On Second Thought

Making diagnostic headway

By Kevin Paul Dupont
September 25, 2011

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Kevin Guskiewicz has a PhD in sports medicine and a deep knowledge of sports concussions, and last week he became $500,000 richer because he figured out in the late 1990s how a $5 stopwatch and a $45 piece of foam cushion could make it much safer for our kids to stay on the playing field. Or, in some cases, remain on the sideline while their heads clear.

“As I’ve told people before, I’ve never made a dime off of BESS,’’ Guskiewicz said last week, shortly after the MacArthur Foundation announced that he was one of its 22 grant recipients this year. “I’ve had people tell me I’m crazy because of that.

“But, hey, think about it. That’s a combined price of, what, 50 bucks? I don’t think I was ever going to get rich off that, anyway. It was far more important, I thought, to get it out in the public domain and start helping people.’’

For those fortunate enough not to have had their bell rung during a game or practice, BESS is the Balance Error Scoring System. Some 15 years ago, Guskiewicz and two of his University of North Carolina graduate students, Bryan Riemann and Jimmy Onate, created BESS as an inexpensive, effective method of diagnosing concussions.

The BESS test, explained Guskiewicz, requires an athlete to undergo a brief, simple series of tests while standing upright - be it on two legs or one. The athlete first performs the required stances on solid, even ground and then again after slipping the rectangular foam cushion, measuring 15 by 18 inches and 3 inches thick, under his or her feet. The clinician overseeing the exam uses a stopwatch to time the athlete’s ability to maintain a stance and records whatever errors in balance he or she commits. As the errors increase, the greater the evidence that the player is concussed.

Voila, the mysteries of an addled brain revealed almost as fast as coaches used to ask, “How many fingers am I holding up?’’

“The percentage of clinicians using BESS is still not where we want it to be,’’ said Guskiewicz, a father of three boys and one girl. “But somewhere between 50-70 percent are using it. In the US, if your team has a certified athletic trainer on the job, you can bet it’s being used.’’

Guskiewicz, 45, originally from Latrobe, Pa., where he played high school football and tennis, knows well the agonies and frustrations related to sports-related brain injuries. He has been studying and agonizing over hits to the head for all of his 16-plus years at Chapel Hill. As a trainer with the NFL’s Steelers during his graduate school days in Pittsburgh, he saw first-hand how dealing with concussions - specifically the diagnostic and treatment protocols - needed to be improved.

“And I want to be clear there,’’ said Guskiewicz. “That wasn’t a Steeler issue or an NFL issue. It’s just where everyone was at that time. The decisions were arbitrary about having players return to action. We knew a whole lot less about concussions then. We needed diagnostic tools.’’

The mysteries continue, but the understanding grows, thanks to people like Guskiewicz. Here in the Bay State, Boston University researchers only recently have detailed the devastating effects of CTE - a degenerative brain disorder discovered in autopsies of a number of former pro athletes. The CTE in those athletes, the researchers are convinced, is the result of concussive and subconcussive hits sustained during their playing days.

In his multiple roles at UNC - professor, trainer, and researcher - Guskiewicz often deals with parents of concussed athletes who are left to ask, “Doc, should my kid keep playing?’’

“I’ve had to do that four times this week,’’ mused Guskiewicz. “And it’s only Wednesday.’’

No easy answer there, either. Some of those parents think a new mouthguard or helmet will provide the fix, make it safe to get back in the game quicker. But, said Guskiewicz, he must remind them that there is no concussion-proof mouthguard or helmet on the market, and no device is going to unring the bell of a concussion. Time is the healer, and about the only guarantee attached is that everyone heals at a different pace.

“And,’’ noted Guskiewicz, “once you’ve had a concussion, you’re more susceptible to another.’’

Parents of athletes, said Guskiewicz, at times can be trickier to treat than their concussed sons or daughters. The kid who feels the pain, he said, often knows or wants to stay out, in large part because she or he experienced the blow, lived its pain, and is scared or confused, sometimes depressed over the initial hit or its lingering effects.

“I’ll get parents who call me, and one of them wants their kid in, the other wants their kid out,’’ said Guskiewicz. “They’re asking for the three of us to get in the room and have me sort it out. I politely tell them, ‘Sorry, but I think now you’re asking me to get in the middle of a domestic argument . . . and I’m really not paid to do that.’ ’’

The MacArthur Foundation hands out its $500,000 grants with no strings attached, and the payments, $100,000 each, are paid to its recipients over five years. The money is meant to make life a little easier for the winners, which, said a grateful Guskiewicz, will allow him to relax a little when writing oft-painstaking grant requests that are central to a researcher’s life. He plans to plow all the money into further research, ideally obtaining matching grants to turn the $500,000 into $4 million or more.

The one true pleasure he may allow himself is a trip to study for 2-4 weeks in Italy, where a group of other answer-seekers is deep into research on concussions.

“This one group over there is doing some exciting stuff, studying how the brain moves inside the skull in certain impact situations,’’ he said. “I’d love to be a part of that, all of us working to piece the puzzle together. It’s often how you find the answer, with everyone taking a look at it from a different angle.’’

A stopwatch, a patch of foam, and a lifetime of looking straight into the pupils of athletes who are injured, shaken, scared, hurting, and confused. No surprise that the MacArthur Foundation felt that blend of ingenuity and dedication was worth a hefty attaboy.

In popular culture, the MacArthur Foundation designees are typically termed winners of the “Genius Awards.’’ In the New York Times last week, a headline noted, “MacArthur Foundation Selects 22 for Its ‘Genius Awards,’ From Poets to Physicists.’’

“Yeah, let me tell you a story about that,’’ said Guskiewicz. “A peer pal of mine called me when he read about it and said, ‘So, Kev, how’s it feel to be a genius?’ And I told him, ‘You know what? Anyone who considers me a genius truly needs to be evaluated for a concussion.’ ’’

Kevin Paul Dupont’s “On Second Thought’’ appears on Page 2 of the Sunday Globe Sports section. He can be reached at

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