Published online August 30, 2010
PEDIATRICS Vol. 126 No. 3 September 2010, pp. 597-615 (doi:10.1542/peds.2010-2005) Mark E. Halstead, MD, Kevin D. Walter, MD, The Council on Sports Medicine and Fitness

Sport-related concussion is a “hot topic” in the media and in medicine. It is a common injury that is likely underreported by pediatric and adolescent athletes. Football has the highest incidence of concussion, but girls have higher concussion rates than boys do in similar sports. A clear understanding of the definition, signs, and symptoms of concussion is necessary to recognize it and rule out more severe intracranial injury. Concussion can cause symptoms that interfere with school, social and family relationships, and participation in sports. Recognition and education are paramount, because although proper equipment, sport technique, and adherence to rules of the sport may decrease the incidence or severity of concussions, nothing has been shown to prevent them. Appropriate management is essential for reducing the risk of long-term symptoms and complications. Cognitive and physical rest is the mainstay of management after diagnosis, and neuropsychological testing is a helpful tool in the management of concussion. Return to sport should be accomplished by using a progressive exercise program while evaluating for any return of signs or symptoms. This report serves as a basis for understanding the diagnosis and management of concussion in children and adolescent athletes.

But examples of the way concussions are handled in one community in Washington, regarded as perhaps the most enlightened state on the issue, demonstrate the limits of such legislative action and how persistent football culture, as well as questions of legal liability and resources, can leave young athletes in danger.

Two parents in Sequim, a small city northwest of Seattle, criticized how a local hospital handled the treatment of their sons after the boys sustained concussions playing high school football this month, with one player’s discharge papers reading, “May return to sports when able.” The other player received no medical attention on the field because emergency technicians were required only for varsity games, and he was on the junior varsity.

Another player’s mother, who asked the Sequim School District to begin a baseline neuropsychological testing program — which can assist in evaluating when a player has recovered and can return to play — was told that such testing, “due to liability and legal issues, is not recommended either by the insurance provider” or the Washington Interscholastic Activities Association.

Other communities across the United States have encountered similar roadblocks to improving player safety. Boston University researchers offered to staff every Wellesley Youth Football game and practice with an athletic trainer to watch for concussions that might otherwise be missed and arrange for treatment — but were turned down because of time and administrative issues, according to the e-mail declining the offer. The official who wrote the message did not return an e-mail seeking comment.

A different group trying to educate communities about concussions offered to speak to participants in a Sarasota, Fla., youth football program and said it was told, “We don’t want to alarm the parents or scare the kids.”

Washington’s law, known as the Lystedt Law and named after Zackery Lystedt, who sustained permanent brain damage during a high school football game, requires education for coaches and parents, the immediate removal of any athlete suspected of having sustained a concussion, and written authorization from a “licensed health care provider trained in the evaluation and management of concussion” before an athlete can return.

The legislation has served as a template for more than a dozen states that have enacted or are considering similar bills. The N.F.L. has lobbied state legislatures and Congress to consider language from the law.

The Lystedt Law, and other state legislation like it, still allows for mismanagement of injuries, said parents in Sequim — including Jean Rickerson, whose son Drew plays quarterback for Sequim High School. This year she started a Web site, sportsconcussions.org, to share information and the best practices with a community of athletes and their parents.

“The situation here is not isolated — that’s why I run the site,” said Rickerson, adding that Drew sustained a concussion in a game two years ago, received little medical care and did not recover for months. “I know there are other communities who are struggling as we are. We don’t have proper experts nearby who know how to handle concussions. I know of a player in Los Angeles who was cleared by a trauma center to go back and play in the game right then. We’re just a snapshot of what’s happening across the country.”

Two players for Sequim High School have received inadequate medical advice about how long they needed to stay out of football after concussions this month, according to interviews with their parents and supporting documents.

Robin Hall’s son Joey, a senior linebacker, was blindsided by an opponent at full speed, snapping his head violently backward before he was slammed to the ground. He was taken by ambulance to the area’s primary hospital, Olympic Medical Center, about 20 minutes away in Port Angeles, where the emergency room doctor diagnosed a concussion.

