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 March 2001
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The Cutting Edge
Tackling Concussions Head-On

A ninth-grade track star stares vacantly at the screen of a laptop computer. His athletic career may very well hang on the word "red," which flashes in big blue letters. "Blue" then blinks in green letters. Then other words appear: Can. Mouse. House. Nurse. In a few minutes the gangling 5-foot 10-inch, 140-pound boy is asked to remember the words and colors that he saw during a 20-minute computer test. Administering the test at the UPMC Center for Sports Medicine is Pitt neuropsychologist Mark R. Lovell, who directs UPMC’s Center for Sports Medicine Concussion Program. Lovell developed the test with Joseph C. Maroon, vice chair of neurological surgery. The results concern Lovell. The boy has trouble remembering what he saw only minutes before on the screen, and it has taken him longer to finish than it should have. Seven months earlier, an emergency room doctor diagnosed the boy with a concussion. Details of the accident, which happened at his school, aren’t clear. Classmates remembered the boy vomiting and little else. The boy remembers nothing that happened just before or immediately after the injury. Since then, he has had balance problems and trouble sleeping and concentrating. He is also depressed.

A jarring of the brain is what causes concussion. For players, "getting your bell rung" has been part of team sports since there were team sports. Blows to the head can shear the microscopic fibers that are the body’s main switchboard wires. Unconsciousness can occur when these tiny fibers break. If the hit is severe, the tearing of the tiny fibers can disrupt the electrical signals that regulate heartbeat, breathing, and blood pressure, resulting in shock and even death. Unfortunately, severe hits are not unusual—touch football doesn’t sell. Maroon says that between 50,000 and 150,000 high school athletes suffer concussions each year. Most heal well. Others don’t. Mood swings, memory loss, and attention-span problems are among the possible long-term effects of a concussion. After a series of concussions, some professional football players have hung up their cleats. In 1994, former Pittsburgh Steeler Merril Hoge retired at age 29 after his second concussion of the season as a running back with the Chicago Bears. Even 10 days after the hit, Hoge said he was dizzy and sleepy and having trouble remembering things. Hoge said he returned to play too soon after the first concussion, making the second concussion much more serious than it otherwise might have been.

Hoge had it right. Treating a concussion successfully depends on gauging its severity, then allowing enough time for the brain to heal. But how do you know when it is safe to allow a player to return? Maroon and Lovell, with help from Steelers’ athletic trainer John Norwig, developed a pencil-and-paper test called the Steelers Battery that the National Football League and National Hockey League have used since 1991 to evaluate concussions. Returning too soon to the game—as Hoge’s experience suggests—leaves the player more vulnerable to another, more serious head injury, Maroon says. The concussion test, which was recently adapted for laptop computers, measures an athlete’s mental acuity and, therefore, the severity of the injury. It can also be administered before the start of the season—a baseline for comparison if the player is hurt during the season. What’s more, the test measures responses from different parts of the brain, making it easier for physicians to determine the exact location of an injury. The test can be given quickly—usually in 20 minutes. Because a physician doesn’t have to administer the test, it’s relatively inexpensive compared with conventional testing. The Center for Sports Medicine provides training services for athletes at 41 area high schools and seven colleges. Test results are being used to build the country’s biggest database of concussion injuries, Maroon says. The database will be tapped for research, meaning fewer athletes may have to take it on the chin—or noggin—in the years to come.—Kris Mamula

Say You Want a Revolution
Africana Studies professor looks at what’s hidden in Caribbean popular music

Not everyone listening to the popular Caribbean music heard the calls for transformation—for equality between men and women, independence, social renewal. And that was no accident. The entreaties were seeded in the lyrics of popular songs by musicians and songwriters from the French islands of Martinique and Guadeloupe who wanted to avoid censorship but still speak to the hearts of their listeners. To conceal these messages from French censors, musicians performed and recorded in Creole, a mixture of seventeenth century French and indigenous African languages. Banned in the classroom for centuries by the French, Creole is a spoken language that disguises, then gradually reveals, hidden meanings.

First, a look at what led to talk of radical change in a dreamy part of the world best known for pristine beaches and fancy resort hotels. Guadeloupe, the bigger of the two, is a butterfly-shaped island 10 times the size of Washington, DC. Martinique is about six times the size of DC. Combined, the two tropical islands have a population of about 841,000—roughly one-third smaller than Western Pennsylvania’s Allegheny County. Because the islands are small, musicians and other performers went to Paris to make records and gain popularity. "They really want to stay home, but they have to go to France," says University of Pittsburgh Africana studies professor Brenda F. Berrian. "The islands’ population cannot support full-time musicians." Mesmerized by the lyrics, Berrian interviewed 31 musician-composers over three years—including conducting one interview in a women’s rest room—to write Awakening Spaces: French Caribbean Popular Songs, Music and Culture, a book about island music that promised to transform the Caribbean paradise between 1970 and 1996.

