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NCAA proposed head-injury settlement raises tough medical questions for doctors and athletes

CHICAGO - A key feature of a proposed settlement of a head-injury lawsuit against the NCAA is the creation of a $70 million fund to pay for medical evaluations of current and former college players in several sports. The provision raises some sticky medical questions. Here are some of them:

WHAT WILL THE EVALUATIONS BE LOOKING FOR?

Players who believe they have suffered sports-related concussions will be checked for conditions including post-concussion syndrome and a devastating incurable brain disease called chronic traumatic encephalopathy, or CTE, that has been diagnosed in several former NFL players who committed suicide. Both conditions can involve headaches, memory and behaviour problems, but CTE is more severe and most feared by athletes. Most experts agree CTE can't be diagnosed until after death, and there is no specific treatment, although some symptoms can be managed with medicine or psychotherapy. Post-concussion syndrome symptoms also can be managed, but diagnosis can be subjective. Special scans can sometimes pick up signs, but some imaging scans may be normal.

CAN DOCTORS DETERMINE THAT SPECIFIC HEAD BLOWS CAUSED LINGERING CONCUSSION SYMPTOMS?

Testing won't answer that question, posing a dilemma for players who may want to file lawsuits seeking to definitely link symptoms with NCAA play.

DON'T BASELINE TESTS ADDRESS THAT ISSUE?

The NCAA doesn't currently require baseline evaluations. The settlement will mandate them at the start of each season for all players. That will give doctors comparison information, but won't affect former players.

WHO WILL DO THE EVALUATIONS?

In the first phase, current and former players will self-report symptoms, including mental troubles and mood and behaviour problems. A five-member medical committee will evaluate the self-reported symptoms and determine which players need in-person testing. The settlement recommends that the committee include Dr. Brian Hainline, the NCAA's chief medical officer, and Dr. Robert Cantu, a leading concussion expert and co-director of Boston University's CTE Center. Cantu has served as a consultant to the NFL and to Boston College's football team. The settlement also recommends neuropsychologist Ruben Echemendia, who has worked with the NHL, and a retired federal judge, Wayne R. Andersen, to serve as committee chair.

At least 10 locations will be designated for testing, which may include neurological and psychological exams.

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