As a new womens' lacrosse referee I initially had mixed feelings about the ongoing debate on the use of helmets in play. Listening to the discussion in referee training sessions that stressed the finesse of the game and the need of the referee to control or slow down play, verses the struggle I felt as a person having a medical degree and realizing the potential hazards of brain injuries, I tried to see both sides. Some people think that helmets will make the game more physical. But after my first official day as a referee standing on the sidelines watching my daughter’s middle school team begin their game, my beliefs became clear. Female lacrosse players need to wear helmets. During the first eight minutes of the game there were three injuries, one related to a child’s head and neck. This player had been checked from behind causing her neck to snap back. She then fell and hit her head on the turf. I witnessed every parent’s/referee’s/coach’s nightmare: a player down and seizing. To my dismay, this player returned to play in less than three weeks and went on to have another concussion and seizure. She is now barred from impact sports for the rest of her life. What I found out about my local school district surprised me and motivated me to try to educate parents and give people the best information possible. After speaking to the athletic trainers in my school district, I was made aware that high school students are given baseline concussion testing but younger players are not. We are now in the process of offering that testing to younger players. Also, while coaches can have in-person or online concussion training it seems that more could be done to help the coaches and parents become more informed about concussions. There are numerous issues that could explain the high incidence of concussions in women's lacrosse. One might be to consider the nutrition and health of girls playing the game today. Both men and women today are better nourished and physically stronger, faster and more powerful than the players of previous years. This has created a weight imbalance as some players can actually outweigh others by a large margin. The physics of combining speed and extra mass can lead to a dangerous combination. Equipment has also evolved to allow for lighter and faster sticks, causing unintended hits in some instances, I'm sure. Another factor is the increase in new players due to the popularity of the sport. Putting players of different skill levels in the same game can set up a difficult dynamic. It is important for players to be aware of their body position in space and reference to other players. This is a skill that comes with time and coaching. Coaching is another aspect of the game that helps teams work together better and control the speed of their game. Neck strengthening exercises can decrease the whiplash motion often caused by a hit to the cranial region. As for me, I have now completed my first season as a referee. I feel that helmets and proper body equipment in womens' lacrosse will make the game safer for everyone. My feeling is that there are too many factors that increase the potential for head injuries and we should mitigate them as best we can. While I realize helmets do not prevent concussions, I do believe they would be helpful to protect young women from unintended hits to the head. Dr. Lori McGowan is an Adjunct Professor of Biology at Harrisburg Area Community College in Harrisburg, Pennsylvania.

While involvement in school sports is probably one of the healthiest things, physically and mentally, your child can do, the pressure to play harder and practice longer brings an increased risk of head injury. Medical, sports and school communities are all taking a serious new look at how to treat concussions caused by a hit to, or shaking of, the head. Falls during equestrian, cheerleading and gymnastics events are producing concussions at an increasing rate, along with the more obvious contact sports like football and soccer. "A concussion is a type of traumatic brain injury (or TBI) and it is similar to a stroke in that both affect normal brain function and may have similar symptoms," explained Neurologist Frederick Nahm, MD, PhD, and head of the Stroke Center at Greenwich Hospital in Greenwich, Connecticut. Immediate symptoms may include confusion, disorientation and sometimes falling unconscious. Ignoring these symptoms is outright dangerous. "During a game, your adrenaline is going and you're pumped up, so it's easy to brush it off. But whether you bump your head during sports, a car accident, a fall or during military activity, it may not be until that night or a few days later that you get a headache or start to feel dizzy or nauseous," Nahm added. "The most important thing with a head injury, if you feel as though you're having symptoms