Ever Wonder What Drives Hardcore Sports Fandom?

Interesting neurological perspective to remember when you can't understand why your friend or loved one is yelling at the TV during the Olympics....and....

Go Team Canada!-JR

The Unique Neurology of the Sports Fan’s Brain

Brian J. Barth

"Sports fans aren’t typically in the mood for academic research in the minutes before a big game. But Paul Bernhardt, an aspiring young behavioral scientist at Georgia State University, was determined. Armed with a bag of sterile vials, Bernhardt inched through the crowd at Atlanta’s Omni arena, politely asking anyone decked out in either University of Georgia or Georgia Tech basketball garb—the teams that were set to battle that evening—for a bit of saliva.

The year was 1991. Fans of the Bulldogs and the Yellow Jackets, the state’s two most renowned collegiate sports institutions, had been hating each other’s guts since 1893, a rivalry affectionately known as COFH: Clean, Old-Fashioned Hate. (Yes, sports rivalries can have names; COFH is historically significant enough to have a 5,000-plus word entry in Wikipedia with 50 citations.) Bernhardt wasn’t there to celebrate a century of feuding, however; he was hoping to break new ground on the scientific understanding of such fandemonium—“highly identified” fans would be the proper psychology term—to explain why being a sports nut, bitter hatred and all, feels soooo gooooood.

The fact that athletes experience a tidal rush of testosterone, a hormone associated not just with male sexuality but with self-esteem, upon winning a big game was well established. But there was a hypothesis floating around among social psychologists at the time that fans ride a similar hormonal high. Bernhardt just needed a little spit, which offers a reliable approximation of the body’s biochemistry at any given moment, to find out."

FULL ARTICLE HERE:

Experts claim better concussion prevention is needed in youth sports

This article discusses an expert's claim that better preventative measures for concussions are needed in youth sports.

Dina Morrissey, M.D., M.P.H., research associate for The Injury Prevention Center at Hasbro Children's Hospital, recently led a study that found that while compliance with mandated provisions in youth sports concussion laws was high among Rhode Island Interscholastic League (RIIL) high schools, compliance with recommended concussion protocols was very limited. The study, recently published in the Journal of Trauma and Acute Care Surgery, suggests that more concussion related standards and protocols need to be written into law in order to raise compliance rates among youth sports groups.

"An estimated 7.7 million children and adolescents participate in organized sports each year and the Centers for Disease Control and Prevention estimates that they sustain between 1.6 and 3.8 million sports-related concussions annually," said Morrissey. "In response to this, the state of Rhode Island passed the School and Youth Programs Concussion Act (SYPCA) in July 2010. The law outlines both mandatory and recommended provisions in regard to managing student athletes with a suspected concussion. Our study assessed compliance with this law among Rhode Island high schools and community league organizations."

In a 2013 statewide assessment of Rhode Island concussion law compliance among RIIL member high schools, non-member high schools and selected community league sports organizations, the study team found nearly universal compliance with mandated elements of SYPCA.

All athletic directors surveyed reported that they require concussion information sheets to be signed by both student athletes and parents prior to the start of each sports season. The research team also found that all coaches and 93 percent of volunteers have completed annual concussion training.

One hundred percent of surveyed groups also reported that any student athlete with a suspected concussion is immediately removed from play, and 93 percent reported that those students cannot return to play until they receive written clearance from a licensed physician, all per the SYPCA mandates.

"These SYPCA laws only apply to schools that are RIIL members," said Michael Mello, M.D., M.P.H., director of the Injury Prevention Center and co-author of the study. "When we explored other non-RIIL schools and sports organizations where SYPCA is recommended but not required, and also any of the recommendations that are not legally required of RIIL members, we found a very different compliance rate."

Only a handful of schools require student athletes to complete any type of pre-season neurocognitive testing, and nearly 20 percent don't offer it to student athletes at all. Half of the surveyed groups reported developing a written return to play protocol.

"These compliance statistics show us that in order to best protect youth athletes in Rhode Island, all recommendations outlined in the SYPCA law should be made mandatory," said Mello. "Additionally, non-RIIL schools, as well as community sports organizations, should also be required to comply with the law."

