will swear you and. >> do you swear the testimonies the truth, the whole truth nothing but the truth. >> thank you. both answered affirmatively and you are now under oath. your subject to the penalties set forth in title 18 of the united states code. i will ask you to give a five minute summary of your statement there'll be a light in front of you that will turn red when your time is up. turn your microphone on and bring it close. >> chairman murphy, and ranking members and members of the subcommittee, good morning and thank you for this opportunity to provide testimony on the important issue regarding youth and youth related sports concussion. i commend you and your colleagues on the work of this committee to shed light on this critical issue. my name is kelly

janz, i am the mom to jake's naked burg. my son was your typical all-american boy devoted to sports, his friends, and her family. jake was often referred to as her social butterfly. he had a big heart and genuinely cared for those in his life. he had a joy about him that others could not resist. his a big a big brother summed it up best when he said jake drank up life like it was pouring from a fire hose. he gave 110% and everything, especially sports. on september 18, 2004 jake got up at 6:15 a.m. in anticipation of his freshman football game. he loved football and all its offered, the physical challenge, this spirit of competition, and most of all the friendship that were involved. he was excited about playing this game because he had been held out of a few practices because the week prior he had suffered an injury where his arms and hands went numb and tingly.

what he described to us sounded like maybe he tweaked his core strength is now. he had had not lost consciousness, he did not see stars, you would not have associated it with the major type of injury. he did not report to his dad or me any headaches during the week, though his friends had said that after that injury he had complained of some headaches. regardless of regardless of that, he was able to return to practices and meet the required number of practices to play on the game day. in warm-ups on the 18th, jake took a really hard hit that appeared to shake him. he noticed me looking on and waved me off to let me know that he was okay. when the game began and he lined up for a play, right before

mac that is what our family did. we were so proud when patrick carried his team to victory. sadly, we lost an amazing young man before he ever had the chance to live his life.

a gifted and promising young children like patrick all over this land are winning battles on the sports field, but sadly losing their chances for a happy, healthy, productive future. his tragic and it was not an isolated incident. parents need to know that one in three players may develop cte. so just coming home and athletes are being diagnosed with ptsd adhd, anxiety, anxiety depression, drug addiction anger issues, et cetera. when in fact, they may have cte. when i see a guy on tv hitting his wife, shooting shooting his ring, are going on a high-speed car chase, i wonder if maybe he played one too many football games. people need to know that this invisible disease is more common than we know.

that it can develop in youth high school, and college levels of collision sports. families need to know what the cause is and what the symptoms are and how to address the disease. this has been hidden in plain sight for much too long, it was was this realization that prompted us to form the patrick cte foundation and the website stop cte.org. we also created a brochure, flag until 14 to help parents understand the key issues of cte. heading the ball has recently been eliminated from youth soccer, checking in hockey has been eliminated in youth leagues. yet, over 2,000,000 children are still putting their precious brains at risk in tackle football. the urgency of this problem is beyond measure. i wish we would have known the truth 25 years ago. there are those out there who would prefer parents did not know about cte.

they will office gave the issue for arguments. they'll say you can get a concussion writing a biker you're turning our warriors into pansies, or do you want them to sit and play video games for the rest of their lives? when you have lost your son to cte, and you understand how it is caused and how prevalent it is, these arguments are hurtful and in my opinion keep children at risk. we see cte as a human tragedy of immense proportion. we need to help everyone in this room and beyond. we all now have the duty to save children and families. cte is 100% preventable. we need to remove repetitive head trauma from youth sports. to do anything else is to be complicit to the problem knowing more families worse will suffer

the pain that we personally endure every day. thank you very much. >> i think both of you for that moving testimony. i'm just going to ask you one question, that is you mention that patrick began playing football at age ten and continued on, do you know if coaches, anyone working with the teams had any specialized training to recognize, or be aware of concussions and injuries and if it was discussed with his team mates. you know there is any that training? >> at that time i knew most of the coaches personally, i would have to guess no. we are going back a ways before people started talking about it. >> was he on the collegiate level two? >> at the college level, as a parent i was never informed of anything like that.

>> okay. >> that would've been nice to know them, but no. >> missed chance, can you answer that too? any training that you thought coaches had to recognize, be aware of anything with concussions or head injuries? >> not back injuries? >> not back in 2004 when jake experienced this. even jake's stepfather and myself are both medical professionals. while we understand obviously hitting your head is a bad thing, we we certainly did not have the background that we have now where you would have the opportunity to truly step back and look at it. perhaps he would have been pulled and not play the next week. so i think in those times we did not have that, now we have an opportunity to make sure that coaches and people involved with our kids have all of that information. >> thank you. >> thank you. just following up on the chairman's questioning, ms. janz, i've been given this

pressure, i think your foundation was involved in helping put this together. it is called reap, remove/reduce, educate adjust/accommodate, pace for the center concussion at the rocky mountain hospital for children. it really goes through a lot of information for educators and parents. it is a wonderful piece. i am wondering, is this distributed, what do folks do with this? >> it is distributed and available. we have made it available to school districts, to various groups. actually i'd like to say anybody i get to listen i'll be happy to give that to. it is a comprehensive way of

managing concussions and it is community-based. it has a section for parents and it has a section for medical professionals and a section for students. also teachers, so everybody has a different piece in this. we are we are not with our kids 24 hours per day. >> and you also have formed of foundation, an advocacy foundation, i am assuming that you also have been working to get information like this out to parents, educators, coaches. >> right. our current goal is that we are working with medical examiners and corners on one end trying to get them to recognize the disease if they are. prevented with a drug overdose, suicide or something like that. on the other end we are trying to get push for parents to have informed decisions that flag football is fun and it could be a lot of very famous of football players never played until high

school. >> and you have your brochure. >> yes. >> your daughter made that? that's wonderful. >> i ask unanimous consent to put both of these pressures into the record. >> without objection. >> thank you for coming. >> we want to thank our first panel, they just called votes so we are going to take a break and vote. we will do that as quickly as congressionally possible. we'll come back, this will give the second panel a time to sit down and be ready. i ask members to get back here immediately because our goal is to finish this hearing before the second set of votes. thank you, this is recessed for the votes. [inaudible]

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[inaudible] [inaudible] speemac, thank thank you we are going to move right away so we want to give everyone the opportunity to testify. i would like to introduce the witness for the second panel. we have mr. eugene buddy, we'll eat up the second panel he has been head football coach at dartmouth college since 2004. he has implemented non- contacted practices. i believe you are also a teammate of of the famous coach from howard university named tim murphy. he is my twin. my like to welcome doctor andrew gregory. mr. kevin -- of usa hockey, he has 20 years experience as a certified athletic trainer now serves as manager player safety

at u.s. hockey. next mr. steve he has served as executive director and no president ceo of la crosse since 1998. then mr. terry o'neill was the founder and ceo of practice like prose,'s mission is to educate high school coaches on alternative practice regimens. next, doctor dawn comstock who is asked associate professor colorado school of public health and a leading expert on high school surveillance. and finally doctor thomas -- >> how is the correct pronunciation. use with bioengineering at purdue university. he is the founding codirector of produced mri facility and a part of the redo trauma group. i

think all witnesses for being here today and i look for to having a productive discussion. you are where the committee is holding investigative hearing and in doing so has the practice of taking testimony under oath. do you have do you have any objection to testifying under oath. see in none i advise you under the rules of the housing committee are entitled to be advised by counsel, do any of you did desire to be advised by counsel today? see no then please write and raise right hand i was aware you in. you will swear that the testimony are about to give is the truth, the whole truth nothing but the truth? thank you. all witness answered in the affirmative, so you are now all under oath subject to the penalties set forth of the united states go. i will ask you to give a five-minute summary of your written statement. please pay attention to the light of front because we are on tight time. you are now recognized for five minutes. make sure your microphone is turned on and you pull it as close to you as possible. almost touching. almost touching. >> thank you mr. chairman. i like to think kelly and care for their testimonies will. it well. it underscores the importance of the committee.