Joey was released about 90 minutes after arriving at the hospital. His release papers, under “Activity Restrictions,” read only, “May return to sports when able.”

Modern guidelines state that athletes of all ages and in all sports, after sustaining a concussion, should not return to play until they display no symptoms (like dizziness, headaches, nausea or sensitivity to light or sound) both before and after gradually increasing physical exertion. It is less known that students feeling symptoms should be advised not to tax their cognitive function by playing video games or even studying too hard.

“It was very old school,” Robin Hall said. “ ‘You got your bell rung? When you feel better, go back to play.’ I was just a little confused. With Jean in our community, and the Lystedt Law in our state, everybody’s being, I thought, educated.”

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Across the spectrum of athletics from youth soccer to the National Football League, concussions are one of the most worrisome of injuries: hard to diagnose and even harder to know when an athlete has recovered. Now, in an unusual combination of real sports and their digital imitators, a handful of colleges, including the University of Maryland, are turning to a video game for help.

Athletic trainers in College Park and on other campuses are using the Wii Fit video game as an objective and practical — if unproven — method of assessing athletes’ balance, an important yardstick for determining recovery from concussion.

For the past year, Maryland and Ohio State have partnered to conduct research into the reliability of Wii Fit — an exercise video game played on Nintendo’s Wii console, which allows for physical interaction between player and game — as an effective concussion management instrument. Darryl Conway, Maryland’s head athletic trainer, said this will be the third year the school has used components of the game to conduct baseline testing of its athletes’ balance.

Proponents of using Wii Fit as a tool to examine concussions praise its simplicity and affordability — not to mention its popularity with student-athletes.

“The athletes love it because what we’ve done is we’ve incorporated this fun game that they’re playing at home into their rehab system,” said Tamerah Hunt, director of research at the Ohio State Sports Concussion Program. “But they’re also enjoying it at a time when they’re injured or at a time when their spirits are down, and they have to come into the athletic training room every day and they have to get all this treatment . . . and it’s kind of a reaction of, ‘Oh, this is fun.’ ”

Others, however, are cautious to accept it as a valid means of treating the injury.

“Obviously, the spotlight on this injury is iridescent right now, and there’s a lot of people that are concerned about it,” said Micky Collins, assistant director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center.

“What I’m afraid of is that that’s leading to sort of this potentially dangerous, really limited scope in terms of how you evaluate this and trying to come up with easy tools and sort of one-size-fits-all recommendations that can end up being very dangerous.”

Increasing concern

The issue of concussions in athletics has emerged as a major health concern in recent years — from professional sports organizations such as the NFL all the way down to high school and youth teams. Increasing efforts have been made to attempt to limit the number of head injuries.

Prior to the start of training camps last month, the NFL announced it would dispense posters to its 32 teams detailing the dangers of concussions in blunt terms. The posters must be displayed in each team’s locker room all season. Additionally, the NFL recently tested 16 helmet models in an effort to improve the technology of its headgear to better prevent concussions; the results of the tests were distributed to league players.

NFL retirees have reported rates of Alzheimer’s and other memory-related diseases at five times or more the national rate, according to a league-funded study. Boston University scientists, whose research was funded in part by the NFL, have discovered a link between head injuries suffered by athletes and a condition that mimics Lou Gehrig’s disease, or ALS.

Also, the NFL and its players’ union have worked to reduce the amount of hitting during team practices in an attempt to decrease the number of player-incurred concussions.

View the original article here

Experts on brain injury are trying to take what they’ve learned on the football field and apply it to the battlefield.

That will mean identifying military personnel who have suffered a concussion, and forcing them to rest until their brains have a chance to heal.

The approach is similar to what happens in the NFL — players who suffer a concussion may be benched for a week or more, even if they object.

Brain injury experts say mandatory rest and evaluation are even more important in combat because of new discoveries about the way energy from an explosion appears to reach the brain and cause damage. The goal is to prevent fighters who have already had one concussion from suffering another while their brain is still especially vulnerable to damage.