Neha Raukar, M.D., director of the Center for Sports Medicine and a co-author of the study, sees many youth athletes in her clinic for concussion treatment. "If a concussion is not treated properly and student athletes return to play too soon, they are at high risk for prolonging their symptoms, meaning more time out of the classroom and on the bench. They are also at risk for experiencing a devastating post-concussion event, such as second impact syndrome, which can be fatal," said Raukar.

"We are only just beginning to understand the long-term consequences of sustaining repeated head trauma and concussions," said Raukar. "Physicians, coaches and school staff alike all need to know the importance of properly diagnosing concussions, as well as the criteria for when a student athlete can both return to school and return to sports."

But, Morrissey also urges that the public needs to play a role and ensure that their school or community sports organization follows all the recommendations in the concussion law. "One example of our community pushing for better concussion protection for our students can be seen in school nurse annual training," said Morrissey. "At the time of our survey, only one quarter of surveyed groups required school nurses to complete annual concussion training. But now there is a new law in place to try to correct this, and Rhode Island is one of only a handful of states to reach out to school nurses for training. This is a clear step in the right direction."

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Do girl's lacrosse players need helmets

This article discusses the need for helmets in lacrosse, especially girls lacrosse which is perceived to he less of a contact sport than boy's lacrosse.

Lacrosse is one of the fastest-growing high school sports in the country. It also has one of the hottest debates regarding its rules — specifically, whether girls who play should be required to wear helmets, as boys are.

Boys lacrosse is a physical sport with heavy doses of contact. Girls lacrosse is regarded as more of a skill sport, with less contact. Players in the girls game are required to wear protective eyewear and mouth guards, but not helmets.

A study recently published in The American Journal of Sports Medicine looked at the types of injuries high school lacrosse players suffer. The study, conducted by researchers from the Center of Injury Research and Policy at Nationwide's Children Hospital and the Colorado School of Public Health, evaluated injuries players suffered from 2008-12. The research found that the most common injury, at 38 percent, were sprains and strains, followed by concussions at more than 22 percent.

Dawn Comstock, a professor at the Colorado School of Public Health and one of the researchers, said the most surprising discovery was how players got concussions.

"In boys, nearly 75 percent of all of the concussions were due to athlete-athlete contact," Comstock said. "Not surprising, since boys lacrosse is a full contact sport. But girls, over 60 percent of the concussions resulted when a girl was struck in the head by a ball or the stick."

Even though girls lacrosse is regarded as a noncontact sport, researchers found that almost 25 percent of concussions came from athlete-to-athlete contact. About 63 percent of the concussions resulted from being hit in the head by a ball or a stick.

According to rules from U.S. Lacrosse, which the National Federation of State High School Associations endorses, girls may wear soft headgear but not hard helmets. Only goalies can wear helmets. Field players wear protective eyewear and mouth guards.

Denver East High School coach Mallory Cleveland would like to see helmets mandated in girls lacrosse. Cleveland played one year of lacrosse without goggles before they were required.

"At that time it was kind of a pain and people didn't like them and there was some lash out," Cleveland said. "But I would say now that it's just a part of the sport, it's something that's a given and everyone is used to them and wears them now. Helmets will definitely be the same thing once they are implemented."

Cleveland said a handful of players on the Denver East varsity and lower-level teams suffered concussions this past school year.

In June, the Florida High School Athletics Association announced that in 2015 all girls lacrosse players will be required to wear helmets.

Comstock said helmets can't eliminate concussions but can help minimize head injuries. When two players run into each other, often the head of one of the players snaps back. This results in brain sloshing, when the brain moves around inside the skull, and can result in a concussion. Comstock said a helmet can help protect against the direct transfer of force when a player gets hit in the head.

Some players and coaches worry that adding helmets will change their game. Cherry Creek assistant coach Ashley Thompson said girls lacrosse is about finesse and technical skills, not physical play. If helmets are required, she's afraid the cost might turn away interested players. Thompson added that coaches are more aware about concussions than in the past.

Denver East senior-to-be Shelby Parks said she would be upset if helmets are required to play girls lacrosse. She said she's never had a concussion and has seen only one player get a concussion during a game. Implementing helmets would make the players more aggressive, she said.

"When you're wearing a helmet or you see someone wearing a helmet, it means they're protected and anything goes," Parks said. "Lacrosse can get aggressive, but the refs are there for a reason and people shouldn't get hit in the head, because that's not a part of the game."

