[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
IMPROVING SPORTS SAFETY: A MULTIFACETED APPROACH
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON COMMERCE, MANUFACTURING, AND TRADE
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
SECOND SESSION
__________
MARCH 13, 2014
__________
Serial No. 113-128
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Printed for the use of the Committee on Energy and Commerce
energycommerce.house.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
94-524 PDF WASHINGTON : 2015
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COMMITTEE ON ENERGY AND COMMERCE
FRED UPTON, Michigan
Chairman
RALPH M. HALL, Texas HENRY A. WAXMAN, California
JOE BARTON, Texas Ranking Member
Chairman Emeritus JOHN D. DINGELL, Michigan
ED WHITFIELD, Kentucky FRANK PALLONE, Jr., New Jersey
JOHN SHIMKUS, Illinois BOBBY L. RUSH, Illinois
JOSEPH R. PITTS, Pennsylvania ANNA G. ESHOO, California
GREG WALDEN, Oregon ELIOT L. ENGEL, New York
LEE TERRY, Nebraska GENE GREEN, Texas
MIKE ROGERS, Michigan DIANA DeGETTE, Colorado
TIM MURPHY, Pennsylvania LOIS CAPPS, California
MICHAEL C. BURGESS, Texas MICHAEL F. DOYLE, Pennsylvania
MARSHA BLACKBURN, Tennessee JANICE D. SCHAKOWSKY, Illinois
Vice Chairman JIM MATHESON, Utah
PHIL GINGREY, Georgia G.K. BUTTERFIELD, North Carolina
STEVE SCALISE, Louisiana JOHN BARROW, Georgia
ROBERT E. LATTA, Ohio DORIS O. MATSUI, California
CATHY McMORRIS RODGERS, Washington DONNA M. CHRISTENSEN, Virgin
GREGG HARPER, Mississippi Islands
LEONARD LANCE, New Jersey KATHY CASTOR, Florida
BILL CASSIDY, Louisiana JOHN P. SARBANES, Maryland
BRETT GUTHRIE, Kentucky JERRY McNERNEY, California
PETE OLSON, Texas BRUCE L. BRALEY, Iowa
DAVID B. McKINLEY, West Virginia PETER WELCH, Vermont
CORY GARDNER, Colorado BEN RAY LUJAN, New Mexico
MIKE POMPEO, Kansas PAUL TONKO, New York
ADAM KINZINGER, Illinois JOHN A. YARMUTH, Kentucky
H. MORGAN GRIFFITH, Virginia
GUS M. BILIRAKIS, Florida
BILL JOHNSON, Ohio
BILLY LONG, Missouri
RENEE L. ELLMERS, North Carolina
_____
Subcommittee on Commerce, Manufacturing, and Trade
LEE TERRY, Nebraska
Chairman
LEONARD LANCE, New Jersey JANICE D. SCHAKOWSKY, Illinois
Vice Chairman Ranking Member
MARSHA BLACKBURN, Tennessee JOHN P. SARBANES, Maryland
GREGG HARPER, Mississippi JERRY McNERNEY, California
BRETT GUTHRIE, Kentucky PETER WELCH, Vermont
PETE OLSON, Texas JOHN A. YARMUTH, Kentucky
DAVID B. McKINLEY, West Virginia JOHN D. DINGELL, Michigan
MIKE POMPEO, Kansas BOBBY L. RUSH, Illinois
ADAM KINZINGER, Illinois JIM MATHESON, Utah
GUS M. BILIRAKIS, Florida JOHN BARROW, Georgia
BILL JOHNSON, Ohio DONNA M. CHRISTENSEN, Virgin
BILLY LONG, Missouri Islands
JOE BARTON, Texas HENRY A. WAXMAN, California (ex
FRED UPTON, Michigan (ex officio) officio)
(ii)
C O N T E N T S
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Page
Hon. Lee Terry, a Representative in Congress from the State of
Nebraska, opening statement.................................... 1
Prepared statement........................................... 3
Hon. Janice D. Schakowsky, a Representative in Congress from the
State of Illinois, opening statement........................... 4
Hon. Leonard Lance, a Representative in Congress from the State
of New Jersey, opening statement............................... 5
Hon. Henry A. Waxman, a Representative in Congress from the State
of California, opening statement............................... 6
Witnesses
William L. Daly, Deputy Commissioner, National Hockey League..... 8
Prepared statement........................................... 11
Answers to submitted questions............................... 181
Dave Ogrean, Executive Director, USA Hockey...................... 20
Prepared statement........................................... 22
Answers to submitted questions............................... 188
Jeff Miller, Senior Vice President, Health and Safety Policy,
National Football League....................................... 27
Prepared statement........................................... 30
Answers to submitted questions............................... 196
Scott Hallenbeck, Executive Director, USA Football............... 42
Prepared statement........................................... 43
Answers to submitted questions............................... 203
Briana Scurry, Former Professional Goalkeeper, U.S. Women's
National Soccer Team........................................... 52
Prepared statement........................................... 54
Richard Cleland, Assistant Director, Division of Advertising
Practices, Bureau of Consumer Protection, Federal Trade
Commission..................................................... 73
Prepared statement........................................... 76
Answers to submitted questions............................... 209
Ian Heaton, Student Ambassador, National Council on Youth Sports
Safety......................................................... 84
Prepared statement........................................... 86
Robert Graham, Director, Aligning Forces for Quality, National
Program Office, George Washington University................... 89
Additional material submitted for the record \1\............. 90
Prepared statement........................................... 91
Answers to submitted questions............................... 214
Dennis L. Molfese, Director, Big 10-CIC-Ivy League Traumatic
Brain Injury Research Collaboration............................ 102
Prepared statement........................................... 104
James Johnston, Assistant Professor, Department of Neurosurgery,
University of Alabama-Birmingham............................... 109
Prepared statement........................................... 112
Answers to submitted questions............................... 218
Timothy J. Gay, Professor, Department of Physics and Astronomy,
University of Nebraska-Lincoln................................. 129
Prepared statement........................................... 131
----------
\1\ The report ``Sports-Related Concussions in Youth: Improving the
Science, Changing the Culture'' and the accompanying slide presentation
have been retained in committee records and also are available at
http://docs.house.gov/Committee/Calendar/ByEvent.aspx?EventID=101897.
Gerard A. Gioia, Chief, Division of Pediatric Neuropsychology,
Children's National Health System.............................. 141
Prepared statement........................................... 143
Answers to submitted questions \2\ 222
Martha E. Shenton, Professor of Psychiatry and Radiology, Brigham
and Women's Hospital, Harvard Medical School................... 153
Additional material submitted for the record \3\............. 154
Prepared statement........................................... 155
----------
\2\ Mr. Gioia did not answer submitted questions for the record by the
time of printing.
\3\ A supporting document has been retained in committee files and also
is available at http://docs.house.gov/meetings/IF/IF17/20140313/
101897/HHRG-113-IF17-Wstate-ShentonM-20140313-SD001.pdf.
IMPROVING SPORTS SAFETY: A MULTIFACETED APPROACH
----------
THURSDAY, MARCH 13, 2014
House of Representatives,
Subcommittee on Commerce, Manufacturing, and Trade,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 10:22 a.m., in
room 2322 of the Rayburn House Office Building, Hon. Lee Terry
(chairman of the subcommittee) presiding.
Members present: Representatives Terry, Lance, Harper,
Guthrie, McKinley, Kinzinger, Bilirakis, Johnson, Long, Upton,
Schakowsky, Sarbanes, Matheson, Barrow, Christensen, and Waxman
(ex officio).
Staff present: Charlotte Baker, Press Secretary; Kirby
Howard, Legislative Clerk; Nick Magallanes, Policy Coordinator,
Commerce, Manufacturing, and Trade; Brian McCullough, Senior
Professional Staff Member; Shannon Taylor, Counsel, Commerce,
Manufacturing, and Trade; Tom Wilbur, Digital Media Advisor;
Michelle Ash, Democratic Chief Counsel, Commerce,
Manufacturing, and Trade; and Will Wallace, Democratic Policy
Analyst.
Mr. Terry. I want to thank everyone for being here, and we
are now with the full committee ranking member, the gentleman
from California joins us. We now have the ability to start our
hearing. So I will introduce you after my statement and before
you start your testimonies. So I will open with my opening
statement. Morning, Jan.
OPENING STATEMENT OF HON. LEE TERRY, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEBRASKA
So good morning and welcome to this morning's hearing.
Today, it is my hope to learn what steps are being taken to
make sports participation safer for all athletes.
Every day, parents make choices about whether or not to let
their son or let their daughter play soccer, or what kind of
mouthpiece to buy their son for his first day of Pop Warner
football. Unfortunately, it seems like every day we hear about
how participation in certain sports can be dangerous. It is
easy to understand how what parents see in the news inevitably
affects youth participation in sports.
Case in point: Earlier this year, President Obama said
publicly that if he had a son, he wouldn't let him play pro
football. Then the First Lady wants us all to move. Seems to
conflict. Messages.
So now, we want a better understanding of the innovations
being made by sports leagues, equipment manufacturers, and the
medical community to make all sports safer. One clear example
is the NHL which has been working hand in hand with the NHLPA
to make hockey safer. Dating back to 1997, the NHL recognized
the dangers of head injuries and took the proactive step of
forming a Joint Concussion Committee. Additionally, the NHL
also established a Department of Player Safety at its
headquarters, the first of its kind for any professional
league. USA Hockey and USA Football, two organizations that
help oversee youth sports in the United States, have followed
the lead of their professional counterparts by employing a
multipronged approach to making participation safer. USA Hockey
now requires coaches to complete an Online education module
specific to the age group they are coaching at, and that
includes safety information, concussion education, and proper
techniques. USA Football, which is endowed by the generosity of
the NFL and the NFLPA, was the first national governing body
for any sport to participate in the CDC's heads-up concussions
in youth sports.
Initiatives and all engaged in providing youth with non-
tackling alternatives to develop their skills. Additionally,
USA Football's Heads Up Football program encompasses 6 elements
meant to make youth's football safer, including coach education
and concussion recognition.
Proactive actions like the ones I just mentioned are
exactly what parents need in order to be assured that
everything possible is being done to keep their child as safe
as possible while they are on the field or ice.
Researchers have also been hard at work to improve the
tools that coaches and doctors have at their disposal when
treating an athlete. For example, Dr. Dennis Molfese, sorry,
Doc, who runs the University of Nebraska's Brain, Biology and
Behavior Center located inside the Huskers Football Stadium,
has been developing an MRI machine that can be used on game day
to assess a head injury. This would allow medical staff to
determine if a player has suffered a concussion, how severe the
injury is, and if that player is able to return.
Equipment manufacturers are also using technology to make
innovation changes to helmets, mouth guards, footwear and other
equipment, all in order to reduce injuries. I feel confident
saying that given the recent rule changes and the rate which
technology is advancing, playing a contact sport today is
likely safer than it has been in the past, however, we must
accept that there is no silver bullet, no helmet or pad is
going to prevent 100 percent of the injuries 100 percent of the
time. This is why we need to consider a multipronged approach
aimed at keeping our kids safer, while still promotion youth
participation in sports. This involves listening to how leaders
like the NFL, NHL, youth leagues and top tier university
researchers are partnering to make progress towards making
sports safer. These are the types of innovations and paradigm
shifts needed to give parents the assurance that all the
possible steps are being taken to improve the safety of their
child on the field.
And I would like to thank our panelists for joining us here
today, and willing to answer our questions. And I would
especially like to thank Dennis Molfese and Dr. Tim Gay for
making the trips to Washington, DC, from Lincoln, Nebraska.
[The prepared statement of Mr. Terry follows:]
Prepared statement of Hon. Lee Terry
Good Morning-and welcome to this morning's hearing.Today,
it's my hope to learn what steps are being taken to make sports
participation safer for all athletes.
Every day, parents make choices about whether or not to let
their daughter play soccer or what kind of mouthpiece to buy
their son for his first day of Pop Warner football.
Unfortunately, it seems like every day, we hear about how
participation in certain sports can be dangerous. It's easy to
understand how what parents see in the news inevitably affects
youth participation in sports. Case in point: Earlier this
year, President Obama said publicly that if he had a son, he
wouldn't let him play pro football.
We want to better understand the innovations being made by
sports leagues, equipment manufacturers, and the medical
community to make all sports safer.
One clear example is the NHL, which has been working hand-
in-hand with the NHLPA to make hockey safer. Dating back to
1997, the NHL recognized the dangers of head injuries and took
the pro-active step of forming a Joint Concussion Committee.
Additionally, the NHL also established a Department of Player
Safety at its headquarters, the first of its kind for any of
the professional leagues.
USA Hockey and USA Football, two organizations that help
oversee youth sports in the U.S., have followed the lead of
their professional counterparts by employing a multi-pronged
approach to making participation safer. USA Hockey now requires
coaches to complete an online education module specific to the
age group they are coaching that includes safety information,
concussion education and proper techniques. USA Football, which
is endowed by the generosity of the NFL and NFLPA, was the
first national governing body for any sport to participate in
the CDC's ``Heads Up Concussion in Youth Sports'' initiative
and has also engaged in providing youth with non-tackling
alternatives to develop their skills. Additionally, USA
Football's Heads Up Football program encompasses six elements
meant to make youth football safer, including coach education
and concussion recognition.
Proactive actions like the ones I just mentioned are
exactly what parents need in order to be assured that
everything possible is being done to keep their child safe
while they are on the field or the ice.
Researchers have also been hard at work to improve the
tools that coaches and doctors have at their disposal when
treating an athlete. For example, Dr. Dennis Molfese, who runs
the University of Nebraska's Center for Brain, Biology and
Behavior, located inside the Husker's football stadium, has
been developing an MRI Machine that can be used on game day to
assess a head injury. This would allow the medical staff to
determine if a player has suffered a concussion, how severe the
injury is, and if that player is able to return to the game.
Equipment manufacturers are also using technology to make
innovative changes to helmets, mouth guards, footwear and other
equipment--all in order to reduce injuries.
I feel confident saying that given recent rule changes, and
the rate which technology is advancing, playing a contact sport
today is likely safer than it has been in the past. However, we
must accept that there is no ``silver bullet.'' No helmet or
pad is going to prevent 100 percent of the injuries 100 percent
of the time.
This is why we need to consider a multi-pronged approach
aimed at keeping our kids safer while still promoting youth
participation in sports. This involves listening to how leaders
like the NFL, NHL, youth leagues and top-tier University
researchers are partnering to make progress towards making
sports safer. These are the types of innovations and paradigm
shifts needed to give parents the assurance that all possible
steps are being taken to improve the safety of their child on
the field.
I would like to thank our panelists for joining us today
and being willing to answer our questions. I would especially
like to thank Dr. Dennis Molfese and Dr. Tim Gay for making the
trip to DC from the University of Nebraska at Lincoln.
Mr. Terry. And my time is over, so I will recognize the
ranking member, Jan Schakowsky, from Illinois.
OPENING STATEMENT OF HON. JANICE D. SCHAKOWSKY, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS
Ms. Schakowsky. Thank you, Mr. Chairman. This is a very
important hearing on improving sports safety. I look forward to
hearing from all of our witnesses on both panels about their
perspectives, experiences, proposals about how to make sports
safer for everyone, from children to professional athletes.
Athletes are continually becoming bigger and faster and
stronger, and despite some efforts to make sports safer, much
work remains. Three hundred thousand sports-related traumatic
brain injuries occur annually in the United States. Sports are
the second leading cause of traumatic brain injury among people
age 15 to 24 years old, second only to motor vehicle accidents.
This is a crisis and one this subcommittee should do everything
in its power to address.
We are going to hear today from Ian Heaton, a high school
senior, who suffered a severe head injury during a lacrosse
game in his sophomore year. Despite his impressive recovery,
that hit, later identified as his third head injury, left him
with a limited ability to enjoy the types of activities many of
his high school students, classmates, take for granted. His
story should serve as a reminder that youth sports injuries can
have have devastating and lasting consequences. And we will
also hear on this panel from Briana Scurry, an Olympic and
World Cup soccer champion, a goalie, forced from the field
after a career-ending traumatic brain injury almost 4 years
ago. Her struggle to overcome the cognitive, physical, and
psychological injuries that followed illustrate that even our
sports heroes are vulnerable to the worst sports injuries.
Both Ian and Briana should be commended for their courage,
and I thank you, Briana, in their recoveries and for their
willingness to testify on this critical issue.
Dave Duerson, a Pro Bowl and Super Bowl-winning safety, and
former member of my hometown Chicago Bears, tragically
committed suicide just over 3 years ago. In doing so, he shot
himself in the chest to avoid any impact on his brain, which he
asked to have donated to medical research in order to allow
scientists to study the impact of the brain trauma he suffered
over his 11-year professional career. It was later disclosed
that Duerson suffered from a ``moderately advanced'' case of
chronic traumatic encephalopathy, a disease linked to repeated
blows to the head, which can result in memory loss, depression,
and dementia.
The Heaton and Scurry stories prove that severe, career-
ending sports injuries can occur at any level of competition,
and the Duerson case should make it clear to all of us that the
impacts of brain trauma go way beyond an athlete's days on the
field and can become more severe over time.
We will also hear today from medical and scientific experts
who have studied the impacts of brain injuries on athletes of
all ages. We will hear about the importance of taking athletes
off the field of play as soon as there is a suspicion of a
brain injury, and keeping them off until they are cleared by a
responsible and trained individual.
And finally, we will hear from the NHL, the NFL, and youth
hockey and football leagues that are responsible for mitigating
traumatic brain injury in their sports. I hope to learn what
changes they have implemented, and will implement, to rules,
practice drills and other aspects of the games that will reduce
the risk of brain injury moving forward.
I am not advocating for an end to sports as we know it, or
maybe not exactly as we know it right now, but I also feel
strongly that 300,000 head injuries per year are too many to
overlook. We should take reasonable steps to reduce the risk.
And I look forward to hearing from all of our witnesses. I hope
this hearing will help the subcommittee to better understand
the safety risks in sports, and what we can and should be done
to limit these risks.
And I yield back the balance.
Mr. Terry. Thank you very much. At this time, recognize the
vice chairman of the committee, Mr. Lance, from New Jersey.
OPENING STATEMENT OF HON. LEONARD LANCE, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Lance. Thank you very much, Mr. Chairman, and thank you
for holding this extremely important hearing. I want to thank
Dr. James Johnston, who will be one of the witnesses, who came
to my office earlier this morning. Thank you, Dr. Johnston.
Experts generally agree that a concussion can be classified
as a brain injury, ranging in seriousness from mild to
dramatic. The Center for Disease Control states a concussion is
caused by a bump, a blow or a jolt to the head, or blow to the
body that causes the head to move quickly. According to the
CDC, the sports that reported the highest number of traumatic
brain injuries were bicycling, football, playground activities,
basketball and soccer.
From 2010 through 2013, the participation rate of children
in youth soccer and football dropped considerably, and some
have pointed to the increased risk of TBI's as a result of
participating in these sports as a reason for the drop in that
participation.
