By Bill Bradley, contributing editor
Oakland Raiders quarterback Terrelle Pryor was cleared Friday, four days after he suffered a concussion against the Denver Broncos. Pryor was set to start Sunday against the Washington Redskins, but he was sidelined the night before the game with a recurrence of post-concussion symptoms.
Noted neuropsychologist Dr. Elizabeth Pieroth told NFL Evolution on Monday morning that this was an example of how there is no objective measure when concussion symptoms have subsided.
"There is no blood test to look at on a concussion," Dr. Pieroth said. "There's no CT; there's no MRI; there's no particular test that said either a concussion happened or has it fully healed.
"The state of science currently is that we use the patient's subjective reporting of how they feel. We use cognitive testing to see if they have any evidence of residual cognitive impairment. And we use balance testing because balance impairment is a very common byproduct of concussions. Those three things together are the best ways to look at if a concussion did happen, and, secondly, do we feel like the person has recovered."
Dr. Pieroth knows this subject well. She works out of the NorthShore University HealthSystem in Evanston, Ill., and serves as neurological consultant for the Chicago Bears, Chicago Blackhawks, Chicago Fire and Chicago White Sox. She also is a member of USA Football's Heads Up Football Advisory Committee.
While she has not examined Pryor, Dr. Pieroth knows well the situation the QB and Raiders doctors faced this weekend.
"Even when we do all of those things and put people through exertion tests -- and we do the best to try to see if they're healed -- is it possible that somebody is not 100 percent healed? Of course," Dr. Pieroth said. "Is it possible that there are some functions that are still disturbed that we don't yet have a way to measure? Of course.
"Oftentimes what can happen is that we put people through an exertional protocol, which I tell people is checks and balances. You're increasing levels of exertion to try to elicit symptoms because if the symptoms return, then you know they're not fully healed. That is reliant on (an) athlete's reporting. We don't have a crystal ball, and we don't have a way of knowing. If the cognitive testing and the balance testing is OK, then we are reliant on the athlete's report."
Dr. Pieroth said doctors are limited during the exertion tests because they can't replicate stadiums, crowd noise and the environment of a game. She said practice and game situations can offer mental stimulations that can retrigger post-concussion symptoms. She also said sometimes this occurs as dizziness, but the symptoms can vary on the individual.
The biggest plus out of this, Dr. Pieroth said, is that Pryor reported the return of his symptoms.
"Five years, 10 years ago, would these athletes have been forthcoming with their symptoms returning? My guess is that they would not," she said. "That's what's comforting to me. Not that he returned and the symptoms came back, but that he was put through standard protocol, he had problems and he told somebody. ... So the (doctors) said let's go back and look to see what's eliciting your symptoms. Then we might have a better indication of what might be going on."
Dr. Pieroth said she has dealt with the return of post-concussion symptoms, but it's not a frequent occurrence after an athlete has passed through the NFL protocol. She said she mainly sees this phenomenon in her work with the NHL's Blackhawks.
"Hockey is very difficult on the visual system," Dr. Pieroth said. "It's a white background, black puck. You're moving quickly. The flow is moving quickly. It's really tough on your visual tracking system. Sometimes, you get a guy who's doing great, but then you get him back on the ice for practice, and that's when the symptoms come back.
"We catch that before he gets back in games. But you can't fully duplicate that experience and you do the best you can. We put them through a lot to make sure they're not getting a return of symptoms."
