Concussion Epidemic in Child Sports Spurs Push on StudiesSonali Basak and Alex Wayne
President Barack Obama announced $86 million in projects to improve detection of concussions in children and research their effects, an effort to reassure parents concerned by the rise of brain injuries in youth sports.
The initiatives will be largely funded by donations from the National Football League, the National Collegiate Athletics Association and Steve Tisch, the chairman of the New York Giants, according to the White House. Some of the projects respond to an October report by the Institute of Medicine that urged new research including a long-term study of how children fare after suffering concussions.
“These efforts are going to make a difference to a lot of people, from soldiers on the battlefield to students on the playing field,” Obama said at a White House summit highlighting the issue today.
The number of Americans ages 5 to 19 with traumatic brain injuries in sports-related incidents grew 62 percent from 2001 to about 250,000 in 2009, the latest year in which government data is available. Obama said that he may have suffered concussions himself playing football as a child.
“There were a couple of times where I’m sure that that ringing sensation in my head and the need to sit down for a while might have been a mild concussion, and at the time you didn’t think anything of it,” he said. “The awareness is improved today, but not by much. The total number of young people who are impacted by this early on is probably bigger than we know.”
For Brandon Morris, who stopped playing football after suffering a concussion at age 19, it’s an effort that’s well worth the funding.
Morris played for four years in high school, and was a freshman at Bucknell University in Pennsylvania when he was knocked out during a practice. Months later, after his mood swings and headaches failed to disappear, his doctors told him that he could die from another hit to the head.
That’s when he walked off the field for good, he said.
“People don’t realize what a concussion really is,” said Morris, now 23 and a private equity analyst at Resource Real Estate in Philadelphia. “I felt a real, tangible difference.”
“The long-term cognitive learning and psychological effects this can have on kids is devastating,” said David Dodick, head of the Mayo Clinic Concussion Program, who planned to attend today’s summit. “It changes the way they learn, it changes their personality.”
Over the past decade, the issue of sports-related concussions has largely focused on a highly publicized debate over the long-term affect on professional football players. Now, an October report by the Institute of Medicine, a arm of the National Academy of Sciences that advises lawmakers on health issues, has refocused the debate on the country’s youth.
The institute’s researchers, who pored through more than 500 papers over 15 months, urged the establishment of a national monitoring system for head injuries in children and asked the U.S. government to finance new research on how kids with concussions fare over the long term.
“From the time that the committee started working on the report, we knew that there was science that needed to be strengthened,” said Robert Graham, the committee chairman.
Among the projects Obama announced is a $16 million long-term study by the National Institutes of Health in Bethesda, Maryland to detect and measure the effects of repetitive concussions. The money comes from the NFL, which promised $30 million in 2012 to back research on brain injuries.
The NFL will also spend $25 million over the next three years to promote youth sports safety, and the NCAA and the Department of Defense will spend $30 million on what the White House called “the most comprehensive clinical study of concussion and head impact exposure ever conducted.”
Tisch, of the Giants, will provide $10 million to the University of California Los Angeles to fund programs aimed at preventing concussions and research their treatment. The money will also help the Centers for Disease Control and Prevention develop a system to “accurately determine the incidence of youth sports-related concussions,” the White House said.
“We have to know what these issues are,” Obama said. “And the fact is, we don’t have solid numbers, and that tells me that at every level we’re all still trying to fully grasp what’s going on with this issue.”
Pressure to Play
More than half of all young athletes fail to report concussions despite symptoms because of pressure to continue playing, Dodick of the Mayo Clinic said. This “culture of resistance” complicates the collection of concussion data and studies of the issue, the report said.
The ambitions of young athletes and their parents may also contribute to increased concussions, and football isn’t the only activity where head injuries are an issue.
In 2012, the American Association of Cheerleading Coaches and Administrators banned a move called the “double down,” in which girls made two twisting rotations before landing on aerial stunts, after reviewing data showing it was tied to concussions in the sport.
“We had backlash from parents,” said Jim Lord, the association’s executive director, in a telephone interview. “‘My daughter’s not going to be able to get a college scholarship if she can’t do this particular skill.’ That’s not true. Your daughter isn’t going to get a college scholarship if she can’t function.”
Other groups have also adjusted their policies to address concerns. In 2010, the Pop Warner football, dance and cheerleading organization instituted a concussion policy for its more than 200,000 participants, saying that home teams must have emergency plans in place and that players, cheerleaders and dancers must be removed from play or practice when a head coach, medical trainer or guardian says it’s necessary.
USA Hockey, the governing body for the sport, has banned checking by players under 12 years old, Obama said.
John Butler, the executive director of Pop Warner, said he’s looking for more data-driven research to assess new guidelines. The problem, he said, is most research is being done at the high school and college level while Pop Warner league participants are ages 5 to 16.
Brandon Morris’ mother, Janice, said she never worried about concussions because her son wore a helmet, there were trainers on site, and coaches assured her son’s safety. That changed after he was knocked out, she said in an interview.
Months afterward, doctors told her that five years of repeated impacts to his head as he played the sport through high school and a car injury during that time left him at high risk. They said “there was damage to his brain and that it would take a lot of time to recover, and to be aware that one more injury could kill him,” she said.
“Had I known then what I know now, he wouldn’t have played,” she said, adding that she’s grateful that coaches are being trained to detect head injury, and that protocol is being put into place for return-to-play time frames.
“It doesn’t help us at this point in time,” she said. “But going forward, it’s going to help a lot of people.”
At Bucknell, “the protocols in place for all Bucknell sports programs reflect the best available information and practices,” said John Hardt, the Lewisburg school’s director of athletic and recreation.
The university “works with its professional medical providers to continually develop and assess concussion management protocols for the recognition, diagnosis, treatment of and recovery from such head injuries,” Hardt said.
Concussion research is still in its “infancy,” said Mayo’s Dodick, whose program is based in Phoenix.
White House Conversations
The White House event grew from a conversation about youth concussions between Obama and his press secretary, Jay Carney, whose children play soccer and football, during the NFL playoffs in January, according to an e-mail from the White House. About the same time, the director of the White House Domestic Policy Council, Cecilia Munoz, had raised the findings of the Institute of Medicine in senior staff meetings.
Participants at the summit included representatives from the NFL and its player’s association, the National Collegiate Athletic Association, Major League Soccer and U.S. Soccer.
An estimated 3.8 million sports- and recreation-related concussions are suffered each year by people of all ages in the U.S., according to the IOM. Dodick said this number could more than triple considering how many injuries are unreported and undiagnosed. While traditional MRIs and CAT scans can detect bleeding and larger brain damage, concussions and sub-concussive impacts are often only detected on the micro-structural level, he said.
“What is the cumulative impact over time?” Dodick asked. “We really don’t know.”