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Do doctors have an obligation to protect athletes from concussions?

This article discusses if doctors have an ethical obligation to teach and protect athletes from concussions.

The American Academy of Neurology (AAN), the largest professional association of neurologists and a leading authority on sports concussion, is releasing a new position paper that states doctors have an ethical obligation to educate and protect athletes from sports concussion and clear them to play only when the athlete is medically ready, standing firm against objections from players, parents or coaches. The statement is published in the July 9, 2014, online issue of Neurology®, the medical journal of the AAN, and is being released ahead of The Sports Concussion Conference, July 11-13, 2014, in Chicago, where the AAN will share the latest scientific advances in diagnosing and treating sports concussion.

The AAN position statement calls for doctors to safeguard the future mental and physical health of athletes as a top priority, especially regarding return-to-play decision-making. Physicians also must educate patients and their families about the dangers of concussion in all relevant sports, according to the statement.

The Academy has spent several years analyzing all of the available research and ethical issues to develop this official position paper, which corresponds with the AAN's guideline on sports concussion.

"With nearly four million sports-related concussions in the US each year, it is imperative doctors are educated and protect these athletes who may have sustained a concussion," said lead author Matthew P. Kirschen, MD, PhD, a neurologist with The Children's Hospital of Philadelphia and a member of the American Academy of Neurology. "Concussions can have devastating effects such as short-term impairments in athletes' cognitive and athletic performance. Repeat concussions have been linked to long-term impairments in brain function, such as problems with learning, memory and behavior."

The statement also:

• Supports wider use of baseline cognitive testing

• Recommends that concussion evaluation and management training be added to neurology residency programs

• Suggests the development of a national concussion registry with mandatory reporting, which may help to document more rigorously the incidence and recurrence of concussion at all levels of play

Ethically, the statement concludes that physicians caring for athletes during and after a sports-related concussion should have adequate training and experience in the recognition and evaluation of both the existence and severity of potential brain injury.

"These strategies could help identify the threshold at which the number and severity of head injuries leads to irreversible brain injury. They may also help to clarify how concussion risk varies with factors like age, gender, puberty stage and ethnicity so athletes and parents can make informed decisions about playing contact sports," said Kirschen.

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Signs of concussion in children

This article discusses concussions in children and how parents can spot them.

What is a concussion?

A concussion is an injury to the brain that may be caused by a blow, bump, or jolt to the head. Concussions may also happen after a fall or hit that jars the brain. A blow elsewhere on the body can cause a concussion, even if an athlete does not hit his/her head directly. Concussions can range from mild to severe, and athletes can get a concussion even if they are wearing a helmet.

Signs and symptoms of a concussion

Athletes do not have to be "knocked out" to have a concussion. In fact, less than one out of 10 concussions results in loss of consciousness. Concussion symptoms can develop right away, or up to 48 hours after the injury. Ignoring any signs or symptoms of a concussion puts your child's health at risk!

Signs observed by parents or guardians

* Appears dazed or stunned

* Confused about assignment or position

* Forgets plays

* Unsure of game, score or opponent

* Moves clumsily

* Answers questions slowly

* Loses consciousness (even briefly)

* Shows behavior or personality changes (irritability, sadness, nervousness, feeling more emotional)

* Can't recall events before or after hit or fall

Symptoms reported by athlete

* Any headache or "pressure" in head (how badly it hurts does not matter)

* Nausea or vomiting

* Balance problems or dizziness

* Double or blurry vision

* Sensitivity to light and/or noise

* Feeling sluggish, hazy, foggy or groggy

* Concentration or memory problems

* Confusion

* Does not "feel right"

* Trouble falling asleep

* Sleeping more or less than usual

Be honest - your child must be honest

Encourage your athlete to be honest with you, his/her coach and your health care provider about his/her symptoms. Many young athletes get caught up in the moment and/or feel pressured to return to sports before they are ready. It is better to miss one game than the entire season - or risk permanent damage!

No athlete should return to activity on the same day he/she gets a concussion.

Athletes should NEVER return to practices/games if they still have ANY symptoms.

Parents and coaches should never pressure any athlete to return to play.

