LINCOLN, Neb. (AP) — Less than an hour after he was loaded into an ambulance after getting knocked unconscious against Ohio State, Nebraska quarterback Tommy Armstrong Jr. was back on the sideline with teammates.
His rapid return was encouraging to anyone who saw Armstrong lay motionless following a hit by Malik Hooker on Saturday night. It also was a bit surprising.
Dr. Robert Cantu, a concussion expert and co-founder of a center that studies head trauma at Boston University Medical School, on Tuesday told The Associated Press a raucous football sideline typically wouldn't be the ideal environment for a person who just sustained a concussion.
"We normally don't encourage people to be in stimulating circumstances right after a concussion," Cantu said. "So we normally wouldn't bring someone back to the sideline. We'd keep him in a quiet environment — not a dark room and all that, but not the stimulation of a football field. So that's a bit atypical.
"But I don't know what his symptomatic status was," Cantu added. "If everything cleared up real quickly, it wasn't necessarily wrong."
Armstrong, according to Nebraska director of athletic medicine Dr. Lonnie Albers, went through a "very thorough medical and imaging process" at the Ohio State Wexner Medical Center and left the hospital without symptoms.
"A member of the Nebraska medical staff was present throughout the evaluation at the hospital, through the dismissal process, and on the sideline upon Tommy's return to the stadium," Albers said in a statement. "Tommy left the hospital symptom-free and reported no symptoms during post-dismissal monitoring at the stadium."
Coach Mike Riley said Monday that Armstrong was going through a concussion protocol and would require clearance from the athletic department's medical staff in order to play in this Saturday's game against Minnesota. Riley characterized Armstrong as "day to day."
Cantu, a consultant to the NFL Head, Neck and Spine Committee, said if Armstrong's symptoms cleared up quickly, it would not be unreasonable to expect him to be ready to play in the next game.
"The important thing is how fast the symptoms cleared up," Cantu said. "The fact he was briefly unconscious is largely not important in terms of severity of the concussion. The severity of the concussion is much more correlated to how long it takes for symptoms to clear. So the fact he was unconscious for a few seconds, that means he had a concussion and needs to be checked out, but it doesn't necessarily mean it's going to be a long period of time he's away."
Nebraska's concussion protocol will require Armstrong to complete a computerized neurocognitive test to show he has returned to his normal neurological state. He then will be monitored to see how he tolerates increasing levels of activity. If he shows he can handle activity without worsening or new symptoms, he's allowed to return to competition.
Dr. Arthur Maerlender, director of clinical research at the university's Center for Brain, Biology and Behavior, is charged with interpreting Armstrong's neuropsychological test results in the protocol.
"There is no magic window of time to stay out," Maerlender wrote in an email to the AP. "Loss of consciousness (LOC) is not a very good predictor of anything. Given current knowledge, athletes can return to contact if all signs, symptoms and test scores are back to baseline and they complete a step-wise physical exertion process.
"Future research may show that to be inadequate, but we have no solid evidence of that yet," he said.
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