his coach has not only employed the technique of the they keep asking their kids to do it correctly. it shows they care about the kids, i am not worried about whether or not he's going to get hurt on the pill because i know that his safety is just as important to them as it is jimmy -- to me. >> this is a vital piece not only of our football program but of our athletic program in fairfax county. >> good. >> all the top cross programs are talking about what are we going to do overall in a very positive way. >> we agree with the mission of usa football and that is to allow her students to participate in competitive athletics and learn so many wonderful life skills, and do it in a way that is healthy. >> i can truly look at apparent and say this is what we have done, this is what heads-up football has brought to fairfax county schools. it is an awesome opportunity for

coaches and parents and kids and officials and everybody to get on the same page to help kids. >> if you're an administrator in a high school, your being asked a question on how you're making this favor for my kids, and we can answer that now. ♪ >> thank you. we appreciate you being here, your it recognized for five minutes. >> thank you very much. i am 42 years old. i served as a starting goalkeeper for the united states women's national soccer team for the years of 1994 to 2008. during that time i helped to lead the team and winning to 11 old metals, in 1996 atlanta games and 2004 athens games, and late 173 international games

over 15 years for the united states. that is a record among female goalkeepers. in the summer of 1999, my 20 amazing teammates and i captured the hearts of america by beating china in a healthy kick shootout alive in front of 90,000 screaming fans at the rose bowl in pasadena, california. i was the one that made the single safe --save before she took off her shirt. i will that you will remember where you were at that moment. it was the kind of event that fans forms eyes forever for the better. my passion and my mission with soccer, my ultimate reward was living my dreams and inspiring the dreams of countless others. today, i'm here before you to share my new mission with you. my new mission is to provide a new face and voice to those who have had and may suffer the long

and difficult recovery of a devastating traumatic brain injury and concussion. my life story reads like a script from oprah winfrey's where are they now. like many of oprah's guest i too have been lost in deep black laces with my face in the dirt, and have only recently begun to claw my way back to my life. on april 25, 2010, my life changed forever. during that day i played a women's professional game against the philadelphia independence in philadelphia and in that game iso deford medic rain injury that ended my beloved soccer career. that was four years ago. i struggled with intense piercing headaches that were so bad that by the evening and was all i could do not to cry myself to sleep. i had to take naps on a daily basis just because my sleep was so disrupted.

i could not concentrate, and i was very moody. i felt completely disconnected from everything and everyone. i was anxious, and depressed. every day, i wondered if i would ever get better. i recently moved to washington dc to have bilateral occipital nerve surgery at georgetown, to eliminate severe headaches that plagued me daily. fortunately, this surgery seems to work, but i'm still being treated for lack of concentration, balance issues, memory loss, and anxiety. i personally and intentionally had my concussion recovery story documented by media outlets by usa today, the washington post, and brainline.org, to bring a ray of hope to those suffering like me.

in september i was alarmed to learn that the number of reported cases of concussions in soccer was second-highest in the united states, with only america's football having more cases. additionally, a recent article published in november stated that one of two youth soccer players will suffer a concussion while playing. i feel the numbers of reported cases are likely understated. they did not designate those who suffered multiple concussions like i have. statistics like these have solidified my urgency of purpose, to shed light on the high frequency of concussions in use, and a devastating emotional toll that prolonged symptoms often cause, yet are too frequently dismissed. i sincerely hope that my presence here today will inspire

increased awareness, understanding, and assistance to help the thousands of young tbi sufferers across this country. i thank you you all for allowing me to testify. >> thank you very much. that was powerful. this is our opportunity now, each of us have five minutes, to ask you questions. let me ask you this one. i too was shocked to learn that soccer had the second most concussions, which is a really dominant youth sport. are you seeing changes within soccer, and unlike there is an obvious top to bottom connection that we heard from the nhl and the nfl, is there anything like that occurring in soccer?

>> thank you for the question. i too was very surprised to read that statistic very i think it is so high in part because of the explosion of players that are playing soccer now in the last 10 years. i am not finding that soccer has completely grasped the harm or the situation like usa football and hockey have. hopefully the governing body for soccer will start to see that there is a great injury for -- danger and having too many head injuries is a bad part of this. >> good game in winning over

china. it was a great game. we all remember that. now to mr. miller. the nfl has seriously undertaken an effort to get the return to play guidelines adopted in can you tell us more about what the guidelines are and how they are developed? >> yes. the model law that was passed out of washington state and taint three primary elements, the first of which would be that parents and the kids would have to sign off on an education sheet to understand the risks before they were allowed to participate. a child who appeared to have suffered a head injury must be removed from playing

immediately, in other words the coaches were asked to act conservatively. a licensed medical evaluator had a turk -- had to return every child to play. all of these laws a very new, and so i know that there are some academics were studying them to see their success. i know there's one anecdote in washington state, the one that had the first one. in the years after the law was passed they did not see a single brain injury, or any blood on the brain of any signal football where -- football player in washington. that is anecdotal and more work is to be done, and i commend those states that are going back and making their laws more

strict because they need to be added to the youth level. >> thank you for the question. have you seen a reduction in concussion at usa hockey after implementing new techniques? >> we don't have the same statistical data. we were talking to the same company to do that sort of thing . we have focused on research, education, and rules enforcement.

we know that a lot of sports at the youth level suffer from a misplaced macho attitude. a lot of coaches think they are coaching at the professional level. that is very important. we have been very strict about returning to play rules. we. the same thing. when in doubt, sit them out. one of the big challenges as quality control. cannot give in to act the same way. because of our emphasis in preventing head injuries and how to recognize them and how to respond to them and making sure this is a medical decision, the

number is dropping. >> great. you are recognized for your five minutes. >> my granddaughter has played ayso soccer from the first time she could hear it now she's is on a traveling high school team. i am very concerned about what you are saying. even more concerned now after you are saying that soccer seems to lag behind other sports. there have been studies that compared the rates every ported concussions from male and female athlete that tend to show female athletes have a higher rate of reported concussions than male athletes in the same sports. what would you say that we need to do immediately? i do worry about her now. and what could happen. what would your advice be to

female athletes, female soccer players and to those who coach and treat them? >> i too find that statistic very alarming. i think one of the things that needs to occur with soccer is officials and referees, coaches need to take their heads out of the sand a little bit and realize this is something that is plaguing our sports as well. the video that was played earlier was a fantastic example of where to start. you teach the coaches the proper way to teach the players how to head and do certain drills to make sure the coaches know how to teach his chances of letting players run around out there and letting the ball hit them and instill -- instead teach them how to head the ball and 6 -- improved the strength of the head muscles.

part of the issue is that they are not as strong as the mail counterparts. that needs to occur. there needs to be in understanding and in education of what you are looking for when a head injury does occur. >> i do not know if soccer is the only sport where you quite deliberately use the head. is that an inherent problem? >> obviously that scenario you will have something highly probable that will happen. if you teach it properly you are going to have the head injuries no matter what you do. i think certain things that happened during the situation is not the only time when concussions occur. mine happened when i was going for a lowball from my left. the player came and hit me in the side of the head with her

knee. it has nothing to do with heading at all. this is not part of that. >> i would love to get your advice as we go forward. anything that i can do out of this body. i worry about my granddaughter. i wanted to ask you a question. retired nfl players face some of the most serious health challenges of any spport but benefits are not on a par with major league rays fall or the national basketball association despite the fact that the nfl has more than $9 billion in annual revenue. does the nfl yet provide lifetime health insurance for former players who did not play under the current collective bargaining?

