With Harper, the Nationals satisfied Major League Baseball’s concussion policy that a panel of independent experts revamped in 2011. That includes baseline testing for each player and umpire; an optional seven-day disabled list for concussed players; and a series of return-to-play steps that must be completed after a concussion diagnosis.
According to Nationals head trainer Lee Kuntz, Harper passed multiple Standardized Concussion Assessment Tool 2 tests immediately after he was removed from the game and in the day after the collision. The four-page exam tests a variety of factors from balance (stand on nondominant foot for 20 seconds with eyes closed and hands on hips) to basic orientation (what’s the time, the month, the day?) to concentration (repeat 7-1-8-4-6-2 backwards).
SCAT2 is a tool best used, Kutcher said, as a method for non-neurologists to organize their thoughts during a neurological examination. But it’s hardly a rubber stamp back onto the field.
Concussions, in fairness, can be notoriously difficult to recognize, as the Centers for Disease Control and Prevention notes, with transient symptoms and potentially vastly different impacts from one person to the next, one day to the next.
“It’s not an uncommon situation where we have somebody who experienced a force and does not produce any symptoms, signs or findings that any tool or scale or protocol will pick up until an hour later, two hours later, the next day,” Kutcher said. “It’s just the nature of the injury. Concussion is a clinical diagnosis made when the patient is experiencing effects of the injury.”
At some point, one has to defer to the involved medical professionals, several of them in this case, with direct knowledge of the situation. The ones who actually examined Harper and know more about his condition than an off-the-cuff comment to reporters or painful television replay.
Harper didn’t start the next two contests (he pinch-hit May 15) as he gradually resumed physical activity. The biggest problem hasn’t been his head. It’s the left knee he whacked on the fence. There’s no reason for outrage or dismissal of Harper’s headache.
“We need to realize a brain can be injured and not produce symptoms,” Kutcher said, “and so it’s an evolution, it’s an injury in progress, especially at the elite-athlete level. … We don’t turn our back on the person and say, ‘Come see me next week in clinic.’ We watch them very carefully.”
The Nationals will, too.