The increased spotlight on concussions in sports has
resulted in an increased amount of research in brain injuries,
as well as research on how to improve sports equipment in order
to prevent such injuries from occurring. Collegiate and
professional sports leagues have implemented standards and
revised their rules in order to decrease the number of brain
injury incidents. The NHL has, as has been indicated, has
required its players to wear helmets on the ice, and the NFL
instituted new standards for evaluating concussions on the
sidelines after the league reported an occurrence of 223
concussions in just over 300 games in the 2010 season.
And State and Federal Governments have also been involved
in tightening safety standards, and since 2009, all 50 States
and the District of Columbia have adopted laws protecting youth
and high school athletes from returning to play too soon after
suffering a concussion or a potential concussion.
This hearing will focus on what more can be done to prevent
brain injuries from occurring in sports, and this is at the
youth level, the amateur level and at the professional level.
And I look forward to the testimony of our distinguished
panels.
Thank you, Mr. Chairman.
Mr. Lance. I have two and a half minutes remaining. Is
there any other member on the Republican side who would like to
speak with an opening statement?
Mr. Terry. OK.
Mr. Lance. I yield back the balance of my time.
Mr. Terry. Especially Missouri. Do they play sports? And on
behalf of the Big 10, I want to welcome Rutgers to the Big 10.
At this time----
Mr. Lance. Thank you very much.
Mr. Terry [continuing]. Five minutes to the full ranking
member of the Energy and Commerce Committee, Mr. Waxman.
OPENING STATEMENT OF HON. HENRY A. WAXMAN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
Mr. Waxman. Thank you very much, Mr. Chairman.
Decades ago, many thought that head injury was serious only
if a player was completely knocked out unconscious, and/or
suffered a severe contusion, after frequent painful blows, even
a young athlete could continue to play, but we now have strong
indications that the effects of repeated brain trauma in
sports, even those received during one's youth, can accumulate
with consequences that are long-term debilitating and even
life-threatening. These consequences can stem from injuries
once considered minor, known as subconcussive blows, which may
not be accompanied by any immediate adverse symptoms.
Serious psychological and emotional disorders have been
documented among former athletes that have suffered repetitive
brain trauma. Researchers have, a number of times, found
evidence of the neurodegenerative disease, CTE, when examining
the brain tissue of dozens of deceased former NFL players. New
imaging technologies have been able to show the metabolic
changes in the brain associated with concussions and
subconcussive blows.
Brain injuries in sports can occur in a wide variety of
situations, and different athletes' brains may respond
differently to an injury. Sports-related brain injury is a
complex matter, requires addressing many interconnected issues,
so when the title of this hearing suggests we take a
multifaceted approach to improve sports safety, I could not
agree more.
First, we need more neuroscience research, radiological and
longitudinal research methods can lead to earlier, more
accurate diagnoses, a better understanding of the risk factors,
and maybe better treatment options for brain injuries.
Second, doctors, league associations, coaches, parents,
players need to work together to establish health regulations,
game rules and a sporting culture that reflects the seriousness
of brain injury, and put the athlete's health first.
Third, we must address the health and safety risks
associated with the athletic equipment, and pursue a better
understanding of how this equipment might be improved.
Three years ago, Congressman Butterfield and I wrote to the
then-chairman at the time of the subcommittee and full
committee chairman, calling for hearings about inadequate
testing standards, lax reconditioning certifications, economic
disparities regarding the safety of football helmets used by
millions of American athletes. We are going to touch on some of
those issues today, but I believe those issues merit deeper
consideration than they are likely to get at today's hearing,
and the subcommittee chairman might consider holding separate
hearings on these matters.
I think it is valuable that the National Football League is
testifying here today, given recent and ongoing disputes
between the league and its players on this very topic. However,
I believe its players organizations should also testify.
Unfortunately, the late notification of the NFL testifying made
it difficult for us to secure players' witness.
Mr. Chairman, today's hearing is important. I appreciate
the subcommittee review of sports-related brain injuries, and I
look forward to working together, all of us, on this issue in
the months ahead. Thank you for holding the hearing, and I look
forward to the testimony of the witnesses.
Yield back my time.
Mr. Terry. Still have a minute left, if the gentleman from
Utah wanted to use it.
Mr. Waxman. Well, I might just point out that moving
physically and conditioning the body is not anywhere near
dangerous as subjecting oneself to brain injuries, so I don't
think they are contradictory.
Mr. Terry. Yes. It is interesting, but the issue is we want
kids to go out and play. We want them to join youth leagues.
Mr. Waxman. And we want sports, but we want to make it as
safe as possible.
Mr. Terry. Absolutely. And to use your last 26 seconds,
then, this is one of those where Jan and I both agreed was
necessary. So this has been a bipartisan effort.
So with that, let us move on to our witness panel. And I am
going to introduce the entire panel now, and then we will start
with Mr. Daly. So we are blessed to have Mr. William Daly, III,
Deputy Commissioner of the NHL. Next to him is David Ogrean,
Executive Director of USA Hockey. Then we have Mr. Jeff Miller,
Senior Vice President, Player Health and Safety Policy,
National Football League. Thank you very much for being here.
And then Scott Hallenbeck, Executive Director, USA Football.
Then a face of a brain injury, concussions, multiple
concussions, within soccer, Briana Scurry, a former
professional goalkeeper, U.S. Women's National Soccer Team. In
the next panel we will have Ian, who is the other face of high-
school-level concussions.
So with that, Mr. Daly, you are now recognized for your 5
minutes.
STATEMENTS OF WILLIAM L. DALY, DEPUTY COMMISSIONER, NATIONAL
HOCKEY LEAGUE; DAVE OGREAN, EXECUTIVE DIRECTOR, USA HOCKEY;
JEFF MILLER, SENIOR VICE PRESIDENT, HEALTH AND SAFETY POLICY,
NATIONAL FOOTBALL LEAGUE; SCOTT HALLENBECK EXECUTIVE DIRECTOR,
USA FOOTBALL; AND BRIANA SCURRY, FORMER PROFESSIONAL
GOALKEEPER, U.S. WOMEN'S NATIONAL SOCCER TEAM
STATEMENT OF WILLIAM L. DALY
Mr. Daly. Thank you. I would like to thank the chairman,
the ranking member, and the subcommittee members for inviting
me to testify today regarding the National Hockey League and
the proactive steps it has taken to promote the health and
safety of the best professional hockey players in the world.
As its playing surface is enclosed by boards and glass,
making it the only major professional sport with no out of
bounds, hockey is a physical game. At the NHL level----
Mr. Terry. Is your mic on?
Mr. Daly. It was, yes.
Mr. Terry. Just pull it a little lower and closer.
Mr. Daly. I will bring it closer. At the NHL level, our
players want it to be physical, and our fans want it to be
physical, but importantly, all constituent groups associated
with the game also want it to be safe. This objective
necessarily includes promoting safe and responsible play in our
game, and the National Hockey League, working together with the
National Hockey League Players' Association, has gone to
elaborate lengths to do that and will continue to do so.
We are pleased to have this opportunity to share with this
subcommittee some of the measures enacted in this pursuit. The
National Hockey League was the first major professional sports
league to launch a comprehensive league-wide program to
evaluate players after they incur head injuries. Beginning in
1997, the NHL/NHLPA Concussion Program has required that all
players on all clubs undergo preseason baseline
neuropsychological testing. After a player is diagnosed with a
concussion, he undergoes post-injury neuropsychological
testing, and his pre- and post-injury test results are compared
to determine when the player is safe to return, or returns to
neurological baseline, which is a relevant determination in the
player's ability to safely return to play.
Data collected and analyzed pursuant to the NHL/NHLPA
Concussion Program confirmed to us early on that
neuropsychological testing results had added value, and should
be taken into account, along with player reported symptoms when
making return-to-play decisions.
The NHL/NHLPA Concussion Committee also has taken
affirmative and proactive steps to issue league-wide protocols
regarding the diagnosis, management and treatment of
concussion. Education regarding concussions and, importantly,
the issuance of warnings to players relating to the risks of
returning to play before the recovery from a prior concussion
is complete, have been a core component of the NHL/NHLPA
Concussion Program since its inception. Education is provided
regularly to all relevant constituents in our league, including
our players, club personnel and NHL on-ice officials.
In addition to enforcing existing playing rules, such as
charging, crosschecking and high-sticking, and more stringently
penalizing dangerous contact, several new playing rules have
been adopted specifically to prohibit involving a player's
head. Our current rule specifically prohibits any body contact
with an opponent's head when the contact is otherwise
avoidable, and the head is the main point of contact. Changes
this season to adopt the hybrid icing rule, and modifications
of rules regarding fighting, have further enhanced player
safety. With respect to the fighting issue in particular, while
it remains a small part of the game, its role is diminishing.
Through 75 percent of the 2013-2014 regular seasons, 68 percent
of the games played have been completely free of fighting, the
highest such percentage since 2005-2006. In addition, the
number of major penalties assessed for fighting is down 15
percent from last season, and down 31 percent from the 2009-
2010 season.
In this important area, it would be the league's intention
to raise, discuss and negotiate any potential playing rule
changes regarding fighting directly with the National Hockey
League Players' Association. Ultimate enforcement of the
playing rules through supplementary discipline is in the hands
of the Department of Player Safety, the first league department
of its kind in professional sports. This department monitors
every one of our 1,230 regular season games, plus all of our
playoff games, and assesses every hit, indeed, every play, to
ensure the league's standards for safety and responsible play
are being adhered to. When the Department determines that the
standard has been violated, supplemental discipline is assessed
in the form of a suspension or a fine, and the Department
creates a video that explains to our players and our fans why
the behavior merited punishment. The cumulative effect of these
efforts has begun to change the culture of the game in a
positive way. As we can see on a nightly basis, players
avoiding dangerous plays and gratuitous contact that they, no
doubt, would have engaged in just a few short years ago.
Since the adoption of the mandatory helmet rule in 1979,
the NHL, together with the NHLPA, has continued to impose a
series of additional regulations regarding player equipment
relating to player safety generally, but also to head injuries
more specifically, including most recently a rule adopted prior
to the start of this season that mandated the use of face
shields by all incoming players, the effect of which should
reduce head injuries generally, in addition to providing
enhanced protection for players' eyes.
The NHL also has participated in concussion initiatives
that extend beyond the NHL, including its representatives'
participation at each of the 4 International Concussion and
Sport Conferences between 2001 and 2012, its support of Federal
and State legislative initiatives regarding concussions, and
the league's support and assistance in the development of
concussion educational programs for youth and junior-age hockey
players.
To summarize, while recognizing there is considerable work
to be done, the National Hockey League has been, and will
remain, absolutely committed to promoting the safety of its
players. We firmly believe it is not only the right thing to do
for our players, but it is the right thing to do for our
business, both in terms of promoting participation at the youth
hockey level, and in maximizing interest by fans and consumers
of the sport at the professional level.
Again, I thank the chairman, the ranking member, and the
subcommittee members for your time and invitation to speak to
you this morning.
[The prepared statement of Mr. Daly follows:]
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Mr. Terry. Thank you. Mr. Ogrean, you are recognized for
your 5 minutes.
STATEMENT OF DAVE OGREAN
Mr. Ogrean. Thank you, Chairman Terry, Ranking Member
Schakowsky, and distinguished members of the subcommittee. It
is a privilege to be with you today to discuss an issue that is
the top priority every day at USA Hockey, and that is the
safety of our participants both on and off the ice.
We have adapted well to changing environments over time,
and we have two particular leaders that we wish to thank, and
who guide a great deal of our decision-making. One is Dr. Mike
Stewart, our Chief Medical Officer, who is the head of sports
medicine at the Mayo Clinic in Rochester, Minnesota, the other
is Dr. Alan Ashare from Saint Elizabeth's Medical Center in
Boston, who is also the chair of our Safety and Protective
Equipment Committee. That committee has been in existence at
USA Hockey for 40 years, and it is an important group helping
to guide our Board in making its decisions.
We have a Risk Management Committee which is concerned with
the safety of the playing environment and the surrounding area,
and in 1999, in cooperation with U.S. Figure Skating, we began
an organization called Serving the American Rinks, or STAR,
which is essentially a trade and education organization for ice
facilities, focusing on a variety of operational aspects,
including safety issues in rinks.
In terms of the safety of our participants, we believe we
can and do positively affect the landscape through 3 primary
areas; education, rules and rules enforcement, and risk
management. Education related to safety happens on an ongoing
basis at USA Hockey, and we utilize many avenues to
communicate. We have, very fortunately, direct electronic
communication with every single home, every player, every
parent, every official and every coach in our organization,
through our database. We are constantly in communication with
them with educational bulletins and news. Our coaches have a
huge influence in providing a safe and responsible environment,
and our coaching education program has long been heralded in
the amateur sports world as the gold standard for coaching
education.
As Congressman Terry referenced, this last year--or, excuse
me, two seasons ago--we added an online educational module that
is age-specific in nature, which also contains critical safety
information, including concussion education. Officials,
obviously, play a very important part in how our game is made
safe as well, and they receive regular evaluation and education
electronically, and are sent video clips and also access to our
national reporting system which tracks penalties, to help us
understand and assess behavior trends. We annually mail posters
to every ice facility in the country to help deliver our
messaging, and, over the years, those posters have focused on
topics including concussion prevention, concussion education,
playing rules emphases, and our heads-up, don't duck program,
to name a few.
As for rules and rules enforcement, we have modified our
rules to adapt to the evolving landscape of the game on an
ongoing basis, from mouth guard and helmet issues to rules
aimed at eliminating dangerous behavior. Another recent
modification in USA Hockey came in June of 2011 when our Board
voted to change the allowable age for body checking in games
from the peewee, or age 11 and 12 level, up to the bantam age
group of 13 and 14. This was done despite many voices around
the country in opposition to change, which nobody seems to
like, but research based on both athlete development and safety
guided our Board decision. It is worth noting that 2 years
later, Hockey Canada followed our lead.
Regarding equipment and its impact on safety, USA Hockey
took a significant step in 1978 when it called for the creation
of the Hockey Equipment Certification Council, or HECC. HECC's
mission is to seek out, evaluate and select standards and
testing procedures for hockey equipment for the purpose of
product certification. It is very similar to NOCSAE, which a
lot of you may be familiar with, that football uses in
certifying its helmets. It is a completely independent body
made up of attorneys, doctors, engineers, manufacturers,
testers and sportspeople. It validates the manufacturer's
certification that the equipment they produce has been tested,
and meets the requirements of the most appropriate performance
standards, and it has been an important part of our safety
story for 35 years.
Before closing, I would like to share with you briefly our
newest off-ice safety program called USA Hockey Safe Sport,
following the lead of the United States Olympic Committee, this
is to protect our participants and educate on policies
regarding hazing zero tolerance, locker room supervision, and
abuse of any kind. In the early 1990s, we were one of the very
first youth sports organizations to require screening of all
adults that have regular access to our youth participants. We
follow-up on 100 percent of calls we receive around the country
of alleged abuse, and our 34 affiliate associations each have a
volunteer safe sport coordinator that helps us as boots on the
ground to provide the safest possible environment for our
participants.
Our sport has enjoyed tremendous growth in the last 25
years, more than doubling in the number of youth players that
we have. As we continue to provide opportunities for young
people, we know that in doing so, we have the responsibility to
make our game as safe as possible, and will only continue to
grow if we are successful in doing so.
Thank you.
[The prepared statement of Mr. Ogrean follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Terry. Thank you. Mr. Miller, you are recognized for
your 5 minutes.
STATEMENT OF JEFF MILLER
Mr. Miller. Chairman Terry, Ranking Member Schakowsky,
members of the subcommittee, appreciate the opportunity to
testify this morning on behalf of the National Football League
on an issue of great importance to the league, and I commend
the committee for taking up this issue.
There is nothing more important to the NFL than the safety
of our players. Commissioner Goodell has stated repeatedly in
the past that he spends more time on the health and safety of
our sport than any other issue that comes before him.
Football has earned a vital place in the rhythm of American
life. There are nearly 6 million kids who play tackle or flag
football across our country, another 1.1 million that play in
high school, 75,000 in college. And so whether it is touch
games in our backyards at Thanksgiving, or games played in our
local parks by our kids, or Friday night high school games,
Saturdays with college, or hopefully plenty of people watching
the NFL on Sundays and Mondays, and occasionally Thursdays,
football plays a significant role in our lives, and we take
that popularity seriously. With it comes a great deal of
responsibility, and that is one that we embrace.
We understand the decisions that we make at our level
affect football at all levels, and probably far beyond that,
and so I appreciate the opportunity to share the NFL's work
with the subcommittee on the health and safety of our athletes
who play our game.
Now, football has always evolved. The rules have always
changed, and so I would like to share with the subcommittee a
few examples of that over the last couple of years, and the
impact that that has had at our level.
It has only been a couple of years ago that we changed the
kickoff line at the NFL, moving it forward 5 yards. We did that
because we had identified the kickoff and the kickoff return is
the single most dangerous play in our sport as related to the
number of concussions. So by moving it forward 5 yards, we
decreased the number of concussions on that particular play by
40 percent. That was in the first year alone, and that number
has stayed steady in successive years.
In addition, for those of you who are fans, you have seen a
greater emphasis on eliminating helmet-to-helmet hits in our
game, you have seen a greater emphasis on eliminating the use
of the crown of the helmet in our game, and you have seen fines
and suspensions, not to mention penalties, as a result of them.
And these are the sorts of things that we are looking to do to
change the culture of how our sport is played. We have
encouraged players to lower their target zones as they tackle,
we have emphasized through our coaching that there are better
ways to go about what they are doing, and we have seen the
results. In the past year alone, between 2012 and 2013, the NFL
has seen a decrease in the number of concussions at our level
by 13 percent. A decrease in helmet-to-helmet hits causing
concussions has been down 23 percent in one year alone. Now,
that is not a victory, that is a trend, and one that we find
encouraging, but there is more work to be done as we begin to
change the culture of the sport as it relates to that.
And we have added other protocols to our sideline to take
care of our players. There is one rule that governs us, and
that is that medical concerns will always trump competitive
ones. So we have added unaffiliated neurotrauma consultants on
the sideline. That is a concussion expert in every city to help
the team physician identify concussions and treat the players.
We have added athletic trainers in skyboxes for the sole
purpose of watching the game, and calling down to the sideline
if they identify an injury, concussive or otherwise, to make
sure that the player is attended to appropriately. And we have
mandated uniform sideline protocols across all 32 of our teams
so that everybody is working off the same playbook, and those
protocols are based on internationally accepted medical
guidelines. We would expect nothing less. And we know as we
change the culture of our sport as it relates to health and
safety, we have an impact far beyond. And so let me cite two
examples of that for the subcommittee. One is our support for
USA Football, and you will hear from Mr. Hallenbeck in a
moment. Their Heads-up Program, among their other offerings,
are changing the game in our parks, in our communities around
the country literally as we speak. The popularity of these
programs, which I won't steal Scott's thunder on, have been
tremendous, and the NFL is a proud supporter of USA Football,
and will continue to be in all that they do to change the game,
and we are proud of his work particularly.