>> no. they are able to continue their metal -- medical coverage when they leave a key cane -- when they leave the game. in the most recent bug argument there were a million dollars that went to the players who went in pre-1993. all of our programs are collectively bargained. during each iteration you have seen changes and improvements made to the programs for retired players including this year. a screening program. >> professional baseball and basketball to provide lifetime health insurance for former players. while i understand the plan, what could be the plan to not provide lifetime health insurance for former players. >> all of our policies are collectively bargained. the improvements that we have

seen as far as care for the retired players whether they be the plan that you mentioned which accounts for any player who suffers from a diagnosis of dimension or those that help join in hip replacements, those are improvements and made it available to players. in addition to another of other practices including help lines. a have additional programs. >> i yield back. >> you are recognized for five minutes. >> thank you very much. the changes that you have made in recent years, the rules change something trees penalties, suspensions for role violations, reducing full contact practice days, can you share data egg you have that this has has a positive impact

on incidents that may encourage leaders at other levels of football? >> absolutely. we're happy to share with the committees and greater information that i can offer. the most interesting number is when you count up the number of all of the concussions that were diagnosed in games and practices preseason and postseason. you see a 13% decrease in year-over-year. >> 13% each year? >> yes. the emphasis has been on eliminating this on the game. these are a significant cause of the injury. in the circumstances we have seen a decrease in the number of concussions by 23% in the past year. there's a lot more work to be done. those could change year over year.

>> i'm happy to hit that further. >> i think we would. this is very helpful. i hope the improvements continued. i believe your testimony indicated that if team high schools and -- in 10 districts -- and 10 districts participate in a pilot program last year and that you're anticipating a 500 to 5000 road this fall. i would imagine high school football is the football that most of us have experience either through ourselves or through a child or a son. this is part of the american tradition. what are your plans for getting

more school football programs at the high school level to participate? what is your outreach entail? how do schools across the country learn about your program? the purpose of this hearing is multifaceted. one of the purposes is to inform high schools across the country about your program as the video indicated occurs here next-door in northern virginia. >> one of the common themes we are hearing is inconsistency. football is probably the most fragmented of all the sports. even at the high school level there are significant challenges. what we are trying to strive for is consistent technique of technique and terminology. now getting out to these youth programs as well as high school programs, the good news is they are being responsive. they are being asked as was mentioned in the video what are you doing about this >> it is a combination. we're talking to state associations. we are talking to coach associations.

we are recommending athletic are his. national ptas involved. we are looking at every conceivable channel to look at the importance of changing behavior. this has been incredibly influentially. we now have the big ten. the acc. the ncaa. we will have all college, says involved and everyone will be involved with these that help influence high school coaches and program in -- programs to help change behavior. >> think you. if there is one message i wish to leave this morning and my five minutes of rationing is that i will hope that all of those involved at your level of football would examine what you are suggesting. that touches virtually all of

the american people. i commend you cannot for the testimony. thank you. >> the that is why we have nhl youth hockey the. -- hockey. it does seem like it trickles out. it gets pushed down to the youth. that was by design. the gentleman from utah is now recognized for your five minutes. >> thank you. i first want to echo something he said in his opening statement. the main sound obvious. this is a complicated issue. there's a lot of complexities. there is a lot we do not know about. brain science. i think we can all re: the notion that this is an issue

that significant investment research is something. it is beyond concussions. it is sports. this is an important issue that is well complicated. i would ask mr. miller. can you walk us to the steps? has one brought more information to the nfl? how has the lead responded? how have you positioned yourself to address the issues of concussions? if you could walk us through this? >> the point you made that the science has evolved on urological issues in neurodegenerative disease is one where it is is a terrific lineup and it can talk to you. we rely on the outside advice a

very well-known, respected neurosciencts and how about to change again to reflect that. that is how we ended up creating a unified concussion protocol for our sideline. that is how we ended up with additional concussion experts on the sidelines based on the outsiders who tell us this is the best way to handle your players. this is what you would do if you follow the advice strictly. >> is this position that do not exist 20 years ago? >> it did not exist 20 years ago. i'm proud to be in the world. it is an exciting one. >> have just the one other

question that may be a little different topic. i have communicated with the nfl about concerns in the issues of human growth hormone testing. i know something real in the last effort here there is agreement to agree later. it had not come together and do something important in can you give us a update on what is going on and on testing for human growth hormone? we do not have human growth hormone testing yet. the league has been ready. unfortunately, our players association has thrown up obstacles. it is fair to say excuses for a time. it also goes to the health and safety of the sport. you do not know where the stuff is coming from and who is giving it to players or players. this is dangerous. it is the wrong example. this is an important issue for us and when we are sorry has not gotten accomplished yet. >> since he was here had to ask

the question. >> i think this is why we wanted to have the association here. that was a pretty strong criticism that you just made. it would have been nice to have the players as well to respond. cut i will have to interject. they were asked and they declined. that is not accurate. they were contacted before yesterday. >> i have one question. where are these things only? where do you see these things going over the next five or 10 or 12 years? do you have some things on the horizon we can be looking forward to? >> as part of the scientific research we entered into, we set aside innovation challenges. the first was to promote new

ideas and how to better diagnose concussions. there are no subject it tests now. we have people from 27 different countries offer ideas. we eventually rewarded dickstein of them. in addition we just completed another challenge that goes around how to protect the brain better. we have more than 40,000 people from 110 countries out on the website. we are reviewing these now. i think that they has there's a lot more attention paid to this and hopefully we're one of the act tours you're going to see chant -- all of these places. >> i appreciate that. i will yield back. >> the gentleman from kentucky is a recognized for five minutes. this might have been the only

soccer game i watch him talk to finish. >> my daughter was interested in soccer. we are interested. >> no pun intended. >> i went over my head. i am sorry. what a great sporting events. it is one of the great moments. to be part of that is something special. it was special because it was you were underdogs. you were determined. you brought it up saying not die. maybe a little exuberance. it was a great moments. i appreciate you doing that and sharing. when i play high school football is a claim to athletic prowess, we practice this. i'm number one time in the south we are all running water breaks. we went to the water break. he falls.

