NFL Hall of Famer "Iron Mike" Webster's life ended in 2002 when he suffered a heart attack at age 50. Four Super Bowl rings, nine Pro Bowls, and voted to the NFL's all-time team in 2000, the driven, ultra-competitive Steelers' center drifted into a life of drug use, homelessness, and enormous suffering after retiring in 1988. In 2005, his son Garrett told ESPN that the only way his father could get to sleep was to taser himself into unconsciousness. Former teammates and friends offered assistance over the years but it wasn't enough. After Webster's death, forensic neuropathologist Dr. Bennet Omalu was determined to find neurological reasons for his cognitive decline. Seventeen years in the NFL at a time when safety precautions and concussion awareness were both minimal had resulted in thousands of impacts to his head. Though his brain looked normal at autopsy, Omalu pressed on until he found the abnormalities that we now call Chronic Traumatic Encephalopathy, or CTE. CTE and Alzheimer's CTE and Alzheimer's 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 Alzheimer’s and CTE can only be accurately diagnosed postmortem through a neuropathological examination of the brain and their progression has remained elusive. But clues about how Alzheimer's spreads from neuron to neuron are now emerging. Whether the same process of progression applies to CTE is currently unclear. Photo: Alzheimer's infects from neuron to neuron The inexorable spread of Alzheimer’s disease through the brain leaves dead neurons and forgotten thoughts in its wake. Researchers at Linköping University in Sweden are the first to show how toxic proteins are transferred from neuron to neuron. Through experiments on stained neurons, the research team – under the leadership of Martin Hallbeck, associate professor of Pathology – has been able to depict the process of neurons being invaded by diseased proteins that are then passed on to nearby cells. “The spread of Alzheimer’s, which can be studied in the brains of diseased patients, always follows the same pattern. But until now how and why this happens has not been understood,” says Hallbeck, who along with his research group has now published their results in The Journal of Neuroscience. The illness starts in the entorhinal cortex – a part of the cerebral cortex, and then spreads to the hippocampus. Both of these areas are important for memory. Gradually, pathological changes take place in more and more areas of the brain, while the patient becomes even sicker. Two proteins have been identified in connection with Alzheimer’s: beta amyloid and tau. Normally tau is found in the axons – the outgrowths that connect between neurons – where it has a stabilising function, while beta amyloid seems to have a role in the synapses where the neurons transfer signal substances to each other. But in Alzheimer’s patients, something happens with these proteins; autopsies reveal abnormal accumulations of both. Why they become abnormal is still unknown, but what is known is that it’s not the large accumulations, or plaques, that damage the neurons. Instead, smaller groups of beta amyloid – called oligomeres – seem to be the toxic form that gradually destroy the neurons and shrink the brain. “We wanted to investigate whether these oligomeres can spread from neuron to neuron, something many researchers tried earlier but didn’t succeed,” Hallbeck says. The study was inaugurated with an experiment on neuron cultures, where researchers injected oligomeres stained with a phosphorescent red substance called TMR using a very thin needle. The next day the neighbouring, connected neurons were also red, which showed that the oligomeres had spread. To test whether a sick neuron can “infect” others, they conducted a round of experiments with mature human neurons stained green and mixed with others that were red after having taken up stained oligomeres. After a day, approximately half of the green cells had been in contact with a few of the red ones. After two more days, the axons had lost their shape and organelles in the cell nucleus had started to leak. “Gradually more and more of the green cells became sick. Those that hadn’t taken up the oligomeres, on the other hand, weren’t affected,” Hallbeck says. The study is a breakthrough in understanding Alzheimer’s and its progress. If a way of stopping the transfer can be found, it could lead to a more effective inhibitor against the disease. Article: Spreading of neurodegenerative pathology via neuron-to-neuron transmission of beta-amyloid by Sangeeta Nath, Lotta Agholme, Firoz Kurudenkandy, Björn Granseth, Jan Marcusson and Martin Hallbeck. The Journal of Neuroscience, 27 June 2012. Photo: Alzheimer's infects from neuron to neuron: Two nerve cells, each about 10 micrometers large, are visible as shadows in this picture. From the beginning only the right one (yellow arrow) contained the toxic, red stained, oligomeric beta-amyloid. When these sick cells make contacts with the healthy, green labeled cells (black arrow), toxic beta-amyloid will spread through the neuronal projections (white arrow). Subsequently, also the green cell will become sick. Credit: Martin Hallbeck Source: The above story is reprinted from materials provided by Linköping University. Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