In addition, the NFL used as inspiration a young child
named Zackery Lystedt who was a 13-year-old youth football
player in Washington State several years ago who suffered
catastrophic injuries playing his sport. He was returned to
play too soon after suffering a concussion. And Zackery still
struggles with the challenges that come from that. His
advocates were able to pass a Youth Concussion Law in
Washington State which our commissioner said we will replicate
in all 50 States around this country to make sure that all
youth sports, not just football, are played more safely, that
kids and their coaches are aware of the risks of concussion,
that they are removed from play should it appear that they
suffer concussion, and most importantly, not return to play
until a medical professional has cleared them. Just this past
month, we are proud to say that the fiftieth State passed that
law, and now the NFL isn't solely responsible for that work,
but we are happy to lead and to be in many of these States to
get this done.
And as my time expires, let me just mention two other quick
components. We have been proud to work with the CDC promoting
concussion materials that have gone out to millions of kids,
posters in locker rooms, and to fund much of their Heads-up
Program. We have also invested tens of millions of dollars in
research; $30 million with the NIH, which is the largest grant
that the NFL had ever given, and the first $12 million of that
has gone out already to study chronic traumatic encephalopathy.
In addition, we are very proud of a $60 million effort we have
with General Electric and Under Armour, both to improve the
diagnosis and prognosis of concussion by developing better
tools, and then secondly to find better ways to protect against
concussion in the first place. These are ongoing issues and
ones that we think are going to yield significant successes in
a short time.
So I apologize for exceeding my limit, Mr. Chairman, but I
appreciate the time.
[The prepared statement of Mr. Miller follows:]
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Mr. Terry. At this time, Mr. Hallenbeck, you are recognized
for your 5 minutes.
STATEMENT OF SCOTT HALLENBECK
Mr. Hallenbeck. Chairman Terry and members of the
committee, thank you for the invitation to testify.
USA Football creates and directs programs and resources
that establish important standards rooted in education for
youth and high school football. We stand with experts in
medicine, child advocacy and sport who believe that education
changes behavior for the better. This is precisely what we are
seeing through our Heads Up Football program, which is already
benefiting more than 25 percent of youth football leagues
across the country in its first 14 months, and we expect to
double that this year.
We advance safety through evidence-based studies by
independent experts, we also lead fun and dynamic instructional
football initiatives for young players, as well as a national
non-contact flag football program. More on these and other
aspects of our work resides in my written testimony. The
remainder of my time will be showing a video of how Heads Up
Football High School Pilot Program is improving player safety
within the Fairfax County Public School system, which earned
high marks from parents, coaches, administrators in its first
season. It paid close attention to hearing from the athletic
directors and the principals and the superintendents of the
schools on how this program is making a difference.
[Video shown.]
[The prepared statement of Mr. Hallenbeck follows:]
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Mr. Terry. Thank you. Now Briana Scurry, appreciate you
being here, and you are recognized for 5 minutes.
STATEMENT OF BRIANA SCURRY
Ms. Scurry. Thank you very much.
Yes, my name is Briana Scurry and I am 42 years old. I
served as a starting goalkeeper for the United States Women's
National Soccer Team from the years 1994 to 2008. During that
time, I helped lead the team in winning two Olympic gold medals
in 1996 Atlanta games and 2004 Athens, and played 173
international games over 15 years for the United States, which
is a record among female goalkeepers.
In the summer of 1999, my 20 amazing teammates and I
captured the hearts of America by beating China in a penalty
kick shootout live in front of 90,000 screaming fans at the
Rose Bowl in Pasadena, California. I was the one that made the
single save during the penalty kicks before Brandi Chastain
took off her shirt. Yes, now I will be many of you recall
exactly where you were at that moment. It was the kind of event
that transforms lives forever for the better. My passion and my
mission was soccer. My ultimate reward was living my dreams and
inspiring the dreams of countless others.
Today, I am here before you to share my new mission with
you. My new mission is to provide a new face and voice to those
who have had and may suffer the long and difficult recovery of
a devastating traumatic brain injury and concussion.
My life story reads like a script from Oprah Winfrey's
Where Are They Now. Like many of Oprah's guests, I too have
been lost in deep, dark places with my face in the dirt, and
have only recently begun to claw my way back to my life.
On April 25, 2010, my life changed forever. During that
day, I played a women's professional game against the
Philadelphia Independence in Philadelphia, and in that game, I
suffered a traumatic brain injury that abruptly ended my
beloved soccer career. That was nearly 4 years ago.
I struggled with intense piercing headaches that were so
bad that, by the evening, it was all I could do not to cry
myself to sleep. I had to take naps on a daily basis just
because my sleep was so disrupted. I couldn't concentrate and I
was very moody. I felt completely disconnected from everything
and everyone. I was anxious and depressed every day, and I
wondered if I would ever get better.
I recently moved to DC to have bilateral occipital nerve
surgery at Georgetown to eliminate severe headaches that
plagued me daily. Fortunately for me, the surgery appears to
have worked, however, I am still being treated for symptoms
such as lack of concentration, balance issues, memory loss,
anxiety and depression. I have purposefully and intentionally
had my concussion recovery story documented by media outlets,
such as the USA Today, The Washington Post and Brainline.org,
in order to bring attention and a ray of hope to those
suffering from TBI like me.
In September, I was alarmed to learn that the number of
reported cases of concussion in soccer was second highest in
the United States, with only American football having more
cases. Additionally, a recent article published in November
stated that one of two female youth soccer players will suffer
a concussion while playing. I feel the numbers of reported
cases are likely understated, and didn't designate those who
suffered multiple concussions like I have. Statistics like
these have solidified my urgency of purpose to shed light on
the high frequency of concussions in youth, and the devastating
emotional toll that prolonged symptoms often cause, yet are too
frequently dismissed.
I sincerely hope that my presence here today will inspire
increased awareness, understanding and assistance to help the
thousands of young TBI sufferers across this country.
I thank you all for allowing me to give testimony. I am
grateful and humbled to have been invited to do so. Thank you.
[The prepared statement of Ms. Scurry follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Terry. Thank you very much. And that was powerful.
So this is our opportunity now, each of us have 5 minutes
to ask you questions.
So, Ms. Scurry, let me ask you this one. I too was shocked
to learn that soccer had the second most concussions, which is
a really dominant youth sport. Are you seeing changes within
soccer and, unlike there is an obvious top-to-bottom connection
that we heard from the NHL and the NFL, is anything like that
occurring in soccer?
Ms. Scurry. Thank you for the question. I too was very
surprised to read that statistic. I think it is so high in part
because the explosion of players that are playing soccer now in
the last 10 years.
I am not finding that soccer has completely grasped the
alarm or the situation like USA Football, USA Hockey have. Part
of the reason I am here today is to shed light that soccer too
should be instrumenting different protocol like NHL and the NFL
are, and hopefully the governing body for soccer, which is U.S.
Soccer, will start to understand that our great sport is in
danger of having too many head injuries, and that something
does need to be done about it, and something needs to be
instrumented.
Mr. Terry. All right. And thank you, and I think your
assessment of the game that you played, and winning that
championship over China, we all, at least I, remember that one
event.
Ms. Scurry. Thank you.
Mr. Terry. It was a great game.
Now, to Mr. Miller, the NFL has taken, I think, seriously,
undertaken effort to get the so-called return to play
guidelines adopted at all State levels. Can you tell us more
about what the guidelines are and how they are developed?
Mr. Miller. Sure, and thank you for the question.
The Zackery Lystedt Law, which is the model law that was
passed out in Washington State, contained three primary
elements, the first of which would be that parents and their
kids would have to sign off on an education sheet a
notification about the risks, signs and symptoms, related to
concussion before they were allowed to participate. The second
was that a child who appeared to have suffered a head injury
must be removed from play immediately, in other words, the
coaches were asked to act conservatively. And finally, that a
licensed medical Provider who has a training in the management
and evaluation of concussions has to return every child to
play. And that part was done in large part to eliminate the
danger that Zackery faced when he returned to play in the same
game too soon.
And all these laws are very new, and so I know that there
are academics who are studying them to see their success, but I
just know, as one anecdote in Washington State, the one that
had the first one, in the years after the Lystedt Law was
passed, they didn't see a single brain injury, in other words,
blood on the brain of any single football player in the State
of Washington, and they had normally seen three or four
significant brain injuries on an annual basis, and those were
eliminated.
Now, that is anecdotal and more work needs to be done. And
I commend those States who are going back and making their laws
more strict, because they need to be expanded to the youth
level. Many of them are high school only. They need to be
expanded to recreational spaces so it is not just school-based
sports. And there is more that can be done, and there are those
that are doing that, and we are happy to work with those.
Mr. Terry. Thank you. Mr. Ogrean, have you seen a
demonstrable reduction in concussion incidents at USA Hockey
after implementing new techniques?
Mr. Ogrean. We do not have the same statistical data that I
think USA Football has invested in, and, in fact, we are
talking to DataList, the same company, to do that sort of
thing.
Any concussions are too many concussions. What we have
focused on is research, education and rules enforcement. The
statement was made in someone's opening remarks regarding the
culture of certain sports, and obviously, we know that a lot of
sports at the youth level suffer from a misplaced, you know,
macho attitude. A lot of coaches think they are coaching at the
professional level, and they are not. And so changing that
culture is very, very important. We have been very, very strict
about return to play rules, and as Scott used the phrase
earlier this morning that I appreciate very much, and we adopt
the same thing, when in doubt, sit them out. And I think when
you are talking about a grassroots sport, in our case, we have
350,000 youth players in 2,500 programs, and that equates to
about 25,000 teams, one of our big challenges is quality
control. You can't get everybody to act the same way or to
think the same way, but we do know, I think because of our
emphasis on preventing head injuries, and what to do with them,
how to recognize them, how to treat them, how to respond to
them, and making sure the return to play decision is a medical
decision and not a coach's decision, that the number is
dropping.
Mr. Terry. Great. My time is over. And so the Ranking
Member, Jan Schakowsky, you are recognized for your 5 minutes.
Ms. Schakowsky. Briana, my granddaughter, has played AYSO
soccer since the first time that she could. Now she is on a
traveling team in high school. She is 16, so I am very
concerned about what you are saying, and even more concerned
now after you are saying that soccer actually seems to lag
behind other sports. And there have also been studies that have
compared the rates of reported concussions for male and female
athletes that tend to show that female athletes actually have a
higher rate of reported concussions than male athletes in the
same sports.
So what would you say that we need to do immediately? I
mean I really do worry about her now and what could happen, so
what would your advice be to female athletes, female soccer
players, and to those who coach and treat them?
Ms. Scurry. I too find that statistic very alarming. I
think one of the things that needs to occur with soccer is
officials and referees, coaches need to take their heads out of
the sand a little bit and realize that this is something that
is plaguing our sport as well. And the video that was played by
Mr. Hallenbeck earlier was a fantastic example of where to
start. You start with the coaches. You teach the coaches the
proper way to teach the players how to head, and do certain
drills to make sure that the coaches know how to teach it
instead of just letting players run around out there, and let
the ball head them; instead, teach them how to head the ball,
and also improve the strength of the neck muscles. For females,
it seems to be part of the issue is they are not as strong as
the male counterparts in heading. And so that needs to occur.
And there just needs to be an understanding and an education of
what you are looking for when a head injury does occur.
Ms. Schakowsky. Let me ask you a question. I don't know if
soccer is the only sport where you quite deliberately use the
head.
Ms. Scurry. Right.
Ms. Schakowsky. Is that an inherent problem?
Ms. Scurry. I don't necessarily think it is an inherent
problem----
Ms. Schakowsky. Right.
Ms. Scurry [continuing]. But, obviously, I think that
scenario, when there is a ball in the air you are going to
head, that there is something highly probable that could
happen, but I think if you teach it properly, you are going to
have those head injuries no matter what you do, just like they
said, when you play the sport, you are going to have injuries
that happen, but I think that certain things that happen during
a heading situation isn't the only reason or only time when
concussions occur.
Mine in particular happened when I was playing in the goal,
going for a low ball from my left, the player came in from the
right and hit me in the side of my head with her knee.
Ms. Schakowsky. Uh-huh.
Ms. Scurry. And that has nothing to do with heading----
Ms. Schakowsky. No.
Ms. Scurry [continuing]. At all, you know. Head to knee,
head to foot, head to post isn't part of that.
Ms. Schakowsky. Well, I would love to get your advice as we
move forward, and anything that I can do outside of this body,
because I certainly----
Ms. Scurry. Fantastic.
Ms. Schakowsky [continuing]. Worry about my granddaughter.
Mr. Miller, I wanted to ask you a question. Retired NFL
players face some of the most serious health challenges of any
sport, yet benefits for former players are not on a par with
Major League Baseball or the National Basketball Association,
despite the fact that the NFL has more than $9 billion in
annual revenue.
So yes or no, does the NFL yet provide lifetime health
insurance for former players who did not play under the current
collective bargaining agreement?
Mr. Miller. No. The players are able to continue their
medical coverage when they leave the game, but they are not
provided lifetime medical coverage.
In the most recent collective bargaining agreement with our
Players Association, there were in excess of $600 million that
went to the players who played pre-1993, and added pensions and
benefits. All of our programs are collectively bargained with
our Players Association, and so I think during each iteration
of our collective bargaining agreements, you have seen changes
and improvements made, excuse me, to the programs for retired
players including this year, for example, this past CBA, for
example. A neurocognitive program, screening program----
Ms. Schakowsky. Well, I understand----
Mr. Miller [continuing]. That provides opportunities----
Ms. Schakowsky [continuing]. But professional baseball and
professional basketball do provide lifetime health insurance
for former players. And while I understand the NFL's ADA Plan,
what could be the reason to not provide lifetime health
insurance for former players?
Mr. Miller. Well, like I mentioned, all of our programs,
all of our benefits, and all of the policies are collectively
bargained with the Players Association, and so the improvements
that we have seen as far as care for retired players, whether
they be the ADA Plan, as you mentioned, which accounts for any
player who suffers from a diagnosis of dementia, neurocognitive
benefits, which help players' joint and hip replacements, all
of those sorts of things are improvements, and are made
available to players should they suffer from those issues, in
addition to a number of other practices and programs, including
help lines and our Player Care Foundation, the Players
Association has additional programs to help players who are in
need at little or no cost, and those programs exist today.
Ms. Schakowsky. I yield back.
Mr. Terry. Mr. Lance, you are recognized for 5 minutes.
Mr. Lance. Thank you very much, Mr. Chairman.
Mr. Miller, the changes that you have made in recent years,
the rules change, the increased penalties, suspensions for rule
violations, reducing full contact practice days, can you share
with the committee data that you have that this, I hope, has
had a positive impact on concussion incidents that might
encourage leaders at other levels of football?
Mr. Miller. Absolutely. We are happy to share with the
committee, you know, some greater information than I can offer
in my oral testimony.
Mr. Lance. Certainly.
Mr. Miller. But the most interesting number from my
perspective is when you count up the number of all the
concussions that were diagnosed in games and practices,
preseason in preseason practices, and postseason in postseason
practices, you see a 13 percent decrease year over year. And--
--
Mr. Lance. Thirteen percent each year? Year over----
Mr. Miller. Thirteen percent between 2012 and '13.
Mr. Lance. Very good.
Mr. Miller. And the emphasis has been on eliminating the
use of the head in the game, and specifically helmet-to-helmet
hits, which are a significant cause of the injury. And in those
circumstances that we have been able to identify where two
helmets collide, we have seen a decrease in the number of
concussions by that cause by 23 percent in the past year.
There is a lot more work to be done, and those numbers
could change year over year. I don't think anybody should rely
upon one-year data as some sort of conclusion, but I am happy
to go into that further with the committee if you would like to
see more of the information.
Mr. Lance. Thank you. I think we would, and this is, of
course, very helpful, and I hope that the improvements
continue.
Mr. Hallenbeck, I believe your testimony indicated that 15
high schools in 10 districts participate in your pilot program
last year, and that you are anticipating 500 to 1,000 will
participate this fall. And, of course, I would imagine high
school football is the football that most of us have
experience, either through ourselves or through a child, and in
my case, a son, and this is part of the American tradition.
What are your plans for getting more school football
programs at the high school level to participate, and what does
your outreach entail, and how do schools across the country
learn about your program? I think the purpose of this hearing
is multifaceted, and one of the purposes, I would hope, is to
inform high schools across the country about your program, as
the video indicated, occurs here, next-door in northern
Virginia?
Mr. Hallenbeck. Thank you. So first of all, one of the
common themes we are hearing, of course, is inconsistency, and
football probably is the most fragmented of all used sports,
and even at the high school level, there are significant
challenges there. So what we are trying to strive for through
this Heads Up Football program is consistent teaching,
consistent teaching of technique, consistent teaching of
terminology, and now getting out to the staunchly independent
youth programs as well as now high school programs, the good
news is they are actually being responsive. If it is their
superintendents, if there are principals, their athletic
directors, they are being asked, as it was mentioned in the
video, ``What are you doing about this?''
Mr. Lance. And you are doing the asking, or the parents and
PTAs are doing the asking?
Mr. Hallenbeck. It is a combination. We are talking to
State associations, high school State associations, we are
talking to coaches' associations, we are talking directly to
coaches, we are working with athletic directors, we are working
with parent groups, national PTA is involved, we are looking at
every conceivable channel to communicate this program and the
importance of changing behavior. And what I am sharing is there
has been a very positive response.
That video by itself, and really the reason I decided to
show it, has been incredibly influential. In addition, we now
have the Big 10, the Pac-12, the Big 12, the ACC, we will
eventually have the NCAA, we will have all college conferences
involved, every one of their coaches will be involved, with
PSAs and things of that nature that help influence high school
coaches and high school programs to embrace the Heads Up
Football program and help change behavior.
Mr. Lance. Thank you. Let me say that if there is one
message I wish to leave this morning in my 5 minutes of
questioning is that I would hope that all of those involved at
your level of football would examine what you are suggesting,
because after all, that touches virtually all of the American
people, and I commend the panel for its testimony.
Thank you, Mr. Chairman.
Mr. Terry. Thank you, Mr. Lance. And I just editorialize,
that is why we have NHL Youth Hockey, NFL Youth Football, is
because it does seem that it trickles down. Whatever is said at
the top, then it gets pushed down to the youth, and so that was
by design.
The gentleman from Utah is now recognized for your 5
minutes.
Mr. Matheson. Well, thank you, Mr. Terry.
I first want to echo something that Mr. Waxman said in his
opening statement. It may sound obvious but I think it is
important that we acknowledge. This is a complicated issue.
There are a lot of complexities to this, there is a lot we
don't know about brain science, and I think we all could agree
that the notion that this is an issue that merits significant
investment and research is really something beyond even
concussions in sports. We have traumatic brain injury in terms
of our soldiers in the field. This is a really important issue
that is complicated, and we ought to make sure we approach it
in a thoughtful and comprehensive way, so, Mr. Chairman, thank
you for scheduling this hearing today.