he knocks all of the watcher over. the coach says if you do not know how to handle that we will not have water today. that was over 30 years ago. that would never happen anywhere today. there was a louisville young man who passed away on a football field. the coach went to trial over it and turned out he was not it. i think the awareness and things i would describe in my youth would never happen on a football field. at least i hope it went in. we still have these injuries. you talked about your injury being in soccer you're wearing cleats in short camps and they sure. somebody hit you in the side of the head with their need. i watch a lot of football. they now have targeting. if you are in college the ball you're ejected from the game for targeting. a lot of the injuries where a

knee hits you in the son of the head. i do not know how you change that kinds of techniques. >> thank you for the question. that is very relevant. my head when i watched last night again on video, it does not seem to be a hit that would have taken me out of the game. as it was, i got hit and there was a few minutes later before i came out. there was not even a foul called actually. that is part of the problem. sometimes a hit is a glancing blow and it does not seem to be anything that is a big deal. for me, my main focus is what is done after a hit occurs. and to keep children and young

players off the hitch -- pitch after a blow to assess them to see if they're ready to go play or not. i think that is the key for me and why i'm speaking out about this. i've been around the country talking to different organizations. i'm finding that kids are getting concussions in a short. of time because they are returning the play too soon. that is where i think a lot of the awareness and education can help. >> you should do everything you can to stop the head-to-head and so forth. they will pull them in tv over and over. someone might jon runyan hits the side of someone else. it is incidental. i guess you are right. you cannot prevent that from happening. >> i think that is right.

one of the recommendations by the fourth conference was to look at the playing rules of the game. in our case we have done that as well. create the best possible situation. in a context for there will be injuries. there will be hit to the head. the problems will occur. we want to make sure we are treating them appropriately. that is where it shifts. >> i was sitting on the edge of the cal meaning and moving. hopefully you fell my assistance and were able to help us win one for our team. thank you very much. i yelled back. i'm glad to meet you. >> now the gentleman from maryland is recognized for five minutes. >> thank you for the hearing and thanks to our panel.

i had a quick question about whether the school district that you have been working with has that effect did by -- affected the liability policies that they maintained as a jurisdiction? is there any trend that may be getting pushed by the example? they may say previously i would have provided an liability coverage to your school district based on these measures. it is this -- it is with what we do. now that there is still this program that enhances the safety of students and young people, we want to see that you have

implemented that in your district or else we are not going to provide the policy coverage or we are going to charge you a higher premium. you get a discount off of your premium as a school district because you have implemented these kinds of measures. i ask that because i think that increase awareness of some of the risks for some of these boards injuries may lead to pressure in terms of liability on school districts. you will get some that may choose a style and a premium that gets charged to push the program out. they do not want the liability that comes with it. i am just wondering if you are

fair of that kind of act or how the liability concerns interject with the safety efforts that are underway. >> thank you for the question. at the high school level we are on the front one-yard line marching down the field. i will mention that we are having very positive conversations with the state of maryland right now. we have a lot to do right now. we have not seen anything from a liability or insurance concern with fairfax county. a worked very closely with all of their schools about the issues. they told us they have the appropriate coverage. at the youth level, we are absolutely seeing the insurance industry at large and really the largest provider of casualty in liability insurance forward and actually stated that if they participate in the heads of football programs they would

receive a discounted program and a more comprehensive coverage. we are actually saying a positive response by the insurance industry which has its merits. >> i yield back. are there any insurance liabilities at usa hockey? >> there are plenty of insurance liabilities. unlike usa football, our participants are all assured by us as a national organization. whether it is player accident insurance or catastrophic or liability, all of that is heart of what our members pay as a membership fee for. those premiums are obviously based upon the number of claims.

that is another business reason why it is in all of our best interest to try to come up with every tech need, every is, every policy that we possibly can to make our game safer. the number one is the safety of the human beings playing our sport. there are good business dreams -- reasons for us to want to do this safer. >> thank you. thank you for your leadership in holding this hearing. i appreciate the diverse panel that is gathered here and important insights you're able to provide. according to the cdc, 175 thousand sports related concussions impact athletes every year. i think today's hearing has been constructive and helping us move forwards. this was taken to pass concussion laws. my home state of eleanor,

education board throughout the state work with the illinois high school association to adopt guidelines that raise awareness of symptoms and ensure students receive proper treatment. encouraging the professional sports league to take steps to address concussions not in their own ranks and also working with leagues to bring this. last week they kicked off a pilot program to provide certified athletic trainers at three high school stadiums during chicago public school games. these are important to combating this issue. i find the steps to the comforting. i would like to ask. let's talk about the equipment

issue. where are we at in terms of what kind of areas of where we were a few years ago. what do you think we should make? is this backed by medical science? is this going into this idea? >> thank you for the question. it is a very important issue. the equipment issue is a very important issue. it is something we are all kissed him with our players association. we have a set committee part of our joint health and safety committee. we look at all aspects of equipment and how it relates to head injuries. how they can approve equipment and perhaps reduce the amount of head injuries we have. we passed some rules over time with respect to some of the equipment we have seen with having both in

the shoulder area and the elbow area and those potentially causing head injuries. we have these in the areas of player equipment. the helmet issue is an important issue and hockey in terms of preventing concussions. one of the things we're looking to work with our manufacturers on his research and trends of dealing with the rotational forces that can cause concussions particularly in a sport like hot and -- hockey and whether those can be developed more accurately. >> there is a great deal where we rely on the national hockey league be the leader and a lot of what they do is of benefit to us in a trickle-down fashion. as i mentioned in my opening testimony, we do have a

protective equipment committee of 40 years standing. they do look at tabor i a t of issues. the face mask is something that is mandatory. it is not in the national hockey league. >> i'm going to have to cut you off just because of time. >> football comments were designed to prevent against goal factors and they do a happy list job for that. they were not designed to protect against concussions. we are not there yet. the league is doing what they can to inspire that. the other thing we do is we do regular helmet testing in concert with our friends at the players association. we can inform them of which ones are working best. >> i would just trickle-down. we are working closely with the fitness industry association and the new football council.

we are working together with how we can improve things. >> we do not wear equipment and our sport. i do want to commend your state for their illinois youth soccer association. they are taking a real lead in concussion awareness. i just did an event in chicago last weekend for the association and talking about concussions. organization is doing a great job. in terms of equipment for my sport, we do not have anything that is widely used. hopefully in the future there will be something to help. >> the gentleman in west virginia is recognized for five minutes. >> i had to slip out for another meeting. maybe some of these questions have been asked. if you could help me out on this. is there anything that we can learn from the defense department with concussions,

injuries that we're are hearing from when we talked to our troops? is there some way we are all talking to each other? if you could help out with that. >> we're very happy with our relationship we have fostered. this is with returning active service members to talk about cultural issues. what is it about the ball or the military that makes it difficult to make them removed themselves. we found a great deal of reticence on behalf of both populations. it instills a question as to how you get someone to talk about or to tell their team a you do not look right and you should get out a field. we learned a lot from that. we meet regularly with the army

to talk about what they are doing from a science perspective. we share the ideas in science we have. they do with us as well. it has proved to be a very cooperative and beneficial arrangement. >> anyone else wants to arrange with that in our military? >> the second question has to do with states have worker compensation programs to deal with various disorders and injuries. if my state, it is treated in a way that people do not have to take legal action to get help through the workers comp row graham. -- program. is that something that would be a benefit in this program? a friend am i am has been -- of mine has been quite a few years in litigation with the nfl. it is so cumbersome. we've also had a east coast hockey league team in our city.

we see some of the injuries. we hear from some of the players about the injury. is there a time we should have a workers comp program for brain injuries? should that be included? they are not required to follow litigation to get help. >> my case actually is a workers comp case. ed gone through workers comp to get the different dock yours to see different techniques that will help me. that is part of my situation am part of the reason why i have taken so long. every time something is suggested or recommended i have to go back to the insurance companies to get permission to do it. sometimes it takes a hearing to get everything to move forward.

