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Effects of head injuries encourage playing it safe

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Jay Cutler reacts after being sacked by Giants cornerback Aaron Ross on Oct. 3. Cutler suffered a concussion and sat out the rest of the game and the next week.

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The evaluation quarterback Jay Cutler likely was given in the locker room at halftime of the Bears' 17-3 loss to the New York Giants on Oct. 3 might have been the product of state-of-the-art research, but it wasn't radically different from the age-old questions asked of athletes suspected of suffering from concussion-like symptoms.

What day is it- What month is it- What year is it-

It was Cutler's answers to a 30-point test that includes questions measuring cognition, memory reaction time, orientation and balance that convinced doctors that he shouldn't return for the second half. How he responds to another battery of tests this week will determine his availability for the game Sunday against the Seattle Seahawks at Soldier Field.

Even if he's cleared to play, there's no way to know whether he has recovered sufficiently from the brain injury he suffered while being sacked an NFL-record nine times in a half at New Meadowlands Stadium.

''Concussions are very unpredictable,'' said Chris Nowinski, a Harvard-educated former football player and professional wrestler, whose own head injuries prompted him to author Head Games: Football's Concussion Crisis. ''Every concussion is different, every person is different and symptoms can be delayed. The symptoms you walked off the field with are not the same symptoms you wake up with the next morning. You go from feeling dazed and maybe light bugs you to waking up the next day and you're exhausted and irritable and have different memory problems.

''Personally, I remember sitting on a couch for three days after one of my concussions and feeling great and feeling good to go. Then as soon as I started working out again, I threw up.''

The NFL doesn't have any set-in-stone rules for how teams are to proceed when players suffer concussions, but there are league-recommended guidelines teams are asked to follow. Assuming the Bears and Cutler followed those guidelines, Cutler would have been monitored by the medical staff during the second half of the game against the Giants and during the flight home.

Physical and cognitive rest are highly recommended. That means Cutler likely spent some time last week in a dark room without sensory input of any kind, relaxing his body and healing his mind.

''When he returned on Monday, he [probably] had no symptoms. Because if you had any symptoms at all, you wouldn't have him watching film,'' said Dr. Mark Adickes, a former NFL player-turned-orthopedic surgeon, who hosts ''Athlete 360,'' a sports-medicine show on Fox Sports Net. ''They probably also on Monday got his heart rate up on a stationary bike to see if his symptoms returned. When they [apparently] didn't return, they let him practice on Wednesday. Then when they [likely] tested him to see where he was, his brain [probably] was not functioning the way it was previously. He [likely] took a step back there.''

It should be noted that Adickes never has examined Cutler and doesn't know the specifics of his case. That said, he said he would ''be shocked if [Cutler] couldn't play this week.''

''It's tough to know exactly what happened,'' Nowinski said. ''The best practice right now is there is no physical or cognitive exertion until you're symptom-free, so Cutler must have been symptom-free when he showed up Wednesday and was therefore allowed to physically exert himself. Hopefully, he was symptom-free the first time he did any physical exertion.

''If he failed the test on Wednesday, it could've meant that practicing created more symptoms or he was not functioning as well as they thought.''

Cutler likely failed one or both of the neuropsychological tests administered by a team doctor and an independent specialist because it later was announced that he wouldn't play against the Carolina Panthers.

Adickes said that a player might be symptom-free and still test below normal on the computer-based test, which might have been what prompted the Bears to rest Cutler.

''We've been doing baseline studies on brain injuries since 1995,'' Bears president Ted Phillips said. ''We were one of the first to do it. We've always been at the forefront, and we're going to stay that way.''

All three experts contacted for this story said they would advise the Bears to take the conservative approach when it comes to Cutler, which it appears they have done.

''It's not perfect,'' Nowinski said. ''Things slip through the cracks. But it's nice to know the players are aware of the risks and the doctors are being conservative. Most important, if Cutler is going to play Sunday, knowing the risk of rushing him back and how you could lose him for the rest of the year is a key concept and a key to the Bears' success.

''What people forget is if you rush a guy back and he gets hit on the head, you might not see him next season or ever again.''

CONCUSSIONS IN FOOTBALLauthor of ¬タリ¬タリHead Games: Football¬タルs Concussion Crisis¬タル¬タル-->