[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
PROTECTING SCHOOL AGE ATHLETES FROM SPORTS-RELATED CONCUSSION INJURY
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
SEPTEMBER 8, 2010
__________
Serial No. 111-153
Printed for the use of the Committee on Energy and Commerce
energycommerce.house.gov
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COMMITTEE ON ENERGY AND COMMERCE
HENRY A. WAXMAN, California, Chairman
JOHN D. DINGELL, Michigan JOE BARTON, Texas
Chairman Emeritus Ranking Member
EDWARD J. MARKEY, Massachusetts RALPH M. HALL, Texas
RICK BOUCHER, Virginia FRED UPTON, Michigan
FRANK PALLONE, Jr., New Jersey CLIFF STEARNS, Florida
BART GORDON, Tennessee NATHAN DEAL, Georgia
BOBBY L. RUSH, Illinois ED WHITFIELD, Kentucky
ANNA G. ESHOO, California JOHN SHIMKUS, Illinois
BART STUPAK, Michigan JOHN B. SHADEGG, Arizona
ELIOT L. ENGEL, New York ROY BLUNT, Missouri
GENE GREEN, Texas STEVE BUYER, Indiana
DIANA DeGETTE, Colorado GEORGE RADANOVICH, California
Vice Chairman JOSEPH R. PITTS, Pennsylvania
LOIS CAPPS, California MARY BONO MACK, California
MICHAEL F. DOYLE, Pennsylvania GREG WALDEN, Oregon
JANE HARMAN, California LEE TERRY, Nebraska
TOM ALLEN, Maine MIKE ROGERS, Michigan
JANICE D. SCHAKOWSKY, Illinois SUE WILKINS MYRICK, North Carolina
CHARLES A. GONZALEZ, Texas JOHN SULLIVAN, Oklahoma
JAY INSLEE, Washington TIM MURPHY, Pennsylvania
TAMMY BALDWIN, Wisconsin MICHAEL C. BURGESS, Texas
MIKE ROSS, Arkansas MARSHA BLACKBURN, Tennessee
ANTHONY D. WEINER, New York PHIL GINGREY, Georgia
JIM MATHESON, Utah STEVE SCALISE, Louisiana
G.K. BUTTERFIELD, North Carolina
CHARLIE MELANCON, Louisiana
JOHN BARROW, Georgia
BARON P. HILL, Indiana
DORIS O. MATSUI, California
DONNA M. CHRISTENSEN, Virgin
Islands
KATHY CASTOR, Florida
JOHN P. SARBANES, Maryland
CHRISTOPHER S. MURPHY, Connecticut
ZACHARY T. SPACE, Ohio
JERRY McNERNEY, California
BETTY SUTTON, Ohio
BRUCE L. BRALEY, Iowa
PETER WELCH, Vermont
Subcommittee on Health
FRANK PALLONE, Jr., New Jersey, Chairman
JOHN D. DINGELL, Michigan NATHAN DEAL, Georgia,
BART GORDON, Tennessee Ranking Member
ANNA G. ESHOO, California RALPH M. HALL, Texas
ELIOT L. ENGEL, New York BARBARA CUBIN, Wyoming
GENE GREEN, Texas JOHN B. SHADEGG, Arizona
DIANA DeGETTE, Colorado STEVE BUYER, Indiana
LOIS CAPPS, California JOSEPH R. PITTS, Pennsylvania
JANICE D. SCHAKOWSKY, Illinois MARY BONO MACK, California
TAMMY BALDWIN, Wisconsin MIKE FERGUSON, New Jersey
MIKE ROSS, Arkansas MIKE ROGERS, Michigan
ANTHONY D. WEINER, New York SUE WILKINS MYRICK, North Carolina
JIM MATHESON, Utah JOHN SULLIVAN, Oklahoma
JANE HARMAN, California TIM MURPHY, Pennsylvania
CHARLES A. GONZALEZ, Texas MICHAEL C. BURGESS, Texas
JOHN BARROW, Georgia
DONNA M. CHRISTENSEN, Virgin
Islands
KATHY CASTOR, Florida
JOHN P. SARBANES, Maryland
CHRISTOPHER S. MURPHY, Connecticut
ZACHARY T. SPACE, Ohio
BETTY SUTTON, Ohio
BRUCE L. BRALEY, Iowa
C O N T E N T S
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Page
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 1
Hon. Bill Pascrell, a Representative in Congress from the State
of New Jersey, opening statement............................... 3
Witnesses
Vikas Kapil, Associate Director for Science, Division of Injury
Response, National Center for Injury Prevention and Control,
Centers for Disease Control and Prevention, United States
Department of Health and Human Services........................ 5
Prepared statement........................................... 8
Nikki Popyer, Senior, Marlboro High School, Marlboro, New Jersey. 19
Prepared statement........................................... 22
Joanna Boyd, Public Education Coordinator, Brain Injury
Association of New Jersey...................................... 24
Prepared statement........................................... 27
Mike Prybicien, M.A., A.T.C., C.S.C.S., Head Athletic Trainer,
Passaic High School, Passaic, New Jersey....................... 31
Prepared statement........................................... 34
Joel Brenner, M.D., M.P.H., F.A.A.P., Medical Director, Sports
Medicine Program, Childrens Hospital of the Kings Daughters.... 39
Prepared statement........................................... 42
Roman Oben, NFL Player for the New York Giants, Cleveland Browns,
Tampa Bay Buccaneers, and San Diego Chargers, 1996-2008........ 53
PROTECTING SCHOOL AGE ATHLETES FROM SPORTS-RELATED CONCUSSION INJURY
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WEDNESDAY, SEPTEMBER 8, 2010
House of Representatives,
Subcommittee on Health,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 1:00 p.m., at
the Fire Lounge, Prudential Center, Newark, New Jersey, Hon.
Frank Pallone, Jr., [chairman of the subcommittee] presiding.
Present: Representatives Pallone and Pascrell.
OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. I call the meeting of the Health Subcommittee
to order, and today we're having a hearing on Protecting
School-Aged Athletes from Sports-Related Concussion Injury.
Before we proceed I do want to ask the unanimous consent to
have Congressman Bill Pascrell participate as a member of the
Subcommittee for this hearing. Without objection so ordered.
There's no one to object but me, so we don't really have a
problem.
I'll initially recognize myself for an opening statement.
Today, as I said, the Health Subcommittee will be having a
hearing on Protecting School-Aged Athletes from the Sports-
Related Concussion Injury. Obviously, we're bringing our work
to a field hearing in my home state of New Jersey here at the
Prudential Center, which is the home of the New Jersey Devils.
I would like to point out, and I'm saying this for Bill's
purpose as well, this is the first and only field hearing that
the Health Subcommittee has had in this Congress, just so you
know.
The hearing will include testimony on Mr. Pascrell's Bill,
H.R. 1347, the Concussion Treatment and Care Tools act of 2009.
I'd like to briefly thank our witnesses for being here today.
We're going to have two panels. Dr. Vikas Kapil will be on the
first panel and then we'll have a second one. I know that some
of the panels have traveled quite a distance and had to battle
New Jersey traffic, which is not an easy feat. I only had to
battle getting into the building. I was actually here on time,
but we had to go to the other end of the building to get in.
But regardless, I want to thank you and I appreciate the fact
that the witnesses are here and, obviously, we look forward to
your testimony.
I wanted to especially recognize Nikki Popyer, I hope I
pronounced it right, who is a senior at Marlboro High School in
my district. Nikki will share her personal story in dealing
with sports concussions. In addition, I want to welcome former
New York Giants offensive tackle Roman Oben, I hope I'm
pronouncing it properly, who I know is a friend of Bill
Pascrell's and who brings a unique perspective to this
discussion.
A concussion, as we know, is a type of brain injury that
changes the way the brain normally works. It doesn't take a
medical degree to know that this type of injury can be a
serious one for young people whose brains are still developing.
I think all the witnesses before us today will discuss in
different ways how concussions have the potential to cause a
host of physical and emotional burdens, affecting child's
developmental, social and academic life.
Concussions are one of the most commonly reported injuries
among the nearly 38 million children and adolescents that
engage in organized youth sports and recreation activities in
the United States. In fact according, to the Center for Disease
and Prevention, CDC, each year U.S. Emergency departments treat
an estimated 135,000 sports-and-recreation related traumatic-
brain injuries among children ages 5 to 18. Furthermore there
is an increased risk for subsequent concussions among athletes
that experienced a previous concussion.
Of the sport-related concussion injuries seen in the
emergency rooms, approximately 65 percent occur among youth
aged 5 to 18--a significant statistic that demonstrates the
importance of today's hearing. What's alarming, however, is a
recent report conducted by Brown University Medical School that
states emergency room visits by kids suffering from concussion
while playing sports have more than doubled in recent years.
The numbers, accordingly, immediately prompted an updated
report by the American Academy of Pediatrics on concussion
identification and treatment for children.
As a parent of children who play youth sports, I want
assurances that when my kids are participating in their team
sports that they have the best medical care and training from
the school and its coaches. Yet, across the nation, only 42
percent have access to an athletic trainer. Meanwhile, states
have implemented a myriad of guidelines for schools and coaches
to follow.
I think we can agree that recreational and competitive
sports are great activities for young athletes, but we need to
protect against the potentially-serious impact of concussions.
We must aim to provide our schools administrators, coaches and
athletic directors with the information and tools needed to
protect youth athletes from the dangers of repeated head
injuries and developing long lasting cognitive issues. Young
people are resilient and don't want to get sidelined by bumps
and bruises, but head injuries shouldn't be ignored.
I look forward to today's testimony. I'm going to recognize
my colleague Mr. Pascrell, but I do want to say, first of all,
I commend him for taking such an interest in this issue. I know
that Bill has been involved in a number of issues related to
brain injury that I think we passed in the previous Congress,
the legislation relative to veterans and others, and I will
assure you there is no one who is more aggressive, and I say
that in a positive way, in trying to move legislation. And
that's why we're here today, because he's so aggressive he
insisted we have this hearing. I recognize my colleague and
friend Mr. Pascrell.
OPENING STATEMENT OF HON. BILL PASCRELL, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pascrell. Thank you, Chairman Pallone, for holding what
I think is a very friendly hearing and welcome you all today.
This is a great location for the hearing. I appreciate the
hospitality of the Jersey Devils as well as the Prudential
Center for allowing us to use their facility.
Before I start I want to take a moment to thank the Center
for Disease Control and Prevention. They've done a fantastic
job over the past several years in spreading awareness of
concussions in school sports through their Heads Up Program. I
want to commend them. It's a great program.
Nikki, you know what I think about you, your parents.
You're a brave young woman. I've worked with you over the last
year on the ConTACT Act making it a better Act because of you
and your input. You greatly increased your fellow students
awareness of concussion, God knows you've saved lives. I thank
you for speaking on behalf of students who have been affected.
Joanna Boyd, where are you, from the Brain Injury
Association of New Jersey. You worked tirelessly over the last
several years. I want to thank you and your organization's
dedication to this issue. In 2006 we worked together to get
grants to New Jersey schools for testing technology, to get the
right technology to provide baselines so we know what we're
talking about so that we can make comparisons and see before
and after situations. I look forward to continuing to work with
the organization.