maybe streamlining that would be of great help. you talked about how we can help the military service people who have tbi's. one of the best things i think would help is more of the psychological anxiety and panic attacks to make sure sure each person that comes back through the military get help in that area, the emotional side of it, not just the physical. that would be very helpful. >> any other thoughts? >> workers compensation law are very different. professional athletes are specifically excluded. it is certainly a mechanism that an increasing number of our athletes are using in cases where they have debilitating injuries from their careers. >> what was your recommendation?

you're saying yes? >> i guess what i would say is i think it is generally available to our for more -- former athletes currently. some of what we're hearing is differently from that. that is why i want to raise it. thank you for your comments about that. i yield back the balance of my time. >> the gentleman from florida. you recognize. >> thank you for holding this very important hearing. i wanted to specifically thank you for speaking out. in make so much of a difference. thank you for your sacrifice. you're going to make a real difference in kids lives. i also want to get back to the protective gear. how does the youth protetive

helmet in paris for safety, quality to the nfl and nhl? can you give me an opinion on that? >> so. i'm certainly no expert on exactly how that compares. they set the standards. all the helmets have to pass that standard. they would say the gobi avenue evan be on that. how it compares to an nfl hammock -- helmet is lighter. the padding is appropriate. i do not know the exact details. it is sufficient based on standards. they are transitioning into what may be into high school or adult comments. i am aware that the technology

is improving in helmet and shoulder pads. >> we worked on a program with the consumer product safety commission. we need to put money toward reconditioning helmets for youth leagues. they have budget constraints, as many do, and did i get around to updating their helmets frequently enough. we put a fair amount of money in that. addressing those needs we know a new helmet is better than an old helmets. most important of all is that they learn how to fit the helmets. that is going to be the number one safety peace. we are aware of these issues. we are trying to make a difference there as well.

>> the high school helmet is not as safe as the nfl? you do have a program to help. is that correct? >> i do not know. >> i know the kids play high school football. the parent will purchase a better quality home and for their child. it is about the kids that soon not have the money. it is so very important. every kid deserves the proper equipment. >> also, can i hear from the hockey as well? >> at the youth level of the helmet is good as the national hockey league. the only thing different is

sized or they had to be certified by the council. you cannot use a helmet that is more than three years old. i would first echo mr. miller's comments that helmets in our sports as well are principally designed to prevent school factors and not to prevent discussions. sometimes they can disperse forth in a way that does prevent purpose. we also have regulations that we make available to our equipment managers and our players with replacing of helmet. each player is essentially asked to replace his home, at least once a season. and his road team home and at least two times a season. frequent replacing of helmets is for our league as well.

>> do they know which size fits the child? have they been briefed on those particular issues? >> i agree that it is a a difference maker. it is a fundamental part of what they had. >> this is a cornerstone of our heads of football program. you have found that they do not know how to properly fit equipment. it is a very important elements. >> thank you or that. >> the nfl hockey stars would have the waste on baseball, asked the ball. there looked up to by some children. do you have program so you can

speak? can you go and speak on these particular issues? >> our players are terrific at this topic. one of the elements we included or offered up was actually what we call an ambassador. for leagues that were thoroughly -- that were early adopters then we get visits in consultation with a retired nfl player. we are trying to do this. they are around the facility more. they interact with players. they were thrilled to participate in helpful ways. >> if anyone want to answer that question you'll have to do it by

writing. oh you have a question? i am sorry. >> i am sorry i am late. i met another hearing. i understand the nfl participated in a program initiated by the consumer products they initiative to help them in low income communities. i really want to commend that. it is going to cost a lot more money to get to the point where . . obsolete. i'm pleased to learn of your donation.

it strikes me of an knowledge meant that wearing an old helmet when playing football is not advisable. it is a statement that would be very influential. we've also heard that reconditioning those under 10 years old is important to ensure the proper phone density and that other degraded parts are replaced. want to ask you the following questions. i guess that is why i'm sitting in the seats. we realize that many issues are subject to negotiations. can they commit to supporting the habitant helmets on the field that are over 10 years old? >> in the youth space. i plead not enough familiarity with the issue. i know there are a couple of states that would be happy to work with you to pursue it.

the first question is committed to prohibiting helmets on the field of over 10 years old. can you commit to the supporting a policy positions that these present an unacceptable safety risk that is right most of the helmet industry? >> i see no reason why we would have a concern with that. it sounds appropriate. >> i recommend that the helmet should be discarded after 10 years. can the nfl committee supporting a position that helmets be discarded after 10 years? >> we would certainly support helmet companies and how they advise people to use their products. >> we have heard stories of using players -- players using beat up helmet or adjusting them by removing some padding.

will the nfl commit to support a policy position that all players should wear helmets that are reconditioned properly? >> all of our players have choices in which helmet they use as long as they pass the standards. that is something that is a point of discussion with the players association. they passed the standards. >> they were reconditioned properly. they have the appropriate padding. >> the helmets are reconditioned regularly. our management works to make sure their helmets are in good working order. >> thank you. >> thank you very much. c-span three.n

>> we continued with the house subcommittee hearing on sports safety and brain injuries and football, hockey, and other sports. . . . .

ommission. he is the student ambassador for the national council on sports he. if i may editorialize, i think jan did a great job of juxtaposing a days of tbi and confessions -- concussions on each panel. this is from a more scientific-based panel. thank you for taking your day away from school. i know how tough it is to be pulled out of school and come testified before congress just like a normal high school students. dr. robert graham at the institutes of medicine. dennis, center for brain biology and behavior at the aimed university of nebraska and think you.

then dr. james johnson, assistant professor at the department of neurosurgery at the university of alabama birmingham. star of screen. professor of atomic, manipulator -- binoculars and atomic physics. a phd division of chief neuropsychology, children's medical hospital. and not quite up to the level of university of nebraska we have the harvard medical school. that is just humor. a professor of psychiatry and radiology at brigham and women's hospital harvard medical school.