The dangers of returning too soon

Returning to play too early may cause Second Impact Syndrome (SIS) or Post-Concussion Syndrome (PCS). SIS occurs when a second blow to the head happens before an athlete has completely recovered from a concussion. This second impact causes the brain to swell, possibly resulting in brain damage, paralysis, and even death. PCS can occur after a second impact. PCS can result in permanent, long-term concussion symptoms. The risk of SIS and PCS is the reason no athlete should be allowed to participate in any physical activity before they are cleared by a qualified health care professional.

Recovery

A concussion can affect school, work, and sports. Along with coaches and teachers, the school nurse, athletic trainer, employer, and other school administrators should be aware of the athlete's injury and their roles in helping the child recover.

During the recovery time after a concussion, physical and mental rest are required. A concussion upsets the way the brain normally works, and causes it to work longer and harder to complete even simple tasks. Activities that require concentration and focus may make symptoms worse and cause the brain to heal slower. Studies show that children's brains take several weeks to heal, following a concussion.

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Study: Concussions take longer to heal from than previously believed

A study analysed people's cerebrospinal fluid to show that it takes longer to heal from concussions than previously believed.

Scientists at the Sahlgrenska Academy, University of Gothenburg, have shown that analysis of the cerebrospinal fluid after concussion can be used to determine the magnitude of brain injury and to follow its course. The studies show that recovery from concussion takes much longer time than previously known, and this may be of major significance for athletes of all ages in return to play considerations.

Sanna Neselius is a scientist at the Sahlgrenska Academy and member of the medical commission of the Swedish Boxing Federation. Her previous studies have shown that amateur boxing causes damage to nerve cells, that can take more than two weeks to heal. This discovery led to her being offered a place in the International Olympic Committee's expert group for boxing-related head injuries.

Sanna Neselius has now defended her doctoral thesis at the Sahlgrenska Academy, in which she shows that sports-related concussion heals much slower than previously known.

Four months recovery

"It has previously been believed that concussion heals in 7-10 days, and the Swedish Boxing Federation has decided the rest period to be of one month after a concussion, in order to be on the safe side. But our studies show that a concussion, such as may be experienced after being knocked out, can take more than four months to heal," says Sanna Neselius, who is herself a former boxer.

Further, the results show that repetitive head trauma in boxing, damages nerve cells in the brain, even though the boxer may not show any concussion symptoms.

Prevent resuming too early

Concussion is one of the most common sports-related injuries, and more athletes experience it every year. In recent years, focus has been directed on the effects of repeated concussions, in which athletes in such sports as ice hockey may be affected by long-term effects.

The cerebrospinal fluid samples analysed by Sanna Neselius and her colleagues can be followed until normalization and thereby be a valuable tool to prevent athletes resuming sport too early.

"The assessment today is often based on physical symptoms, neuropsychological tests, and the neurological examination of the athlete. Our studies show that these tests are not sensitive enough, nor can we rely on the athletes self-reported lack of symptoms. Concussion symptoms usually pass after a few days, but the neurological damage may still be present," says Sanna Neselius.

Safe rehabilitation

She continues: "The first sample is recommended to be taken 10-14 days after the concussion. This allows us to see the magnitude of the injury, and gives an idea of how long the healing process will be. I hope that brain injury markers in the cerebrospinal fluid, and hopefully also later in blood, can be used at all levels in all sports. By this we can use individual measurements to plan and guarantee safe rehabilitation."

Sanna Neselius points out that the brains of children and adolescents are more sensitive and require longer time to heal.

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Study: Concussion rates double in high schoolers

A study claims that rates of concussions have doubled between 2005 and 2012 for high school athletes.

The rate of concussions in U.S. high school athletes more than doubled between 2005 and 2012, new research shows.

The trend probably reflects an increased awareness and more legislation governing concussions in student athletes, and not more danger in sports, the study authors noted.

"The bottom line is that rates have gone up," said lead researcher Dr. Joseph Rosenthal, an assistant professor of physical medicine and rehabilitation at Ohio State University. "We don't know the exact reason. This was an observational study, so I can't say for sure, but I believe what is explaining the increase is the increased awareness, not that sports are more dangerous. It's just that the concussions are being recognized more, which is good news."

The study was published recently in The American Journal of Sports Medicine.

Concussions are usually due to a blow to the head, often in sports such as football or ice hockey, but they also occur in other sports.

The researchers analyzed data from a sample of 100 U.S. high schools that have one or more certified athletic trainers on staff.

