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

suffering a concussion. she talks about her experience. we will talk to 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. >> brain trauma, as you indicated, it is a major health issue of our time. why is that so? let me put that in perspective. there is a consensus that sports

is advantageous for young people. 50 million americans participate in group sports and athletic competition and this is beneficial. athletic. social. from the athletic point of view, they learn that exercise is good for one 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, fair play, teamwork. these are beneficial values that carry through the lifetime. the downside has emerged, at the highest level, professional football, soccer, basketball,

there are traumatic 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. president obama: concussions are not just a football issue. people made 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 disability. we want to understand the gelatinous organ encased inside of a skull. when we move, there is minimum movement in the brain. there are impact forces that can jar the brain. it is only 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. in addition, there are inertial forces, like a whiplash injury, when someone bangs into your body, which shakes up the brain.

they often have significant consequences on people's neurological state. this varies from the modest to moderate or severe. modest falls into two categories. in some cases, the recovery may take longer. with moderate or severe brain injury, the recovery takes longer. what leads to this is younger people are more susceptible and 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. if you have had two, you are likely to have a third or fourth. it is not only bad in itself. it is bad for the future of the athlete. there are severe initial symptoms. if you have these, you are likely to have a prolonged recovery. where are you most susceptible? both in men and women, it occurs in adolescence, from 12-19. why that is so is because there are important brain changes that occur through adolescence.

the key ones you will hear about later on are pruning and malination. cells make 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 mediated by axons, and they are 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 traumatic brain injury. it becomes incumbent to use other health measures for coaches, trainers, athletes, and the person in the game to realize that they need to pull the athlete from the game and to not allow them to return to the game. they should not play again, until they have been cleared by a health professional. this is absolutely essential. in order to discuss these issues in depth, we have an extraordinary panel and we begin with an outstanding soccer

player. she decided 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. we have dawn, who is interested in circumstances that bring this out. we have tom, who is interested in the consequences of concussions and is doing a long-term study of students to see what the behavior consequences are. susan studies brain mechanisms of concussions. walter is interested in seeing if we can come up with treatments so that we have this major panel to discuss this and we are ready. charlie: thank you very much.

>> i started playing soccer at four years old against my will. after my first practice, it was something i loved and wanted to do all the time. i played soccer since that day 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. i misheaded the ball. i was having headaches and trouble sleeping. i did not think it was a concussion and i had a game the next day. i decided to play. i got to my game the next day and it was the semifinals and i got 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 decided 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 was on -- i went to the emergency room and they gave me a muscle relaxer for my neck. i just stayed home with my mom. charlie: not identified the concussion. you already said that they would have insisted she not get on 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. my eyes have been struggling

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. going back to my notes goes back 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 telling them i have headaches and troubleshooting. >> your case is well-known and 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 needs to be talked about and known.

i am glad to be a face for that. charlie: 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. there are 20,000 each among baszketball players 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, parents, coaches, all of them becoming more aware of concussion. charlie: is it across sports or is it soccer and contact. >> it is difficult to find the a parent of a high school athlete who explains the concussions and recognizes that it is an important thing that needs to be addressed. they are higher in competition

than in practice and this may be because athletes do not want to come out of the game and because there is more events of contact that occur in competition, compared to practice. this varies by sport and, in ice hockey, the concussion rates are higher than 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

than practice? >> you are more likely to hit your opponents harder than your teammates -- than practice? >> yes, you are more likely to hit your opponents harder than your teammates. ♪

charlie: let me turn to tom 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 disruption in brain function, described as an alteration in a level of consciousness. people may appear confused, as described, and it is followed by other symptoms, like headache, blurred vision, sensitivity to light and noise. the other demand is problems with thinking and the big one is problems with memory and attention. the good news is that these resolve over 7-10 days or several weeks. we have known that there is a group where it is not the case and it persists for some time

. way the concussion happens, the scroll is great -- skull is great at protecting a brain. there are certain rough edges and areas that make it more likely brain gets damaged. you do not have to have that to have damage or the injury and symptoms described.

the very movements of a brain, a gelatinous material, there are forces that result and that can damage the delicate fibers that connect a nerve cell. these are delicate and this kind of twisting action can damage the connectivity and functions. putting it together, the next image will show what is most likely to be damaged and the perfect storm for the psychiatric complaints that map 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 it, it maps onto that nicely. there were difficulties with schoolwork and decreased speed of information processing. you look at areas of the brain in regions that were vulnerable and it was interesting with a common complaint from people who have concussions and the next

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 have not come up with a better one. this comes nicely with what we know about the mechanics of the brain injury. charlie: do we know why some recover better than others? >> there are those who have had more than one injury that take longer to recover and there is an interesting link between behavioral and psychological issues.

there seems to be an interaction with this and, some of the biomechanics are the same with stretches and strains impacting the region. we are finding some interesting work that suggests genetic factors impact this. you and i might differ for 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.