thank you for being here for a very impressive and esteemed panel a scientists and experts. we will start. your now recognize for your -- you are now recognized for your five minutes. >> the green light is on. is it better? i am the assistant director for the division of advertising practices at the federal trade commission's bureau of protection. i am pleased at this opportunity to provide information about the actions we have taken over the last few years with respect to concussion protection claims. claims that implicate serious health concerns, especially those potentially affect and children and young adults are always a high priority at the commission. the commission strives to protect consumers using a

variety of means. section five of the federal trade commission act prohibits unfair acts or practices. in interpreting section five, the commission has determined a practice is deceptive if it is likely to mislead a consumer acting reasonably and is likely to affect the consumer's conduct, choice, or decision about a particular product at issue. the commission does not test products for safety. it does require an advertiser have a reasonable basis for all objective claims conveyed in an ad. the commission examines specific facts to determine the type of evidence that will be sufficient to support a claim. when claims involve health and safety, advertiser generally must have confident, reliable, scientific evidence substantiating the claim. as awareness of the dangers of concussion has grown,

manufacturers have begun making concussion protection claims for an increasing array of products. these include football helmets and mouth guards, but also include other products. in august 2012, the commission announced a settlement with the makers of brain pad. the commission alleged it lacked a reasonable basis that they reduced concussions, particularly those caused by lower jaw impacts and falsely claimed scientific evidence proved the mouth guards did so. final order prevents them from representing any equipment as assigned to protect the brain from injury will reduce the risk of concussion unless the claim is true and substantiated by reliable scientific evidence. the commission sent out warning letters to nearly 20 other

manufacturers of sports equipment advising them of the settlement and warning them they might be making deceptive claims about their products. the ftc has monitored these websites and is working with them as necessary to modify their claims. in some cases, to ensure the necessary disclosures are clear and prominent. commission staff continues to survey the marketplace for concussion reduction claims and alert advertisers who are making potentially problematic claims of our concerns and of the need for appropriate substantiation for such claims. commission staff also investigated concussion reduction claims made by three major manufacturers of football helmets. the staff determined to close investigations without taking formal action, by which time all three companies had discontinued the potentially deceptive claims or agreed to do so. those cases are discussed in greater detail in the written

testimony. the commission plans to continue monitoring the market for products making these claims to ensure advertisers do not mislead consumers about the capabilities or science. at the same time, we are mindful of the need to tread carefully to avoid inadvertently chilling research or impeding the development of new technologies and products that truly provide concussion protection. the commission appreciates the committee's interest in this important area as well as the opportunity to discuss our effort to ensure the information provided to consumers, in particular to the parents of young athletes, is truthful and not misleading. thank you. >> ian, you are recognized for your five minutes. >> thank you for the opportunity

to share my story. i am here as a student ambassador for the national council on youth sports safety. i'm also a senior at bethesda chevy chase high school in bethesda, maryland. i was a sophomore playing in a high school off-season lacrosse game when i sustained a serious head injury we later discovered was my third concussion. until then, i did not appreciate what a great life i was living. i got good grades in challenging classes, played high school lacrosse, was working on my second degree black belt in martial arts, had a job i loved, performed in my school's jazz ensemble, and had an active social life. it was over in a split second. my concussion left me with only 5% of normal augmented activity. i was almost immobilized. i spent 2.5 years recovering and wondered if i would ever get that life back. it has been a long, slow process. at first, all i wanted to do was sleep.

noise and even moving my eyes caused headaches and nausea. i was enrolled in the program where i received ongoing evaluation and treatment for symptoms. after missing school for two weeks, i tried to go back but was not able to function. the frustration of trying to focus on lectures and the constant sensory bombardment made a normal school day impossible. however, i eventually enrolled in a home teaching program. with the help of my tutors and family, i was able to complete my course work at my own pace. i finally returned to school in december but was still far from recovering. i have spent the 2.5 years since my concussion slowly regaining organizational skills, the ability to learn and retain information, and most important, my personality.

during this time, my friends and family learned to recognize the signs i needed to shut down from any kind of mental or physical activity for a day or two. these relapses were tough and discouraging. they meant i had to drop a class and miss a band trip to chicago, among other things. the worst was when i could not go to my first concert, the red hot chili peppers. the friend i gave my ticket to owes me. the spring after my injury, i was cleared to return to sports but made the hard decision i would not play lacrosse or other intensive sports again. i know a lot of people recover and return to play, but the possibility of another concussion means i could lose everything again and not come back the next time. i now look at my recovery as something that has made me stronger. but i know i am one of the lucky ones who had resources and medical attention i needed and a school system aware of concussion issues and provided an unusually high level of support.

it is not over yet. my recovery continues. my outlook is positive, and i am excited about the future as i prepare for college. i'm thinking about becoming a high school math or science teacher. i have a hard question. what can be done to create a safer sports environment to ensure when injuries do occur the support for full recovery is available? we cannot just do away with youth sports. i played baseball, soccer, and lacrosse. being on those teams gave me a healthy outlet. it taught me important lessons. sports are one of the best parts of growing up in becoming a strong adult. they teach us if we work hard, we will become skilled and proud of our accomplishments. they teach us how to be part of a team, have pride and success, and learned the lessons of defeat. they teach us sometimes we have to quit thinking of ourselves and think of the good of the team. for these and many other reasons, i hope steps can be

taken so future young athletes have these opportunities. there are two important things i think would make a big difference. the first is to change the cultures of hitting hard to take out an opponent rather than playing to win through skill and brushing off injuries to get back into the game. while better equipment may decrease injuries, it is coaches, parents, and players who have to back away from the need to win at all costs were fear the losing status of the team is out for injury, to be willing to recover fully before returning to play. it will take a while, but if youth and professional sports are to survive, these attitudes must be embraced. when injuries do occur, we must have a way for qualified personnel to quickly assess injuries on the field, how players get immediate attention, and support recovery through schools and medical institutions. these are the things that were done for me and are the reason i

have been able to return to normal. as a student ambassador, the message i hope to give young athletes is this. you think you are invulnerable and take risks and brush off injuries because you think you will recover quickly from anything that happens. you won't. don't be a hero, especially when it comes to your head. it is the only brain you will have. your personality is who you are. it is not worth a couple of seasons of glory to lose the opportunity of a lifetime. thank you. >> very good. dr. graham, you're recognized for five minutes. >> my name is bob graham. i served as the chair of the institute of medicine sports related concussions and youth study. you have my testimony before you and copies of the study. i will take these minutes to give you a summary. the institute of medicine is part of the national academy of

sciences, chartered by congress to provide advice to congress and the executive on various scientific issues. we were specifically impaneled to look at the evidence about the causes and consequences of concussion in youth and military, the state of concussion diagnosis and management, the role of protective equipment, and sports regulation. we had 17 members on our committee. we worked in 2013. dr. molfese was a member of the committee. we came with six recommendations. the first was the cdc needed to establish a better mechanism for national surveillance to comprehensively capture the incidence of concussions. you heard a number of figures in one sport or another. we know where they are measured. we do not know the incidences in sports where they are not measured or more closely watched. we need that baseline to know the degree to which we have a

problem, and as we take corrective measures, the success rate we are having in making an impact on decreasing the incidences of concussion. we need better surveillance and epidemiology. the two, a couple of recommendations related to research. we need the nih and dod to look more specifically at what metrics and markers are for concussions. how do you assess the severity of a concussion? how do you find diagnostically whether an individual has had a concussion? now it is based on observation and self-report. are there physiologic markers that could be used to give us better documentation concussion

has occurred? perhaps without the individual knowing it or without it being observed. secondly, we need the nih and dod to look at the short and long-term consequences of concussions. we have heard testimony of individuals who have had one or more concussions, long-term consequences. some sense of the epidemiology and what treatment and interventions may be, and what rehabilitation may be. the fourth recommendation was to the ncaa and national federation of state high school associations to look at age-appropriate techniques and playing standards. your first panel talked a bit about that, mostly at the professional level. but can you change the manner in which the sport is practiced and

