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Eric Lindros, Paul Kariya, Pat LaFontaine, Rob Niedermayer - the list of players who have suffered from concussions this season could go on and on.

It seems the National Hockey League has seen a growth in the number of concussions the past two seasons. With NHL players getting bigger, stronger and faster and the collisions on ice becoming more dangerous, it's no wonder the amount of head injuries in the league seem to be on the rise.

But are concussions occurring more often in the NHL, or are players just being more cautious with a potential career-ending head injury?

Dr. Ruben Echemendia, member of the NHL advisory board on concussions, said the players are more aware of the seriousness of concussions than they used to be.

"What I've witnessed, very much at the NHL level, is a heightened awareness of concussions among the players and the severity of a concussion," Echemendia said.

"As a result, they're becoming more cautious. That doesn't mean they're playing the game with any less intensity, or that they're less physical in the game. That just means now they're more willing to report to their trainers that `maybe I don't feel so hot,' or `I didn't remember that last play or that last shift, and I need to sit out.'"

Players, coaches, trainers and physicians started taking more notice of the seriousness of concussions after situations that players like former New York Islander Brett Lindros have faced. Lindros, the younger brother of the Flyers superstar Eric Lindros, was forced to retire from the NHL after suffering a series of concussions that severely impacted his health.

Eric Lindros, usually the one dishing out big hits on the ice, received a concussion when Pittsburgh's Darius Karparaitis hit him with a clean check on March 7. Lindros, who had his head down on the play, had to be helped off of the ice after the collision with Kasparaitis' shoulder. He isn't expected to return to the lineup until mid-April.

It is situations like this that lead Echemendia and a concerned group of his peers to submit a proposal to the NHL before this season to conduct neuropsychological tests on all NHL players before and during the 1997-98 season. The NHL mandated the program in cooperation with the NHLPA, which is the only one of its type that is league-wide in nature and tests every player in the league.

So when Eric Lindros or Pat LaFontaine talk of having to get their "numbers" up to the level they were at before they suffered a concussion, they're speaking of the results of these neurological tests.

Before the season, over 900 hockey players were baseline tested during NHL training camps. Echemendia, who is the clinical coordinator and supervisor for the entire Northeast Division and the participating consultant for the Pittsburgh Penguins, said 58 players were tested during the Pens' training camp alone. Virtually any player who had a chance of playing in the NHL this season was given a 30-minute test to see how their brain normally functioned without the influence of a concussion.

Then if a player received a concussion during the season, they would be tested again at certain times to see the difference in brain functions pre- and post- concussions. Players are tested between 24 to 48 hours after suffering a concussion, then one week later, and then on a weekly basis until they return to play.

"The study has been going very well," said Dr. Charles (Chip) Burke, who is the Penguins' team physician and president-elect of the Executive Committee of the Team Physician Society. "It helps the players. It educates them and gives them something to go by. It helps the league because they have a program in place and helps them in a public relations manner. And it helps the doctors by giving us a lot of information on concussions."

Echemendia said he was surprised at the reception of his study by the players and the teams.

"These guys were inquisitive, asked a lot of questions, wanted to know how the tests measured certain things," Echmendia said. "I think it was both a positive experience for them and for the people doing the testing. Even though it was frustrating for (the players)."

The tests given to players include the monitoring of the following skills: information processing speed, problem solving ability, memory, new learning and visual-spatial skills. But for those players in the league who aren't fluid in English, a separate test had to be created to monitor foreign-born participants in the study.

"Because one of the key issues in the NHL is the multiple languages that are spoken, we had to develop tests that are less susceptible to language differences," Eschmendia said. "We have a variant of our battery that is given to those individuals where English isn't their native language."

While the tests are not by any means going to prevent concussions, they will be able to help doctors determine several things. First of all, the doctors want to know what deficits a player has after suffering a concussion, including what symptoms they have and what problems they are experiencing. Second, they want to determine when the effects of the concussion are over and when the player can return to play safely.

"We can't prevent the first concussion with these tests," Echemendia said. "What we can prevent is a secondary injury that occurs real close to the first one when the effects from the first one are still lingering."

Those secondary brain injuries are called second impact syndrome (SIS). It occurs when a second concussion is received within hours, days or weeks of a prior concussion. Depending on how close a second concussion is to a first means a lot as far as the long-term effects are concerned. SIS results in rapid brain swelling that could lead to a coma or even death.

That's why it is so important to chart out when concussions occur and how long the effects linger in an individual. SIS has been a major concern for LaFontaine over the past couple years. Since he has had so many concussions, he is more susceptible for another one. And if that next concussion occurs before all of the effects from the prior one have subsided, LaFontaine could be in a lot of trouble with SIS.

