President Obama's recent remarks regarding concussions in football reopened the discussion of the safety of the game just days before Super Bowl Sunday. In an interview appearing in the New Republic Obama says, "If I had a son, I'd think long and hard before I let him play football. And I think that those of us who love sports are going to have to wrestle with the fact that it will probably change gradually to try to reduce some of the violence." Leaders from sports-related organizations including pee-wee, high school, college and professional have worked for several years now to understand the injury, provide guidance to athletes and coaches, and fund research related to the effects of brain trauma. Changes have been broad and deep. NFL Commissioner Roger Goodell has surrounded himself with the most well-respected medical professionals in the concussion field, seeking their council. As co-chairmen of the NFL Head, Neck and Spine Committee, Drs. Richard Ellenbogen (chief of neurosurgery, Univ. of Washington) and Hunt Batjer (President of the Neurological Society of America) have assembled an impressive team, including senior adviser Dr. Robert Cantu, co-director Center for the Study of Traumatic Encephalopathy. Chronic traumatic encephalopathy, or CTE, is a degenerative brain disorder suspected to be associated with repetitive hits to the head. Previously only diagnosed post-mortem, evidence of the disease was recently found in five former NFL players who took part in a groundbreaking diagnostic study at UCLA. The committee is also actively involved in improving on-field recognition and assessment policies, helmet technology, and brain impact research. In 2011, the NFL dedicated over $100 million over the next decade to medical research, with the vast majority of those dollars committed to the science of concussions, their prevention and care. Concussions have always been a part of sports, and have never been limited to football. Soccer, volleyball, wrestling, lacrosse, bicycling, and yes, playground activities can all cause concussive injuries. Girls are at risk as much as boys. Seniors and soldiers suffer too. Change of this magnitude takes time. Those athletes who have paid the price through their individual suffering are heroes, having opened the door for the rest of us, exposing an issue whose time is due. Former NFL linebacker Junior Seau, who tragically took his own life in 2012 at age 43, was later diagnosed with CTE, which many believe contributed to his death. He and the other NFL, NHL and professional boxers who died at a young age and were later diagnosed with CTE, have commanded our attention. In 2006, Zachery Lystedt suffered a debilitating brain injury during a middle school football game at age 14, and now fights daily to escape his wheelchair. Zachery, with the help of Commissioner Goodell and the NFL, led us to develop legislation in almost every state helping to safeguard youth athletes from the effects of concussions. Zach's hero, Baltimore Ravens Ray Lewis will play in Sunday's Super Bowl. Zach and the estimated 111 million viewers will watch a safer game, one that is still evolving, striving to maintain the integrity of the contest while preserving the health of its players for the future. Thankfully, visionaries like Commissioner Goodell appear in the right place at the right time. Under his leadership the NFL has, and is, providing a road map and the necessary funding to investigate the questions and find solutions that will improve our understanding of risk as it applies to protecting our youth, preserving the competitive spirit, and honoring the bonds that bind us as teammates and fans. Photo courtesy: Creative Commons; copyright dcJohn 2004

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.

