n = 256) were 55.7% lower than expected when compared with simulations from NFL community cohorts. For 30 of 32 teams (94%), observed counts fell at or below expectation, including 28 teams (88%) for which rates were lower. Two teams fell above baseline expectation. The NFL/NFLPA protocols that governed team facilities, travel, gameday, and activities outside of the workplace were associated with lower infection rates among NFL players compared with the surrounding community. The NFL's 2020-2021 season are consistent with the hypothesis that robust testing and behavioral protocols support a safe return to sport and work.

NFL Football: A History of America's New National Pastime

The National Football League (NFL) seems nearly omnipresent today in the United States. Even people who are not football fans know the team names and recognize the star players. That was certainly not the case one hundred years ago when the league was founded at a car dealership in Canton, Ohio. How this change occurred is the story that Richard C. Crepeau tells in NFL Football: A History of America's New National Pastime. Originally published in 2014, the University of Illinois Press issued this revised edition in 2020 to coincide with the NFL's centennial. The author has expanded a couple of chapters from the previous edition and added a new chapter.The book is divided into three sections: “The Formative Years,” “The Rozelle Era,” and “The New NFL.” Within each section, chapters are often thematic, which occasionally means there is some repetitiveness. The first section examines the birth of professional American football in the 1890s and its slow growth through the early decades of the twentieth century. Initially centered in the factory and mill towns of the Ohio Valley, professional football developed as a game to entertain the working class on Sundays. By 1920, team owners decided to create an organization, the American Professional Football Association, the forerunner of the NFL. The league's first decade was rocky; few teams survived into the 1930s. (An excellent appendix lists all NFL franchises by the year they were founded, including those that folded.) Crepeau moves through the NFL's formative years quickly. The league's founding and first decade are covered in about thirteen pages. The author then summarizes the next decade and a half (1930‒45) in twelve pages. This is mostly a work of synthesis, so Crepeau cannot be blamed if the literature on early professional football and the first several decades of the NFL is thin. But readers hoping for more on the formative years will be disappointed.Crepeau begins to hit his stride by the third chapter, which examines the late 1940s and 1950s. In this chapter, some important themes emerge—the NFL as a business enterprise, the reoccurrence of labor disputes, race and racism in the league, and the role of television in shaping the sport. These themes are continued into Part 2, which looks at what Crepeau calls “The Rozelle Era.” This is the book's longest section, and it forms the core of the book. In this middle section, chapters follow a general chronology but are also organized thematically. Chapters 4 and 5 examine the rise of professional football as a major cultural phenomenon in the 1960s, as well as the NFL's dispute and eventual merger with the American Football League (AFL). Television, of course, played a major role in propelling professional football to the forefront of American culture. As Crepeau notes, “The landscape of the NFL changed permanently with the coming of television, the AFL, and the commodification of nearly everything” (61). Thanks to the game's seemingly made-for-television controlled violence and drama, Crepeau argues, by the end of the 1960s, “football was clearly the national pastime” (90). In Chapter 6, the author takes a deep dive into television contracts and the ever-increasing amounts of money that they brought to the league. After discussing expansion, battles over team moves, and the league's handling of various publicity problems (Commissioner Pete Rozelle's specialty) in Chapters 7 and 8, Crepeau turns to labor disputes in Chapter 9. His coverage of the formation and growth of the NFL Players Association (NFLPA), as well as the three major strikes of the 1970s and 1980s, is excellent and probably makes Chapter 9 the strongest one in the book.Section 3 begins with the rise of Paul Tagliabue as the new commissioner following Rozelle's retirement, and the subsequent chapters focus on Roger Goodell's tenure as commissioner. Although Crepeau does not ignore social and cultural issues in the book's concluding section, at times, it comes across as largely an institutional history of the league from 1990 to the present, with the commissioners—Tagliabue and then Goodell—as the central actors. The author devotes two pages, for instance, to Goodell's handling of Baltimore Ravens running back Ray Rice's assault of his fiancée in 2014; the emphasis is on Goodell, not on domestic violence. The final chapter examines the Super Bowl as America's gaudy new national holiday.Creapeau's book examines the NFL as a business and a cultural phenomenon. It succeeds on both accounts. Anyone looking for a short overview of the NFL's meteoric rise to America's national pastime should begin with Crepeau's book.

Optimizing SARS-CoV-2 Surveillance in the United States: Insights From the National Football League Occupational Health Program.