I was going to ask Mr. Miller, without taking too long,
because this is an open-ended question, but could you kind of
walk us through the steps, as information and research has
brought more knowledge to the NFL, how has the league
responded, and how have you positioned yourself on these issues
to address the issues of concussions? And just if you could
walk us through some of the history of how it has evolved
within your organization.
Mr. Miller. Yes, I am happy to do it, and thank you for the
question.
I think the point that you made that the science has
evolved----
Mr. Matheson. Um-hum.
Mr. Miller [continuing]. On neurological issues, certainly
neurodegenerative disease, is one that the second panel, where
there is a terrific expert lineup, can talk to, but we rely on
the outside advice of very well known, well respected, probably
internationally known neuroscientists to advise us as to what
the state of the science is, and how best to go about changing
out game to reflect that. And so that is how we ended up
creating a unified concussion protocol and return to play
protocol for our sideline. That is how we ended up with
additional concussion experts on the sideline. This is based on
the advice of outsiders who tell us this is the best way to
handle your players, this is the best way to treat the game,
and if you want a culture of safety, this is what you would do,
and we follow their advice strictly and meet with them very
frequently.
Mr. Matheson. All right. And I notice your title is Senior
Vice President of Health and Safety Policy. That has got to be
a position that didn't exist 20 years ago, I bet?
Mr. Miller. It did not exist 20 years ago----
Mr. Matheson. Yes, so----
Mr. Miller [continuing]. And I am proud to be in that role,
and it is an exciting one.
Mr. Matheson. I know this hearing is concussions, but since
you are here, I have to ask you one other question that may be
a little different topic.
Over the last few years, I have communicated with the NFL
about my concerns about the issue of human growth hormone
testing, and I know that is something that was raised in the
last collective bargaining agreement effort, and there is an
agreement to agree later, but that hadn't always come together
as much, and I know this is something that is important to the
league.
Can you give us an update on what is going on on testing
for human growth hormone?
Mr. Miller. Sure. We appreciate the question.
Unfortunately, we don't have human growth hormone testing--
--
Mr. Matheson. Right.
Mr. Miller [continuing]. Yet. The league has been ready,
able, willing to pursue it, as you mentioned, since it was
agreed upon in the collective bargaining agreement.
Unfortunately, our Players Association has thrown up
obstacles--probably fair to say, from our perspective,
excuses--for a period of time. And I think the testing goes to
the integrity of the game, certainly. It also goes to the
health and safety of the sport.
Mr. Matheson. Yes.
Mr. Miller. You don't know where this stuff is coming from.
You don't know who is giving it to a player or players, and you
don't know what they are putting in their bodies, and that is
dangerous and it is also the wrong example to set. And so this
is an important issue for us, and one that we are sorry has not
gotten accomplished yet.
Mr. Matheson. Well, that is an important issue to me, and
that is why I wanted to raise it. I know that it is not this
topic of this hearing, Mr. Chairman, but since he was here, I
had to ask the question.
Ms. Schakowsky. No, but if the gentleman will yield just--
--
Mr. Matheson. Yes, I will yield.
Ms. Schakowsky [continuing]. For one sentence. I think that
is why we wanted to have the Players Association here too
because, you know, that was a pretty strong criticism that you
just made. It would be nice to have had the players as well to
respond.
Mr. Terry. Well, I will have to now interject. They were
asked and they declined.
Ms. Schakowsky. Yesterday.
Mr. Terry. No.
Mr. Matheson. Well, anyway----
Mr. Terry. That is not accurate.
Mr. Matheson. Well----
Mr. Terry. They were contacted before yesterday----
Mr. Matheson. I want to reclaim my time----
Mr. Terry [continuing]. And they still rejected.
Mr. Matheson [continuing]. For one more question though, if
I can. I have one more question for you. Where do you see
things going? I know when you try to crystal ball, it is
dangerous because you never know, but where do see things going
in the next 5, 10, 20 years in terms of where technology is
going to take us? Do you have some things about looking out on
the horizon that we can be looking forward to?
Mr. Miller. Yes, I will give you a specific example. As
part of the scientific research that we entered into with GE,
the world's leader in diagnostics, we set aside what we call
innovation challenges, two $10 million pots of money. The first
was to promote new ideas on how to better diagnose concussions.
There aren't any objective tests now. They are all subjective
analyses.
Mr. Matheson. Right.
Mr. Miller. And we had people from 27 different countries
around the world offer ideas. We eventually rewarded 16 of them
so far, biomarkers, blood tests, these sorts of things. And
then in addition, we just completed another challenge that
echoes around protective ideas, how to protect the brain
better. We had more than 40,000 people from 110 countries
around the world visit the Web site.
Mr. Matheson. Wow.
Mr. Miller. We had people from 19 different countries offer
ideas on new protective equipment, and we are reviewing those
now. And I think that because there is a lot more attention
paid to this, and hopefully we are one of the actors that are
catalyzing the science, that you are going to see changes in
all of these places relatively soon.
Mr. Matheson. OK. Appreciate that.
Mr. Chairman, my time is up so I will yield back.
Mr. Terry. Thank you. The gentleman from Kentucky is now
recognized for 5 minutes.
Mr. Guthrie. Thank you, Mr. Chairman. Thank you for being
here. And, Ms. Scurry, thank you for being here. That, quite
honestly, might have been the only soccer game I have ever
watched from top to finish. It was----
Ms. Scurry. Thanks a lot.
Mr. Guthrie [continuing]. About the time that my daughter
was interested in soccer, so we were watching it----
Mr. Terry. No pun intended with the top.
Mr. Guthrie. Top to--OK, no pun intended. That went over my
head, I am sorry.
But what a great sporting event, and it is one of the great
moments, and to be part of that is something special. And I
think it was special because it was just so much America. It
was youthful, you were underdogs, you were grit, determined,
and you brought up Brandi Chastain, not I, and maybe a little
exuberance, but it was a great moment, and I appreciate you
doing that and sharing.
But I played high school football. That is my claim to
athletic prowess, I guess, but we practiced in August. I
remember one time, in the south, 90-something degrees, and we
are all running water breaks, we run to the water break and
some smart aleck kicks another guy's foot so he falls, knocks
all the water over. So the coach says, well, if you guys don't
know how to handle that, we are just not going to have water
today. So that was over 30 years ago, and that would never
happen anywhere today. There was actually in Louisville a young
man who passed away on a football field, and the coach went to
trial over it, and turned out he wasn't convicted but--so I
think the awareness and, you know, stuff like what I described
in my youth would never happen on a football field anywhere
today, or at least I hope it wouldn't, but we still have these
injuries. And I think, Ms. Scurry, you talked about your injury
being--it wasn't heading, it wasn't changing tactics, it was
just--in soccer you are wearing cleats and short pants and a
shirt, and somebody hits you in the side of the head with their
knee----
Ms. Scurry. Right.
Mr. Guthrie [continuing]. And when you look at, I watch a
lot of football, of course, then they will have targeting, you
know, if you are in college football, you are ejected from the
game for targeting. But a lot of the injuries you will see, if
the quarterback gets knocked down and somebody runs and their
knee hits them on the side of the head. And I don't know how
you change those--and how do you deal with that kind of--I know
you are trying to do the techniques and tackling and not
heading the ball the right way, but just the incidental things
that happen because you are playing a sport that you are going
100 miles an hour. Do you have any comments on that, Ms.
Scurry?
Ms. Scurry. Yes, well, thanks for the question.
That is very relevant, actually, because my hit, when I
watched it actually last night again on video, it doesn't seem
to be a hit that would have taken me out of the game. As it
was, I got hit and then there were a few minutes later before I
actually ended up coming out.
Mr. Guthrie. Wow.
Ms. Scurry. There wasn't even a foul called, actually. So
that is part of the problem, right? Sometimes a hit is a
glancing blow, and it doesn't even really seem to be anything
that is a big deal, but I think for me, my main focus is what
is done after a hit occurs. And to keep children and young
players off the pitch after a blow occurs to assess them, and
then determine whether they are ready to go return to play or
not. I think that is the key for me and why I am speaking out
about this, because I have been around the country talking to
different organizations, and I am finding that kids are getting
concussions, five, six, seven, in a very short period of time,
because they are returning to play too soon, and that is where
I think a lot of the awareness and education can help.
Mr. Guthrie. Well, thank you.
And, Mr. Miller, with that, you should do everything you
can to stop the head-to-head and so forth, but it seems,
because they will play them on TV over and over--this is when
somebody gets injured and they are out, like a knee of the
lineman hits, somebody like Jon Runyan hits the side of
somebody else's head--I mean, it is just incidental, but I
guess you are right, you can't really prevent that from
happening, but it is how you react to how that happens. Is
that----
Mr. Miller. Well, I think that is right. One of the
recommendations made by the Fourth International Concussion
Conference in Zurich was to look at the playing rules of the
game. And in our case, we have done that, and I know other
sports have done that as well, so you create the best possible
situation.
Mr. Guthrie. Um-hum.
Mr. Miller. In a contact sport, there will be injuries, and
there will be, you know, hits to the head, and those problems
will occur. And so where that happens, we want to make sure
that we are treating them appropriately, and so that is where
the focus shifts from prevention to appropriate treatment.
Mr. Guthrie. Well, thank you. And I am about out of time. I
just want to say, Ms. Scurry, I was sitting on the edge of the
couch, leaning and moving as they were shooting against you,
and hopefully you felt my assistance and were able to help us
both together win one for our team, right?
Ms. Scurry. Absolutely.
Mr. Guthrie. Thank you very much. And I yield back, Mr.
Chairman. Very good job and I am glad to meet you.
Ms. Scurry. Thank you. You too.
Mr. Terry. Thank you, Mr. Guthrie. Now the gentleman from
Maryland is recognized for 5 minutes.
Mr. Sarbanes. Thank you, Mr. Chairman, and thanks for the
hearing, and thanks to our panel.
Mr. Hallenbeck, I had a quick question about whether the
school districts that you have been working with that have been
implementing this, has that affected the like liability
policies that they maintain as a jurisdiction? In other words,
is there any trend towards they may be getting pushed by the
insurance industry, for example? So in other words, insurer
would say, well, previously, I would have provided liability
coverage to your school district based on these measures or
assurances that the district mad with respect to how it is
conducting its sports program, but now that there is this
program that enhances the safety of students and young people,
we want to see that you have implemented that in your district
or else we are not going to provide the policy coverage, or we
are going to charge you a higher premium. I mean you can look
at it the other way. You get a discount off of your premium as
a school district because you have implemented these kinds of
measures. And I ask that because I think that increased
awareness of some of the risks from these sports injuries may
lead to pressure in terms of liability on school districts. And
you will get some that may choose, based on the premium that
gets charged, to push the program out because they don't want
the liability that comes with it.
So I was just curious whether you are aware of that kind of
effect from the program, or more generally aware of kind of how
the liability concerns intersect with some of these safety
efforts that are underway.
Mr. Hallenbeck. Thank you for the question.
At the high school level, we are literally on the front,
you know, one-yard line marching down the field. And I will
mention that we are having very positive conversations with the
State of Maryland right now about participating in Heads Up
Football across the entire State.
So we have a lot to do there. We have not seen anything
from a liability concern, insurance concern. With Fairfax
County, we worked very closely with all their schools and their
school district about those issues, but they told us, and we
checked ourselves, they felt they had the appropriate coverage.
However, to your point, at the youth level, we are absolutely
seeing the insurance industry at large, and really the largest
provider of casualty and liability insurance, step forward and
actually stated that if youth football leagues participate in
the Heads Up Football program, they would receive a discounted
program, and a more comprehensive coverage. So we are
absolutely seeing a positive response by the insurance
industry, which, of course, has its merits.
Mr. Sarbanes. Thank you. I yield back.
Mr. Terry. Mr. Ogrean, are there any insurance liability
issues at USA Hockey?
Mr. Ogrean. Yes, Mr. Chairman, there are plenty of
insurance liabilities, and I think unlike USA Football, for
example, which is much more decentralized than are we, our
participants are all insured by us as a national organization.
So whether it is player accident insurance or whether it is
catastrophic insurance, whether it is liability and even D and
O for all of our leagues, all of that is part of what our
members pay us a membership fee for.
Those claims, or those premiums, rather, are obviously
based upon the number of claims. And so that is another
business reason why it is in all of our best interests to try
to come up with every technique, every practice, every policy
that we possibly can to make our game safer. The number one
reason, of course, is the safety of the human beings playing
our sport, but there are good business reasons for all of us to
want to do everything possible to make the game safer.
Mr. Terry. Thank you.
Mr. Kinzinger, you are recognized for 5 minutes.
Mr. Kinzinger. Thank you, Mr. Chairman. Thank you for your
leadership in holding this hearing, and to all of you, thank
you for being here and bearing through a bunch of politicians.
I appreciate it.
I appreciate the diverse panel that has gathered here, and
the important insights you guys are able to provide on the
prevalence of concussions in sports.
According to the CDC, 175,000 sports-related concussions
impact youth athletes each year, and I think today's hearing
has been very constructive in helping us to move forward on
understanding that and alleviating it.
I have read much about the legislative action taken across
the United States to pass concussion laws. In my home State of
Illinois, similar legislation was passed in 2011 to require
that education boards throughout the State work with the
Illinois High School Association to adopt guidelines that raise
awareness of concussion symptoms, and ensure students receive
proper treatment before returning to the team. In addition, it
is encouraging that professional sports leagues and teams are
taking steps to address concussions not only in their own
ranks, but also working with collages and youth leagues to
bring attention to the issue.
Last year, the Chicago Bears--go Bears--kicked off a pilot
program to provide certified athletic trainers at three high
school stadiums during Chicago public school football games.
Such high profile initiatives are important to combatting this
issue, and I applaud the Chicago Bears for their leadership.
Again, I find these steps to be promising, but we are still
confronted with staggering numbers of youth being impacted by
sports-related concussions.
I would like to ask just a few questions, maybe not take
all 5 minutes, maybe I will.
Let us talk about the equipment issue. I will ask each of
you to respond.
Where are we at today in terms of what kind of equipment is
being utilized to protect, versus maybe where we were a few
years ago, what kind of advances are yet to be made that you
think we are on the cusp of making or that we should make, and
then is this backed by medical science? Is that what is going
into this idea?
So, Mr. Daly, I will start with you and I guess whatever
you want to put into that subject would be great.
Mr. Daly. Well, thank you for the question.
It is a very important issue, obviously. The equipment
issue is a very important issue, and something we are focused
on jointly with our Players' Association. We have a protective
equipment subcommittee that is part of our Joint Health and
Safety Committee. So we look at all aspects of equipment and,
particularly as it relates to head injuries, how we can improve
equipment, and perhaps reduce the amount of head injuries we
have. We have passed some rules over time with respect to some
of the equipment we had seen develop over the years with hard
padding, both in the shoulder area and the elbow area, and
those potentially causing head injuries. So we have mandated
padding of those areas areas of a player's equipment.
The helmet issue is a difficult issue, particularly in
hockey, in terms of preventing concussion, and one of the
things we are looking to work with our manufacturers on is
research in terms of dealing with the rotational forces that
can cause concussions, particularly in a sport like hockey, and
whether a helmet can be designed to deal with those more
effectively than it currently does.
Mr. Kinzinger. Thank you, sir.
Mr. Ogrean?
Mr. Ogrean. I think Mr. Daly answered the question pretty
well for our sport. There is a great deal where we rely on the
National Hockey League to be the leader, and a lot of what they
do is of benefit to us in a trickle-down fashion, but as I
mentioned in my opening testimony, we do have a Safety and
Protective Equipment Committee of 40-year standing. They do
look at a variety of issues. The facemask, for example, is
something that is mandatory----
Mr. Kinzinger. OK.
Mr. Ogrean [continuing]. In youth hockey. It is not in the
National Hockey League, though the shields for incoming players
are now a standard.
Mr. Kinzinger. I am going to have to cut you off just
because of time. Mr. Miller?
Ms. Ogrean. That will be fine.
Mr. Miller. Sure. Football helmets were designed to prevent
against skull fractures, and they do a fabulous job of that.
They were not designed to protect against concussion, and so
that sort of technology or design, I know that the helmet
manufacturers are working on it. We are not there yet, and the
league is doing what it can to inspire that, especially with
our partnership with GE and Under Armour, to get new ideas
around that. And the other thing we do is we do regular helmet
testing in concert with our friends at the Players Association,
so that we can inform our players of which helmets are working
best.
Mr. Kinzinger. And, Mr. Hallenbeck, or, Ms. Scurry, you
guys?
Mr. Hallenbeck. Yes, trickle-down effect, again, is
important there, and the only thing I would add is we are
working now closely with the Sport and Fitness Industry
Association and their new Football Council, so we are getting
insight from them, and working together on how we can improve
things.
Mr. Kinzinger. Thanks. And, Ms. Scurry?
Ms. Scurry. As you know, we don't wear equipment in our----
Mr. Kinzinger. Right.
Ms. Scurry [continuing]. Sport, but I do want to commend
your State for their Illinois Youth Soccer Association is
taking a real lead in concussion awareness. I actually just did
an event in Chicago just last weekend----
Mr. Kinzinger. OK.
Ms. Scurry [continuing]. For the association, and talking
about concussions. And so your organization is doing a great
job.
But in terms of equipment for my sport, we don't really
have anything right now that is widely used, but hopefully in
the future there could be something to help.
Mr. Kinzinger. Great. Thank you. Mr. Chairman, I will yield
back.
Mr. Terry. Gentleman from West Virginia is recognized for
your 5 minutes.
Mr. McKinley. Thank you, Mr. Chairman. I had to slip out
for another meeting, so maybe some of these questions have been
asked, but if you could help me out on this a little bit, one
is: Is there anything that we can learn from the Defense
Department with concussion injuries that we are hearing from
when we talk to our troops that come back? I am just wondering
if there is some way that we are all talking to each other? If
you could help out on that.
Mr. Miller?
Mr. Miller. Yes, I am happy to take that question. We are
very proud of our relationship that we have fostered over the
last couple of years with the U.S. Army and specific memorandum
of understanding that went back a couple of years that covers a
variety of different things.
We have gotten current and retired players together with
returning active service members to talk about cultural issues.
What is it about football or what is it about the military that
makes it very difficult for somebody to remove themselves from
play, or, certainly in the case of the military, from a battle.
We found a great deal of reticence on behalf of both
populations, sort of a shared reticence to remove themselves
from their comrades or teammates. And it instills a question as
to how you get somebody to talk about, to tell their teammate
or to tell their colleague, hey, you don't look right, you
should get off the field. And so we have learned a lot from
that.
And let me just add briefly as well, we meet regularly with
the Army to talk about the research that they are doing from a
scientific perspective. We share our agenda, we share the ideas
that we have, and they do with us as well, and it has proven to
be a very cooperative and beneficial relationship thus far.
Mr. McKinley. OK. Anyone else want to add to that, about
our military?