Michael Prybicien. Where are you, Michael? Thank you for
coming from Passaic, I was just in Passaic earlier this
morning, to help us see how athletic trainers are in intrical
part of the solution. Thank you for coming here today.
Dr. Joel Brenner. Where are you? Dr. Brenner, thank for you
making the trip all the way from Virginia to lend us your
medical expertise as we work to protect our children's health.
And finally, Roman Oben. Where do I start with Roman. Super
Bowl champ, NFL Pro, making the transition from success on the
gridiron to success after the NFL. I can remember Oben ten
years ago as an intern in my office. You've come a long way.
All of the NFL players I've talked over the last three, four
years, we finally are doing something about that, about head
injuries, about concussions. Guys who play for sometimes three,
four years, sometimes ten years, almost throughout the line of
being vegetables because the league would not address it. They
are addressing it and they endorse our legislation. I thank you
for being here, Oben. We're honored to have you.
So we're at the beginning of the school year. Congressman
Jim Ringwood, welcome Congressman Jim Ringwood of Pennsylvania.
We started the congressional brain injury task force with a
number of us in the committee. Of course it does fit in a
telephone booth 11 years ago. We had no idea, believe me, we
did not, of how prevalent brain injuries would become over the
years for school sports. But today the Center for Disease
Control and Prevention estimates as many as 3.8 million sports
and recreation-related brain injuries occur each year, that's a
phenomenal number. And remember you do not have to have a blow
to the head to have a concussion, but a blow to the head and a
concussion is brain damage, whatever degree.
You've already probably seen the news over the last month,
concussions have become a growing problem for our schools. A
study published this past September, in the September issue of
Pediatrics, a journal of American Academy of Pediatrics found
that between 1997 and 2007 a number of children--the number of
children seeking emergency medical care for concussions is
doubled. More troubling is that between 2001 and 2005, the
beginning of this decade, approximately half of all emergency
department visits were sports-related conclusions.
Many parents and students today do not realize how
dangerous contact sports are until it's too late. In 2008 this
difficult reality hit home in a high school student from my
district Ryan Darrell. He died after returning to a football
game without fully recovering from a previous concussion.
In discussing the dangers of repeat concussion, the biggest
worry is a student suffering a second impact syndrome, a
condition that is debilitating if not deadly. We know today
that 41 percent of concuss athletes are returning to play too
soon. That is a fact of life. Under guidelines set out by the
American Academy of Neurology, again I repeat, I can't repeat
it enough, concussions are a brain injury. For an athlete that
has suffered a concussion, getting off the failed can literally
be the difference between life and death. Second impact
syndrome is preventable. There's no excuse for our children
having to face the life changing realities of this condition.
In Ryan's memory and to prevent this devastating injury
from affecting other families, Congressman Tom Platts of
Pennsylvania and I introduced the ConTACT Act, H.R. 1347. Our
Bill does two essential things to protect students. First, it
brings together a conference of stakeholders to establish
concussion management guidelines which will be used to prevent
identity, treat and manage concussions in school-age children.
These are physicians, these are therapists, these are
neurologists, et cetera. These are the professionals who will
establish the guidelines, not the Congress. We need to
establish our own guidelines for our own mental fitness. It
then authorize grants to state for adopting and disseminating
and implementing these guidelines and for the purchase of
testing equipment to carry out baseline and post-injury
neuropsychological testing for student athletes.
You can have a neurological psychological base test, it
makes no sense unless we have a test of a student who has been
injured so that we can make a comparison. This is exactly the
mistake that the Department of Defense has made on a
congressional directive of 2007 when the Department of Defense
decided in November of 2008 that they weren't going to pay the
attention to the exit neurological psychological test. They not
only botched in not protecting our soldiers when they went on
the field our sons and daughters, our neighbors, but they
botched them being tested when they come off the field to see
how severe the injury is. We do not want to submit to that same
stupid mistake.
We know that some states have passed legislation requiring
schools to implementing concussion guidelines. When a school
district attempts to crap concussion policies, it will find a
range of varying guidelines. That's going to be confusing. To
be clear, there are no federal guidelines at this time to help
students adopt uniform policies. Therefore, in tackling the
issue today and in reviewing the Bill, the ConTACT Act, we are
taking action to make school sports safer for all children. In
fact, we are considering expanding it beyond the middle school
and the high school into specific organized sports for young
folks within each community.
Support continues to build for the ConTACT Act. It is
endorsed by the Brain Injury Association of America, the Easter
Seals, the National Football League, the Players Association,
the Parkinson's Action Network, the State Head Injury
Administrators, American College of Rehabilitation and
Medicine.
I look forward to working with the Committee on this
important legislation. I want to thank you, again, Chairman
Pallone. I know many things have come through the Health
Subcommittee. It's been a momentous session, to say the least.
For your leadership on this committee and in bringing this
issue to the forefront. As you know, the Bill has been heard in
a few other committees before coming to your committee, and I
thank you for your time.
Mr. Pallone. Thank you, thank you Congressman Pascrell.
That concludes our opening statement since it's just the
two of us. We're now going to turn to our witnesses. As I said,
we have two panels. Dr. Vikas Kapil is on the first panel by
himself. Welcome and thank you for being here. I see Vikas
somehow became Vick, I guess it doesn't matter to you.
Dr. Kapil. Yes, sir. No, Vick is great.
Mr. Pallone. Let me mention that you are a physician and
Associate Director for Science of the Division of Injury
Response from the National Center for Injury Control and
Prevention at the Centers for Disease Control and Prevention.
We normally have five minutes. I'm not going to hold you to it
too much because we don't have that many witnesses today and
your statement becomes part of the record. In the discretion of
the committee you can submit additional briefs and pertinent
statements and writings at the conclusion of the record
afterwards if you'd like. I ask you now to begin with your
statement. Thank you.
STATEMENT OF VIKAS KAPIL, ASSOCIATE DIRECTOR FOR SCIENCE,
DIVISION OF INJURY RESPONSE, NATIONAL CENTER FOR INJURY
PREVENTION AND CONTROL, CENTERS FOR DISEASE CONTROL AND
PREVENTION, UNITED STATES DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Dr. Kapil. Thank you, sir.
Thank you and good afternoon, Chairman Pallone and
Congressman Pascrell. My name is Dr. Vikas Kapil. I'm an
emergency medicine and public health physician currently
serving as the Associate Director of Science at the Division of
Injury Response at CDCs injury center. It is an honor to be
here on behalf of CDC.
I would like to highlight for you today some key facts
about sports concussion among youth, described prevention and
response efforts that are currently underway and also talk a
little about some of the partnerships we're engaged in at CDC
to address this critical problem among this nation's youth.
As you already touched on, traumatic brain injuries are a
serious threat to the health and well-being of children and
adolescents in the United States. A TBI is caused by a bump, a
blow or even a jolt to the head or a penetrating head injury
that disrupts the normal function of the brain. The majority of
TBI that occur each year are concussions or other forms of mild
TBI. While most athletes with a concussion recover quickly and
fully, some will have symptoms that last for days, weeks or
even much longer.
Signs and symptoms of concussion include but are not
limited to headaches, nausea, vomiting, difficulty
concentrating, irritability, sadness and sleep disturbance.
Similarly, repeated mild TBIs occurring over an extended period
of time, i.e., over months or years, can result in cumulative
neurological and cognitive deficits. There are also case
reports of catastrophic and fatal injuries among young athletes
following repeat TBI occurring within a short period of time,
such as hours, days or weeks while they were still symptomatic
from a previous incident.
We know that children are more likely to sustain a
concussion and take longer to recover than adults, and if they
do sustain one concussion they're also at increased risk for
subsequent incidents.
To help address this problem CDC has developed a Heads Up
initiative to educate health care professionals, coaches,
athletic directors, athletic trainers, parents, school
professionals, clinicians and also athletes themselves about
concussion to help improve prevention, recognition and response
to this serious injury. Because coaches and parents are often
the first line of defense against sports-related concussions
among young athletes, the Heads Up material focus on providing
practical information, such as an action plan, a list of
concussion signs and symptoms that is readily available on a
clipboard or in another easily reached place and can be used at
all games and practices.
One example is CDC's new Heads Up on line training for
youth sports coaches. This course provides coaches with what
they need to know about concussions in less than 30 minutes so
they can be prepared for the sports season.
Complementing the information included in our Heads Up
initiative, a number of states have also undertaken efforts to
address sports concussion among youth and high school students.
As you know, several states have passed or are considering
legislation on concussion in sports. CDC will be working in the
coming years to evaluate these state laws and to assess their
implementation successes and challenges as well as their
intended and unintended impact.
CDC currently supports 30 state health departments to
conduct TBI surveillance for all causes as well as to engage
coalition, to promote strategy, to address critical problems
such as TBI.
We have more than 60 partners on the Heads Up initiative.
These partners play a crucial role in getting this information
out to those who need it most. One example of this is CDC's
partnership with the National Football League on concussion
awareness and promoting the Heads Up initiative. In 2008 CDC
partnered with the Seattle Seahawks and the Brain Injury
Association of Washington to implement an education campaign
based on CDC's Heads Up initiatives. This campaign, called
Heads Up Washington, helped create momentum in Washington for
passage of the nation's first state-based sports concussion
law, the Zackery Lystedt Law.
CDC has also worked with the NFL to disseminate the Heads
Up information to 20,000 high school football coaches, and in
the coming months CDC with support from the NFL will work on
development of education tools for clinicians on return to play
management for young athletes.
Although there are promising interventions and a number of
strategies currently being employed to address this issue,
there are still opportunities for improvement. We need to
improve the ability to monitor and track the number of sports-
related concussions that occur among young athletes, and get a
better sense of the circumstances surrounding those injuries.
These types of efforts can help inform and optimize prevention
and response strategies.
Lastly, we need to ensure that future initiatives are
developed with scientific integrity and are disseminated widely
to ensure all those who work with children and teens in sports
setting have the information they need to keep these young
athletes safe. We also need to continually and systematically
evaluate current and future strategies, including programs and
policies, such as the state policies that I mentioned earlier.
In conclusion, we can reduce the dangers of sports-related
concussions on our nation's youth by bringing prevention,
recognition and response strategies to scale, and ensuring that
they are accessible to sports teams, schools and youth sports
programs as well as clinicians. Scaling up these approaches
necessitates collaboration between the public health community
as well the health care community and a broad range of partners
and stakeholders, such as national organizations and those in
education.
I would like to thank the Subcommittee for its continued
support of CDC and its injury and violence programs. I would be
happy to take any questions that you may have at this time.
Thank you.
Mr. Pallone. Thank you, Dr. Kapil. How do you pronounce it?
Dr. Kapil. Kapil.
[The prepared statement of Dr. Kapil follows:]
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Mr. Pallone. You know the way it works, we alternate. Five
minutes questions for me and then Congressman Pascrell and
we'll go back and forth. I wanted to ask though, I know you
mentioned--you stated that--well, you mentioned CDC's
partnership with the Seattle Seahawks NFL Team, the Brain
Injury Association of Washington, and you stated that the
Washington Heads Up Concussion and Sport Campaign provide a
momentum for the Zackery Lystedt Law, and that was the first
law in the nation that established return and play guidelines.
