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

ANN ARBOR -- A grant from the NCAA will kick off a groundbreaking, long-term study of concussion and other head injuries among athletes, led by University of Michigan researchers and their colleagues around the country. The NCAA will provide $400,000 to begin to fund a longitudinal study by the National Sport Concussion Outcomes Study Consortium, a new group that includes three founding members from the University of Michigan: Jeffrey Kutcher, M.D., associate professor of neurology; James T. Eckner, M.D., assistant professor in physical medicine and rehabilitation; and Steven Broglio, Ph.D., assistant professor of kinesiology. With the NCAA grant, the Consortium will study more than 1,000 male and female college athletes who compete in 11 sports at three schools. Researchers hope to track those athletes throughout their lifetime to monitor long-term effects of head injuries.But the Consortium has even bigger plans. Kutcher says the group is seeking funding to expand the effort and begin enrolling athletes as early as high school, then follow them through college and even into professional careers. "We're hoping this could become a Framingham heart study for sports concussion," says Kutcher, referring to the study that began in 1948 with more than 5,000 people and has led to the identification of major cardiovascular disease risk factors."This study will be essential to improving our understanding of the risk to brain health for those who play sports. There is no data like this, it's groundbreaking. It will define the landscape." Kutcher and the U-M faculty founded the Consortium with Kevin Guskiewicz, Ph.D., chair of the Department of Exercise and Sport Science at the University of North Carolina; Chris Giza, M.D., of the Department of Neurology at UCLA; and Michael McCrea, Ph.D., professor of neurosurgery and neurology and director of brain injury research at the Medical College of Wisconsin. "There's a tremendous need for data that describe both the short and long-term health consequences of concussions," says Kutcher, who also is director of the Michigan Neurosport Concussion Program at U-M. "There are some hints, and a series of case reports in the literature, but no well-controlled study that addresses the long-term questions. To do that study, and do it correctly, requires following a population of athletes over time and documenting their brain function, while controlling for other variables." David Klossner, the NCAA's director of health and safety, said supporting the consortium's study will aid efforts to promote a safe competitive environment. "The NCAA is seeking to foster innovative research among its member universities to increase knowledge about the short-term and long-term neurological consequences of playing sports," Klossner said. "In addition to monitoring trends in concussions through the Association's injury-surveillance system, this research is another important step to enhance student-athlete safety." In this first phase of the study, the Consortium researchers will study athletes in contact sports in men's football, soccer, basketball, ice hockey, and lacrosse; women's water polo, soccer, basketball, field hockey, and lacrosse. Non-contact sport participants also will be recruited from the track and field and swimming and diving teams. Kutcher believes the data the study collects will provide a more comprehensive understanding of concussions. The short-term effects have been examined for several years, and technological advancements have helped improve the understanding of impacts on the brain by using shock sensors embedded in players' helmets. "There has been considerable attention paid to concussion recently, by the media and others, spurred by reports of National Football League players, hockey players — people who have had a long history of contact — having a very particular kind of dementing illness," says Kutcher. "But that story is only beginning to be told. We need to do the appropriate research to figure out the scope of the problem." Kutcher also directs the NBA's concussion program, is a consultant to the NHL Players Association and the team neurologist for the University of Michigan Athletic Department. He has been instrumental in crafting the concussion policies of the NCAA, Big Ten and Mid-American Conference. He has testified before U.S. Congress on helmet and equipment safety. For more information and free online courses about recognizing and responding to concussions, go to https://www.michiganneurosport.com/ SOURCE University of Michigan Health System Read more here: https://www.sacbee.com/2012/03/14/4336415/groundbreaking-long-term-study.html#storylink=cpy Photo: Wikimedia Commons