closer? as i mentioned i would like to thank kelly for the story. i am buddy i've been a college football coach for 35 years. i've coach and ivy lee, d sec, the pac-10, the big tank conference usa and the yanking conference. during summers yanking conference. during summers i work with age groups, peewee's through high school age kids. football is a very special game. the life lessons with all the team sports, things people people learn, the friendships they make, the experience they have, i love the game of football. but i love my players more. looking at concussive head injuries through the course of time, i was five years ago made the decision that we would eliminate tackling from our practices. in season practice preseason practice, and the guarantee i make to parents is, their son comes to dartmouth they will never tackle or be tackled by another dartmouth ballplayer for the four years. making that decision i was not

100% sure i i was doing the right thing. i worried about my players, or as i putting them at a competitive disadvantage? was was i preparing the believer games? it was not a popular decision among my staff. it went from complete ridicule to disbelief to condemnation in some parties. i was convinced however, i did a lot of research on it that the weight we teach tackling was not the way we tackling gains. what i looked at at length is a defensive tape and how we tackle. we try to replicate that tackling that we saw against pads and other players, and going to the live concept, tackling sleds, we developed at dartmouth the school of engineering a mobile tackling device which is been beneficial in terms of replicating a moving target. with that, we actually tackle more than anybody else in the country.

each of my players annually, 800, 500 or 800 tackles per year. but never one against another human being, the timer guys tackle or ten games the only time our guys tackle or ten games per year during the course of the season. what happened is our injury reduction has been phenomenal. miss tackles which we drop track dropped significantly. people asked me whine quite simply, the skill of tackling, we practice more than we did when we're tackling my. it is a shame but it is a shame but in our sport the most injurious act, tackling is the one that is practice the least because of the risk of injury. so by putting our guys in a position to tackle with regularity and it was not anticipated we become much more efficient than in the sport of tackling. you hear rug be tackling, football is a different story. shoulder tackling we do preach. we do not talk about the head other than take it out of contact points. it's like writing a book, you

don't just throw someone on a bike and let them start to figure it out, there is a process, training wills and so on, support from parents. support from parents. i do the same with the ballplayers. a lot of folks ask if they can do that at different levels without question. people look at the nfl and i use them as a model, they hit less than anybody in the world. there concussive results in practice are probably some of the best. we have gone from a football team that struggled to championship team and at 117 games the last two years. iv championship this year, we had zero defensive concussive injuries. it is all a process of how you present to your players. the buy-in has been appreciable. it it has been wonderful, recruiting standpoint. in other people use it and i speak naturally with this, perhaps cool, youth football, they'll say will how do you teach someone who is never tackle the human being. bullets paul, walk run.

start with pads and progress four. i fully believe that at any level the approach we take and a kick on a video if i could now think i have time. we will demonstrate more accurately than they could with words how we actually practice tackling. >> we tackle literally every day that we practice. we people in position to execute. they practice different, the defensive line, we have broken it down to the kinds of tackling and repetition the end result is they at a very high level.

>> it thank you very much. i now recognize doctor gregory for five minutes. >> chairman murphy, members of the subcommittee, my name is doctor -- i am a pediatric specialist that -- i'm with the american college of sports medicine and a member of usa football medical advisory committee. i am at not a you usa football employee nor do i receive compensation for being on the committee. i'm the parents of an 18-year-old daughter who is a soccer player. thank you for the invitation to testify on the behalf of usa football. in short it is the national sick

body and member of the u.s. olympic committee it is an independent, nonprofit organization. we create resource and direct program establishing standards using the best available science and educating coaches, peers, and applets. our programs are endorsed by more than 40 organizations spanning medicine and sport including the american college of sports medicine, the national athletic training association. i would like to highlight three elements of how usa football addresses player safety. the first of that is education. we train more youth in high school coaches can buy than other organization in the u.s. education is the core of our heads up football program. we are going to highlight that. this is is delivered through online courses and imprison clinics. there are six educational components to this program which you can see listed on the sly. concussion concussion recognition response, fairness and hydration, sudden cardiac arrest, proper equipment fitting and then tackling a blocking techniques. more than 6300 youth leagues in 1100 high school hundred high school nationwide's represented about 1 million young athletes in rolled in heads up football in 2015.

the second element is research. usa football football advances player safety by commissioning independent research. according to a 2014 youth football study encompassing more than 2000 players leaks that participated in the heads up program showed a 76% reduction of injuries during practice, 38% of injuries during games, ready for% fewer concussions during practice and 29% decline in concussions during games. a subset of this group showed the players in the leagues had enrolled in heads up football had fewer impact during practice which made quite to more than 100 fewer impacts in the season. on the high school level fairfax county public schools have have reported 43% decline in football league concussions

since 2013 for 3000 players since implementing heads up football. a24 football. a 24% decline in overall football injuries. finally we'll highlight innovation. usa football provides practice guidelines, practice planning tools and defined levels of contact. you can see the levels of contact listed on the side including air, bag, control, which is a noncontact or non-taking down rule, flood which is a control drill what you are not taken to the ground but there is contact and then finally live action where you are taking down to the ground. more young football are in the fundamentals of advancing to full contact. where usa football program is in place, today's youth football is not the same as it used to be for your children or what you may have watched. will conclude with a video showing the difference that usa football has and the difference we're making.

>> the pilot program for heads up football may be the first player safety coaches it completely changed everything, were looking around going why are we not all doing this. there is nothing here that fundamentally changes the game of football. there's nothing here that we're not currently teaching. were just were just teaching a 25 different ways. ultimately there is a sena return that were making the game safer. >> it's the right thing and responsible thing to do as a league administrator i cannot even imagine. heads up football has change the way we play. it it is change the way we practice, we have one consistent match of what were

talking about how we are teaching our applets to play the game. from ankle biters by their through 12th grade, we have one consistent curriculum. that's part of the establishment of what we do and how we coach now it helps us to be a better community. we have seen a sound decrease in concussions, inclusion injuries we are able to show with data what the differences. several high schools played in back to back state championships and have fewer injuries than about 25 high schools. that's a big deal. >> were making tackles now then we went made a few years ago just because we constantly hammer in the basics. our generation is getting taught a different way to tackle like this is the right way, do this. do it yesterday, both from the youth core level and then from the high school level. this is only making this a better game. better, safer game. >> thank you. i will now hear the testimony for five minutes.

