>> this hearing will come to order. it will be an absolutely wonderful hearing. there are actually 14 centers in front of you. you just cannot see all of them. it is something we're working on with nasa. we have become invisible at proper moments. i am very proud that you are here, and i am very proud of our two senators over here. this one, although you never know looking at him, is a football player, or was, i guess i should say. >> it was years ago. >> so i am going to make an opening statement, and i wish each of them will try to keep it brief. we want to have plenty of time for you to talk and for us to question. i am so grateful for all of you being here. it is a mass of subject. the story which i may tell about my son it reveals that parents cannot always be as effective as they would like to be. i have not decided whether that

is an innovation of his privacy. anyway, every afternoon at the end of the school day, millions of our children had to the playing fields, and gymnasium's, or hockey rinks to participate in sports. playing sports is not just make our kids stronger and healthier, it teaches them important values. they learn about hard work, leadership, and about living with pain and going through it, about working together for a common goal. the camaraderie that comes out of sports units is wonderful to see. it is real, and it lasts forever. most of our young athletes will not end up playing sports at the collegiate or professional levels, but we hope they will all carry the positive lessons that they learn on the playing field throughout life, and they will. the hearing today is about the injuries that tens of thousands of these athletes sustain every

year while playing the sports they love. many of us are reluctant to talk about the risks involved in planning sports, because we know what a positive role sports plays in our community. on the other hand, the last thing we can do here is not talk about this problem of concussions and gear and all the rest of it. america has to have this conversation, and there will be many, many hearings on it, i know. more of our children should be playing sports, not your. to many kids are spending their afternoon in front of the computer or tv screens instead of on these boards feel. that is set every day by everybody involved in health care. i will give you a couple of pathetic figures. according to the latest data compiled by the cdc, only 17% of american high-school students get one hour of daily physical activity. which is our current health guidelines, they say that you need to have that to stay

healthy. only 17%, one-third of our children, are now overweight or obese, which it makes it more likely they will suffer from chronic health conditions such as heart disease or diabetes, things that will plague them for the rest of their lives, as what we will be talking about today could do to something about the risks involved in playing sports are also very real. by now we have all heard about the nfl players are struggling with serious mental and physical health problems because they sustained repeated mile traumatic brain injuries, which is what concussions are called, i guess, medically, during their planning years. it is very sad. i have seen a number of these players, people that i worship growing up, in wheelchairs'. who is the guy that played -- he was a cornerback for the

raiders. the greatest interception guy for of all time. woody -- i mean, it was awful. i was at an event with him, and he was seated in a wheelchair and cannot even pull his head up. i leaned down and whispered in his year -- i think i kissed him, too, not sure. having seen it this and that, especially this was eight years ago and nobody was talking about it. we now understand that it is not an injury only nfl players can suffer. according to research conducted at the nationwide children's hospital in columbus, ohio, more than 70,000 high-school football players sustain concussions every single year. it is not just a football program. one of our witnesses will talk about the concussions she suffered while playing soccer

in high school and college. according to nationwide children's hospital, more than 10,000 high school girls' soccer players sustain concussions each year. so what we're going to do is we're going to hear from ms. ball and our other witnesses today, who i should name -- dr. jeffrey kutcher. you're not in my opening script, so i have to do this. this is a bit -- from the university of michigan, director of nuero support. and dr. ann mckee from boston university, and director of neuropathology core, the alzheimer's disease center at boston university. and mr. mike oliver, executive director of the national

operating committee on standards for athletic equipment. we welcome all of you. of you. i will close right there and ask if the chairman of the subcommittee would wish to say something because he has been terrific on this subject, and also the ranking member. the head. >> thank you, mr. chairman, for holding this very important hearing this afternoon. as a former player, it is something i am interested in, but also there are so many moms and dads and coaches and players across the country that are very interested and probably should be more interested in what they realized. that is the great thing about having this hearing, to try to get the information out and discuss the potential serious problem. not a potential, very serious problem, but a serious problem,. .

sports help build youth and social relations and learn to work as a team while keeping them physically active and healthy and having fun. participation in high school sports is almost -- has almost doubled in the last 30 years. this is fantastic news and it is important to highlight the benefits of playing sports. participation also carries with it significant risk of energy. last week there was news of a tragic death of a high-school football player who died after sustaining a head injury during a game. it is important everyone, coaches, parents, physicians, and the athletes themselves understand those risks and be able to identify injuries when they occur. concussions have the potential for severe injury. multiple concussions can cause significant repercussions later in life. especially with many recent

media reports of high-profile incidents in the nfl, we often a secede football with consumption -- with concussions. concussions are a risk with playing football, but players in many sports run the risk of cystine concussion as we will hear from ms. bell and her story. it is important for those involved to be aware of the dangers associated with concoctions, know how to recognize signs and symptoms, and what to do if a player suffered a concussion. i will look forward to hearing the research to further the knowledge we have about concussions, but many questions remain about the causes and effects of concussions. i'm interested from hearing on the experts on what is known and where we can go from here. as we will also discuss, there is a variety of athletic equipment on the market that claimed to use concussion- reducing or confession --