Reducing the number of concussions suffered by student-athletes is on the minds of many, including those that lead some of the most prestigious universities in the nation. Soon, following in the footsteps of changes made last year to Ivy League football programs, athletes in other sports may see the adoption of more protective measures as well. Ivy League football players saw significant changes in their practices last season after the eight presidents, two of whom are medical doctors, acted to reduce the number of impacts to their student-athletes' brains in an effort to minimize concussions. In July 2011 the Ivy League Concussion Committee developed a new set of regulations limiting full-contact practices to two per week, three less than allowed by the NCAA. In addition, of the preseason "two-a-days" only one can be full contact. Similar sport-specific regulations may be applied to other activities such as lacrosse, hockey, and soccer in the near future. “We are leading other conferences,” said Ivy League Executive Director Robin Harris. “I don’t know of any conference looking at this in the same manner that we are. We really see this as an area that we can be a leader in terms of the medical care safety of our athletes as well as in terms of the research we contribute to our collective understanding of concussions and athletics,” according to the The Harvard Crimson. Ivy League Deputy Executive Director Carolyn Campbell- McGovern was apart of this game change, “A lot of the recommendations from the football report were naturally going to be applied to other sports as well, particularly the education components, sideline testing components, and any other of those types of enhancement,” Campbell-McGovern said. Recommendations for each sport, lacrosse, soccer, and hockey, will likely be different. On Wednesday, the Ivy League Concussion Committee met in New York to discuss what changes will be made. The committee will also review recommendations made by each sport's subcommittee. Athletic trainers, including Harvard Head Athletic Trainer Brant Berkstresser, physcians, and administrators make up the concussion committee. It is co-chaired by presidents David Skorton of Cornell, and Jim Kim of Dartmouth. Harvard Medical School instructor and doctor at Children's Hospital Boston's Division of Sports Medicine, Michael J. O'Brien has ideas for change. He says he sees 300-400 concussions every month, 98 percent of them sports-related. “The bigger risk is the athlete who gets injured, flies under the radar a little bit and gets a hit a few more times in that game or in the next two or three games. The injuries to that athlete tend to be exponential, their threshold to injury is much worse, and the damage is exponential. Using computer based testing to get objective information rather than just reporting symptoms would help," O'Brien said. Source: Ivy League Aims to Abate Concussions - The Harvard Crimson March 30, 2012 Questions/comments? contact Jean Rickerson at Jean@SportsConcussions.org

Pop Warner, the nation's largest youth football organization announced Tuesday it is taking steps to eliminate hits to the head and reduce the number of concussions suffered by players. Chairman of the Pop Warner medical advisory board, Dr. Julian Bailes said, "The impact of head-to-head contact causes the most severe concussions, so we felt it was imperative that Pop Warner take a proactive approach and limit contact in practices. We're trying to take away all at once the head-to-head contact in practice." Pop Warner is the nation's oldest and largest youth football, cheerleading and dance program, with over 400,000 members ranging in age from 5-14. Starting in August many teams practice nine hours a week until Labor Day when most are then shortened to six hours. Research has shown that some of the hardest hits and many concussions occur during practice, not games. New rules prohibit head-to-head hits and limit contact in practices to 40 minutes a day. Full-speed head-on blocking and tackling drills where players line up more than three feet apart are no longer allowed. In April 2012, veteran journalist and former Dateline co-anchor, Stone Phillips produced a report entitled, "Hard Hits, Hard Numbers," detailing a Virginia Tech study on head impacts in youth football. Accelerometers placed inside 7- and 8-year-old players' helmets recorded hits from 15g-100g, surprising researchers. Previously, many believed that players that age did not have the speed or strength to deliver hits of those magnitudes. Over 4 million sports- and recreation-related concussions occur each year in the United States and more than half of those are suffered as a result of football, reported NBC News. Source: Ahead of Season, Pop Warner renews safety emphasis -- USA Today -- June 12, 2012Pop Warner limits contact in practice --boston.com -- June 12, 2012Pop Warner issues new safety regulations -- NBC News --June 12, 2012Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org Source: Pop Warner limits contact in practice -- Boston.com -- June 12,2012 Pop Warner issues new safety regulations -- NBC News --June 12, 2012 Questions/comments? contact jean@SportsConcussions.org

Collisions. Headers. Goalpost run-ins. Soccer athletes and fans can't help but wonder which elements contribute most to the frequency of concussions in the sport, particularly among young girls. Researchers have been collecting data in helmeted sports for many years using accelerometers embedded in head gear, but non-helmeted sports have presented obvious challenges. Impact data has provided some of the most critical science in the concussion field. As a result, the forces that players sustain in various contact sports are well-documented and found, in some cases, to be alarming. The latest addition to the data bank was the inclusion of an impact study on 7-and 8-year-old football players and the adult-sized forces they incurred during practices. Now the focus is turning to other sports, including soccer. A new study by researchers at Wayne State University, published in the Journal of the American College of Sports Medicine offers insight into head acceleration in girls' youth soccer (U14) during game play. HITS The Head Impact Telemetry System (HITS) used to measure the force impacts, was utilized in this study. Small accelerometers typically mounted inside helmets, transmit data wirelessly to researchers on the sideline. In this case, soccer headbands with the padding removed were outfitted with the instrumentation. Impacts over 10g, or 10x the force of gravity, were recorded and analyzed at a later time alongside corresponding video footage to determine the nature of the hit. For reference, a sneeze might be 3g, a fighter pilot might "pull" 9g during maneuvers, and high school football players regularly sustain hits ranging from 60-100g and higher, many without reporting concussion symptoms. A total of 24 girls participated in the study, conducted during scrimmages on grass fields. Scrimmages lasted 30 to 65 minutes each. None of the players suffered a concussion during the research. Results There were 47 header impacts and 20 non-header impacts observed during the study. Non-header impacts included collisions with another player, player falls, collisions with goalposts, and unintended collisions with the ball. Researchers found: - majority of non-header impacts (40%) were player-to-player collisions - most headers impacted the front of the head; the peak linear acceleration (force) recorded was 4.5g- greatest header force occurred on the right side of the head and was measured at 62.9g - most head impacts players sustained in one scrimmage was four - side headers resulted in greater forces than back headers - player collisions resulted in the highest number of nonheader impacts and had a maximum force of 56.7g - impacts from player falls measured a maximum force of 23.7g - a goalpost collision measured a maximum of 27.1g Researchers hypothesized that non-header impacts would exceed those from heading the ball, but that was not what the case. Many of the players experienced multiple impacts in a single scrimmage, the cumulative effects of such impacts within a short time frame are unknown. Conclusions Concussions can occur in any sport and amending equipment and making rule changes to decrease the frequency and severity of the injury depends on science. Soccer has emerged as the leading cause of sport-related concussions for young girls and researchers are working to unravel the reasons why. Hypotheses range from less neck strength, to hormonal differences to better reporting by females. Source: Medicine & Science in Sports & Exercise: June 2012 - Volume 44 - Issue 6 - p 1102–1108 doi: 10.1249/MSS.0b013e3182444d7d Applied Sciences Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