The second question has to do with, States have Workers'
Compensation programs to deal with the various disorders and
injuries. Black lung in my State, it is treated in a way that
people don't have to take legal action to get help through the
Workers' Comp program. Is that something that would be of
benefit here in this program for injuries? A friend of mine has
spent quite a few years in litigation with the NFL over this
matter and just thinks it is such a cumbersome--and we also
have an East Coast Hockey League team in our city, and we see
so many injuries, and we hear from some of the players and
coaches about that injury. Is there a time that we should have
a Workers' Comp program for brain injuries? Should that be
included in something?
Ms. Scurry. If I----
Mr. McKinley. If they are not required to file litigation
to get help.
Ms. Scurry. If I may. My case actually is a Workers' Comp
case. I have gone through Workers' Comp to get the different
doctors, to see different techniques that will help me, and
that is part of my situation and part of the reason why it has
taken so long because every time something is suggested or
recommended, I have to go back to the insurance company to get
permission to do it, and sometimes it takes a hearing to get
everything moved forward. So maybe streamlining that somehow
would be of great help.
And also in your previous question you talked about how can
we help the military service people who have TBIs. For me, one
of the best things I think would help is more of the
psychological side and testing depression and anxiety and panic
attacks to make sure that each person who comes back from the
military who has a TBI gets help in that area, the emotional
side of it, not just the physical. That would be very helpful,
I think.
Mr. McKinley. OK, thank you. Any other thoughts?
Mr. Daly. Well, Workers' Compensation laws are really
different jurisdiction by jurisdiction, including for us in
Canada where professional athletes are specifically excluded in
most Workers' Compensation law, but it is certainly a mechanism
that an increasing number of our former athletes are using in
cases where they have debilitating injuries from their playing
careers.
Mr. McKinley. So what was your recommendation then? You are
saying yes?
Mr. Daly. Well, again, I----
Mr. McKinley [continuing]. We should be pursuing looking at
that, or----
Mr. Daly [continuing]. I guess what I would say is, I think
it is generally available to our former athletes currently, the
Workers' Compensation protection.
Mr. McKinley. I guess maybe that some of what we are
hearing is different from that, that is why I want to raise it,
but thank you for your comments about that.
I yield back the balance of my time.
Mr. Terry. Gentleman yields back. Now Mr. Bilirakis from
Florida, you are recognized for 5 minutes.
Mr. Bilirakis. Thank you, Mr. Chairman. I appreciate it
very much. Thank you very much for holding this very important
hearing, and I wanted to specifically thank Ms. Scurry for
really speaking out. I really appreciate it. It makes so much
of a difference, and thanks for your sacrifices. You are going
to make a real difference in kids' lives.
I also want to get back to the protective gear, the
helmets, what have you. And how does the youth, and we can ask
all of you, how does the youth helmet, the protective gear,
compare as far as safety, quality, to the NFL and NHL? Can you
give me an opinion on that?
Mr. Hallenbeck. So I am certainly no expert on exactly how
that compares, other than--I mean, my understanding is that
there obviously is NOCSAE, the standard bearer, and they set
the standards, and certainly all the helmets out there have to
pass that standard, and I think the manufacturer, if they were
sitting here, would say they go above and beyond that. How it
compares to an NFL helmet, I think generally speaking, the
youth helmet is lighter but the padding and so forth is
appropriate. I don't want to suggest I am defending them. I
don't know the exact details. I know it is sufficient based on
standards and so forth. Many of the kids, though, I mean the
players, youth players, I mean by 10 and 11 and 12 years old,
they are transitioning into what might be considered, you know,
certainly high school or adult helmets, so they are getting the
best available.
And the other thing I would add is, certainly I am aware
that the technology is improving in helmets and shoulder pads,
and football equipment generally is definitely improving.
Mr. Bilirakis. Mr. Miller?
Mr. Miller. Sure. We worked on a program with the Consumer
Product Safety Commission, our Players Association, and some
others recently that we would put money towards reconditioning
older helmets for youth leagues. Certainly, the leagues that
have, you know, budget constraints, as many do, probably don't
get around to updating their helmets or what they call
reconditioning them frequently enough. And so we put a fair
amount of money into that program in coordination with the
CPSE. I know Scott, USA Football runs an equipment grant
program as well. So, addressing those needs. We know that a new
helmet is better than an old helmet. We know a reconditioned
helmet is better than one that hasn't been. Most important of
all is that coaches learn how to fit the helmets. That is going
to be the number one safety piece to the equation as it relates
to kids. And so we are aware of these issues and we are trying
to make a difference there as well.
Mr. Bilirakis. So, in your opinion, the youth helmet or the
high school helmet is not as safe as the NFL, but you do have a
program to help. Is that correct?
Mr. Miller. Yes. I don't know about the----
Mr. Bilirakis. The quality might not be as good.
Mr. Miller. I don't know about the comparative safety of
the helmets.
Mr. Bilirakis. OK.
Mr. Miller. I suppose that is probably a question that----
Mr. Bilirakis. Can I talk to you about this----
Mr. Miller. Of course.
Mr. Bilirakis [continuing]. Particular program----
Mr. Miller. No question.
Mr. Bilirakis [continuing]. To help out, because I know for
parents where the kids play high school football, and the
parent will purchase a better quality helmet for their child,
and, you know, I am concerned about the kids that don't have
the, you know, the parents don't have the money, you know, to
purchase that, and it is so very important. So I would
appreciate working----
Mr. Miller. Happy to.
Mr. Bilirakis [continuing]. With you on this.
Mr. Miller. Every kid deserves the proper equipment.
Mr. Bilirakis. There is an existing grant program out
there. I would like to hear about it. And then also, can I hear
from the hockey as well----
Mr. Ogrean. Sure.
Mr. Bilirakis [continuing]. NHL?
Mr. Ogrean. At the youth level, I think the helmets are
just as good as the National Hockey League, the only difference
is size. They have to be certified by the Hockey Equipment
Certification Council. There is a 3-year expiration date on
every helmet. You can't use a helmet that is more than 3 years
old.
Mr. Bilirakis. Very good. NHL wants to----
Mr. Daly. Yes. No, I would first echo Mr. Miller's comments
that, you know, helmets in our sport as well are principally
designed to prevent skull fractures. They're not principally
designed to prevent concussions, and sometimes they can
disperse force in a way that does prevent concussion but that
is not their principle purpose. We also have regulations that
we make available to our equipment managers and our players
with respect to frequent replacing of helmets. So each player
is essentially asked to replace his home helmet at least once a
season, and his road team helmet at least two times a season,
because we are worried about aging effects and degradation that
accompanies travel requirements for our team. So frequent
replacing of helmets is a priority for our league as well.
Mr. Bilirakis. Are their coaches educated? I mean do they
know which size fits the child? Have they been briefed on those
particular issues, because that is so very important? Youth
sports, hockey and football.
Mr. Ogrean. They are. I agree with Mr. Miller that it is a
big difference-maker, you know, in the helmet doing its job,
but it is a pretty fundamental part of what a coach has to do
to make sure the players on his team all have the proper
equipment and are wearing it in the right way.
Mr. Bilirakis. Very good, yes. Sir, would you----
Mr. Hallenbeck. And I would just add----
Mr. Bilirakis [continuing]. Like to comment?
Mr. Hallenbeck. Yes. I would just add that it is a
cornerstone of our Heads Up Football program----
Mr. Bilirakis. Very good.
Mr. Hallenbeck [continuing]. Equipment fitting, because,
frankly, at the youth and high school level, we have found they
don't know how to properly fit equipment, so it is a very
important element within the program.
Mr. Bilirakis. Thank you very much for including that. As
far as, you know, the youth, of course, the NFL Hockey stars,
what have you, baseball, basketball, they are looked up to by
our children, as you know. Do you all have programs where you
can speak--that speak, you know, maybe go to the schools,
football players, what have you, professional football players,
go to the schools and speak on these particular issues?
Mr. Miller. Yes, our active players are, by and large,
terrific at this topic. One of the elements that we included or
offered up to USA Football as part of their Heads Up Football
program was actually what we call an ambassador. So for leagues
that were early adopters of the program, they would get visits
and consultation with a retired NFL player.
We are trying to encourage our clubs, with great success by
the way, they have really done a terrific job of embracing in
their communities the youth leagues and others, and so that
they are around the facility more, that they interact with
coaches, trainers, and certainly players, which obviously
bring--the star quality of it brings attention to it, which was
part of the motivation in the first place. But we have found
retired players thrilled to participate, and really active and
helpful to the end that you suggest.
Mr. Terry. All right, gentleman's time has expired.
Mr. Bilirakis. Thank you.
Mr. Terry. So if any of you want to answer that question,
you will have to do it by writing.
And brings me to the point that--you have a question, I am
sorry. Recognize the gentlelady from Virgin Islands.
Mrs. Christensen. Thank you. And thank you, Mr. Chairman.
Sorry I am late, I was at another hearing downstairs.
Mr. Miller, I would like to ask you this question. Many
tens of thousands of helmets are used every year that are more
than 10 years old. I understand that the NFL participated in a
program initiated by the Consumer Product Safety Commission by
donating money that would go towards new helmets for youth
football players in low income communities, and I really want
to commend the NFL for this initiative.
Of course, it is going to cost a lot more money to get to
the point where virtually all kids around the country who play
football no longer wear old helmets that are likely degraded or
obsolete. I am pleased to know of your donation to the CPSC
initiative, because it strikes me as an acknowledgement that
wearing an old helmet when playing football is not advisable. A
statement from the NFL that would be very influential. We have
also heard that reconditioning those under 10 years old is
important to ensure the proper foam density, and that other
degraded parts of the helmet are replaced.
So I wanted to ask you the following questions for a yes-
or-no answer. I guess that is why I am sitting in Chairman
Dingell's seat. We realize that many issues are subject to
negotiations, but can the NFL commit to supporting prohibiting
helmets on the field that are over 10 years old?
Mr. Miller. In the youth space? You are talking
specifically about youth football, prohibiting helmets that
are----
Mrs. Christensen. Yes.
Mr. Miller [continuing]. Older than 10 years there? I, you
know, I plead not enough familiarity with the issue. I know
that there are a couple of States who have taken that step, and
we would be happy to work with you to pursue it. The prime
place that, as you mentioned, that we work within in promoting
new or refurbished----
Mrs. Christensen. Well----
Mr. Miller [continuing]. Helmets is with the CPSC or
through USA Football, who has a grant program as well, but----
Mrs. Christensen. So the first question is committing to
supporting prohibiting helmets on the field that are over 10
years old. Could you commit to the supporting of policy
position that helmets more than 10 years old present an
unacceptable safety risk? That is the position that is taken by
most of the helmet industry.
Mr. Miller. If that is the position of the helmet industry,
I would see no reason why we would have a concern with that.
That sounds appropriate.
Mrs. Christensen. Riddell and Adams strongly recommend that
their helmets should be discarded after 10 years. Can the NFL
commit to supporting a policy position recommending that
helmets be discarded after 10 years?
Mr. Miller. We would certainly support the helmet companies
and how they advise people to use their products.
Mrs. Christensen. We have also heard stories of players
using beat-up lucky college helmets, or adjusting their helmets
by perhaps removing some padding in the helmets for comfort.
Will the NFL commit to support a policy position that all
players should wear helmets that are reconditioned properly?
Mr. Miller. Well, all of our players have choices in which
helmets they use, as long as they pass the NOCSAE, the
certification by these standards. And so that is something that
is a point of discussion with our Players Association, and
players have to use helmets that pass the standard. So I----
Mrs. Christensen. And that means----
Mr. Miller [continuing]. We are happy to support that.
Mrs. Christensen [continuing]. That they were reconditioned
properly, and they had the appropriate padding?
Mr. Miller. Sure. The NFL players' helmets are
reconditioned regularly, is my understanding, and our equipment
managers work with the players to make sure that their helmets
are in good working order.
Mrs. Christensen. Thank you, Mr. Chairman.
Mr. Terry. Thank you very much.
[Recess.]
Mr. Terry. All right, why don't we have our witnesses take
their respective places? OK, if we could have everybody take
their seats. And as you are settling in, this is, pun intended,
the more heady part of our hearing today where we are dealing
with neuroscience and medical research and physics--well,
physics when Dr. Gay arrives.
So panel two, I will introduce you from Mr. Cleland on
down. Mr. Cleland is the Assistant Director, Division of
Advertising Practices at the Federal Trade Commission. We have
Ian Heaton, Student Ambassador for the National Council on
Youth Sports Safety. And if I might editorialize, I think Jan
did a great job of juxtaposing a face of TBI and concussions on
each panel. And Ian, as a high school lacrosse player, is that
face for the more scientific-based panel. So thank you, Ian,
for taking your day away from school. I know how tough it is to
be pulled out of school and come testify before Congress. Just
like a normal high school student. Then Dr. Robert Graham,
Chair, Committee on Sports-Related Concussion in Youth at the
Institute of Medicine. Dennis Molfese, Ph.D., Director, Center
for Brain, Biology, and Behavior at the famed University of
Nebraska. Thank you, Doctor. Then Dr. James Johnston, Assistant
Professor, Department of Neurosurgery at the University of
Alabama Birmingham. Star of screen, Dr. Tim Gay, Ph.D.,
Professor Atomic, Molecular and Optical Physics, University of
Nebraska. Gerard Gioia, Ph.D., Division of Chief
Neuropsychology, Children's Medical Hospital. And not quite up
to the level of University of Nebraska, we have the Harvard
Medical School. That is just humor. Professor of----
Voice. Ha ha.
Mr. Terry. Yes. Professor of Psychiatry and Radiology at
Brigham and Women's Hospital, Harvard Medical School. Thank you
for being here for a very impressive and esteemed panel of
scientists and experts.
And, Mr. Cleland, we will start. You are now recognized for
your 5 minutes.
STATEMENTS OF RICHARD CLELAND, ASSISTANT DIRECTOR, DIVISION OF
ADVERTISING PRACTICES, BUREAU OF CONSUMER PROTECTION, FEDERAL
TRADE COMMISSION; IAN HEATON, STUDENT AMBASSADOR, NATIONAL
COUNCIL ON YOUTH SPORTS SAFETY; ROBERT GRAHAM, DIRECTOR,
ALIGNING FORCES FOR QUALITY, NATIONAL PROGRAM OFFICE, GEORGE
WASHINGTON UNIVERSITY; DENNIS L. MOLFESE, DIRECTOR, BIG 10-CIC-
IVY LEAGUE TRAUMATIC BRAIN INJURY RESEARCH COLLABORATION; JAMES
JOHNSTON, ASSISTANT PROFESSOR, DEPARTMENT OF NEUROSURGERY,
UNIVERSITY OF ALABAMA-BIRMINGHAM; TIMOTHY J. GAY, PROFESSOR,
DEPARTMENT OF PHYSICS AND ASTRONOMY, UNIVERSITY OF NEBRASKA-
LINCOLN; GERARD A. GIOIA, CHIEF, DIVISION OF PEDIATRIC
NEUROPSYCHOLOGY, CHILDREN'S NATIONAL HEALTH SYSTEM; AND MARTHA
E. SHENTON, PROFESSOR OF PSYCHIATRY AND RADIOLOGY, BRIGHAM AND
WOMEN'S HOSPITAL, HARVARD MEDICAL SCHOOL
STATEMENT OF RICHARD CLELAND
Mr. Cleland. I am Richard Cleland. I am assistant director
for the Division of Advertising Practices at the Federal Trade
Commission's Bureau of Consumer Protection. I am pleased to
have this opportunity to provide information about the actions
we have taken over the past few years with respect to
concussion protection claims; claims that implicate serious
health concerns, especially those potentially affecting
children and young adults are always a high priority at the
Commission.
The Commission strives to protect consumers using a variety
of means. First and foremost, the Agency enforces Section 5 of
the Federal Trade Commission Act, which prohibits deceptive and
unfair acts or practices. In interpreting Section 5, the
Commission has determined that a representation, omission or
practice is deceptive if it is likely to mislead a consumer
acting reasonably under the circumstances, and it is material
that it is likely to affect the consumer's conduct or choice
decision about a particular product at issue.
The Commission does not test products for safety and and
efficacy; it does, however, require that an advertiser have a
reasonable basis for objective claims conveyed in an ad. The
Commission examines specific facts of the case to determine the
type of evidence that will be sufficient to support a claim.
However, when the claims involve health and safety, the
advertiser generally must have competent and reliable
scientific evidence substantiating that claim.
As awareness of the dangers of concussion has grown,
sporting goods manufacturers have begun making concussion
protection claims for an increasing array of products. These
include football helmets and mouth guards, but also include
other types of products.
In August 2012, the Commission announced a settlement with
the makers of Brain Pad mouth guards. The Commission's
complaint alleged that Brain Pad lacked a reasonable basis for
its claims that the mouth guards reduced the risk of
concussions, particularly those caused by lower jaw impacts,
and falsely claimed that scientific evidence proved that the
mouth guards did so. The final Order in that case prohibits
Brain Pad from representing that any mouth guard or other
equipment designed to protect the brain from injury will reduce
the risk of concussions, unless the claim is true and
substantiated by competent and reliable scientific evidence. In
addition, the Commission sent out warning letters to nearly 20
other manufacturers of sports equipment, advising them of the
Brain Pad settlement, and warning them that they might be
making deceptive concussion claims about their products.
The FDC has monitored these Web sites and is working with
them as necessary to modify their claims on their sites, and in
some cases, ensure that the necessary disclosures are clear and
prominent. Commission staff continues to survey the marketplace
for concussion reduction claims, and alert advertisers who are
making potentially problematic claims of our concerns, and of
the need for appropriate substantiation for such claims.
Commission staff also investigated concussion reduction
claims made by three major manufacturers of football helmets;
Riddell Sports, Incorporated, Schutt Sport, Incorporated, and
Xenith, LLC. In these matters, the staff determined to close
the investigations without taking formal action, by which time
all three companies had discontinued the potentially deceptive
claims or had agreed to do so. Those cases are discussed in
greater detail in the Commission's written testimony.
The Commission plans to continue monitoring the market for
products making these claims, to ensure that advertisers do not
mislead consumers about the product's capabilities or the
science underlying them. At the same time, we are mindful of
the need to tread carefully so as to avoid inadvertently
chilling research, or impeding the development of new
technologies and products that truly provide concussion
protection.
The Commission appreciates the committee's interest in this
very important area, as well as the opportunity to discuss our
Agency' effort to ensure that the information being provided to
consumers, in particular, to the parents of youth athletes, is
truthful and not misleading.
Thank you.
[The prepared statement of Mr. Cleland follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Terry. Thank you. Now, Ian, you are now recognized for
your 5 minutes.
STATEMENT OF IAN HEATON
Mr. Heaton. Chairman Terry, Ranking Member Schakowsky, and
members of the subcommittee, thank you for the opportunity to
share my story today.
My name is Ian Heaton, and I am here as a student
ambassador for the National Council on Youth Sports Safety. I
am also a senior at Bethesda Chevy Chase High School in
Bethesda, Maryland.