you have to tell someone and seek evaluation. Taking time to heal makes a lifetime of difference Getting a 14-year-old to take it easy, to stop using the computer, to stop texting, is not easy, but it's very important to get that teenager to understand what happened. Parents need to be involved to get the injured child engaged by allowing the brain to rest as part of the healing process. Dr. Nahm points out that, "a thorough treatment plan focuses on the emotional, psychological, and behavioral issues that can arise following even a mild brain injury." Without proper healing, a student who never worried may develop anxiety about performance at school, and may find that no matter how much effort they put into it, they can't manage to hold the grade point average they had prior to injury. "These secondary complications, like anxiety disorders or a new phobia of tests, memory problems, depression, apathy, inattention and other behaviors are indelible and can be difficult to treat. It's not something the student can control or work harder to 'fix' because It's the result of an injured brain. Only a physician trained in the treatment of concussion or traumatic brain injury (typically a neurologist or neuropsychologist) can do a thorough assessment for a severe brain injury," said Dr. Nahm. Returning to normal activity without proper healing creates an increased risk of second impact syndrome; repeated head injury, especially injury before total healing has occurred, carries a far more serious threat to long-term complications. If you bang your head, take it seriously, tell someone, and even if you have no immediate symptoms, take the time for an evaluation. Photo: Courtesy College of William and Mary/ (C) Creative Commons Story Source: Science Daily: https://www.sciencedaily.com/releases/2012/09/120912093159.htm The above story is reprinted from materials provided by Greenwich Hospital. Questions/comments? Contact Jean Rickerson at jean@sportsconcussions.org

SEQUIM, Wash. -- Battle-tested and a little weary from last fall’s high school football season, Travis Anderson, an experienced EMT and paramedic John Riley, understand the nuances of concussions. Athletes who — if they are conscious – say they are ‘fine,’ coaches who may not be sure an athlete needs medical attention, and parents told by ER staff that rest is the prescription for recovery, trying to make sense of the mountain of hospital medical bills. They’ve seen it all, and it’s not easy. First responders like Anderson and Riley from Clallam County Fire District #3 in Sequim, Wash., are a luxury for school districts around the country. Part of a crew made up of paid staff and volunteers, they wait in the corners until given the signal by a coach or referee, or a player goes down and stays there. Like other on-field personnel they can’t see every impact and don’t always know if an athlete is deteriorating on the bench after a big hit. They depend on an educated coaching staff and fellow teammates for their cues. Anderson said,”We’d like to be called sooner rather than later. If there’s any question, especially with a suspected concussion, call us.” Too little care Only about 42 percent of high schools nationally employ athletic trainers, a dismal number in the eyes of many concussion experts who continue to advise against any school district or private organization offering contact sports without proper sideline medical care. Given the budget crises facing many school districts, it is not surprising so few heed this advice. But the challenges in rural areas are even greater. Long distances separate football fields from hospitals and fire stations can serve several high schools. Resources are simply too lean. Many sports-related concussions “Our fire department provides sideline staff for high school football games, and as many junior varsity games as we can. We consider it part of our community service effort and quite frankly, we feel strongly about protecting our student-athletes and their futures,” said District #3’s Fire Chief, Steve Vogel. His first responders have been on the sidelines at Sequim School District's games since 1982. Chief Vogel’s staff has a long history dealing with sports concussions. Former Sequim football player Adrien Gault suffered a catastrophic brain injury during a game in 2006 and was airlifted to a Seattle trauma center where doctors gave him a four-percent chance of survival. He continues to work through his recovery. This past fall, a Sequim student suffered a brain aneurysm during a Friday afternoon PE class and died a few days later. That same Friday there were six significant concussions on the football field a few hundred yards away, said a well-informed source, turning the field into a war zone. Fire District #3 was there for it all. “There were more concussions