Rosenthal's team found that the concussion rate increased from 0.23 to 0.51 concussions for every 1,000 athlete exposures. An athletic exposure is defined as a single athlete participating in one competition or a practice.

From 2005 through 2012, just over 4,000 concussions occurred in seven sports. These included football, soccer, volleyball, basketball, wrestling, baseball and softball.

Five of those sports had increases that were statistically significant. These included football, boys' basketball, boys' wrestling, boys' baseball and girls' softball. High school football had the highest rates of concussion, according to the study.

Increased awareness is probably behind the higher numbers, agreed Steven Broglio, an athletic trainer and director of the Neurosport Research Lab, at the University of Michigan in Ann Arbor. He is also chair of the National Athletic Trainers' Association position statement on the management of sport-related concussion.

"I'm not entirely surprised at this uptick," said Broglio. More concussions are being recognized due to a number of factors, including increased media coverage on the dangers of concussions and position statements about concussion management from organizations such as his, he added.

Another recent study suggested that awareness about the dangers of concussions is higher. Researchers from Children's Hospital Colorado tracked the compliance of high school athletes who suffered from concussions and how well they followed the return-to-play guidelines.

The researchers found that half of the athletes they tracked were compliant in 2007, but by 2013, 80 percent were. Those findings were presented at the recent annual meeting of the American Society for Sports Medicine in New Orleans.

All 50 states and the District of Columbia have some kind of law designed to protect young athletes from returning to play too soon after a concussion. Experts agree that children who have a concussion need evaluation by a health care professional and need to be cleared before they can return to sports.

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Causes of childhood concussion in rural versus urban areas

A study of causes of childhood concussions in rural versus urban areas shows that children living in rural areas get concussions from motorized vehicles and children living in urban areas get concussions from sports.

Researchers at Western University (London, Canada) have found youth living in rural areas are more likely to sustain concussions from injuries involving motorized vehicles such as all-terrain vehicles and dirt bikes, whereas youth living in urban areas suffer concussions mostly as a result of sports. Hockey accounts for 40 per cent of those injuries. The study which reveals where and how children are receiving concussions is published in the Journal of Trauma and Acute Care Surgery.

Dr. Doug Fraser, a scientist with the Children's Health Research Institute at Lawson Health Research Institute and Tanya Charyk Stewart, the Injury Epidemiologist for the Trauma Program at Children's Hospital, London Health Sciences Centre (LHSC) and their team tracked all the youth under the age of 18 who presented to the LHSC emergency departments with a concussion over a six year period. There were 2,112 paediatric concussions, with a steady increase in number treated each year.

"It was important for us to learn about who is getting injured, where they're getting injured, and why they're getting injured. Once you answer those questions, then you can implement targeted injury prevention programs," says Dr. Fraser, an associate professor in the Departments of Paediatrics, Physiology & Pharmacology and Clinical Neurological Sciences at Western's Schulich School of Medicine & Dentistry.

Concussions are a particular concern for children and adolescents because their brains are still developing and they are more susceptible to effects of a head injury. The goal following this research is to create injury prevention programs that target and educate those at high risk of sustaining a concussion.

Concussions can often be predictable. Along with properly following the rules of the sport and wearing the protective equipment, Charyk Stewart suggests, "In sports, if you have been hit, then just get off the field immediately and stop play. If you are experiencing any symptoms, be seen by a doctor."

Dr. Fraser explained what to look for in a child who has experienced a head injury, "Watch the person carefully. In young children look for symptoms like, irritability or an inability to console the child. If the care giver has any concerns at all; if a person has any symptoms whatsoever in conjunction with an injury, they should immediately go and be seen by a doctor. Better safe than sorry, so be seen."

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The difference between concussions in high school and in professional sports

This article explains the difference between concussions in high school sports and concussions in professional sports.

No sports enthusiast will ever forget the goal line collision between Pittsburgh Steelers' Le'Veon Bell and Baltimore Ravens' Jimmy Smith or when Detroit Tigers Catcher Alex Avila was drilled by David Ross of the Boston Red Sox.

Both of these plays caused two serious concussions and both of these athletes returned to play about a week later.

But that's professional sports.

When a high school athlete suffers a severe concussion, it could take weeks before they are back on the field. That's for multiple reasons.