Now, since that was enacted in 2009 many others states would
follow suit and have enacted or are considering legislation. So
my first question is, how do you foresee national concussion
management guidelines and, again, I'm referencing Mr.
Pascrell's Bill, how do you foresee those national concussion
management guidelines interacting with current state efforts?
Dr. Kapil. As you indicated, Chairman Pallone, many states
are actively passing laws or contemplating similar legislation
that dictates how youth athletes with concussions should be
managed. It would helpful from our perspective for national
guidelines to demonstrate consistency and compatibility with
those state laws and ongoing implementation efforts from the
states.
Mr. Pallone. A second question a long the lines of
coordination but with respect to funding activities, in your
testimony you highlighted several prevention efforts that CDC
has adopted including the Heads Up Program and the Injury
Program. How are the activities described, again, in Mr.
Pascrell's Bill H.R. 1347, different from current CDC funded
TBI activities? You know, I'm trying to, you know, Congressman
Pascrell come up with a good Bill of federal guidelines or
national guidelines, I should say, and grant programs, but, you
know, the question all my colleagues ask every time, you know,
do we need federal versus state laws and I think you've
answered that, but then, you know, what would be different that
we would be funding from what you're doing now.
Dr. Kapil. The CDC's current TBI related activities are
focused on all populations and all age groups regardless of
etiology. These types of activities include surveillance,
research, education, policy evaluation. For example, our 30
states programs that you mentioned receive funding under our
CORE Injury Program to conduct broad injury surveillance kinds
activities including TBI, developing partnerships and providing
education for selected populations among other focused areas.
CDC is also supporting work to disseminate clinical management
guidelines for adult populations with mild TBI seen in
emergency departments. We plan to expand this work to include
guidelines for the pediatric population or general traumatic
brain injury in the future.
Mr. Pallone. I guess what I'm trying to get at, I now
you've answered, you know, obviously Congressman Pascrell feels
there are huge gaps here. Some states have guidelines, some do
not, that's why we need federal. You're doing some programs
but, you know, it still provides for a lot more grants. So I
mean, I guess what I'm trying to get at is you feel that there
are gaps that the federal guidelines or the national guidelines
there's still a lot of states either don't have guidelines are
they're not adequate and you feel that the grant programs that
are provided under the legislation are needed because you're
not doing enough, that's essentially what I'm trying to find
out.
Dr. Kapil. Chairman Pallone, we don't have an official
position on the Bill. We have provided some technical comments
and we appreciate the opportunity to do that, to provide those
comments to the Committee. If you'd like what we can do is
provide some additional detail and specificity and follow-up.
Mr. Pallone. Sure. I'll be happy to have any written
follow-up to my questions, that would be good. We don't have
the bell here, so I don't know how I'm doing time wise.
Mr. Pascrell. You're doing fine.
Mr. Pallone. I still have a couple minutes. Let me go to my
second question. You touched on the issue of preseason, I think
you said something about preseason baseline and post-injury
testing. I went through this with my son, you know, that before
he--and I have two daughters and a son and they all play
different sports at different times, some more than others.
And, you know, I notice that with my son before he started to
play football that they had some kind of preseason testing. So,
I guess my question is, if you could discuss the issue with
these preseason baseline and post-injury testing in a little
detail. What is the benefit of doing that type of testing and
in your professional judgment should this type of testing be
computerized, what factors might be taken into account with
respect to computerized testing.
Dr. Kapil. Yes, sir. So neurocognitive testing is a
promising tool in the evaluation of people with TBI. It may
provide more objective and consistent evaluation of baseline
status offering health care providers the opportunity to
compare post-injury findings with baseline results. In the past
CDC had actually provided some funding for studies that have
reviewed the effectiveness of some neurocognitive assessment
tools in the evaluation and management of TBI. Computerized
testing offers some potential advantages, particularly for
screening large numbers of people. And it also means that
future comparisons to baselines test results are somewhat
easier to conduct and also effects of test learning by subjects
can be minimized because the test is computerized.
However, CDC believes that the neurocognitive testing is
only one part of a comprehensive strategy in the appropriate
evaluation and management of TBI, and that should be conducted
and interpreted by knowledgeable, experienced and qualified
health professionals.
Mr. Pallone. You know, I'm not that familiar with it,
obviously, but in other words let's use football for example.
Would normally this kind of preseason baseline testing be done,
you know, at the high schools in my district before the kids
play?
Dr. Kapil. I can't speak, Chairman Pallone, I can't speak
specifically to the circumstances in your district.
Mr. Pallone. Let's say nationally.
Dr. Kapil. Yes, sir. But it is widely used.
Mr. Pallone. It is widely.
Dr. Kapil. Yes, sir. The computerized testing is widely
used both in professional sports, in high schools, in colleges,
you know, wide variety of settings. So, it's certainly possible
that in the high schools in your community it is being used. In
some cases to conduct baseline testing which can then be
compared in the future, and in other cases if baseline testing
isn't available, you know, a post-injury test can be compared
to normative values that are available that are gender specific
and age specific.
Mr. Pallone. And then like my last question, I'm sure my
time is up, we can always come back. Is that only done for
sports where there's a lot of contact like football, I don't
know basketball, whatever, or would they do it for all sports,
how does it work.
Dr. Kapil. Well it certainly could be done for any sports
in which there's risks for traumatic brain injury. And as you
know, even though the rates do vary from sport to sport to some
extent, the risk is not insignificant in sports even outside of
the organized sport settings such as high school basketball and
football for example in youth sports. In those kinds of the
settings I suspect the use is probably much less frequent than
it would be in organized settings.
Mr. Pallone. And more likely in contact sports like
football. I mean, obviously you wouldn't be doing it in like
track, would you, I don't know or you would.
Dr. Kapil. I'm hesitating only slightly because there are
sports that are not traditionally thought of as contact sports
which are associated with fairly significant risk for traumatic
brain injury and cheerleading is an example and it comes to
mind. So, certainly in some settings a sport like cheerleading
it would perfectly appropriate to consider neuro-psych
assessments or computerized neuro-psych assessment. But again,
it's part of a comprehensive strategy as opposed to using the
test results in isolation, so it should be done at a
comprehensive strategy in our opinion incorporating a whole
host of other important aspects in terms of prevention
recognition and management of TBI.
Mr. Pallone. It's funny you mentioned cheerleading, because
my eldest daughter always complained to me that they never paid
much attention to the cheerleaders. Thank you.
Congressman Pascrell.
I think I went over, so now they're going to bring out the
clock.
Mr. Pascrell. Dr. Kapil, I'm glad that you mentioned--there
are many myths circulating about which sports produce,
according to the number of people proportionately in that
sport, the most injury. We are way off in what we would think
is a result. There are many, many female sports that are
producing very serious situations. Many times because the
proper equipment is not being used to protect, and we don't
want wutzies out on the field, but we do want to protect our
kids. I don't think the two things are incompatible, would you
agree.
Dr. Kapil. I would agree, sir.
Mr. Pascrell. In the sports that we least think are going
to produce these injuries, we're thinking of boxing, we
thinking of football, but we know that girls soccer, girls
polo, many of those sports provide a worse situation. Now, I'd
like to know two things. Number one, what is the CDC doing to
enunciate what is the difference between the female athlete and
the male athlete in terms of who's more vulnerable to these
violent acts.
Dr. Kapil. I'm not aware that we've done any specific work
in that area, Congressman Pascrell.
Mr. Pascrell. There's been some studies done.
Dr. Kapil. Yes, sir, there have. We may well have over the
last, you know, since the inception of the injury center at
CDC, we may have well supported some work in that area.
Certainly it's a very, very important issue. And you've raised
another very valid important point as well, is that we don't
want these kinds of efforts to dissuade or discourage children
from participating in healthy sports-related activities, which
are very important for them for other reasons. In terms of the
specifics of the kinds of studies that are related to female
athletes and male athletes supported by CDC, I would have to
get back to you on that and I'll be happy to do that.
Mr. Pascrell. The culture may be prompting a parent or a
student to say I can go back in there or to not even
communicate his injury. I mean, that happens, doesn't it.
Dr. Kapil. Yes.
Mr. Pascrell. And either through peer pressure or parents
who want to assimilate their own talent in their daughters or
sons and want to play through their kids out there on the
field. I don't care whether it's hockey or ping-pong, I don't
care what it is. You would agree with me on that too.
Dr. Kapil. Sir, I have three children of my own and they
all participate in sports, a variety of sports, and I would
wholeheartedly agree. The cornerstone of our efforts at CDC are
prevention and recognition and then appropriate response. The
prevention aspects, of course, involve the rules of play,
things like the use of appropriate protective equipment,
policies regarding play. The difficult part from my
perspective, the real challenge is the awareness both among
athletes, coaches, as well as parents, school professionals and
even clinicians on the awareness of that even a relatively
seemingly minor ding to the head could have significant and
serious consequences. Absolutely right.
Mr. Pascrell. You said that many times about a blow to the
head. What I have researched, and correct if I'm wrong, you
don't have to have a blow to the head to have a concussion,
explain how that happens.
Dr. Kapil. This is also correct. A jolt which doesn't
involve necessarily a direct blow to the head. The brain is
basically encased in the skull and there's some fluid and
membranes around it, but just a sudden and violent movement of
the head can move the brain around sufficiently inside the
skull that it actually can strike the sides or the back or the
front of the skull and actually cause a significant injury as
well. So that's absolutely true.
Mr. Pascrell. And that is what's happened to many of our
soldiers who report after a situation that they did not receive
a blow to the head in these road side bombs. There is a
conscious statement when they're asked. No, I didn't get hit in
the head, nothing happened to my head. And yet we know quite
well that there was damage to the brain after the test. Let me
just ask this about the test.
It doesn't make any sense to have an entry level test, be
it neuropsychological or computerized, whatever, if you don't
have an exit test, correct?
Dr. Kapil. Certainly a baseline test is important for
comparing.
Mr. Pascrell. What do you compare it to.
Dr. Kapil. Right. So, the most typical use of this would be
that you would have a baseline test and then subsequently if an
injury occurs, for example, that test result following an
injury could be compared to the baseline. One of the
challenges, of course, and maybe one of our next witnesses will
touch on this, is that the baseline test isn't always
available, which means in those cases then you are basically--a
post-injury test result would need to be compared to some
normative, expected normative data for that age and gender
patient.
Mr. Pascrell. Do you think every athlete that we're talking
about in this legislation should be given a baseline test
before they go out in to any field of combat or
competitiveness.
Dr. Kapil. Sir, we--again, we think that--our perspective
is that neurocognitive testing is potentially a very important
tool. However, it's part of a comprehensive strategy to be
approached to TBI and the availability of baseline testing as a
comparative tool for future would be potentially useful.
Mr. Pascrell. The type of test is significant. You wouldn't
give a questionnaire though, would you.
Dr. Kapil. I'm sorry, sir.
Mr. Pascrell. You don't think a baseline test is a
questionnaire before and after, that's not a baseline test to
you, is it.
