Researchers everywhere are trying to wrap their minds around concussions.

Who is the most susceptible? What are the long-term effects? How can they be prevented?

At Harvard and Purdue, in Canada and Sweden, doctors are racing to find the answers.

Aynsley Smith, an associate professor of orthopedics in the sports medicine program at the Mayo Clinic in Rochester, Minn., is monitoring all of these efforts. She is Mayo’s resident concussion expert, which means she’s one of the most plugged-in academicians in the world when it comes to brain injuries.

And she is the first to acknowledge that what is unknown about concussions far outweighs what we do know.

“The problem is we’re still not making great diagnoses,” Smith said. “We’re doing the best we can. But there’s a new consensus (among international specialists) every couple of years.”


The current concussion assessment tool is called the Scat 3, and it emphasizes testing memory and balance to determine whether a youngster has suffered a brain injury.

“We think about the diagnoses still being pretty subjective and kids can lie and make it harder to diagnose it,” Smith said. “Or the opposite, kids may not want to be on the field or the ice and so they exaggerate (their symptoms).”

Dr. Paul Berkner co-founded the Maine Concussion Management Institute at Colby College in 2009 in an effort to better diagnose and prevent the injuries in this state. The group has made inroads in teaching coaches and athletic trainers what to look for and to immediately pull athletes from the field of play if they suspect a concussion. The next step would be to collect enough data to know how many concussions are occurring among high school athletes in Maine.

“We are in the infancy of our understanding what is happening in the brain. In the meantime, kids are going to be playing football. But kids have been playing football for 40 years. The risks are the same,” Berkner said.

“It is sort of the last frontier of medicine. We have no clue what the brain does or how it does it. We don’t know what concussions do. We don’t know why we’re seeing more of them. It could be that athletes are bigger and stronger. High school, middle school athletes are doing weight training. They’ve never done that before. It could be because kids are playing one sport year-round. They’re less adaptive if they only play one sport. There’s so much we need to know.”

Smith said there is a litany of new theories about concussion prevention and diagnosis. Among them:


The “Fair Play” model for youth sports. This is touted by the Mayo Clinic and was implemented in Minnesota hockey in the past eight years. Essentially, it rewards good sportsmanship by giving teams an extra point for not exceeding a predetermined number of penalty minutes, with the penalties being weighted so that the most dangerous of them (hits to the head, checking from behind) are the most costly to teams. “It still gives you room to make mistakes that are sort of accidental. It’s not perfect. For the most part, it’s pretty promising,” Smith said.

A test for concussions similar to the way an electrocardiogram diagnoses heart attacks. Smith said potential victims would be fitted with a device resembling earphones and be given a four-minute test to provide objective data about their brain function.

A blood test that could be used as a biomarker to diagnose concussions and gauge their severity. A study out of Sweden last month focused on total-tau, a protein that leaks from the brain into the blood, apparently at much higher rates for concussed athletes.

The Halifax Consciousness Scanner, a portable medical device that is being used to quickly and accurately measure brain status. Last fall, researchers started to test whether it could accurately assess concussions.

The Multi-directional Impact Protection System, or the MIPS helmet, developed in Sweden in 1997. Smith said the helmet uses technology that allows the outer shell to separate on impact, thus displacing some of the kinetic energy that would be transferred directly to the brain. She compared it to safety improvements made in stock-car racing in recent years.

A Harvard study in 2011 focused on what happens to the axons and dendrites in the brain cells during blast trauma. The dendrites tended to pull away so that the connection to the next cell was lost. If that is also what is happening during concussions, Smith said, there’s a small hope that an inhibitor could be developed, essentially allowing an athlete to take a whiff from an inhaler before competition as a way to reduce the risk of brain injury.


A team of researchers at Purdue attached sensors to the helmets of high school football players to find out how many blows to the head and in which areas are most likely to lead to brain trauma. This could lead to establishing a maximum number of hits a player could take before being forced to sit out, sort of like a pitch count for a baseball pitcher.

Lisa Favreau, the athletic trainer at Cape Elizabeth High School, understands the frustration of not having answers but is happy that so many people are seeking them. She said the 500 students she serves feel like her younger siblings.

“You want them to succeed and you don’t want them to get injured. You want to protect them and so you wrack your brain all the time, like, ‘How can I stop this from happening?’ And I don’t know what that answer is yet. Maybe someday way down in the future they’ll figure it out,” Favreau said.

“There are always new protocols for rehab, new helmets. It’s ever-changing. Everybody’s got a thought about how to prevent it, how to rehab it, how to evaluate it. The education is great. The more awareness, maybe the sooner we can catch things, the better off we’ll be.”

Mark Emmert can be contacted at 791-6424 or at:

Twitter: MarkEmmertPPH


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