during that one game than I’ve seen in my entire career, including my time as a running back in high school,” said Anderson. “It was a rarity.” Neither he nor Riley, who played tight end in high school remember suffering concussions during their football careers. They believe they’re seeing so many due to increased awareness trickling down from the NFL. Anderson said, “I think the attention on the concussion issue in the NFL is having an affect on all levels of the game, all the way down to the youngest players.” Emergency Medical Services for Children (EMSC) Guidelines and training for first responders come in the form of online education modules and concussion-related drills practiced several times a year. Soon-to-be-released state protocols developed by emergency room physicians, critical care nurses, EMTs, and others who make up the state committee of the federal Emergency Medical Services for Children program include a sports-concussion guide for first responders. Upon distribution, this document will provide a handy reference for those who attend youth and high school athletic events. “The Emergency Medical Services for Children (EMSC) program works to ensure proper pediatric care is available on ambulances and in hospital emergency departments nationwide,” said Ian Weston, Co-Director of the EMSC program headquartered in suburban Wash. D.C. “Emergency care providers are integral in ensuring our children get the right care when it counts.” When to call 911 Concussion symptoms can be subtle and may not appear right away, leaving room for mistakes to be made if athletes are not properly monitored when a concussion is suspected. The following are symptoms that require a call for emergency evaluation: •headaches that worsen •seizures •neck pain •very drowsy, can't be awakened •repeated vomiting •increasing confusion or irritability •weakness, numbness in arms and legs •unable to recognize people/places, less responsive than usual For more information see Should we call 911?, signs and symptoms Photo: (L) John Riley (firefighter/paramedic); (R) Travis Anderson (firefighter/EMT) Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

As the on-ice passion of the NHL playoff games intensifies so do the penalties, particularly for vicious hits to the head. Saturday's games resulted in three separate incidents that will highlight the league's commitment to cracking down on illegal hits that may, and often do, cause concussions. Brendan Shanahan, Senior Vice President, Player Safety and Operations held hearings on two of the three violations Sunday afternoon. The third is scheduled for Monday. The hits are reviewed on video and the suspensions are explained in great detail by Shanahan on the NHL network (see videos below). Shanahan suspended New York Rangers forward Carl Hagelin for an illegal hit that forced opponent Daniel Alfredsson's head into the glass. Alfredsson, the Senators captain, left the game for evaluation and his status for the rest of the playoffs is uncertain. On Monday the team announced he had suffered a concussion on the play. This is Hagelin's first major penalty. The Wall Street Journal reports that disciplinary action against Hagelin may increase if Alfredsson, who has a history of concussions, is unable to return to the series. A one-game suspension was also issued Sunday for Ottawa Senators defenseman Matt Carkner for continuing to pummel an "unwilling opponent," Rangers forward Brian Boyle, who was knocked to the ice after Carkner delivered two powerful blows to his head. Carkner continued to hit Boyle as he lay on the ice. Boyle did not return the punches. Carkner was classified as an "aggressor" under NHL rules and was assessed a minor penalty for instigating, a major penalty for fighting and a game misconduct. Blackhawks forward Andrew Shaw is scheduled for a hearing on Monday for a shoulder-to-head hit on Coyotes goalie Mike Smith that left him down on the ice writhing in pain. Shaw earned a charging major and game misconduct on the play. Smith remained in the game. Last Thursday, Vancouver Canucks forward Byron Bitz was suspended for two games for a vicious hit to the head on Los Angeles Kings forward Kyle Clifford the night before. Clifford's head was shoved into the glass causing him to miss at least one game. In addition to the suspension Bitz was assessed a major penalty for boarding and a game misconduct the night of the game. Carl Hagelin/ Daniel Alfredsson Matt Carkner/ Brian Boyle Byron Bitz/ Kyle Clifford Source: NHL Network Questions/comments? Contact Jean Rickerson at jean@SportsConcussions.org