It is not yet known why girls suffer concussions at a higher rate than boys. The most prevalent theories range from lesser neck and upper body strength, to better reporting among females, to hormonal differences. Researchers at Emory University in Atlanta are currently in the third phase of a clinical trial designed to determine if the hormone progesterone, normally associated with female reproductive processes, can protect damaged neurons. Administered within four hours of the injury and lasting for three days, results of the treatment have been positive so far. Although catastrophic injuries in sports are rare, the question regarding applicability of a related treatment for concussion remains open. Pilot study highlighted efficacy Every 15 seconds, someone in the United States sustains a significant traumatic brain injury. Approximately 2 million adults and children in the United States suffer from traumatic brain injuries each year - leading to 50,000 deaths and 80,000 new cases of long-term disability, according to the Centers for Disease Control and Prevention. Despite the enormity of the problem, scientists have failed to identify effective medications to improve outcomes following a traumatic brain injury. Emory researchers, however, concluded in an earlier pilot clinical trial that giving progesterone to trauma victims shortly following brain injury appears to be safe and may reduce the risk of death and long-term disability. Their previous three-year study, called ProTECT I (Progesterone for Traumatic brain injury--Experimental Clinical Treatment), enrolled 100 participants at Grady Memorial Hospital. It was designed to evaluate whether progesterone can be administered intravenously in a safe and reliable way. "We found evidence that progesterone is not only safe for use in patients suffering from traumatic brain injuries," says Wright. "We also found a 50 percent reduction in mortality in those patients treated with progesterone. Even though this was a small pilot study, we found signs that progesterone improved functional outcomes and reduced disability in patients with moderate brain injury. "By expanding our test sites to 17 major trauma centers across 15 states and enrolling more than 1,000 patients, we hope to confirm these preliminary findings and determine if progesterone benefits victims of acute traumatic brain injury," says Wright. Progesterone common in males and females Progesterone is naturally present in small but measurable amounts in the brains of males and females. Human brain tissue is loaded with progesterone receptors. Laboratory studies suggest that progesterone is critical for the normal development of neurons in the brain and exerts protective effects on damaged brain tissue. Donald G. Stein, PhD, Asa G. Candler Professor of Emergency Medicine, Emory School of Medicine, and director of Emory's Department of Emergency Medicine Brain Research Laboratory, pioneered discoveries regarding the effect of progesterone following traumatic brain injury - first discovering the neuro-protective properties of progesterone in the laboratory more than 25 years ago. "The results that we are now seeing, and hope to continue validating, are an incredible and gratifying reward for more than 25 years of concentrated research," says Stein. "My work first started when I began to notice evidence that women tended to respond to treatment and recover better than men after suffering from brain injury and stroke. Many people do not realize that it's not just a female hormone; both men and women produce progesterone directly in the brain, as well as other tissue. "Ultimately, we learned that progesterone basically does in brain injuries what it also does during fetal development - protect cells and tissue," says Stein. "To now witness the translation of this laboratory research into a treatment that may have life-saving benefits is breathtaking." Source: A Hormonal Remedy for Brain Injuries is Explored --The New York Times -- June 21, 2012 Atlanta To Serve as National Epicenter for Promising Phase III Brain Injury Treatment Trial - Emory University Photo courtesy of (c) 2008 Eddy Grady@creativecommons.com Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

As a new womens' lacrosse referee I initially had mixed feelings about the ongoing debate on the use of helmets in play. Listening to the discussion in referee training sessions that stressed the finesse of the game and the need of the referee to control or slow down play, verses the struggle I felt as a person having a medical degree and realizing the potential hazards of brain injuries, I tried to see both sides. Some people think that helmets will make the game more physical. But after my first official day as a referee standing on the sidelines watching my daughter’s middle school team begin their game, my beliefs became clear. Female lacrosse players need to wear helmets. During the first eight minutes of the game there were three injuries, one related to a child’s head and neck. This player had been checked from behind causing her neck to snap back. She then fell and hit her head on the turf. I witnessed every parent’s/referee’s/coach’s nightmare: a player down and seizing. To my dismay, this player returned to play in