Dolphins' handling of Tua Tagovailoa's head injury brings ataxia into the NFL conversation

Ataxia, an obscure neurological term with deep roots in Minnesota, was thrust into the NFL's concussion protocol lexicon last week and has impacted this week's Vikings game at Miami.

"The great part for us is there are tens of millions of football-obsessed Americans out there this week that have now heard the word ataxia," said Andrew Rosen, executive director of the National Ataxia Foundation, based in the Twin Cities since it was founded in 1957. "We'd like them to learn more, but it's significant awareness for us because a lot of people had literally never heard the word before last weekend."

Ataxia — defined by the NFL and NFLPA as abnormality of balance/stability, motor coordination or dysfunctional speech caused by a neurological issue — was included in a modified concussion protocol as a mandatory "no-go" symptom following a two-week investigation into the missteps made in the decision to allow Dolphins quarterback Tua Tagovailoa to return to the field after suffering what appeared to be a head injury in a 21-19 win over the Bills on Sept. 25.

Tagovailoa stumbled and fell after being hit but did not report or show any signs of concussion during his locker room exam, the rest of the game or leading up to when he did suffer a concussion in a scary scene during Miami's next game at Cincinnati four days later.

On Oct. 9, a day after the "ataxia" clause was introduced, the Dolphins played the Jets. As fate would have it, Tagovailoa's replacement, former Viking Teddy Bridgewater, was spotted stumbling after being hit on his first pass of the game and became the first NFL player to be benched by ataxia. He passed his locker room concussion exam.

Even with Tagovailoa and Bridgewater's status up in the air on Wednesday, Dolphins coach Mike McDaniel went ahead and named rookie seventh-round pick Skylar Thompson as his starter against the Vikings. Thompson had a 58.4 passer rating in last week's 40-17 loss to the Jets.

Vikings quarterback Kirk Cousins and safety Harrison Smith applauded the "ataxia" clause this week.

"I know every year this game keeps getting safer, and they keep finding ways to help players, protect players and hopefully prolong guys' careers and life after football," Cousins said. "I think it's trending in the right direction."

"It seems pretty reasonable to me," Smith added. "Football players can figure out how to beat tests sometimes while still not being in a place where they should be playing."

According to the NAF, ataxia is the result of dysfunction in the cerebellum, which is the part of the brain between the cerebrum and the stem. It can be caused by genetics or exposure to outside issues such as head trauma.

Dr. John W. Schut, who lost family members to the disease, founded the NAF and began its research 65 years ago. He, too, inherited the ataxia-causing gene.

In 1993, another Minnesotan, Harry Orr, now director of the University of Minnesota's Institute of Translational Neuroscience, teamed up with Dr. Huda Zoghbi of Baylor University to identify the first genetic defect known to cause a type of ataxia.

The University of Minnesota also houses the Bob Allison Ataxia Research Center in honor of the former Twins outfielder who died in 1995 at age 60 of complications from a form of ataxia known as Olivo-Ponto cerebellar atrophy.

The NFL didn't consult with the NAF before modifying the concussion protocol. But Rosen said the NAF was quick to contact the league to ask if it can help player safety while further riding the wave of awareness that comes with sharing the spotlight with the country's most popular sport.