Top defensive cover man CB Keenan Lewis had to leave the game when he sustained a head injury late in the third quarter of the team's Wild Card win over the Eagles on Saturday night. Much to New Orleans Saints fans dismay, the Eagles immediately and successfully went after Corey White, the proverbial and literal "next man up", who moved over from his #2 CB spot, and the 20-7 lead was soon a memory while we agonized through a much too close for comfort ending to that game.
At the time of the injury, it was obvious to those watching at home that Lewis was lobbying hard to get back in the game, but the team had to adhere to the league's concussion protocol, as evidenced in this snippet of Katherine Terrell's post-game "Did You See?" post on nola.com:
Payton said putting Lewis back in the game was not even an option.
"There's no such thing," Payton said. "There's just the doctors, and that's the right thing."
Lewis had to go through concussion protocol testing on the sideline and was forced to watch as the Eagles immediately completed a 40-yard pass to DeSean Jackson on the next play. They scored a few plays later as Lewis frantically tried to get someone to let him back in the game.
Cornerback Corey White said Lewis' helmet had to be taken away so he couldn't return.
"Oh yeah, he was about to (run back in)," White said. "He was trying to get on the field."
Eventually, Lewis was escorted to the locker room, shaking his head in frustration all the way. He later came back to the sideline, sans helmet, but did not return to the game.
But what about now? With the Saints moving on to face the Seattle Seahawks in the Divisional Round on Saturday afternoon, the health of the team's shutdown corner is the leading story line to follow this week.
In Sunday's conference call with the media, Payton had this to say when asked about Lewis's status:
We'll keep you guys posted on any of our players.
Yeah, ok. Thanks, coach. Here's my best guess as to what he'll say later on today, or whenever he's next required to report injuries: "Keenan has a head, and we'll just have to see where it's at."
So, in the interest of educating myself and in turn you, the fans, I have reviewed the NFL's Concussion Protocol to bring you the salient and relevant details as they pertain to Lewis's possible return to the field of play this week.
My source on this is a post that appeared on NFL.com on October 1, 2013, NFL's 2013 protocol for players with concussions, and written by the NFL Head, Neck and Spine Committee and Bill Bradley, contributing editor, whoever those peeps are.
In Training Camp, team doctors begin by assessing functions that can be affected by a concussion such as: memory, cognition, and balance, as well as collecting detailed player concussion histories, and also information on any current symptoms that players are experiencing prior to submitting them to a standardized baseline concussion tool.
Here are some more detailed and technical specs:
This history and physical examination information is supplemented with baseline neuropsychological testing, comprehensive tests that assess memory, reaction time, attention span, problem-solving abilities and other cognitive skills. Some neuropsychological tests are computer based such as the ImPACT test -- Immediate Post-Concussion Assessment and Cognitive Testing. and the Automated Neuropsychological Assessment Metrics (ANAM) test developed by the Army. Other neuropsychological tests are standard paper and pencil tests typically administered by a neuropsychologist. Each team has a neuropsychologist to interpret the neuropsychological tests and serve as a consultant to help with this aspect of concussion care.
Then, with all this info on file, it can be utilized for comparison when a player actually becomes concussed during a game.
During every game, there is now a guy up in the booth monitoring live game action and television replays to ID players who may need to be examined by sideline medical staff. Each game will also feature the services of a neuro-trauma expert physician unaffiliated with any NFL team, who can be consulted by the NFL medical team or players during the game.
When a player is suspected of being concussed, the team doc first runs through a quickie six-item checklist on findings that necessitated the players' removal from the game (loss of consciousness, unresponsiveness, confusion, amnesia, and other concerning symptoms), and then administers the full sideline concussion assessment tool. (Click it for access to a pdf of it!) The assessment tool includes items from the preseason baseline testing as well as day, date, time, month, venue, quarter, who scored most recently, the team's previous opponent and result, etc., and it takes about 8-12 minutes to complete.
Once actually diagnosed with a possible concussion, the player must leave the field for the locker room for a bit, and have medical personnel monitor him for the remainder of the game, and after the game, they determine if he is stable enough to go home with care instructions to get physical and cognitive rest, avoid certain medications and alcohol, and follow up care plans. The player is also given phone numbers to call if there are any questions or concerns.
Following this initial rest, the team doctors monitor the player to see when he appears to have returned to baseline functioning, paying special attention to these questions:
Do symptoms return when a player watches practice or when he watches film? Is there return of symptoms with physical activity?
And then the process rolls forward thusly, hypothetically:
If the player is progressing, he would be become eligible for increased physical activity. The workouts would ramp up over a few days if no symptoms occur.
A player feeling normal one day after the game might pass cognitive testing Tuesday and begin a light exercise program, intensify their exercise routine Wednesday, participate in non-contact aspects of practice on Thursday and return to full practice Friday. But if a player has a history of concussions or isn't progressing as quickly as planned, the process moves accordingly.
The medical team increases the exercise regimen to full speed as the player proves he can handle the escalation without incident. Some teams stage controlled contact drills featuring, for example, one lineman blocking another the way they would in an unpadded practice.
Once a team doctor signs off on a player's return, the player is evaluated in person by an unaffiliated concussion expert physician approved by both the NFL and NFL Players Association. This unaffiliated expert also must sign off on the player's health before he is allowed to return to play.
So, even with an understanding of these steps, it's important to realize that there is no official set-in-stone timeline for return...(but KL coming back in time for Saturday night's game is not out of the question.)
"The thing that I think is important here is you don't manage concussions by a calendar," Dr. [Stan] Herring said. "Some guys may come back in a week. Some guys may come back in six weeks. These steps don't have an expiration date on them. The player's history of injury and other issues come into play."
Note: Stan Herring is a Seahawks/Mariners team physician and member of the NFL's Head, Neck, and Spine Committee.
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Now, armed with this knowledge, we can all pay close attention to Coach Payton's words and the official injury reports and track the hopefully speedy return of the Saints' top cornerback.
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