‘Out Like A Light’

That’s what happened to Jake Mathers, a Marine, during one seven-month tour in Iraq. Mathers got his first concussion during a firefight near Ramadi. He was firing his weapon when an enemy truck packed with artillery shells and gasoline exploded not far from him.

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Sgt. Victor Medina sought help outside the military medical system for treatment of a traumatic brain injury.

“All I saw was sparks, and then I went out like a light,” says Mathers. “I woke up and my nose was bleeding, my ears was bleeding, my tear ducts were bleeding.” Mathers’ body was intact, though. So he stayed with his unit and suffered more concussions.

“There were several,” he says. “An RPG hit my truck one time. I got knocked out. Another time, we’re going down this street called Ice Cream — probably the worst street in Ramadi … and one of the guys shot an RPG and it hit the hood of our vehicle and blew up.”

Mathers says he can’t remember how many concussions he had during his seven-month tour, and he has trouble remembering a lot of things now that he’s back home in Monroe, La.

“I’ll lose my pack of smokes like three or four times a day, and I’ll buy different packs of smokes ’cause I forget that I bought them,” he says. “Or sometimes I’ll be driving down the road and forget where I’m going or lose my car keys, cell phone.”

Mathers also has headaches, nightmares and problems sleeping.

Concussion From A Blast Wave

The conflicts in Iraq and Afghanistan have produced a lot of people like Mathers — people who had multiple concussions in a short period of time, says David Hovda, who directs the Brain Injury Research Center at UCLA. Each injury is usually the result of a relatively small explosion, he says.

It makes me a little mad. People are like, oh well, you seem fine. Well, you know, I’m not. It’s not like I’m missing a leg. But I’m missing something that I can never get back.

The blast can produce “a concussive wave, or a blast wave, that actually moves the head and body very violently and that can, in fact, cause a concussion,” Hovda says.

Brain scans show that for days or even weeks after an injury like this, the brain’s metabolism slows down, which leaves some cells starved for energy, he says.

“During the time when this metabolism is altered,” Hovda says, “the brain not only is dysfunctional, but it’s also extremely vulnerable, so that if it’s exposed to another mild injury, which normally you’d be able to tolerate really well, now there can be long-term devastating consequences.”

It’s the second hit or the third that often does the lasting damage, Hovda says. So Hovda and others have been urging the military to act more like the NFL and order troops off the field when they’ve had a head injury.

That message seems to be getting through.

An About-Face For Military Policy

A few months ago, Adm. Mike Mullen, the chairman of the Joint Chiefs of Staff, announced that troops near a bomb blast must be removed from combat for 24 hours and must be checked for traumatic brain injury.

Implementing this policy is important for several reasons, Hovda says. One is that concussions often cause fuzzy thinking.

“If you’re going to call in a mortar strike,” Hovda says, “you have to do some fancy math and some really sophisticated calculations in your head, and you could create a problem if this isn’t done correctly.”

Another reason to aggressively look for brain injury is that it’s very hard to tell who might have sustained one, experts on brain injury say. Experiments on animals show that shock waves from a blast can cause brain damage even if the head is completely protected, says Ibolja Cernak, who studied brain injuries on the battlefields of Kosovo. Now she works at the Johns Hopkins University Applied Physics Laboratory in Maryland.

Shock waves from a blast compress the abdomen or chest wall violently, Cernak says, transferring the bomb’s kinetic energy to blood and other fluids.

“So this kinetic energy now inside the body generates oscillating pressure waves which travel everywhere — to the organs, but also to the brain,” she says, where they may kill or damage brain cells.

Shock waves also can reach structures deep in the brain that control things like blood pressure, balance and speech, Cernak says. And she says the blast can cause a breach in the blood-brain barrier, which usually protects the central nervous system from substances that could cause dangerous inflammation.

“These inflammatory molecules and mechanisms start to give irreversible damages and changes in the brain very comparable to Alzheimer’s,” Cernak says.

Studies suggest that repeated injuries in a short period of time greatly increase the risk that will happen.