>> thank you chairman murphy ranking member and distinguish members of the subcommittee. it is a privilege to be here today on behalf of usa hockey to discuss the issue of player safety. usa hockey takes safety as a top priority, it always has and has been a leader in safety among youth sports. safety starts with our leadership and goes on down to the rest of our organization from our president jim smith our executive director executive director, our chief medical and safety officer, who it's from the mayo clinic in rochester, minnesota. the chairman chairman from our safety and protective equipment from saint elizabeth medical center in boston, he chairs a committee that is been around for 40 years which guides our board and making safety policies for sport. the usa hockey foundation yearly awards grants in the areas of injury prevention and research with ice hockey injuries. recently i was hired as manager of player safety, full-time position that usa hockey.

which further shows a commitment to safety in our sport. finally, we have had hockey equipment and certification counsel which was urged to be formed by usa hockey in 1978. this is an independent body which studies equipment that manufactures and meets the standards of protection in ice hockey. when we look at prevention, we start with our rules and enforcement. we have a very strict officiating education program which involves online modules for rest at every level. classroom work and on ice clinics. at every level i officials are working, they are supervised, mentored and given feedback and shown videos of proper rule enforcement to make the game safer.

we have implemented stricter penalties with emphasis on boarding, charging, checking from behind and had contact. in 2009 and 2010 a rulebook focused on the standards of a rulebook focused on the standards of play and emphasis on body checking. in 2011 our executive board rolled to make a rule change which increase the legal age of body checking in our sport from 12 and under level to the 14 and under level. this decision was based on scientific research, not only on player skill development but also safety and injury risk between those age groups. in 2009, usa hockey created the american development model. this model is an age-appropriate skill development and training based off of research of long-term athlete development. our coaching education program has been a gold standard in youth sports for years. in 2011 in 2011 and 2012, there became online required modules for coaches which include concussion awareness and recognition for all the age-appropriate levels. within the structure we have published a check in the right

way for youth hockey which is an age-appropriate for skills to properly body check in the game of hockey. it starts with skating and is always focused on attitudes, ethics, and respect for the sports and components. it goes from skating positioning angling, stick positioning in angling, stick position coming body contact and body checking. heads up don't duck was a program initiated in 1995, this was followed in 2010 buyer heads up hockey program. both programs emphasis both programs emphasis is playing the game with your head up, specially when coming in contact with the words, go poster opponents, keeping your heads out of taking a body body check. do not check from behind, and a library of skills and drills to teach these tour players. we educate our members constantly through information available on our website.

electronic communications through newsletters for parents, players and officials. which often have concussion awareness and education materials in them. usa hockey will start publishing and electronic newsletter specific to safety in the fall of 2016. currently the mayo clinic sports medicine is doing research to identify objective testing to identify those athletes with the potential concussion using blood biomarkers, sideline eegs in the king david test. the studies funded by our usa hockey foundation. finally on the treatment side, we have we have a comprehensive concussion management program available to all of our associations which is a minimum standard for any usa hockey program to follow. the biggest message and this is when in doubt, sit them out. thank you for allowing me to speak here today on this important topic of player safety and concussion. >> thank you.

you are not recognized for five minutes. >> morning chairman murphy ranking members and distinguish members of the house oversight and investigations subcommittee of the energy and commerce committee. my name is steve, name is steve, i serve as ceo of u.s. lacrosse. our nonprofit organization has proactively led and funded many sports specific prevention and research initiatives that have resulted in a number of interventions in the areas of rules, equipment, and education. we have all supposed to dissipate actively in the efforts of numerous collaborations focused on reducing injury risk which i have referenced in my written testimony. lacrosse is the oldest sport native to the north american continent. native american players were stocking men by jesuit missionaries in the 16 hundreds. modern rules for lacrosse were first adopted in the late 19th century but to distinctly different versions of the sport evolve for men and women. lacrosse has experienced an unprecedented surge of popularity in recent years. in part due to the formation of u.s. lacrosse is a sports first

national governing body in 1998. u.s. lacrosse established a sport science and safety committee when the organization was formed. that committee is comprised of prominent medical and research professionals representing a variety of specialties as well as representatives from a number of sport organizations. we have been described as one of the proactive sports organizations in the country relative to our commitment to injury prevention. we are recognized for our efforts in that regard last may through the introduction of kendra hr 267. our committee prioritize and recommends interventions and leaves that of element of educational initiatives intended to reduce injury risk and directed to coaches, officials players and their parents. my written testimony includes references to the published research and safety interventions u.s. lacrosse has led. we also have invested sneakily in the development and deployment of the sports first standardized coaching officiating curriculum.

unfortunately public school public focuses too often directed at equipment interventions which are less effective in preventing injury then assuring players are properly taught and games are properly officiated. among the biggest challenges we face is convincing youth leagues of state high school associations that require our standards for lacrosse specific coach and education is fundamental to a safer and more enjoyable playing experience. the prevention of lacrosse related concussion is a particular area of focus her u.s. lacrosse. we are committed considerable time and resources for research and prevention. the benefits of play and sports are well documented. while it crosses considered safe compared to other sports and activities serious injury such as concussions occur. as much as we have learned about concussion in recent years particularly the critical importance of recognizing symptoms and removing children

from play until clear by medical professional trained medical professional management. we also learned learned that no piece of protective equipment on the market today can prevent a concussion. the mechanism of injury is different from sport to sport, and in the case of lacrosse it is different in boys lacrosse and girls lacrosse. we have learned that the injury and its recovery can be very different experience for girls and boys. this demands further focus and study. we have learned that increased sports specialization at younger ages is increasing the number of injury exposures of young athletes in contributing to increases of overuse injuries on developing bodies. perhaps most important lay we have learned that the vast majority of children who express a concurrent caution can recover fully if there injury is recognized quickly and the receive proper care. concussion remains a significant health concerning youth sports. it will remain a priority for youth lacrosse. accordingly, we will continue to invest in research that helps us learn more about the mechanism and frequency of the injury and both boys and girls lacrosse in order

to advance educational, role and equipment interventions both effective in reducing risk. thank you for the opportunity to share my thoughts on this important issue as well as your efforts to increase health and well-being of our nation's young athletes. >> thank you. mr. o'neill you're reckless for. mr. o'neil you are reckless for five minutes. >> chairman, thank you. >> the microphone on please. >> is it on? put you as close as possible. >> thank you. okay. so mr. chairman. we like to begin if we may with a soundbite, 30 seconds from doctor n mckee which follows on many comments heard earlier this morning. doctor mckay is one of our colleagues, these were her comments two months ago.

>> is not about concussion, it's about limiting head injury. head injury that occurs on every single play of the game at every single level of this game we have to eliminate somehow the cumulative head had impact. to me, what our job is as american citizens is to maintain the health of these young athletes for the entirety of their life. if there something we can do to limit this risk it needs to be done immediately. >> thank you. >> immediately mr. chairman. the word chairman. the word we heard this morning as well that his arm meet middle name. immediately. let me begin by saying here's where we started with our chase for immediate results. the national football league, 32 teens, 2000 players as you know, practicing for five months in regular and postseason. there were 271 total concussions in the nfl this last year, 271. the question not in games but in practice. how many concussions on practice fields last season?

answer, eight because they learn how to practice. those a concussions a concussions in the universe of 271 represents 3%. now the big question, what is that number in high school football do you think? what percentage of high school football head trauma occurs on the practice field? sixty-75%. the worst most shameful statistic than all of football. this is the reason we are in business. this. this is the reason why a number of hall of famer's, at no appearance fee chase around the country with us, among them warren moon, tony dorsett, mike ditka, showing high school coaches on video how to practice with less contact. these men do this generously because they believe this is the future of football. so let's quantify our recommendations.

we are going to show you how they practice in the pros. this is called full speed to contact practice which means they run the playful speed to get the timing, the pacing, the choreography of the play. at the last moment, the woman of imminent contact, rather than tackle, they break away from each other. it is a football ballet as you see it here. here's dartmouth college, you will see a pass down the middle, a safety in practice here could light up this receiver with a perfectly legal hits. it is his teammate so at the last minute he veers away from it. he will say that tackle for saturday, okay. in the nfl cleveland browns, watch number 22 and white here. he will track this playful speed, everybody stays on their feet because only bad things on their feet because only bad things happen when you go to the ground. he tracks the ball, but at the moment he might tackle, he stops.

