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Concussions: Long Term Effects and

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Kyle Shenfeld

on 18 February 2014

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Transcript of Concussions: Long Term Effects and

Concussions: Long-Term Effects and Neurological Underpinnings
Concussions: Generally
What Causes a Concussion?
Brain freely floating within cerebrospinal fluid
Initial impact, or coup, causes a countrecoup when brain strikes inside of skull
Brain swells- in severe cases, it puts pressure on the brain stem, which controls breathing and other basic life functions
Shaking disrupts the brain's normal chemical balance
Source: U.S. Centers for Disease Control and Prevention. University of Pittsburgh Medical Center; Graphic: Andrea Machietto, San Jose Mercury News
Football Anatomy of a Concussion
Physical Symptoms
Headache*
Nausea
Vomiting
Balance Problems
Dizziness
Visual Problems
Fatigue
Sensitivity to Light or Noise
Numbness/Tingling
Dazed or Stunned
Cognitive
Feeling mentally "foggy"
Feeling slowed down
Difficulty concentrating
Difficulty remembering
Answers questions slowly
More Emotional
Sleeping Issues
Drowsiness
Sleeping less/more than usual
Trouble falling asleep
1. Clinical Symptoms
Symptoms assessed using a combination of self-reported questionaires and clinical interview questions
Following a concussion, athletes may experience any or all of 21 disparate symptoms including:
Irritability
Sadness
Nervousness
Concussion Evaulation
Definition:
Concussion may be caused either by direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head
Concussion Diagnosis:
Sports-related concussion is a hetergeneous injury that is characterized by a myriad of symptoms, variable clinical presentations and recovery trajectories
1. Clinical Symptoms
2. Neurocognitive Testing
*Most-Common Symptom: 75% of patients report this symptm
3. Neuroimaging
4. On-Field Sideline Evaluation
Looking Inside the Helmet
When football player takes a hit to the head speeds range from 17-25 mph with a force averaging 98X the force of gravity
The shock wave passes through the brain and bounces off the skull
Concussion usually occurs on opposite side of impact
Impact can cause bruising of the brain, tearing of blood vessels, and nerve damage
Sources: School of Hard Knocks, MayoClinic.com, Biokinetics, Washington Post, Science Daly, Kidshealth.org, Kaiser Permanente, The Denver Post (Andrew Lucas, Jeff Goertzen)
2. Neurocognitive Testing
Computerized Neurocognitive Testing (NCT)
Provides essential tool in comprehensive approach to asessing sports-related concussions.
NCTs take approximately 20-30 minutes to complete and assess patient's:
Demographics (i.e. age, sex)
Concussion History and Injury information
Concussion Symptoms (i.e. headache, nausea, dizziness)
Cognitive Tests (i.e. attention, memory, processing speed, reaction time)
Current NCTs Tests:
Automated Neuropsychological Assessment Metrics (ANAM)
AXON/CogSport
CNS Vital Signs
Headminders
Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)
ImPACT Test
Test includes 4 clinical composite scores covering:
(1) Visual Memory
(2) Verbal Memory
(3) Processing Speed
(4) Reaction Time
Built-in validity measures to detect individuals not completing test with full effort
3. Neuroimaging
Neuroimaging contributes
little
to concussion evaluation
CT and MRI:

can indicate if more serious brain injury and/or underlying neuropathology are suspected
Findings for over 90% of CTs and structural MRIs are negative
Alternative Imagine Techniques (fMRI, DTI):
Not yet established for clinical assessment and monitoring of recovery of athletes following sport-related concussion
fMRI (Functional Magentic Resonance Imaging):
utilizes performance of specific tasks while subject is in scanner
Used to detect changes in blood oxygenation and neural activity
DTI (Diffusion Tensor Imaging):
measures movement of water within brain
Used to evaluate white matter fiber structure, which can be altered after concussion
Following a concussion, researchers
still differ
on the amounts of:
FA (fractional anisotropy):
measure of white matter integrity or density in brain
MD (mean diffusivity):
measure of average magnitude of diffusion in the brain
Sources: Kumar R, Husain M, Gupta RK, Hasan KM, Haris M, Agarwal AK, Pandey CM, Narayana PA (2009) Serial changes in the white matter diffusion tensor imagine metrics in moderate traumatic brain injury and correlation with neuro-cognitive function. J Neurotrauma 26: 481-495; Henry LC, Tremblay J, Tremblay S, Lee A, Brun C, Lepore N, Theoret H, Ellemberg D, Lassonde M (2011) Acute and chronic changes n diffusity measures after sports concussion. J Neurotrauma 28: 2049- 2059; Mayer AR, Ling J, Mannell MV, Gasporovic C, Phillips JP, Doezema D, Reichard R, Yeo RA (2010). A prospective diffusion tensor imagine study in mild traumatic brai injury. Neurology 74: 643-650; Wilde EA, Ramos MA, Yallampalli R, Bigler ED, McCauley SR, Chu Z, Wu TC, Hanten G, Scheibel RS, Li X, Vasquez AC, Hunter JV, Levin HS (2010) Diffusion tensor imaging of the cingulum bundle in children after traumatic brain injury. Dev Neuropsychol 35: 333-351
4. On-Field or Sideline Evaluation for Concussion
Player should be evaluated
by a physician or other licensed healthcare provider
onsite using standard emergency management principles
If no healthcare provider is available, player should be safely removed from practice or play
Once first-aid issues are addressed, assessment of the concussive injury should be made using:
Sideline assessment tools (i.e. SCAT3)
SCAT3 does
NOT
adequately assess neurocognitive function (i.e. reaction time, processing speed, design memory) and must be augmented by clinic-based assessments
Source: Michael C., Anthony K., Erin R., Christopher M., Freddie F. A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion. Knee Surg Sports Traumatol Arthrosc (2013) 22: 235-246
Right to Play Policy
It is CRITICAL for clinicians to follow a standardized return to play (RTP) protocal.
"When in doubt sit them out"
Current Internatonal Consensus Statement identifies need for stepwise RTP protocol, where athlete may progress to next level ONLY WHEN asymptomatic at current level for 24 hours
Source: McCrory P, Meeuwisse WH, Aubry M, Cantu RC, Dvorˇa ́k J, Echemendia RJ, Engebretsen L, Johnston K, Kutcher JS, Raftery M, Sills A, Benson BW, Davis GA, Ellenbogen R, Guskiewicz KM, Herring SA, Iverson GL, Jordan BD, Kissick J, McCrea M, McIntosh AS, Maddocks D, Makdissi M, Purcell L, Putukian M, Schneider K, Tator CH, Turner M (2013) Consensus statement on concussion in sport: the 4th international conference on concus- sion in sport, Zurich, November 2012. J Athl Train 48(4):554–575
Management & Recovery
Risks If Concussion Not Properly Managed
Most recover in 1-2 weeks, 95% recover in 3 months.
If not completely recovered, could result in additional concussion

Second Impact Syndrome
A Concussion prior to recovery from a prior concussion
Athlete is still sympotmatic
Mostly males < 21 years old
Cumulative Effects of Concussions
After 1 Concussion
: Risk of concussion is
4-6X
greater
After 2 Concussions
: Risk is
8X
greater
Increased risk of later depression, dementia, or CTE
Chronic Traumatic Encephalopathy (CTE)
Progressive degenerative disease from multiple concussions
Build up of
tau protein
in brain
Center for the Study of Traumatic Encephalopathy
35 brains of deceased athletes in study (13 belonged to former NFL players)
12/13 NFL brains manifested CTE
Sources: Silberman, Marc Richard. Concussions in Sport Mitigating Risks in the Student Athlete. NJSportsMed.com; http://www.sportslegacy.org/research/cte/
Is NFL Responsible for Long-Term Concussion Effects?
Sources: http://www.forbes.com/sites/alexberezow/2013/12/11/are-repeated-concussions-really-killing-nfl-football-players/
http://newyork.cbslocal.com/2013/03/11/nfl-announces-major-research-project-on-preventing-concussions/
Several high-profile suicides among former NFL players have stirred a debate over whether or not repetitive concussions in football can cause cognitive decline later in life (CTE)
Both the NFL and Riddell find themselves embroied in litigation surrounding the long-term effects of concussions
NFL Concussion Litigation
NFL & Concussions
Mike Webster:
Played in NFL for 17 years
Died in 2002 at the age of 50
During playing career:
Known as "Iron Mike"
Prior to death:

Urinating in his own oven
Squirting Super Glue on his rotting teeth
Tazering himself into unconsciousness just to get some sleep
Suffered from depression, memory loss and crazy behavior
1997: HELP!
Webster went to lawyer Bob Fitzsimmons for help
Medical records confirmed closed-head injuries as a result of multiple concussions
NFL awarded Webster $3000/month,
the lowest level of disability
Autopsy after death:
Showed Webster suffered from CTE
NFL Concussion Statistics
Hits Per College Football Season:
Average college football player sustains 950-1100 sub-concussive blows per season
Hits are enough to do cumulative damage to young brain tissue but NOT enough to cause immediate symptoms
NFL Concussions Per Season:
Approximately 1700 concussions sustained in NFL per season
Study Conducted By NFL's Committee On Mild Traumatic Brain Injury (MTBI):
Mean impact velocity of 9.3m/second (20.8 mph); and
Head velocity change of 7.222 m/second (16.1 mph)
As Compared To Car Accidents:

involve impact durations of less than 6m/second for head impacts
Source: Michael C., Anthony K., Erin R., Christopher M., Freddie F. A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion. Knee Surg Sports Traumatol Arthrosc (2013) 22: 235-246
Source: Dunn, Catherin K. Football is Taxing on Player's Brians - So Why Not Tax the NFL? A Simple Solution To the Headache of Concussion Litigation. http://nflconcussionlitigation.com/?page_id=1011
Source: Dunn, Catherin K. Football is Taxing on Player's Brians - So Why Not Tax the NFL? A Simple Solution To the Headache of Concussion Litigation. http://nflconcussionlitigation.com/?page_id=1011
General Motors:
Defendant's Claims
Davis-Frye Analysis
"General scientific recognition may not be established without the testimony of impartial experts whose livelihoods are not intimately connected with the evidence at issue."
When conducting a Davis-Frye analysis, a trial court should focus on the method, process or basis underlying an expert's conclusions
The evidence demonstrated that SPECT scans were generally accepted within the scientific community as having an ability to show abnormalities in brain functioning.
They are used in the same fashion that a CT scan might be used by an expert to evaluate a patient and reach a diagnosis
Result
The SPECT and expert testimony was deemed credible
SPECT Scans
Single-photon emission computed tomography (SPECT)
Different than MRI or CT scan
SPECT measures: blood flow and activity patterns
When using SPECT, physicians look for 3 things:
1. Areas of your brain that work well
2. Areas of your brian that are low in activity, and
3. Areas of your brain that are high in activity
General Motors (SPECT Scans)
Source: http://articles.mercola.com/sites/articles/archive/2012/10/28/psychiatry-needs-spect-imaging.aspx
The trial court erred when:
It allowed plaintiff to present a SPECT scan at trial
In defendants' pretrial motion in limine:

Argued the trial court should omit any reference to the SPECT images of plaintiff's brain because these scans are not generally accepted within the scientific or medical communities
The monetary award was not so egregious as to warrant remittur
AND
Boyd v. Bell
The Role of Uncertainty
Much ambiguity ensued as to cause Boyd's neurologic disabilty
The side effects of such head trauma may not set in until many years after the trauma itself is suffered
A SPECT was conducted, though the expert testimony showed disagreement among various neurological specialists as to whether and to what extent the injuries Boyd suffered were a result of his head trauma
Result for Boyd
Uncertainty as to whether Boyd's disability arose from the injuries he incurred in professional athletic competition precluded any finding of abuse of discretion under ERISA
With a deferential standard like this, it is very difficult for someone like Boyd to win a claim, especially if he or she does not report the issues they are suffering right away
Despite the fact that the effects of the injuries may not manifest themselves until many years later
Takeaways
It seems like the neurological ramifications of concussions are not entirely clear, as even experts as vastly differing opinions
This is why the NFLPA has made such an effort to prevent concussions - not only are they extremely dangerous, but the ramifications stemming there from may not be readily traceable to the particular injury in fact
Source: Boyd v. Bert Bell/Pete Rozelle NFLA Players Ret. Plan, 410 F.3d 1173 (9th Cir. 2005)
NFL Settlement Case
$765 Million Settlement
DENIED
In a stunning development, U.S. District Judge Anita Brody rejected the proposed $765 million settlement between the NFL and more than 4,800 retired players (plus 1,000 of their family members) who sued the league over concussions
Brody's central concerns:
Not enough money
was set aside for each of the potentially 20,000 retired NFL plarswhowul be eligible to receive money for the rest of their lives
Lack of data
in support of settlement's assumptions
Funding would be for:
1. Treatment
2. Research
Lack of Data
"Lack of Data" particularly relevant for our course:
Options
The Bottom Line
Legal case against the NFL for concussions much harder than the media suggests because of "lack of data"
Aside from NFLPA suit, settlement is even more difficult because several suits have been brought against the NFL (and associated equiment companies) by players in their individual capacity
Source: http://sportsillustrated.cnn.com/nfl/news/20140114/judge-rejects-proposed-nfl-concussion-settlement/
*Keep in Mind
Very uncommon for a judge to reject a settlement that:
Both Sides agree to
AND
Recommended by netural court-appointed mediator (former U.S. District Judge Layn Phillips)
An exclamation that more research on concussions and their neurological effects on athletes is lacking and in need of support (specifically through funding and research)
Judge Brody's
REJECTION
All still struggling to agree upon the potential short and long-term effects of concussions
NFL
NFLPA
U.S. Court system
New settlement proposed:
$1 Billion+
Figure might be shot down as arbitrary:
Lack of neurological and economic data on the subject
Return to litigation
If NFL and retired players fail to reach new settlement that gains Judge Brody's approval, likely return to litigation (could take years to play out)
Not litigation retired players should feel confident about
Players
: strong moral case that NFL acted unethically in how it treated player concussions, BUT
NFL:
1. Statutes of Limitations: Players' claims may be time-barred under various state's laws
2. Assumption of risk inherent in fooball
3. Injuries caused by head trauma from football may have resulted from injuries sustained in high school or college

The Suit
• Best is suing Riddell and NFL on the grounds that the NFL “was aware of the evidence and the risks associated with repetitive traumatic brain injuries … but deliberately ignored and actively concealed the information.” Equipment company Riddell, which manufactures the NFL’s helmets, also was named in the suit.
• Best is suing on his own behalf (not on behalf of the NFLPA)
• Best suffered at least 5 concussions in his career
3: NFL's Detroit Lions
2: University of California (Berkley)
• Might the litigation open the door for athletes against collegiate universities as well?

NFL/Riddell's
Counter-Arguments
Statute of Limitations:
Products liability statute of limitations in California is only 2 years
Assumption of risk:
In the sports context California's 2nd district defined a risk as inherent in a sport when “its elimination (1) would chill vigorous participation in the sport, and (2) would alter the fundamental nature of the activity.”
Comparative Negligence:
Whose fault is it – the NFL’s, Riddell helmets, or both?
Does Riddell owe the players a duty under the Collective Bargaining Agreement (CBA)?