Until recently, concussions on the battlefield didn’t get that much attention. Jake Mathers, the Marine, says that’s probably because they don’t leave any visible scar.

“It makes me a little mad,” he says. “People are like, oh well, you seem fine. Well, you know, I’m not. It’s not like I’m missing a leg. But I’m missing something that I can never get back.”

Mathers says he hopes his story will help protect the next generation of fighters.  

Morneau was batting .345 with 18 homers when he slid into second base during a July 7 game and collided with Toronto’s second baseman. Morneau was diagnosed with a concussion. But for reasons that doctors can’t explain, sometimes symptoms of a concussion linger. Morneau said this week that he is still has symptoms.

The wealth of evidence showing concussions are serious brain injuries that can lead to long-term neurological damage is beginning to influence a generation of athletes, from pro to rec leagues, said Dr. Richard G. Ellenbogen, chief of neurosurgery at Harborview Medical Center in Seattle, and co-chairman of the NFL’s head, neck and spine medical committee.

Post-concussion syndrome — also called post-concussive syndrome — was referred to as shell shock in military circles in the past. It consists of symptoms such as headaches, cognitive difficulties (such as difficulty concentrating), irritability and fatigue that a person experiences weeks, months or even a year after a concussion. Doctors don’t know why some people experience post-concussion syndrome and others don’t.

Oftentimes, a brain scan will show nothing amiss, but the symptoms return when the patient begins activity again, Ellenbogen said. Rest is the only remedy. Studies show that returning to action, and risking further head trauma, can contribute to long-term health problems, such as dementia.

Morneau’s decision adheres to medical guidelines that call for rest until the symptoms are completely gone.

“What we’re seeing happen is a culture change in sport,” Ellenbogen says. “We’re taking concussions seriously because we’re seeing the long-term sequelia. We’re realizing concussions are not good for you.”

Morneau expressed concern about his long-term health when he talked with reporters earlier this week.

“I think the biggest thing the doctor said to me was, ‘I’m confident you’ll get better, confident you’ll be ready for spring training, but if you go out there and get hit again I don’t want you to be feeling like this when you’re 50,’ ” Morneau told the Associated Press. “That’s kind of what made me realized that there is the potential for this to carry on for a long time, and I think that’s definitely what we’re trying to avoid.”

The decision by a high-profile athlete to put his health before a possible World Series ring should send an important message to athletes of all levels, Ellenbogen said. The number of children in the U.S. seeking emergency medical care for concussions  incurred playing competitive sports more than doubled in the five years leading up to 2005, according to a study published recently in the journal Pediatrics.

“This is enlightened, judicious handling on the part of the [Twins] organization,” Ellenbogen said. “Here is a star athlete sitting out. It’s not about winning anymore; it’s about being safe.”

– Shari Roan / Los Angeles Times

 Oct. 12, 2010 — A small study of high school football players suggests that players who endure multiple impacts to the head may experience brain impairment, even in the absence of a diagnosed concussion.

Researchers led by Thomas Talavage, PhD, of Purdue University in West Lafayette, Ind., and colleagues identified 11 male high school football players, ages 15 to 19, who were either diagnosed by a doctor as having a concussion, withstood a high number of hits to the head during practice or games, or withstood an unusually hard impact. Among those 11 players, three were diagnosed with concussions during football season, and eight had no documented concussions.

The players wore the appropriate safety gear throughout the season, including helmets equipped with sensors so that the researchers could record and analyze impact data. The impact data were then compared with brain-imaging scans and cognitive tests performed by each player before, during, and after football season. Talavage and his team also video-recorded the athletes while they played on the field.

Four of the eight players who appeared to be uninjured, meaning they did not have a diagnosed concussion, showed significant changes in brain function, such as memory. These players had endured multiple hits to the top front of the head, near the dorsolateral prefrontal cortex. This is an area of the brain critical for planning and organization. The three players who were diagnosed with concussions also showed changes in brain function and memory.