As female participation in sports grows rapidly, there is a popular notion that there are gender-related differences in athletes' responses to sports-related concussion, and prior research has supported these gender discrepancies. However, a Vanderbilt University Medical Center study, conducted to review symptoms and neurocognitive findings in male and female high school soccer players, shows no gender-related differences. "There has been good data that suggests girls score worse on neurocognitive testing following a sports-related concussion. Our hypothesis was that a tightly-controlled study would replicate what others have shown previously," said Scott Zuckerman, M.D., a neurosurgery resident who conducted the study with colleagues at the Vanderbilt Sports Concussion Center. The researchers selected 40 male and 40 female concussed patients who were matched, as closely as possible, for age, medical/psychiatric history, years of education, lack of special education assistance, history of psychiatric treatment, number of prior concussions, timing of pre- and post-concussion testing, and sport (all engaged in soccer). This is the first study to control for type of sport played when looking a gender differences, Zuckerman said. "Prior studies have used mixed groups of athletes from a variety of sports. We suspected that since concussions vary from sport to sport (i.e., helmets vs. none, varying biomechanical forces, etc.), if the variable of sport was controlled, gender differences might disappear." The only significant gender-related difference they could identify was that female soccer players reported a greater number of symptoms post-concussion. There were no significant differences in post-concussion neurocognitive scores. "We were somewhat surprised and were not sure what to expect in such a tightly controlled population," Zuckerman said. "Our hypothesis was that females would experience greater levels of acute, post-concussive, neurocognitive impairment than males, fitting with what most of the prior literature says, but we found virtually no difference between males and females." Zuckerman said this is a significant finding for the treatment of sports-related concussion. "When we see any child after concussion, we don't want to make snap decisions based on gender. Gender may not be as big a modifying factor as previously thought." This study is the first from V-SCoRe, or Vanderbilt Sports Concussion Research. Collaborators include Allen Sills, M.D., Gary Solomon, Ph.D., Andrew Gregory, M.D., Alex Diamond, D.O., and Jonathan Forbes, M.D., and medical students Mitchell Odom and Young Lee. "This effort is just getting off the ground, and we're investigating many more modifying factors in concussion, including age, sleep, symptoms, prior history of attention deficit disorder," Zuckerman said. "Our goal is to create new knowledge in this area and help providers better understand when a young athlete can return to play safely." Story Source: The above story is reprinted from materials provided by Vanderbilt University Medical Center, via Newswise. Journal Reference: Scott Zuckerman et al. Response to acute concussive injury in soccer players: is gender a modifying factor? Clinical article. Journal of Neurosurgery: Pediatrics, 2012 DOI: 10.3071/2012.8.PEDS1239

NFL Hall of Famer "Iron Mike" Webster's life ended in 2002 when he suffered a heart attack at age 50. Four Super Bowl rings, nine Pro Bowls, and voted to the NFL's all-time team in 2000, the driven, ultra-competitive Steelers' center drifted into a life of drug use, homelessness, and enormous suffering after retiring in 1988. In 2005, his son Garrett told ESPN that the only way his father could get to sleep was to taser himself into unconsciousness. Former teammates and friends offered assistance over the years but it wasn't enough. After Webster's death, forensic neuropathologist Dr. Bennet Omalu was determined to find neurological reasons for his cognitive decline. Seventeen years in the NFL at a time when safety precautions and concussion awareness were both minimal had resulted in thousands of impacts to his head. Though his brain looked normal at autopsy, Omalu pressed on until he found the abnormalities that we now call Chronic Traumatic Encephalopathy, or CTE. CTE and Alzheimer's CTE and Alzheimer's are both “neurodegenerative diseases.” That is, they are brain diseases that result in the progressive destruction of brain cells, eventually leading to cognitive, behavioral, and other impairments. Both Alzheimer’s and CTE can only be accurately diagnosed postmortem through a neuropathological examination of the brain and their progression has remained elusive. But clues about how Alzheimer's spreads from neuron to neuron are now emerging. Whether the same process of progression applies to CTE is currently unclear. Photo: Alzheimer's infects from neuron to neuron The inexorable spread of Alzheimer’s disease through the brain leaves dead neurons and forgotten thoughts in its wake. Researchers at Linköping University