Jahvid Best Litigation
Sources: http://nfl.si.com/2014/01/28/jahvid-best-concussion-lawsuit; http://nflconcussionlitigation.com/wp-content/uploads/2012/08/Helmet-to-Helmet-copy.pdf
How to Prevent Concussions
Helmets Lower Incidence of Concussions
Research:
Led by Stefan Duma, Professor and head of the Virginia Tech – Wake Forest School of Biomedical Engineering and Sciences
Researchers from Virginia Tech University embedded sensors into 2 different types of football helmets
Helmets:
Riddell VSR4 and Riddell Revolution
Sensors:
helped measure biomechanics and head acceleration of over 1 million head impacts
From 2005-2010:
1833 college football players equipped with helmets
Results:
Researchers found Riddell Revolution helmet
reduced
concussion risk in players by up to 54% compared to the Riddell VSR4
Reliability of Results:
First to control the # of times players hit their heads→ allows them to compare “apples to apples.”
Old studies did NOT take into account that certain players get hit more frequently than others
BUT Reluctant to Change:
College and NFL teams still drawn to VSR4 even though risks are higher

Diminishing The Force of Helmet-to-Helmet Hits
Research:
Led by Vijay Gupta, UCLA Professor with expertise in biomechanical engineering
Gupta created a polymer that could diminish the force of helmet-to-helmet hits on a football field or shockwaves from explosive devices on a battlefield
Testing:
Gupta used lasers and a grandfather-clock-sized hammering machine
Results:
As of 2013 research, Gupta and his team have been able to achieve up to a
25% reduction
in the force a person would feel
25% reduction
: translates to a similar reduction in the probability of getting a concussion
Polymer must be placed
inside the helmet on the foam padding
If placed outside helmet, it
increases
impact force

No Helmet Brand Safer Than Another
No Helmet Can Completely Prevent Concussion
Research:
In 2000: Biomechanics firm hired first by the NFL and later by Riddell to test helmets and study head injuries
Results:
Warning:
“No football helmet, no matter how revolutionary, could prevent concussions.”
BUT:
Riddell still allowed to market the helmet as protective against concussions
Riddell promoted helmet (Riddell Revolution) by saying that players who wore helmet were 31% less likely to suffer a concussions
Discussed in Jahvid Best case

Helmet Ads: Is Marketing An Accurate Representation?
Helmets
Source: http://www.foxnews.com/health/2014/01/31/football-helmet-design-can-lower-concussion-risk-study-finds/)
Source: http://today.ucla.edu/portal/ut/developing-new-materials-to-prevent-248008.aspx
This grandfather-clock-sized machine is so powerful it shakes the floor when it drops its weight onto a helmet
To help ensure that players would want to wear safer helmets, UCLA engineering professor Vijay Gupta and his team of students kept the polymer thin so as not to alter current football helmets too much
Source: http://www.latimes.com/science/sciencenow/la-sci-sn-concussion-high-school-football-helmet-mouthguards-20131028,0,7936827.story#axzz2tWS1kM1p
Source: http://espn.go.com/espn/otl/story/_/id/9228260/report-warned-riddell-no-helmet-prevent-concussions-nfl-helmet-maker-marketed-one-such-anyway
From Riddell 360 Promotional Information
Improved Concussion Protection
Safer, more protective, and advanced frontal helmet protection designed to reduce concussions
Through years of data collecting and testing, and after analyzing over 1.4 million helmet impacts using their Head Impact Telemetry System (HITS), which records the frequency and severity of impacts players receive during games and practices, hits to the side and front
All Riddell Concussion Reduction Technologies specially designed to cushion to head, absorb impact, and reduce the risk of concussions by 31%, when compared to a traditional helmet (Neurosurgery, February 2006, Vol 58, No.2.)
BUT: Advertisment does NOT mention that helmet CANNOT eliminate concussions AND/OR the risks and dangers of concussions
Societal Ways to Prevent Concussions
Coaching/Parenting Concussions
Sources: http://www.cdc.gov/washington/~cdcatWork/pdf/concussions.pdf; http://sportfoundation.org/concussion-clinic/concussion-prevention/)
Educate athletes, parents and coaches about concussions
Teach athletes the risk of playing with a concussion
Work with league and school officials to monitor changes in athletes following a concussion
Center for Disease Control (CDC) Concussion Management Action Plan
Choice of Participation
Sources: http://www.sportsonearth.com/article/63895452/); - http://espn.go.com/espn/otl/story/_/page/popwarner/pop-warner-youth-football-participation-drops-nfl-concussion-crisis-seen-causal-factor
Roundtable Discussion:
Aspen Institute’s Sport and Society program hosted roundtable discussion in Nov 2013 in Washington DC on youth football safety and the sport’s future
In attendance at roundtable:
NFL’s top lobbyist
Executive Director of the NFLPA
Journalists, Academics, Lawyers, School Officials, Coaches, and Scientists
Results:
Sports concussion expert Robert Cantu proposes
children under age 14 NOT play tackle football
because both brains and bodies are developing and therefore more vulnerable to serious injury
Marist College Poll:
1/3 Americans say that knowing about the damage concussions cause would make them less likely to allow their sons to play football
Washington Post Survey:
of about 500 NFL retirees, less than 50% would recommend that children play
Pop Warner Decline:
nation’s largest youth football program saw participation drop 9.5% between 2010 and 2012

