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The Worst Case
Michael Farber
December 19, 1994
Doctors warn that repeated concussions can lead to permanent brain dysfunction
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December 19, 1994

The Worst Case

Doctors warn that repeated concussions can lead to permanent brain dysfunction

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Thin November sunlight streams through a picture window, logs hiss in the fireplace, and as Al Toon uncurls his six feet four inches from a couch to stoke the fire, no living room in the world is this fragrant, this warm, this safe. "This," Toon says, "is a good day."

He is not talking about the crackling fire or the tranquil autumn afternoon. Since the terrible toll of concussions ended Toon's eight-year NFL career in 1991, the interiors of his life have been different. The 40 billion neurons in his brain sometimes do not obey orders. No, today is a good day in the one place it truly matters. Inside his head.

On days like these, Toon, 31, wants to smile. He isn't irritable. The slightest sound—an almost imperceptible buzz from a lightbulb, a hum from the computer in the study—doesn't assault him. Most mornings Nick, his six-year-old boy, walks into Al and his wife Jane's bedroom and asks, "How you feeling, Dad?" On days like these, Al answers, "Good, son."

Oh his bad days, however, a mental switch is thrown—"You know how an eye doctor puts a cloudy lens over your eye during an exam, and everything changes all of a sudden?" says Toon—and he is plunged into a part of himself that's painful to visit. He takes scant pleasure in his 40-acre spread, with its horses, polo field and riding arena, in the farm country west of Madison, Wis. He is short-tempered, fatigued, sensitive to light. He doesn't dance to his own beat; he just wants the drumming to stop.

The bad days are less frequent now, although Toon still can't watch his three children on a merry-go-round without getting dizzy. More than two years after his final concussion—the fifth or ninth or maybe the 13th of his NFL career, according to the various ways that concussions are defined and reported in football—Toon, a former New York Jet wide receiver, is suffering from postconcussion syndrome.

"People are missing the boat on brain injuries," says Dr. James P. Kelly, director of the brain-injury program at the Rehabilitation Institute of Chicago and an assistant professor of neurology at Northwestern University Medical School. "It isn't just cataclysmic injury or death from brain injuries that should concern people. The core of the person can change from repeated blows to the head.

"I get furious every time I watch a game and hear the announcers say, 'Wow, he really got his bell rung on that play.' It's almost like, 'Yuk, yuk, yuk,' as if they're joking. Concussions are no joke."

A concussion is a traumatically induced disturbance of neurological functions, most often the result of a direct blow to the head. A concussion can also occur during the rapid acceleration or deceleration of the head due to an event such as an automobile accident, even if the victim is restrained by a seat belt. There are three grades of concussion—although doctors disagree on certain points of classification—starting with the mildest and most common, the "ding" that has infiltrated the lexicon of America's Sundays.

According to a now widely accepted scale developed by Kelly, in a grade 1 concussion—the kind you might have if you bumped your head on a table and "saw stars" for an instant—a player remains conscious and suffers only momentary confusion, although he usually experiences headache, dizziness and some short-term memory loss. The athlete's head clears quickly, and no medical intervention is necessary. In a grade 2 concussion, the player suffers amnesia, as well as nausea and a ringing in the ears. A grade 3 concussion renders the athlete unconscious.

According to a somewhat different scale designed by Dr. Robert C. Cantu, chief of neurosurgery and director of Sports Medicine at Emerson Hospital in Concord, Mass., a loss of consciousness of from one to five minutes constitutes only a grade 2 concussion. The loss of consciousness for five minutes or more means a grade 3.

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