The researchers found that these changes in cognitive function persisted at the end of the season.  According to Talavage, new preliminary data show that the players might recover before the start of the next season, but additional research is need to determine the extent of recovery.

The findings are published online in the Journal of Neurotrauma.

“Our key finding is a previously undiscovered category of cognitive impairment,” says Talavage, associate professor of biomedical engineering and electrical and computer engineering and co-director of the Purdue MRI Facility.

When a person is hit in the head, the brain bounces back and forth in the skull, the researchers explain, which can lead to damaged brain cells and even damage to surrounding tissue. Such an impact can break nerve fibers called axons or connective cell tissue called synapses. This, in turn, could interfere with proper brain cell signaling.

The study results come just weeks after authorities reported that a 21-year-old Pennsylvania college football player who had committed suicide also suffered brain damage. The young player was diagnosed by Boston University researchers with chronic traumatic encephalopathy, often seen in boxers and National Football League players who have suffered repeated head trauma.

The Purdue researchers say their findings raise the question of how many hits it takes to cause brain impairment. This information could help lead to improvements in safety guidelines and more sophisticated safety gear for players.

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In an effort to discover whether concussion injury occurrence and treatment had changed, researchers compared those two consecutive six-year periods to determine the circumstances of the injury, the patterns of symptoms, and a player’s time lost from NFL participation. Those time periods were chosen because concussion statistics were recorded by NFL teams using the same standardized form. It recorded player position, type of play, concussion signs and symptoms, loss of consciousness and medical action taken.

Researchers found that in 2002-2007 there were fewer documented concussions per NFL game overall, especially among quarterbacks and wide receivers. But there was a significant increase in concussions among tight ends. Symptoms most frequently reported included headaches, dizziness, and problems with information processing and recall.

Significantly fewer concussed players returned to the same game in 2002-2007 than in 1996-2001 and 8% fewer players returned to play in less than a week. That number jumped to 25% for those players who lost consciousness as a result of the injury.

“There are a number of possible explanations for the decrease in percentages of players returning to play immediately and returning to play on the day of the injury as well as the increased days out after (a concussion) during the recent six year period compared to the first six year period,” write authors Ira R. Casson, M.D.; David C. Viano, Dr. med.; Ph.D., John W. Powell, Ph.D.; and Elliot J. Pellman, M.D. “These include the possibility of increased concussion severity, increased player willingness to report symptoms to medical staff, adoption of a more cautious conservative approach to concussion management by team medical personnel and a possible effect of changes in neuropsychological (NP) testing.”

The article “Twelve Years of NFL Concussion Data” in the Nov/Dec 2010 issue of Sports Health, is available free for a limited time here.

Source:
Jim Gilden
SAGE Publications  Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions. 

But a new study of an Indiana high school football team hints that some athletes are suffering brain injuries that go undiagnosed, allowing the players to continue getting battered, unaware of the possible cognitive damage that has been done.

Of 21 high school players monitored for a full season by a team of researchers from Purdue University, four players who were never diagnosed with concussions were found to have suffered brain impairment that was at least as bad as that of other players who had been deemed concussed and removed from play.

“They’re not exhibiting any outward sign and they’re continuing to play,” said Thomas Talavage, an associate professor at the Weldon School of Biomedical Engineering at Purdue and the lead researcher on the study. “The cognitive impairment that we observed with them is actually worse than the one observed with the concussed players.”

The potential long-term impact of jaw-dropping collisions in sports has become a hot-button issue this NFL season. In the first week alone, four players sustained concussions, including starting quarterbacks Kevin Kolb of the Philadelphia Eagles and Matt Moore of the Carolina Panthers. The Bears’ Cutler suffered a concussion Sunday night against the New York Giants, and it remains uncertain whether he’ll be cleared to play this weekend.

But the Purdue study shines a light on injuries more insidious than full-blown concussions, ones that don’t always result in outward symptoms yet could add up to cause serious long-term cognitive problems.