in Sweden are the first to show how toxic proteins are transferred from neuron to neuron. Through experiments on stained neurons, the research team – under the leadership of Martin Hallbeck, associate professor of Pathology – has been able to depict the process of neurons being invaded by diseased proteins that are then passed on to nearby cells. “The spread of Alzheimer’s, which can be studied in the brains of diseased patients, always follows the same pattern. But until now how and why this happens has not been understood,” says Hallbeck, who along with his research group has now published their results in The Journal of Neuroscience. The illness starts in the entorhinal cortex – a part of the cerebral cortex, and then spreads to the hippocampus. Both of these areas are important for memory. Gradually, pathological changes take place in more and more areas of the brain, while the patient becomes even sicker. Two proteins have been identified in connection with Alzheimer’s: beta amyloid and tau. Normally tau is found in the axons – the outgrowths that connect between neurons – where it has a stabilising function, while beta amyloid seems to have a role in the synapses where the neurons transfer signal substances to each other. But in Alzheimer’s patients, something happens with these proteins; autopsies reveal abnormal accumulations of both. Why they become abnormal is still unknown, but what is known is that it’s not the large accumulations, or plaques, that damage the neurons. Instead, smaller groups of beta amyloid – called oligomeres – seem to be the toxic form that gradually destroy the neurons and shrink the brain. “We wanted to investigate whether these oligomeres can spread from neuron to neuron, something many researchers tried earlier but didn’t succeed,” Hallbeck says. The study was inaugurated with an experiment on neuron cultures, where researchers injected oligomeres stained with a phosphorescent red substance called TMR using a very thin needle. The next day the neighbouring, connected neurons were also red, which showed that the oligomeres had spread. To test whether a sick neuron can “infect” others, they conducted a round of experiments with mature human neurons stained green and mixed with others that were red after having taken up stained oligomeres. After a day, approximately half of the green cells had been in contact with a few of the red ones. After two more days, the axons had lost their shape and organelles in the cell nucleus had started to leak. “Gradually more and more of the green cells became sick. Those that hadn’t taken up the oligomeres, on the other hand, weren’t affected,” Hallbeck says. The study is a breakthrough in understanding Alzheimer’s and its progress. If a way of stopping the transfer can be found, it could lead to a more effective inhibitor against the disease. Article: Spreading of neurodegenerative pathology via neuron-to-neuron transmission of beta-amyloid by Sangeeta Nath, Lotta Agholme, Firoz Kurudenkandy, Björn Granseth, Jan Marcusson and Martin Hallbeck. The Journal of Neuroscience, 27 June 2012. Photo: Alzheimer's infects from neuron to neuron: Two nerve cells, each about 10 micrometers large, are visible as shadows in this picture. From the beginning only the right one (yellow arrow) contained the toxic, red stained, oligomeric beta-amyloid. When these sick cells make contacts with the healthy, green labeled cells (black arrow), toxic beta-amyloid will spread through the neuronal projections (white arrow). Subsequently, also the green cell will become sick. Credit: Martin Hallbeck Source: The above story is reprinted from materials provided by Linköping University. Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

The Dynavision D2 ™ is an FDA cleared medical device with a long history concerning sports performance enhancement and an even longer history concerning neuro visual rehabilitation of stroke and brain injured patients. Physical medicine rehabilitation practitioners have used it to train brain injured patients to improve hand eye coordination since the 1980s. With a pedigree from the neuroscience community concerning rehab and from the sports community for improving performance it was a logical fit that the D2 ™ be applied to the management of the athlete with a concussion. The Dynavision D2 ™ is a light board with 64 lights mounted in a board along with a small screen. The primary task is to hit the red or green lights. It assesses speed and coordination. When the computer screen and lights are used together there are numerous tasks the athlete can be asked to do. Several universities and professional sports organizations have adopted the Dynavision D2 ™ as part of the concussion management program, and for good reason. The Dynavision D2 ™ can be used as part of baseline testing. The