Dr. Kapil. And again, sir, I'm slightly out of my area of
expertise in terms of neurocognitive assessment. The test
should be conducted, whether it's computerized or not
computerized should be conducted by an individual who is
knowledgeable in the area, understands neurocognitive
assessment and testing and can interpret the results
appropriately.
Mr. Pascrell. And who might that be.
Dr. Kapil. It could be a variety of individuals under
different circumstances. So, I would not label appropriate
individuals with a particular degree or particular title. In
some cases it may be appropriately trained physicians, it might
be other clinicians such as advance practice nurses or nurses.
It could be psychologists and neuropsychologists. So it could
be a variety of different kinds of appropriately trained and
qualified health care professionals.
Mr. Pascrell. I hope we don't do what the Department of
Defense did. They tested 550,000 of our soldiers, your sons an
daughters, my sons and daughters and relatives and our
neighbors before they went into the battlefield. You know how
many they tested coming out of the battlefield.
Dr. Kapil. No, sir.
Mr. Pascrell. 3,000. You know why they tested only 3,000.
Dr. Kapil. No, sir.
Mr. Pascrell. Well, they tested 3,000 because they're the
only ones they thought that got injured. You know what they
gave them, a questionnaire. I have the questionnaire right here
if you're interested.
The point I'm trying to make is this is serious, this is
life or death in many instances. This determines who goes back
out, who's redeployed, in our case who goes out in the field.
Serious business.
I thank you for your testimony today.
Dr. Kapil. Thank you.
Mr. Pallone. Thank you. Thank you, Mr. Pascrell. Thank you,
Dr. Kapil.
I think we're going to move to the second panel.
Dr. Kapil. Great. Thank you very much.
Mr. Pallone. I appreciate you coming here. I assume you
came from where.
Dr. Kapil. From Atlanta.
Mr. Pallone. Thank you. We really appreciate you being here
today, your testimony.
Dr. Kapil. My pleasure and we appreciate the Committee's
thoughts.
Mr. Pallone. And any questions that you want to follow-up
with in writing please do so.
Dr. Kapil. Yes, sir. Thank you.
Mr. Pallone. Thank you.
The next panel come forward now.
Welcome to all of you and thank you again for appearing
today. Some of you had to come from a distance as well. Let me
introduce each of you first. I'll start from my left is Ms.
Nikki Popyer, who I mentioned previously, is a senior at
Marlboro High School in Marlboro, New Jersey in my district.
There is Ms. Joanna Boyd who is a Public Education Coordinator
for the Brain Injury Association of New Jersey. Mr. Michael
Prybicien who is Head Athletic Trainer at Passaic High School.
Dr. Joel S. Brenner who is Medical Director of the Sports
Medicine Program at the Children's Hospital of the King's
Daughters. Where is that?
Dr. Brenner. Norfolk, Virginia.
Mr. Pallone. And then lastly is Mr. Roman Oben, who I met
before and spoke to briefly, who is a former NFL player with
the New York Giants, Cleveland Browns, Tampa Bay Buccaneers and
the San Diego Chargers from 1996 to 2008. He's been involved in
many community activities since then and has taken a special
interest in this issue and is a friend of yours, right?
Mr. Pascrell. Yes.
STATEMENTS OF NIKKI POPYER, SENIOR, MARLBORO HIGH SCHOOL,
MARLBORO, NEW JERSEY; JOANNA BOYD, PUBLIC EDUCATION
COORDINATOR, BRAIN INJURY ASSOCIATION OF NEW JERSEY; MIKE
PRYBICIEN, M.A., A.T.C., C.S.C.S., HEAD ATHLETIC TRAINER,
PASSAIC HIGH SCHOOL, PASSAIC, NEW JERSEY; JOEL BRENNER, M.D.,
M.P.H., F.A.A.P., MEDICAL DIRECTOR, SPORTS MEDICINE PROGRAM,
CHILDRENS HOSPITAL OF THE KINGS DAUGHTERS; AND ROMAN OBEN, NFL
PLAYER FOR THE NEW YORK GIANTS, CLEVELAND BROWNS, TAMPA BAY
BUCCANEERS, AND SAN DIEGO CHARGERS, 1996-2008
Mr. Pallone. Thank you very much being here today.
As I said, we try to keep to five minutes. They've actually
given us the timer now so you can look at it. I'm not going to
hold you to it completely, but just to try to keep it in mind
as we proceed. And as I mentioned with our previous witness,
that you can submit additional briefs and pertinent statements
in writing. So if you can't answer a question, we'd like you to
answer our questions, but if you can't and you want to follow-
up in writing that's fine.
We'll start with Nikki Popyer. Thank you again.
I'm not actually sure if you're in my district or
Congressman Holtz' district. We haven't determined that for
sure because we split Marlboro. Thank you.
STATEMENT OF NIKKI POPYER
Ms. Popyer. Thank you. My name is Nikki Popyer and I'm a
senior at Marlboro High School. Thank you for the opportunity
to represent the many student athletes in schools all over the
country who have suffered concussions.
I have been playing basketball since I was in kindergarten.
I immediately fell in love with the sport and never passed up
an opportunity to train and perfect my game. As a young child
playing sports gave me something positive to fill my free time,
taught me how to be part of the team, develop long lasting
relationships based on common goals and rewarding me with
healthy self-esteem that succeeding at something brought.
As I got older, I strove to work as hard as possible in
order to attain the personal goals I had set for myself. Not
once did I choose something over basketball. I grew to be
competitive while still maintaining my humility. It was that
competitive nature that drove me to play through the usual
strains, sprains, broken bones, disappointment and achievement
and ultimately a string of concussions that robbed me of my
passion and my dream.
Today I speak to you with a stunning seven basketball
related concussions and another half dozen or so since I had
stopped playing. You see, at this point it doesn't take much to
knock me out. A mere tap to my head from the instant hug for a
picture has made me lose consciousness. The head injury started
in seventh grade when an opponent and I dove for a loose ball
and my head hit the floor. That was followed by a slide on the
wrestling mats, a broken nose after I was flipped over by a
defender, and just a series of unlucky moves. In many instances
I was unconscious for several minutes and sometimes taken to
the ER by ambulance. One especially malicious hit left me
unable to see for moments following the impact. Each time I sat
out a little longer, but what my parents didn't know was that I
was already having symptoms of post-concussion syndrome, but my
only thought was to get back on the court. I didn't tell them
that I had constant headaches or that I couldn't stand bright
lights or loud noises, that my hands tingled or that I was
becoming unable to concentrate in school.
Ironically, my parents were doing the right thing and
taking me to many doctors who either dismissed my injuries as
just a bang on the head or grossly misinformed us about the
danger of repeated head injury or the potential of developing
long lasting cognitive and neurological issues that could
derail not only my basketball career, but can affect my entire
life.
We did as we were told. If they told me to sit out two
days, I did. If they told me to stop playing until I was
symptom free for the same duration as I had symptoms, I did.
Unfortunately, none of them knew enough about concussions to
treat me correctly. I was continually allowed to return to
play, unaware that the concussions were cumulative and not the
stand-alone events that they had led us to believe they were.
This is why I am here. It's not enough to assume
administrators, coaches, athletic directors and health care
professionals can arm themselves with the right information and
tools needed to protect youth athletes from ending up in my
predicament. There is a great need for a bill on concussion in
school sports, like the Concussion Treatment and Care Tools
Act. Without uniform guidelines and the money to implement
them, it will take schools longer to help students understand
the importance of addressing a concussion and delay applying
the protective protection they need. I have spent a great deal
of the last two years working to increase awareness, and I can
promise you that not all the doctors and coaches are capable of
handling students with head injuries, and only a handful of
those students are capable of making decisions themselves.
Through the web I have had the opportunity to talk to
dozens and dozens of kids who are just like me. Who either
received the wrong diagnosis and treatment or chose to hide
their symptoms. I urge them to be honest and take enough time
off to truly heal before returning to play. Even in my school,
where I am a very visible example going back too soon, my
friends are still trying to cheat it. And I can tell you that
all across the country student head injuries are not being
taken seriously enough.
I am very fortunate that my school has an excellent
computerized neuro-cognitive testing program in place, and
certified athletic trainer Mark Brandle and athletic director
Dave Reiden who advocate for and protect all of the students.
Unfortunately, that's not what I am hearing from other areas.
Especially in these times of severe cut-backs in school
programs, it is imperative that those schools who have tools in
place keep them, and those who do not are helped to get them.
I urge you to consider Congressman Bill Pascrell's
legislation, the ConTACT Act, as another layer of protective
gear for all the kids on fields and courts and gyms everywhere.
Thank you for allowing me this opportunity to speak for all
those healthy aspiring youth athletes who we should help keep
that way. Thank you.
[The prepared statement of Ms. Popyer follows:]
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Mr. Pallone. Thank you, Nikki. And really thank you for not
only being today but being an advocate on this subject because
I think it's so important.
You remind me a little bit of my daughter. You said you're
a senior, right?
Ms. Popyer. Yes.
Mr. Pallone. She's a senior too and she has long hair like
you, so you remind me of her. Thank you for being here.
Ms. Popyer. Thank you for having me.
Mr. Pallone. Sure.
Ms. Boyd.
STATEMENT OF JOANNA BOYD
Ms. Boyd. Usually I don't need a microphone, however.
Chairman Pallone and Congressman Pascrell, thank you very
much for having me here today. My name is Joanna Boyd. I'm the
Public Education Coordinator for the Brain Injury Association
of New Jersey. I am testifying on behalf of the Brain Injury
Association of New Jersey and for the Brain Injury Association
of America that is comprised of 43 state affiliates all working
toward the common goal of elevating awareness, research,
education and advocacy for people with brain injuries.
I'm testifying today because it is urgent that we address
this public health cries that concussions present to our
youths. Athletes who return to play before their brains heal
experience a slower recovery and they're at risk for a second
impact syndrome that can cause severe damage to the brain and
even death. Second impact syndrome can be prevented. At the
present time we do not have education, protocols or policies in
place that adequately protect our youth from not only second
impact syndrome, but also from the cumulative nature of
multiple concussions.
The Brain Injury Association of New Jersey began to address
concussions in sports in 2004 by convening a committee of
experts in the field of concussions who are also invested in
the safety of our young athletes. The Concussion in Youth
Sports Committee developed a consensus statement for New Jersey
on concussions and we solicited endorsements from key groups in
the state.
Then we held a Summit at Giants Stadium in 2006. Delegates
from all these different groups that have this interest in the
health and well-being of our youth were invited to come and
learn the most current research base information about
concussions. Another purpose of the Summit was to illicit
support from these groups for a statewide campaign to address
awareness, raise awareness about concussions in youth sports
with the goal to lower the incidents to protect young athletes
from cumulative effects of multiple concussions, an to prevent
second impact syndrome.
At that time we also rolled out that matching fund grant
program that Congressman Pascrell spoke about. And we made, as
you said, Congressman, matching funds grants available to up to
100 high schools in New Jersey to purchase a three year
subscription for computerized baseline testing. The
subscription would allow for another 300 students year after
year for the three years to become baseline, and then which, of
course, is available for re-testing.
By the way, and as an aside, it took us almost four years
in order to fill that grant capacity to 100 high schools.