and lets the ball carrier continue. 48 and brown, lead black here, one of the most vicious hits in football. what hits and football. what does he do? forty-eight in brown, he identifies the player to be blocked, he comes to his, six is hit and just lisa's hands on it. what about this defensive back in the shadow? is he going to tackle on a wednesday or thursday? no. he did everything to put himself into position etc. make the tackle. seattle seahawks, same thing. and they going to tackle a teammate in the going to tackle a teammate in the middle of the week, or save it for sunday? they save it for sunday. contrast that now with high school football. here's a high school scrimmage quarterback has four teammates with their hands on them. i they going to hold him up rather than taken to the ground? this this has been a good practice exercise for everybody involved. we have learned a little something from it. let's go back to the quarterback. we take them to the ground or wrap them up and hold them? we took them to the ground and broke his wrist. totally needless. at at the same high school in connecticut, a

young man named cody gifford played. son of frank and kathy lee gifford. frank was a colleague of mine and abc sports, he actually made the team as a walk on. he can't believe how proud his father was. my son liam also played on the same high school and is a backup quarterback. frank gifford and i used to talk about this frequently. one day we said and put together the composite injuries between her two sons. concussions, the fractures, the new ligaments. how many of those occurred in games and how many practice? two in games, eight in practice. utter madness mr. chairman. so, what what we recommend to rectify the problem question we are the only organization of the five national organizations who operate in the space that is committed to immediate abolition of contact football below the

age of 14, and ninth ray. we want to convert those leaks to flight. no contact until ninth grade. once in high school, no full contact in spring, summer, off-season, three hours total in preseason, 30 minutes per week during the season. >> we have to wrap up so we can continue on. >> how does this compare to the other major organizations operating in the space question national federation of high school and usa football which operate in concert will allow three times as much contact is we do, pop warner is much as four times as we recommend. the ncaa, six times as much as we recommend. >> thank you. during questions if there's other comments you want to make were way over time.

>> thank you. it is an honor to be asked to testify for this committee, particularly representing colorado school of public health at the university of colorado. under congresswoman and her state. i'm here today because i run the national high school sports related injuries study. have done so for 11 years. in effect i've dedicated my entire career to trying to improve high school athlete safety, not because i'm a policymaker clinician, but because i collect the data that is needed to drive to informed evidence-based decisions. i want i want to share just a few examples today and describe why those are so important. this first slide shows high school data just simple concussion rates over time. you can see concussion rates were stable for a few years before dramatically increasing, in fact doubling between 2,082,012. they leveled off in recent years. understanding trends over time like this is crucially important

post so we can evaluate the magnitude of the problem and also so we can determine which intervention may be effective and which may not. only long-term surveillance information can provide this data. the next slide shows some of the information i heard earlier that we do not want to wait to try to do intervention work because we don't want to wait for the years and years to collect the data. we don't have to wait. i intentionally put just one year worth of high school data appear to show you that even with one year of surveillance we can look at patterns and trends across sports, across genders, across types of activity. this is just the tip of the iceberg. i capture up to 300 variables on every concussion that is reported to make system. i can tell you when, why how and to whom the concussion occurred. this. this data can drive evidence-based intervention

efforts. i, and many other researchers in the united states have the drive, desire, resources technological and methodological, and experience to be able to do this work at the youth level just as it is currently is being done at the collegiate and high school level. what we we do not have is the funding. injury surveillance can also demonstrate positive outcomes as well. very important. this slide shows that we actually had a big success when it comes to managing high school athlete concussions. in 2007-2008 academic year, 30% of athletes diagnosed with a concussion return to play in less than seven days which is a violation of return to play guidelines and disturbingly 8% return to play the same day they were injured, that is unacceptable. look at how things have improved. last year in 2014-2015, less

than 2% return to the same day they were injured. this is a result of prevention. not equipment prevention, but education and regulation prevention. effective prevention in public health, we talk about three legs of a stool, equipment is one piece in terms of concussion but educating individuals and providing good, strong policy policy based on evidence are the other two legs. i would love to come away from the efforts of this committee, incredibly important efforts with the ability to do this work at the youth level. currently, no one can give you this type of data for children playing sports who are younger than high school age. that is a travesty. we have got to protect our children who are sports because we want them to play sports.

i'm not against sports, not even against contact sports, despite my appearance i played rugby for 13 years, yes, i am only am only 4-foot 11 inches and i played rugby. i appreciate the fact that participating in sports is a very important way that children can incorporate physical activity as part of a daily, healthy lifestyle. we need everyone sitting at the table and our policy representatives like the distinguished members of this panel to work together to drive evidence-based, prevention practices now. now. we do not want to wait for 30 years to learn about long-term consequences of concussion. that that is secondary prevention. we need primary prevention. i already know that concussions are bad for us. i want to keep kids from being injured in the

first place. thank you. >> thank you very much. now doctor you recommend for five-minute. >> thank you. i am thomas am thomas and professor of electrical computer engineering up to university. i've been a member of recent years at the ncaa task force on concussion emma member of the scientific advisory board to the ncaa care consortium. i'm about a member of the concussion consortium which is a multi-institutional effort to bring together researchers who have a history of publishing and doing research in the area of concussion and traumatic brain injury together to so many problems. i served with a neurotrauma group, i'm also the lead pi for the purdue college of engineering preeminent team in engineering health your brains. as our rabid sports fan of the pittsburgh steelers and expert pirates and father of four active young children this is an issue near and dear to my heart has been for a long time. as a part of the neurotrauma group i want to summarize really quickly that our goal and our

proposal to the future is to achieve saver participation in you sports. our goal is to make sure more children can participate in sports more frequently. without risking injury or reduced risk of injury to something that is acceptable to us such as riding a bicycle or playing baseball or basketball. our goal is to achieve this in the education of applets parents, coaches, and healthcare providers regarding risks of concussive and sub- concussive injuries. through engineering engineering based improvements in protective equipment, through modeling and appropriate preventative methodologies that allow us to monitor exposure to head injuries and the risk and finally as has already been described, improved training of athletes. for the past seven years our pioneering study has been engineering based following the model illustrated on the slide where playing structural health monitoring, technique developed from basic materials and basic structures in our everyday

world, like claims bridges and automobiles so you do not strike evaluation, you document that material is in good health before you continue forward with its youth and as that material exists, you affect either repair or allow them to rest and recover. this methodology has been applied seven years in the study of high school girls playing soccer and boys playing football. in our study applying this methodology began like most of the other studies where real initial effort was to understand why some kids got a concussion and some kids didn't. we discovered rapidly and essentially driven research since that time that in truth many children we think are not injured are changing their physiology, changes in brain, strongly subjective an underlying brain injury. what is critical is not only athletes who are supposedly healthy who do not have signs of concussion and not diagnosed or examined by the athletic trainer

as having a concussion will look abnormal in this manner for five month after the season which means they may be spending ten months of the year in an abnormal state. we already know ahead of time it is never a good idea to hit your head the question now becomes how long is it these athletes are injured and what can we do to prevent that injury in the first place so the study has been going for seven years and if we are able to find funding in the future we will continue this study ideally later this year and we wish to be working from this methodology with the goal being that if we understand how inputs, mechanical inputs, whiplash events from the body, being hit in the head, snapping to the side of rotating abruptly will allow us to understand how each of those events affect the brain, we can go back and

