By Christine Murray, Kristine Lundgren, Gwen Hunnicutt, and Loreen Olson
Members of the Traumatic Brain Injury and Intimate Partner Violence Research Group at the University of North Carolina at Greensboro
Note: This blog post is also being published on the Stop Abuse Campaign blog. You can find this post by clicking here.
In recent weeks and months, the National Football League (NFL) has faced intense scrutiny over its handling of the Ray Rice domestic violence perpetration case. The case dominated the headlines as two separate videos emerged, showing first that Janay Rice was left unconscious by the assault in February, and second that Ray Rice delivered a powerful punch to her face that knocked her unconscious. The graphic video left many people reeling about the severity of the abuse, as well as the minimal repercussions that Rice faced initially.
As an interdisciplinary group of researchers who study the risk of traumatic brain injury (TBI) among survivors of domestic violence, we watched those videos through a different lens. We saw an example of one of the many types of domestic violence that places the victim at risk of experiencing a TBI. We cannot comment directly on Janay Rice’s health, but the video depicts that she lost consciousness, and loss of consciousness is one of the symptoms associated with an injury to the brain. In fact, it is the first symptom listed in the NFL’s Head, Neck, and Spine Committee’s Protocols Regarding the Diagnosis and Management of Concussion.
The NFL knows a lot about concussion, which is a mild form of TBI. In December 2013, the NFL donated $30 million to the Foundation for the National Institutes of Health (NIH) to fund research on understanding and diagnosing TBI. This donation was made on the heels of a $765 million settlement that the NFL made in August 2013 with former players who sustained game-related injuries to the brain. Professional football players face a high risk for TBI. Current research--which the NFL does not dispute in recent court documents--suggests that as many as one-third of former players will experience one or more brain injuries with negative, often chronic health consequences.
For at least two decades, the NFL has been studying and developing policies and protocols to prevent, identify, and respond to TBI among its players. As a result of these efforts, the league implemented rules designed to prevent TBI, such as banning the types of hits that are most likely to result in an injury. Furthermore, they adopted protocols that provide guidelines for examining injured players to determine the potential for TBI immediately following an injury, for managing symptoms, and for determining when players can return to play. Some of the major requirements of these protocols include that players who experience an injury which poses a risk for TBI must be assessed immediately, and if a brain injury is suspected, the player must be removed from the field right away, and then follow a detailed, phased process that involves daily monitoring in order to be gradually and safely reintroduced to game play.
Any doubts that the NFL does not recognize fully the severity of TBI should be erased by the protocols’ stipulations that, during each game, each team is assigned an Unaffiliated Neurotrauma Consultant to provide an objective evaluation of potential TBI, and at each game there is a designated athletic trainer whose role is to watch the game from the stadium booth and be a spotter for potential TBI, using both direct observation of the game and video replay.
Of course, the NFL’s policies and protocols regarding TBI address the actions of players on the field, and the NFL’s role and responsibility for protecting the safety and wellbeing of players’ relationship partners could be debated. However, the NFL is practicing a dangerous double standard when it takes the issue of TBI so seriously among its players, but ignores the harm of potential TBI resulting from a domestic violence event perpetrated by those same players. Based on the five steps in the NFL’s Return-to-Play Protocol following a diagnosed TBI, Ray Rice may have missed more games had he been the one knocked unconscious in the elevator, rather than the two games he was required to miss in accordance with his initial suspension from the NFL for knocking Janay Rice unconscious.
Although there is growing recognition of the potential for TBI among survivors of abusive relationships, to date there has been relatively minimal attention to this issue in both research and practice related to domestic violence. However, current research suggests that as many as 30% to 74% of all victims of domestic violence who seek services from battered women’s shelters and emergency departments have a TBI (Kwako et al., 2011). Unlike other populations in which there is greater attention to the dangers of TBI--especially professional athletes--survivors of abusive relationships typically have far fewer resources and less immediate access to assessment and rehabilitation services when they experience a potential TBI. Furthermore, the cyclical nature of abusive relationships means that survivors who experience one TBI are at a greater risk of reinjury. Multiple TBIs place survivors at risk of even more serious physical and mental health consequences.
The current dangerous double standard within the NFL regarding TBI experienced by players on the field and TBI resulting from a domestic violence incident underscores the need for more resources and cultural change--both within the NFL and in the general population--that will prevent further violence, provide support to survivors of abuse, and hold offenders accountable. As the NFL faces increased calls to work to prevent domestic violence among its players and take action when it occurs, one specific area in which the NFL can respond is by applying its vast resources and knowledge base surrounding TBI to improving resources for survivors of domestic violence who are at risk for sustaining this type of injury.
Kwako, L. E., Glass, N., Campbell, J., Melvin, K. C., Barr, T., & Gill, J. M. (2011). Traumatic brain injury in intimate partner violence: A critical review of outcomes and measures. Trauma, Violence, & Abuse, 12, 115-126. doi: 10.1177/1524838011404251