Also the campaign developed material and disseminate these
throughout New Jersey and we made posters. We had a tear off
pad, basic information about concussions. We distributed these
to First Responders at the First Aid Convention, at the
Teachers Convention, to school nurses, everywhere that we could
think of. This was a pad of information where if concussion was
suspected, you could rip off a page and send it home with the
child to hopefully educate parents about what was going on. We
developed an electronic newsletter called Game Plan and a
website Sports Concussion dot com as a portal for individuals,
athletes, parents, teachers, coaches and others to access the
most current information about concussion.
Our most recent funding is a result of collaboration among
several groups, including a local philanthropic organization,
the Mountanside Health Foundation, the NJSIAA, which is the New
Jersey Interscholastic Athletic Association, one of the sports
conferences in New Jersey, the Super Essex Conference, I
believe they have over 30 schools participating, and the Brain
Injury Association of New Jersey, of course. We came together
to develop a curriculum that could become part of an agenda for
the Sportsmanship Program that the NJSIAA encourages the sports
conferences to hold annually.
This program is intended to be a pilot program which upon
completion would be available to all New Jersey high schools,
sports conferences through the NJSIAA. Part of this
demonstration phase is to gather some information about what
our student athletes know and what they don't know, so we have
a little pre-post test. And we're trying to learn from the
results of these tests where we are in our educational efforts
with our young athletes.
We know that they know that a concussion is a brain injury,
they can say those words and they can answer yes to that
question. What we don't know is if they really have digested
that information and if it will change their behavior. So the
next phase of our campaign will move forward to emphasize that
it is critical to rest the brain after a concussion and then
even when symptom free, to follow a step-by-step return to play
protocol.
In October 2008, as you mentioned, Congressman Pascrell, we
lost a New Jersey student athlete to a tragedy on the field.
This initiated a new awareness that concussion is definitely a
brain injury and the consequences can be the most severe. After
discussions about drafting legislation about concussions, the
members of two of our committees, the Concussion Committee and
the Advocacy of Political Affairs Committee, approached
assemblyman Patrick J. Diegnan as a potential sponsor for
legislation in New Jersey. Assemblyman Diegnan responded by
holding a hearing, much like this, in March of 2010 to gather
information about concussion in youth sports.
The result of the hearing was to introduce Assembly Bill
Number 2743, which would require the development of a Student
Athlete Awareness Program concerning the prevention, risk and
treatment of sports-related brain injuries. With bipartisan
support Assembly Bill Number 2743 was passed by at New Jersey
Assembly on June 28, 2010. A companion Bill, Senate Bill Number
2106 sponsored by Senators Cody and Vitale is pending
consideration by the Senate Education Committee.
Throughout our concussion campaign Congressman Bill
Pascrell has been a long time devoted champion of this issue.
He has stressed the importance of protecting student athletes
for many years. The concussion treatment and Care Tools Act is
an important step toward protecting our youth from the effect
of multiple concussions and second impact syndrome.
At the federal level, we believe that the ConTACT Act could
incentivize states that have not already made a commitment to
drafting concussion legislation to make concussion law a
priority and to provide states with a minimum guideline
requirement to manage concussion issues in our schools. The
Brain Injury Association of New Jersey believes that the
minimum guidelines should be developed by a panel of
stakeholders including athletes, advocate, medical personnel,
including everyone who works with student athletes such as
neuropsychologists and school nurses. Also, the Brain Injury
Association of New Jersey believes that the grant to states for
baseline and post-injury testing would be a great opportunity
for schools who are trying to protect their students on a
limited budget.
The ConTACT Act would give coaches, parents, athletic
trainers and school administrators the tools to keep our
children safe. The tools, one of the most important tools is
that educational piece. We need the education desperately. This
act would ensure that the coaches are trained in recognizing
the symptoms of concussion and brain injuries and injuries that
could lead, events that could lead to second impact syndrome.
It is truly time to get serious about this. It's time to
protect our youth from needless disability, protect parents
from becoming life long caregivers for their children. We need
to protect taxpayers from the cost of these long-term
consequences of severe disabilities from brain injuries,
because every system in our country is affected in dollars by
these events.
So, the Brain Injury Association of New Jersey and the
Brain Injury Association of America and all its affiliates want
to applaud you, Congressman Pascrell, Chairman Pallone, for
listening to this issue, for hearing our words and for bringing
this legislation forth for this hearing. Thank you.
[The prepared statement of Ms. Boyd follows:]
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Mr. Pallone. Thank you, Ms. Boyd. Thank you for all that
you've done in our state on this issue. It's really important.
I appreciate your incentive.
Mr. Prybicien.
STATEMENT OF MICHAEL PRYBICIEN
Mr. Prybicien. Thank you very much. Chairman Pallone,
Representative Pascrell, I am Mike Prybicien, Head Athletic
Trainer at Passaic High School in New Jersey, and I am the
President of the Athletic Trainers Society of New Jersey. As a
father and a health care professional practicing athletic
training for the past 17 years, I am passionate about the
safety in youth sports.
Thank you for allowing me the opportunity to speak on
behalf of the National Athletic Trainers' Association and the
Athletic Trainers of New Jersey about the athletic trainers
role in concussion management and the important issue of youth
sports safety.
As you may know, athletic trainers are health care
professionals who collaborate with physicians to optimize
activity and participation of its patients. Athletic training
encompasses prevention, diagnosis, and intervention of
emergency, acute and chronic medical conditions leading to
impairment, functional limitations and/or disabilities.
All Athletic Trainers must pass a national certification
examination, and 70 percent of our membership has a masters
degree or higher. In most of the 47 states where they are
licensed or otherwise regulated, the national certification
exam is required for an athletic trainer, to maintain its
certification with required continuing education.
Although the issue of concussions in sports has received a
great deal of attention in the media in recent months, it's not
a new problem. Athletic trainers have been carrying for
concussed athletes and warning of the dangers posed by this
unique injury for years. As athletic trainers and health care
professionals specializing in team sports, we're the first line
of defense in the prevention, diagnosis and emergency treatment
of head traumas and other athletic injuries.
The NATA has a long history of working with research
experts to explore the prevention and proper treatment of head
injuries. In 2009 we issued a head impact during high school
football, a vile mechanical assessment study. The study
revealed that high school football players sustain greater head
accelerations after impact than do college level football
players, which can lead to concussions and serious cervical
spine injuries as well. Further, the study urged high school
coaches to teach proper tackling techniques in order to reduce
the risk of head and neck injuries among its athlete.
While much focus has been given to players in the NFL, it
is important to remember that high school athletes represent
the single largest segment of football players in this country,
and account for the majority of sports-related concussions. In
a given year between four and six percent of high school
football athletes sustain concussions. Corresponding to an
estimated 43,000 to 67,000 injuries. In fact, there are five
times as many catastrophic football injuries among high school
athletes than college athletes. Estimates indicate, however,
the true incidence of injury is likely even higher. Some
research suggests that more than half of high school athletes
who get concussed do not report their symptoms. Even when faced
with these disturbing trends and the fact that seven million
students participate in high school sports in America, the NATA
estimates that only 42 percent of public high schools in
America have access supposed to an Athletic Trainer. In fact,
the NATA estimates that across the country, the ratio of
students athletes to Athletic Trainers is 2,678 to 1.
According to a New York Times article at least four
American high school students died of football head injuries in
2009. Most suffered from the aforementioned second impact
syndrome, a rare but catastrophic dysregulation of the brain
activity that can occur when a young football player or athlete
sustains another hit before the brain has recovered from their
earlier concussion. In nearly all cases, such tragedies could
have been prevented if the symptoms of concussions were
recognized and heeded, giving the brain enough time to fully
heal.
Further studies show 50 percent of second impact syndrome
resulted in death.
Female high school soccer players suffered 40 percent more
concussions than the male counterparts, according to a journal
of athletic training study.
Female high school basketball athletes suffered 240 percent
more concussions than males. Again, another journal on athletic
trainers study.
The NATA has endorsed Representative Bill Pascrell's
Concussion Treatment and Care Act and Senator Robert Menendez's
companion Bill in the Senate. The Association applauds the
creation of national guidelines to address prevention,
identification, treatment and management of concussions of
school-aged children.
The NATA stands ready to assist in development of national
guidelines and offers to assist in any way possible. Ideally,
the NATA would like to see that state athletic associations in
conjunction high school sports associations and local brain
injury association chapters, are implemented in the
dissemination and implementation of these guidelines.
The ConTACT Act should be praised for recognizing the need
for baseline testing in student athletes in addition to the
post-injury testing. Furthermore, we applaud authorization for
appropriations to ensure this measure.
In New Jersey all of our professional sports teams and New
Jersey National--excuse me. In New Jersey all of our
professional teams and collegiate athletic teams require the
use of an Athletic Trainer, and 86 percent of the New Jersey
State Interscholastic Athletic Association Schools employ the
services of an Athletic Trainer.
The Athletic Trainers' Society of New Jersey is a
professional association consisting over 1,000 members. We
prided ourselves at being at the forefront of concussion
education, not only for our patients, but the medical community
as well. In August of 2010 we held a Concussion Summit, which
consisted of a panel of nationally recognized speakers, as a
means to education physicians and health care providers who
play a role in the management of sports-related concussions.
More than 200 health care providers attended this event. In
March of 2010, we co-sponsored a concussion support group
meeting for parents and students athletes who have been the
victim of a concussion.
The ATSNJ applauds the efforts of our state legislators, in
particularly Assemblyman Patrick Diegnan, Senator Richard Codey
and Senator Paul Sarlo who have introduced legislation with
regard to either concussions and/or student athlete safety. The
ATSNJ is thankful that the New Jersey legislators have included
and valued the input of the ATSNJ and its members through the
development of such important legislation.
The NATA has developed recommendations on addressing head
injuries in football. These recommendations include a Graded
Symptom Checklist, which is distributed through the NATA's
position statement Management of Sports-Related Concussion.
In addition to the national youth sports crisis in America,
the NATA has spearheaded the youth Sports Safety Alliance, and
initiative to raise awareness, advance legislation, and improve
medical care of young athletes. This call to action includes
the following.
Ensuring that youth athletes have access to health care
professionals who are qualified to make assessments and return
to play decisions.
Two, ensuring pre-participation physicals before play
begins.
Three, recognizing the difference in an injury and working
toward the elimination of the culture of playing through pain
without assessment.
In addition to these items, NATA strongly supports the
recognition of athletic trainers under the Medicare and
Medicaid programs. This would encourage private insurance
companies to reimburse athletic trainers for physical medicine
and rehabilitation. This legislative action is important, as it
will assist more athletic trainers being available to high
schools, local youth sports and medical facilities to treat
those injured individuals suffering from head trauma or other
sports-related injuries.
I would once again like to thank Chairman Pallone and
Representative Pascrell for inviting me here today. I greatly
appreciate the opportunity to participate in this hearing and
offer myself and the National Athletic Trainers' Association as
a resource to you and the other members of the Subcommittee as
you work toward addressing this important issue facing the
youth in our nation. Thank you.
Mr. Pallone. Thank you very much.
[The prepared statement of Mr. Prybicien follows:]
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Mr. Pallone. Dr. Brenner.