less than three weeks and went on to have another concussion and seizure. She is now barred from impact sports for the rest of her life. What I found out about my local school district surprised me and motivated me to try to educate parents and give people the best information possible. After speaking to the athletic trainers in my school district, I was made aware that high school students are given baseline concussion testing but younger players are not. We are now in the process of offering that testing to younger players. Also, while coaches can have in-person or online concussion training it seems that more could be done to help the coaches and parents become more informed about concussions. There are numerous issues that could explain the high incidence of concussions in women's lacrosse. One might be to consider the nutrition and health of girls playing the game today. Both men and women today are better nourished and physically stronger, faster and more powerful than the players of previous years. This has created a weight imbalance as some players can actually outweigh others by a large margin. The physics of combining speed and extra mass can lead to a dangerous combination. Equipment has also evolved to allow for lighter and faster sticks, causing unintended hits in some instances, I'm sure. Another factor is the increase in new players due to the popularity of the sport. Putting players of different skill levels in the same game can set up a difficult dynamic. It is important for players to be aware of their body position in space and reference to other players. This is a skill that comes with time and coaching. Coaching is another aspect of the game that helps teams work together better and control the speed of their game. Neck strengthening exercises can decrease the whiplash motion often caused by a hit to the cranial region. As for me, I have now completed my first season as a referee. I feel that helmets and proper body equipment in womens' lacrosse will make the game safer for everyone. My feeling is that there are too many factors that increase the potential for head injuries and we should mitigate them as best we can. While I realize helmets do not prevent concussions, I do believe they would be helpful to protect young women from unintended hits to the head. Dr. Lori McGowan is an Adjunct Professor of Biology at Harrisburg Area Community College in Harrisburg, Pennsylvania.

PITTSBURGH – The unpredictable nature of concussions is one of the most frustrating factors to the millions of sufferers each year, but early neurological indicators and symptoms can predict a protracted healing time in certain cases, according to specialists at UPMC and the University of Pittsburgh School of Medicine. “It’s a highly variable injury with a variety of outcomes,” said Michael “Micky” Collins, Ph.D., director of the UPMC Sports Medicine Concussion Program and co-investigator of the Pitt/UPMC study published in the February issue of Neurosurgery. “We see some patients who take a day or two to recover, and some who take a year or longer to recover. If clinicians had a way of determining within two days of injury who’s going to take a month or longer to recover, that’s a very important piece of information to have. It’s a game-changer.” The study, one of the first to examine concussion prognoses, showed that specific neurocognitive “cut-off” scores derived from ImPACT™ (Immediate Post-concussion Assessment and Cognitive Testing) improved clinicians’ ability to predict which sports-related concussions could take longer –- as much as five times longer -- to rehabilitate than others. They found, in as many as 85 percent of the cases, the scores could warn athletes, parents, coaches, schools, teams and health professionals when a concussion is likely to take on average a month to heal. Such an objective prognosis could help clinicians to better prepare a treatment plan, arrange academic accommodations for students and set tangible expectations for return to play and school, Dr. Collins said. The study reviewed 108 high-school football players who were given ImPACT tests within a median of two days after their concussions. Fifty boys experienced a recovery lasting, on average, 33 days before returning to play, and those longer rehabilitations could be forecast by specific “cut-off” scores in ImPACT Visual and Processing Speed testing. Migraine and cognitive symptoms also appeared to have predictive power. Study participants who scored above the threshold levels recovered within a median of seven days. “We’ve established statistical ‘cut-offs’ that indicate people who take a month or longer to recover,” Dr. Collins said. “Eighty percent of concussed people recover inside of three weeks. This prognostic information allows us to develop a risk profile of athletes who don’t recover well from this injury. Other study authors include Brian Lau, B.S., from the Pitt School of Medicine, and Mark Lovell, Ph.D., the Concussion Program’s founding director who retired from UPMC last summer. About UPMC Sports Medicine Cohttps://n Program The first-of-its-kind UPMC Sports Medicine Concussion Program, established in 2000, is the largest multi-disciplinary clinical and research program that focuses on the diagnosis, evaluation and