>> from our studios in new york city, this is charlie rose. charlie: tonight, we continue the exploration of the magnificent human brain with sports trauma, focusing on kids and young adults making emergency room visits as a result of brain injuries from sports and recreation. it has ignited a national discussion about the risk of contact sports. bellucci turned down a

scholarship to play sc occer after suffering a concussion. she talks about her experience. susan from the university of pennsylvania and thomas mcallister from the school of medicine. as you know, we have a nobel laureate from clemson and a medical investigator. i'm pleased to have all of them at this table. tell me about concussions among the young. trauma, as you indicated, it is a major health issue of our time. why is that so? let me put that in perspective. sportss a consensus that

is advantageous for young people. 50 million americans participate in group sport athletic competition and this is beneficial. it is athletic. it is social. from the athletic point of view, they learn that exercise is good and many are likely to carry this forward for the rest of their life, ensuring a healthier life span. in addition to the physical values, there are social values that come. one learns from team sports a sense of honesty, fairplay, teamwork. these are beneficial values that carry through the lifetime. of, atnside has emerged the highest level, professional basketball,ccer,

there are dramatic brain injuries that can lead to severe brain damage, making us worry if we are taking sufficient care of young people to protect them from this. this has become a national issue with obama calling a meeting on this, raising the issue. >> concussions are not just a football issue. 220,000 emergency room visits from sports and recreation. 250,000. the total number of young people is probably bigger than we know. >> obama made it clear that young people are susceptible to brain injuries and brain injuries are the leading cause of death and its ability.

we want to -- and disability. we want to understand the gelatinous organ encased inside of a skull. when we move, there is minimum movement in the brain. cane are impact forces that jar the brain. separated by a fluid layer. the impact force is from bumping into the skull by another skull hitting it, hitting the ground, hitting a soccer ball. are inertialthere injury,like a whiplash

when someone bangs into your body, which shakes up the brain. they often have significant consequences on people's neurological state. modestries from the injury. twofalls into categories. in some cases, the recovery may take longer. with moderate or severe brain injury, the recovery takes longer. is youngerto this andle are more susceptible older people, having had a prior -- more susceptible than older people.

it takes longer to recover and, if you have had a concussion, you are more likely to have a second. you areave had two, likely to have a third or fourth. itself.t only bad for it is bad for the future of the athlete. initiale severe symptoms. if you have these, you are likely to have a prolonged recovery. where are you most susceptible? women, it occurs 12-19.escence, from because there is are important brain changes that occur through adolescence. the key once you will hear about

pruning and malination. they may contact to one another and the brain works by it overproducing synapses that it needs to make sure that every possible contact is covered. with adolescents, the brain matures and the inappropriate contacts are gotten rid of to streamline and make the brain function highly. the brain enlarges and we need speed of communication, which is , and they areons covered by a fatty sheath. there is a process that is

applied to ensure this. these are the processes that are critical and, because of this, the brain is susceptible to injury. one of the tragedies of this is, because of this, we do not have a pharmacological treatment for a dramatic brain injury. incumbent to use other health measures for coaches, trainers, athletes, and the person in the game to realize that they need to pull to athlete from the game and not allow them to return to the game. a should not play again, until they have been cleared by a health professional. this is absolutely essential. issuesr to discuss these in depth, we have an extraordinary panel and we begin

with an outstanding soccer player. decide to give up competitive athletics and coaches soccer players to prevent them from having the difficulties she had. she will describe what it is like to have a concussion. interestedn, who is in circumstances that bring this out. interested, who is in the consequences of concussions and is doing a long-term study of students to see what the behavior consequences are. mechanismses brain of concussions. seeingis interested in if we can come up with have this so that we major panel to discuss this and

we are ready. charlie: thank you very much. soccer ated playing four years old against my will. wasr my first practice, it something i loved and wanted to do all the time. dayayed soccer since that until i was a senior in high school. when i was 15 years old, i got my first concussion. i did not know it was a concussion. ball.eaded the i was having headaches and trouble sleeping. i did not think it was a theussion and i had a game next day. i decided to play. i got to begin the next day and and i got semifinals into a rough tackle, falling to the ground and hitting my head

on the ground hard. i got up from the fall and i was confused as to where i was. i got that back quickly. my vision was extremely blurry. my head was spinning. it was an important game and i decide to push on. after that, i went to the emergency room after i finished the game and i had whiplash in my neck and i had a concussion. i had to take a week off of school. i was very moody. i could not sleep. it was a tough time for me. -- i went to the emergency room and they gave me a muscle relaxer for my neck. i just stay home with my mom. charlie: not identified the concussion. that they would