concussion-preventing technology. navigating the many products and claims in the marketplace, especially on line, can be overwhelming. it can be easy to read the something offers the best maximum security protection, and assumed their child will be safe from injury. that is simply not true. some products they offer better protection than others, but we need to explore what resources exist to help parents and coaches know what level of safety and product will actually provide. i do not know how the average parent or coach can be confident that the equipment they purchase offers a great year safety benefit or if it's advertisement contains deceptive claims. i hope our witnesses today will be able to help me answer this question. along with knowing the safety benefits and limitations of sports equipment, parents and coaches need to educate

themselves on what to look for in the event that an athlete has a potential concussion. there are a number of different materials available for this purpose. perhaps the most well known effort is the heads up initiative led by the cdc and partnership in -- in partnership with a number of organizations and individuals. there also other campaigns for coaches, how to do proper execution of place and tackles. education campaigns must be effected in order to affect change i am interested to learn if there is the that that shows whether these efforts are reaching a wide enough audience in promoting awareness sufficiently. i know the hearing will draw attention to the issue. parents, coaches, and athletes must have resources available so they can understand the severity

of concussions and how to react when one occurs. the benefits from participating in sports are many, and i hope the potential for injury does not prevent anyone from plane. i think you for calling this a board hearing and look forward to hearing from our witness. i ask for consent from the statement from the sporting goods manufacturers association and usa football be in the record. with that i yield back. >> i thank the senator. senator udall has been huge in putting together all this. >> thank you for the nice comment, and i appreciate you holding this hearing today. i would like to say a few words and ask my full statement be put in the record. mr. chairman, i greatly appreciate your efforts to promote brain research and as chairman of this committee york close attention to consumer

protection issues. concussions used to be dismissed as simply dings or bell ringers. we know that a concussion is a form of traumatic brain injury that should be taken seriously. according to a recent center for disease control report, emergency room visits for sports and recreation-related traumatic brain injuries increased by 60 percent over the last decade. the cdc attributes this rise to greater concussion, awareness, which is a good thing. now that athletes and parents have a better understanding of concussions, some sports equipment makers appear to be taking advantage. there are a number of anti- concussion and concussion- reducing devices on the market. while we should encourage any innovation to protect young athletes, we need to make sure that advertisers play by the rules.

witnesses today can shed light on anti-concussion claims used by some sports equipment manufacturers. although we now know more about the dangers of concussion, we should not forget how important sports and physical activity is for children. the cdc estimates only 18% of american high-school students participate in at least one hour of physical activity today. that is the amount recommended by the department of health and human services. among high school students in new mexico, only 23% are getting it. this could lead to negative health consequences that last a lifetime. we need to encourage kids to play sports, to exercise, and to be more physically active. injury is always a risk, but the benefits far outweigh the dangers. as we learn more about the dangers of concussions for young athletes, which can take steps to make sure that they play more

safely. of what to think the witnesses for being here and testified today. i especially want to recognize ms alexis bell, traveled from albuquerque. in removing the testimony, i find it especially poignant that dr. mckee discusses a former nfl player who took his life earlier this year. in 2007 he testified before this committee. according to news reports, he informed his family he wanted his brain to be studied. he hoped people could learn more about the affect the brain trauma so kids could play football more safely in the future. in keeping with this sentiment, and took his hearing will advance the goal of making sports safer for children. thank you very much for being here and the ranking member for being here. i appreciate it. >> that is a powerful statement.

ms. alexis bell, i'd like to call on you first. >> thank you. i am a senior at the university of new mexico. i have played soccer since i was 4. it high-school i was a player of the year. my junior year in college i was the academic all-american, captain of the team, and received first-team all- conference honors. i was medically disqualified from participating in athletics in 2009. this is following to concussions i sustained at the beginning of the season. >> i want you to slow down a tiny bit so you did not miss a syllable.

>> during preseason i was offered to shadow a doctor in the e.r. it was clear i had a concussion due to the dizziness and seizure that followed. my coaches were not pleased when i informed them of the concussion. i sat out for a week. after that week i met with him again. he asked me than normal concussion questions. i was still experiencing headaches, it was the week of our first game and i wanted to play. i played for about two weeks. the third game, i took a header on the top of my head. i needed assistance to leave the field. the week following this concussion was horrible.

i was playing terribly. i was no longer able to sleep at night. i would fall asleep at 3:00 in the morning. i could not pay attention in any of my classes. the most disturbing change was a twist in my personality. i would go to practice and feel to avoid of the motion. i would sit in my room and stare into space. i did not know who i was any more. i thought that alexis, the high-performing athlete, was permanently gone. i took a test that showed my visual memory was impacted. my doctor explained i was experiencing symptoms of the combination of the two concussions i had sustained. i was shocked.

we talked about the status of my future in soccer. we talked about what would happen if i sustained another concussion. i had sustained 10 concussion. he said i should hang up my cleats. i had to separate my head for my heart. concussions are a serious injury to your brain. too often coaches and parents dismiss the severity of concussions because they are not a visible injury. this is not the case with concussions. a doctor cannot see a physical man the vacation -- a manifestation of the concussion. i had no idea my insomnia i felt was correlated to an injury i

had sustained. this is something i want to emphasize today. athletes should be aware if they sustained a concussion symptoms can last a lifetime. athletes should be aware of the efficacy of helmets. it was supposed to be prevented the measure against concussions, but clearly this did not hold true. it is essential for athletes and coaches to know athletes are not free from concussions because they have head gear. i believe is important to note the mentality of trying to play as soon as possible is very prevalent. there is pressure on athletes to deal with injuries or they will be in jeopardy of losing their starting position. this " is an environment where it is easy to -- the school is

an environment where it is easy to lie about your conditions. this is a very poor decision, but i do not understand the severity of concussions at the time. i continued to play much longer than i should have. i certainly return to the plate too quickly. people have only one brain for life. i will not be able to gain the respect that i lost as a struggle to the final season of soccer. in order to prevent more stories like mine, concussion awareness needs to be more prevalent. i believed most coaches and athletes do not understand the ramifications of concussion. people need to understand that wearing protective gear does not stop concussions from occurring. thank you for inviting me here today.