management of sports-related concussion in athletes of all levels. The UPMC clinicians and researchers treat more than 13,000 patients a year, and published more than 75 clinical research studies in peer-reviewed scientific journals. About ImPACT ImPACT™ (Immediate Post-Concussion Assessment and Cognitive Testing) is an independently validated and researched concussion-evaluation system that has become the most widely used in the United States. Co-founded in the early 1990s by Drs. Mark Lovell, Joseph Maroon and Michael “Micky” Collins, who have a proprietary interest in ImPACT Applications, Inc., ImPACT is a 20-minute test that is a standard tool used as part of comprehensive clinical concussion management adopted across the NFL, NHL, NBA, Major League Baseball, college and high-school athletics -- with roughly 3 million people tested. Source: UPMC press release- https://www.upmc.com/mediarelations Photo courtesy UPMC

KANSAS CITY, Mo. -- The National Operating Committee on Standards for Athletic Equipment (NOCSAE) issued a warning to athletes and parents of athletes to thoroughly understand the extent of protection provided by – or not provided by – athletic equipment worn while playing sports. This warning follows claims made by several companies that products such as head bands, supplements or mouth guards reduce the incident of concussion. NOCSAE issued the warning at the onset of its summer meeting held this year in Kansas City. NOCSAE is an independent organization with the dual purpose of setting standards for the performance of athletic equipment and funding research necessary to advance the science of sports. Through NOCSAE's independent process, physicians, academic researchers, coaches, trainers and manufacturers come together to establish standards based on accepted science and reliable data. "Parents, athletes and coaches are becoming more informed about concussions, and this increased awareness is vitally important to advancing athlete safety. But it also creates a demand for quick solutions. Unfortunately there are quick solutions offered for sale which have neither scientific nor medical support that validate their claims to prevent or reduce concussions," said Mike Oliver, NOCSAE executive director. "Any device or supplement promoted as being able to prevent, diagnose or cure a concussion must be supported by scientific data and peer-reviewed research. Currently there is no definitive scientific research linking mouth guards, head bands, supplements or other specialty products to a reduction in concussion risk or severity. For companies to suggest otherwise misleads athletes, parents and coaches into a dangerous false sense of protection against concussion. NOCSAE warns athletes and parents of athletes to get the facts about sports equipment and concussion protection and not rely solely on marketing and promotional materials when making equipment decisions." NOCSAE does not maintain any standards for such products, and, therefore, no such products can be claimed as meeting the NOCSAE standards. While protective equipment certified to the NOCSAE standard play an incredibly important role in protecting athletes on the field of play, they should be not the primary approach to protecting against concussion. Learning to avoid unnecessary head impacts, reporting concussion symptoms to a coach or parent and following trained medical management decisions about when a concussed athlete can return to play are far more likely to prevent a concussion or reduce the chance of chronic problems that may be related to untreated concussions. For more information, please visit www.nocsae.org. About NOCSAE NOCSAE, the Nhttps:// Operating Committee on Standards for Athletic Equipment, is an independent and nonprofit standard-setting body with the sole mission to enhance athletic safety through scientific research and the creation of performance standards for protective equipment. Formed in 1969, NOCSAE is a leading force in the effort to improve athletic equipment and, as a result, reduce injuries. NOCSAE efforts include the development of performance and test standards for football helmets and facemasks, baseball and softball batters and catchers helmets, baseballs and softballs, ice hockey helmets, soccer shin guards, lacrosse helmets and facemasks and polo helmets. NOCSAE is comprised of representatives from a number of groups which have an interest in athletic equipment – including manufacturers, reconditioners, athletic trainers, coaches, equipment managers, sports medicine and consumer organizations. These diverse interests have joined forces in an attempt to arrive at a common goal of reducing sports-related injuries. NOCSAE is a nonprofit, charitable organization supported by individuals and organizations with an interest in athletics. SOURCE: National Operhttps://ommittee on Standards for Athletic Equipment (NOCSAE) Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org Back to top RELATED LINKShttps://www.nocsae.org Source: PR Newswire (https://s.tt/1ezQW)

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