correctly develop protective technology, helmets that will prevent concussion rather than skull fracture, we can develop appropriate methodology for identifying when an athlete should skip practice because clearly we want the kids to miss practice, not games, and be able to evaluate whether or not recovery has been truly complete. can we actually document that an athlete who has been pooled and is getting ready to return to play looks healthy enough that it makes sense for them to go back into play. with that, we really feel as a premier trauma group and myself as a researcher in engineering that most of these changes can be made with no cost to the enjoyment of the game but are very likely to improve the freedom and comfort to engage in these activities without any substantial consequences beyond is associated with other noncollusion sport baseball, bicycling or whatever and we really feel the science is far enough along these changes should be made now rather than wait any more time, 30 million kids every are exposed to

potential injury. there is no reason not to act. >> i want to recognize, start with some questions and let members know we are going to continue through that vote so we will start out recognizing the audience, nick lowery played for the patriots, jets and chiefs. thank you for your interest in concussions. shawn springs, redskins, patriots and seahawks, pro bowl, thank you for your interest in concussions and former colleague bill the dock getting greedy. he drove the mascot car. nice to know your skill sets were seen where they were played

by georgia tech. i recognize myself five minutes. from the perspective of youth sports organizations, what are the greatest deeds in terms of research related to concussion and player safety? your comments on those? >> for clarification the greatest needs? my first response is to agree with don comstock, we have the database in college and high school. establishing a database for sports injuries imperative. >> you have a comment on that? >> i would echo doctor gregory's statements that we need to have a database of injuries occurring in youth sports so we can make these decisions. we don't want to wait for the future but we need to gather this information. >> i agree. we are trying to do our best to

fund research, we need greater resources to drive the research into the youth play area. >> is there a way to help coaches and teams keep track of their own database? coaches keep track of their own data to see what happens with their own coaching style. have you ever done that? >> doctor comstock probably has a word here but the challenge is the quality of the data that is collected. unless it is collected well and consistently which coaches generally don't want to do, we are concerned about having flawed data. >> any comment on that? >> we are concerned about the quality of the data and that is directly correlated to who is reporting the data. at the high school and collegiate level we rely on athletic trainers to report this

data to us but i and others have been investigating ways to modify our surveillance system to enable a parent or coach who is trained appropriately and appropriately motivated should be able to report perhaps not 300 variables per injury but at least enough variables to drive forward a lot of these discussions. >> coach stevens, you did look for specific data. >> the conference in general overseas, each medical team in the institution to report back. >> it is helpful to give the feedback along those lines? >> it is. you see where you stack up to other teams. >> how significant is the issue of athletes not reporting concussions? if they themselves have symptoms but not giving that information on can you comment on that? >> i can tell you at all levels that is an issue. the problem is knowing what the symptoms of concussion are and

if you report to somebody, that person knowing what the symptoms of concussion are. i do think what don showed with that dated the concussion rates are going down as a result of education, coaches, athletes and players on the signs and symptoms of concussion. having said that, we have to continue those efforts so everyone is aware of that. >> want to comment on the player? >> the same graph that showed the doubling of concussion rates between 2008 and 2012, high school athletes didn't suddenly become twice as fast, strong and vicious. the years preceding that there were concussions occurring that were not diagnosed so the increase in concussion rates truly reflect a great deal of education that has been done by individuals on this panel and groups like the national state high school association to make sure when a concussion occurs it is recognized. >> may not have been prior to

that increase that concussions weren't occurring, they were just getting reported. that means educating players on the importance of doing this. >> and parents and families, parents of these young athletes, to educate them as well. >> this is an ongoing problem, this is working or you have a ways to go? >> the fact that that curve has peaked and leveled off actually is an indication coupled with the last slide i showed the chose how much better we are doing at managing concussions. both of those speak highly to the success we have had to date in educating parents, coaches, athletes, policymakers about concussion. we have further to go particularly in younger groups. >> thank you. yield for five minutes. >> i want to take a look at the science out there. by the way, it was really an excellent panel with everybody giving a great perspective.

doctor talavage, your work examines high school football players and high school soccer players. can you tell us from your research about the head impacts from contact sports and how they impact head injuries? >> yes. what we have observed is when athletes take large amounts of belows per week, whether they be of a modest side like 10 g or above 10 g is a reference, if you stand up and drop into your chair you will generate roughly 10 times the force of gravity acceleration on your head. when players are taking numbers of 60 to 70 blows per week in football for example those male athletes tend to start showing alterations in brain physiology that are suggestive of damage to neurons or at least some sort of impairment in the way information passes around your brain and results in you being able to respond to a question or task or achieve a target on a game or particular activity. for our female soccer players

who have been in our study they do not take quite that number of blows but one of the things we have observed is they get hit pretty much every day. in the state of indiana high school football practice two days a week, soccer, no restriction, they tend to practice 5 or 6 days per week. we find not only are the changes from the actual raw number of how they are getting hit but strongly appears to be a consequence at how much time off they are given which suggest there are natural repair mechanisms we can exploit and i believe when we have reduced contact cases we are benefiting our athletes. >> we had a form in this committee in march, you heard us talking about it. at that for him there were researchers who suggested we don't have enough science to act on this issue. they said we should wait until there is more research. what is your response? >> i don't believe that.

>> that is because you actually have scientific research? >> we have 16 papers and publications and working with several other institutions, penn state university, northwest university, michigan state university, state of nebraska, to publish work that shows there are changes in the brain. >> if you wouldn't mind getting that data to this committee that would be helpful for us in our investigation, thank you. i want to ask a couple of questions, doctor comstock, about gender differences, concussions and head drama. the surveillance data you suggested shows girls soccer has one of the highest rates of reported concussions among high school sports is what do we know about gender differences and concussion rates? are girls more likely to get concussions than boys? >> that is a million-dollar question. we reported in 2007 that in gender comparable sports, by the

same rules, same equipment on the same field, soccer and basketball girls have higher concussion rates than boys. that has been replicated by other researchers in other publications. what we don't know at this point people are working on the question is is a bio physiological problem? are girls somehow different? are they really sustaining more injuries or is it a sociocultural issue because we don't have a definitive objective diagnostic test for concussions, we are reliant on reports and young female athletes may be more likely to report it. >> do we need to get more data? >> we already have data that is consistently showing this gender difference. >> what do we need to prove it? >> this is a case where surveillance data isn't enough. we need more detailed research to determine if there are bio physiological difference or is it a sociocultural issue. >> you are not in your head. >> this is the intent of our study. if we understand how the brains are changing we can determine if

it takes less to do it. >> you have girls and boys. >> i want to ask one more question. you say there is no data, no surveillance for under high school-ages. is this something that should be instituted so people like you can get that data to see what is going on? >> yes. i will give you the name of ten other researchers who can. >> who should set it up? >> my work has not been federally funded. i had tween 9 funding sources in 11 years of surveillance, the ncaa fund their own system. i think it should be a federal effort but i don't care if it is joint effort of every one of these organizations somehow we have to do it. >> thank you for coming. >> votes are called, we will continue to roll through. >> i think the panel for being

here this morning. can i just ask you, your testimony when i read through it last night was like this is a revelation and seems so obvious once you understand marco my gosh this is a repetitive injury so you're not repeating the injury during practice so the only contact is on game day but that must have been a hard decision to make. when i was a kid growing up it was always repetition repetition repetition, practice practice practice. >> my coaching staff is waiting for a punch line. they thought i was kidding. i put enough time and effort into it and thought it was the appropriate approach. >> you feel now five years into this you feel you have -- >> a difference in practice safety, injuries have dropped. frontline guys practice through the course of the season defensively had, two players missed games this year, one with