>> thank you. you did that extremely well. steven threet. >> thank you for inviting me. it is an honor to be seated here, on a topic that has changed my life, and i am happy to raise awareness of such a critical issue. dealing with concussions can be a difficult process for the injured player and the family, so it was exciting to me to see such a capable group of individuals who are willing to learn more in an effort to better educate and protect athletes. throughout my career, i face a multitude of injuries. none caused more confusion, literally and figuratively at the time they occurred, then concussions. each of the documented concussions i experienced or

unique in the way the occurred. i system concussions from hits directly to my head by another player, from my head hitting the ground, and as a result of consecutive impacts on separate place. all symptoms were similar, ranging from slight dizziness and blurred vision to wide sensitivity, the severity of symptoms had no recognizable pattern. in two of the cases i return to play one week after the injury. in one instance, it only took me two weeks to recover. my final concussion i suffered in 2010 resulted in sentence that i decided to in my football playing career. during my playing days, brain injury was never a major concern to me. after my first concussion, i was able to start the next game. it was not until my symptoms became serious that my attitude

about the injury change. at the time when i decided to retire, i saw my decision as the right one to make. in the aftermath, it has become apparent to me that my decision can also be seen as an example of how dangerous brain injury is. i wish people acknowledge the seriousness of brain injury. in all sports, a certain aggressive mentality is required to be successful. the passion intensity of a football player is what makes the game at people. as a former quarterback, i know the importance of and took pride in being physically and mentally tough, outworking my opponent, and leaving it all on the field, and plenty injury. athletes must understand that a mild brain injury is not a mild shoulder separation. it is not an injury to be played through. they should understand that

plank 3 a brain injury is not a sign of tustin s, but says that athletes are still uninformed. statistics have revealed that athletes who have sustained a concussion when per -- return to play too early. this makes me believe the only focus should be to create an open dialogue between athletes, coaches, doctors, and families that address the seriousness of brain injury in athletics and the need for work a full recovery before returning to play. it is possible to decrease the statistics, and in a progress on this issue is being made and many states have passed legislation dealing with protocols. unfortunately, there is no brain brace or a magic pill for immediate recovery. there is a misunderstanding about prevention and treatment within the andcorps. for example, football helmets

are thought of as the brain protector when in reality it is designed to protect bone structure of the individual and not the brain. if the helmet could guarantee concussion prevention, i would still be playing football. i would like to thank you for the opportunity, but thank you for taking the time to learn and show your support for this issue today. i look forward to the future progress the biden know will be made -- to the future project i know will be able to be made in the future on this topic. >> thank you. dr. kutcher, bring us some michigan and neurosport wisdom. >> i will do my best. it is my distinct honor to join you today. i'm grateful to be given the opportunity to provide my testimony. i'm a sports neurologist at the university of michigan. i have been the director of michigan neurosport.

our program provides care for athletes of all ages and abilities and conducts research on sports can deduction -- concussion. in my practice i care for athletes at the time of injury to the return to play process, to the course of their seasons, and after they retire. i have been the chair of the sports neurology section of the american academy of neurology. they are dedicated to the care of athletes of all levels. i am currently leading the effort to produce an evidence- based clinical guideline on sports concussion, an effort that includes the grading of every academic paper ever published on sports concussion. i have been named a director of the national basketball association's concussion program and assault for the national

hockey league players association. this is the issue of sports concussion that has been gaining interest over the last couple of years. the ones who play it are professional context sports. while these athletes and experienced the greatest doses of had impact, they represent only a small fraction of the population at risk of being injured. this is what i am encouraged the hearing today is focusing on protective equipment being used by all athletes regardless of andel of play e, age, gender. it is a common misconception that concussions only occur in males. it is actually higher in females. concussion occurs at every age at every sports.

the majority of these occur in our youth. there's great uncertainty and concern regarding the notion of possible long-term effects of concussion. especially on the pdf population, which may be at an even greater risk. what is a concussion? let's spend a moment describing that. it is an injury to the brain that occurs when the brain moves fast enough or suddenly enough to disrupt the normal electrical function of its components cells. given the brain is floating in fluid inside the skull and at the head can act as a pendulum when the body is struck, movement of the brain significant because concussion can occur with or without a direct blow to the head. as long as the skull and brain inside of it is accelerated or decelerated with enough force, the normal process these of the brain can be compromised. this includes transit disorientation, slow thinking,

or other signs of dysfunction. symptoms like headache and sensitivity to light are quite common. concussion cannot be diagnosed by any one test. diagnosis can only be made after a careful clinical evaluation performed by a health-care professional. it is important to realize concussions are not the only brain injury that can occur from head trauma. bleeding in and around the brain or skull fracture can occur any time. there is emerging evidence brought forth by dr. mckee that forces from multiple impacts that may not even produced concussion may have a potentially negative long-term health affect on our brains. helmets have an important role to play in head injury prevention. without them, the potential for serious injury would make many