Like emergency workers rushing to a disaster scene, cells called microglia speed to places where the brain has been injured, to contain the damage by ‘eating up’ any cellular debris and dead or dying neurons. Scientists at the European Molecular Biology Laboratory (EMBL) in Heidelberg, Germany, have now discovered exactly how microglia detect the site of injury, thanks to a relay of molecular signals. Their work, published May 24, 2012 in Developmental Cell, paves the way for new medical approaches to conditions where microglia’s ability to locate hazardous cells and material within the brain is compromised. “Considering that they help keep our brain healthy, we know surprisingly little about microglia,” says Francesca Peri, who led the work. “Now, for the first time, we’ve identified the mechanism that allows microglia to detect brain injury, and how that emergency call is transmitted from neuron to neuron.” When an emergency occurs, cries can alert bystanders, who will dial the emergency number. A call will go out over the radio, and ambulances, police or fire engines in the area will respond as needed. In the brain, Peri and colleagues found, injured neurons send out their own distress cry: they release a molecule called glutamate. Neighbouring neurons sense that glutamate and respond by taking up calcium. As glutamate spreads out from the injury site, this creates a wave of calcium swallowing. Along that wave, as neurons take up calcium they release a third molecule, called ATP. When the wave comes within reach, a microglia cell detects that ATP and takes it as a call to action, moving in that direction – essentially tracing the wave backwards until it reaches the injury. . Lost alert: when microglia (green) cannot detect ATP (bottom), they don’t move to the injury site as they usually would (top).Photo credit: EMBL/Peri Scientists knew already that microglia can detect ATP, but this molecule doesn’t last long outside of cells, so there were doubts about how ATP alone could be a signal that carried far enough to reach microglia located far from the site of injury. The trick, as Peri and colleagues discovered, is the long-lasting glutamate-driven calcium wave that can travel the length of the brain. Thanks to this wave, the ATP signal is not just emitted by the injured cells, but is repeatedly sent out by the neurons along the way, until it reaches microglia. Dirk Sieger and Christian Moritz in Peri’s lab took advantage of the fact that zebrafish have transparent heads, which allow scientists to peer down a microscope straight into the fish’s brain. They used a laser to injure a few of the fish’s brain cells, and watched fluorescently-labelled microglia move in on the injury. When they genetically engineered zebrafish to make neurons’ calcium levels traceable under the microscope, too, the scientists were able to confirm that when the calcium wave reached microglia, these cells immediately started moving toward the injury. Knowing all the steps in this process, and how they feed into each other, could help to design treatments to improve microglia’s detection ability, which go awry in conditions such as Alzheimer’s and Parkinson’s diseases. Source: Sieger, D, Moritz, C., Ziegenhals, T., Prykhozhij, S. & Peri, F. Long-range Ca2+ waves transmit brain damage signals to microglia.Developmental Cell, published online 24 May 2012. Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

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 Cohttps://n 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

USA Football and Steelers' staff had a host of recommendations for increasing concussion safety for area youth football players at Saturday's coaches clinic at the UPMC Sports Complex in Pittsburgh. Know the signs and symptoms. Teach proper tackling technique. Limit full-contact padded practices. "The whole idea is to help our kids play the game of football the right way," Steelers president Art Rooney II said to nearly 100 youth coaches, according to the Pittsburgh-Post Gazette. The Centers for Disease Control and Prevention estimates there are 3.8 million sports and recreation-related concussion annually. Most injuries are sustained while bicycling, followed by organized contact sports such as football and ice hockey and playground mishaps. Last month, data were released on the forces incurred over the course of a full season by 7- and 8-year-old football players in northern Virginia. The magnitude of the hits were measured using accelerometers placed inside several helmets. Many were comparable to forces felt in a pillow fight, but some were on par with those sustained by high school or collegiate players. The higher magnitude forces typically occurred during practices, not games. Ed Passino, Northeast regional manager for USA Football urged coaches to limit full-contact practices. "One thing that we're teaching throughout the country is that you don't have to hit every day in practice," Passino said. "It's not 1950 anymore. Update the way you handle practice. "Maybe you only hit one day a week, you can still conduct form tackling without full-on collisions." The eight Ivy League presidents, two of whom are medical doctors, limited contact practices for their football teams last summer, allowing fewer than the NCAA. USA Football concussion safety information Source: Concussions at head of youth coaches camp -- Pittsburgh-Post Gazette -- May 20, 2012 Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org 7 completed 18 scheduled

SportsConcussions.org Named One of Constant Contact’s 2011 All Stars SportsConcussions.org recognized for achieving exemplary marketing results SEQUIM, Wash. — April 4, 2012 – SportsConcussions.org, a non-profit concussion education organization, has received the 2011 All Star Award from Constant Contact®, Inc., the trusted marketing advisor to more than half a million small organizations worldwide. Each year, a select group of Constant Contact customers are honored with the All Star Award for their exemplary marketing results. SportsConcussions.org’s results ranked among the top 10% of Constant Contact’s customer base. “We’re pleased to be recognized by Constant Contact for achieving strong marketing results, said Jean Rickerson, CEO and Founder of SportsConcussions.org. “Constant Contact’s tools have helped us reach a large audience with the all-important message regarding sports-related concussions in a very efficient way. We look forward to increasing our communication efforts even more in the coming year, to help protect more athletes. We are very grateful to all of our customers who follow us on our website, on social media and through our weekly newsletter. Our goal is to provide them with ideas and resources so they can protect athletes in their local communities.” Constant Contact looked at the following criteria to select this year’s All Stars: · Frequency of campaigns, events, and surveys · Open, bounce, and click-through rates · Event registration rates · Survey completion rates · Use of social features · Use of mailing list sign-up tools “There is nothing we like more than to see our customers finding success. It’s the reason Constant Contact was founded, and it’s a thrill to see the fantastic results that our All Stars are achieving,” said Gail Goodman, CEO of Constant Contact. “This group is really leading the charge when it comes to delivering relevant, engaging content that drives real business results. We salute this year’s All Stars for their success, and are honored to have played a part in their achievements.” About SportsConcussions.orgSportsConcussions.org is a non-profit organization dedicated to raising awareness about sports-related concussions. According to the Centers for Disease Control and Prevention (CDC) up to 3.8 million people suffer from a recreation- or –sport related concussion each year. SportsConcussions.org is anchored by a website that is update daily, featuring news, ideas and resources for school districts, leagues, coaches, parents and athletes. The organization also holds community workshops and conferences, and establishes baseline testing programs. About Constant Contact, Inc. Constant Contact is revolutionizing the success formula for small organizations through affordable, easy-to-use Engagement MarketingTM tools that help create and grow customer relationships. More than half a million small businesses, nonprofits, and associations worldwide rely on Constant Contact to drive ongoing customer dialogs through email marketing, social media marketing, event marketing, and online surveys. All Constant Contact products come with unrivaled KnowHow, education, and free coaching with a personal touch, including award-winning customer support.