have insisted she not get on the plainfield. -- the playing field. >> you knew something was wrong and you did not want to leave the field because the team depended on you. >> i would have tried to push through anything, no matter what the symptoms were. i was so competitive and my passion was incredible for the game. i did not want to stop, even if i knew something was terribly wrong. >> instead of leaving the field, they feel -- charlie: the nfl has a policy where they examine the concussion when they come off the field. today, how are you? >> a lot better. there are things i still struggle with. at school, i have 2-3 headaches a week and sometimes five days without a break. strugglinge been

since my last concussion, almost two years ago. my pupils are not the same size all the time and, with that, it is hard for me to be in lecture and looking at the powerpoint. back back to my notes goes to my headaches. >> are you under the care of physicians? >> not anymore. after the last one, i have not gone back to the doctor, other than ton them i have headaches and troubleshooting. andour case is well-known you are at a summit with the president and you introduced the subject there. you have become a part of the conversation. >> which i am really happy about. it is unfortunate all this happened to me. i think it is something that is to be talked about and known. i am glad to be a face for that.

how prevalent are concussions among young people? >> more prevalent than most realize and, with high school sports, there were 150,000 concussions with football players and 60,000 with girls soccer players. among best0,000 each ballplayers and wrestlers. those are estimates with surveillance data. the concussion rates have increased over time and this is a time where statistics might be something good with a rapid increase over time that likely does not indicate a true increase in concussions.

most of the changes have improved player safety and this demonstrates dramatic increases we have had in education, knowledge, young athletes, all of themches, becoming more aware of concussion. is it across sports or is it soccer and contact. is difficult to find the parent of a high school athlete who explains the concussions and recognizes that it is an important thing that needs to be addressed. competitionher in

in and in practice and this may be because athletes do not want to come out of the game and ofause there is more events contact that occur in competition, compared to practice. and, in iceby sport hockey, the concussion rates are higher then in practice. the competition rates are only twice as high in softball. a lot of it tends to be the activities associated with the sports and, across the spectrum of sports, the most common mechanism is athlete contact. there are incidences of athlete to athlete contact.

charlie: more in competition then practice question mark what you are more likely to hit your opponents harder than your teammates -- then practice? you are more likely to hit your points harder than your

charlie: let me turn to tom bennett and talk about what happens when there is a concussion. >> from a clinical standpoint, it was described as. the force and the mechanics that

were touched on, there is a ,isruption in brain function described as an alteration in a level of consciousness. confused, aspear described, and it is followed by other symptoms, like headache, blurred vision, sensitivity to light and noise. demand is problems with thinking and the big one is problems with memory and attention. theseod news is that days orover 7-10 several weeks. we have known that there is a

case where it is not the for some times and a concussion happening it is predicting nicely the with of symptoms described the inside of the scroll and areas that are particularly vulnerable. kull is great effort checking the head. when you put the brain out of areas there are rough that make it more likely for the brain to get damaged. you do not have to have that to have damage or the injury and

symptoms described. , a very movements of a brain gelatinous material, there are forces that results that can fibers thatelicate connect a nerve cell. are delicate and this kind of twisting action can damage the connectivity and functions. putting it together, the next what is mostow thely to be damaged and perfect storm for the

maphiatric complaints that nicely into regions that are responsible for what was described. memory is common and the next image shows the brain regions that are important and the memory function, if you compare that nicely.nto there were difficulties with decreased speed of information processing. you look at areas of the brain in regions that were vulnerable with awas interesting common complaint from people who

the nextussions and image shows a region that is important and, if you designed the injury that was calculated to damage cognition and behavioral symptoms, you could not come up with a better one. this comes nicely with what we know about the mechanics of the brain injury. someie: do we know why recover better than others? >> there are those who have had more than one injury that take there is recover and an interesting link between

behavioral and psychological issues. there seems to be an interaction with this and, some of the same withcs are the stretches and strains impacting the region. we are finding some interesting work that suggests genetic factors impact this. forand i might differ genes. >> the brains are always developing and new connections are being made. this is more dramatic during childhood which changes occurring in the young brain that are dynamic.

peaksergy the brain uses in childhood and adolescence and aks inood flow pe childhood and adolescence. there are connections that are molded to make us who we are and that is because connections that are not useful are taking away -- taken away during this time. everyone worries about injuries that occur during developmental where things are dynamic. think about one of the things that completes itself in the developing brain with the wires that go into your young 20's and

they determine the speed and efficiency of connections in different parts of the region. it is a dynamic time we are talking about today. good point on learning mechanisms in the adult brain. ande are new mechanisms retractions of connections. these are things that go into play. you have the outgrowth and getting rid of it. amazing. >> absolutely. >> it is fascinating. charlie: explain that. >> you think about how skills