Hunt Batjer, chairman of the department of neurological surgery at the Northwestern University Feinberg School of Medicine and co-chairman of the NFL’s Head, Neck and Spine Committee, said the Purdue study — which he was not involved in — is timely, as many researchers are now debating what is more damaging: the intensity of an individual hit or the cumulative impact of repeated collisions.

“This is part of what we’re trying to do at the professional level, to determine at what level does further trauma to the head result in potential neurological damage,” Batjer said. “There could be changes that may not affect the player now but might affect them 10 or 20 years later. Those thresholds just aren’t known.”

He noted that an autopsy on Cincinnati Bengals receiver Chris Henry, who died in a domestic dispute last year, found that he suffered from chronic traumatic encephalopathy, or CTE, a brain disease caused by repeated brain trauma. But the receiver reportedly had not suffered concussions in his collegiate or professional career, indicating that the head injuries — like those found in the Purdue study — didn’t rise to the level of a clinical diagnosis.

“On a daily basis, there’s no effect these guys are going to observe, really,” said Talavage, the Purdue researcher. “There’s no immediate deficit. But what we are concerned about is that there have been a number of reports of NFL players and former college players who have shown scarring on their brains even without concussions, and we know that you can develop CTE without having a history of concussions. So the question from our study becomes, ‘Are we seeing a possible explanation?’”

Talavage and his team conducted their research by placing monitoring equipment inside the helmets of players at Jefferson High School in Lafayette, Ind. They did baseline tests on each player before the season, invited several players in for additional tests each week and then conducted a postseason assessment of the subjects.

Four of the 21 players were diagnosed with concussions during the course of the season. But what surprised the researchers was that four players who showed no symptoms of concussion had significant performance drops on routine cognitive tests. Brain imaging tests also showed decreased activity in the parts of the players’ brains associated with working memory.

“We were not expecting to find them, they just kind of popped up,” Talavage said. “When you talk to players in this group, there’s no outward sign. Yet here we are finding changes in testing scores and changes in their brain metabolism that show something that we’re a little worried about.”

Three of the four players were linemen, and one was a wide receiver. Talavage said that because the research is ongoing, none of the four players has been told about the brain scan results.

One of the 21 players monitored was Joel Ripke, 17, an offensive lineman. He has played football since fourth grade and absorbed about 1,800 hits to the head last season.

“A little bit of head contact can help (while blocking) because the helmets are pretty hard compared to your hands,” said Ripke, a senior who hopes to play college ball. “There are a lot of guys who complain because I kind of lead with my head a bit too much. A couple guys complain about it a little, but that’s football.”

Ripke said he was happy to be part of the research and not at all afraid to continue playing.

“It’s kind of good that people are paying attention to high school players and how the hits affect their brains,” he said. “But I kind of just play. It’s in the back of my mind, but I just play. I love it.”

That zest for the game can make the issue of brain injury difficult for coaches to address.

“It’s a tough slope because you could end up scaring kids away from even playing football, and you see that a lot,” said Michael Holmes, the football coach at Leo High School in Chicago. “We make our kids conscious of it, but we don’t try to scare them.”

Reilly O’Toole, quarterback at Wheaton Warrenville South High School, said he doesn’t think at all about head injuries.

“If you think about injuries or concussions, that’s when they happen,” he said. “Once you start playing not to get hurt, that’s when you get hurt. It’s a contact sport. If you don’t like contact, you shouldn’t be playing.”

One step Talavage suggests is cutting down the number of full-contact practices that high school teams hold. That sentiment is echoed by the Sports Legacy Institute in Boston, which focuses on brain trauma in athletes.

“We have pitch counts for youth baseball because we understand that a kid throwing a ball 100 times a day for years could wear out his elbow without a single injury,” said Chris Nowinski, co-founder of the institute and co-director of Boston University’s Center for the Study of Traumatic Encephalopathy. “It’s not crazy to think the brain can operate the same way.”

Tribune reporters Chris Hine and Paul Skrbina contributed to this report. View the original article here

Twellman still deals with the effects of a concussion he sustained during a collision with a goalkeeper two years ago, one that possibly cost him a shot at making the U.S. World Cup team and cut short his 2010 season after going on injured reserve in late June.

