Data Don’t Care If NFL Players Lie About Concussions (and other musings on CTE)

NFL fans watching the playoffs last week probably saw Patrick Mahomes take a concussion-inducing DDT from the Cleveland Browns defense. There was no hiding a wobbly Mahomes trying to regain his senses in front of millions of viewers. While the Kansas City Chiefs have declared Mahomes fit enough to play in this Sunday’s AFC title game against the Buffalo Bills, we can’t help but wonder if were just turning our heads away from the seriousness of the matter once again.    

Baseline measures are extremely important in the world of Applied Behavior Analysis (ABA). Emphasis on extremely. Baseline is really the only way to know the type of influence a treatment or environmental event has on a person’s behavior. In short, data gathered during baseline periods are often the factor when determining what effect ABA treatment has had on a target behavior. I mean, how else would we know if a behavior has increased or decreased if we never knew how much it occurred to begin with?

The practice of establishing baseline levels as a starting point is not just limited to the field of ABA. You probably guessed that from the title of this piece. We won’t go into all the things that incorporate the use of baseline in some form because I’d be typing in perpetuity. However, we would like to highlight an area in which baseline can be used to help save lives.

Chronic Traumatic Encephalopathy has received an increasing amount of attention in the last 10 or so years. Thank goodness for that. If you’ve never heard of the term, you’re probably more familiar with its abbreviation CTE. If you’re a fan of the National Football League (NFL), you’re probably sick of hearing about it. Being a huge NFL fans, we feel doubly guilty writing this piece. One part of me feels like a traitor to football for jumping on the CTE bandwagon. Another part is worried that I’m contributing to the demise of some of my sports heroes by forking over my cash to watch them play this violent sport.    

But the NFL is such an excellent case study for CTE since there aren’t many professions in which people are legally hit on the head over time. The NFL is out in the open for all to see and can be regulated to a certain degree. With the proper regulations in place, accurate data can be collected. And with the TV coverage the NFL receives, it’s likely every hit to the head or concussion for a particular player is documented somewhere on video. This is different than a situation in which researchers may not have as much access to information. For example, it would probably be harder to track the severity of head trauma for a person who has been physically abused in their home over time.

If we were king of the NFL for a year, independent neuropsychological testing would be a quarterly requirement for every player as a bare minimum. Results of their very first battery of tests would serve as their baseline level that future tests would be compared against. Of course this would not be a pure measure of baseline (it would not account for head trauma occurring in high school or college), but it would be a darn good place to start. Best case scenario is that we’d be made king of the sports universe though. Then, we would require testing to start before anyone plays any contact sport for the first time. The younger testing occurs, the better. That would provide a true baseline. Ahhh…a sports mag can dream can’t it?

Requiring the NFL to provide independent neuropsychological testing to every single player (even kickers) on a quarterly basis has multiple benefits. First, independent testing is just that – independent. These assessors don’t have a dog in the fight and would not buckle under pressure from the NFL or any of its teams to falsify results. Second, it would provide important information regarding any change in an individual’s cognitive functioning in a given quarter. This information is crucial since there is no way to test for the presence of CTE while someone is alive. However, by administering a battery of appropriate tests, medical professionals will have data to compare to those initial baseline levels for each player. This will allow them to identify any decline in functioning in the short term and also over time. Furthermore, the data would provide insight into which specific positions on the field of play are more vulnerable to symptoms associated with concussions or CTE. This would then hopefully prompt the NFL to make rule changes to protect certain positions.

Most importantly, DATA DON’T LIE! If a player is functioning at levels below their baseline, or if their functioning is gradually declining over several quarters, it’s time to pump the breaks and come up with a plan. It doesn’t matter if the player is telling you he’s fine or that the hit he took last game looked much worse than it actually was. It doesn’t matter if the coach expects him to be available for the big game on Sunday or if the owner dismisses his symptoms as migraines. DATA DON’T CARE about a player’s pride, the sanctity of football, or a team owner’s bottom line.  

We’re not sure what volume of research is needed to definitively link CTE to playing professional football. For us, the volume of “isolated” incidents is enough. Growing up in southern California, Junior Seau was a bit of a local legend. Seau claimed to have suffered over 1,000 concussions in his 20 year NFL career. In retrospect, there is no doubt we were cheering him on during many of those blows to the head. That thought is a bit of a hard pill to swallow in the present. Junior Seau committed suicide by shooting himself in the chest in 2012. His brain was donated to the National Institute of Health where abnormalities consistent with CTE were identified.    If playing football is ever definitively linked to CTE, it would mean the absence of it would stop CTE from occurring in football players. Sounds weird right? To stop football players from getting CTE, do not allow them to play football. As a cool sports mag that views sports as both entertainment and an effective tool to teach life skills, that’s not a reassuring thought. How about we just start with mandatory neuropsychological baseline testing with quarterly follow-ups and go from there?

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