PIONEERING TESTS STOP BRAIN INJURY TRAGEDIES

Source: http://www.telegraph.co.uk/sport/main.jhtml?xml=/sport/2007/02/28/sfnham28.xml  

By Peter Hamlyn 28/02/2007

Kneeling at the head of an unconscious John Terry during Sunday's Carling Cup final, the Chelsea doctor, Bryan English, might have been forgiven for wondering if he was suffering a curse. Widely credited - including by the Dame herself - with the reconstruction of Kelly Holmes' injury-torn career, this calm and considerable talent has probably seen more severe head injuries in his last few months at Chelsea than in the rest of his career at the top of sports medicine.

Safe hands: John Terry receives treatment on the pitch in Cardiff

Two knock-outs and one crushed skull would make a respectable annual tally for a division let alone a single club. It reads more like the logbook of a jump jockey doctor where the rates of head injury are 200 times higher.

My professional diet is one of sporting brains and spines and yet I firmly recall my surprise some years ago at being delivered of a season's third concussion victim from a single Premier League club. It was Arsenal. I cockily suggested to that sage of sports medicine Gary Lewin, the Arsenal and England physiotherapist, that he try teaching ball recognition skills as in each instance their players had headed objects other than the ball, i.e. a post or another player's head.

But what I had encountered in football were minor head injuries. By contrast Bryan English has faced a barrage of serious head injuries more typical of boxing, motor and equestrian sports.

From the second I saw Terry on his back I knew the Chelsea captain was seriously injured. Look at the replay - he was completely still with his hands held rigidly up in front of his chest. Only the most basic functions of his brainstem remained operational. And yet he was back at the Millennium Stadium later in the day to join the Chelsea celebrations. This rapid return to the ground reflects the changes that have revolutionised head injury treatment in sport; there have been two big ones.

In times past a player in his state would have been compulsorily admitted to hospital and observed for 24 hours lest a blood clot formed. Now, virtually all hospitals have scanners and the test is done as you come through the doors. If it shows no blood clot you may go home to complete what will be a good recovery. By contrast if there is a blood clot it can be removed before it causes lasting damage.

The injured boxer, Michael Watson, had his clot diagnosed after an extraordinary shambles and still lives with the disastrous consequences more than a decade and half later. The weekend saw his colleague, Nigel Benn, host a benefit night for their fellow boxer, Gerald McClelland, whose fate reflects the fact that even with brisker management the outcome can still be awful. But early scanning has brought much more frequent success and directly saved lives thanks to the changes brought in after Watson's courtroom battle.

The second revolution is one that Terry may encounter in the days to come as he tries to return to the field of play. It is in the nature of any professional sportsman to want to get back as soon as possible.

However, if a sick brain is injured again before it has fully recovered there is a concern that catastrophe may strike. Known as the second impact syndrome, a minor knock can result in devastating consequences.

Pioneering work in Australian Rules Football has led to the development of simple computerised tests of the brain's cognitive function which can now confirm recovery more precisely than even the most expensive scan.

Terry may, like many of his fellow Premier League players, have had a baseline test at the season's start. Once any symptoms have worn off and the test returns to baseline, play may be resumed in safety.

The system has replaced one based on arbitrary time suspensions which saw perfectly fit players kept out of competition for weeks longer than necessary and yet others returned while clearly still ill because they had served their time. So successful has the new system been in both protecting players and returning folk to sport early that pre-season testing is a requirement for all jockeys and professional rugby players in England as well as all FISA-regulated motor sport worldwide.

The tragedy is that those most at risk from too early a return are teenagers and the tests being commercially operated are placed beyond the financial reach of virtually all schools, amateurs and even the aspiring elite. It is an ambition of my centre to deliver to and the world a free test available on-line, suitable for teenagers, in time for the 2012 Olympic Games in London .

If anyone has £200,000 to spare I will personally endeavour to see the project delivered.

Of you who remember the tragic events of a few years ago at Sherborne School in Dorset where a young boy died of what appears to have been a minor second head injury during a rugby match may find the price of such progress too cheap for comfort.

Peter Hamlyn is a consultant neurological and spinal surgeon and Director ofThe Centre for Sports and Exercise Medicine.

Thank you for visiting my fundraising page. Please dig deep and sponsor me online.

Donating through this site is simple, fast and totally secure. It is also the most efficient way to sponsor me: Brain and Spine Foundation will receive your money faster and, if you are a taxpayer, an extra 28% in tax will be added to your gift at no cost to you.

So please sponsor me now!

Many thanks for your support.