Detroit – Major League Baseball's policy on concussion protocol, adopted before the 2011 season, does not differentiate between players who've been diagnosed once with a concussion and those, like Tigers catcher Alex Avila, who have had multiple concussions.
"They are reviewed the same as if it was a first time," Tigers head athletic trainer Kevin Rand said. "The process is the same for all players regardless of how many they've had."
Rand, however, has absolutely treated Avila's most recent brain injury with more caution.
Avila has been out since Sept. 14 when he was hit in the face on a swipe tag by Indians first baseman Carlos Santana. It was the second time he was concussed in a three-week span.
He also missed time last year with concussion symptoms.
So, Rand has been going beyond the protocol outlined by Major League Baseball. The good news, Avila passed all the tests and he was cleared by Major League Baseball to return to action Monday.
The bad news, Avila was rusty, going 0-4 with three strikeouts in the Tigers 2-0 loss.
"In this instance, he's been symptom-free, from a living perspective, since Tuesday," Rand said. "From a baseball perspective, well, we've been more cautious with him on this one because I know when we put him out to play last year, he had a resumption of the symptoms."
Avila had what is called delayed onset of the symptoms when he was concussed last year. It happens frequently with football players. The symptoms sometimes show up a day or two after the actual concussive hit.
And Rand said that even though Avila was technically symptom-free since Tuesday, he was still not right and was having difficulty tracking pitches and performing some baseball activities. Rand had Avila checked out by an independent neurologist in Kansas City on Friday – by the same neurologist the Chiefs use.
"There have been no return of the symptoms," Rand said.
Rand detailed the steps that Avila has gone through this week:
* He was symptom-free (no headaches, light-headedness, nausea) since Tuesday.
* He was put through some light activity (non-baseball exercises) and he got through that without incident.
* He was put through baseball-specific activity (hitting soft-toss, hitting off a tee, he caught Anibal Sanchez's bullpen and hit against him in the simulated game). The symptoms began to abate on Sunday.
* Once the symptoms did not recur, he was put through repeat ImPACT testing (Immediate Post-Concussion Assessment and Cognitive Testing), which determines, among other things, brain processing speed, memory and reactive time. All players establish a baseline score on this test before the season. Avila got back to his baseline.
* He was also put through a SCAT3 test (Sport Concussion Assessment Tool, third version).
He took the ImPACT and SCAT3 tests again Monday afternoon.
Rand submitted all the documentation to the league before the game Monday. The documentation was reviewed by an independent board of doctors and neurologists hired by the league.
"Once they have all the paperwork, the turnaround is pretty quick," Rand said.
At around 6:10 p.m., about an hour before game time, the league notified the Tigers Avila was cleared.
"I was clearly frustrated as the week went on," Avila said after the game. "I know you have to be careful with head injuries, but at the same time I want to play. I love this time of year. At the same time, they want to make sure I'm OK. Each day (during a layoff) is a guessing game."
There is no test available, though, for determining whether another foul tip off the mask or glove to the face will cause more brain trauma for Avila.
"I know a lot has been made of the foul balls I've taken," Avila told reporters in Kansas City. "It's just part of the job. It's the position. I've made peace with that, so it's nothing that bothers me when I go into a game.
"I'm not worried about getting hit. That doesn't bother me anymore. That's just the reality of the situation. I just kind of take what comes along that day."