of our recreational activities unacceptably risky. with the introduction of hard shell helmets, skull fractures for plank football have been eliminated. when thomas did not do well is significantly slowed down the contents of the skull. these concussions occur by those experienced by the brain are extremely unlikely to be prevented by helmets. there are no convincing day that in the literature that showed any particular helmut been better than any other in preventing sports concussion. given the many variables that exist in the athletic population and the exposure to index, it is perform a to exp

tiral. -- trial. a study of concussion is limited by the ambiguity of the outcome being studied. there are no public data sustaining other protective equipment prevent concussions. with sports such as soccer, protective head gear is the exception, i've seen the use of headgear altering playing style in the wrong direction. as the new-found sense of protection encourages more physically aggressive play. i am asked about the claims parents hear about the equipment they should buy. no piece of equipment can significantly reduce concussions from occurring. concussion prevention is much more about teaching proper technique, planned by the rules, and editing the overall dissident acts. the harm i see caused by

products that can to prevent concussion is far more than that financial harm of paying more for something that is not likely to work. it is the harm that comes from having a false sense of security, for not understanding how the injury occurs, and what can be done to prevent its. the public deserves to know equipment has incident an inherently limited ability to prevent concussion. there is a tremendous amount yet to be learned about concussions and the effects on brain health. -- i amkurt by today encouraged by today's hearing. >> thank you, very much, doctor. can we go on to dr. mckee? >> data for the invitation to testify today on sports concussions and their consequences. i'm a professor of neurology at pathology at the boss in the university school of medicine, and i direct the neurology at

the neurologyv.a. irector for another department. mild traumatic brain injury is a temporary very state under logic to function resulting from forces on the brain, acceleration and deceleration, collateral, and rotational forces. sub concussion is caused by the same type of forces, but the forces are milder and the symptoms are produced. in all of these conditions, concussion or sub concussion, the brain looks normal after the injury and there's no detectable damage on routine imaging, which is why these eight injuries are considered invisible. the acceleration, deceleration, our official forces caused the brain to move rapidly within the skull and brain which is firm, but gelatinous, is stretched and

deformed by these forces. as the brain is deformed, there's also stretch and string of the individual nerve cells that supports cells within the brain. the abnormalities' associated with concussion and said concussion occur at the microscopic cellular, molecular, and metabolic levels. if an athlete returns to play before the symptoms result, the athlete risks developing post because of some drum and second impact syndrome, a rare but often fatal condition. in addition, repetitive not because of injury can trigger a progressive deterioration of the brain. chronic traumatic encephalopathy it's a nerve degeneration that evolves slowly over decades and does not become apparent until many decades after the player retires from suppsports. this is why concussion awareness

is so critical and my proper diagnosis -- and proper diagnosis is so useful. >> and more so in the part of relatively young children whose brains are still growing? >> absolutely. the immature brain is more susceptible to concuss of injury than the mature adult brain. children and young adults recover slowly from a concussion. these athletes are more at risk from concussions do to their disproportionately large had size and the weakness of their neck musculature. there also susceptible to secondary impact syndrome. second impact sambar -- syndrome happens when they suffer a

second injury before symptoms from the first impact have cleared. the athlete returns to play too early and receives a second but to the head, which may be remarkably miner. the affected athlete might appear stunned, but in the next few minutes, the athlete collapses to the ground and the outcome is often fatal or associated with severe and permanent disability. since 2008, as director of the center for the study of traumatic and several of the brain bank, have diagnosed this in the brains of individuals, which has more than doubled the history of the world's history of this condition. i have diagnosed this in 40 football players, professional, college, as less high-school players, five hockey players, and 15 military veterans. cte causes changes in personality individuals with cte

more charitable and aggressive. they develop mood changes such as depression and become suicidal and develop drug and alcohol abuse. as the disease progresses they develop short-term memory loss hich leads to increasing impairment and sometimes dementia and parkin is some -- parkinsonism. under normal circumstances, this abnormal protein is found in only a minute did on it is -- only limited quantities. for example, advanced cte found in the brain indave duerson. he began playing football at 8 and experience more than 10 concussions in his nfl career.

after retiring he was successful and had a loving family. at the age of 46, he experienced financial difficulties. he became a hot tempered and physically and verbally uses. he developed mood swings. on february 17, 2011, he killed himself inside his florida apartment. he left instructions to donate his brain to my laboratory and my examination showed he was suffering from moderately severe cte, even though he was only 50. another example is all when thomas -- is owen thomas. one day into doesn't tend he called his parents and told them he was having trouble with his courses. two days later he hanged himself. i saw in his brain unmistakable c unmistakable cte.

paring the brains, there is remarkably similar pathology shh showing if owen had lived another 30 years, his cte would have advanced to the stage shown in dave duerson. during a game, a high school player hit the ground. as he walked to the bench, he complained of severe headache, and then collapsed. he died the following day. examination showed a hemorrhage consistent with early changes of cte. is the youngest player ever diagnosed with changes of cte. i have now examine the brains of 58 individuals with cte found early cte college and high school players.