"They too have to go through certain criteria, just like our high school athletes do. However, they are being monitored 24/7. Seven days a week, 365 days a year by the medical staff. They have somebody with them pretty much at all times," said Mike Casselman, HealthWorks.

In high school, it's a different story.

"Though we have athletic trainers there on a daily basis, there might be a day or two gap where the communication isn't there," Casselman added.

The issue of 'chronic encephalipathy' in many NFL players has been receiving a great deal of media attention. In the cases of retired players, it appears most had long careers in the NFL after playing in both high school and college.

In most cases, they played football for more than 20 years and suffered multiple concussions in addition to hundreds of other blows to the head.

But its not just football players that can receive a concussion and its not just from helmet to helmet impact.

"It can be by whip lash. It could be from a quick fall," said Frank Moore, Marion County Athletic Director. "Football would be one you would think. But soccer has a lot of concussions, along with basketball."

Casselman agreed.

"I'm telling you. A big one is cheerleading. People might not think that. It's very competitive in this area. You have the bases that are catching the flyers. They take an elbow, they take a knee," Casselman said.

While many professional athletes blame concussions for their memory loss and depression, little is known about the long term effects concussions can have on high school athletes.

"No concussion is the same and you need to take a very serious approach if they have any of the signs and symptoms," Moore said.

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A blood test may help diagnose concussions

This article discusses research that claims that a blood test could be a non-subjective way to diagnose a concussion.

A report Monday in the journal Pediatrics says kids who suffer concussions should lay off reading, homework and video games. By giving their brains a rest, most can recover in 20 to 50 days, about twice as fast as those who keep doing those activities.

We also have news regarding how concussions are diagnosed. Researchers are developing a test that could be a game changer.

Quarterback Taylor Kelly of the Arizona State Sun Devils understands the mindset of college football players when it comes to injuries: They are going to want to keep playing.

"Guys just want to go out and play it, you know?  They don't care if their heads are a little banged up," Kelly said.

Neurologist Dr. Javier Cardenas specializes in brain injury. He says overcoming the reluctance of athletes to admit symptoms is only one of the problems in diagnosing concussions.

"Right now when we identify a concussion it is purely subjective. We look at symptoms. Do they have headaches? Do they have dizziness? There is no objective information. Having something objective is the holy grail of concussion," said Cardenas.

This season, Kelly and his teammates took part in a study trying to find a better way to detect concussion. Riddell, the athletic equipment company, supplied the team with helmets that measure all head impacts during practices and games. Then, after every game, the players gave samples of their blood, saliva and urine.

These are now being analyzed at the Translational Genomics Research Institute in Phoenix to see whether evidence of head trauma shows up in body fluids as a so-called biomarker.

Brain cells contain generic material call microRNA. Normally, tiny spheres containing that material break off and make their way into the spinal fluid, then the bloodstream. During a concussion, the bran actually bounces against the skull, and researchers believe the impact can cause changes in the microRNA, changes they hope can be detected in blood tests.

TGen scientists are comparing the RNA in each player's body fluids with the impact data from his helmet to see if they match up.

"It might be that we can actually protect players. So identify players who are at risk but have them take it easy, sit out more, based how their biomarkers are rising over time," said Kendall Van Keuren-Jenses, a member of the research team.

The scientists have data illustrating how the technology might have helped one of the players in the study.

The graphic shows the head impacts recorded in his helmet over several weeks. One hit was the equivalent of four times the punch b a heavyweight boxer – the hardest impact received by any player in the study. He continued to play, and was diagnosed with a concussion 10 days later.

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NIH and NFL will research long-term effects of concussions

This article outlines research that will be done on the long-term effects and consequences of concussions. This research will be done as a partnership between the National Institutes of Health (NIH) and the National Football League (NFL).

The U.S. National Institutes of Health is teaming up with the National Football League on research into the long-term effects of repeated head injuries and improving concussion diagnosis.

The projects will be supported largely through a $30 million donation made last year to the Foundation for the National Institutes of Health by the NFL, which is wrestling with the issue of concussions and their impact on current and former players.

There's growing concern about the potential long-term effects of repeated concussions, particularly among those most at risk, including football players and other athletes and members of the military.

Current tests can't reliably diagnosis concussion. And there's no way to predict which patients will recover quickly, suffer long-term symptoms or develop a progressive brain disease called chronic traumatic encephalopathy (CTE), according to an NIH press statement released Monday.