STATEMENT OF JOEL BRENNER, M.D.
Dr. Brenner. Good afternoon, Chairman Pallone and
Representative Pascrell. I appreciate the opportunity to
testify today at this field hearing regarding the sports-
related concussions in children and adolescents. My name is
Joel Brenner and I am proud to represent the American Academy
of Pediatrics. I'm currently the Chair Elect at AAP consult for
sports medicine and fitness. As a pediatrician and board
certified in primary care sports medicine, adolescent medicine
and pediatrics, I am intimately aware of the dangers sports-
related concussions have on our youth.
In my clinical practice I often see 10 to 12 new contusion
cases among school athletes each week. This fall as student
athletes return to the playing fields, we must remember the
unique medical needs of children and take appropriate action to
minimize the harmful impact of concussions on our nation's
youth.
Sports-related concussions pose a unique risk to the
pediatric population. Children and adolescents are still
undergoing a significant period of brain development, and thus
are even more susceptible to the damaging effect of a
concussion.
Children and adolescents are also particularly high risk of
experiencing second impact syndrome, a condition that occurs
when an athlete who has sustained an initial head injury
sustains a second head injury before the symptoms associated
with the first have fully cleared.
While sports-related concussions are increasingly common in
youth and high school sports, the long-term effects of this
traumatic brain injury are still relatively unknown. We are
certain, however, that concussion is not a condition that can
just be toughed out, but rather a serious medical injury of
unique concerns to child and adolescents. Age-appropriate
concussion prevention and management techniques are vital to
reducing the risk of serious long-term injury and complications
among athletes.
The number of children visiting the emergency departments
for concussion is on the rise. A study published this month in
AAP's professional journal Pediatrics found that 50 percent of
pediatric concussions seen in the ER were sports-related.
Younger children between the ages of 8 and 13-years accounting
for 40 percent of this sports-related concussion.
Concussions represent as estimated 8.9 percent of all high
school athletic injuries. However, data are significantly
lacking on concussions in grade school and middle school
athletes.
Concussions can cause symptoms that interfere with
children's school performance, social and family relationships
and participation in sports. Signs and symptoms of concussions
typically resolve in seven to ten days in a majority of cases.
However, for some athletes recovery may take weeks or months or
longer.
Identifying and diagnosing the signs and symptoms of
concussion may involve several different tools and approaches
depending on the nature of injury. There is no single best
method for diagnosing; rather a comprehensive evaluation may
require a range of approaches from a sidelines physical exam
and comprehensive history to neuropsychological testing.
Any pediatric or adolescent athlete who is suspected of
sustaining a concussion should be evaluated by a health care
professional. A neurological exam, inquiring into the symptoms
and assessment of cognitive functions should be performed. If a
concussions is identified the athlete should be removed from
the remainder of the practice or game on that day.
Neuropsychologic testing has become commonplace in the
evaluation of an athlete with a concussion. Such testing
provides a means to an objection measure of brain function.
Neuropsychological testing is one of several tools in the
concussion assessment, but does not independently determine
whether an athlete has experienced a concussion or when the
athlete may safely return to play. The goal of managing a young
athlete with a concussion is to hasten recovery by ensuring
that the athlete is aware of and avoids activities and
situations that may slow recovery.
The American Academy of Pediatrics supports the
establishment of federal guidelines for concussion management,
and believes that prevention, identification, treatment, and
management of concussions in children and adolescents is of the
utmost importance. We commend Representative Pascrell for
introducing the H.R. 1347.
The lack of comprehensive national concussion management
guidelines jeopardizes children's health and has prompted the
AAP to take action to address this deficiently. AAP's Council
on Sports Medicine and Fitness has devised a comprehensive
clinical report on sports-related concussion in children and
adolescents. The is the first and only clinical report on
sports-related concussion that addresses solely to children and
adolescents, and this was just released last week. It is our
expectation that his clinical report and these recommendations
can serve as starting points for the development of federal
standards and contribute to the national dialogue on pediatric
concussion management. The top four recommendations are:
Number one, pediatric and adolescent athletes should never
return to play while symptomatic at rest or with exertion.
Athletes also should not be returned to play on the same day of
concussion, even if they become asymptomatic.
Two, any pediatric or adolescent athlete sustaining a
concussion should be evaluated by a health care profession,
ideally a physician, with experience in concussion management
and should receive medical clearance before returning to play.
Three, athletes with a concussion should rest, both
physically and cognitively, until their symptoms have resolved
both at rest and with exertion. Teachers and school
administrators should work with students to modify workloads to
avoid exacerbation of symptoms.
Four, neuropsychological testing objective data to athletes
and their families following a concussion. Neuropsychological
testing is only one tool in the complete management of a
sports-related concussion. It does not alone make a diagnosis
or determine when return to play is appropriate.
The American Academy of Pediatrics believes these
recommendations and guidance should be included in any federal
action on this issue. It should also be noted that timely
medical attention for any athlete suspected of sustaining a
concussion is important, and the presence of an Athletic
Trainer for sideline evaluation is ideal. Even with the
promising advances of computerized neuropsychological testing
and recent investments in prevention, early diagnosis, and
treatment of concussions in young athletes, requiring all
schools and other organizations that sponsor or conduct high
risk activities to have an Athletic Trainer on site, would not
only improve concussion management but also help decrease other
morbidities at the same time.
AAP is grateful for the Committee's continued commitment to
child health, and we hope that you will consider us a partner
in efforts to reduce the occurrence of sport-related
concussions in our nation's youth.
I thank you for the opportunity to testify.
Mr. Pallone. Thank you, Dr. Brenner.
[The prepared statement of Dr. Brenner follows:]
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Mr. Pallone. Mr. Oben.
STATEMENT OF ROMAN OBEN
Mr. Oben. Good afternoon. Representative Pascrell, Chairman
Pallone. I like to thank you guys for your time in inviting me
to share my testimony today.
I'm currently an Account Executive for CBS Outdoor. I co-
host the Giants pre- and post-game radio show on WFAM, as well
as the Big East Game of the week on SNY Network and I'm an
adjunct professor at Fairly Dickinson University sports
administration department.
I like to thank you guys again and thank the panel, the
second panel for your expert testimony and witnesses.
I want to talk about my career briefly that began in West
Africa where I was born and started as a 14-year-old playing
football for the first time at Gonzaga High School in
Washington, DC where I grew up. I was considered what you would
call a late bloomer. I was 5,11", 190 as a freshman. Two years
later I was 6,4" 230 pounds, so I think God was good to me by
giving me great size. But I eventually became a heavily
recruited individual and collegiate athlete, and I accepted an
academic athletic scholarship at the University of Louisville.
Now, many are familiar with the recent movie the Blind
Side. I was moved to the left tackle position and I played the
blind side well in college, became an all American and played
for 12 years in the NFL and also won--was a starting left
tackle for the Super Bowl Champion Tampa Bay Buccaneers in
2002. Along with the highs of winning and competition in the
NFL, unfortunately have seen many peers and teammates alike,
suffer the physical and emotional damages caused by multiple
concussions. These stories range from waking up to finding
yourself in an examination room and forgetting how you got
there, to not remembering your home address and your cell phone
number.
Now, while I may not have an expert degree in any
scientific field, I do consider myself an expert at what it
takes to play at the highest level. I had seven knee surgeries,
two reconstructive foot surgeries, and at 35 being told that
you have the physical body of someone 30 years your age, I do
consider myself an expert participant in sports.
Now, I believe that football is the greatest game in the
world because it's the greatest team sport in all sports. One
person can't score 40 points and carry the team. Everyone has
to do everything right on every play for a play to be
successful. We also learn how to exert our physical limitations
pass normal human capacity. Playing with a monster of no pain
no gain and toughing it out.
Now a father of two elementary age children who are very
active in sports, Tae Kwon Do, flag football, soccer,
wrestling, lacrosse, basketball, and this is all in the same
season, by the way. I've seen children train their bodies
physically at an earlier age, and play at the youth sports
level at a much higher degree of competition than the backyard
ball that we all grew up playing. For example, my 9-year-old
son can do 30 push-ups. I don't think I could do 30 until I was
at least a sophomore in high school. So athletes have gotten
bigger, faster and stronger at earlier ages. Unfortunately,
this bigger, faster, stronger youth athlete creates a situation
where the physical impact and the trauma is much more severe
than it was when I grew up.
I must add that one thing you cannot physically develop is
the brain, the skull that protects it. The spine, the joints
and the ligaments.
Now, I don't speak for the NFL as a whole, but we're well
aware that the NFL has worked tiredlessly and has done an
excellent job in partnering with the CDC to improve the
awareness, diagnosis and treatment of concussions. For example,
if a person suffers a concussion or what's deemed as an injury,
if the doctor isn't clear you can go back and play no matter
what the coach says, no matter how you feel or your assistant
coach, you're not going back to play. That wasn't the case my
last year in the NFL, and for a lot of the many men that I saw
and played with, peers, teammates who proudly carried the NFL
shield.
Now, we're on the wake of another anniversary of 9/11. And
I remember that year the NFL was the first organization to step
up and say that we weren't going to play the game because of
the tragedy that happened to the lives that affected our
nation.
Now, some of these trends in professional sports in a whole
are followed by colleges, high schools and youth sports. I
think the same trend and necessary education on the youth level
of competitive sports will help eliminate the long history of
poor education and information on the concussion issue. The
ConTACT Act H.R. 1347 is a necessary legislation that is needed
to educate and set guidelines for concussion management for all
school sponsored supporting events so that we can create a safe
environment for youth sports.
I want to thank again the Subcommittee. I would openly
welcome any questions that you guys may have for me at this
time. Thank you.
Mr. Pallone. Thank you very much and thank you also for
being here today and for your long involvement with this issue.
We're going to go right to the questions. As I said, we go back
and forth between myself and Congressman Pascrell. I'll start.
I have to ask everyone of you something, but I don't know
if we have time for that. Let me start with Nikki Popyer.
You talked about at one point, you referenced, I couldn't
help but emphasize, you know, given the economic climate that
we face today that there have been so many cutbacks at the
state and local level in school programs, you know, in funding.
I don't know that that is necessarily true of Marlboro, I'm not
trying to suggest it with the situation in Marlboro. You know,
I think that that's a very good point because, you know, when
we talk about this federal legislation that my colleague
Congressman Pascrell introduced, one of the questions is, you
know, he proposed these various grant programs and, you know,
one question comes up is do we need this, do we need these
additional things, and I think that that's a very important
point, which is right now we're in a situation where a lot of
schools are cutting back. If they start eliminating, you know,
prevention programs for concussion, then it may very well be
that the federal government needs to step in, particularly now
given that. I don't know how, you know, wide spread your
knowledge is about that, but I mean, is that happening, do you
see that happening at all?
Ms. Popyer. Well, I mean I think making the grant to have
the impact test or any kind of those neuro cognitive testing is
like--you need to have them. It's like sending a football
player without a helmet, sending a soccer player without shin
guards. I think it's just another piece of equipment protective
gear for the kids. And I think that if there's enough money to
get a grant for this, then I think it's definitely necessary
and that it's going to help people and protect them from
becoming like me.