I was a sophomore playing in a high school off-season
lacrosse game when I sustained a serious head injury that we
later discovered was my third concussion. Until then, I did not
appreciate what a great life I was living. I got good grades in
challenging classes, played high school lacrosse, was working
on my second degree black belt in martial arts, had a job I
loved teaching taekwondo, performed at my school's jazz
ensemble and combo, and had an active social life. It was over
in a split second.
My concussion left me with only 5 percent of normal
cognitive activity, and I was almost immobilized.
I have spent 2 \1/2\ years recovering, and, at times, have
even wondered if I would ever get that life back. It has been a
long, slow process.
At first, all I wanted to do is sleep. Noise, light, and
even moving my eyes caused headaches and nausea. I was enrolled
in the Children's Hospital SCORE Program that Dr. Gioia will
describe later, where I received ongoing cognitive evaluation
and treatment for symptoms.
After missing school for 2 weeks, I tried to go back but
was unable to function. The frustration of trying to focus on
lectures, moving through the pandemonium of the halls, and the
constant sensory bombardment made a normal school day
impossible. However, through my school, I eventually enrolled
in a home teaching program, and with the help of my tutors and
family, was able to complete my semester coursework at my own
pace. I finally returned to school in December but was still
far from recovered.
I have spent the 2 \1/2\ years since my concussion slowly
regaining organizational skills, the ability to learn and
retain information, and, most important, my personality. During
this time, my friends and family learned to recognize the signs
that meant I needed to shut down from any kind of mental or
physical activity for a day or two. These relapses were
particularly tough and discouraging, and meant that I had to
drop a class and miss a band trip to Chicago, among other
things. The worst was when I had a crash and could not go to my
first concert, the Red Hot Chili Peppers. The friend I gave my
ticket to really owes me.
The spring after my injury, I was medically cleared to
return to sports, but made the hard decision that I would not
play lacrosse or other intensive sports again. I know that a
lot of people recover and return to play, but the possibility
of another concussion means I could lose everything again, just
like that, and not come back the next time.
I now look at my recovery as something that has made me
stronger, but I know that I am one of the very lucky ones who
had the resources and medical attention I needed, and a school
system that is aware of concussion issues and provided an
unusually high level of support.
It is not over yet. My recovery continues, but my outlook
is positive and I am excited about the future as I prepare for
college. I am thinking about becoming a high school math or
science teacher.
I now have a hard question. What can be done to create a
safer sports environment, and to ensure that when injuries do
occur, the support for a full recovery is available? We can't
just do away with youth sports. I have played baseball, travel
soccer, and league and high school lacrosse, and being on those
teams not only gave me a healthy outlook, it taught me
important lessons.
Sports are one of the best parts of growing up and becoming
a strong adult. They teach us that if we work hard, we will
become skilled and proud of our accomplishments. They teach us
how to be part of a team, to have pride and success, and learn
the lessons of defeat. They teach us that sometimes we have to
quit thinking of ourselves and think of the good of the team.
For these and many other reasons, I hope that steps can be
taken so that future young athletes have these opportunities.
There are two important things I think would make a big
difference. The first is to change the cultures of hitting hard
to take out a good opponent, rather than playing to win through
skill, and brushing off injuries to get back into the game.
While better equipment may decrease injuries, it is coaches,
parents and players who have to back away from the need to win
at all costs, or fear the losing status on the team when out
for an injury, to be willing to recover fully before returning
to play. It will take a while, but if youth and professional
sports are to survive, these attitudes must be embraced.
Second, when injuries do occur, we must have a way for
qualified personnel to quickly assess injuries on the field,
have players get immediate attention, and then support recovery
through schools and medical institutions. These are the things
that were done for me, and are the reason I have been able to
return to normal.
As a student ambassador for the NCYSS, the message I hope
to give young athletes is this. You think you are invulnerable.
You take risks and brush off injuries because you think you
will recover quickly from anything happens. You won't. Don't be
a hero, especially when it comes to your head. It is the only
brain you will have, and your personality is who you are. It is
not worth a couple of seasons of glory to lose the opportunity
of a lifetime.
Thank you.
[The prepared statement of Mr. Heaton follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Terry. Very good. Dr. Graham, you are recognized for 5
minutes.
STATEMENT OF ROBERT GRAHAM
Mr. Graham. Thank you very much, Chairman Terry, Ranking
Member Schakowsky.
My name is Bob Graham. I served as the chair of the
Institute of Medicine, Sports-Related Concussions in Youth
Study. As you have my testimony before you, and I think copies
of the study itself, I will just try to take these minutes just
to give you a summary.
The Institute of Medicine is part of the National Academy
of Sciences, which is chartered by the Congress to provide
advice to the Congress and to the Executive on various
scientific issues. We were specifically empaneled to look at
the evidence about the causes and consequences of concussion in
youth and military, the state of concussion diagnosis and
management, the role of protective equipment, and sports
regulation.
We had 17 members on our committed. We worked in 2013. Dr.
Molfese, who will follow me, was a member of that committee,
and we came with just six recommendations. The first was that
the CDC needed to establish a better mechanism for national
surveillance to comprehensively capture the incidents of
concussions. You have heard a number of figures this morning
about the concussions in one sport or another. We know what the
incidence is where they are measured. We do not know what the
incidence is in sports where they are not measured, or where
they are not more closely watched. We need to have that
baseline to really know the degree to which we have a problem,
and as we take corrective measures, the success rate that we
are having in making an impact on decreasing the incidence of
concussions.
So, number one, we need better surveillance, we need better
epidemeality. Number two, a couple of recommendations related
to research. We need the NIH and the DOD to look more
specifically at what metrics and markers are for concussions.
How do you assess the severity of a concussion, how do you find
diagnostically whether or not an individual has had a
concussion. Right now, it is largely based upon observation, on
self-report, but are there some physiologic markers that could
be used to give us better documentation that a concussion has
actually occurred, perhaps without the individual knowing it or
without it being observed. Secondly, we need the NIH and DOD to
look at more carefully and longitudinally at the short- and
long-term consequences of concussions. We have heard testimony
in this panel, the prior panel, individuals that have had one
or more concussions, what are the long-term sequella of an
individual or multiple concussions. That gives us some sense
about not only, again, the epidemiology of the problem that we
are dealing with, but what treatment and interventions may be,
and what rehabilitation may be.
Fourth recommendation was to the NCAA and the National
Federal of State and High School Associations to look at age-
appropriate techniques, and roles and playing standards. And
again, your first panel talked a little bit about that, mostly
at the professional level, but can you change the manner in
which the sport is practices, and the rules of engagement in
the sport that may decrease the risk of concussion. There was
one example from the hockey area where they had changed the
level where they allowed body checking, and felt that they saw
a decrease in concussion. We think that that same sort of
examination should take place at the college and the elementary
and high school level to see whether or not that can have the
same impact.
The fifth recommendation had to do with a better study of
what the role may be for protective equipment. And again, your
first panel talked a lot about that. The committee had a number
of questions about that. Our committee found that there was
very little evidence that helmets protect against concussions.
And there is a lot of data in that, and I think some of the
other panelists will be talking about that. You may come away
with an equivalence degree in physics this morning. It is a
complicated issue, but there are a number of suggestions. You
know, we certainly did not recommend you don't use helmets.
They do protect against bone injury and soft tissue injury, but
the suggestion that a helmet itself may decrease the incidence
of concussion, the evidence does not appear to be there to us,
and we think that the NIH and DOD, again, have a role in
looking more specifically at what we may be able to do related
to the biomechanical determinates and protection against
concussions.
And then our final recommendation had to do with the topic
which has come up frequently, and that is changing the culture
and the way concussions are viewed. This is a significant
injury. Athletes need to be encouraged to report, to take
themselves out of the game. Coaches and parents need to be
encouraged to say, for your own protection, you need to be
removed and give yourself a chance for recovery.
Thank you very much.
[The prepared statement of Mr. Graham follows:] \1\
---------------------------------------------------------------------------
\1\ The report ``Sports-Related Concussions in Youth: Improving the
Science, Changing the Culture'' and the accompanying slide presentation
have been retained in committee records and also are available at
http://docs.house.gov/Committee/Calendar/ByEvent.aspx?EventID=101897.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Terry. Thank you. And then, Dr. Molfese, you are
recognized for your 5 minutes.
STATEMENT OF DENNIS L. MOLFESE
Mr. Molfese. Thank you, Chairman Terry, Ranking Member
Schakowsky, and members of the subcommittee for this
opportunity.
If we could have the slides. Go to the next slide. Yes. So
I think the earlier group talked about a number of--if you can
go ahead and put that on Power Point--a number of sports where
the rate of concussion is particularly high. There are, of
course, differences in rates for men and women, and Dr. Gay
will talk about some of that in terms of weaknesses of women's
necks relative to men's necks and how that puts them perhaps at
more risk for concussion.
Next slide. Concussion accounts for, in the United States,
roughly about 75 percent of traumatic brain injuries. It is a
brain injury. There is damage to the brain. There is the
discussion about whether it is permanent or temporary. In the
military, the rate is 77 percent. So it turns out that youth
sports are a good model for also looking at concussion in terms
of the military. And, in fact, most of the military concussions
occur in situations most like they do with the rest of America.
Some certainly occur in theater, but majority occur outside of
theater in accidents like we all are sort of prone to
experience.
Next slide. If we look at brain injuries overall, there are
estimates--these are all estimates, of course, and they vary
across the literature, but we are looking at somewhere probably
in the neighborhood of about 4 million traumatic brain injuries
per year in the United States. Severing part of that is that
our birth rate in the United States is also roughly about 4
million. This does not count other ways that children are
exposed to head injuries. Perhaps a disciplining, irate parent
who slaps a child, that creates rotational movement that can,
in fact, produce a concussion. Those, one would suspect, are
largely unreported.
Recovery generally is fairly quick, usually within anywhere
from a few hours to a few days. Some will persist to 2 weeks,
even perhaps out to 6 weeks, but roughly about 20 percent seem
to persist beyond that time.
Next slide, please. This is a slide just on some data that
we have under review, but it will give you sort of a sense.
These are data recorded using brain electrical activity. So
basically, you have a net of 256 electrodes that fits on the
head in about 10 seconds or so. And we present a series, in
this case, a series of numbers. One number at a time. All the
college athletes had to do was simply say whether the number
they currently see matches or does not match a number that
occurred two positions earlier. And on the left side, those
orbits, those circles you see, the colored circles on the left
for match and non-match, those are imagines of the brain
electrical activity on the scalp recorded from those
electrodes, between 200 and 400 milliseconds. So 2 tenths to 4
tenths of a second after the number appears. So the schematic
on the right shows you the head position. So it is a very rapid
brain response. For those athletes who have no history of
concussion, we see a very clear difference in the electrical
activity for the match versus the mismatch. A lot of yellow and
green in the top left orb, and in the bottom we see red and
various shades of blue from the front of the head to the back
of the head. On the right though, these are individuals who
have a concussion history of 1 to 2 years earlier, not current,
and yet at 200 to 400 milliseconds, their brains cannot
discriminate whether those two numbers are the same or
different. They ultimately get these tasks correct, but it
takes them roughly 200 milliseconds longer. That is 20
synapses. So the processing speed is slow. And after 2 years,
one might suspect that is a permanent change.
The next slide, I think that--yes, so in terms of critical
scientific gaps, some of these we do what Dr. Graham talked
about, you know, how does concussion affect the brain in the
short and long term. We really don't have much information
about that. What is the dose requirement, Dr. Graham talked
about that, to produce a concussion, post-concussion syndrome,
CTE, how can we reliably, objectively detect when the brain is
injured, and when, importantly, it is fully recovered. We have
no ways to do that. Lots of individual differences from one
person to the next. We think there are genetic factors
involved, but there could also be a concussion history that a
person may not really think they have. How many of us have
bumped our head getting in and out of a car. So we have a quick
rotational movement, and that could produce perhaps a
concussion. And then how does the brain recover from TBI. And
then, finally, how we improve and accelerate recovery. We
really have no scientific basis for any of our interventions.
Thank you.
[The prepared statement of Mr. Molfese follows:]
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Mr. Terry. Thank you. Dr. Johnston, you are now recognized
for 5 minutes.
STATEMENT OF JAMES JOHNSTON
Mr. Johnston. Hi, Chairman Terry, Ranking Member
Schakowsky, and members of the committee. Thank you for
inviting me to testify before you today, alongside this
illustrious panel about our experience in Alabama following the
passage of concussion legislation, as well as the work we are
currently doing at the University of Alabama Birmingham to
improve sports safety.
As in the State of Nebraska, youth sports and youth
football are an extremely important part of our culture, and as
a result, we take the safety of our children very seriously as
well.
As well known to the committee, the problem of concussion
has gained prominence over the past decade thanks to important
research and advocacy work done by scientists, physicians, and
public health professionals at many centers across the United
States, and through the work of public officials highlighting
this research. Of significant concern, recent studies have
identified potential long-term health consequences including
depression, chronic traumatic encephalopathy and other
neurodegenerative diseases associated with repeated impacts.
While college and professional football gets the most media
attention, it is important to keep in mind that greater than 70
percent of all football players in the U.S. are under 14 years
of age. Any effort directed at improving safety in football and
other impact sports will need to address these youth athletes.
Parallel to enacting of Alabama's concussion law in 2011,
as in many States, the Alabama State Concussion Taskforce,
Children's of Alabama, and Think First Alabama, initiated a
statewide concussion education and awareness program, and it
worked. In that first year, we observed a 500 percent increase
in referral of youth athletes referred to the Concussion Clinic
at Children's of Alabama, a trend that has held steady since
that time with about 350 youth athletes seen every year.
To optimize care of this rapidly increasing patient
population, we developed a multidisciplinary protocol, it is in
my Appendix 1, following the Zurich Consensus Guidelines,
athletes were evaluated by physicians with expertise in
concussion, kept out of sports or school until symptom-free,
referred for neuropsychological testing when appropriate, and
supervised in a gradually return to play and/or return to think
program. A formal study performed in 2012 demonstrated that
establishing this program resulted in significantly better
concussion care and decreased institutional resource
utilization.
Even though these efforts have certainly resulted in
improved recognition and treatment of concussion in Alabama and
in other States, we believe that much remains to be done in
order to prevent sports-related brain injury in the first
place. Given the difficulty of delineating a specific
concussion threshold, as has been said previously, using
existing helmet accelerometer technology and other subjective
ways of evaluating athletes, researchers have begun to widen
their focus from concussion to correlating cumulative impact
exposure over time, with changes in advanced MRI imaging
techniques and neuropsychological changes, even in the absence
of clinically diagnosed concussion. Animal models of
subconcussive impacts have also demonstrated problems with
complex spatial learning, cognitive impairment, and, as is seen
also in football players, compared with single impact controls
and those who have not had these injuries.
Though definitive conclusions about threshold for impact
frequency hit counts cannot be drawn from these early studies,
it has become clear that subconcussive impacts, that is, those
impacts that don't result in concussion, also play a role in
cumulative brain injury over time and need to be studied.
Recent studies of youth players by researchers at Wake
Forest suggest that a significant portion of young players'
head impact actually takes place during practices, and the
largest impacts happen to take place during those practices, a
lot of time doing outdated drills, like Oklahoma Drill or Bull
in The Ring, that are supervised by well-meaning but untrained
coaches. Emulating top level collegiate programs, which don't
do these practices and these drills, teams like the University
of Alabama, Ivy League and others, the Alabama High School
Athletic Association recently published nonbinding guidelines
to limit full contact hitting practices to twice per week. I
believe this type of intervention is complimentary to the stuff
that USA Football is talking about, about techniques, not just
the techniques of hitting but also the number of hitting
practices per week, as well as what drills are going to be done
during practice. Pop Warner has instituted similar guidelines
to this, but again, that is a small section. Limiting the
frequency of hitting at practices as well as the type of drills
would have a large effect on safety, significantly decreasing
the cumulative impact exposure for every youth football player
in America.
It has also become clear that football helmet standards
currently defined by the National Operating Committee for
Standards in Athletic Equipment must be updated to reflect or
improve understanding of the etiologies of concussion. It is
clear that both linear impact and rotational acceleration play
a role in concussion pathophysiology, and only linear impact is
studied by the NOCSAE system, which was from a skull fracture
tolerance model developed in the 1960's.
We believe that having a more complete picture of the
impacts that are seen in the football field are necessary in
order to come up with meaningful standards. In collaboration
with the University of Alabama Football Program, engineers at
UAB, led by Dean Sicking, previously of the University of
Nebraska, and the developer of the safer barrier for NASCAR and
IRL have recently developed a robust video analysis system to
analyze impacts, and then recreate them in a purpose-built lab.
In conclusion, the passage of concussion awareness
legislation, community education, and recent advances in our
understanding of head impact exposure in youth athletes have
all improved the overall safety of impact sports, and that we
are recognizing concussions more frequently, however, much work
remains, specifically in concussion education, and drafting of
policies to limit head impact exposure for youth athletes in
contact sports. As part of this push to a multifaceted approach
to a complex problem, I believe the development of new helmet
standards is also crucial for the development of safer helmets.
Mr. Chairman, thank you for the opportunity to testify.
[The prepared statement of Mr. Johnston follows:]
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Mr. Terry. Thank you. Dr. Gay, you are now recognized for 5
minutes.
STATEMENT OF TIMOTHY J. GAY
Mr. Gay. Thank you, Chairman Terry. I would like to thank
the subcommittee for inviting me to testify today.
I am speaking to you as a football fan who happens to be a
physicist. My main professional interest in the game is the
understanding of how protective equipment works and how it can
be improved.
Today I wish to consider several aspects of football that
are problematic as far as concussions go, and how we might move
forward to make the game safer.
American football is an inherently violent sport. That is
one of the reasons we love it. The forces encountered in
football can be huge. Consider a big hit between a running back
and a linebacker at full speed. We can show, using Newton's
Second Law, that the force each player exerts on the other
exceeds \3/4\ of a ton. This is why football is called a
contact sport.
Two players who collide at full speed, helmet to helmet,
are experiencing the same force to their heads that one of them
would feel if he had a 16-pound bowling ball dropped on his
helmet from a height of 8 feet.
Medical knowledge of concussions is in its infancy, but we
know one thing for sure: Forces to the head and neck cause
concussions, and we have just heard how big these forces can
be. Here is another problem: They are getting bigger.
Since 1920, the average weight of pro linemen has increased
almost 60 percent, to just over 300 pounds. At the same time,
these players have gotten about 10 percent faster. Combining
the factors of speed and mass to calculate kinetic energy, the
energy available to cause injury, we find that the amount of
energy dumped into the pit at the line of scrimmage on any
given play has almost doubled since 1920. In exact opposition
to this trend is the fact that players are shedding their
protective gear. Thigh and kneepads that used to be centimeters
thick, now bear a remarkable resemblance to teacup doilies.