develop over time and you go through tremendous advances. brain, it is questionable if anything is working in there at all. this isy changes and the physical basis of that. charlie: the brain is influenced by every experience. >> absolutely. you see the spectacular representation of this. there are connections that are inappropriate or unnecessary. we do not know the mechanisms underlying it. availablere centers mouth guardsd that help us understand the range of acceleration and help us understand that, for one person in a scenario, it is a

very different acceleration set that happens and it appreciates the chance that, given the acceleration, the magnitude matters and it contributes. the sensors cannot tell us if the concussion has occurred. charlie: it cannot. >> they only tell us the acceleration of the head. we need the athlete to tell us. critical and seems there is no way to determine a concussion has occurred from a sensor? >> it will only tell us what has occurred in the head. >> there are a lot of different factors. there are a number of different

settings that cause different peoples and we rely on to report the symptoms. we have thought that accelerations have not capture the complete understanding of a risk of accelerations that has .ccurred and we need something encourage people who are playing sports to be sensitive and report discomfort that they hear. ignore been raised to anything and continue to play. andave to educate people make sure that nothing serious is happening. important withly

those involved. to play the idea was through the pain. >> that is what you did. >> the high school athletes returned in the same day. that -- 8% returned to play and, now, it is less than 2%. if you look at the guidelines, we see dramatic differences. returned within six days. now, it is less than 10%. >> more would be helpful. charlie: absolutely. >> it is not all or nothing.

the particular acceleration, we expect people to have concussion symptoms if they move with the acceleration. you can see high levels of , at low levelsd of rotation, you are unlikely to. risk is important and it probably changes with age and other circumstances. if you talk about the helmets designed, they prevent skull fracture and they are not designed to prevent concussions. technology has not identified the means to reduce the rotational acceleration that is happening in the brain. important tore wear to prevent serious

injuries. there is a demand for products andelp in this middle range it could make a big injury risk. you would like to reduce the head rotation and you like to reduce the head rotation. when the head hits the ground and the body continues to move, if the head is attached to the ground, there is a rotation of the head. so, the frictional surface allows the head to move along in a straight line and with a material that allows to slow down and ramp down the .eceleration car to the front of the

slow us down when a collision occurs and we need to slow down the rotation that occurs at impact. there is innovative technology that allows the head to slide. it is only good for helmets. preventgle with how to the on helmeted. of aere is a profile formula one driver. >> it prevents the rotation and the impact with the level of importantll have impact and it may end up being neck notisk with the being as strong as the mail. women work, the impact is

less. >> they work hours on strengthening the neck. >> they walk away from the her and this crashes -- these horrendous crashes. what susan said, the acceleration and deceleration with impact. seen is, after a concussion, which is not like a actuallyture, it is the beginning of a progression that lasts and we see energy ands that change over time this provides important nutrients and oxygen.

if the concussion of occurs in this setting, the response to the brain could be different. that we wereay told, this is consistent with injured brains being on top of another injury and it is devastating with long-lasting symptoms. if in doubt, spit it out. do not go back into play until the symptoms are over. is previoustiplier concussions and how long the symptoms had been. i would say that the second risk factor is age and we see how a young brain is changing over time and the energy needs of the

brain. the blood flow is high. if the symptoms of concussion brain it happens when the needs it most for development and you understand prolonged symptoms that are worse over time. are on topibutions of the mechanical. deathis a common cause of in children. increase risk in youth and there may be a possible concussion. we think that women may be at higher risks for concussion and we are not sure if tissue deformation causes profound response in women or, if women

will report the symptoms more. what we need are the equivalent of x-rays or blood test. charlie: more evidence of women being smarter than men. >> the show's concussion rates vary by sport and gender. for example, among girls soccer players, it is about 21 per 10,000 athletic exposures. 21 girls will experience concussions. with voice, it is only nine. it is twice as high in girls. comparing girls and boys basketball, it is three times higher with girls.

charlie: how many concussions is too many? >> you never know what will be the last straw. one, iay i got another could be ok or in bed for a year. >> what was the most severe concussion? eader and up for a h

hit another player. , i wascame to disoriented, confused. once i realized where i was, i decided to keep playing it did not tell anyone. semifinals and i wanted to keep it to myself. i was eating lunch and opening my jaw. , a seriousunching crunching, and i was scared. we went to the doctor and they were concerned. the could not tell me what it was. after i was checked, they thought i had a skull fracture. it was just fluid surrounding the skull from impact. i was out of school for two

weeks and i do not think i have been the same. my grades dropped. not significantly, but they did. i was depressed and did not want to admit it. outside, i would look ok. at home, i would close my curtains and lay in bed. that youse students can learn from the experience. what was the impact of the last concussion and how did it impact your life in school work? the next one will be twice as bad. that is what people have to listen to and make a reasonable choice on. i would throw in another thing that susan mentioned, it is not just a number. it is a sequence of how close they are. there is a rare event that is

hitl called the second phenomenon. the brain has not recovered and the athlete goes out and he is a little dazed and not reacting normally. the second hit causes another caution that causes the brain to swell and can be fatal. a ghost the point that, close in time concussions are the most dangerous. >> because the brain swells. boom. hit it and symptoms will be worse and longer-lasting. each concussion was worse than before. >> is there an issue with accurate reporting? starts before concussions.

