Upside the Head

From the concussions of Eagles DeSean Jackson and Kevin Kolb to the tragic suicide of Penn football star Owen Thomas, Philly has been the epicenter of sports head-injury news. Now, two Penn researchers are poised to put a big dent in the problem

Because of their nerdy interest in an old eye test, Galetta and Balcer find themselves in the midst of an incredibly important public health debate—one that will determine how, and if, many youth and professional sports are played in the future. Already, big changes are going into effect. This summer, the Ivy League Concussion Committee—for which Galetta and Balcer were chosen as neurology consultants—ordered its football teams to cut full-contact practices from five a week to two, in hopes of reducing head impacts. Several days later, the NFL announced it was limiting full-contact practices to one a week.

No one knows how these changes will affect sports. While they will decrease hits to the head, could they also make it harder for players to learn to block, hit and tackle properly, and thus leave them more vulnerable? Has anyone researched this? Is anyone going to? “Good questions,” Galetta says. “I don’t know the answers to most of them.”

ONE SUNDAY LAST OCTOBER, in a plush club box overlooking Lincoln Financial Field, where the Eagles were playing the Atlanta Falcons, a high-powered group of concussionistas from across the country gathered to schmooze and, between drinks and a buffet of hot dogs and cheesesteaks, hear about some unpublished research that would rock their world.

In the small, congenial crowd were a deputy undersecretary for health at the VA; four high-ranking military officers interested in traumatic brain injury; NFL Hall of Fame cornerback Mike Haynes; and a couple of medical experts from the BU group, along with their advocacy partner, Chris Nowinski—perhaps the only former professional wrestler with a degree from Harvard. Nowinski pumps up the volume on brain research via his nonprofit Sports Legacy Institute.

The group had been convened by Steve Devick, the broad-faced, compact, excitable 59-year-old Chicagoan who co-invented the King-Devick test 35 years ago with an optometry-school classmate—never expecting it to do more than satisfy a course requirement. (“I think I got a B.”) Devick didn’t practice optometry full-time for very long—he quickly branched out into real estate and entrepreneurship. He’s best known as a founding investor and director of Platinum Entertainment—sold in the late ’90s for $3.7 billion. (If you barbecue, you probably know one of his other efforts: He was a co-founder of Blue Rhino, one of the first companies offering propane tank exchanges.)

Devick explained to the noshing brain experts that he’d been pleasantly surprised in the early 1980s to learn that his obscure test—which measures saccadic eye movements, the incredibly fast motions crucial to vision and perception—had become popular for assessing children with reading disabilities. Over the years, he’d watched—especially after the rise of Google—as his little test was used in various settings. In 2008, when he read an article suggesting saccadic eye movements could help diagnose sports concussions, he was enthused: An offensive guard in high school, he still looks and thinks like a football player. The chance to get involved in the biggest health problem facing his favorite sport was captivating. He started scouring the country for the best researchers to test his test. That’s when he found Steve Galetta and Laura Balcer at Penn. They were intrigued, but refused to be paid to study King-Devick—they didn’t want anyone suggesting their results were influenced by money.

Since they didn’t want to wait through a whole football season for preliminary test-of-concept results, Galetta and Balcer chose to study a group more predictably hit upside the head—boxers and mixed martial arts fighters. At sparring sessions in the Boston area, they assessed 39 fighters using King-Devick and, as a control, another much more involved and better-established test, the Military Acute Concussion Evaluation (MACE). The results proved almost exactly the same.

As the group in the Eagles box discussed these intriguing findings, they noticed that play had stopped. Through the open windows, they looked down and saw Eagles superstar wide receiver DeSean Jackson prone on the field near the Falcons’ 30-yard line—and Atlanta cornerback Dunta Robinson sprawled nearby. On replay, the video monitors showed what would become one of the season’s most compelling arguments for rule changes to lessen head injuries. Eagles quarterback Kevin Kolb, himself just coming off a concussion, had thrown a wobbly pass to Jackson in the flat. When Robinson couldn’t get there in time to knock it down, he launched his body, headfirst, directly into Jackson’s face-guard.

The head-injury experts gasped collectively at the replay. Both players were taken off the field with concussions.

WHILE THE FIRST-EVER international conference on “Concussion in Sport” was held in Vienna in 2001, it wasn’t until a few years later that the public started paying attention, thanks to American soldiers returning from Iraq with traumatic brain injuries, and a handful of high-profile NFL retirees who were suffering obvious brain trauma in their 40s and 50s.

The first NFL player to have his brain studied—by Pittsburgh pathologist Bennet Omalu—was Steelers all-star Mike Webster, who died in 2002 at age 50 after years spent living mostly out of his car, suffering from amnesia and dementia. At the time, nobody paid much attention to head impacts, except for the most dramatic ones, usually occurring during pass receptions or kickoffs. But Webster was a center, and his helmet-to-helmet contact had been more repetitious than extreme. Omalu used the extensive damage he found in Webster’s brain to make the first strong link between lower-impact football hits and chronic brain injury—a link the NFL quickly denounced as impossible.

Meantime, scientists were beginning to understand just how often and how hard players were being hit, largely because of the new HITS system, developed by a Dartmouth biomedical engineer. HITS uses small digital accelerometers in helmets to record the location and intensity of each jolt. (You’ll be hearing a lot about it soon, when top helmet manufacturer Ridell starts marketing a consumer version to high schools all over the country—theoretically allowing coaches and athletes to have a record of every hit kids take to the head.)

But the real turning point in public awareness came at the end of week 11 of the 2006 NFL season, when 44-year-old retired Eagles defensive back Andre Waters—whose emphatic tackling style inspired the NFL rule protecting quarterbacks in the pocket—committed suicide by shooting himself in the head. After Waters’s death, amid speculation about his depression, former pro wrestler Chris Nowinski—who’d retired because of concussions and was trying to draw attention to the issue with a slim autobiography—convinced the Waters family to let Bennet Omalu study Andre’s brain. He found degeneration normally associated with Alzheimer’s in patients twice Waters’s age.