Bronx, NY — Patients vary widely in their response to concussion, but scientists haven’t understood why. Now, using a new technique for analyzing data from brain imaging studies, researchers at Albert Einstein College of Medicine of Yeshiva University andMontefiore Medical Center have found that concussion victims have unique spatial patterns of brain abnormalities that change over time. The new technique could eventually help in assessing concussion patients, predicting which head injuries are likely to have long-lasting neurological consequences, and evaluating the effectiveness of treatments, according to lead author Michael L. Lipton, M.D., Ph.D., associate director of the Gruss Magnetic Resonance Research Center at Einstein and medical director of magnetic resonance imaging (MRI) services at Montefiore. The findings are published today in the online edition of Brain Imaging and Behavior. The Centers for Disease Control and Prevention estimates that more than one million Americans sustain a concussion (also known as mild traumatic brain injury, or mTBI) each year. Concussions in adults result mainly from motor vehicle accidents or falls. At least 300,000 adults and children are affected by sports-related concussions each year. While most people recover from concussions with no lasting ill effects, as many as 30 percent suffer permanent impairment – undergoing a personality change or being unable to plan an event. A 2003 federal study called concussions “a serious public health problem” that costs the U.S. an estimated $80 billion a year. Previous imaging studies found differences between the brains of people who have suffered concussions and normal individuals. But those studies couldn’t assess whether concussion victims differ from one another. “In fact, most researchers have assumed that all people with concussions have abnormalities in the same brain regions,” said Dr. Lipton, who is also associate professor of radiology, ofpsychiatry and behavioral sciences, and in the Dominick P. Purpura Department of Neuroscience at Einstein. “But that doesn’t make sense, since it is more likely that different areas would be affected in each person because of differences in anatomy, vulnerability to injury and mechanism of injury.” In the current study, the Einstein researchers used a recently developed MRI technique called diffusion tensor imaging (DTI) on 34 consecutive patients (19 women and 15 men aged 19 to 64) diagnosed with mTBI at Montefiore in the Bronx and on 30 healthy controls. The patients were imaged within two weeks of injury and again three and six months afterward. The imaging data were then analyzed using a new software tool called Enhanced Z-score Microstructural Assessment Pathology (EZ-MAP), which allows researchers for the first time to examine microstructural abnormalities across the entire brain of individual patients. EZ-MAP was developed by Dr. Lipton and his colleagues at Einstein. DTI detects subtle damage to the brain by measuring the direction of diffusion of water in white matter. The same technology was used by Dr. Lipton and his team in widely publicized research on more than 30 amateur soccer players who had all played the sport since childhood. They found that frequent headers showed brain injury similar to that seen in patients with concussion. The uniformity of diffusion direction – an indicator of whether tissue has maintained its microstructural integrity – is measured on a zero-to-one scale called fractional anisotropy (FA). In the latest study, areas of abnormally low FA (reflecting abnormal brain regions) were observed in concussion patients but not in controls. Each concussion patient had a unique spatial pattern of low FA that evolved over the study period. Surprisingly, each patient also had a unique, evolving pattern of abnormally high FA distinct from the areas of low FA. “We found widespread high FA at every time point, all the way out to six months and even in patients more than one year out from their injury.” said Dr. Lipton. “We suspect that high FA represents a response to the injury. In other words, the brain may be trying to compensate for the injury by developing and enhancing other neural connections. This is a new and unexpected finding.” At present, diagnosis of concussions is based mainly on the nature of the patient’s accident and the presence of symptoms including headache, dizziness and behavioral abnormalities. DTI, combined with EZ-MAP analysis, might offer a more objective tool for diagnosing concussion injuries and for predicting which patients will have persistent and progressive symptoms. The paper is titled “Robust Detection of Traumatic Axonal Injury in Individual Mild Traumatic Brain Injury Patients: Intersubject Variation, Change Over Time and Bidirectional Changes in Anisotropy.” Contributors include Namhee Kim, Ph.D.; Tova M. Gardin, B.A.; Keivan Shifteh, M.D.; Mimi Kim, Sc.D.; Molly E. Zimmerman, Ph.D.; Richard B. Lipton, M.D.; and Craig A. Branch, Ph.D., all of Einstein and Montefiore; and Young Park, M.D., who earned his degree from Einstein; and Miriam Hulkower, a medical student at Einstein. Source: Novel Brain Imaging Technique Explains Why Concussions Affect People Differently Albert Einstein College of Medicine at Yeshiva University -- Newswise; June 9, 2012 Questions/comments? contact Jean Rickerson at jean@SportsConcussions.org

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

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