"We need to be able to predict which patterns of injury are rapidly reversible and which are not. This program will help researchers get closer to answering some of the important questions about concussion for our youth who play sports and their parents," Story Landis, director of the National Institute of Neurological Disorders and Stroke (NINDS), said in the news release.

Two of the projects will receive $6 million each and will focus on determining the extent of long-term changes that occur in the brain years after a head injury or after numerous concussions. They will involve researchers from NINDS, the National Institute of Child Health and Human Development and academic medical centers.

One of the projects will attempt to define a clear set of criteria for various stages of CTE. It will also seek to distinguish it from Alzheimer's disease, amyotrophic lateral sclerosis (Lou Gehrig's disease) and other degenerative brain diseases that as of now can only be determined in brain tissue samples collected after death. The objective is to find medical signs of CTE that might eventually be used to diagnose the illness in living people.

The other project will seek to identify the long-term effects of mild, moderate and severe traumatic brain injury (TBI) and compare them with features of CTE. The goal is to identify signs that could be used to diagnose brain degeneration linked to traumatic brain injury in patients.

While the two projects focus on different aspects of traumatic brain injury, "their combined results promise to answer critical questions about the chronic effects of single versus repetitive injuries on the brain, how repetitive TBI (traumatic brain injury) might lead to CTE, how commonly these changes occur in an adult population, and how CTE relates to neurodegenerative disorders like Alzheimer's disease," Landis said.

Six other pilot projects will receive a total of just over $2 million and last up to two years. They will concentrate on improving the diagnosis of concussions and identifying potential medical signs that can be used to assess a patient's recovery. If the early results are promising, these projects may form the basis of more extensive research, the news release said.

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Concussion tests are outpacing scientific research

Computerized concussion testing is becoming more common in sports even though there is little scientific research regarding the tests' effectiveness. Professionals should learn the benefits and limitations of the computerized tests they use.

Computerized neurocognitive testing for concussions is widely used in amateur and professional sports, but little research over the past decade proves its effectiveness, a paper published this month in the journal Neuropsychology Review says.

Jacob Resch, director of the Brain Injury Laboratory at The University of Texas at Arlington, is lead author on the review, which updates a 2005 look at the available research on computerized neurocognitive testing. In 2005, researchers said not enough evidence existed to support clinical use of the then relatively new assessments.

The more recent work acknowledges that computerized tests, such as those marketed under the name ImPACT, HeadMinder, CogState, and ANAM, have become extremely commonplace across the sports world. But, the authors still urge caution with their use and point out a need for more peer-reviewed studies.

"Limited data has been published since 2005 to assist clinicians in determining the clinical value of this form of testing," Resch said. "While these products are an important component of concussion management, their development, marketing and sales seem to have outpaced the evidence. So, some caution is needed."

Co-authors are Michael McCrea, an author of the 2005 study and director of brain injury research at the Medical College of Wisconsin, and C. Munro Cullum, professor and head of the neuropsychology program at UT Southwestern Medical Center.

"Given the attention that concussion in sport has gained in recent years, it is surprising there has not been more research into the some of the newer computer-based methods used to evaluate post-concussion symptoms," Cullum said. "Since there is no single brain-test or biomarker for concussion at this point, the diagnosis of concussion remains a challenge in many cases, as it relies upon reported and observed symptoms."

Resch, McCrea and Cullum found 29 peer-reviewed articles since 2005 have addressed the characteristics of commercially available computerized neurocognitive tests. After a detailed analysis, they concluded that evidence on reliability and validity of the tests wasn't consistent.

For example, in a May 2013 study published by the Journal of Athletic Training, Resch and other researchers found that the ImPACT test misclassified healthy study participants as impaired as much as 46 percent of the time for some evaluation factors. ImPACT stands for Immediate Post Concussion Assessment and Cognitive Testing and is by far the most used computerized neurocognitive test for concussion management.

An Institute of Medicine report early this year said that the number of people 19 and under treated in U.S. emergency rooms for concussions and other non-fatal, sports and recreation-related traumatic brain injuries increased from 150,000 in 2001 to 250,000 in 2009. With the recent settlement of a landmark lawsuit filed by former NFL players, concussions remain in the headlines and on the minds of athletes, parents, coaches and others in the sports world.