Evidence to understand effective strategies for surveillance and early detection of SARS-CoV-2 is limited. To describe the results of a rigorous, large-scale COVID-19 testing and monitoring program. The U.S. National Football League (NFL) and the NFL Players Association (NFLPA) instituted a large-scale COVID-19 monitoring program involving daily testing using 2 reverse transcription polymerase chain reaction (RT-PCR) platforms (Roche cobas and Thermo Fisher QuantStudio), a transcription-mediated amplification platform (Hologic Panther), and an antigen point-of-care (aPOC) test (Quidel Sofia). 32 NFL clubs in 24 states during the 2020 NFL season. NFL players and staff. SARS-CoV-2 test results were described in the context of medically adjudicated status. Cycle threshold (Ct) values are reported when available. A total of 632370 tests administered across 11668 persons identified 270 (2.4%) COVID-19 cases from 1 August to 14 November 2020. Positive predictive values ranged from 73.0% to 82.0% across the RT-PCR platforms. High Ct values (33 to 37) often indicated early infection. For the first positive result, the median Ct value was 32.77 (interquartile range, 30.02 to 34.72) and 22% of Ct values were above 35. Among adjudicated COVID-19 cases tested with aPOC, 42.3% had a negative result. Positive concordance between aPOC test result and adjudicated case status increased as viral load increased. Platforms varied by laboratory, and test variability may reflect procedural differences. Routine RT-PCR testing allowed early detection of infection. Cycle threshold values provided a useful guidepost for understanding results, with high values often indicating early infection. Antigen POC testing was unable to reliably rule out COVID-19 early in infection. The NFL and the NFLPA.

Implementation and Evolution of Mitigation Measures, Testing, and Contact Tracing in the National Football League, August 9-November 21, 2020.

The National Football League (NFL) and the NFL Players Association (NFLPA) began the 2020 football season in July, implementing extensive mitigation and surveillance measures in facilities and during travel and gameplay. Mitigation protocols* were evaluated and modified based on data from routine reverse transcription-polymerase chain reaction (RT-PCR) tests for SARS-CoV-2, the virus that causes coronavirus 2019 (COVID-19); proximity tracking devices; and detailed interviews. Midseason, transmission was observed in persons who had cumulative interactions of <15 minutes' duration, leading to a revised definition of high-risk contacts that required consideration of mask use, setting and room ventilation in addition to proximity and duration of interaction. The NFL also developed an intensive protocol that imposed stricter infection prevention precautions when a case was identified at an NFL club. The intensive protocol effectively prevented the occurrence of high-risk interactions, with no high-risk contacts identified for 71% of traced cases at clubs under the intensive protocol. The incorporation of the nature and location of the interaction, including mask use, indoor versus outdoor setting, and ventilation, in addition to proximity and duration, likely improved identification of exposed persons at higher risk for SARS-CoV-2 infection. Quarantine of these persons, along with testing and intensive protocols, can reduce spread of infection.

Brain Injuries in American Football: Understanding the Injury, Difficulty in Helmet Optimization, and Current Communication Practices – A Narrative Review

Background: Over 2.7 million people suffer traumatic brain injuries (TBIs) annually in the United States. TBI involves the application and generation of external forces and impulse loads respectively to the head whereby the brain moves relative to the skull. Despite numerous studies, further understanding of TBIs is necessary, requiring consistent attention. Objective: The purpose of this article is to investigate the history of American football helmets and provide an academic and practitioner review as it relates to TBIs. This study is a literature review that also considers perspectives from an autoethnographic frame. Method: An extensive literature review was performed to assess the history of TBI as it relates to American football. This article evaluates helmet design optimization and American football safety as well as an exploration into the sports’ education methods for players and staff alike. Results: Despite developing helmet designs that can better attenuate impact forces, reducing linear and rotational movement, the skull and brain move very differently relative to one another. Helmet designs and tools for measuring forces require further validation techniques to determine resultant forces and movement for the brain. Current biomechanics research lacks sufficient methodology for defining TBI thresholds, making helmet optimization difficult. Conclusion: According to past research, no helmet can eliminate all TBI risk; however, processes are in place lead by the National Football League (NFL) and NFL Players Association to educate players, coaches, and staff at all levels of competition of the protective capabilities of available helmet options.