Mr. Pallone. I mean, I know that some schools are actually
eliminating athletic programs altogether, but I mean, it might
even be worse if they have the programs but they eliminate all
the prevention, you know, type activities that you're talking
about in the process, which I guess is something that could do.
Anybody else want to comment on that, if you would. I mean, I
don't know that we know that it's necessarily happening, but I
think it's a fear.
Mr. Prybicien. I mean, you bring up some very good points.
I think there's a combination of things going on. I'll speak
specifically of New Jersey. A combination of athletic programs
being eliminated, freshman programs being eliminated, athletic
trainer positions being cut as well as, you knows some things
called where there's like pay to play, which are paying for
services to be able to play in sports. But, you know, the point
that you bring up that is very good, is the fact of, you know,
if sports aren't eliminated, eliminating some of the tools,
whether it be concussion education, baseline testing, removal
of an athletic trainer, any of those things that are viable
assets to the prevention of concussions or other sports-related
injuries, you know, is probably worse than eliminating sports
altogether.
Mr. Pallone. Well, you know, we passed a Bill and, you
know, I know this is a much larger level, but we passed a Bill
as Congressman Pascrell knows, we went back in August to just
pass that Bill and gave money back to the state so they can
rehire teachers. And I think that is what we're going to see
more and more, the federal government has to step in and help
on some of these programs whether it's what we're talking about
today or other things because the state and local cutback
significantly.
Let me go back to you Mr. Prybicien. Both Ms. Boyd and you,
I think almost everyone of you talked about the--well, actually
maybe let me ask Ms. Boyd this, but every one of you brought up
this issue of the second impact syndrome and the cumulative
impact. I think one of you actually said that there are a
significant number of deaths that occur from second impact, you
know, with brain injury. I didn't hear, maybe you can tell us a
little bit more about specifically what we can do with that. I
know in Mr. Pascrell's Bill he talked about different grant
programs, the baseline testing, you know, post-injury testing.
What's the best way to deal with the second impact? I mean,
that's kind of been the most disturbing thing to me today to
hear you talk about that.
Ms. Boyd. The second impact syndrome can result in
catastrophic brain injury. What that translates into, if you're
talking about a high school student who survives a second
impact syndrome, you're talking about a young person who is in
the process of developing his own identity, making plans for
the future, moving on to college or to a training, and all of
that instantaneously ends with that onset of a significant
severe brain injury that causes life long difficulties.
Mr. Pallone. But what I'm saying is, what can we do with
these training programs and other testing to try and prevent
that, is that where the trainer comes in.
Ms. Boyd. Well, the trainer but it's everyone else. The
trainers are the best educating staff in the school when it
comes to these kinds of injuries. They are at, you know, the
top of the game when it comes to who knows what's going on with
concussions in that school environment. School nurses take a
close second. But my point is that the results of second impact
syndrome need to be known. People don't recognize that brain
injury is a number one killer and disabler of youth in America.
People do not know that. Just like we didn't know how
significant concussions were and how much they affected our
youth. This is critical.
I mean, the personal side of it for a family and an
individual who has a life long disability is one thing, but our
entire country pays the price for this. It's not just one
individual's quality of life or their future. We know that kids
experience concussions differently, but we respond to children
with concussion differently. If you have a 7-year-old who has a
concussion and it's out is sorts and wants to sleep all the
time and is acting out because the lights are bothering them
and the sound is bothering them and they can't focus in school,
they're probably sent for time out instead of for cognitive
rehabilitation. And this the issue, is that we needs to
understand what a brain injury is. We need to know what a
concussions. Parents needs to know.
One of the things that concerns me are parents and families
who have no health insurance. They have no health insurance and
the coach sends them out of the game, and now you have a family
who sees that their child, their athlete is not themselves. Is
there the presence of a concussion or isn't there, and they go
to the family doctor and the family doctor evaluates to the
best of their knowledge base and clears them to play in a week.
How do we know that that student is still safe. Well, baseline
testing certainly will help with that. It does not diagnose a
concussion. It tells you when there's a reliable change in the
baseline score, that's what baseline testing will do. It will
tell you watch out, keep your eye on this child. You don't know
how significant a concussion is until that child is healed.
There is no way to say this is a grade one concussion or a mild
concussion until all of the symptoms are gone.
Mr. Pallone. Let's do this. Bill, I'm going to yield to you
and then maybe we'll have a second round.
Mr. Pascrell. Mr. Oben, I wanted to ask you this, from the
beginning of going into the National Football League to the
time--and after your 12 years were up and you decided that you
were going to go do something else, did you see any appreciable
change in how the league addressed the issue of concussion,
could you be as specific as possible.
Mr. Oben. I think what I noticed in my last season there
was definitely one thing, there was a change of philosophy. We
had a lot more old school coaches, quote unquote, tough it out,
grind it out, no pain no gain, what I said earlier. As I a got
further in my career a lot of the younger coaches were of a
different philosophy and there are a lot of players that I knew
about, I'm sure you guys have known, Wayne Gwebeck, for
example. And there's a guy like that on every team, there's two
or three guys like that on every team. You play hard and you go
out and play with game because you know if you don't go in
there's somebody to replace you. They're always asking guys to
replace you. But I think as a whole the players, the players
union they got a lot smarter and they put a lot more on the NFL
to do a little bit more than what they were doing when
concussions.
Mr. Pascrell. When you see the players and what's happened
with to them in their late 40s and early 50s and when you talk
to these guys it's pitiful how this was able to go on. I mean,
this didn't just happen with one blow. This did not just happen
in one particular situation. This was, to go back to what Nikki
just talked about, a cumulative situation. And these things all
add up, don't they Nikki.
Ms. Popyer. Yes.
Mr. Pascrell. When we say a cumulative, what do you mean by
that.
Ms. Popyer. Well, when I started getting concussions in
seventh grade, I didn't really know what was going on and it
was just a little headache and then I was fine in a few days.
But as I got more of them everything seemed worse and it's
because my brain wasn't completely healed from the first time I
got a concussion. So, each one builds it up and makes it all
worse, and now I'm stuck with a 24, 7 headache and these
problems in school and in life in general.
Mr. Pascrell. But we've listened to doctors today and they
say that when you're younger you're more vulnerable, and yet
when you see what's happened to NFL players, some of them
played three, four years, some of them played ten years, 12
years, and they can't control themselves. I mean, I'm not
exaggerating, am I.
Mr. Oben. Not at all.
Mr. Pascrell. It's sad, it really is. And I played
football, all kinds of sports. In my neighborhood if you came
out when you were hurt you were a sissy, which was pretty
stupid, wasn't it.
Ms. Popyer. Definitely. I know as an athlete that I wanted
to get on the court no matter what. I loved basketball and I
would risk anything for it until we actually found the right
doctor, that's Dr. Jill Brooks who's a neuropsychologist. She
was the first one to shut me down. But hearing that as an
athlete, we just want to get back on the court and do what we
love and I mean it's hard, but it's the better thing to do.
Mr. Pascrell. Why did you listen to her and there were
other folks who told you before that to see what kind of----
Ms. Popyer. I mean, I went to plenty doctors and no doctor
ever told me to stop playing, no one told me the effect that
I'll have. I went to the same doctor at the emergency room
several times and almost every time he said sit out one to two
days, you're fine, you got your bell rung, just go back in
there, you're fine. No one ever told me that once you get
another one it's going to be worse and it's going to be harder
to recover, but. I mean, the knowledge we have now definitely
will help a lot of people.
Mr. Pascrell. Did any doctor or professional ever tell you,
Nikki, that every time you get a concussion, and there's all
different kinds of concussions, some are very mild, some are
very severe, did any doctor ever tell you that a concussion is
brain damage.
Ms. Popyer. No, not one until Dr. Jill Brooks had ever said
anything about a concussion really being serious.
Mr. Pascrell. What is your response to that, Dr. Brenner.
Dr. Brenner. I think it's very unfortunate and that's
something that we've been targeting. Every time I see an
athlete the very first thing that I ask them is do they know
what a concussion is, that's the very first thing that we talk
about is that a concussion is a brain injury. Often times the
parents and the athletes are not aware of that. Luckily as we
get more education out there more and more ascribe. I think
it's important for people to understand there have been studies
that looked at youth and the term concussion versus mild
traumatic brain injury. People were admitted to the hospital
with the term concussion were released sooner than those
releases from a minor traumatic brain injury. So, it's
important for people to understand that a concussion is a brain
injury versus none.
Mr. Pascrell. Thank you.
Ms. Boyd, we talked about this before. What is your take, I
want you to just start? I mean, you talk about education a lot
and how parents need to be educated. Let me tell you something,
congressmen needed to be educated. They didn't know what I was
talking about ten years ago. I just about knew what I was
talking about. How do we get to the next level so that people
can make sense of what they're hearing and perform?
Ms. Boyd. You know, education begins when it's initiated
sometimes, you know, in the neighborhood and sometimes from our
legislators. So, I think that initiating legislation certainly
brings awareness right up. Just like the media has done and the
NFL. We have them to thank for so much more awareness about
concussion. The education needs to go--we need to get a
complete education, just like we did with seat belts. Seat
belts came about when I was a kid. My mother went out there and
she cut them right out of car because nobody was going to tell
her to wear a seat belt or what to do in the car. Well, we have
that same mind set with people who are working with our young
athletes and working with children who fall down off their--or
ride their scooters without a helmet. So, the education needs
to be comprehensive. We need to understand what concussion is,
we need to know how to recognize it and then we need to know
what to do about it.
At the Brain Injury Association we have information and
family help lines. People will call and say my son was
diagnosed with a concussion, where do you go, what do you do
for treatment. We need to know as a society, we need to
understand that the concussion is a brain injury. If you have a
concussion you need to see a specialist, your concussion needs
to be monitored. So, our family physicians, our pediatricians
need to know how to do that. They need to know the questions to
ask. They need to get involved in these kids lives. If there's
a significant concussion that is not healing, the symptoms
continue and continue, then as in Nikki's story it's probably
necessary to see a specialist.
A neuropsychologist is a specialist who specializes in
brain behavior relationships. Rather than doing a quick
neuropsychological testing, would probably do a more extensive
battery of tests to understand how the brain is working.
Mr. Pascrell. Let me ask the question, Mr. Prybicien, you
see these kids everyday and you deal with them, you deal with
the students, you deal with their parents, the trainer, what is
your take on what you just heard and how do you address it; and
B of that is, does the school ever talk to you about liability.
Mr. Prybicien. Well, the school hasn't talked about
liability, okay, that's number one. How do I address it, one
thing from hearing everybody today I want to say concussions
can take many forms, okay. Concussion education to me consists
of proper handouts to parents, it could be watching a DVD or
video. When we talk about that is, all my athletes, you know,
the great initiative in New Jersey, all of our student athletes
see a video. It doesn't matter what sport their playing. You
know, my tennis team, my cross country team, they all so a
video on concussions, science and physical and education
because, you know, you can have a tennis player, which we just
saw in the U.S. Open recently, who slipped and had a fall
earlier in the day and then suffered concussion type like
symptoms during the match. So, concussion doesn't have to occur
specifically during this sporting activity. So, you're
educating as many people as you can.
