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

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

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 brain appears to be wired more like the checkerboard streets of New York City than the curvy lanes of Columbia, Md., suggests a new brain imaging study. The most detailed images, to date, reveal a pervasive 3D grid structure with no diagonals, say scientists funded by the National Institutes of Health. “Far from being just a tangle of wires, the brain’s connections turn out to be more like ribbon cables -- folding 2D sheets of parallel neuronal fibers that cross paths at right angles, like the warp and weft of a fabric,” explained Van Wedeen, M.D., of Massachusetts General Hospital (MGH), A.A. Martinos Center for Biomedical Imaging and the Harvard Medical School. “This grid structure is continuous and consistent at all scales and across humans and other primate species." Wedeen and colleagues report new evidence of the brain’s elegant simplicity March 30, 2012 in the journal Science. The study was funded, in part, by the NIH’s National Institute of Mental Health (NIMH), the Human Connectome Project of the NIH Blueprint for Neuroscience Research, and other NIH components. “Getting a high resolution wiring diagram of our brains is a landmark in human neuroanatomy,” said NIMH Director Thomas R. Insel, M.D. “This new technology may reveal individual differences in brain connections that could aid diagnosis and treatment of brain disorders.” Knowledge gained from the study helped shape design specifications for the most powerful brain scanner of its kind, which was installed at MGH’s Martinos Center last fall. The new Connectom diffusion magnetic resonance imaging (MRI) scanner can visualize the networks of crisscrossing fibers – by which different parts of the brain communicate with each other – in 10-fold higher detail than conventional scanners, said Wedeen. “This one-of-a-kind instrument is bringing into sharper focus an astonishingly simple architecture that makes sense in light of how the brain grows,” he explained. “The wiring of the mature brain appears to mirror three primal pathways established in embryonic development.” As the brain gets wired up in early development, its connections form along perpendicular pathways, running horizontally, vertically and transversely. This grid structure appears to guide connectivity like lane markers on a highway, which would limit options for growing nerve fibers to change direction during development. If they can turn in just four directions: left, right, up or down, this may enforce a more efficient, orderly way for the fibers to find their proper connections – and for the structure to adapt through evolution, suggest the researchers. Obtaining detailed images of these pathways in human brain has long eluded researchers, in part, because the human cortex, or outer mantle, develops many folds, nooks and crannies that obscure the structure of its connections. Although studies using chemical tracers in neural tracts of animal brains yielded hints of a grid structure, such invasive techniques could not be used in humans. Wedeen’s team is part of a Human Connectome Project Harvard/MGH-UCLA consortiumExternal Link: Please review our disclaimer. that is optimizing MRI technology to more accurately to image the pathways. In diffusion imaging, the scanner detects movement of water inside the fibers to reveal their locations. A high resolution technique called diffusion spectrum imaging (DSI) makes it possible to see the different orientations of multiple fibers that cross at a single location – the key to seeing the grid structure. In the current study, researchers performed DSI scans on postmortem brains of four types of monkeys – rhesus, owl, marmoset and galago – and in living humans. They saw the same 2D sheet structure containing parallel fibers crossing paths everywhere in all of the brains – even in local path neighborhoods. The grid structure of cortex pathways was continuous with those of lower brain structures, including memory and emotion centers. The more complex human and rhesus brains showed more differentiation between pathways than simpler species. Among immediate implications, the findings suggest a simplifying framework for understanding the brain’s structure, pathways and connectivity. The technology used in the current study was able to see only about 25 percent of the grid structure in human brain. It was only apparent in large central circuitry, not in outlying areas where the folding obscures it. But lessons learned were incorporated into the design of the newly installed Connectom scanner, which can see 75 percent of it, according to Wedeen. Much as a telescope with a larger mirror or lens provides a clearer image, the new scanner markedly boosts resolving power by magnifying magnetic fields with magnetically stronger copper coils, called gradients. Gradients make it possible to vary the magnetic field and get a precise fix on locations in the brain. The Connectom scanner’s gradients are seven times stronger than those of conventional scanners. Scans that would have previously taken hours – and, thus would have been impractical with living human subjects – can now be performed in minutes. “Before, we had just driving directions. Now, we have a map showing how all the highways and byways are interconnected,” said Wedeen. “Brain wiring is not like the wiring in your basement, where it just needs to connect the right endpoints. Rather, the grid is the language of the brain and wiring and re-wiring work by modifying it.” Curvature in this DSI image of a whole human brain turns out to be folding of 2D sheets of parallel neuronal fibers that cross paths at right angles. This picture came from the new Connectom scanner.Source: Van Wedeen, M.D., Martinos Center and Dept. of Radiology, Massachusetts General Hospital and Harvard University Medical School Reference Wedeen VJ, Rosene DL, Ruopeng W, Guangping D, Mortazavi F, Hagmann P, Kass JH, Tseng W-YI. The Geometric Structure of the Brain Fiber Pathways: A Continuous Orthogonal Grid. March 30, 2012 Science. ### The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website. The NIH Blueprint for Neuroscience Research is a cooperative effort among the NIH Office of the Director and the 15 NIH Institutes and Centers that support research on the nervous system. By pooling resources and expertise, the Blueprint supports transformative neuroscience research, and the development of new tools, training opportunities, and other resources to assist neuroscientists. About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website. Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

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

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

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

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