people may be aware of the emphasis and, if someone has a blow it has been tested with memory, they may diagnose the concussion because the performance has dropped a little. there is now a point where athletes know this and they will not try as hard as they might on the preseason evaluations. if they have a blow or a concussion, it will be harder to diagnose and easier for them to be returned to play before they are ready. >> the other thing is that, part of the problem is that not all symptoms occur at the time of the injury. susan described football players with sensors in helmets and measuring the impact and how hard they are. it is more complicated to figure

out the blow that results in the concussion and, a great example and theng a head ground. knee omebody comes by and 3-4 init can be succession. it can be difficult to know and some do not report symptoms. they may come in and say, i did not feel right over the weekend and i had headaches. reporting is problematic. studyt is where animal comes into play. you can control the interval and understand the critical number and the interval.

thee understanding is that rates and patterns are dependent on ada from clinical settings. and, athletes have choices if i got her playing sports, to go to atell me to center. now, they can go to urgent care centers or a pediatric concussion clinic. we do not have a national surveillance system to capture data on young athletes under high school and we do not really know what is going on in that group. >> it is amazing. and, i a major problem can think of few areas of medicine where such serious damage can occur and there is such an effective surgical approaches at the moment.

why is that so? >> the problem has been, as people have said, we have not seen anything in the brain in those cases and, it has been difficult for scientists to develop treatments. >> with the models? >> or the human condition. we do a study and do not see anything. there will be signs being done that will lead to something. the first video we are going to at thean experiment done national institutes of health and they mounted a microscope and you can see what happens in an instance where there is a compression to the surface of the brain. you see the normal brain and the brain with compression. holes and green

cells are dying in real time. we are looking at the response to the deaths. these ugly things they call jellyfish microgleal. that there isout a drug that prevents this process from occurring and it has been known for a long time. scavenger.e radical the brain uses oxygen and the downside is that oxygen produces chemicals that, if they get free , produced damage. that up. what isglimpse of

coming down the road. a free radical medication. >> what are some of the consequences? serious dementia comes out of concussions. >> this is tricky to explain. give me time. what we are going to see speaks these areconcern that relatively short-term consequences and there could be a possible serious condition in boxers. the brain becomes shrunken and the person becomes demented. in the bottom panel, you see a brain with this disease. the signature is the deposition of a protein inside the brain.

actor and it is inosited in the brain and this condition. initially, we thought this was a unfortunately, smallnd players have very deposits and you can see that in the middle panel. now, there is a clinical deposit and there are experiments that spread and this is the beginning know how we do not

frequent it is or if the spread occurs in everyone. certainly, that is the biggest fear. are some that are haveved for use and would been convinced that everybody would get better after a concussion in short order and there was not a lot of impetus to develop the interventions. interventions, i think that we touched on awareness with people and we educated people about the nature of the injury and at this table. >> that is right. being able to let people know does nothave an injury

mean that your life is ruined and the odds are that you are going to get better. here are things you might expect to see happen and accommodations you would want to make. the expectation is that you are going to get better, rather than izing the injury is important. wewhat is important is that have spent a great deal of effort on diagnosis and looking , havingntial treatment spent little effort on primary prevention. i think that it is important for people to come away from this with a knowledge that there are things you can do. >> any questions about changing the rules of the game? >> there have been dramatic recommendation and there have

been strong recommendations ofut limiting the number days a week football players are allowed to put his feet and full contact drills. athletes 10 and under should no longer be allowed to head a ball while playing soccer. these are dramatic efforts to and kids safe for preventing them from getting a concussion in the first place. >> i hope we become more knowledgeable on this and i do not want kids to shy away from playing soccer. sports turned me into the person i am and has helped me with character, teamwork, leadership. know what to do when

something needs to happen. i do not think anybody noticed. obama heard that you are doing this and he sent me a message and said that he would like to have a final word. can we play his tape? have bettero research, better data, better , wepment, better protocols need more athletes to understand how important it is to do what we can to prevent injuries and admit them when they happen. we have to change the culture. charlie: thank you, mr. president. we will continue the exploration and time. tell me what we are going to do? >> we spoke about sports trauma. we are going to talk about the thatological consequences

produce serious damage to the brain. by parentstreatment or children and aspects of inheritance that have psychological brain consequences that are quite frightening. will speak about the psychological parallels to physical trauma. for beinghank you here. we will see you for the next episode. see you then.

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