an ankle sprain and without discretion, a lacerated kidney, a freak incident, he missed five games, that was it. the regularity, the rules of the game are get the guy on the ground, not injure him, get him on the ground. you can teach that skill set and we practice extensively and do a very good job understanding it is there is a risk playing the game, we can minimize the risk. >> let me ask you this. when you look at your record prior to instituting this program and in the years since, is there a marked difference? >> we were 0-10, 0-8 the last two seasons, 8-numtwo, 9.1. >> you have done better as a coach in that time. >> appreciably better appreciably so. >> fascinating story. it seems obvious, a repetitive injury, we will reduce the risk

by reducing repetition certainly want to thank you. >> the more you hit. >> thank you for bringing that, i am -- i don't know that i was aware of that. i don't know how i would've been aware of it. i want to ask you because when i started reading your testimony, marco my gosh, that would be dangerous, those other guys that -- dreadful stories you read about people who try to hurt each other in the game but you had the observation watching a practice it is almost like a ballet. do i understand that? >> yes. we point out with the video the players execute every aspect of the play in rehearsal for sunday until the moment of imminent contact at which point they break away from each other and pat each other on the back. in the high school level the proof of the efficacy of this is in the state of wisconsin.

the only state adhering to our standards at this point. put the standards in two years ago the 2014 season the university of wisconsin medical school did a study, results published last october, wisconsin high school football cut its concussions by more than half by adhering to our standards. that is a breathtaking number because in one year, quality of wisconsin football has never been better, players are ready to play. it is the high school model of dartmouth. >> is their widespread acceptance of that at the high school level? >> i am glad you asked. coach stevens and i went to the high school clinic seven weeks ago in madison. because of these restrictions and because the coaches need to know how to practice with less contact we had enormous

attendance, 125 coaches and the greatest follow-up we experienced in our 30 clinics around the country more than half of those coaches asked for copies of our videos so they could show them to their staff, show them to our players and teach their players in the 30 minutes, 30 minutes of contact per week in practice how to practice. >> i can't help but observe evan smith won dancing with the stars a few years ago, probably based on that same concept. word some pro players using dance moves and ballet moves to improve their performance? >> they were. this approach of less contact in the pros dates back to bill walsh of the 49ers in the 1980s and has been refined and developed by his disciples along the way to a point where so many college players look forward to entering the pros in order to

avoid the carnage of 90 minutes twice a week will contact in college practice and instead practice the way the dallas cowboys have for many years. >> thank you, i yield back. >> i recognize mister county for five minutes. >> i think the moms that were here. i want to thank kelly jensen, kinzle zegel. mister o'neil, you showed that video of doctor mckee answering my question at that roundtable and i wanted to focus on cte because i think very little focus has been on these sub concussive brain injuries and as she said it is about limiting the head injury that occurs on every single play of the game at every single level of the game and i followed up that question to jeff miller of the nfl, the

chief person for health and safety and said what do you think? is it linked to football? he said yes, certainly. little did i know that this was a kind of explosion that happened outside that room. even started some conversation about what is the future of football, is there a future for the kind of football we play? there has been a lot of talk about concussions but i wanted to ask now more about cte. doctor talavage, what does your research indicate about the effect of hits sustained by high

school players and brain function even though they don't rise to the level of concussion? >> at this point the linkage is a little nebulous coming from our end. when you are able to look and see individuals have experienced large numbers of hits over there career, tend to have more deficits and are more likely to have a cte, there is good circumstantial evidence for clear linkage between total exposure and total amount of brain stress accumulated from getting hit repeatedly day after day, year after year. within our own athletes what we can identify as our athletes spend 5 to 8 months of the year in a state of almost chronic inflammation. when you have chronic inflammation that is a bad thing, the cells are not able to eliminate waste, not able to bring in nutrients to keep those cells healthy. if what we are seeing has proven to be true in continued study that we do have a level of chronic inflammation essentially

for 5, 8 months of the year we are definitely putting our athletes at risk for types of biochemical processes that will lead to cte. >> is there a test for cte before autopsy, after death? >> there are several imaging methodologies that propose to identify the presence of biomarkers in the body but there is nothing that has yet been confirmed. >> my understanding is the kind of sub concussive events have to do with the brain inside the skull and have virtually nothing to do with helmets. >> a helmet can absorb energy and it would be very easy to improve helmet designs but companies are not interested in it. their goal is to meet standards and the standard set forward to prevent skull fracture and death on the field which was their goal but they do nothing to

prevent concussion at this point. energy absorption would reduce the amount of energy that reached the brain. if you reduce the energy that reachs the brain you will reduce the torsion, pool, stretch, compression on cellular tissue and if you do that you will start to see a reduction in sub concussive hits, you should see a reduction in the observation of concussion and in the long-term see a reduction in situations like cte. >> doctor comstock, you don't think kids under what age should be playing tackle football? >> i never made any recommendations. >> i thought you said something about that. >> other researchers have given cut off points. >> did someone on the panel say that? >> i did. our organization is the one in 5 national organizations operating in this space that believe strongly that gradeschool boys and girls should play flag football exclusively and contact football should start in ninth grade with a transitional phase in seventh and eighth grade

where in shorts and t-shirts boys who intend to play in ninth grade learn how to tackle and block using state-of-the-art in tackling technique called see hearts -- seahawks tackling. one of our leading supporters and a fellow who tours with us has made a number of videos for us. >> there has been a good deal of pushback after jeff miller made his comments, gerri jones, owner of the dallas cowboys, has absolutely disregarded that. there has actually been some marking of that. this idea of conduction between manliness and football is really concerning.

i wanted to ask a couple of other questions. doctor gregory. if -- let me ask you before my time runs out. usa football guidelines limit full contact practice to four times a week, but this represents more contact practices that occur at higher levels of football like the college level and even in the nfl. given all this evidence of repeated hits to the head why hasn't usa football taken steps to further limit full contact practice for young children? >> the question is a good one and we recognize tackling causes injuries. if you look at data we do have an youth football. >> so why haven't you? >> what we have instituted his ways of trying to decrease the

number of hits that there are. if you take it away completely you still have to learn the skill. at the youth level we don't have the resources we have at high school or college level to teach the skill. we are trying to teach the skill, to learn how to tackle appropriately. that is the goal, to do it well and protect your head. >> thank you. at this time i will recognize myself or five minutes to ask questions. mister o'neil, thank you for the work you do, the information you gave us today. you advocate children under 14 should not be permitted to tackle and should be limited to high school athletes which how do we are sure they learn proper tackling technique so when they do into game situations they are not going to resort to instinctive or more dangerous tackling heading down whatever the case may be? if they don't get that practice when the contact is not as hard as it will be later is there a

concern of them internalizing those techniques? >> of staff would allow me to queue up the 17 second video clip which j is number 24 on our agenda here. 's coach seto is the guru of tackling. he and pete carroll have devised a system in seattle that has become the standard in just two years, introduced two years ago in the spring, they put out three videos and coach seto tours with us. it is not that. it is as i say number 23. rocky seto tackling in shorts. to answer your question, what we recommend in seventh and eighth