History of opioid use as a risk factor for current use and mental health consequences among retired National Football League athletes: A 9-year follow-up investigation

BackgroundMany retired National Football League (NFL) athletes manage pain with opioids during their playing careers and in retirement, though the longitudinal association between opioid use and health outcomes pertinent to an NFL career are not yet known. This study aimed to assess the relationship between opioid use in 2010 and current use, depressive symptoms, and health related quality of life (HRQoL) among NFL retirees. MethodsFormer NFL athletes from the Retired NFL Players Association initially recruited in 2010 for a study examining risk factors of opioid use and misuse were re-contacted (N = 89) from 2018 to 2019 and administered measures of pain, opioid use, depressive symptoms, and HRQoL. Binomial regression examined the association between 2010 opioid use with current use, moderate-severe depressive symptoms, and average and above HRQoL (physical and mental) while controlling for covariates. ResultsNearly 50 % of retirees using opioids in 2010 currently used. Compared to non-users, retirees who used opioids in 2010 had greater odds of current use (AOR: 3.71, 95 % CI: 1.02−13.56, p = 0.046) and experiencing moderate-severe depressive symptoms (AOR: 5.93, 95 % CI: 1.15−30.54, p = 0.033). Retirees reporting use in 2010 also evidenced lower odds of reporting average or above mental HRQoL (AOR: 0.13, 95 % CI: 0.03−0.67, p = 0.015) compared to non-users. ConclusionsThis study showed that among NFL retirees, early retirement opioid use predicted current use and deleterious effects on mental health, including moderate-severe depressive symptoms approximately nine years later. This investigation further supports the importance of early intervention of pain and opioid use among this population.

Loans and Marketing Guarantees in Athlete Agent Recruiting

Athlete agents use various means to recruit prospective clients. Controversial yet common methods include offering loans and marketing guarantees to prospective clients. In each transaction, the agent provides his client with money, in some cases amounting to millions of dollars. The agent typically expects repayment of the loan whereas the marketing guarantee is an advance on future marketing income that the agent will arrange for the athlete. While both National Football League Players Association (“NFLPA”) agent regulations and state athlete agent laws prohibit agents from offering inducements to prospective clients, neither authority considers loans or marketing guarantees illicit or prohibits them. This Article details the use of loans and marketing guarantees in the football agent recruiting process. The Article also explores both NFLPA and state athlete agent law, which is based on the Uniform Athlete Agents Act or its revised version’s prohibitions on athlete agents providing inducements to prospective clients. It describes the fiduciary relationship between athlete agents and their clients and the duties that result under agency law. Next, the Article applies agency law to the provision of loans and marketing guarantees by athlete agents to their clients, determining that agency law seeks to prohibit such transactions. The Article then discusses the application of attorney ethics regulations to attorneys who serve as athlete agents and provide loans and marketing guarantees, finding that attorney-agents who engage in this activity violate ethics regulations. The Article concludes by explaining why both athlete agents and athletes should be leery of these dealings and by urging the NFLPA and individual states to expressly prohibit them.

Negative health consequences of pain catastrophizing among retired National Football League athletes.

This study examined the association between pain catastrophizing with pain interference, depressive symptoms, and health-related quality of life (HRQoL) among National Football League (NFL) retirees. Former NFL athletes from the Retired NFL Players Association (N = 90) were recruited from 2018 to 2019 via telephone and were administered measures of pain, substance use, depressive symptoms, and HRQoL. Multiple linear and binomial regression analyses examined the association of pain catastrophizing with pain interference, depressive symptoms, and HRQoL while controlling for covariates (i.e., pain intensity, concussions, opioid use, binge alcohol use, years since NFL retirement, and marital status). Many retired NFL athletes reported moderate-severe depressive symptoms as well as poorer perceived physical health compared with general medical patients. Greater pain catastrophizing was associated with more severe pain interference, greater odds of reporting moderate-severe depressive symptoms, and lower odds of reporting average and above physical and mental HRQoL after adjusting for relevant covariates. Concussions were not associated with any of the study outcomes. Given the findings from this study, health care professionals should monitor symptoms of catastrophizing among current and retired NFL athletes. Assessment and requisite treatment of pain catastrophizing may assist these elite athletes in reducing depressive symptoms, while improving pain interference and HRQoL in this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