reno cte -- we know cte usually occurs in individuals in their teens and 20's. once triggered, the degeneration progresses slowly to involved widespread the generation of many brain structures. we know the symptoms of cte are subtle and began in mid life, including irritability, depression, suicidal ideation, and memory loss. we know there is a slow deterioration. there are many things we did not understand about cte. we do not understand the exact incident and prevalence of this disorder, even though we clearly understand disease exists and is surprisingly common. what factors determine who will develop cte? many concussions, how many sub concuss of injuries, how close together the injuries, and at

what age -- these are aspects of the disease that are unknown at this time. we did not know how to diagnose the disease in living individuals, how to reverse its course. we can make important changes to prevent this disease from developing in young athletes and those changes include understanding what a concussion is, recognition of a concussion when it occurs, and proper medical management of concussion after a tappan street we can teach our young athletes to play smart and keep their head out of the game as much as possible. rule changes to protect athletes from dangerous teleplay, ruled enforcement, and education will go along way to reducing the frequency of concussion and a concussion. in a way that sports are played, continued education increased scientific interest and research into the mechanism of cte, and the the vomit of tools can make

enormous improvement to protect the mental health of millions of young athletes and service members for many years to come. thank you. >> that was excellent. so we then finish with mr. mike oliver. executive director of the national operating committee for standards of equipment. i'm still confused about what you do, what you all do, and what you do not do. >> i think i can cover that. thank you, mr. chairman, and members of the committee. i appreciate the invitation to provide testimony and answer questions on the topic that is extremely important to me personally as well as to the organization i represent. my name is mike oliver. since 1995 have served as the executive director and general counsel for nocsae, national

operating committee for standards of athletic equipment, which publishes standards for athletic equipment. we operate as a board of 18 directors representing a wide variety of national sports medicine and other interested medic -- organization. each organization by definition to our bylaws selects members to sit as a director on the board. in addition to the 18 voting directors, nocsae has two voting positions. there is no single controlling interest or interest group on the nocsae board. a balance of interest is inherent in our bylaws. there's no membership category.

funding for the operation and research be undertaken is received to licensing fees we charged manufacturers who want to certify equipment to our standards and to use are trademarks and registered logos, properties, and phrases. . nocsae is not a certifying body, we monitor product performance through mandatory third-party laboratory delegation testing as required by our standards as well as direct product testing through an accredited testing laboratory with the we contract to provide technical support and services. decisions regarding changes to standards or the creation and adoption of new standards are driven by science and motivated by the desire of all board members to protect athletes, not by issues of manufacturer liability, profit, or any other interest. the mission nocsae is to establish standards

for athletic equipment. in fulfilling that mission, we have funded more than $60 million in research grants since the first grant was issued in 1994, and the number includes more than $5 million dedicated to concussion-related research. to be certified as meeting our standards, helmets must score less than 1200 severity index units on each of 16 in tax conducted at 12 miles per hour, including two high temperature in packs. -- impacts. although the standard for helmets that nocsae publishes are not concussion specific, we address linear forces involved

in most concuss of events, and a helmet that passes provide some level against this concussions caused primarily by in deuced near acceleration to the brain. we did not promote helmets as being concussion prevented because there is no way to accurately measure the extent of protection provided. what the standard does not address and cannot get address and is a subject that is not addressed by any other standard in the world is how to establish and incorporate a thresher road for additional accelerations of the head that result from impact force is not directed to the center of gravity of the head. these accelerations are directly involved in causing accident it number of concussions, and these types of accelerations can occur without a blow to the head. there is no protective equipment standard available today from any source that specifically addresses concussion prevention. the development of the concussions-specific standard

for protective equipment requires substantial scientific support that compliance with the standard would in fact further eliminate or reduce the severity of concussions without increasing the risk of injury in other areas. while helmets play an important role in protecting athletes on the field of play, helmets are not the only solution to providing better protection against concussion. prevention, diagnosis, treatment, and management decisions about when and affleck should return are equally important, and in some circumstances, may be more immediately effective in reducing the number of concussions. education programs reference earlier to the address these issues and are underway for coaches and nocsae is entered enter a partnership to create specific heads up to parents program as an educational resource to permit this education, among those who are motivated to provide the best level of protection and

education to their children. nocsae recognizes concussions are complex events and scientists are working hard to understand these issues. are one of the primary funding sources for this research, and we are hopeful answers will be found that will permit an amendment to our standards that will effectively address concussions. any device, including helmets, promoted as being able to prevent come out dogmas, or cure concussion, must be supported by scientific data and peer- reviewed research. the same is true with regard to standards for athletic equipment. the fund concussion research with intent to advance the science so changes can be made to standards that will reduce concussions without increasing risk in other areas. we have taken specific steps to be ready to do that when the answers are found. hamas

i look forward to your questions and discussion today on a copy that we considered to be extremely important. thank you. >> we have been joined by senator klobuchar from minnesota, where they are having quarterback difficulties. [laughter] >> we do have a team, however. >> i am from west virginia. i deserve that. what is interesting -- that is good. [laughter] i have spent -- my mother spent about 12 years dying from alzheimer's. i cannot really be sure. but die she did. my wife's father died from