results of the baseline tests are used for comparisons should a concussion occur. These same athletes may also train their eye hand coordination using the Dynavision D2 ™ for performance enhancement. This means the device is familiar to them and true baseline and performance parameters can be obtained. After a concussion, the Dynavision D2 ™ can be used as part of a traditional neuro cognitive examination and monitoring program. The baseline Dynavision D2 ™ results can be compared to repeat tests to see if deficits are present. Further, programs designed to assess multiple brain cognitive parameters can be performed in just a few minutes. The three tests assess: eye-hand coordination while multi-tasking, memory and cognition, cognition and executive functions. Observing the subject and noting their scores allows for an assessment of their concussion status. One of the strengths of the Dynavision D2 ™ is that it has an established cadre of programs that anyone can use. These programs can be used for rehab, prehab and diagnostics. Plus it has a relatively intuitive program option that allows more experienced practitioners and ADT trained individuals to design their own programs to meet their needs. This means that the Dynavision is a highly flexible and adaptable platform. Every person who works with athletes, injured athletes and neuro patients knows that each person is different and unique; training and rehab methods need to be personalized. Fortunately the Dynavision allows us to customize the programs to address the needs of the patient. There are numerous anecdotes where a patient who expresses a deficit that he/she is having to a rehab person who can write and try a program to help that patient during that very rehab session. One of my patients at the concussion clinic in theUniversityofCincinnatiwas injured in a wind storm. During her baseline neuro exam, we utilized the tests mentioned above and additional tests based on her specific results. The D2 was able to demonstrate the patient was unable to multi-task, making numerous math errors on simple 1 digit additions. In addition, based on a general neuro exam, the patient exhibited deficiencies in ocular motor, memory and executive function. This patient specifically benefited from the D2 as part of her neuro exam because the D2 gave measurable, unbiased results. The results of the exam were utilized to incorporate D2 training into her rehab program to improve binocularity, reaction time, multi-tasking, and cognition skills. In my opinion, without using the D2, this patient’s rehab would not have been as successful and it could have been possible to overlook subtle deficiencies that D2’s measurable results are able to track. In the center of the Dynavision D2 ™ is a tachistoscope; or small computer screen. This screen is used in several of the evaluation and rehabilitation methods. It adds tremendous flexibility to the system because it can be used to add tasks to what the subject is required to do. With the tachistoscope the patient can now be required to do a hand-eye task as well as reading or other task from the screen. This allows for multitasking to be performed and adds to the flexibility and strength of the Dynavision D2 ™ as a tool to manage the concussion patient. Repeating the evaluations on the Dynavision D2 ™ can be used as part of quantitative monitoring of the subjects as they progress through concussion rehab. The Dynavision produces reliable numbers that reflect the subjects’ performance or highlights deficiencies. When the Dynavision D2 ™ is used as part of the rehab training it becomes a cornerstone in the patient’s care and the patient can see, based on their own results, how well they are doing. Rehabilitation methods can be tailored to the needs of the patient and with many years of experience from the stroke and brain injury literature there are numerous options for the Dynavision D2 ™ to aid in a concussion rehabilitation program. About the Authors: Dr. Clark is a certified athletic trainer, professor of neurology and member of the concussion management team in the University of Cincinnati. He is an expert in complications post acquired brain injury and has published several texts and over 100 scientific articles. Mrs. Umberg is a former concussion patient and the patient referred to in this Case Study. Having used Dynavision as part of her rehab program she has since become a patient advocate and team member in the concussion management team in the University of Cincinnati and Dynavision Trainer. Disclaimer; the statements made are not screened or approved by the FDA. Source: Joseph F. Clark and Jennifer A. Umberg Department of Neurology, University of Cincinnati, Cincinnati Ohio; 45267-0536. Corresponding author: Joseph F. Clark, Professor of Neurology, joseph.clark@uc.edu.