Now he’s volunteered to join a Boston University medical school program in which researchers are trying to better understand the long-term effects of repeated concussions. He’s one of 300 athletes in just the last two years who have agreed to undergo a battery of annual tests and donate their brain after death.

“It’s not hard (to donate) in that you want to help people down the road,” Twellman told The Associated Press in a telephone interview. “But it is hard since they want your brain because it’s been damaged.”

In addition to the athlete volunteers, the families of 40 deceased players have donated brain and spinal column tissue of their loved ones to the center. The material has been studied to see if repetitive head injuries possibly led to a degenerative disease known as chronic traumatic encephalopathy.

Chris Nowinski, the co-founder of the Sports Legacy Institute, leads the charge to round up donors.

A former football player at Harvard, Nowinski got involved after his career with World Wrestling Entertainment was cut short because of repeated concussions that were so bad he couldn’t even remember the script for the bout.

“I think we all know that this is a significant problem that has been ignored,” Nowinski said. “These athletes are like, ‘I don’t need my brain when I go, especially if something good can come of it.’”

Still, it’s not always an easy sell.

“Even good friends of mine who are former athletes are completely uncomfortable with the idea of donating your brain,” Nowinski said. “But we need a registry to accelerate our search for treatment.”

So far, the athlete registry consists primarily of pro wrestlers, hockey and football players, including former NHL standout Keith Primeau and current Baltimore Ravens offensive lineman Matt Birk, according to a partial list provided to the AP.

Donors to the brain bank include former Philadelphia Eagles safety Andre Waters and Penn football player Owen Thomas, both of whom committed suicide. The family of pro wrestler Chris Benoit also bequeathed his brain after Benoit killed his wife, son and himself at his suburban Atlanta home in June 2007.

All three athletes showed signs of CTE, a disease that has been connected to depression and impulse control issues in NFL players who have sustained concussions.

Thomas, who would have been a senior, killed himself in April. He had no history of concussions, but an autopsy on Thomas’ brain by the center’s researchers showed he had the early stages of CTE.

Ideally, Nowinski said the center would like to sign up 50 athletes from each sport. Most of the volunteers are men, but there are women in the registry including soccer player Cindy Parlow and swimmer Jenny Thompson.

Athletes who are enrolled in the registry take a medical history every year, perform cognitive tests and answer an array of questions, such as if they’ve been dealing with bouts of depression. It’s a way to establish a medical baseline, helping researchers watch for signs of CTE, which can eventually lead to dementia.

“We have no idea how much head trauma is necessary to produce (CTE),” said Dr. Robert Cantu, a clinical professor of neurosurgery and co-founder of the institute. “We just know those who play sports and who have higher amounts of head trauma have a higher incident of it. … This is just the tip of the iceberg in terms of studying this problem.”

Cantu said studies have shown a first-string college football player in a given year experiences between 800 and 1,500 blows to the head of a G-force greater than 20. That’s the equivalent of about a 20-mph car crash each time.

View the original article here

Traumatic brain injury “may lead to problems with memory and communication, personality changes, as well as depression and the early onset of dementia,” the document reads. “Concussions and conditions resulting from repeated brain injury can change your life and your family’s life forever.”

NFL to Players: Wear More Padding
Survey: NFL Players Hide, Fear Concussions

The acknowledgment of such risks is a significant change from a pamphlet previously distributed to players, starting in 2007.

That pamphlet said: “Current research with professional athletes has not shown that having more than one or two concussions leads to permanent problems if each injury is managed properly.”

60 Minutes: A Blow to The Brain

The new wording was first reported by The New York Times. NFL spokesman Greg Aiello confirmed the changed language Tuesday.

Aiello said the document was a joint effort of the NFL’s and union’s medial committees “and reflects their views after wide-ranging consultation with leading medical experts,” including the Centers for Disease Control and Prevention.

“It is intended to present the most current and objective medical information on concussion and will be distributed to the players and clubs in the near future,” Aiello said.

Watch a “60 Minutes” story on head injuries in football below:

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