alzheimer's. there are 5 million people that have timers in this country. one of the stunning things about alzheimer's -- are working in a traumatic brain injury area, you can do that while you're working on alzheimer's, because there are a lot of common threads in there. the stunning thing is "the new york times" out with an article saying the last 30 years of research at the great institutes of research in this country had produced absolutely no progress whatsoever on finding out the cure for alzheimer's, but for preventing, not for slowing it down, not even for testing if you have it, although that may be on the way, but that his doctorate, which is what we want to pick that is a stunning figure. now comes along the injuries

that are sustained by concussions, more poignant by the fact that they come so early in life and can have such terrible consequences that you, ms. bell, decided you would not do what you had prepared to whole life to do, is not very typical. it is a wise decision to make. i want to throw this at all of you. you could develop a 50-pound helmet, all it would do is it would more securely to make sure your head does not expect open. it would not do one thing for the movement of the brain to stop the movement of the brain. which then, if you say that emphatically enough, it raises the question, what can you do

medically? you can analyze. we do that with alzheimer's. there is a registry of people's brains who leave them to be studied to. that does not do them any good. i want to raise two questions. one is to the medical side of this -- do you think i am wrong? because it is relatively early discovery? i did not know at all that somebody who played soccer could get this until i watched that movie about the wedding, when we beat china back in 1980, and that incredible, powerful back, that the chinese allstate away

from, because she just flat and then. she had chronic fatigue syndrome. she did not have a brain concussion of any sort. you see soccer a lot. all of us watch soccer a lot more. you see people using their heads and you do not notice whether there are bands on them or not. the amazingness of the interests of the american people about this problem -- the amazingness of the ignorance of the american people about this problem. i want to know how helpful you are about finding a solution to all this, so the brain is not falling off its axis? can this happen? >> i am hopeful. we did not know about this

disease five years ago in any way. what we have learned has been extraordinary. we have made enormous gains in understanding how the disease progresses. now we're understand this disease exists and can try to model the experimental systems and come up with their peace that might help us treat meeting patients. i think this disease may ultimately be a window or provide insight into diseases like alzheimer's disease. alzheimer's is characterized by a buildup of the protein tau as well, and understanding how this disease starts and progresses, we may actually add insight into alzheimer's and how it starts. one of the most difficult things about alzheimer's is we have no idea -- it starts silently, maybe in a person's 50's. we can never identify how it starts, but this is a disease we

know has a time course and we know what to expect. it helps over time. it will give us an opportunity for intervention. yet the thing about alzheimer's is most of those therapies -- >> because of helmets or other -- >> understanding that the actual path to logic process and intervening there, intervening at the start of a disease where it is triggered or preventing it from progressing through the nervous system. there is a trance and disability to the nervous system, where it develops in wonder cell and-- in one nerve cell and transmits to another. one of the issues is we were focused on a protein, and that has come up -- have not come up with much. we have not focused on tau that

much. that is what we need to pay attention to. >> can i ask one of you two athletes, is it the prevention of something he now know you already have from becoming worse that interests you the most? well, the answer has to be asked. or is it the absolutely vast amount of change in the way everybody in this country thinks about the playing of sports, the carrying out of sports, the responsibility people have proved there is a lot of coaches in rural states that are also math teachers. that is not good for either coaching or math. that is the way that works. people do not know. if you're talking about not letting it happen in the first place, that means you have to tell the person to keep their head up. try telling that to an nfl player who has just been shot

blocked by somebody and has a chance get back at him. human behavior is very hard to control. i do not know whether -- what the chances are or if we have enough time, or maybe if the shock of what people are learning or if we do more of this, that coaches and parents -- parents are a lot less helpful than they think they can be. they had a lot less influence on kids because kids want to go ahead and do it. i am 17. do not tell me i can't do this again. you do after you know you have it and try to prevent it from happening? >> i would say yes. i believe awareness would be the biggest issue. if you could increase the knowledge base for the general public and for the athletes, i feel like recovery -- athletes

would do better with recovery. they would take time for their brains to recover. i do not think brain injury is viewed as a serious issue throughout athletes. it was not for me until i had a concussion that changed what i was able to do in school, on a daily basis. >> i'm way over time. in your locker rooms, both of you, is there a discussion about all of this? among the athletes themselves? >> concussions are talked about lightly, at least when i went through playing. a lot of people, even if you got a concussion monday and you were resting, -- you got a concussion one day, and you arresting, people would ask, why are you sitting out? you see your fellow athlete got a concussion, you need to give them the respect to let them rest. that comes from the culture we

have right now about ignorance of concussions. >> the doctors get a good training on this in their medical -- >> not as good as i would like. >> they find they can make more money elsewhere and the part? >> pretty much. a comment on your original question about if i am optimistic or not. yes, i am optimistic. your story about alzheimer's and the lack of improvement in understanding for treatments is typical of the situation. it is also not unique to brain pathology in general. think about stroke and multiple sclerosis. we do not have a cure for these in there. the brain is complicated. i want to comment that we're talking about were the one thing here, at least two or three. cte, a degenerative

neurological process that is the most likely come from repetitive blows to the head, and concussion are two different things, and i do not think for a moment that these folks here at high risk of developing cte, the degenerative disease itself. we are at a stage where we are starting to understand the scope of the problem. we do not know the prevalence of this. we're finding the tau more and more often in braids of athletes who have had in packs and military personnel, but house does -- but how does tau relate to neurologic disease? i do not want to overalarm these people who have had concussions that they are going to have cte your and life. >> paula just to my colleagues. -- i apologize to my colleagues. >> i was going to ask, you