PITTSBURGH – The unpredictable nature of concussions is one of the most frustrating factors to the millions of sufferers each year, but early neurological indicators and symptoms can predict a protracted healing time in certain cases, according to specialists at UPMC and the University of Pittsburgh School of Medicine. “It’s a highly variable injury with a variety of outcomes,” said Michael “Micky” Collins, Ph.D., director of the UPMC Sports Medicine Concussion Program and co-investigator of the Pitt/UPMC study published in the February issue of Neurosurgery. “We see some patients who take a day or two to recover, and some who take a year or longer to recover. If clinicians had a way of determining within two days of injury who’s going to take a month or longer to recover, that’s a very important piece of information to have. It’s a game-changer.” The study, one of the first to examine concussion prognoses, showed that specific neurocognitive “cut-off” scores derived from ImPACT™ (Immediate Post-concussion Assessment and Cognitive Testing) improved clinicians’ ability to predict which sports-related concussions could take longer –- as much as five times longer -- to rehabilitate than others. They found, in as many as 85 percent of the cases, the scores could warn athletes, parents, coaches, schools, teams and health professionals when a concussion is likely to take on average a month to heal. Such an objective prognosis could help clinicians to better prepare a treatment plan, arrange academic accommodations for students and set tangible expectations for return to play and school, Dr. Collins said. The study reviewed 108 high-school football players who were given ImPACT tests within a median of two days after their concussions. Fifty boys experienced a recovery lasting, on average, 33 days before returning to play, and those longer rehabilitations could be forecast by specific “cut-off” scores in ImPACT Visual and Processing Speed testing. Migraine and cognitive symptoms also appeared to have predictive power. Study participants who scored above the threshold levels recovered within a median of seven days. “We’ve established statistical ‘cut-offs’ that indicate people who take a month or longer to recover,” Dr. Collins said. “Eighty percent of concussed people recover inside of three weeks. This prognostic information allows us to develop a risk profile of athletes who don’t recover well from this injury. Other study authors include Brian Lau, B.S., from the Pitt School of Medicine, and Mark Lovell, Ph.D., the Concussion Program’s founding director who retired from UPMC last summer. About UPMC Sports Medicine Concussion Program The first-of-its-kind UPMC Sports Medicine Concussion Program, established in 2000, is the largest multi-disciplinary clinical and research program that focuses on the diagnosis, evaluation and management of sports-related concussion in athletes of all levels. The UPMC clinicians and researchers treat more than 13,000 patients a year, and published more than 75 clinical research studies in peer-reviewed scientific journals. About ImPACT ImPACT™ (Immediate Post-Concussion Assessment and Cognitive Testing) is an independently validated and researched concussion-evaluation system that has become the most widely used in the United States. Co-founded in the early 1990s by Drs. Mark Lovell, Joseph Maroon and Michael “Micky” Collins, who have a proprietary interest in ImPACT Applications, Inc., ImPACT is a 20-minute test that is a standard tool used as part of comprehensive clinical concussion management adopted across the NFL, NHL, NBA, Major League Baseball, college and high-school athletics -- with roughly 3 million people tested. Source: UPMC press release- https://www.upmc.com/mediarelations Photo courtesy UPMC

The apparent self-inflicted death of legendary NFL linebacker Junior Seau has sent a shock wave throughout the world of sports. Seau played professional football for nineteen years for the Chargers, Dolphins and Patriots and was a 12 time Pro Bowl selection. His flamboyant playing style and jolting hits electrified fans for years. He was 43 years old. This is a time for grief and remembrance. Seau was an integral part of the San Diego community and dedicated time and effort to his charitable foundation. His family needs prayers and support. Normally, speculation as to causation would be premature, but these are not normal times. The spectre of head injury and the disastrous lifetime ramifications call for emphatic action. There is a largely undiagnosed health epidemic which has surrounded contact sports at the youth sports, high school, collegiate and professional level and it is a ticking time bomb. For many years a veil of denial has obscured the reality of what the long term impact of multiple concussions portend. I first became concerned in the late 80's and 90's when I represented half the starting quarterbacks in the National Football League. As I went with