the energy the brain uses peaks in childhood and adolescence and the blood flow peaks in 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 taken away during this time. everyone worries about injuries that occur during developmental stages 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. >> you make a good point on learning mechanisms in the adult brain. there are new mechanisms and retractions of connections. these are things that go into play. you have the outgrowth and getting rid of it. it is amazing. >> absolutely. >> it is fascinating. charlie: explain that. >> you think about how skills develop over time and you go through tremendous advances.

the teenage brain, it is questionable if anything is working in there at all. it really changes and this is 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. >> there are centers available in helmets and mouth guards 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. charlie: this seems critical and 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 symptoms and we rely on people to report the symptoms. we have thought that accelerations have not capture the complete understanding of a risk of accelerations that has occurred and we need something. >> we need to encourage people who are playing sports to be sensitive and report discomfort that they hear. we have been raised to ignore anything and continue to play. we have to educate people and make sure that nothing serious is happening. it was enormously important with those involved.

charlie: the idea was to play through the pain. >> that is what you did. >> the high school athletes returned in the same day. -- 8% returned to play and, now, it is less than 2%. if you look at the guidelines, we see dramatic differences. in 2007, 30% 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 acceleration and, at low levels of rotation, you are unlikely to. this type of 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. helmets are important to wear to prevent serious injuries. there is a demand for products

to help in this middle range and 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 deceleration. we have the front of the car to

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. we struggle with how to prevent the on helmeted. >> there is a profile of a formula one driver. >> it prevents the rotation and the impact with the level of fitness will have important impact and it may end up being at more risk with the neck not as strong as the male. when women work, the impact is

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

if the concussion occurs in this setting, the response to the brain could be different. in the same way that we were 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. the risk multiplier is previous 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 occur, it happens when the brain needs it most for development and you understand prolonged symptoms that are worse over time. these contributions are on top of the mechanical. >> it is a common cause of death in children. >> it can 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. >> my image shows 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 boys, 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. say i got another one, i could be ok or in bed for a year. >> what was the most severe concussion? >> i went up for a header and hit another player.

when i came to, i was disoriented, confused. once i realized where i was, i decided to keep playing. i did not tell anyone. we had state semifinals and i wanted to keep it to myself. i was eating lunch and opening my jaw. i felt a crunching, a serious crunching, and i was scared. we went to the doctor and they were concerned. they 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. >> i advise students that you 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

fatal called the second hit 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 concussion that causes the brain to swell and can be fatal. close in time concussions are the most dangerous. >> because the brain swells. >> you hit it and boom. >> the symptoms will be worse and longer-lasting. each concussion was worse than before. >> is there an issue with accurate reporting? >> it 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 is hitting a head and the ground. when somebody comes by and knees you, it can be 3-4 in 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. >> that is where animal study ies come into play. you can control the interval and understand the critical number and the interval. >> our understanding is that the

rates and patterns are dependent on data from clinical settings. young athletes have choices and, if i got her playing sports, they would tell me to to go to a 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. this is a major problem and, i can think of few areas of medicine where such serious damage can occur and there is

such ineffective 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 see is an experiment done at the 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.

you see dark 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. now, it turns out that there is a drug that prevents this process from occurring and it has been known for a long time. it is a free radical scavenger. the brain uses oxygen and the downside is that oxygen produces chemicals that, if they get free, produced damage. this sops that up. maybe a glimpse of what is 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 to a real concern that these are relatively short-term consequences and there could be a possible serious condition . 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.

it is a bad actor and it is deposited in the brain and in this condition. initially, we thought this was a rare event and, unfortunately, we found players have very small 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 stage and we do not know how frequent it is or if the spread occurs in everyone.

certainly, that is the biggest fear. >> there aren't some that are approved for use and would have 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. of all the 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 that you have an injury does not 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 catastrophizing the injury is important. >> what is important is that we have spent a great deal of effort on diagnosis and looking for potential treatment, having spent little effort on primary prevention. i think that it is important for parents 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 recommendations and there have

been strong recommendations about limiting the number of days a week football players are allowed to participate in full contact drills. athletes 10 and under should no longer be allowed to head a ball while playing soccer. these are dramatic efforts to keep kids safer and 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. i want to know what to do when something needs to happen. i do not think anybody noticed.

>> well, 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? obama: we have to have better research, better data, better equipment, better protocols, we 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 next time. tell me what we are going to do? >> we spoke about sports trauma. we are going to talk about the psychological consequences that produce serious damage to the

brain. so, brutal treatment by parents or children and aspects of inheritance that have psychological brain consequences that are quite frightening. we will speak about the psychological parallels to physical trauma. charlie: thank you for being here. we will see you for the next episode. see you then. ♪

>> it is noon in hong kong. i'm here with an update of our stories. australia upon the guest growth in 15 years. gdp expanding 0.9%. describes the recovery as respectable. citigroup will not change its bonus pool. howgers -- depending on markets perform any final year. declining to comment.