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

Starting in 2012, helmet reconditioners will no longer accept helmets 10 years or older. Leagues that have depended on reconditioning their helmets every year and cannot afford replacement gear will be most affected. Although helmets do not prevent concussions, most experts agree that newer ones are preferable to used, and an older, unreconditioned helmet might increase the risk of injury. Many leagues ask their booster clubs for assistance with fundraising as this issue has now reached a critical phase. Limited grants for replacement helmets by leading manufacturers are now available for eligible youth leagues in several areas around the country. Applications are now being accepted for youth football programs seeking to replace their league's helmets before the start of the 2012 season. The Centers for Disease Control and Prevention, USA Football and partnering organizations have introduced a helmet replacement program for youth in underserved communities. It is estimated the program will provide almost 13,000 new helmets to athletes in low-income communities beginning in July 2012. To qualify a league must meet the following criteria: - Operate a youth football league (no middle or high school programs) - Live in one of the following areas: Cleveland, New Orleans, New York, or the San Francisco Bay area - Serve an economically disadvantaged area The application process requires registration at USA Football, the governing body for youth football under the NFL. The application is accessible only after viewing a concussion awareness video and pledging to utilize USA Football's resources to educate members of your league before the 2012 season. A visit from an official to verify the ages and number of helmets exceeding 10 years of age in your inventory will occur by mid-June, with new helmets arriving prior to the beginning of the 2012 season. Participating helmet manufacturers include Rawlings, Xenith, Riddell and Schutt. 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

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

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

COLUMBUS, Ohio – There is no magic test to determine when an athlete is ready to get back into the game after they have suffered a head injury. Researchers have started using an interactive video game, a tool many athletes are already using in rehabilitation, to test balance for concussion assessment and management. The reliability of the video game for assessing athletes’ concussions has not been confirmed, but a study by a sports medicine researcher from The Ohio State University Wexner Medical Center may provide insight to the use of the Nintendo’s Wii Fit for concussion management. Team athletic trainers often determine whether an athlete has a concussion based on their physical examination, cognitive ability, self-report of symptoms and balance. "Student athletes love it because we have incorporated fun into their rehabilitation and concussion assessment," said Tamerah Hunt, director of research at the OSU’s Sports Medicine Concussion Program. “For many school districts, it is an affordable option and can be portable, making it convenient for sideline testing and travel with the team for away games.” Researchers from Ohio State and the University of Maryland are conducting baseline testing for concussion management in collegiate athletes, and will soon do the same among high-school athletes. Recent concussion guidelines suggest postural control is an important part of the assessment process, which makes balance an important piece of information in determining recovery from a head injury. “It’s not the perfect system, but can be considered as an option to provide basic objective information about balance,” said Hunt, whose previous research includes examining concussion recovery patterns among high school students in several states. “It’s another tool to have in our toolkit because determining when an athlete has recovered can be subjective,” Hunt admits. “Athletes are more likely to engage with a video game than to take another boring concussion test or admit they are still hurt,” said Hunt. “We currently base much of our assessment on an athlete telling us about their symptoms. The video game allows us to broadly analyze center of gravity, to help us be more objective.” Athletes participate in three different yoga poses as demonstrated on the Wii Fit game and are given a score which determines how well the athlete maintained center of balance. Baseline testing provides athletic trainers with an idea of how an athlete normally functions. If an athlete suffers a head injury at a later date, the athletic trainer can assess the balance of the athlete compared to their normal ability. According to Hunt, an athletic trainer must obtain the baseline measures to compare the athlete to themselves because everyone performs differently. Preliminary data suggests a moderate correlation to current methods used in concussion assessment, ranging from 0.75-0.82, depending on the stance. “Additional studies need to be performed to determine the long-term reliability of the measures and other factors associated with test scores, such as fatigue,” said Hunt. This is just the beginning of studies using alternative measures of balance assessment like the Wii Fit for concussion management. The National Collegiate Athletic Association concussion guidelines support using the video game as a postural assessment tool. It is not yet approved as a medical device by the Food and Drug Administration. Source: Ohio State University Wexner Medical Center -- May 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

