Q+A: Douglas Terry, PhD
Neuropsychologist Douglas Terry, PhD, works with the National Football League as the senior director of Research, a role focused on initiatives to enhance the health and safety of NFL players. This is an extension of Terry’s expertise in sport-related concussion and cumulative head impacts.
Q. What goes through your mind when you see a player take a hard hit?
It’s always difficult to see someone get injured and be symptomatic while in the national spotlight. We’ve been seeing this on the field for years, but in the past, fans might not have recognized the symptoms or had enough clarity on the broadcast to fully realize what was happening.
We need to understand how the injury to the brain is impacting the player and how to rehabilitate them safely and appropriately. As researchers, due diligence is on us to understand the difference between what things look like on the broadcast versus what the athlete is truly experiencing from a physiological and neurological level. Surprisingly, we’ve learned when you compare the recovery times of people who had a concussion with a loss of consciousness versus not having a loss of consciousness, there are very minimal differences in their recovery time.
That’s not what we would have assumed, because when you see someone lose consciousness, you tend to think the brain injury might be worse or more severe, or it might take someone longer to recover. Some research has supported that gut feeling, but most research has not. It’s only through several studies examining the same topic (in this example, loss of consciousness vs. not) that we feel comfortable changing our thinking about the injury.
Q: Concussions happen in everyday life without the fanfare of prime-time TV. How has this impacted both research and treatment?
We know things like car accidents and slips and falls are the leading causes of concussions. It’s harder to study those individuals because some might go to urgent care, some might go to their primary care doctor, or some might go to a hospital. Follow-up care tends to be very variable in these individuals, and it’s difficult to study because the places these individuals get seen are often not set up for conducing systematic research.
This means we’re not able to capture all concussions out there. And if you only look at concussions where someone ends up going to the emergency room, you might only see the scariest or most severe concussions versus other concussions that did not require emergency room care.
Most concussions, around 80%, get better in two to four weeks with minimal treatment. Given that, the injuries weren’t rising to the threshold for it to be more systematically studied by the academic and research community.
Q: Why is it easier to study concussions in pro athletes?
Concussions are traditionally tough to study, because these are injuries treated out in the community by a first-line provider, often without specialty follow-up.
Athletes, including professional athletes, represent a unique model because they are plugged into a medical system. Athletic trainers and team doctors monitor athletes before a concussion, at the time of concussion, immediately after a concussion, and daily until they return to play. It’s end-to-end observation that allows us to comprehensively research it from start to finish.