How Agents Are Regulated in the NFL and the Potential Lessons for FIFA

American football differs in countless ways from the sport the rest of the world calls football and Americans call soccer. One difference that invites further examination is the approach the two sports have taken to regulating those who represent players in contract negotiations, known as “player agents” or “contract advisors” in the U.S. and restyled as “intermediaries” according to FIFA. In the U.S., player agents are regulated principally by the players’ unions, which possess the legal authority, incentives, and resources to develop the regulatory competence needed to improve the quality of agent representation. By contrast, FIFA deregulated the agent industry in 2015, withdrawing from licensing intermediaries and instead deputizing its 211 affiliated national football associations to regulate in this area. It has been reported that the resulting system exposed FIFA players and clubs to grossly permissive standards and wildly inconsistent enforcement approaches, and decreased the quality, transparency, and ethics of the services provided. In anticipation of FIFA governance reforms to be implemented over the next two years, including revisions to the transfer system and to intermediary regulations, this article examines the agent regulatory scheme considered a model across U.S. professional sports: namely the National Football League Players Association's Regulations Governing Contract Advisors. Despite differing legal regimes that shape how these entities respectively may operate, it is suggested that FIFA can draw some valuable lessons from the NFLPA approach. The article outlines the legal framework within which players’ unions such as the NFLPA may regulate agents. It describes current NFLPA Regulations and considers recent amendments that have stoked U.S. agent resentment, provoked threats of legal challenge, and exposed the tension between athletes’ rights to select the agent of their choice and players unions’ authority under U.S. law to regulate agent qualifications and conduct. It concludes with a comparative law perspective on how the NFLPA experience predicts significant gains in intermediary service standards, should the proposed FIFA reforms be implemented.

The National Football League payroll cost function and labor market institutional changes

Sports club payroll costs typically comprise over 50% of sport clubs' total operating expenses, but little is known empirically about this largest component of club costs. Using data from the National Football League Players Association Salary Cap Information System from 1981 to 2000, a National Football League club payroll cost function is estimated to examine the impact of labor market institutional changes (strikes and collective bargaining) and to test existing theoretical sports club cost functions. As expected, strikes have a negative effect on total payroll, and the two collective bargaining agreements had opposite effects during this time period. Additionally, empirical support is provided for the standard two‐team sport league cost function.

Peterson, Brady, and Elliot: Analyzing “the Trilogy” in Light of the NFL Commissioner’s Discipline Authority

This research paper analyzes how the cases of NFL players Adrian Peterson, Tom Brady, and Ezekiel Elliot have affected the role of the commissioner of the National Football League (NFL) and the commissioner’s disciplinary authority in the NFL. Although the commissioner is considered a powerful figure, and historically courts have deferred to the commissioner concerning matters of league discipline, this deference is not limitless. The Peterson, Brady, and Elliot cases each helped shape how the role of the commissioner and the commissioner’s disciplinary authority in the NFL is being amplified in light of the language used in the current collective bargaining agreement (CBA) negotiated by the the NFL and the NFL Players Association (NFLPA) in 2011, legal precedent that limits a court’s ability to review an arbitrator’s decision, the law of the shop, and the CBA’s missing due process protections traditionally found in the court room. The findings and implications learned from "the Trilogy" show that players were unable to secure by lawsuit what they failed to achieve through collective bargaining. Although "the Trilogy" illustrates the commissioner’s vast authority, the next round of collective bargaining negotiations are an opportunity for the both the League and the NFLPA to cooperatively revise the player discipline process to curb a consistent stream of high-profile and public challenges of commissioner discipline, possibly encouraging the sides to move away from an adversarial relationship toward a more of a partnership.