Recently, nearly 40 percent of athletic trainers reported using a computerized neurocognitive tests as part of their response to a sports-related concussion, according to the new paper. The convenient computerized tests are typically used, just as pen and paper versions were in the past, to establish a baseline to use as a point of comparison after an athlete is injured. But, because concussion symptoms can vary widely across individuals and may be subtle, clear documentation of mild brain injury can be difficult.

The findings of the new survey should serve as a caution to those utilizing and interpreting computerized cognitive test results, the researchers said.

"Neurocognitive testing is an important component of the concussion assessment, but should not be used as a stand alone method to diagnose injury or determine an athlete's level of recovery and fitness to return to play," said McCrea. "A multi-dimensional approach is supported by the evidence as best practice."

Until more research is done, the new paper from Resch, McCrea and Cullum recommends healthcare professionals who use the tests take some precautions, including:

• Making an informed decision when choosing a test and investigating its limitations.
• Making sure the test is part of a multi-faceted concussion management approach.
• Incorporating a clinical neuropsychologist into the sports-related concussion management team to assist in interpretation of test results.
• Ensure proper training of those administering the test.
• Conducting quality control reviews of baseline testing.

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Youth concussions in sports

This article discusses the basics of youth concussions, discusses the signs and symptoms, and provides resources for more information.

Athletes sometimes joke about “getting your bell rung” or feeling a “stinger” after taking a hit to the head during sports. However, adolescent concussions are common and can have serious consequences.

WHAT IS A CONCUSSION?

A concussion is a type of brain injury. The brain is made of soft tissue and is surrounded by a cushion of spinal fluid. The skull surrounds the brain and protects it. A person can injure their brain by getting hit on the head, or even the body, resulting in the brain moving around in the skull. This can lead to bruising of the brain, damage to blood vessels, and injury to nerves. People can get a concussion from a fall, a car crash, or a sports injury.

CONCUSSIONS AND SPORTS

One of the most common ways children and adolescents get concussions is through sports injuries. A recent review estimated that up to 3.8 million recreation- and sports-related concussions occur each year in the United States. The sport with the highest risk of concussion in high school is football. In girls' sports, the rate of concussion is highest in soccer and basketball. Girls have a higher rate of concussion than boys when they are in similar sports. Young athletes' brains are still developing, thus they may be at higher risk for the effects of a concussion. The way in which the injury happens may be very important in predicting how serious the injury will be. This was described in a study in this month's Archives.

SIGNS AND SYMPTOMS

The signs and symptoms of concussion fall into 4 categories:

• Physical: Headache is the most frequently reported symptom of a concussion. Nausea and vomiting can also occur. Problems with balance, vision, and fatigue are also common.
• Cognitive: A feeling of mental “fogginess” or feeling “slowed down” are also common. Loss of memory is a symptom that suggests a more serious injury.
• Emotional: Symptoms may include irritability, sadness, or nervousness.
• Sleep: Symptoms may include feeling drowsy and sleeping more than usual. However, some patients sleep less than usual and have difficulty falling asleep.

CONCUSSION: TRUE OR FALSE

• If my child is in a soccer game and hits his head, the concussion should be “toughed out” until the end of the game.
  False. Children or adolescents who have a concussion, or parents or coaches suspect they have one, should always be evaluated by a qualified health care provider before returning to play.
• You do not have a concussion if you did not lose consciousness.
  False. A concussion often does not result in loss of consciousness; brain injury occurs even without this.
• My child had a concussion and her pediatrician said she should take a break from playing basketball and from playing video games.
  True. After a concussion, all athletes should be restricted from physical activity until they have no symptoms both with rest and with exercise. Physical and cognitive exertion should be avoided. Activities such as doing homework, playing video games, using a computer, or watching television may worsen symptoms. A return to full activities should only occur under the guidance of a qualified health care provider and should stop if symptoms return with activities.
• A concussion can take weeks or even months to fully recover from.
  True. Symptoms of a concussion usually resolve in 7 to 10 days, but some athletes may take weeks or months to fully recover.

FOR MORE INFORMATION

American Academy of Pediatricians
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;126/3/597

INFORM YOURSELF

To find this and other Advice for Parents articles, go to the Advice for Parents link on the Archives of Pediatrics & Adolescent Medicine website at http://archpedi.ama-assn.org/.

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