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

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

New Findings Provide Important Data for Refining Diagnosis Postmortem analysis of the brains of ten professional athletes with chronic traumatic encephalopathy (CTE) provides new insights into the specific types of brain abnormalities associated with this diagnosis, reports a study in the July 2011 issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health. The findings may help to refine the cellular criteria for making the postmortem diagnosis of CTE, provide initial clues as to some possible subytpes, and improve identification of cases. The study was led by Drs. Bennet I. Omalu and Julian Bailes of the Brain Injury Research Institute at West Virginia University.Detailed Information on Brain Abnormalities in CTE The researchers performed a detailed evaluation of autopsy brain specimens from 14 professional athletes and three high school football players who died unexpectedly. The goal was to take an in-depth looks at the cellular-level abnormalities associated with chronic traumatic encephalopathy (CTE)—a progressive neurodegenerative disease caused by repeated head trauma, seen especially in high-level competitive athletes. Patients with CTE develop mood disorders, cognitive dysfunction, and other psychiatric symptoms, typically occurring years after a history of repeated concussions. Drs. Omalu and Bailes have played a pivotal role in CTE research, having reported on the first three cases of CTE in American football players. Of the 14 professional athletes in the study, ten had autopsy brain findings consistent with a diagnosis of CTE. The CTE cases were seven football players, two wrestlers, and one boxer. Most died from non-natural causes—mainly suicide or trauma. The authors present a detailed analysis of the neuropathological findings in their cases of CTE. The main feature was "neurofibrillary tangles" (NFTs) and "neuritic threads" (NTs) scattered in different areas of the brain. The brains also show evidence of localized areas of brain trauma occurring amny years previously. Findings Suggest Possible 'Emerging' Subtypes None of the athletes with CTE had the characteristic brain atrophy (shrinkage) of Alzheimer's disease. None of the brains showed the widespread amyloid deposits typical of Alzheimer's disease, but some had scattered to frequent amyloid deposits. Although there are not yet enough cases to develop a true classification system, the authors identify some possible "emerging phenotypes" of CTE, based on the number and location of NFTs and NTs and amyloid deposits. The researchers also examined the brains of three high school football players who died of trauma sustained during competition. None of these young athletes met criteria for a diagnosis of CTE. However, one brain showed early, "incipient" abnormalities similar to those of CTE brains, likely related to repeated brain injury. Since the first reported case in 2002, there has been growing concern about CTE and other consequences of repeated head trauma and concussions in football players and other athletes. The findings have led to renewed discussion of the consequences of head trauma—not only in athletes, but also in other high-risk groups such as combat veterans. The Brain Injury Research Institute was created to study the short and long-term impact of brain injury and concussions and the development of CTE. Drs. Omalu and Bailes and colleagues hope their findings will contribute to further research into the neurological and psychosocial impact of CTE. In addition to proposing some possible subtypes of CTE, they suggest a set of pathological tests to be performed in diagnostic investigation of possible CTE. They believe that "CTE diagnosis and surveillance should become intrinsic components of routine patient care work-ups and routine hospital/medical examiner autopsies in high risk cohorts like athletes." Source: Study Takes a Closer Look at Brain Abnormalities in Athletes with CTE -- Lippincott Williams & Wilkins -- Newswise July 12, 2011 Questions/comments? Contact Jean Rickerson at Jean@SportsConcussions.org