If you're educating a student, athlete on concussion once
they've had a concussion, you're educating them too late. The
education needs to be out there at the forefront prior to them
ever getting a concussion.
The same thing goes on with me and my parents. We've heard
the word, you know, mild concussion. I never use that word mild
when I'm discussing a concussion with parents. They'll say,
well, is it grade one, grade two, grade three, is it mild, is
it severe. I said, we'll have that discussion when your son and
daughter's signs and symptoms are gone because you can't
discuss those things. So, you know, to me education takes the
form of all the things I talked about, whether it be mass
media, whether it be DVD, videotape, handouts. Conversations go
a long way. And still in the world that we live in today with
blogs and internet, you still can't replace the face-to-face
contact in talking to parents. Getting them the proper referral
to the proper physicians, which are concussion specialists just
like--or pediatricians who are going through the proper
education with concussion management. All those things are
important in the overall education of concussions.
Mr. Pascrell. Thank you.
Mr. Pallone. I just have brief follow-up on Mr. Prybicien
and then I'll go back to you, Bill. I think a lot of the
questions I had were answered with Mr. Pascrell.
Mr. Prybicien, you mentioned that the state of New Jersey
seemed to be pretty good with--did they actually mandate
athletic trainers, how does it work in New Jersey?
Mr. Prybicien. We don't mandate. Probably about 10 to 15
years ago the Department of Education in New Jersey recognized
athletic training as one of its certificate degrees within the
school system which helped tremendously with that high
percentage. I will say----
Mr. Pallone. The percentage was like 80, 90 percent.
Mr. Prybicien. 86 percent of all of our high schools which
conduct an interscholastic athletic--and have an athletic
trainer and 93 percent of our public schools. That's from 2009
the Athletic Trainers Society of New Jersey took a survey and
that's where we came up with those numbers. We're trying to
maintain those numbers. As we talked about here we're in
unexpected economic times, like unprecedented economic times,
so athletic trainers are, you know, feeling the crunch just
like a lot of professionals are in the school system.
Senator Paul Sarlo in New Jersey is actually trying to do a
requirement for any school that has an interscholastic sport in
New Jersey has an athletic trainer at the school. He introduced
that legislation on the New Jersey Senate side about a year
ago. So, we're trying to stay active. We're trying to keep that
number as high as possible. But, I guess to go back to your
question, it's just with the Department of Education
certificate that helps us keep our numbers so high.
Mr. Pallone. So, it's not mandated now.
Mr. Prybicien. It's not mandated, no.
Mr. Pallone. And then if they have somebody at the school,
are they necessarily participating in all the sports or just
some schools.
Mr. Prybicien. Well, for myself, for example, it's a
crossover, you know, most athletes play multiple sports.
Mr. Pallone. It's part of like their health curriculum or--
--
Mr. Prybicien. What we do is, I am at the school, I provide
injury evaluation, injury rehabilitation, I'm at practices, I'm
on site. So if, you know, I watch for a mechanism of injury,
that's where we may be a little bit different from a physician.
We're on the sidelines, so we see a certain hit maybe take
place in a game or certain fall. We can go over and request the
coach take that athlete out, we can take a look at them, you
know, when they come to the sideline. You know, a lot of times
I'll just walk back and forth on the sidelines. You're looking
for a certain look in somebody's eyes, you're looking for a
disorientation. We are a health care provider that probably,
you know, we have our education, but we also develop
relationships, you know. Maybe Roman could speak of it, of his
relationship with his athletic trainers on the next level. We
develop relationships with our patients and that develops a
trust where a lot of times, you know, we may be the only person
that they feel comfortable coming to and telling us about their
signs and symptoms.
Mr. Pallone. Maybe I'll go to Mr. Oben. I guess what I'm
trying to say is, you talk about this play through the pain
and, you know, how we had to reverse that culture. So I mean,
are we going to do it by, you know, putting something in the
health curriculum, are we going to do it by having more
athletic trainers, how are we going to do it.
Mr. Oben. I think definitely on the youth level I can speak
with the--I'm very anti, I call the volunteer dad area, where
you have a lot of dads who just want to coach their kids. In
all the sports I named in my testimony I didn't name tackle
football because I don't trust the system that exist. So, I
think we have to streamline the process of the type of
education they're getting. There has to be one way to give them
this education and make sure it's equally balanced across the
board for just this education on concussions and how it's
treated. If one kid is tough and the other kid out there wants
to play, all of that has to be the same, it all has to be the
same, so. I won't let my kids play football until probably
junior high school because there's a reason why they play
sports. Learning to nurture your skills, your ability to have
fun, to set goals, and that's why we play sports.
Million dollar contracts are not at stake when you're 11-
years-old. I think when you're on the professional athlete
level it's a different protocol I think you have to go through,
but the NFL is just taking the charge. Like I said, I remember
after 9/11 just for an example, the NFL taking charge, when you
can go back and play and when you can't, and I think that
definitely has to trickle down to the youth level as well.
Mr. Pallone. Did you want to add something.
Mr. Prybicien. One other thing that I always say to my
student athletes as well my parents. You know, we live in a
society where we're very, you know, we want to push, we want to
get to the next level, we want to do everything we can either
as a parent for our children or if you're a student athlete you
want to compete. You know, Nikki mentioned quite a few times in
her testimony today how she wanted to compete. When I work with
student athletes, that's who I want to treat too. I want to
treat that athlete that wants to get back on the field because,
you know, different from concussions when I deal with a lot of
other injuries that I'm rehabilitating, that person who wants
to get back on the field is coming in, they're doing their
rehabilitation, they're doing everything, but when I get to
concussions I always use a different line with my student
athletes. And I say, you have to understand we're doing what's
best for you. I don't expect you to like my decision of not
returning to play or the doctor's decision of not returning to
play, but all I ask is you respect it and to understand that
we're doing what's best for you for your entire life, not
necessarily for a game or championship or anything like that.
Mr. Pallone. Dr. Brenner.
Dr. Brenner. I just wanted to point out, you know, I think
New Jersey has to be commended that they have such high
involvement of athletic trainers, having close to 90 percent,
but it's really more of anomaly nationwide with 42 percent
nationwide of schools having athletic trainers. There are high
school athletes right now and middle school athletes who are
playing football on Friday nights without any health care
providers on the sidelines. And so, you know, I think one thing
that has to be addressed is having an athletic trainer, someone
on the sidelines for all these events.
The other thing that has to be addressed is we've been
talking about school athletes, but from the study that came out
last week, 75 percent of 8- to 13-year-olds who had a sports-
related concussion, 75 percent were from recreational athletes,
50 percent of the 14- to 19-year-olds who were recreational
athletes. So we have to do something positive for the
recreational athletes. So that needs to be included in any type
of mandate.
Mr. Pallone. I appreciate this. I don't like to bring in
my--sometimes I don't like to bring in my own kids when I talk
about these things because it gets personal, but I can't help
in this case because, you know, my son was all excited as a
freshman that he was going to play football, and I never played
football and I wasn't much of an encouragement at all, I have
to be honest with you. Then he was injured, and it wasn't a
concussion though, but he was injured and the doctor
recommended he not play anymore. He was devastated. The doctor
didn't say absolutely, but that was his recommendation, but to
me I said no, you're not going to do it. So then, the coaches
asked him if he wanted to be a manager and he ended up managing
the JV team last year and now this year he's managing the
varsity team, he's a sophomore. You know, what you were saying,
I think Mr. Oben said or Mr. Prybicien, you know, he just loves
it, he loves managing the team. It's the whole idea of a team
sport and being involved even though he can't play he is
getting just as much out of it. Maybe I say that. He probably
would disagree with me.
But, you know, I really--I don't know exactly how to say
this. But I just really appreciate the fact that all of you not
only take an interest in this issue and deal with student
athletes, but also appreciate kind of the psychology of kids
because I think that even as a parent I don't necessarily
understand but I think you do, and that's really great.
My colleague.
Mr. Pascrell. Thank you, Mr. Chairman. I hope you leave
today with a better understanding of the legislation is
secondary, but a better understanding of what the culture is
about viewing these kinds of injuries and how we may be
changing, and that's because we've seen changes in any one
state or in professional football.
Several weeks ago, Mr. Chairman, there was a large meeting
at Bloomfield High School. Ms. Boyd was there. We had about 600
students, student athletes, coaches, trainers, some doctors.
There's such a hunger for information about this. It reminded
me of what happened in 2003 and 2004, 2005 when a group of us
returned from Iraq and Afghanistan several times and viewed our
soldiers at a time when the military did not have a very sound
protocol of dealing with TBI or posttraumatic stress disorders.
It was disheartening. It was disheartening to see how they were
treated back here in the states as well throughout. Not that it
was any conscious effort to make things difficult, but people
didn't know what to do, literally did not know what to do. They
were not prepared for this kind of injury. Preparation. We
heard that word mentioned many, many times today. So, the
preparation is significant.
And what's happened since 2004, 2005 there was no money in
the budget. I mean, we didn't pay for the war but we didn't pay
for the aftermath either. What happened was that a few of us on
both sides, all sides, so some good, I think, came out of this
war, believe it or not. And that is we stroke the fire to get
more money into research and development. And more has been
done on the development of the brain in the last five years
that I've seen because we are saving soldiers lives that would
have been dead five years ago. No question in my mind about
that.
So, I mean, you may say this is apples and oranges, we're
talking about kids. We're basically talking about the same
thing, that is preparing them, training them, making sure we
know what to do. God forbid if there's an injury, a concussion.
So, I am very hopeful, I'm very hopeful. I'm an eternal
optimist that we can do much better now that we brought the
military and the civilians together to respond. And all of
these organizations that I talked to you about are doing a hell
of a job day in and day out, they're on the case. We had a
great panel, I don't say that often. I usually tell people
exactly how I think. We had a great panel. You've been very,
very helpful, hopefully to the Chairman as well. I know that he
listened very carefully. I want to get this legislation passed
before we get out of here. I'm going to do the best that we
can, right, Frank. That is my closing comment.
Mr. Pallone. I will say that we are going to try. And I
know that, you know, we don't have a lot of time left, but
we're certainly going to try. And certainly I agree with
Congressman Pascrell, this has been a very good hearing and
it's a very important issue and I want to commend him, you
know, for taking such an interest in the issue.
Now, you said that you're the eternal optimist. I didn't
know that, that's kind of interesting. And then I forget what
the other thing was that you said you were.
Mr. Pascrell. I'm a lot of things.
Mr. Pallone. You definitely were very aggressive in making
sure that we had this hearing today, and I'm sure you'll be
equally aggressive in trying to get the Bill passed.
I want to thank you, all of you for coming here today. I
thought it was a very worthwhile hearing on a very important
issue.
Let me just in closing I just want to remind everybody that
we could submit additional questions to you in writing, which
we would, obviously, like you to answer, and that could even
come from, you know, other members of the Subcommittee that are
not here today. Usually within ten days the clerk submits those
to you, so if you don't get them within ten days you probably
won't get them. I just want you to be aware that there is
additional written questions that could come forward. And,
again, thank you again.
[Whereupon, at 3:15 p.m., the subcommittee was adjourned.]