Kassav, a Paris-based studio group, led the call for change in the late 1970s with high-energy dance music called zouk. The emergence of zouk coincided with radical social change—the rural-based economies of the islands were collapsing. Exports of sugar, for example, which had comprised one-quarter of the islands’ exports, ceased by 1975 as France tightened its grip on the islands’ economies. Tourism was replacing economic self-sufficiency. Socially, too, problems were worsening—the rate of divorce, use of illegal drugs, and domestic violence were on the rise. Zouk, which derives its name from a Martinican Creole word that refers to a party, was often written off as "bubblegum" music. Kassav’s lyrics spoke of social harmony, hope, and respect between men and women—at first blush. A closer look at the secondary meanings revealed lyrics urging the need to be free from the chains of imperialism and the vestiges of slavery. "The black man already knows/his black brother led him/to dance along the river/so that they can be prisoners/chained in the boat. /Two centuries ago/the boat arrived. /Are our spirits still chained/to the bottom of the boat? /Unchain yourself."

Most troubling for Berrian is what has happened after the 26-year period analyzed by her book. Zouk’s promise of social renewal has not been realized. Kassav’s lyrics are more political than ever, she says, but the youth dismiss the importance of the music. Worse, outright plagiarism and knock-offs of the zouk sound have diluted the music’s social critique and calls for reform. "It hurts me to see this," Berrian says. "I don’t know how you turn it around." Berrian’s book provides a strong historical snapshot, showing a time of promise and hope in a troubled tropical paradise.—KM

Cambodia’s Slow Rebirth
Once peaceful agrarian society struggling for stability

Over the span of 10 centuries, Cambodians built a thriving, peaceful, agrarian society. It took only four years to destroy it. Another two decades of guerrilla warfare, political strife, and intervention by the world’s superpowers were necessary to undo the damage caused by the US-Vietnam War and the brief, but bloody, reign of the Khmer Rouge. The complicated web of events is unraveled in Cambodia Confounds the Peacemakers, 1979-1998, a recent book by University of Pittsburgh political science professor Joseph J. Zasloff and his longtime colleague, MacAlister Brown of Williams College.

Zasloff has spent what he calls four rewarding decades studying what was once called French Indochina. It’s a path he chose by accident in 1959, when he completed an application to teach overseas as a Smith Mundt professor. The form asked which countries he would be willing to teach in. "I checked 15 boxes," he says. "I got a letter a few months later that said, `You have been selected to teach at the University of Saigon.’ I had to look at a map," Zasloff says, chuckling.
His uncertainty evaporated when he arrived in Vietnam, which had gained its independence from France five years earlier, and found it "fascinating and enjoyable." "It is a charming city," says Zasloff, who extended his initial one-year teaching assignment for a second year. "I had eager students. It was a marvelous, exciting, totally involving experience."

Soon, Zasloff’s work was getting noticed. The journal Commentary published the results of his study of peasant protests and the assassination of government officials in South Vietnam. The piece caught the attention of the Rand Corp., which asked Zasloff to lead a team in researching the morale and methods of the Viet Cong. Later, he briefed top-ranking US military officials, including Army General William Westmoreland, on his findings.

In contrast to its neighbors, Cambodia was "a haven of peace," says Zasloff, until the US military became convinced that Cambodia was harboring Viet Cong and began bombing the country’s eastern border.

The resulting havoc allowed the Khmer Rouge to seize control in 1975. During their 45 months in power and under the dictator Pol Pot, between 15 and 30 percent of Cambodia’s population perished. But the Khmer Rouge miscalculated badly and attacked neighboring Vietnam. In response, the Vietnamese routed the Khmer Rouge and installed a puppet regime in Cambodia in 1979. Four factions began fighting for control of Cambodia, Zasloff says, "and no one could win." By 1989, with the Soviet Union collapsing, its subsidies to satellite states ended, Vietnam withdrew its troops from Cambodia. On Zasloff’s next visit to Cambodia, his hosts proudly pointed out that soldiers at the airport wore Cambodian uniforms.

The Cold War thaw provided the opening for the United Nations to meet in Paris with the competing Cambodian factions and create a new government. The resulting election, held in 1993, had a 90 percent turnout and was declared "free and fair" by UN observers. Yet two prime ministers emerged from the election to share power—a shaky coalition that could not hold. By 1997, one was forced from office, and again blood spilled in Cambodia. When a new election was held in 1998, Zasloff and Brown, whose friendship dates to their graduate school days, were dispatched to monitor the process.

"It was a remarkably well-run election," Zasloff says, though allegations of fraud were later rampant. Under the current constitutional monarchy, there has been progress in restoring normal life to Cambodia. But, he adds, the reality is that Cambodia remains rife with corruption, and the country’s abundant natural resources are being "rapaciously exploited." In addition, American interest in the region has waned since the end of the Pol Pot regime. Zasloff has written several articles detailing observations made during his most recent trip. "We’ve been studying what happened in Nazi Germany for decades now. But what happened in Cambodia even surpasses that in its proportions and its horror. There are a whole set of unanswered questions, and not a whole lot of people talking about it." —Jason Togyer



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