Horse collars, popular with linemen of my generation, have gone
the way of the flying wedge. Modern football helmets are
technological marvels, but players choose them not for their
collision cushioning ability, but for how cool they look.
Another problem is the poor state of our medical knowledge.
While I am not competent to explain these issues, I think it is
safe to say that a room full of head trauma physicians will not
agree on the details of what concussions are, or what causes
them. This means that the diagnosis and treatment of
concussions has a long way to go. As our understanding of these
issues improves, we may find that injury rates due to the
increasing energy of the game and the wholesale shedding of
equipment have increased faster than we thought.
Finally, football is big business, especially at the
college and professional levels. When monetary forces manifest
themselves as they do in, for example, bounty programs and
illegal doping to improve performance, the game becomes more
dangerous.
What are the solutions? We need better equipment, but this
can get tricky. For example, it is apparent that adding more
energy absorbing foam to the outside of a helmet will lower the
force delivered to a player's skull. This has been tried in the
past. The problem is that the added padding increased the
helmet diameter, as well as its coefficient of friction,
meaning that the opposing player can exert a lot more torque on
your head. Nonetheless, several companies today are proposing
the same basic padding idea for youth football, for whose
players the risk of collisions to the head is almost certainly
greater. The use of the Star System for rating helmets, and the
Hit System for monitoring collisions to a player's head,
represent important first steps toward improving football
safety for a variety of reasons that disregard players' safety,
they are largely ignored.
Our understanding of the physiological and epidemiological
issues related to concussions must be improved. There is now an
understanding in the NFL and at the college level that
significant research in this area is needed. Several of the
members of this panel, including my colleague from Nebraska,
Dr. Molfese, are leading cutting-edge efforts in this area.
Finally, some incremental rule changes and more stringent
enforcement of existing rules are needed. In my opinion, some
of the new rules regarding targeting, peel-back blocking, and
definition of a defenseless opponent, are making players more
hesitant on the field. These rules may, thus, actually,
increase the risk of injury. Rule changes should be studied and
possibly reversed.
It is my belief that a return to the level of padding worn
in the 1970s would make the game significantly safer. More
thorough doping rules should be developed and actually
enforced. The NFL season should be reduced to 14 games, and the
college season returned to 11. Finally, more stringent
requirements regarding when a player with a concussion can
return to the game need to be implemented.
These are my thoughts for your consideration. Thank you for
your attention and your valuable time.
[The prepared statement of Mr. Gay follows:]
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Mr. Terry. Thank you for your valuable time.
And, Dr. Gioia, I appreciate you being here. You are
recognized for 5 minutes.
STATEMENT OF GERARD A. GIOIA
Mr. Gioia. Yes. Thank you, Chairman Terry, Ranking Member
Schakowsky, and members of the subcommittee. I appreciate the
opportunity to speak on behalf of the safety of our children in
this country.
So I am a pediatric neuropsychologist at Children's
National Health System here in Washington, DC, and the director
of the SCORE Concussion Program. I am a clinician, a
researcher, and a public health educator. Today I would like to
take my time to focus my comments on the importance of public
health education for youth concussion, using my expertise as a
clinician and a researcher, and I have worked for the last
decade with the CDC on their Heads-up Concussion Program
materials.
We all know, and I think Ian said it just perfectly, that
sports and recreation provide important developmental
opportunities to enrich the lives of our youth. They teach life
lessons. But we have to balance those incredible benefits of
sports participation with careful attention to safety issues,
and science must drive our action-oriented approach.
Concussions are serious injuries to the brain that threaten
the development of our youth. In an attempt to protect our
youth, we now have laws in all 50 States and the District of
Columbia, all with the good intent of protecting our student
athletes through rules for educating coaches and parents, and
removing suspected concussions, and not allowing them to return
until properly cleared. All States include the high school at
this level, but only 15 out of those 51 include youth sports.
So less than \1/3\ are looking at the majority of athletes.
In preparing for this testimony, I was posed with an
important question and challenge within youth sports. With
concussion awareness now at an all-time high, are youth sports
teams and organizations, and parents, more aware but still not
sure what to do about it. And the simple answer to that
question, with my experience, is yes. Many coaches and parents
are not equipped to know what to do with a suspected
concussion. Mechanisms to teach active recognition and response
to every coach and parent are inconsistent and limited in
scope. The health and safety of youth athletes is largely in
the hands of coaches and parents at the youth level. They need
medically guided training and early identification of
concussion and protection. Coaches and parents must receive
training and action-oriented concussion recognition and
response. Awareness isn't enough, and they have to be prepared
properly.
We know that, as you have heard, repeated concussions
present the greatest challenge to our youth. So our greatest
challenge is really the universal consistent and effective
implementation of these 51 laws so that we can prepare those
coaches and parents to know what to do, and have the tools with
which to do it.
At Children's National Health System, over the past 10
years, our SCORE Program has delivered hundreds upon hundreds
of action-oriented parent and coach concussion education and
training program, using the Heads-up materials from the CDC. We
have learned much about the community needs and how to deliver
the message. So we deliver scenario-based training where we
present to coaches and parents an actual situation, and what
they must do to recognize and respond. This is all very, very
important as we put these responsible adults in place.
You have heard about some important other kinds of
activities and good examples of head-safe action, head-smart
action, such as USA Football's Heads-up Tackling Program, where
coaches are educated in concussion recognition and response,
but also taught techniques that we believe can improve taking
the head out of the game, but we have to go further in all
youth sports. We do not have a coordinated universal strategy
at this point for action-oriented, solution-driven methods to
recognize and respond to these injuries. We have the tools, we
have many of the programs, but we do not at this point have the
delivery mechanism to do that. So we have to build also on
active partnerships between youth sports organizations and
medical care systems. Concussions are complicated. They are not
simple. We are not asking parents and coaches to be clinicians
and to go out and diagnose. We have willing teammates, as you
have heard, through USA Football, U.S. Lacrosse, USA Hockey,
USA Rugby and other organizations, but we need to build those
partnerships, we need the help of the professional sports
leagues, as you hearing from the NHL and the NFL and the sports
manufacturing world, to team with us. We also need a
quarterback ultimately to make this happen. We have to leverage
the efforts of other organizations like the National Council on
Youth Sports Safety, the Youth Sports Safety Alliance, The
Sarah Jane Brain Foundation's PABI Plan, all of this is
important for us to do. So we need, obviously, funding to do
that to move forward.
Can we move from awareness to action? Yes, we can.
Concussions are serious injuries that threaten our youth, but
we do not need to be scared away from that, we do not need to
avoid developmentally appropriate participation in sports
activities. What we need to do is focus on how to teach
recognition and response, and our country needs a good
universal mechanism to implement community focused youth
concussion solutions, and we believe that that can help
children ultimately as they enjoy the benefits of sports.
Our SCORE motto applies here. It says, ``Play hard, play
safe, but play smart.''
Thank you.
[The prepared statement of Mr. Gioia follows:]
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Mr. Terry. Very good. Dr. Shenton, you are now recognized
for your 5 minutes.
STATEMENT OF MARTHA E. SHENTON
Ms. Shenton. Thank you. I want to thank Chairman Terry,
Ranking Member Schakowsky, and members of the subcommittee. I
am honored to be here today.
My focus is going to be on radiological evidence of both
concussion and subconcussive blows to the head. And if I could
have the next slide.
What is known is that mild traumatic brain injury is common
in sports injury, and when we are talking about a single mild
TBI, about 80 percent get better, between 15 and 30 percent go
on to have persistent concussive symptoms, as have been
described today.
What is most concerning though are what has been called
chronic traumatic encephalopathy and other neurodegenerative
disorders, and that is the second one where it is repetitive
mild traumatic brain injury that we are really concerned with.
And the clearest evidence comes from postmortem studies.
If I could have the next slide? Here is a postmortem slide.
This is Ann McKee's work that shows how protein in the brain,
and those are the brown areas that show up. And this is in a
case of a retired professional football player who had
symptoms, and was presumed to have chronic traumatic
encephalopathy, which was confirmed at postmortem.
Next slide, please. Now, here are four individuals, A, B,
C, and D. What is interesting here, and this is work by
Goldstein, it shows that blast injury and repetitive brain
trauma look the same at postmortem. So we have a military
person at 45 with one close-range blast injury, a 34-year-old
with two blast injuries, an amateur football player at the age
of 18 with repetitive concussions, and then a 21-year-old with
subconcussive blows to the head only.
Next slide please. So what is known? We have gone over the
first two. The third is mild TBI is very difficult to diagnose,
and that has been a really serious problem because if you use
conventional CT and conventional MRI, you are not likely to
find differences or abnormalities in the brain, and so many
people have said there is no problem then. The problem is the
correct advanced tools have not been used until more recently.
And now with advanced neuroimaging, we are able to both
diagnose and move towards prognosis and hopefully intervention.
Advanced neuroimaging techniques such as diffusion imaging,
which we have been using in our laboratory, show radiological
evidence of brain alterations in living individuals with mild
TBI. And so if we can detect this early, and we can perhaps
then look at underlying mechanisms and characterize what is
going on in order to come up with preventative measures.
Next slide, please. So this is a study from our group,
looking at hockey players from university hockey players in
Canada. And the bottom line is over on the right. The first is
at preseason and the second is at postseason. The red dots are
three individuals who had concussion during play, from
preseason to postseason. And the increase is increase in extra
cellular water in the brain, which is not a good sign.
Next slide, please. We also looked at brain matter, looking
at cortical thinning in the brain, and that is the cortex where
neurons are in the brain. And this is a study in former
professional football players who were symptomatic when we
looked at them. And what we found was that there is cortical
thinning compared to age-matched normal controls. What is most
concerning, however, is that blue line that shows that the
cortical thinning accelerates with age, whereas the red line,
our control group, where it is almost completely flat. And this
suggests that cortical thinning may indicate abnormal aging and
a risk for dementia that we can see right now in living
individuals.
Next slide, please. Now, this is a study that we did in
Germany with elite soccer players, and we selected them
specifically for not having a history of concussion, and not
having any symptoms whatsoever. And what we found was, compared
to professional swimmers, there was a huge difference between
the two groups, with the controls on the left and the soccer
players on the right. Almost a complete separation between the
two groups, with an increase in what is called radial
diffusivity, which is a measure of damage to myelin in the
brain.
Next slide please. So what we don't know: Why do concussive
and subconcussive trauma result in some and not in others?
Another question we don't know is, Why do some develop
neurodegenerative disease while others do not? What are the
predisposing factors? Is exposure or genetics involved, because
not every football player, not every soccer player, not every
hockey player who plays and gets hit to the head ends up with
these neurodegenerative diseases, which is what, I think,
people are most concerned with.
And next slide. So what we need is diagnosis to detect
brain injury early. We have imaging tools now that are
sensitive, widely available, and can be applied in vivo,
prognosis to follow recovery and degenerative processes. So we
need to follow recovery and degenerative processes in order to
predict who will have a poor outcome, and who will have a good
outcome. And knowing that, we might be able to intercede with
treatment to halt the possible cascade of neurodegenerative
changes.
And finally, just in summary, next slide. Sports concussion
leads to alterations of the brain's white and gray matter.
Advanced neuroimaging is sensitive to detect brain alterations
following concussion and subconcussive brain trauma, and the
impact over time is important. We need longitudinal studies to
identify different stages of recover, and being able to pick
out ahead of time what is going to lead to a poor outcome so
that we can intercede.
And finally, some measures of safety, such as rules for
returning to play are needed following observable evidence of
brain trauma.
Thank you.
[The prepared statement of Ms. Shenton follows:] \1\
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\1\ Additional information has been retained in committee files and
also is available at http://docs.house.gov/meetings/IF/IF17/20140313/
101897/HHRG-113-IF17-Wstate-ShentonM-20140313-SD001.pdf.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Terry. Thank you. Very impressive testimony from
everyone, and I was even impressed that you all stuck to the 5
minutes, pretty close.
Now, I am going to go back to Dr. Molfese because I think
your testimony and Dr. Shenton's kind of juxtapose each other
here very nicely.
So part of what your research is doing is finding that
baseline of the new athletes that enter University of Nebraska.
So is this allowing you to detect the injuries earlier, that
there may have been some pre-existing subconcussion? How are
you identifying that, what is it telling you, and what is the
university doing to implement some level of protections?
Mr. Molfese. Well, one of the major changes we have seen,
and I think this is occurring across the field now, is the
effort to get pre-concussion data. So basically, more and more
schools are moving to assess student athletes prior to the
start of the season, and that certainly is what we are doing.
And then should a player be injured, and they are identified
through trainers or the medical team. One of the weaknesses
here is that the players do not always self-identify, and so we
have run across that a number of times in our testing, or we
will pick up something on our test the trainers and the medical
team didn't know about simply because the player didn't
disclose. And then we also try to test somebody else who plays
a similar position but has not been injured, and they act sort
of as a game control over the course of a season. And
generally, what we are finding is both effects that occur
across the season and just our normal players who have no
history of concussion being identified, their brain speed of
processing does change over the 4 to 5 months of training and
the season, but then with the players who are--who do
experience a concussion, we see, in terms of brain electrical
activity, again, the slowdown of about 200 milliseconds. That
is four times faster than the slowdown you see in Multiple
Sclerosis, for an example, for a contrast. So clearly, the
brain has changed the way it is processing.
We are just now moving to start intervention programs with
the players that we identify. There is some data out there with
early Alzheimer's that suggest working memory-type tasks may
take even a week of intervention, shows a 4-to-5-week continual
gain in improvement, and so we are trying to see if we can see
some of that occurring.
Mr. Terry. Thank you.
Dr. Gay, in regard to concussions, though many times it is
not a direct blow, but coup contra coup, it is being hit so
that the head is going back and forth, and the brain is
sloshing around.
You mentioned going back to 1970s type of equipment, and
Tom Osborne likes to talk about the neck roll. Describe to me
what you mean by 1970s equipment, and how it may actually
reduce concussions.
Mr. Gay. Thank you, Mr. Chairman.
Yes, the neck roll, what I call a horse collar, is really a
piece of equipment that has disappeared from the game. And it
does an important thing, it essentially immobilizes the head.
So if concussions are incurred by the rattling of the brain
back and forth, especially from a blow to the side, the horse
collar will substantially damp that down. To my knowledge,
there are no epidemiological studies of that being effective,
but my personal opinion, even though I am largely ignorant of
medical science, is that if you immobilize the head, that is
going to solve a lot of the problems, especially with these
rotational hits. Yes.
Mr. Terry. Dr. Graham, does that make sense?
Mr. Graham. I think whether or not the horse collar would
have that effect, I don't know, and, of course, our committee
was based purely on science and, you know, reviewing the
literature, but I think the principle is, you want to find ways
to minimize the linear and rotational forces that come into
effect with a blow to the head, and whether you can do that by
equipment, whether you can do that by change in play, you know,
that is what you have to do to decrease the incidence of
concussion.
Mr. Terry. Thank you. I only have 11 seconds left, so I
will yield back and recognize the Ranking Member, Ms.
Schakowsky.
Ms. Schakowsky. You know, in addition to the science, so
much talk has been about culture, and it seems to me that that
is very important. So a change in the culture means not only
managing head injuries when they occur, but also encouraging
safer play to reduce the risk of head injuries.
So, Mr. Heaton, you spoke about the need to change the, I
am quoting from your testimony, ``the win at all cost''
attitude among players and coaches. What would you tell teams
to help them change that attitude, both within themselves and
teammates, and perhaps more challenging, in coaches?
Mr. Heaton. Thank you. Well, frankly, I would actually
encourage the coaches to stress this as much as possible, as
well as the parents, because the coaches and the parents are
there to help us learn how to play these sports correctly, and
if they can emphasize not having to worry about winning to the
point where you get hurt, then it will trickle down to the
players, and then the players become coaches, and then it is
this never-ending cycle of teaching and making sure that the
players know that winning is not the most important thing. You
know, it feels great to win, but I would much rather lose than
have another concussion.
Ms. Schakowsky. Clearly, you were aware because of the
severe consequences of the brain injury, but do you think that
youth athletes understand what those symptoms are?
Mr. Heaton. Yes. I think it is getting better, indeed,
especially in my school. I mean we emphasize making sure that
you know the symptoms of concussions, and I feel like it is
spreading as well, but I----
Ms. Schakowsky. Let me ask Dr. Gioia that, too.
Mr. Heaton. OK.
Mr. Gioia. Yes, certainly, at this point, the education
programs are also being directed toward the athletes, and quite
honestly, about 5 years ago, maybe 6 years ago, there was a
study that showed that that was the number 1 reason why
athletes were not coming out of the game, because they didn't
know how to tie together the symptomatology. It wasn't simply
that they didn't want to lose playing time, but they didn't
know what they were dealing with in themselves.
Ms. Schakowsky. Right.
Mr. Gioia. But we also believe that athletes and teammates
need to watch out for each other, because the concussed athlete
themselves may not have the wherewithal to know that they
aren't right, and yet their teammate right next to them
oftentimes does. So there is a responsibility within that team
to take care of each other, and that is an important focus.
Ms. Schakowsky. And that goes to culture as well.
Mr. Gioia. Yes, absolutely.
Ms. Schakowsky. Yes. Yes.
Dr. Shenton, please explain a little bit how advanced
neuroimaging works, and describe the types of changes in the
brain your lab is able to detect that traditional imaging
can't, and also some of the types of neuroimaging used by your
lab have been a significant part of the research on diseases
like Alzheimer's and schizophrenia. Why are the same imaging
techniques appropriate for research on these diseases and
research on sports-related brain injuries?
Ms. Shenton. OK, I have a slide, which is just at the end
of my slides, that just explains in one slide diffusion
imaging, which I think would help out here.
Ms. Schakowsky. The one slide I really didn't understand
was comparing swimmers with----
Ms. Shenton. With soccer players----
Ms. Schakowsky. Right.
Ms. Shenton [continuing]. But I was going to go through----
Ms. Schakowsky. All right, go ahead.
Ms. Shenton [continuing]. And just show you----
Ms. Schakowsky. OK.
Ms. Shenton [continuing]. Why diffuse external injury is
important because the injury that happens in the impact to the
brain is generally a stretching of the cables in the brain,
which is really the white matter, and for example, the corpus
callosum is the largest white matter track in the brain, and so
you get sharing. And this doesn't show up on tradition CT or
MRI. In fact, the first mild TBI conference I went to, no one
showed a brain. And I looked to my colleague and I said why
would no one show a brain. And he said because everyone knows
that you can't see anything on the brain. And I said, but then
nobody is using the right tools here.
And this is just a very simple principles of diffusion
imaging. If you look on the left, this is ink that goes on a
Kleenex. It goes in all directions, and that is called
isotropic diffusion. If you look on the right, it says
anisotropic diffusion. So you are dropping ink on newspaper,
and newspaper has fibers so it restricts the water. And this is
the same principle that is used quantitatively to look at the
brain, so that, if you are in CSF, it is very round, and it is
isotropic, everything goes in the same direction. If you are
looking at white matter, you are restricted in 2 directions,
and so you can measure what the integrity is of white matter
fiber bundles in the brain. And that is what you need to look
at in mild TBI.