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

Wisconsin governor Scott Walker signed youth concussion legislation into law today at Lambeau Field in Green Bay. Support for the bill came from physicians, student-athletes, the NFL's Green Bay Packers and other organizations. NFL Commissioner Roger Goodell has exhibited an unwavering committment to the adoption of concussion legislation nationwide, starting with the Washington state concussion law named after middle school football player Zackery Lystedt, who was injured during a game in 2006. Like the Lystedt Law, Wisconsin's concussion law calls for the removal of any athlete suspected of having suffered a concussion and requires a player to obtain written medical authorization before resuming activity. The new law also requires the state Department of Public Instruction to work in conjunction with the Wisconsin Interscholastic Athletic Association to develop guidelines and education standards for parents, coaches, and athletes. Source: Walker signing bills legalizing wolf hunt, cracking down on youth concussions -- Star Tribune --April 2, 2012 Questions/comments? Contact Jean Rickerson at Jean@SportsConcussions.org

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

Common sense has led many to believe that youth football players can't possibly sustain high-impacts like their adult counterparts. But veteran correspondent Stone Phillips' report "Hard Hits, Hard Numbers," features researchers at Virginia Tech (VT) who recently turned that theory upside down when they analyzed impact data from the helmets of 7- and 8-year old players in Montgomery County, Virginia. Accelerometers placed inside seven helmets wirelessly transmitted data to scientists on the sideline for a season's worth of practices and games, with surprising results. The bottom line? Maybe it's time to take another look at practices, drills, and helmet design to minimize the forces absorbed during an average season. Regardless of the significance of the impact, none of the players sustained concussions during the season. Therein lies an enduring mystery, why small impacts can cause concussions in some players while others walk away from big hits. The force of acceleration is often measured in g. Fighter pilots may "pull" 9g in an F-16, a sneeze may register 3g. They're part of everyday life. But because of the heightened interest in sports-related concussions, researchers are looking at a multitude of ways to reduce brain impacts for everyone from adults to youth. But first, they had to identify if there was even an issue at all. Worth a look The VT study was the first of its kind to measure the impacts sustained during youth football. Having worked for nine years recording over 150,000 hits with the helmet impact system at the university, researchers turned their attention to an area youth league. The forces averaged about 15g, meaning half of the hits measured below that level, the other half above. In one case, well above. One hit measured 100g, a big hit by college standards. Most of the more forceful impacts came during practice. Highlights from PBS NewsHour include: - reseachers believe 98g or above is a red flag for a possible concussion - a total 753 impacts were recorded - average player sustained 107 impacts in one season; high school players average about 500; college players sustain about 1,000/season - there were 38 impacts of 40g or greater; almost every one occurred during practice - six impacts measured over 80g the lower range VT researchers consider to be the risk of concussion - youth football players lack strong neck and chest muscles of older players to maintain head stability - 50, 60, 70g loads were surprising - location of impact is important as are individual differences and tolerances - there is more helmet-to-helmet contact in youth football than occurs in older players; most impacts occurred to the front of the helmet - more head-to-ground impacts found at college level Changes afoot Researchers concluded that addressing changes in practice would likely reduce the number of impacts per season, an important factor in any youth sport. Less contact drills, fewer contact practices and other modifications would be beneficial, particularly as the effects of sub-concussive hits, impacts that may cause changes in the brain without causing symptoms, continue to be studied. Source: Stone Phillips Reports Pint-Size Footbal Players Take Big-League Hits -- PBS NewsHour -- April 3, 2012 Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org