the rules of engagement in the sport that may decrease the risk of concussion? there was one example from the hockey area where they changed the level where they allow body checking and felt they saw a decrease in concussion. we think that same examination should take place at the college and elementary and high school level to see whether they can have the same impact. the fifth recommendation had to do with a better study of the role for protective equipment. your first panel talked a lot about that. the committee had a number of questions about that. our committee found there was very little evidence helmets protect against concussions. there is a lot of data. i think other panelists will be

talking about that. you may come away with an equivalence degree in physics this morning. it is a complicated issue. there are a number of suggestions. we did not recommend you don't use helmets. they do protect against bone injury and soft tissue injury. but the suggestion the helmet itself may decrease the incidence of concussion, the evidence does not appear to be there to us. we think the nih and dod have a role in looking more specifically at what we may be able to do related to the biomechanical determinants. our final recommendation had to do with the topic that has come up frequently. that is changing the culture and the way concussions are viewed. this is a significant injury. athletes need to be encouraged to report, to take themselves out of the game. coaches and parents need to be encouraged to say for your own protection, you need to be

removed and give yourself a chance for recovery. thank you. >> dr. molfese, you're >> dr. molfese, you're recognized for your five minutes. >> thank you for this opportunity. if we could have the slides. go to the next slide. yeah. the earlier group talked about a number of -- if you can go ahead and put that on powerpoint. a number of sports where the rate of concussion is particularly high. there are differences in rates for men and women. dr. gay will talk about that in terms of weaknesses of women's necks relative to men and how that puts them at more risk for concussion. the next slide.

concussion accounts for roughly 75% of traumatic brain injuries in the united states. it is a brain injury. there is damage to the brain. there is discussion about whether it is permanent or temporary. in the military, the rate is 77%. youth sports are a good model for looking at concussion in the military. most military concussions occur in situations like they do with the rest of americans. some certainly occur in theater. but the majority occur outside of theater in accidents. next slide. if we look at brain injuries overall, these are all estimates and they vary across literature. we are looking in the neighborhood of 4 million traumatic brain injuries per year in the united states.

part of that is our birth rate in the united states is roughly about 4 million. this does not count other ways children are exposed to head injuries. perhaps an irate parent who slaps a child creates rotation movement that can produce a concussion. one would suspect those are largely unreported. recovery generally is fairly quick, usually within a few hours to a few days. some will persist to two weeks or out to six weeks. roughly about 20% seem to persist beyond that time. next slide, please. this is a slide on data we have under review. these are data recorded brain electrical activity.

you have 256 electrodes that fits on the head in about 10 seconds. we present a series of numbers, one at a time. all the college athletes had to do was say whether the number they see matches or does not match the number that occurred two positions earlier. on the left side, the colored circles, on the left for match and non-match. those are images of the brain electrical activity on the scalp recorded by the electrodes after the number appears. the schematic on the right shows you the head position. it is a very rapid brain response. for those athletes with no history of concussion, we see a clear difference in the electrical activity for the match versus mismatch. a lot of yellow and green in the top. in the bottom, we see red and

shades of blue from the front the back of the head. on the right, these are individuals who have a concussion history of one to two years earlier, not current. their brains cannot discriminate whether those two numbers are the same or different. they get these tests correct ultimately, but it takes them longer. the processing speed is slowed. after two years, one might suspect that is a permanent change. the next slide. some of these are a review of what dr. graham talked about. how does concussion affect the brain in the short and long-term? we don't have much information about that. the dose requirement to produce concussion and postconcussion syndrome. how can you reliably detect when

the brain is injured and when it is fully recovered? we have no ways to do that. lots of individual differences from one person to the next. we think there are genetic factors involved. there could also be a concussion history the person does not think they have. how many of us have bumped our heads getting in or out of the car? that could produce a concussion. how does the brain recovery from tbi? finally, how we improve and accelerate recovery. we have no scientific basis for any interventions. thank you. >> thank you. dr. johnston, you're recognized for five minutes. >> thank you for inviting me to testify today alongside this illustrious panel about our experience in alabama. >> could you pull the microphone a little closer?

>> is that better? following the passage of concussion legislation as well as the work we are currently doing at the university of alabama birmingham to improve sports safety. sports are an extremely important part of our culture. we take the safety of children seriously. the problem of concussion has gained prominence over the last decade. recent studies have identified long-term health consequences including depression and other diseases associated with repeated impacts. while college and professional football gets the most media attention, it is important to keep in mind greater than 70% of all football players in the u.s. are under 14.

we will need to address the issues athletes. parallel to enacting the alabama concussion law in 2011, the task force initiated a statewide concussion education and awareness program. it worked. in the first year, we observed a 500% referral increase in student athletes referred. it is a trend that has held steady with about 350 youth athletes seen every year. to optimize care of this increasing population, we created a protocol following the zürich guidelines. they were evaluated, kept out of sports until symptom-free, referred when appropriate, and supervised in a return to play and return to think program. that resulted in better care.

even though these efforts have resulted in improved recognition and treatment in alabama and other states, we believe much remains to be done to prevent injury in the first place. given the difficulty of delineating the threshold using existing technology and other ways of evaluation, researchers have begun to widen the focus to cumulative results. animal models have demonstrated problems with complex spatial learning, cognitive impairment. definitive conclusions about threshold for impact frequency cannot be drawn from the early studies. it has become clear that sub-concussive impacts need to be studied.

recent studies at wake forest suggest a significant portion of young players' impacts takes place during practices. the largest take place during practices doing outdated drills with untrained coaches. top programs don't do these. the alabama association published nonbinding guidelines to limit full contact hitting practices to twice a week. i believe this is complementary to techniques and numbers of practices per week. pop warner has instituted similar guidelines. limiting the frequency of hitting in practicing would lower the exposure for every player.

it is clear helmet standards must be updated to reflect our improved understanding of concussion. it is clear both types of impact play a role but only linear is studied from a model developed in the 1960's. we believe having a more complete picture of the impact seen on the football field is necessary to come up with meaningful standards. engineers have recently developed a robust analysis system to analyze impacts and re-create them in a lab. the passage of legislation, community education, and recent advances in understanding have

improved overall safety. we are recognizing concussions more frequently. more work remains in education and drafting policies to limit head impact exposure. i believe the development of new helmet standards is crucial. thank you for the opportunity to testify. >> thank you. dr. gay, you're recognized for five minutes. >> i'm speaking to you as a football fan who happens to be a physicist. my main professional interest in the game is the understanding of how protective equipment works and can be improved. i wish to consider several aspects of football that are problematic as far as concussions and how we might move forward to make the game safer. american football is an inherently violent sport. that is one of the reasons we

love it. the forces encountered in football can be huge. consider a big hit between a running back and linebacker at full speed. we can show the force each player exerts on the other exceeds 3/4 of a ton. this is why football is called a contact sport. two players who collide at full speed helmet to helmet are expensing the same force to their heads one would feel if he had a 16 pound bowling ball dropped on his helmet from eight feet. medical knowledge of concussions is in its infancy. we know one thing for sure. forces to the head and that cause concussions. we've just heard how big these forces can be. here is another problem. they are getting bigger. since the 1920's, the average weight of pro-linemen has increased 60%. these players have gotten 10% faster.

