walter walter i koroshetz ig can we come up with treatments. so not only do we have a mainly health problem but we have a major health flannel panel and we're in for a fantastic discussion. >> rose: thank you. tori, what happened? >> i began playing soccer when i was four years old a little against my will. after my first practice, it was something i immediately loved and something i wanted to do all the time. so i played soccer. since that day until i was a senior in high school and around when i was 15 years old is when i got my first concussion. i really didn't even know it was a concussion. i headed the ball and someone else. when i got home, i had a lot of headaches and trouble sleeping. i didn't think of the possibility of concussion, and i knew i had an important game the next day, so i decided to play anywayt. once i got to my game the next day, it was the semifinals and one of our state cup appearances and i had gotten into a rough tackle and fell to the ground and hit my head on the ground pretty hard. once i got up from the fall, i was kind of confused as to where i was, but i gained that back pretty quickly, but my vision was extremely blurry, my head was spinning, i was doesy, but knowing it was an important game, i decided to push observe. after i finished the game, i went to the emergency room, and turned out i had whiplash in my neck and a concussion. so i had to take probably a week off of school. i was very moody. i couldn't sleep. it was a very tough time for me. >> rose: were you under medical care at this time at all? >> no. when i went to the emergency room, they gave me a muscle relaxer for my neck. other than that, i just stayed home with my mom. she took off work. >> rose: that's the problem there, not identifying the concussion. if, in fact, according to what you've already said, if there would have been some identification, everyone would have insisted she not play till it cleared up. you had how many concussions? >> i've had five. tot what dug did you know something was wrong but you didn't want to leave the field because you realized the team depended so much on you? >> i think at that point i would have tried to push through anything, no matter what my symptoms were. i was so competitive and my passion was incredible for the game to where i didn't want to stop even if i knew something was terribly wrong with me. >> instead of leaving the field when they feel ill -- >> rose: in the n.f.l., a doctor exams anybody who thinks they might have a concussion as soon as they come off the field. so today, how are you? >> today i'm a lot better, but i still struggle with things. with my workload at school, i have about two 2003 headaches a week. sometimes i'll have headaches for five days without any break. my eyes have been struggling since my last concussion which is almost two years ago. both my pupils are not the same size all the time. so with that, it's really difficult for me to be in lecture and be looking at the board and looking at the powerpoint and going back to my notes. that really stimulates my headache. >> rose: are you under the care of neuroscientists and physicians? >> not anymore. i mean, after my last one, i haven't really had to go back to the doctor. i have been telling them i still have headaches and probably troubleshooting every idea we have. >> rose: your case was not known. you were there with the obama summit and the president and you introduced the subject there. >> yeah. >> rose: so you've become a part of the conversation without the impact of concussions. >> which i'm really happy about. it's unfortunate all this had to happen to me but i do think it's something that needs to be talked about and known so i'm glad i could help with that. >> rose: how prevalent are concussions among young people? >> more prevalent than people realize. at high school age, high school-sanctioned reports, last year sf 0,000 concussions among football players, off0,000 among girl soccer players, 45,000 among boy soccer players and 20,000 each among girls basketball players and boys wrestlers, and those are national estimates based on national injury surveillance data. over the last decade, concussion rates increased dramatically over time. now, this is one of those times where some scary-looking statistics might actually be something good. this rapid increase over time likely does not indicate a true increase in the incidence of concussion. high school athletes haven't grown dramatically bigger and faster and stronger over the last decade and most of the rule changes at the high school level in the last decade actually improved player safety. i think what this image actually demonstrates is the dramatic increases we've had in education, in knowledge. the young athletes, their parents, the coaches, the policymakers have become more aware of this issue of sports-related concussion. >> they recognize it more readily. >> exactly. >> rose: is it across the spectrum of sports or primarily football, soccer, those contact sports? >> well, i think awareness was originally generated because of high-profile incidents at the professional level, but now it would be very difficult to find a parent of a high school athlete that couldn't at least explain some of the signs and symptoms of concussion and recognize that it's an important injury that needs to be addressed. another thing this image demonstrates is concussion rates are significantly higher in competition than in practice. >> rose: yes. and part of this may be because athletes, like tori, simply don't want to come out of the game, but it's also because there is more events of athlete contact that occur in competition compared to practice. these differences between competition and practice rates vary dramatically by sport, however. for example, in boys high school ice hockey, competition concussion rates are 13 times higher than practice concussion rates, while in girls softball, computation rates are only twice as high as practice rates. >> rose: how do you explain this? >> a lot of it are just the activities associated with individual sports. across the entire spectrum