Receded near point of convergence and gait are associated after concussion

ObjectiveTo examine post-concussion gait among patients with and without receded near point of convergence (NPC) and uninjured controls.DesignProspective observational study.SettingRegional sport-concussion clinic.ParticipantsThirty-one patients presented 10.1 [95% CI=8.1, 12.1] days post-concussion (57% female, age=16.5 [15.4, 17.7]); 38 controls were tested (55% female, age=15.5 [13.6, 17.4]). Participants completed symptom, NPC, and single/dual-task gait assessments. Exclusion criteria were a current lower extremity injury or diagnosed learning disability.InterventionThe effect of group (receded NPC, normal NPC, control) and task (single/dual) were evaluated via ANOVA. NPC and gait correlations were calculated.Outcome measuresNPC was the patient-reported diplopia point while a fixation target moved toward the nose. Receded NPC was &gt;5 cm from the tip of the nose. Three inertial sensors quantified gait; variables included average gait speed, cadence, and stride length.ResultsNineteen concussion patients presented with receded NPC, 12 did not. Symptom severity was not significantly different between groups (27.1 [18.6, 35.6] vs. 26.3 [17.1, 35.5]). Those with receded NPC exhibited slower average gait speed (1.02 [0.93, 1.11] m/s vs. 1.19 [1.14, 1.24] m/s, p&lt;0.001) and shorter stride lengths (1.11 [1.05, 1.18] m vs. 1.27 [1.23, 1.31] m, p=0.001) than controls. Near NPC and single-task gait speed were moderately correlated (ρ=−0.54, p= 0.002).ConclusionsAdolescents with receded NPC post-concussion exhibited significant gait-related alterations compared to healthy controls; those with normal NPC did not. Vergence and gross motor system dysfunction may be interrelated following concussion and may provide useful information to post-concussion evaluations.Competing interestsDr. Meehan receives royalties from ABC-Clio publishing for the sale of his book, Kids, Sports, and Concussion: A guide for coaches and parents, and royalties from Wolters Kluwer for working as an author for UpToDate. He is under contract with ABC-Clio publishing for a future book entitled, Concussions, and with Springer International publishing for a future book entitled, Head and Neck Injuries in Young Athletes. His research is funded, in part, by a grant from the National Football League Players Association and by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament. Dr. O’Brien receives royalties from Wolters Kluwer for working as an author for UpToDate. He is under contract with Springer International publishing for a book entitled, Head and Neck Injuries in Young Athletes. Drs. Howell, Shah, and Raghuram have no conflicts of interest to report.

Vestibular and vision deficits following concussion in children under 12

ObjectiveVestibular and oculomotor visual (VOM) deficits are emerging as key characteristics of youth concussion. However, since most studies of paediatric concussion focus on adolescents, little is known about the extent to which younger children experience this deficit. To address this gap, we used an electronic health record (EHR) system across a large paediatric healthcare network to quantify the presence of VOM deficits following concussion in patients under age 12.DesignDescriptive epidemiology.SettingData were collected from all primary (n=31) and relevant specialty care (n=4) network settings.ParticipantsWe identified all patients aged 5–11 years who had ≥1 clinical visit for concussion at a network primary or specialty care site from 7/1/2014 through 6/30/2015. We included the 82% of these patients for whom a concussion electronic clinical decision support tool within the EHR was used during their initial visit.Outcome measuresThe proportion who demonstrated each VOM deficit – balance, saccades, gaze stability, and convergence – was calculated among all who were assessed for that deficit.Main results871 patients were included (median [IQR]: 10 [8, 11] years). On physical examination, 58% had at least one VOM deficit. 44% had balance abnormalities, 39% had saccadic dysfunction, 28% had deficits in gaze stability, and 10% convergence insufficiency.ConclusionsIn this sample, vestibular oculomotor visual deficits following concussion in young children were common. Improved recognition of the deficits will lead to timely diagnosis and appropriate management, including school accommodations for oculomotor visual challenges and vestibular therapy for motion sensitivity issues.Competing interestsNone.KB, Arbogast serves as a consultant to the National Football League Players Association on head injury topics.

The effect of prior concussion history on dual-task gait following a concussion

ObjectiveTo examine gait characteristics among patients following their first lifetime concussion, second or greater lifetime concussion, and individuals with no concussion history.DesignProspective observational study.SettingRegional sport-concussion clinic.ParticipantsFourteen patients presented following their first lifetime concussion (57% female; 15.6 [95% CI:=13.0, 17.2] years of age; 11.1 [8.3, 13.9] days post-concussion), 21 following their second or greater lifetime concussion (52% female; 16.9 [15.5, 18.4] years of age; 8.6 [6.2, 11.1] days post-concussion), and thirty-one controls without a concussion history (65% female; 15.0 [14.2, 15.8] years of age). Exclusion criteria included a current lower extremity injury or diagnosed learning disability.Interventions/independent variablesParticipants completed gait evaluations and medical history questionnaires. MANCOVAs evaluated between-group gait differences; correlations were calculated between the number of lifetime concussions and gait.Outcome measuresParticipants recorded their number of prior concussions. Three inertial sensors quantified single and dual-task gait; variables included average gait speed, cadence, and stride length.Main resultsDuring dual-task gait, patients reporting for their ≥ second lifetime concussion walked significantly slower (0.81 [0.75, 0.89] m/s vs. 0.92 [0.86, 0.97] m/s;p=0.009) and with smaller stride lengths (0.98 [0.92, 1.04] m vs. 1.08 [1.04, 1.13] m;p=0.02) compared to controls. A moderate correlation was detected between dual-task gait speed and the number of prior concussions (ρ= 0.44,p= 0.04).ConclusionsPatients with a prior concussion history demonstrated altered dual-task gait strategies relative to controls. Dual-task gait velocity and number of prior concussions were moderately correlated, suggesting a worsening effect from multiple concussions across the lifetime.Competing interestsNone.Dr. Meehan receives royalties from ABC-Clio publishing for the sale of his book,Kids, Sports, and Concussion: A guide for coaches and parents, and royalties from Wolters Kluwer for working as an author forUpToDate. He is under contract with ABC-Clio publishing for a future book entitled,Concussions, and with Springer International publishing for a future book entitled,Head and Neck Injuries in Young Athletes. His research is funded, in part, by a grant from the National Football League Players Association and by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament. Drs. Howell, Beasley, and Vopat have no conflicts of interest to report.