combining speed and mass to calculate kinetic energy, we find the amount of energy at the line of scrimmage on any given play has almost doubled since 1920. in exact opposition is the fact in exact opposition is the fact that players are shedding protective gear. poor scholars, popular with lineman of my generation, have gone the way of the flying wedge. modern helmets are technological marvels, but players choose them not for the cushioning ability but for how cool they look. another problem is the poor state of our medical knowledge. i'm not competent to explain these issues. i think it is safe to say a roomful of head trauma physicians will not agree on the details of what concussions are or what causes them. the diagnosis and treatment have

a long way to go. as our understanding improves, we may find injury rates have increased faster than we thought. finally, football is big business, especially at the college and professional levels. when monetary forces manifest themselves as they do in bounty programs and illegal doping to improve performance, the game becomes more dangerous. what are the solutions? we need better equipment. this can get tricky. it is apparent adding more energy absorbing foam to the outside of the home it will lower the force delivered to a skull. this has been tried in the past. the problem is the added padding increases the diameter as well as the coefficient of friction, meaning the opposing player can exert more torque on your head. nevertheless, some companies are proposing the same idea for youth football.

the use of the star system for rating helmets represent important first steps toward improving football safety. for a variety of reasons that disregard player safety, they are largely ignored. our understanding of the physiological and epidemiological conditions must be improved. there is an understanding in the nfl and college level that significant research is needed. several members of this panel are leading cutting-edge efforts in this area. finally, some incremental rule changes and more stringent enforcement of existing rules are needed. some of the new rules regarding targeting are making players more hesitant on the field. these rules may increase the risk of injury.

rule changes should be studied and possibly reversed. it is my belief a return to the level of padding worn in the 1970's would make the game safer. more thorough doping rules should be developed and enforced. the nfl season should be reduced to 14 games. the college season returned to 11. more stringent requirements regarding when a player with a concussion can return to the game need to be implemented. these are my thoughts for your consideration. thank you for your attention and valuable time. >> thank you for your valuable time. you are recognized for five minutes. >> thank you. i appreciate the opportunity to speak on behalf of the safety of our children in this country. i am a pediatric neuropsychologist at children's national health system in

washington, d.c., and the director of the concussion program. i would like to take my time to focus my comments on the importance of public health education for youth concussion using my expertise as a clinician and researcher. i have worked for the last decade with the cdc on their heads up concussion program materials. we all know, and i think ian said it perfectly, the sports and recreation provide important developmental opportunities to enrich the lives of our youth. they teach life lessons. we have to balance those incredible benefits with careful attention to safety issues. science must drive our action oriented approach. concussions threaten the development of our youth. in an attempt to protect our youth, we have laws in all states with the good intent of

protecting our student athletes through rules for educating coaches and parents and removing suspected concussions and not allowing them to return until cleared. all states include the high school at this level, but only 15 of 51 include youth sports. less than 1/3 are looking at the majority of athletes. in preparing for this testimony, i was posed with an important question. with awareness at an all-time high, are organizations and parents more aware but still not sure what to do about it? the simple answer is yes. many coaches and parents are not equipped to know what to do with a suspected concussion. mechanisms are inconsistent and limited in scope. the health and safety of youth athletes is largely in the hands

of coaches and parents at the youth level. they need medically guided training and early identification and protection. coaches and parents must receive training on recognition and response. awareness is not enough. they have to be prepared properly. we know repeated concussions present the greatest challenge. our challenge is the implementation so we can prepare coaches and parents to know what to do and have the tools with which to do it. over the past 10 years, our program has delivered hundreds of education and training programs using the headset materials from the cdc. we have learned much about the community needs and how to deliver the message. we deliver scenario-based training where we present to

coaches and parents an actual situation and what they must do to respond. this is important as we put these responsible adults in place. you have heard important other activities and examples of head safe and had smart action such as the tackling program where coaches are educated in response and recognition but also taught techniques we believe can improve taking the head out of the game. we have to go further in all youth sports. we do not have a universal strategy to recognize and respond to these injuries. we have tools and programs, but we do not have the delivery mechanism to do that. we have to build on partnerships between organizations and medical care systems.

concussions are complicated. we are not asking parents and coaches to be clinicians and diagnose. we have willing teammates as you have heard, but we need to build those partnerships. we need the help of the professional sports leagues. we need the manufacturing world to team with us. we need the quarterback to make this happen. we have to leverage the efforts of other organizations like the national council on youth sports safety. all of this is important for us to do. we need funding to do that to move forward. can we move from awareness to action? yes, we can. concussions are serious injuries that threaten our youth. we do not need to be scared away from that or avoid participation in sports activities.

we need to focus on how to teach recognition and response. our country needs a universal mechanism to implement community focused solutions. we believe that can help children as they enjoy the benefits of sports. our motto applies. it says play hard, play safe, but play smart. thank you. >> you are now recognized for your five minutes. >> thank you. my focus will be on the radiological evidence of concussion and sub concussive blows to the head. what is known is mild traumatic brain injury is common in sports injury.

when we are talking about a single mild tbi, about 80% get better. between 15% and 30% have persistent symptoms. what are most concerning our chronic disorders. that is the second one. it is repetitive mild traumatic brain injury we are concerned with. the clearest evidence comes from postmortem studies. the next slide. this is a postmortem slide that shows protein in the brain. this is the brown areas. this is in the case of a retired professional football player who had symptoms and was presumed to have chronic traumatic encephalopathy which was confirmed postmortem. here are four individuals.

this work shows injury and repetitive brain trauma look the same postmortem. we have a military person at 45 with one close range blast injury, a 34-year-old with two blast injuries, an amateur football player at 18 with repetitive concussions, and a 21-year-old with sub-concussive blows to the head only. mild tbi is difficult to diagnose. that has been a serious problem. if you use conventional ct and mri, are not likely to find differences in abnormalities in the brain. many have said there is no problem. the problem is the correct tools have not been used until recently. with advanced neuroimaging, we are able to diagnose and move towards prognosis and hopefully intervention. advanced neuroimaging techniques

which we have been using show radiological evidence of brain alteration in living individuals with mild tbi. if we can detect this early and look at underlying mechanisms and characterize what is going on to come up with preventative measures. the next slide. this is a study from our group looking at hockey players in canada. the bottom line is on the right. preseason is the first. the second is postseason. the red dots are three individuals who had concussions. the increase is an increase in extra-cellular water in the brain, not a good sign. we also looked at gray matter, that is the cortex where neurons are in the brain. this is a study in former professional football players

who were symptomatic. we found there is cortical thinning compared to age matched controls. what is most concerning is the blue line that shows it accelerates with age. this suggests it may indicate abnormal aging any risk for dementia we can see in living individuals. the next slide, please. this is a study we did in germany with elite soccer players. we selected them specifically for not having a history of concussion and not having any symptoms. we found compared to professional swimmers, there was a huge difference between the groups. that control is on the left and the soccer players on the right. there's all most a complete

separation between the groups with the measure of damage to myelin in the brain. what we don't know. what is a result in some and not others? why do some develop neurodegenerative disease while others do not? what are the predisposing factors? is it exposure? are genetics involved? not every player who gets hit ends up with these neurodegenerative diseases. next slide. we need diagnosis to detect brain injury early. we have tools that can be applied. prognosis to follow recovery. we need to follow recovery and degenerative processes to predict who will have a poor

outcome and a good outcome. knowing that, we might be able to intercede with treatment to halt cascade of changes. in summary, sports concussion leads to alteration of the white and gray matter. neuroimaging can detect injury following trauma. the impact over time is important. we need longitudinal studies to identify different stages of recovery and being able to pick out ahead of time what will lead to a poor outcome so we can intercede. some measures of safety such as rules for returning to play are needed after observable evidence of brain trauma. thank you. >> thank you. very impressive testimony from everyone. i was impressed you all stuck to the five minutes, pretty close.

