12/01/2011 - An athlete may weigh 250 pounds, but all that bulk is controlled by a mere three-pound brain. Those three pounds control the other 247 pounds, the muscles and bones and heart and lungs that enable athletes to perform their feats of strength and agility.
And Nashville’s professional athletes entrust their precious three pounds to Gary Solomon, Ph.D.
Solomon, associate professor of Psychiatry and Neurological Surgery at Vanderbilt University Medical Center, serves as team neuropsychologist for the Nashville Predators hockey team and consulting neuropsychologist for the Tennessee Titans. He also assists with concussion programs for both teams and is a founder of the Vanderbilt Sports Concussion Center.
Solomon had only been to one hockey game in his life when he got the call in 1998 asking him to do baseline cognitive testing for Nashville’s new hockey team. After a player sustained a concussion, the cognitive test would be repeated and compared with the baseline figures in order to determine when the athlete was back to normal neurocognitive function.
“I had never cared for professional athletes before, and I didn’t really have any hesitations to get involved, but I don’t think I fully understood the demands of working with teams, though I learned that pretty quickly. The time demands, the competitiveness, how much is at stake. There is lots of pressure,” Solomon said.
In 2005, Solomon’s role expanded to psychological care for the Predators’ players and management. He also provides services to the Predators’ primary minor league affiliate, the Milwaukee Admirals, and has provided similar services to members of the Titans.
This season has been especially busy for Solomon, as he helps Predators’ players cope with the August death of former teammate Wade Belak and the plane crash carrying a Russian hockey team that included two former Predators and one former Admiral.
“Belak’s death hit the guys pretty hard, and a lot of them came back early for his memorial. Then just a few days later the Russian team was killed. We knew many of those guys. That really got the season off to a different kind of start,” Solomon said.
At home games, Solomon makes rounds in the locker room, talking over issues with the players and coaching staff and counseling injured or scratched players. Usually by the second period he has joined the rest of the medical team in the stands about five rows behind the Predators’ bench.
“It’s like a little MASH unit,” he said. “There is an orthopaedic surgeon, an internist, a dentist, a plastic surgeon, a chiropractor, an ophthalmologist and myself, a neuropsychologist. If we’re needed, the trainer can just point and we go to the locker room. I only see about half the game at best.”
In 1999, the Titans began baseline concussion testing and asked Solomon to help implement their program. He also began evaluating potential draft picks, and each year he spends three weeks in March and April testing 30-35 players.
“We do tests to evaluate how each player is going to learn things best, how they’re going to learn the playbook and get it in their head the smoothest way possible. We also focus on psychological matters, personality issues, whether they’ve had difficulty with substances in the past, temper, difficulties with the law, how they’re going to respond to intense coaching, how they’re going to handle money and status,” he said.
“Their performance on the field is not always the determining factor in terms of success. It’s not always their speed in the 40-yard dash or how many bench presses they can do. In many instances, it’s how they will handle the fame and fortune, and teams want to know that going in.”
For both the Predators and Titans, the amount of concussion care Solomon gives varies from season to season.
“It depends a lot on the roster. Once a player gets a concussion their risk for another increases significantly. Overall, the players have gotten bigger, stronger and faster, but the size of the rink and the field hasn’t changed and by and large the protective equipment hasn’t changed significantly, although efforts are being made in this regard.”
Solomon found himself answering the same questions from athletes on sports concussion over and over, so in 2006 he co-authored the book “The Heads-Up on Sport Concussion.”
Now his research interest lies in one of today’s big issues — the long-term effects of concussion.
“Undoubtedly there are cases of suicide and dementia associated with a history of concussion, but it’s difficult to say with certainty that all these problems stem from concussion. It may not be a very popular position to take, but I’m hard-pressed to believe two or three sports-related concussions are the sole cause of suicide in midlife or dementia later in life,” Solomon said.
“I think we’ll find out eventually that people with certain genetic predispositions who get overlapping concussions, who don’t heal properly between concussions, may be the ones at risk for dementia later in life.”
Solomon hopes to recruit local retired football and hockey athletes for annual neurocognitive tests to follow them longitudinally. He has also applied for funding for a study of athletes just entering the NFL to assess base rates of their mental states and biopsychosocial histories.
“We don’t have good information about what percentage of these people entering the NFL have a family history of psychiatric illness, alcohol and drug problems or a family history of dementia. In order to start looking at whether concussions cause these things, we have to know the baselines.”
Solomon first became interested in concussion at one of his first jobs in a state psychiatric hospital in South Carolina. It was the early 1970s, the time when segregation was coming to an end and race riots were frequent. A young African-American male had been hit in the head and was admitted to the hospital because he was behaving erratically.
The neurologist said the patient’s EEG was normal and he did not lose consciousness, so he did not have a concussion. The psychiatrist thought he was having a conversion disorder or an acute stress episode. The internal medicine physician said medically he was fine.
“It just fascinated me that these three different doctors said three different things. He clearly wasn’t himself and I wanted to know why,” Solomon said.
He started studying neuropsychology and did his dissertation on closed head injury, as concussion was called then. He did his internship at Vanderbilt in 1982-1983 and later returned to Nashville to open a private practice.
Solomon returned to VUMC in February and was instrumental in opening the Vanderbilt Sports Concussion Center, which provides comprehensive concussion care for athletes of all ages.
He is especially committed to the safety of high school athletes, working with the Tennessee Secondary School Athletic Association on revisions to its concussion policy. Along with Alex Diamond, D.O., and Allen Sills, M.D., he has also submitted a grant proposal for a statewide evaluation of the condition of high school football helmets.
Still, Solomon worries that all the publicity about concussion-related deaths and its long-term effects is causing a fear of sports participation.
“A concussion is an injury that, if managed correctly, according to agreed-upon international standards and guidelines, will be cured 95-plus percent of the time,” Solomon said.
“Sports are a tremendous source of personal growth and development. I think they’re a great way to learn teamwork and how to get along with people, and I am concerned about people not having that opportunity because of the belief that one concussion is going to cause irreversible brain damage.
“If you really wanted to look at it statistically, the highest risk activity your children are going to do is drive a car. The odds of your children sustaining a life-threatening or life-ending injury are much greater when they drive a car than playing football or hockey,” Solomon said.©2014 Vanderbilt University Medical Center