Were to happen. When something happened to me, one, i dont think anyone noticed and i dont think they knew what the to do. Rose brain series sportsinduced trauma, underwritten by the sloane foundation, coming up. Rose funding for charlie rose has been provided by and by bloomberg, a provider of multimedia news and Information Services worldwide. Captioning sponsored by Rose Communications from our studios in new york city, this is charlie rose. Rose tonight we continue exploration of the human plain brain with sportsinduced trauma. Well focus specifically on young people. Kids and young adults make nearly 250,000 emergency room visit each year as a brain injuries from sports and recreation. Our increasing understanding of this traumas neurological effects have ignited a discussion about the risk of Contact Sports. Tori bellucci was an allmet Soccer Player in maryland, she turned down a scholarship in college after she suffered her fifth concussion. She joins us to talk about her experience. Also sign cysts, Walter Koroshetz of the National Institutes of health, Susan Margulies of the university of pennsylvania, Thomas Mcallister of the Indiana University scoostles medicine, dawn comstock of the university of colorado anschutz and, once again, dr. Eric kandel. He is, as you know, a noble laureate, bureau of of Columbia University and Howard Hughes medical investigator. I am pleased to have them here at this table. Tell me about concussions among young people. Sportsinduced trauma, this has emerged as one of the major Health Issues of our time. Why is that so . Let me put this in a bit of a perspective. There is a general consensus that team sports is extremely advantageous for young people. 50 million americans participated in group sports, in athletic competition. And this is beneficial in two ways. Athletic and social. From the athletic point of view, they learn early on that almost daily exercise is good for one, and many of them are likely to carry this forward for the rest of their life, ensuring them a healthier life span than they would otherwise. In additiono the physical values, there are also social values that come with it. One learns from team sports a sense of honesty, fair play, team work. These are very beneficial values that also help carry people through a lifetime. But a down side emerged recently, as you indicated. The medias called attention to the fact that at the very highest level, professional football, soccer, basketball, there are traumatic brain injuries associated with sports activity and some of them can lead to severe brain damage and that has made us worry whether or not were taking sufficient care of our young people to protect them from this, and this has become a national issue. President obama called a summit meeting on this in may in which he raised this issue. Could sri the tape, please. Concussions are not just a football issue. Young people made nearly 250,000 emergency room visits with brain injuries from sports and recreation. 250,000. The total number of young people who are impacted by this early on is probably bigger than we know. So as president obama made absolutely clear, young people are particularly susceptible to traumatic brain injuries, and traumatic brain injuries is the leading cause of death and disability in young people. So we want to understand, you know, what this is about. What is a traumatic injury about . The brain is a gelatinous organ that is protected by being encased in a rigid, bony skull. When we move about, there is minimum movement in the brain, but as a result of two kinds of forces, impact forces or inertia forces, there can be serious jarring of the brain as it is moved rapidly back and forth in this closed space. It is only separated from this bony inflexible skull bay fluid later called the cerebral spinal fluid. Impact forces are actually from physically bumping in against the skull either by another skull hitting it, by hitting the ground, by hitting a soccer ball. But in addition to this, there are inertia forces which dont involve any contact at all. Its like a whiplash injury in which somebody bangs into your body and can shake up the brain or when you fall on to the ground, it can shake up the brain and often these forces interact with one another and have significant consequences on peoples neurological states. The traumatic brain injury varies from being modest to being moderate or severe. The modest injury falls into two cargts. The vast majority of them are about 90 recoverable within seven days but, in some cases, even with modest injury, the recovery may take longer. With moderate or severe brain injury, the recovery takes longer. One of the factors that lead to this prolonged recovery, there are several. One is younger people are more sususmoresusceptible than older. A prior concussion means it takes longer to recover. One of the sad things of a prior concussion is if youve had one, youre more likely to have a second and if youve had two, youre much more likely to have a third or fourth. So concussion is not bad in itself but what it does for the future of the athlete playing, one of the predictors for these long recoveries besides prior concussion, there are also severe symptoms. Amnesia or loss of consciousness, particularly profound ones, if you have them youre likely to have a prolonged recovery. At what period are you both south susceptible for traumatic brain injury, both male and females, the peak injury occurs during adolescents occurring from about 12 to 18 or 19 years of age. Why is that so . Everyone who has had an adolescent child realizes there are important brain changes that occur during adolescents and the two key ones which well hear about later on are called pruning and myelination. Pruning, the cells make contact with each other and the brain produces many more synapsis than it actually needs to make sure every possible contact is covered. But with adolescents, the brain matures, inappropriate contacts are gotten rid of. So those that are not functioning are gotten rid of to streamline and make the brain function as a highly efficient computation device. As the brain enlarges, we need speed of communication between one region and the other, thats mediated by long structures called axeons and theyre covered by myelin and myeliniation is the process. And the brain is susceptible to injury when this is going on. One of the tragedies is because of the enormous susceptibility, we still dont have any pharmacological treatment for traumatic brain injury and it becomes all the more incumbent to use other health measures, for people who are the coachers, trainers, athletes themselves and the person in the game to realize when the concussion has occurred to immediately pull the athlete from the game and not to let him return to the game on that particular day. In fact, they should not play again until they have been cleared by a health professional. So this is really absolutely essential. In order to really, you know, discuss these issues in depth, we brought together a really extraordinary panel. We begin with tori bellucci, an outstanding Soccer Player and, because of several concussions, she has decided to give up competitive athletics and she now coaches Soccer Players to prevent them from having the kinds of difficulties shes had, and shes going to describe to us directly what its like to have a concussion. We have dawn comstock who is interested in the incidents of concussionings and the circumstances to bring this out. Thomas mcallister is interested in the cognitive behavioral consequences of concussion and is doing a longterm study of College Students to see what the behavioral consequences is. Susan margulies is interested in the brain mechanisms of concussions and studies this not only in people but in animal models. And 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 were 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 didnt 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 didnt 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 couldnt 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 thats the problem there, not identifying the concussion. If, in fact, according to what youve 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 . Ive had five. Tot what dug did you know something was wrong but you didnt 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 didnt 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 im a lot better, but i still struggle with things. With my workload at school, i have about two 2003 headaches a week. Sometimes ill 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, its 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 havent 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 youve become a part of the conversation without the impact of concussions. Which im really happy about. Its unfortunate all this had to happen to me but i do think its something that needs to be talked about and known so im glad i could help with that. Rose how prevalent are concussions among young people . More prevalent than people realize. At high school age, high schoolsanctioned 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 scarylooking 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 havent 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 weve had in education, in knowledge. The Young Athletes, their parents, the coaches, the policymakers have become more aware of this issue of sportsrelated 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 highprofile incidents at the professional level, but now it would be very difficult to find a parent of a High School Athlete that couldnt at least explain some of the signs and symptoms of concussion and recognize that its 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 dont want to come out of the game, but its 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 athletetoathlete contact. So collision sports have more instances of athlete contact in competition. Rose and more in competition than practice. Correct. Youre 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 well 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 thats 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, lets say, seven to ten days or perhaps several weeks. But weve known for a long time that there is a Certain Group of folks for whom thats not the case, and the symptoms can persist for a fair amount of time. Whats 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 whats important to know is its great the skull is great at protecting the brain from lots of things. But when you put the brain in motion and its moving out of phase with the skull itself, its rubbing up against somewhat a hostile work environment. You can see the cutaway, there are images or rough areas along the skull that make it more likely the brain is damaged in those particular areas, but you dont 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 neuropsychiatric 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, socalled 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 couldnt 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