The concussion study in the NHL has been able to provide vital information for doctors to make better decisions for players.

"We haven't analyzed the data at a group level yet, but what we can say is that the program has been highly successful," Echemendia said. "(We are) documenting symptoms and following those symptoms to their resolution. So that we, for the first time, have more objective evidence of when a player can return to play safely and when the signs of the concussion have stopped."

Concussions are hard to diagnose and treat because they can't be seen through any medical techniques available. There is also so much individual difference in people's symptoms and length of recovery that group data that could be gathered would not be helpful in diagnosis and treatment. That's why gathering baseline tests for individual players has been so important in the NHL program. The baselines give doctors a starting point that they can compare to a player's neurological state after suffering a concussion.

For the most part, Echemendia said the vast majority of concussions will resolve and a person will be symptom-free within a week to 10 days. But, he said, not all individuals heal at the same rate due to a number of factors.

"I think the difference between this type of injury and a knee injury is that you can see the effects of a knee injury," Echemendia said. "You can do an X- ray. You can do range of motion tests. You can do a number of different things. And it hurts. You know, when you try to skate and you've got a bum knee, it really hurts.

"That's not the case with a concussion. You can still have lingering symptoms, but not be fully aware of them. And it only comes out on this type of testing. It's at that point that the players start to become frustrated. They can't see it. And they can't feel it."

And then, more often than not, they decide to come back to action. Over the years hockey players have been known as tough athletes, able to shake off almost any kind of injury. They want to return to action as soon as possible because they love the sport. And they don't want to lose their jobs.

Echemendia and the other head injury specialists are trying to get this "old-time hockey" attitude of playing through pain and returning to action before being completely healed out of the game.

Dr. Mark Lovell, chairman of the National Hockey League's Neuropsychology Advisory Board and head injury consultant to the National Football League, said the old-school philosophy of playing through the pain and coming back too early is starting to wear out its welcome in the league. In the past, players would question doctors when they suggested sitting out a longer period of time to make sure all symptoms have subsided, but that's not the case anymore.

"In one year, I've seen a dramatic change in that philosophy," Lovell said. "Players would always look at you like they were saying, `Why are you doing that?', but all it took was having players like Eric Lindros, Paul Kariya and Pat Lafontaine sitting out of the lineup all at one time.

"Now players are taking this very seriously. Eric Lindros is a big guy at 6-foot-4. They know Lindros is not a wimp. But all of a sudden he's out with a concussion...."

At times the teams have also been known to rush players back from the injured list before they should have been. Hockey has turned into a business, and teams want to get the most out of their players, who are sometimes referred to as investments.

But Echemendia said that when it has come to concussions this year, both players and teams have been nothing but cooperative with the medical staffs.

"I can tell you from my vantage point," Echemendia said, "we have not been pressured in any way to return a player to play, or to say a player should return to play, when we feel they shouldn't."

Craig Patrick, general manager of the Pittsburgh Penguins, played eight seasons in the NHL and remembers very well that the thinking of players, coaches and doctors during that time was much different than it is today.

"It has really become a science," Patrick said. "Back when I played (if a player received a concussion) they told you to take some aspirin and you were ready to play."

But as more research has been done on head injuries and the dangers associated with them have been discovered, the NHL seems to have changed its ways. Patrick likes the NHL's new concussion study, saying that he's all for protecting players careers and taking major precautions.

"If we're going to make mistakes," Patrick said, "I'd rather do it on the side of safety."

While it might seem like keeping star players like Paul Kariya out of the lineup for an extended amount of time is excessive, setting those players up for a career-ending head injury is reason enough for many to be overcautious.

"Very often players think `Oh, these are the guys who keep us from playing,' but that's not our goal at all," Echemendia said. "Our goal is to prevent them from having a career-terminating injury. Our goal is to prevent them from having a catastrophic injury. And that actually by managing these concussions appropriately, they'll spend more time in sports than less time in sports.

"Some people believe there's much ado about nothing, but I think that that's a significant minority. That's what everyone was exposed to. They didn't know. The research wasn't out there and people weren't aware of the facts. I mean look at the media now with the Snickers commercial: `I'm Batman'. It's still a joke. Concussions are a joke."

But as research into concussions grows, Echemendia hopes brain injuries are taken more seriously by athletes in all sports, not just ice hockey.

"I would like to see that athletes in sports where there is a significant risk of concussion have a program in place that allows them to manage their concussion in the best way possible," Echemendia said. "I would also like to see (concussion awareness) move into the high schools. That's a critical issue."

But until then, professional athletes like those in the NHL will have to serve as an example to kids and adults as to what they should and should not do when they suffer a brain injury.

"It's kind of on the forefront," Patrick said. "Athletes are bigger, stronger and faster. It's something that people have to pay more attention to."

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