Now, if you have someone come in with a moderate or severe
brain injury, you don't need this kind of technology.
Ms. Schakowsky. Uh-huh.
Ms. Shenton. They are going to just be put into
neurosurgery, and they are going to do an operation. It is
these very subtle brain injuries that aren't recognized using
conventional imaging, where you can recognize it if you use
something like diffusion imaging. And we have shown over and
over again now that you can see--and it is not just our group.
Starting in 2003, people started using diffusion imaging
because it is the most sensitive imaging tool that exists today
to look at diffuse external injury, which is the major injury
in mild TBI.
So what needs to be done now is to look at acute injury,
and see what predicts outcome, like do acute injury at 72
hours, at 3 months, at 6 months. Can we then predict, knowing
that what happens at 72 hours, if we have someone in our lab
that is trying to separate water that is outside cells versus
in cells. If you can predict from 72 hours, then you can go
back and say, OK, maybe we want to put in anti-inflammatory
medications if this is a neuroinflammatory response.
We don't know enough right now. The only way to know is to
do these longitudinal studies, and follow over time using very
sophisticated imaging technology, in my opinion. Once you know,
you can diagnose. Once you diagnose, you----
Ms. Schakowsky. So this could be very promising----
Ms. Shenton. Yes.
Ms. Schakowsky [continuing]. Not only for our athletes, but
our returning veterans and----
Ms. Shenton. Yes.
Ms. Schakowsky [continuing]. Applied eventually to
schizophrenia or Alzheimer's?
Ms. Shenton. Well, actually, we have applied--I am
primarily schizophrenia research, that is----
Ms. Schakowsky. OK.
Ms. Shenton [continuing]. What I have done for 30 years
before I became a TBI researcher in 2008. And we have a measure
called free water, this kind of imaging that shows that early
on at the very first episode of schizophrenia, you see fluid
around all of the brain that is free water, it is isotropic,
but in just the frontal lobe, you see it more restricted to
inside tissue. And this is a brand new technique that was
developed by a Fulbright Scholar that is in our lab from
Israel. And so----
Ms. Schakowsky. OK, I am going to have----
Ms. Shenton. OK.
Ms. Schakowsky [continuing]. To say thank you----
Ms. Shenton. Fair enough.
Ms. Schakowsky [continuing]. Because it is very promising.
Mr. Terry. Two and a half.
Ms. Schakowsky. Thank you.
Mr. Terry. Yes, thank you.
Gentleman from New Jersey is recognized.
Mr. Lance. Thank you, Mr. Chairman.
Dr. Johnston, you stated that many sports-related
concussions still go undiagnosed, and I would like to know why,
in your opinion, that is the case, and how can we improve that
in our State laws, and also the involvement of coaches and
players and PTAs, areas where we need to have improvement?
Mr. Johnston. Thank you for the question.
I think I would echo what has been said by others on the
panel. It is on. It is on. Sorry. I would echo what has been
said by others on the panel, that I think that a lot of it has
to do with recognition. Obviously, people are very good at
recognizing when someone gets knocked out on the field, but, of
course, that is a very small percentage of all concussions, and
I think that as our understanding of all the various symptoms
that can go with concussion have arisen, it becomes incumbent
upon us to improve the quality of the education that we give to
our coaches, players, trainers, officials, about the symptoms
of concussion. I think that that is the main reason. My sense
is that, in general, the culture, at least speaking for the
State of Alabama, that all the coaches that I have come into
contact are believers, they are not, you know, purposefully
hiding, you know, kids and putting them back in knowing they
have concussions, but I think that sometimes it is hard to
recognize, especially when young athletes don't tell you how
they are feeling, and other issues which I guess were brought
up with the importance of teammates being involved with
diagnosing these players so they can be pulled and
appropriately evaluated.
Mr. Lance. How close, in your opinion, are we to a better
design for helmets?
Mr. Johnston. I think that we are at the very beginning. I
think that we have been using a standard that has not changed
for 40 years, that was designed for skull fractures----
Mr. Lance. Yes.
Mr. Johnston [continuing]. That has served its purpose, and
I think that many investigators around are working to improve
the quality of the standards to include linear and rotational
acceleration, as well as other important aspects of impacts.
And just like the automotive industry did 30 years ago with,
once you start ranking cars with safety ratings, the market can
be relied upon for manufacturers to improve their helmet
designs to improve their sales. So I think that is the stage we
are at. I think standards are an important part of the
equation.
Mr. Lance. Thank you.
Dr. Gay, in your testimony, you have discussed the fact
that there is a numerical rating system for a helmet's impact,
I think it is designed at Virginia Tech, the Star System, and
you have called it the best tool we have for analyzing the
merits of various helmet systems.
Can you briefly explain how the numerical scoring system
works?
Mr. Gay. Yes, thank you, Mr. Vice Chairman.
Basically, it involves a test where you drop the helmet
from a given height, a varying height, to the side, to the
front, to the back. It tries to simulate the kinds of impacts
that a football player would actually experience, and numerical
scores are given to the maximum acceleration that the NOCSAE
head inside the helmet feels for these given drops, based on a,
in my opinion, fairly crude initial model of what causes
concussions. There is no effect to take into account rotation,
there is no effect of temperature, and, in my opinion, the
reproducibility is not as good as one would like, having tried
to do examples of these kinds of tests in groups that I have
been involved with.
So I think it is a good first start. It is the best we have
right now. I think it needs to be paid attention to, but there
is a lot of room, a lot of room for improvement.
Mr. Lance. Thank you, Dr. Gay.
And finally, Ian. How old are you and what grade are you
in?
Mr. Heaton. I am 18 and I am a senior.
Mr. Lance. And does that mean you will be going off to
college in the autumn?
Mr. Heaton. Yes----
Mr. Lance. And----
Mr. Heaton [continuing]. I will.
Mr. Lance. And do you know yet where you will be attending
college?
Mr. Heaton. I am going to Elon University in North
Carolina.
Mr. Lance. In North Carolina. My congratulations to you,
and my condolences to your parents on the cost of higher
education in this country. It is a great school. I have a
goddaughter who is a freshman there. That means she is a little
older than you, but I will be happy to introduce you to her.
And let me say, I am very proud of your testimony, and I
could not have done what you have just done when I was 17 or
18, and certainly, I think the Nation has benefitted by your
outstanding testimony.
Mr. Heaton. Thank you.
Mr. Lance. Thank you.
Mr. Terry. Gentleman from Mississippi, you are now
recognized for 5 minutes.
Mr. Harper. Thank you, Mr. Chairman. And thank each of you
for being here and sharing your expertise on what is a topic
that we are really just learning about, as it has been in the
news for several years, but it is, I think coming to the
forefront. And your work and your information, your testimony
on the record here today I think will be beneficial to us.
As a parent of a 24-year-old young man with Fragile X
Syndrome, I particularly appreciate the work that you do at the
Children's Hospital, you, Dr. Gioia, you, Dr. Johnston, but in
preparation for this, I had some discussion with some parents
back home, and the interesting discussion is I had several
friends who have daughters playing youth soccer, and a number
of them reported an increase in the number of concussions
suffered by young ladies playing youth soccer. You know, we
seem in the news to always associate it with NFL, and helmet-
to-helmet contact, and concussions and things that we see on
the field of play, but it appears in everything we do in life,
every sporting event, there is that danger and that risk. That
is why, I think, what you are doing with the Think First
Alabama, Dr. Johnston, the preventive part of it is how do we
educate our players and coaches, parents, and perhaps, using
the teammate approach, the safest thing may be to have the
backup position player be the one to report for the first
teamer when they need to come out, you know, that might get
them off the field. But thank each of you for your work.
And, Dr. Johnston, educate just a little bit on what is a
subconcussive impact? What does that mean, and how important is
that when addressing concussion diagnoses, and should
subconcussive impacts affect rules of game and play, and if so,
how?
Mr. Johnston. Yes, so I think that the definition of a
subconcussive impact would be all those other, the 99.9 percent
of impacts that happen that don't result in a concussion,
meaning a diagnosed concussion. And as has been pointed out
previously, the rub with concussion is the diagnosis part. If
you look at some of our historical studies about rates of
concussion in different sports, it is very variable, and a lot
of that has to do with who is diagnosing it and, you know the,
you know, males versus females, whether or not men are more
likely to report or less likely to report symptoms. But I think
that a subconcussive impact is all those other impacts that we
have found more and more information with the important imaging
that has been done in Boston and other places, that even these
subconcussive impacts have results in terms of anatomic, you
now, structural changes in the brain over time.
So I think that the subconcussive impact needs to be
addressed in terms of lessening the overall cumulative impact
load that every player has. Football is kind of the most
obvious thing----
Mr. Harper. Right.
Mr. Johnston [continuing]. In terms of player practices and
how many practices a week children should be able to do hitting
and whatnot, but I think that has applications for all sports.
Mr. Harper. OK, thank you.
And, Dr. Molfese, if I could ask you a question. Just for
clarification first, if I could ask, the 77 percent of military
that----
Mr. Molfese. Yes.
Mr. Harper [continuing]. That figure, is that how many of
TBI cases have suffered concussions, or is that 77 percent of
all military? I wasn't quite----
Mr. Molfese. That is of traumatic brain injuries----
Mr. Harper. OK.
Mr. Molfese [continuing]. Seventy-five to 77 percent are
concussions, mild TBIs.
Mr. Harper. I gotcha, OK. And can you tell us more about
the sideline imaging work that you are doing? You know, is this
practical, is this something that we can expect to see rolled
out to sidelines across America to diagnose our athletes, and
perhaps how about onto battlefields to diagnose our warriors?
Mr. Molfese. I think it is very possible. We have actually
already published a paper just this last year in 2013, where we
took one of our EEG systems and recorded on the sideline of a
field. The biggest challenge for us in making it practical is
to get the processing time down. At this point, it takes us an
hour. If we can get it down to 5 minutes, then I think we can
sell it to the coaches, because they are the ones really that
are going to determine.
And I guess at this point, given all the other issues, the
common tests we use right now are like the SCSI 3 and the
impact, which are some neuropsych assessment tools, sort of
questions to the player, and they have to reflect and they may
be a little foggy because of the concussion, but these tests
don't have any predictability or reliability after 2 days post-
injury. That is our big problem. It doesn't predict recovery
time, it doesn't predict the severity of the injury, and so on.
So these biomarkers that we all are talking about are really
the critical things that we are hoping are going to be much
more reliable, more predictive.
Mr. Harper. Thank you very much. And thank each of you for
being here.
And I yield back.
Mr. Terry. Thank you. And, generally, this would end, but
we all have so many questions, we are actually going to do a
second round, and plus the bells aren't going to go off for at
least another 7 minutes. Jan does have a conflict, and she has
given us approval that she is going to leave, but she trusts us
to ask legitimate questions.
Ms. Schakowsky. But let me just really thank this panel,
the previous panel as well, but the intensity now of the
scientific research and then its application to the playing
field, and actually so many other fields, I really want to
thank you for telling us what is going on. And I also did want
to thank Ian Heaton for coming here today. I think it is
important to have people like Briana and Ian to tell their
stories, and give us a face to the importance of this. I want
to thank the FTC too for making sure that false claims aren't
made, but this is so important, so appreciated, and then we
will have to figure out where it leads us, but it certainly has
informed us. Thank you.
Mr. Terry. Yes. I would agree with every word of that.
So this is a question to you, Dr. Molfese, and Dr. Shenton,
and it dovetails into what the gentleman from Mississippi was
talking about as well, but are the symptoms of a concussion or
TBI uniform enough so that it is possible for early detection
or developing a checklist for a coach or a parent to be used,
you know, by non-medical? We will start with you, Dr. Shenton.
Ms. Shenton. No. The symptoms----
Mr. Terry. Well, that was easy.
Ms. Shenton. The symptoms overlap with depression and PTSD,
and that has been a real problem. In fact, there was a paper
published in The New England Journal of Medicine that said when
you remove the effects of depression, and you remove the
effects of PTSD, mild TBI doesn't exist. And that is a real
disservice, and it used to be that people would claim that when
people came in complaining that they still had symptoms from
hitting their head, since there was no evidence from
conventional MRI or conventional CT, they said go see a
psychiatrist. So it was really not appropriate at all, because
there is at least a small minority of people who have mild
concussion who go on to have symptoms, and they can go on for
months, for years, and then they can clear up. So that is
separate even from CTE.
What you need is radiological evidence for diagnosis, the
same way you would want to know values of a blood test for
cholesterol or a broken leg. And I think we are moving in that
direction, and that is what we need is the hard evidence----
Mr. Terry. OK.
Ms. Shenton [continuing]. Because the symptoms are too
nonspecific.
Mr. Terry. All right. Dr. Molfese?
Mr. Molfese. There are actually studies published looking
at the number of symptoms, and a wide variety of a number of
symptoms people will report. There is no data that indicates
whether somebody reports lots of symptoms versus a few
symptoms, that that has any relation to how long they are going
to recover, how serious the injury is, how great the impairment
is----
Mr. Terry. Right.
Mr. Molfese [continuing]. Unfortunately.
Mr. Terry. So can we get to the point where the seventh
grader takes a big hit, that there is a checklist, per se, that
the coach could use to determine if that kid should go back
into the game?
Mr. Molfese. Well, I think in general, there certainly are
guidelines out by the CDC and others that list concussion
symptoms. And so I think the general bias at this point is if
the individual reports any of these symptoms, that they should
be pulled, because we do know that there is data to indicate
that if you do have a concussion and then you start playing
again before the symptoms resolve, the likelihood of even death
is much greater.
Ms. Shenton. Um-hum.
Mr. Terry. All right.
Mr. Molfese. Not to mention further significant concussion
that is going to take longer to recover.
Mr. Terry. All right. So this one is for Dr. Johnston and
Dr. Gioia.
One of the debates that is occurring in the State of
Nebraska right now is you have a child, all right, a high
school student that suffers a concussion during a game. So it
has been diagnosed. What do you do next? Right now, the thought
is you keep him home or her home, dark, no electronics. That is
kind of the norm. There is a discussion whether that is
appropriate or not, or to what length.
What do you know? What would you recommend?
Mr. Johnston. Well, I will tell you about how we handle
things in Alabama, and I think a lot of what we do is based on
the CDC Guidelines and the Zurich Guidelines, which is that
once an athlete is diagnosed, they are removed from the field
of play, and then they are evaluated. We use the SCAT, which is
the sports concussion assessment tool, which is a sideline-
based assessment. We also use it afterwards as well. It has
kind of a quick mini inventory of neurological exam and
neurocognitive function. And then when children have symptoms
that persist, you know, obviously, they don't return to any
sort of play or even an escalation of activity until their
symptoms have completely resolved. And then those children who
have persistent symptoms lasting beyond the 1 to 2 weeks are
then referred to neuropsychologists, like Dr. Gioia, and a
traumatic brain injury program.
So I guess I would defer to you for----
Mr. Terry. What would you recommend----
Mr. Gioia. Yes.
Mr. Terry [continuing]. Dr. Gioia?
Mr. Gioia. Yes. This is a big question at this point. This
really comes to what is the best treatment for this injury. And
let me just say, the field is moving on this one, and the
recommendations that we make, and I have written several recent
papers on this, is that in that acute stage of symptoms,
probably the first few days, maybe for some a little bit longer
if there is a more severe number of symptoms, is that they
really reduce their activity, cognitive and physical. But what
you want to be doing though is start to increase that activity
over time. So we don't black box kids until they are
asymptomatic. That has a lot of likely negative effects on
kids, obviously, being removed.
So what we do is we initially shut them down, restrict
them, then we gradually start to bring them back into school
and into physical activity, but that has to be individualized
based, again, on the severity of that symptom presentation. And
that is where we are right now. We need a whole lot of research
to really help validate that.
Mr. Terry. Thank you. And, Mr. Lance?
Mr. Lance. No questions.
Mr. Terry. Gentleman from Missouri gets to ask another
question.
Mr. Harper. Mississippi.
Mr. Terry. Mississippi.
Mr. Harper. No, I was just looking down.
Mr. Terry. Yes, I thought you were Billy Long.
Mr. Harper. That hurt. That hurt. Thank you, Mr. Chairman.
And a couple of questions that I would have. One would be,
Dr. Gay, if I may ask a question?
Mr. Gay. Yes, sir.
Mr. Harper. In your testimony, you state that football
players at the elite levels are shedding equipment to increase
speed and mobility.
Mr. Gay. Yes.
Mr. Harper. The decision of which helmet to wear is their
own, and that player often chooses a helmet's looks, shape,
feel, perhaps, over its collision cushioning ability or safety
features.
Do some positions require different levels of collision
cushioning, and if so, would you recommend a special helmet for
specific positions that would meet all current safety
standards?
Mr. Gay. Yes, that is a great question.
Currently, there are no position-specific helmets being
made. I think the helmet manufacturers try to do the best they
can for everybody. I would say that, not to belabor the point,
but I think for linemen, where you typically get no severe hits
but a lot of subconcussive blows, that horse collar is crucial.
I wouldn't recommend that a wideout wear a horse collar. That
would really affect the quality of the play.
It is an interesting point because, certainly, some players
might tend--and this is why I am an advocate for the Hits
System. It will give us much more detailed information about
which positions get hit where. One could envision, if we have a
large database, then improving helmet design to react to that
kind of information.
Mr. Harper. OK. Dr. Graham, if I could ask you. How much
money has been spent on sports concussion research, and where
is most of the funding coming from for that research?
Mr. Graham. That, unfortunately, was not an issue that our
committee looked at, nor would we have had the resources to,
you know, to pull it out.
Mr. Harper. Sure.
Mr. Graham. But, you know, clearly, you can identify some
research that is being done in the Federal sector that applies
to this, but the private research that may be done by the
sports leagues, by the manufacturers of equipment themselves, I
don't know any good way to quantify that for you.
Mr. Harper. Gotcha. All right. Well, look, I appreciate
everybody being here, and it is a very important issue. We love
our children going through sports, we love to watch it, and we
don't want anybody being hurt that shouldn't be hurt. And so,
hopefully, this increased focus will lead to better research,
better safety equipment, detection, and, of course, prevention.
So thank you very much. Thank you, Mr. Chairman. I yield
back.
Mr. Terry. Thank you, the gentleman from Mississippi.
Mr. Harper. Thank you.
Mr. Terry. And I just want to thank all of you. This was
truly an all-star panel of medical experts and physics. And
much appreciated, Ian. Thank you.
And so that does conclude our hearing for today.
Now, for our witnesses, we, whether we showed up or not,
have the right to send you a question, and it is called a
written question. We have about 14 days to write those and
submit them to you, and I appreciate a couple of weeks, not
over, you don't have to do it right away, but at least if you
can get them back to us, if there are any, within about 14
days.
And I just, again, want to thank you for coming out here
and providing some very, very valuable testimony for us.
And we are adjourned.
[Whereupon, at 1:27 p.m., the subcommittee was adjourned.]
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