Researchers at Nationwide Children's Hospital in Columbus, Ohio, found that of the 14,635 high-school sports injuries reported during the 2008-2010 school year, 13% were concussions. The majority of them were uncomplicated, in fact, 40% of the students who suffered concussions saw their symptoms disappear within three days. Most returned to play within three weeks, but a significant number -- about 25% -- returned to play the same day they were injured, a situation many state concussion laws are designed to address. "This improper practice was widespread," noted researchers Mallika Marar, Natalie McIlvain, Sarah Fields and R. Dawn Comstock, who found it in 12 of the 20 sports they studied. "This clearly violates the consensus statement on sports-related concussion, which recommends that no adolescent athlete who sustains a concussion should return to play on the day of the injury,"reported WPTV.com. Other findings included: Most common symptoms: headache (94.2%), dizziness (75.6%) and difficulty concentrating (54.8%) More than one: Eleven percent had suffered concussions before, highest rate of recurrence was boys' wrestling (20%) Most by number: football (47%) followed by girls' soccer (8.2%) Most common practices/games: games; exception was cheerleading, participants were 10x more likely to be hurt during practice Most by gender: boys; although concussions in girls' sports represented a higher number of overall injuries Most common occurrence: athlete-to-athlete contact; girls were more likely to suffer a concussion from striking the ground or being struck by another players' piece of equipment such as a hockey stick The study was published in the January edition of the American Journal of Sports Medicine. Source: Study: High school athletes return from concussion too soon -- WPTV.com Questions/comments? Contact Jean Rickerson at Jean@SportsConcussions.org

Alzheimer’s disease and Chronic Traumatic Encephalopathy (CTE) 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 diseases also lead to dementia. The distinction between Alzheimer’s and dementia is very often misunderstood, even by many doctors. “Dementia” is a clinical syndrome defined by memory and other cognitive impairments that are severe enough to cause difficulties in social and/or occupational functioning (i.e., reduced independence in functioning). Dementia is not an illness or a disease. Dementia is not a “mild” form of Alzheimer’s. Rather, it is analogous to “fever,” in that it tells you that you are sick, but doesn’t say what is causing the problem. Similarly, dementia means that there is something wrong with the brain’s functioning, but not what is causing it. Several illnesses and diseases can lead to dementia, including Alzheimer’s disease which accounts for approximately 75% of all cases of dementia. However, several other neurodegenerative diseases result in dementia, including CTE. Alzheimer’s and CTE are distinct diseases. Both Alzheimer’s and CTE can only be accurately diagnosed postmortem through a neuropathological examination of the brain. There have been several new scientific breakthroughs over the past few years that now allow doctors and scientists to be much more accurate in diagnosing Alzheimer’s during life. However, at this time, there is no method of diagnosing CTE during life, although our group at the Boston University Center for the Study of Traumatic Encephalopathy (CSTE) recently received a grant from the National Institutes of Health to begin developing these types of tests. One of the major differences between Alzheimer’s and CTE involves what causes each of the diseases. There is no known specific risk factor that leads to Alzheimer’s. For CTE, however, it is believed that repetitive brain trauma (including concussions and subconcussive blows to the head) is a necessary, but not sufficient risk factor. That is, everyone that has been found to have CTE in postmortem examination has had a history of repetitive brain trauma, including athletes (e.g., football and hockey players, boxers and wrestlers), as well as others, such as combat military personnel, developmentally disabled individuals who repeatedly bang their heads, and victims of domestic abuse. Boxers and football players (especially lineman) appear to be the most likely to get the disease because of the repetitive brain trauma exposure. But, it is important to note that not everyone with a history of repetitive brain trauma will develop CTE. Our center is currently conducting research into the other potential additive risk factors, such as genetics, age of initial brain trauma exposure, frequency and overall duration of exposure, etc. This research will hopefully lead us to understand why one person gets the disease and another person does not. This line of investigation, along with our new study to develop methods of diagnosing CTE during life, will eventually lead to effective treatments and prevention strategies. Robert A. Stern, Ph.D. is a Professor of Neurology and Neurosurgery; Co-Director, Center for the Study of Traumatic Encephalopathy; Director, Clinical Core, BU Alzheimer's Disease Center, Boston University School of Medicine.