mentioned the 17-year-old who had passed away and had one reported concussion, then passed away as opposed to whether the other reported concussions prior to that? >> no, i do not have any other reported concussions. >> so you do not know if he played through concussions, or there are repeated blows of positions he was in. it is a real problem. you have testified so well. the problem is to play athletics at the level you play that, you are playing every day you go out there. there are sometimes they are not significant injuries, but a fingernail that was pulled off -- these are nagging things that can be very painful that

athletes are taught you got to play to that or you do not get to the level that you were able to play through. it is very difficult. to follow up, you did not feel like then that head injuries, the concussion aspect, which talked about very much or in your career? >> for me it was not a serious topic until my last concussion i had come up playing quarterback. i had to be out on the field. whether a shoulder separation, ankle sprain, shoot it up, i am ready to go, and that is not the case with brain injury. he cannot take something to get rid of the pain and deal with that later and let it recover at a later time. >> not being in a horrible pain? >> exactly. >> do you agree with that, ms. bell? >> i agree completely.

now concussions are something that are being taught in youth sports, but when i was growing up, and high school, college, it was just a concussion. that is all it was. we really spend a lot of money on trying to figure out the ied components of this, which is similar or the same, whatever. do we have a test now that we can identify if somebody has gotten a pretty good blow? is there an easy test? >> no, we need lots of research to determine that, and we do not have a way of identifying a concussion other than a series of psycho metric test, balance tests. we do not have an easy way of

the testing, or monitoring it. that is a very important issue that the v.a. is addressing as well as the department of defense. that is a crucial issue. >> you are board certified and well-trained, and i suppose which your licensure, you have to achieve so many hours of continuing education to continue or certification. what i am wondering in the course of this, we have not talked about the education aspect of people that are wanting -- mr. threet, your wanting to get in, you're coaching a little bit now, perhaps you're going to pursue that. in the course -- were you a p.e. major? >> no, sir, and coaching in my playing career.

>> what i am concerned about is when you are taking the course, coaching football, basketball, whenever, if they are talking about this and the importance of -- go ahead. >> i can speak to that. at the n.c.a.a. level, they have a policy that all athletes and coaches need to receive concussion education annually and go to conferencesyou see cot policy as well. at the university of michigan now, every year all of our athletes could a lecture from me or one of my delegates on concussion. so things are improving. there is a long way to go, especially as we go levels, to high school and junior high school. we have a lot more work to do, but there is a push in that direction to make people get education before they

participate, either the player or coach. >> i think that is excellent, and those are the things of will make a difference. again, encouraging our teaching institutions to include that in the curriculum. also, the state sanctions, you know, as they do their continuing education, to make this summit that is talked about every year would be very, very helpful. the other thing i would like to touch on very briefly, and you all can comment. the idea of being able to certify a held that -- a helmet that something that will not prevent concussions are whatever. the chairman mentioned above the 50-pound helmet. i guess theoretically, he reinforced the helmet and make it better, and you can do that you actually create may be

another problem in doing that. can you comment briefly about it that, -- for the record, we have talked about this a lot, but the fact that that is not possible? the advertisements that we see. >> certainly, i appreciate that comment because it is very apropos of the difficulties we face in trying to come up with a standard to address a specific issue like concussions. to a certain extent, the mass of a helmet is protective. the more the mass, the more energy it takes to move the helmet and move the head. in theory, it has an infinite mass of the point is struck and then goes back to zero mass afterwards, which is clearly impossible to do. but there are limits on what you can do with a helmet as far as mass. at a certain point, the extra weight becomes a risk in other areas, and you increase the risk of neck injuries and other injuries by doing that. so there is a trade-off in that

regard. i do think there is progress that can be made once science gets to the point where they can identify those specific forces are combination of forces or resulting forces that are likely responsible for some of these concuss of issues. the thing that is probably most restrictive is the fact that, right now, you cannot study a living human brain at that level, at the molecular level, or the exxon low-level, while it is being subjected to blows from the outside to see how they respond. there are ways to collect data in the field to show how much the forces are and how much the head is seeing. we just started a very large research project with dartmouth university, dartmouth school of engineering, and wayne state university to look at the use of diffusion imaging mri's, which can look at the nerve fibers following an injury, to

follow a football player for making tussive -- concuss ive event and put it into a finite program that would then hopefully let us model what happens to the brain when is struck in certain circumstances and make that model be about to start coming up with concepts about how to address those forces, had to attenuate certain kinds of forces better than they are being done right now. with the goal, and yes a very hopeful we will get there at some point, to be able to come up with a standard that we can confidently say if the helmet meets the standard, then you can have a comfort level that it will provide against -- provide protection against concussions. not all concussions. but it would be designed to meet those specific issues that we no cause compassion. but having the science behind

that is absolutely preliminary, and you cannot move forward without it. >> thank you, mr. chairman. >> thank you, centers. senator udall. >> dr. creature, your testimony states, and i think you said this also orally here, there's no data on the published in medical literature that shows any particular helmut being better than any other at preventing sports confessions. last year, however, the ceo of rydell testified before a different congressional committee that rydell has " independent, a peer review, published research in the medical journal of neurosurgery, february 2006, showing that revolution reduces the risks of concussions by 31% when compared to traditional helmets." one of the authors of the 2006 study told the "new york times"