grade. rather than hitting each other they need to learn in shorts and t-shirts an introduction to weight training, they need strengthening of their next which all scientists would agree is important in preventing concussions. they need to learn how to where the pads and be ready with this gradual run up to ninth grade to be prepared without the many collisions in use contact football. as we heard from doctor mckee so eloquently two months ago it is the cumulative head trauma that causes brain injury. you don't want to start that at age 5 which is permissible according to some organizations are presented here today, boys 5 years old playing contact football in our minds is quite surprising. >> we will look at the video. >> i will be happy to show it to

you. >> examples of cases where young kids have not had contact until they reach high school age or been successful? >> thank you for asking. tom brady, eli manning, peyton manning. >> i have heard of those folks. >> archie manning has waxed eloquently in the washington post, his phrase was god, what a great game flag football is. my son, a quarterback would not be playing college football if he hadn't played flag instead of contact widget taught him everything he needed about defense, making decisions, making good throws, all the teamwork, believe me, those who suggest those qualities can only be developed in contact football have not heard my younger son and his teammates in the backseat of a car as i drive around recounting their victories in flag football four

and five years ago, the highlight of their athletic careers, already made football fans for a lifetime, they wore the nfl jersey playing flag, came out healthy with an experience that has made them the young men they are. >> coach stevens, any thoughts on this in terms of if you wait until you are older to learn tackle techniques is it a problem? >> they are still going to catch up quickly. one of tween 9 kids in high school had fairly successful careers. there is a litany of people, it is not absolute, the big thing is to educate, they are going to play at a young age, educate them properly, start slowly and make sure you deprive them of as much contact as possible. >> thank you for that. doctor gregory, anything you want to share? >> i will add that i think if you are going to take contact away the education piece is

imperative. also the usa football administered the largest flag football lead in the country and so we are proponents of flag football. it is not usa tackle football which is all-inclusive so it is important that we promote flag football as well. >> let's go back, mister o'neil, your organization is trying to change the culture of high school football by advocating limited contact akin to what is used at the professional level. in your testimony highlight the fact that only one state has adopted your standard so far. have others expressed interest? >> a good question mister hudson. what we need is more participation from state governing bodies around the country and is traveling, when a state governing body gets behind it, as happened in california two years ago, a piece of legislation passed there for the

first time in any state limiting contact on the practice field. they invited us out for a tour. coach seto of the seahawks, warren moon, we hit four cities in four days and had enormous participation because the cif made it mandatory for every state, every coach in the state. we saw 1200 coacs in two days. we are going to alabama in july, a very enlightened states, executive director who understand has made our clinic after seeing us last year, mandatory for every coach in the state. we will greet a ballroom fool of 1000 coaches in alabama on july 20th. >> any opposition you have received? >> absolutely. i dragged coach stevens to places where there were 450 coaches at a convention. in our session 20 showed up at

the other 430 were standing in the hallway saying they don't want to hear it. it is not like we are a raging success. it is next and it will be until the state governing bodies at least give us a hearing and mandate all stakeholders, not just coaches come into the room and hear what we have to say and see it on video. when we do we almost never fail to convert. >> thank you. at this time i will recognize mister paul for five minutes. >> earlier this year the ivy league received significant attention for their move to eliminate tackling during regular-season practices and the league now has no contact practice during the regular season as well as strict rules about the amount of practice during the spring and preseason. you implemented these changes at dartmouth several years before they were adopted by ivy league.

what motivated you to reduce the amount of contact in practice and what was the initial reaction when you proposed those changes. >> the injury rate was the stimulus too many guys going down, concussion surfacing and struck me as we can do this in a better way, watching what we did on research on tackling and we started to do it. it was not well received, it is still not well received by a lot of people. i made a recommendation at the ivy level in the discussion. all the coaches played against dartmouth knew how we played, the vote was unanimous. everyone was progressive in mindset to say this was the direction we should travel. >> how have the rates of head injuries changed since you implemented these policies? have you seen any other benefits? >> five years ago like most programs in the country 15 to 20

during the course of the year. this past season we had two preexisting situations, young men no longer participating, defense which was nationally ranked, had 0 concussions this year. spring practice the last two years of my numbers are correct we had 0 in spring practice, that is concussion season college football. >> full contact practice is necessary to assure success on game day and for athletes future careers. >> to the deck of eminent contact you can do everything you need to you can replicate tackling styles and i believe and try to convince high school coaches you can do it at any level, i have a 3-year-old grandson with tackle pads off of the couch and see he gets it and crawl, walk, run mindset can introduce skill sets down the road but don't have to be

practiced that frequently. >> given the research do you think engaging in full contact practice three or four times a week there is significant risk for young athletes? >> without question. the more you hit the greater the risk of injury by eliminating we have seen that in all aspects of the game, shoulders, next, backs, arms diminished appreciably. >> we see many rule changes being implemented across leaks, across states. there has been criticism that these upset the integrity of the game. what do you think of the announcement that pop warner is eliminating kickoff and kick returns, will that prevent brain injuries? >> good question. my reaction is this is pop warner's way of saying gradeschool boys are not capable physically of playing the game the way it is designed. they are making the argument these boys should be converted

to flag football until they reach physical maturity at 14 or 15 to play the game the way it is structured. we advocate know basic changes in the game and there will be no further rule changes that will make the game noticeably less dangerous. the game is the game. we don't advocate major changes to it but we say strongly boys in grade school are not prepared to play at the way it is designed and boys and girls are to be playing flag football until boys make a transition if they choose to play contact in ninth grade. >> just so i understand you don't think any other change would better protect the kids if they continue? >> it won't be football if we continue to strip away the kick return, the punt return, the three point stance, any number

of proposals out there, we think those are ways, heads up tackling is an attempt to sanitize the very difficult, physical act of tackling, tackling is tackling, rocky seto's seahawks tackling defines it as it should be done at three levels of football where the game should be played. if boys can't tackle the way the technique was designed they shouldn't be playing contact football they should be playing flag until they are ready physically to play. >> thank you gentlemen. at this time i will recognize my colleague from virginia. >> i apologize i took my jacket off, ran out to vote and i got wet. i apologize for that. mister o'neil. my boys are 8 and 10.

my 10th girl tried tackle football. it is not available for him now. have you all done studies and testimony on how many kids because they are not ready to do tackle drop out of the sport? >> we haven't but it is a very good point. football loses any number of good candidates for the fact that we throw these boys in unprepared physically at a young age. there is a soundbite i am adding soundbites i would like to play when we finish but one minute of john madden, former colleague at cbs tells the story wherein his son, coached ninth grade football at a school in california for 15 years and john said to him if you take a boy who did not play contact youth

football, a pretty good athlete, match against a boy who did play contact football through gradeschool how long would it take the boy who did not plan to catch up with the skills of the boy who did? joe maddon, his son, said to him one week. one week it would take him to catch up to what supposedly had been learned by a youth contact player those eight years he took that head trauma from age 5 through 13. >> i appreciate that. have to move on. i was intrigued young women having more concussions than young men, do you have enough data is that true through all these groups, middle school high school and college? >> in the age groups we have good surveillance data it has been consistent with my data and other good surveillance systems, the high school and collegiate age group, in middle school and younger age groups we have very small studies of one league or one school district based on

those. we don't have national surveillance to answer that question. >> we have limited time here. mister stantonson, the us invested in deployment of sports first standardized coaching and officiating education curricula. you observed probably trained coaches and officials are the most effective interventions for player safety. is that based in part on changes you have seen on injury rate since deploying the curriculum? >> in part yes. it is more based on our fundamental belief that if we can't teach a sport correctly the outcomes are get though it -- not going to be what you want. i would add part of the challenge we see that hasn't been mentioned is in sports like soccer and lacrosse we are