of 24 sports i study, the most common method of concussion is athlete-to-athlete contact. so collision sports have more instances of athlete contact in competition. >> rose: and more in competition than practice. >> correct. you're much more likely to hit your opponent in a game than you would your teammates in practice. >> rose: let me turn to tom, then, and talk about what happens when there is a concussion. >> charlie, from a clinical standpoint, i think tori described it very nicely, but, basically, as a result of the force and the mechanics that eric alluded to and we'll touch on further, there is a disruption in brain function that is usually described as an alteration in the level of consciousness, which simply means that people may have incomplete memory for the event, they may appear confused, dazed, astory described, and then that's often followed by a variety of other symptoms, such as headache, may have blurred vision, sensitivity to light and noise and dizziness are particularly common, along with headache. the other sort of major domain people will prescribe are problems with thinking and usually the big ones are problems with memory, attention and concentration. the good news is that most times these symptoms gradually resolve over, let's say, seven to ten days or perhaps several weeks. but we've known for a long time that there is a certain group of folks for whom that's not the case, and the symptoms can persist for a fair amount of time. what's interesting is that the way that the concussion happens and the way the brain is designed and the skull is designed and so forth actually predict nicely the kind of symptoms tori described. you can see again two forms, one can be from the brain hitting the inside of the skull and the areas in red on that slide suggest the areas that are particularly vulnerable, and then what's important to know is it's great -- the skull is great at protecting the brain from lots of things. but when you put the brain in motion and it's moving out of phase with the skull itself, it's rubbing up against somewhat a hostile work environment. you can see the cut-away, there are images or rough areas along the skull that make it more likely the brain is damaged in those particular areas, but you don't even have to have that in order to have the injury and symptoms tori described. i think just the very movement of the brain itself, eric described it as a somewhat gelatinous material and not of uniform density, so as the brain is moving, there are shearing forces that result, and that can damage the delicate white matter fibers or ax axons that connecte fiber to another. these are delicate so this twisting or action can damage that and damage the connectivity of the different brain functions. so putting it all together, the next image will show the particular brain regions which are, you know, most likely to be damaged, and what i think makes concussion and brain injury in general a sort of perfect storm for the kinds of neuro-psychiatric complaints tori described, these images are showing the symptoms tori had. memory is the common complaint. the next image shows which brain regions are important in memory function. fink you compare that to the other image, you can see it maps on to that very, very nicely. tori, i think, described some difficulties with schoolwork, and lots of our athletes describe that. they describe it as not thinking as quickly, sort of decrease of speed information processing, so-called executive function, and if you look at areas of the brain particularly relevant to executive function, they map nicely on the regions that are vulnerable to con cuesive injury. and then i thought it was interesting, tori, you mentioned being somewhat moody, somewhat depressed. this is an enormously common complaint from people who have concussion and other type of brain injuries, so the psychological health as suspect is impacted. and brain regions are thought to be important. once more, if you were to design an injury calculated to sort of damage cognition and neural behavioral symptoms, you couldn't have designed a better one, unfortunately. so the point of all this is, i think, the symptoms that we see follow very nicely from what we know so far about the mechanics of how the brain is injured. >> rose: do we know why some people recover better than others? >> well, eric alluded to come of the reasons we know of. folks who have had more than one injury tend to take longer to recover. younger athletes may have a more prolonged recovery. there is also an interesting link between other kinds of behavioral and psychological health issues. so folks who have had struggles with those kinds of concerns in the past, there seems to be an interaction with it. and then as we'll hear from dr. margulies, the bio mechanics, not every injury are the same in how they affect different brain regions and that may play a role. very interesting work suggests genetic factors may impact this. so you and i might differ in terms of the genes that we have for getting better or not getting better after a concussion. >> rose: let me turn to walter and talk about how the young brain is different. >> right, charlie, so i think our brains are always developing, even in adult life. new connections are being made. this is much more dramatic during childhood. the the changes occurring in the young brain are so dynamic. the energy that the brain uses peaks in late childhood and adolescence. the blood flow peaks in late childhood and adolescence. and as eric said, the brain is a massive computer where the connections are just tremendously exuberant right at the beginning. then it's molded over time by activity and experience to make us who we are. that molding period, as eric mentioned, is because connections that are not useful are taken away, the sna synaptic bruining and that's occurring at a peak during this time period. everyone is worried about the injury that occurs during the developmental stage whence things are more dynamic. the myeliniation, the insulation and wires that connect different brain regions goes on into your 20s