earlier this year that he disagreed with rydell's market in the 31% figure without marking the limitations. but they have used the concussion safety claim in its marketing extensively. here is one example with this poster that is behind me. this is an example taken today rom the website of rydell's parent company. i think you can read that. do you think this single 2006 study provides a reasonable basis for riddell to claim that the research shows that revelation hellman's can reduce the risk of concussion by 31% compared to the traditional helmets? >> , no, i do not peter i am aware of the study. what i said is there's no significant data to make that claim in the literature. i know there's an data, but

there mainly to the problems with that study. first is the quality of the study itself, how it was set up, trying to get two different populations, one wearing a certain help lead, one wearing a note -- another kind of helmet. you want these to be as equal as possible in terms of which, they are wearing. that was not done very well in the study, to the point that i would not consider the study designed to be x and -- a acceptable protocol. and that figure is a relative peace -- percent change. the one that the old helmet had a 7.6% confession rate over the steady times been. the other one had a 5.3% rate. with the change, it was 2.6%, the absolute percent change. that was relative. but when you put the 31% figure in front of people like that,

they are going to the their third wendy's and less concussions. actually, it is 2.6%. and that amount, given the study limitations, with more than account for that noise in the data. >> you can see why a parent would see something like this, see 31%, and think i am going to get a really protective helmet for my child. really what we're talking about is something that is very, very misleading. >> i do see that every week in my clinic. i see patients coming in with their parents sang the want to buy the new helmet, this is the concussion helmet, and what did you think about it. this is a very real conversation we have all the time. >> and they're asking the question over and over again? >> correct. >> typically, what did you tell them, and you know what they do

afterwards? >> my advice is the most important thing you can have is a new helmet if you can get one. tried to avoid the reconditioning situation because you do not know if the helmet is still up to standards. but it is important make sure the helmet fits correctly. after that, i say look at the different manufacturers. if money is not an option, by the highest one on the line. what is lost in this conversation is you cannot have a confession without force, right? but force is not the only thing going on here. if i took 100 athletes or 100 people and concussed them, you'll get 100 different responses, or give them a blow to the head, the same force. so that -- say that the issue is ignoring the fact that forces acting on a brain that is very individualized and very dynamic. so at the end of the day, pick

between a helmet that it's the least amount of force through vs one gets a little more force through, i will pick the one that it's the least amount of force through. to say it is going to prevent concussion is not understanding the whole complexity of the issue. >> thank you very much. thank you, mr. chairman. >> thank you. >> thank you very much, mr. chairman. again, i heard about this really for the first time -- i had heard stories at my state, but at the alzheimer's dinner in minnesota. an athlete actually came and spoke about the research. i walked away sort of blown away is some of the facts and the things out there and the need for more education. and then held an alzheimer's fund this summer. one of the things i learned was that this is early diagnosis of alzheimer's, and i learned that a lot of the players are donating their brains, i

understand, that it dementia, to research. early diagnosis of alzheimer's and also in the advancement or problems due to a concussion could help us not just of the patient but potentially develop a cure. pat summit was diagnosed, for the basketball coach in history for college that won the most games, and the mayo clinic was able to do that because they have advanced ways to now recognize what early diagnosis -- and i finally realized that as part of finding a cure. because you cannot practice different kinds of solutions and the medications and things without knowing early on. if you wait when someone is to advance, you cannot actually tell whether things are working not. >> absolutely. you have to have some sort of test that can monitor the course

of the disease in order to be able to tell in a living patient if it is being effective. the first thing we have to do is develop diagnostic markers, biomarkers of both concussion and these other from mop -- phenomenons. ive ussion, post-concuss syndrome, and ct. once we develop therapies in the lab and experimental models and we get to the point where we are testing them in living couple, -- people, we can actually see if they're actually working. >> it dr. fisher at the academy of neurology in minnesota, we are proud of that association. can you talk about the work that is being done to skindell -- develop meaningful evidence based practice guidelines so that we are able to get that for

athletes and that there is any scientific gathered available on that? >> if you look at the literature, you will see maybe a dozen or more sort of consensus statements. groups get together and come up with what the experts thing should be the best way to approach confession diagnose since and management peter to date, there has not been ever that has looked at the totality of the literature in a critical way, looking at the quality of the data, sorting through the papers, and coming up with what is evidence-based in this issue. we started this two and half years ago. it is a committee of 12 people. five neurologists, seven non- neurologists. other folks are from other medical specialties, sports medicine, podiatry, and others. the goal here was to really create a sense of where we are and where we need to go. there are some of our management practices that have some evidence, but i will tell you that most of them do not. so the goal here, and we're hoping to be published in the

spring of 2012, is to really set forth, you know, what are the steps we need to take to get the data to have a good sense that we're doing something that is evidence-based? >> very good. thank you so much for being here today. i know that organizations like the brain injury association, nfl, athletic trainers association, cdc are working to increase awareness, educate the public. as students who have had this happen, what do you think the best ways are to get the information out there to your fellow students and players? >> well, i believe there's a lot of progress being made already through information and educational seminars that we have at the schools. i know in arizona, i was part of bill 1521 that implemented protocol for high school athletes of the have to attend the class, their parents and coaches have to attend the class.