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

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

ATHENS, Ga. --- The University of Georgia Athletic Association's Sports Medicine Department will host a conference on Emergency Care in Sports (ECS) at the Georgia Center for Continuing Education this Wednesday-Friday. Within the conference, a free healthcare symposium will be held discussing the management of sport-related concussions. “Although most sports injuries are relatively minor, life threatening injuries are unpredictable and can occur without warning,” said Ron Courson, Assistant AD for Sports Medicine for the UGA Athletic Association. “Due to a relatively low incidence rate of catastrophic injuries, those tasked with overseeing organized athletics often develop a false sense of security. All personnel involved with the organization or sponsorship of athletic activities share a professional responsibility to provide for the emergency care of an injured athlete”The ECS Conference will open Wednesday with sessions covering emergency situations as well as action and crisis management plans for those instances. Thursday's schedule includes presentations covering spine, cardiac and heat exertional situations. On Friday, the conference will concentrate on various trauma situations, including an AirMed helicopter landing demonstration on the UGA football practice fields."Proper management of emergencies is critical and should be handled by trained personnel," Courson said. "Emergencies can occur during any physical activity or at any level of participation, and heightened awareness associated with the nature of the incident and its management is critical.” In association with the conference, a free symposium on sport-related concussions will be conducted in the Mahler Auditorium at the Georgia Center on Wednesday, May 30 at 8 p.m. The symposium will feature the airing of the CNN Dr. Sunjay Gupta Reports "Big Hits, Broken Dream" followed by a panel discussion. Courson will moderate the discussion, which will feature the following noted healthcare providers in the area of sport concussion: Kim Walpert, MD, neurosurgeon, UGA; Fred Reifsteck, MD, head team physician, UGA; Mike Ferrara, PhD, ATC, director, sports concussion research laboratory; and Angela Yi, PhD, clinical neuropsychologist, Shepherd Center."We are excited about offering the concussion management seminar as a free educational resource for anyone in the local health care community," Courson said. "This is a hot topic in sports medicine today and we have an excellent panel of presenters. It should be a great opportunity to share current information in this area and exchange new ideas in concussion management."The symposium is approved for continuing medical education (CME) for physicians and board of certification continuing education units (BOC CEU) for certified athletic trainers in attendance and is being sponsored by the Georgia Neurological Surgery and Comprehensive Spine; the University of Georgia; Athens Regional Medical Center; and St. Mary's Healthcare System. For more information on the conference or symposium, email ugaecsconference@gmail.com. Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

CHICAGO, May 24, 2012 -- Riddell Sports and USA Football today announced a renewed commitment to educating athletes and parents about concussion awareness. Starting today every new Riddell football helmet shipped to retailers and customers will include a hangtag offering concussion education that includes information from the Centers for Disease Control and Prevention (CDC) Heads Up program. Riddell's concussion education hangtag is the first of its kind among sports helmet manufacturers. "We have a longstanding commitment to player protection and continue to look for new ways to educate athletes and parents. As the leading manufacturer of football helmets, Riddell has raised concussion awareness through on-helmet labels and informational hangtags for over a decade," said Dan Arment, President of Riddell. "The new hangtag contains valuable information from the CDC and is the latest example of how Riddell will address concussion awareness with athletes and parents." Approximately three million American children age 6-14 play organized tackle football, placing it among the country's most popular youth sports. Since May 2009, 35 states and the District of Columbia have passed legislation to strengthen concussion education across youth and high school sports. Riddell's new hangtag will be attached to each helmet through an ear hole. The tag is titled "Raise Your Concussion Awareness" and lists concussion signs and symptoms, including CDC guidelines on what to do if a concussion is suspected. "Riddell shares USA Football's commitment to player safety and concussion awareness," USA Football Executive Director Scott Hallenbeck said. "Every parent who has a child playing youth football should ask their league two questions: 'How are your coaches trained to teach my child?' and 'Are your coaches educated on the symptoms and management of concussion?' Helmet hangtags will make certain that Riddell customers have a baseline of knowledge in this area and are directed on where they can learn more online." Riddell is the official football helmet and protective equipment partner of USA Football, the sport's national governing body in the United States. USA Football has partnered with the CDC to advance concussion education since 2007, particularly in high school and youth football. About USA Football: USA Football, the sport's national governing body in the United States, hosts more than 100 football training events annually offering education for coaches, skill development for players and resources for youth football league commissioners. The independent non-profit is the official youth football development partner of the NFL, its players and each of the league's 32 teams. Indianapolis-based USA Football manages U.S. national teams within the sport for international competition and provides $1 million annually in equipment grants and subsidizes youth league volunteer background checks. Endowed by the NFL and NFL Players Association in 2002 through the NFL Youth Football Fund, USA Football is chaired by former NFL team executive Carl Peterson. About Riddell: Founded in 1929, Riddell is a premier designer and developer of protective sports equipment and a recognized leader in helmet technology and innovation. One of Easton-Bell Sports, Inc.'s most well-known brands and the Official Helmet of the NFL®, Riddell is the leading manufacturer of football helmets, shoulder pads and reconditioning services (cleaning, repairing, repainting and recertifying existing equipment). SOURCE: Riddell Questions/comments? Contact Jean Rickerson at jean@SportsConcussions.org

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

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

MINNEAPOLIS – A new study suggests that head impacts experienced during contact sports such as football and hockey may worsen some college athletes’ ability to acquire new information. The research is published in the May 16, 2012, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study involved college athletes at three Division I schools and compared 214 athletes in contact sports to 45 athletes in non-contact sports such as track, crew and Nordic skiing at the beginning and at the end of their seasons. The contact sport athletes wore special helmets that recorded the acceleration speed and other data at the time of any head impact. The contact sport athletes experienced an average of 469 head impacts during the season. Athletes were not included in the study if they were diagnosed with a concussion during the season. All of the athletes took tests of thinking and memory skills before and after the season. A total of 45 contact sport athletes and 55 non-contact sport athletes from one of the schools also took an additional set of tests of concentration, working memory and other skills. “The good news is that overall there were few differences in the test results between the athletes in contact sports and the athletes in non-contact sports,” said study author Thomas W. McAllister, MD, of The Geisel School of Medicine at Dartmouth in Lebanon, N.H. “But we did find that a higher percentage of the contact sport athletes had lower scores than would have been predicted after the season on a measure of new learning than the non-contact sport athletes.” A total of 22 percent of the contact sport athletes performed worse than expected on the test of new learning, compared to four percent of the non-contact sport athletes. McAllister noted that the study did not find differences in test results between the two groups of athletes at the beginning of the season, suggesting that the cumulative head impacts that contact athletes had incurred over many previous seasons did not result in reduced thinking and memory skills in the overall group. “These results are somewhat reassuring, given the recent heightened concern about the potential negative effects of these sports,” he said. “Nevertheless, the findings do suggest that repetitive head impacts may have a negative effect on some athletes.” McAllister said it’s possible that some people may be genetically more sensitive to head impacts. The study was supported by the National Institutes of Health and the National Operating Committee on Standards for Athletic Equipment. Source: American Academy of Neurology -- May 16, 2012 Questions/comments? contact Jean Rickerson at Jean@SportsConcussions.org Photo courtesy of JamieLWilliams (c)2006 CreativeCommons.com

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

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