seeing significant privatization which means kids are playing more frequently more games at younger age levels. privatization and sports specialization is compounding this concern. >> you mention one of the biggest challenges, why is that a challenge if you are quick, i will appreciate it? >> culture and tradition. >> the good news is my 16-year-old daughter had a concussion and they pulled her out for two weeks. she got it playing lacrosse. i have only got a minute left. there is something you haven't had an opportunity to touch on you would like to. >> no. >> you agree that the more we train folks on how to do it right -- >> we have a lot of that built

into our coaching which we have had. >> do you have the same by in difficulties? >> not all high school associations are governed by us hockey so we don't have any influence there so there is no uniformity among those leads. >> there is a lot of privatization. mister stenderson mentioned that, playing youth lacrosse and that is outside the city directly, the high school arena school systems. i came back because i thought this was an important hearing. i appreciate your testimony and we will continue to work on

this. >> i recognize mister tonko for five minutes. >> appreciate witnesses being here today and having this panel of expert witnesses is a good opportunity to have dialogue on how to further enhance this. i would like to ask some questions about changes to rules governing contact especially for kids. doctor gregory, you are here as a member of the usa advisory committee. what can you tell us about the guideline changes usa football has made to making the sport safer for young athletes? >> you are probably aware there are practice guidelines in place to limit contact as part of the heads up program showing increase of decreasing injury and that is contact, 30 minutes per practice more than four practices a week. decreasing the number of potential hits which has been

shown to occur by limiting the amount of time. >> my understanding is usa football does not operate in seven teams. >> that is correct. we can only make suggestions, the same problem, we want these leagues to follow recommendations but we can't enforce them. >> it is just a recommendation, no way to implement those guidelines. >> no way to enforce it. just like my other colleagues talked about by showing them that it worked, you get buy-in from youth coaches. >> have you been monitoring the rate of injuries, particularly head injuries since fomenting these changes. >> three areas we showed with dateless youth football study, fairfax county information here and indiana the programs that implemented the heads up

football the educational component all injuries head injuries all went down. >> do you know anything more than that, dropping -- >> numbers already but i can get them to you. >> as long as the committee has them. we have heard from coach stevens about his success at dartmouth eliminating contact practice from mister o'neil, practice like prose advocacy for additional rule changes to reduce contact for young players. the ivy league has eliminated contact practice and the nfl allows 14 contact practices over doctor talavage, what do these measures like reducing the number of contact practices and giving players longer rests between such practices to 4 players, what is the effect as

it relates to the brain? >> the more time off they have the more opportunity for the body to repair any damage that occurred, the more time you give them off the less likely they are to be impaired and less likely to get hurt in the future. >> given what science is telling us why has football not considered stricter rules for guidelines to eliminate contact with players. >> what has been demonstrated at dartmouth and the high school level is fairly new and compelling and the challenge is can we replicate this at the youth level without the resources they have at the collegiate and high school level and that is the difficulty. we can make recommendations, we can enforce it. for us we have to make sure if we make a recommendation like that we back that up by understanding it can be implemented if we recommend it and that is what we need

resources to do. >> yesterday pop warner announced they would eliminate kick returns to reduce head injuries and reduce contact practice, 33% to 25%. do you think these measures will be effective using head injuries for kids? >> they are a good start. the main issue back to one quick comment from before, one or two or three hits per game will not have a terribly substantial effect. i would be more excited to reduce contact practice time. >> those would be the first additional changes you would encourage. doctor gregory, is usa football considering similar measures? >> say that again. >> is usa football considering similar measures introduced by pop warner?

>> this is an evolving game. this is up for consideration and implementations like this will be looked at and study and see if it does have the same effect youth has at other levels. >> earlier this month democrat sent a letter to scott executive director of usa football. and young football players, and concussive and some -- a response on may 25th, can you confirm usa football will provide the committee with response by that date? >> i can confirm that. >> i yield back. at this point recognize miss clark for five minutes. >> thank you. i think -- i thank our witnesses for bringing expertise before us. i would like to talk about the change in culture. we have to address culture and

attitude for a long time kids watched their idols deliver the hardest it feels, the most on the ice. as we make changes we also need to ensure that that permeates the culture as well. do you believe players are convinced of the importance of reporting concussions? >> they are getting there. it is incumbent on the coaching staff to make players aware it is okay for coaching staff members, the old-school mindset, the player may not respond. culture supports they will report. >> do you believe coaches and medical staff at higher levels of play take concussions seriously? >> i think they do. coaching profession is conservative and a lot of guys five years ago start coaching

five years ago they grew up at a time you didn't self-report, didn't know about concussive head injury and people didn't teach what they were taught as players. that is part of the culture that needs to change. >> do you think we have been successful in spreading that message? >> not as successful as we need to be, the broader the better, limiting injury, all about that. >> the same question, how can we convince players and coaches to report concussions and treat them seriously? >> great question. when we do our clinics around the country we quantified 19 cases of second impact syndrome you heard about earlier this morning, we tell those stories in detail with video of players involved, tell the stories of catastrophic injury in an effort to scare straight through the

coaches these young boys who need this information. i so my son's concussions as an example. he lied about his symptoms, did everything to stay on the field. only when confronted with an impact test that showed he had failed the cognitive index test, only then did he admit he was suffering a concussion is was going to miss three or four weeks of play. it is a huge problem still in high school football and we think it is a subject about which we need to be direct with players. we tell these stories to the coaches and encourage coaches to tell the players stories of what catastrophic injury can be in their lives if they don't self-report and self diagnose. >> many kids model their behavior after -- the athletes. we need to assure athletes at the highest levels are sending the right messages about taking brain trauma seriously.

what can the college of professional athletes in the league do to carry that message forward? >> coaches have to drive that message unless we change the way we coach the game. putting into place and mvp, mobile virtual player technical device, has been tremendous because we replicate a moving target at no risk of injury. steps like that, players follow the direction of coaching staff, coaching the coaches is critical to getting our message across. >> what is effective for us is taking hall of famer's around the country, warren moon tells the audience he suffered his first concussion at the age of 7 on a practice field in california needlessly, not an inner practice at the age of 7 and tells his personal story about hiding symptoms and coming to a recognition later in his career how foolish that was.

we take anthony around telling the story of playing for a coach in cincinnati who wanted to hit and hit every day including the day before games on a saturday they are hitting each other in goldline and short yardage drills before a sunday game and he says we have a new coach and that coach took our approach which was virtually no contact and we won both ways but he said i sure felt a lot better and my teammates did too, my second approach is so much more effective. >> any of you have any comments what you think the fans should be requiring? >> fans should be aware of it as well. it is not gladiatorial. we have someone's child playing the game and understand big hits, the rules of the game don't dictate taking people out of play by forcing injury, just get them on the ground. if there is understanding that long-term people can be in jeopardy if we don't change the

way we approach the game. >> the hits of the week are not good hits if you ask us and that is what is being shown as a highlight, not the goal, got to change that. >> got to change the culture. it requires everyone who is participating. i yield back. >> i ask unanimous consent the national research council report sports related concussions, changing the culture introduced into the record. also want to do another promotion of the briefing but we are hosting on pediatric trauma may 24th and other interested

parties and in conclusion i would like to thank all of you witnesses and members who participate in today's hearing a very important issue, we gained a lot of insight, ten business days to submit to the record, to respond promptly to those questions. the subcommittee is adjourned. [inaudible conversations] [inaudible conversations]

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