Questions raised about Eagles' evaluation of concussions

When Eagles middle linebacker Stewart Bradley staggered on the Lincoln Financial Field grass and toppled over Sunday, there was an easy assumption: Something was wrong.

"It's hard to imagine him coming back into this game in light of what we just saw," said Troy Aikman, the former Cowboys quarterback who had suffered multiple concussions and was calling the Eagles-Packers game on TV for Fox.

Yet, after roughly four minutes of real time - not game time - the Eagles put Bradley back on the field.

Bradley was soon pulled for good, this time diagnosed with a concussion. Quarterback Kevin Kolb was also sidelined by a concussion. And he, too, was initially cleared to play and briefly returned to the game.

The missed initial diagnoses raised questions about the team's evaluation of the players.

"The thing with concussions is, you want to make sure that you don't miss it because you want to make sure they don't go back in too soon," said David Gealt, assistant director of the concussion program at Cooper University Hospital. "If you are thinking that someone does have a concussion, then you obviously want to be on the more conservative side and keep them out until you figure out what's going on."

Eagles head coach Andy Reid defended his medical staff Monday and said it followed the proper procedures. He emphasized that once it became clear that Bradley and Kolb had concussions, they were taken out of action.

The team will continue to monitor the players this week. It's unclear if they will be able to play Sunday in Detroit. On Monday, Reid said, "They didn't feel great."

"We stuck to the criteria there and then followed up on it. As we look at this, that's the most important thing," Reid said. "We didn't just stick them out there without having to follow the protocol. But we also made sure that we stayed on top of it when they came back off the field and made the decision when symptoms were there."

Reid would not make head athletic trainer Rick Burkholder available to answer questions, saying, "I gave you everything that needs to be done."

On the air, Aikman said he was surprised when Bradley got back in the game. Former Giants linebacker Antonio Pierce, speaking on ESPN radio Monday, said he was "shocked" by Bradley's return, based on the video of the initial injury.

Julian Bailes, cochair of the NFL Player's Association's concussion committee and a former colleague of Burkholder's with the Steelers, said concussions can be difficult to evaluate.

"Sometimes a concussion is not readily apparent," said Bailes, chair of West Virginia University's department of neurosurgery.

Gealt said that after an initial check for a concussion it is important to look again for symptoms that might not immediately appear.

"You're usually going to want to reevaluate them in another 10 minutes, make sure they don't deteriorate," Gealt said. "You may not have headaches right away. You may not have blurred vision right away or dizziness."

Kolb, whose head and face were jammed to the field by Packers linebacker Clay Matthews, returned to the game roughly 21 minutes after the hit that caused his injury.

Despite much publicized new guidelines for handling concussions, NFL spokesman Greg Aiello said the decisions are still up to individual teams.

"Our return-to-play statement serves as guidance. Note the language," Aiello wrote in an e-mail.

"Did the Eagles follow the guidelines? It appears the answer to that is 'yes,' " said Thom Mayer, medical director for the NFL players' union

Mayer did not directly speak with Eagles officials, though. He said he got his information from Elliot Pellman, an NFL medical adviser and a controversial figure in the debate on concussions. Pellman spoke to Eagles trainers, according to Mayer. Pellman once chaired the NFL's research committee on concussions but resigned amid questions over his qualifications and conclusions that attributed less risk to concussions than other experts.

Pellman referred an interview request to Aiello.

The head of the NFL Brain, Head and Neck Medical Committee also looked at the issue.

"We are all comfortable with the fact the players received appropriate treatment in these cases, as per the guidelines set out by the commissioner and by the players association," said Hunt Batjer, cochair of the panel.

The guidelines say players who have suffered the injury - or are showing any of several symptoms - should not return to play on the same day.

Some of the symptoms include "confusion as evidenced by disorientation to person, time or place."

Asked if Bradley had showed these symptoms, Reid said, "when he came off of the field and went through the protocol and the testing there, that he was clear minded and able to pass it."

However, Eagles trainers were evaluating Kolb when Bradley got hurt and may not have seen his initial stumble.

Reid said Kolb and Bradley would be evaluated by the Eagles staff Wednesday and again Friday. If they clear a concussion test, they will then be checked by an independent doctor, William Welch, chief of neurosurgery at Pennsylvania Hospital.