i'm going to go back to dr. molfese because years juxtapose each others nicely. your research is finding the baseline of the new athletes that enter university of nebraska. is this allowing you to detect injuries earlier? there may have been pre-existing subconcussion. how are you identifying that? what is it telling you? what is the university doing to implement some level of protections? >> one of the major changes we have seen occurring across the field is the effort to get pre-concussion data. more schools are moving to

observing students before the start of the season. should a player be injured, one of the weaknesses is the players do not always self identify. we run across that a number of times in our testing. we will pick up something on our tests that the trainers and medical team did not know about because the player did not disclose. we also try to test someone else who plays a similar position has not been injured. they act as a control over the course of the season. we are finding what occurs across the season in normal players with no history of concussion, their speed of processing does change over the four or five months of training and the season.

with the players who experience concussion, we see a slowdown of about 200 milliseconds. that is four times faster than the slowdown in multiple sclerosis, for contrast. clearly, the brain has changed the way it is processing. we are moving to start intervention programs with the players identified. there is some data with alzheimer's that suggest working memory tasks, even one week, can show continual gain and improvements. we are trying to see some of that occurring. >> thank you. dr. gay, in regard to concussions, many times it is not a direct blow. the head is going back and forth

and the brain is sloshing around. you mentioned going back to 1970's type equipment. describe what you mean by 1970's equipment and how it may reduce concussions. >> the neck roll or horse collar is a piece of equipment that has disappeared from the game. it does an important thing. it immobilizes the head. if concussions are incurred by rattling of the head back and forth or a blow to the side, the horse collar will substantially damp that down. to my knowledge, there are no studies of that being effective. my personal opinion, even though i am largely ignorant of medical science, is if you immobilize

the head, that will solve a lot of the problems, especially with rotational hits. yeah. >> dr. graham, does that make sense? >> whether or not the horse collar would have that effect, i don't know. our committee was based truly on science and reviewing the literature. i think the principle is you want to find ways to minimize the linear and rotational forces that come into effect with a blow to the head. whether you can do that by equipment, by change in play, that is what you have to do to decrease the incidence of concussion. >> thank you. i only have 11 seconds left. i will recognize my ranking member.

>> in addition to the science, so much talk has been about culture. it seems that is very important. a change in the culture means not only managing head injuries when they occur, but also encouraging safer play to reduce the risk of injuries. mr. heaton, you spoke about the need to change the win at all costs attitude among players and coaches. what would you tell teams to help them change that attitude? >> thank you. i would encourage the coaches to stress this as much as possible, as well as the parents. coaches and parents are there to help us learn how to play these sports correctly.

if they can emphasize not having to worry about winning to the point where you get hurt, it will trickle down to the players. the players become coaches. it is the cycle of teaching and making sure players no winning is not the most important thing. it feels great to win. but i would much rather lose than have another concussion. >> you were aware of the severe consequences of brain injury. do you think youth athletes understand what the symptoms are? >> yes. i think it is getting better, especially at my school. we emphasize making sure you know the symptoms of concussions. i feel like it is spreading as well. >> when he asked the doctor. >> at this point, the education

programs are being directed toward athletes. about five or six years ago, there was a study that showed that that was the number one reason why athletes were not coming out of the game, because they did not know the symptomology. they did not know what they were dealing with. we also believe athletes and teammates need to watch out for each other. the concussed athlete may not have the wherewithal to know they are not right. their teammate often does. there is a responsibility within that team to take care of each other. that is an important focus. >> that goes to culture as well. these explain how advanced neuroimaging works. describe the type of changes in the brain your lab is able to detect that traditional imaging cannot, and also some of the

imaging used by your lab have been a significant part of the research on diseases like alzheimer's and schizophrenia. why are the same imaging techniques useful? >> i have one slide that explains diffusion imaging. >> the one i did not understand was comparing soccer players? >> i was going to show you why it is important. the injury that happens with the impact to the brain is generally a stretching of the cables in the brain, the white matter. the corpus callosum is the largest white matter track in the brain. this does not show up on traditional ct or mri.

the first mild tbi conference i went to, no one showed a brain. i looked to my colleague and said, why would no one show a brain? he said because everyone knows you cannot see anything on the brain. brain. but nobody is using the right tools. this is a simple principle of diffusion imaging. on the left, this is ink that goes in all directions. you are dropping ink on newspaper. newspaper has fiber so it restricts the water. this is the same principle used to look at the brain. in cfs, it is round. everything goes in the same direction. if you're looking at white matter, you are restricted in two directions. you can measure the integrity of white matter fiber bundles in

the brain. that is what you need to look at in mild tbi. if you have a moderate or severe brain injury, you don't need this technology. they will be put into neurosurgery and they will do an operation. it is the subtle brain injuries that are not recognized using conventional imaging where you can recognize it if you use something like diffusion imaging. we have shown you can see. it is not just our group. starting in 2003, people started using it because it is the most sensitive imaging tool that exists today looking at the major injury in mild tbi. what needs to be done is to look at acute injury and see what predicts outcome. at 72 hours, three months, six months. can we predict what happens at

72 hours? we have someone in our lab trying to separate water outside the brain. if you can predict from 72 hours, you can go back and say maybe we want to put in anti-inflammatory medications. we don't know enough right now. the only way to know is to do these longitudinal studies and follow over time using sophisticated imaging technology. once you know, you can diagnose. >> this could be very promising, not only for athletes before returning veterans, and applied eventually to schizophrenia or alzheimer's. >> i am primarily schizophrenia research. that is what i have done for 30 years before i became a tbi researcher in 2008.

we have a measure called free water based on imaging that shows at the first episode of schizophrenia, you see fluid around all of the brain. it is free water. it is isotropic. in the frontal lobe, you see it were restricted to tissue inside. this is a new technique developed by a fulbright scholar in our lab from israel. >> i'm going to have to say thank you. >> thank you. the gentleman from new jersey is recognized. >> dr. johnston, you stated many sports related concussions still go undiagnosed. i would like to know why that is the case and how we can improve that. with state laws and the involvement of players, coaches,

pta's, areas where we need to have improvement. >> thank you for the question. i would echo what has been said by others on the panel. i think a lot of it has to do with recognition. people are very good at recognizing when someone gets knocked out on the field. that is a very small percentage of all concussions. as our understanding of the symptoms has arisen, it becomes incumbent on us to improve the quality of education we give to coaches, players, trainers, officials about the symptoms of concussion. my sense is in general, culture, speaking to the state of alabama, the coaches i have come into contact with are believers.