clients like Troy Aikman and Steve Young to post-concussion visits with neurologists there were too many unanswered questions. How many head injuries is too many? What are the long term ramifications? How long should a player sit out after suffering the hit? Physicians had few concrete answers, the brain was the last frontier of medical research. I finally decided that I could not in good conscience represent players in a sport that we intuitively knew could cause devestating consequences to the mental faculties of athletes, without becoming an active crusader to raise awareness of the danger. I felt like an "enabler" facilitating a "meat grinder" career. In the 90's we held three concussion conferences in Newport Beach with the leading neurologists, helmet manufacturers, and playing surface representatives talking to Steve, Troy, Warren Moon, Drew Bledsoe and many other clients. We issued a white paper calling for a standardized regimen of diagnosis and "return to play protocols." We urged better helmetry and protective devices. We asked for a neurologist to be put on the sideline and that the head and neck be banned from blocking and tackling. Not much changed. The players themselves were in a state of denial concerning physical health. They had been taught from Pop Warner on to ignore pain, hide injury so as to not lose their starting position or jeopardize their status on the team. They didn't want to be known as "training room" players and be stigmatized and isolated from their peers. They were young men and athletes, two categories that viewed long term health as an abstraction. The most critical priority for them was the next play. And retired athletes were stoic and didn't talk about impaired memory or depression to younger players. In some cases, because concussion is not visible like a leg injury, they may not have known. In conjunction with the Los Angeles based Concussion Institute we helped facilitate another series of Concussion Seminars seven years ago. This time there was concrete data presented by researchers like Dr. Julian Bailes, Dr. Robert Cantu, Dr. Kevin Guskiewicz and Dr. Robert Hovda that seemed to indicate that three was the "magic number." Three or more concussions apparently raised exponentially the post-career risk of dementia, Parkinson's and depression. Presentations were made about the existence of a genotype-an allele of which produced heightened risk of concussion and severe post-concussion consequences. A pattern developed in which the repetitive head injuries produced chronic traumatic encephalopathy, permanent brain damage. Player's like the Bears' Dave Duerson developed depression. Often loss of job and family would occur. And in some cases, suicide. To their credit, Commissioner Roger Goodell and the NFL responded by convening a physician's conference. They issued a whistleblower edict which urged players to report other impaired players. And they adopted baseline testing, developed by Dr. Mark Lovell. A cognivitive test is given prior to a season and in the case of concussion is followed by a second test. This is an objective way to measure the degree of damage and insure that players are asymptomatic at rest, on an excercise bike, and at practice before they are cleared to play. This is something that every parent should insist on for their "collision sport" children. Pro football may be most visible, but the risk is present in many other sports and at the collegiate, high school and youth levels. The adolescent brain may take three times as long to recover and it is still in formation. The physics of collision have changed -- bigger,stronger, faster athletes colliding with a stationary object. And so the problem will accelerate and not diminish. The simple act of offensive and defensive lineman colliding thousands of times produces low level concussive events. What will the cumulative effect of the injury mean for athletes in their forties and fifties? I knew Junior Seau since the day he and his massive Samoan friends partied back stage as he was drafted in New York City. He was only 43. I represented him for a time. I love sports, but love the individuals who play them more. As Peter, Paul and Mary sang, "How many deaths will it take 'till we know that too many people have died?" We need to find the answers, they can't just be "blowing in the wind." Leigh Steinberg was a sports agent for almost forty years. He represented many of the nation's most recognizable athletes including Troy Aikman, Steve Young, Drew Bledsoe, and Warren Moon. Leigh negotiated over $2 billion in contracts during his career. He was also the inspiration for the 1996 movie Jerry Maguire starring Tom Cruise. He is now CEO of Steinberg Sports and Entertainment located in Los Angeles, California. Leigh is a member of the SportsConcussions.org Advisory Board. Photo, above: (c) 2009 Dave Sizer@creativecommons.com Questions/comments? contact Jean Rickerson at Jean@SportsConcussions.org