Interrelationships among neuroimaging biomarkers, neuropsychological test data, and symptom reporting in a cohort of retired national football league (nfl) players

ObjectiveTo assess interrelationships among neuroimaging findings with neurocognitive test performance and symptom endorsement in a cohort of retired professional (NFL) football players.DesignProspective cohort study.SettingNeurology clinic.ParticipantsForty-five retired NFL players.InterventionMRI scan assessment of cavum septum pellucidi, global mean score of Fractional Anisotropy (FA), and microhemorrhages.Outcome measuresNine neuropsychological tests and multiple symptom and depression scores. Associations among the three independent neuroimaging results with these outcome measures were assessed utilising Pearson’s, Spearman’s Rank, and Point-Biserial Correlations.ResultsThe retirees reported an average of 6.9 (±6.2) concussions and 13.0 (±7.9) sport-related “dings” in the NFL. Assessment of cavum septum pellucidum yielded a negative finding in 10 subjects (22%), while 32 (71%) had a small, and 3 (7%) had a large one. Four (9%) of the subjects had microhemorrhages present and average FA mean was 0.459 (±0.035). Number of sport-related “dings” was correlated with an increased risk of microhemorrhages (r=0.305, p=0.042). The majority (50.8%) of the correlations obtained among the three neuroimaging parameters and the neurocognitive/symptom scores were below the threshold of a “small” effect size (r&lt;0.10). The remaining (49.2%) correlations fell somewhere between “small” and “medium” effect sizes (0.1&lt; r&lt;0.3). However, all correlations were statistically non-significant.ConclusionsThe current results demonstrate minimal and statistically non-significant correlations among neuroimaging, neurocognitive, and symptom scores examined in a cohort of NFL retirees. While an often-accepted paradigm, certain neuroimaging findings may not relate consistently and directly with neurocognitive test performance and clinical symptom burden.Competing interestsNone.GS Solomon receives consulting fees from the Tennessee Titans (NFL), the Nashville Predators (NHL), and the athletic departments of several universities; all fees paid to institution. In addition he is a member of the ImPACT Scientific Advisory Board and receives reimbursement for expenses to board meetingsAK Sills is a consulting physician to the Nashville Predators (uncompensated) and also serves as an unaffiliated neurotrauma consultant for the NFLExaminations of the NFL retirees were sponsored by the National Football League (NFL) and coordinated with the NFL Players Association (NFLPA). IR Casson served as a member of the NFL MTBI Committee from 1994-2009 and as a co-chair from 2007-2009. He has done consulting for law firms and insurance companies.

Ambush by Dre: A Case Study of the National Football League and the Challenges Arising from Conflicting Sponsorship Strategies

In this case study, students are exposed to the issue of stakeholder management through the lens of the National Football League (NFL), using a contemporary example of ambush marketing and player endorsement deals as the primary context. The case depicts nonfictitious events that involve players and their disdain for league policies regarding donning brands and products that violate exclusivity agreements the league has with other companies. After identifying the origins of the circumstances, the case profiles the three principal stakeholder groups involved (i.e., the players, the ambushed sponsor, and the focal organization) through their respective leaders (i.e., DeMaurice Smith, executive director of the NFL players association, Bob Maresca, president of Bose Corporation, and Roger Goodell, Commissioner of the NFL). Using fictitious commentary, the case culminates with the three actors utilizing the services of a sports consultancy firm as they work together to determine the best course of action. Learning objectives include understanding collegiality in a professional setting, and mitigating conflicting sponsorship strategies.