Taking a look at concussion protocols

There's an admission on my part.

While reading about concussion protocols in regards to Carlos Dunlap and now Brandon Ghee, you've accepted the term loosely as something that happens before the player returns. Beyond that, what actually happens isn't exactly understood. What's involved? Is there actually a checklist? What does the player have to endure before he's cleared to play again?

Every team applies their own protocols, but most testing and treatment is applied to every team across the league. Some may add an additional step as a precaution, but the major basis for most application. The league also introduced a comprehensive concussion evaluation and management protocol this year, which includes an unaffiliated neurotrama expert at every game who is responsible for identifying symptoms of a concussion. This expert is responsible for all sideline concussion assessments.

When a player is diagnosed with a concussion, there's a protocol that they must undergo before they're cleared. A critical point that must be stressed is that there actually isn't a checklist for someone diagnosed with a concussion. It's the process and interpretation of the information that's available to the team's medical staff and neurological experts.

Baseline Test: These are tests given by team doctors before training camp, which tests orientation, memory, concentration and balance. Many teams apply ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). There are many aspects to the baseline tests, which you can view here. League rules require a neuropsychologist to assist with administering and interpreting these results.

These tests provide a baseline for a player that suffers a concussion. Most team physicians and neurologists won't even sign off on a player until the postconcussion test that's administered (sometimes frequently) is close to the results from their baseline test.

When a Player Suffers A Concussion: If a player is even suspected to have suffered a concussion, tests are administered on the sidelines by a neurologist using advanced testing equipment. Most tests generally run for eight minutes. League rules require players that are diagnosed with a possible concussion to leave the field for the locker room, joined by medical personnel. After the game is over, doctors will determine if he's capable of flying home.

Doctors test the player the following day and compare the results to the baseline test that was done before training camp. They'll see if a player's symptoms return while watching practice, or film, and even after a light workout. Then they'll decide if the player requires another round of cognitive testing, but only if symptoms have subsided. Once they have, players generally begin treatment and rehabilitation.

Rehabilitation: Tests are administered in five phases, increasing a player's heart rate (increased more each time). The player must go through each phase without showing symptoms and there is usually a 24-hour resting period between each phase. As long as he emerges asymptomatic from each test, he'll continue on with the next one.

Usually these phases start with 30 to 40 percent of the target rate, then 40 to 60 percent (including lifting weights and balance work), followed by 80 percent with sprints and full weights in a "noisy environment", and then a return to football activity without contact.

Clearance: Once a player successfully completes the rehabilitation component, a team physician, who is monitoring and checking the player for improvement throughout the entire process, will clear him. Then an independent neurologist, hired by the NFL and the NFLPA, makes the final decision if a player can return.

Information used from The Boston Globe, ESPN, CarrickBrainCenters.com, FloriaToday.com,