Assumption of Risk
Premise of Series
Throughout the series, coaches and parents offer insight into why they believe football is important, what motivates them as individuals, and what valuable lessons they believe the children learn from their discipline and dedication.
But in a youth football league where participation medals mean nothing and winning means everything, the adults in FRIDAY NIGHT TYKES also grapple with questions like:
How much competition is too much?
Is the sport safe for young children?
At what price are we pushing our kids to win?
Encouraging Bad Behavior:
How TV Is Promoting Concussions
On February 5, 2014, Good Morning America reported that 2 coaches featured on “Friday Night Tykes” have apologized for their own behavior after being suspended for encouraging bad behavior among their eight and nine-year-old players
Parental Responsibility:
Should parents be held responsible for forcing kids to play football?
What is the best way for parents to inform thier children of long-term risks (i.e. second-impact syndrome)?
Assumption of Risk

Should athletic trainers be mandatory at football games?
Survey of Chicago public high school football teams:
10.5% had a physician present during games
8.5% had an athletic trainer
During Practice:
NO school had a physician and only 1 school had a trainer
National Athletic Trainers’ Association:
Only 42% of high schools nationwide in 2010 had access to a certified athletic trainer
NFL Rule Changes
Crown of the Helmet:
Both runners and tacklers are prohibited from initiating contact with the crown of their helmet outside the tackle box. The components of an illegal hit are: (1) The player must line up his opponent, (2) the player must lower his head, and (3) the player must deliver a forcible blow with his crown to any part of the opposing player's body.
Supplemental discipline for Rule Violation:
All violations of player safety rules are subject to potential fines or suspensions. All violations of rules regarding contact to the head of defenseless players shall be considered for suspension if: (1) the striking player took an unobstructed path, (2) the opponent's position hasn't been affected by another player, and (3) contact was clearly avoidable. Mitigating factors will be taken into account if they are available.
One or more prior violations of this type means the player will be suspended, even if there are mitigating circumstances.
Result in 2014 NFL Season:
Players tried to “hit lower” to avoid helmet to helmet contact
Resulted in above-average number of knee/lower body injuries (i.e. ACL/MCL/PCL tears)
NFL's Inevitable Struggle:
NFL is still struggling to balance changing the game and promoting safety

Friday Night Tykes
What America Should NOT Be Teaching Children
Source: http://www.gao.gov/assets/130/124719.html)
Athletic Trainers
Source: http://www.sbnation.com/nfl/2013/8/8/4594316/nfl-rule-changes-2013; http://mmqb.si.com/2013/12/04/nfl-injury-increase-2013/
Concussion's Growing Awareness (The Need For)
Knowing The Cause of Symptoms
Example:
Boyd took Advil and did not realize potential long-term severity and future day-to-day issues.
Boyd’s lack of awareness
Initially he did not think his day-to-day post-career problems were concussion-related, and this wound up being a detrimental fact in his suit to recover against the NFL for his injuries.
Awareness:
Had the “concussion topic” been more prevalent back then, Boyd likely would have suspected that his issues were concussion-related earlier on, which would have greatly strengthened his suit against the NFL.
There are psychological (depression-type) symptoms associated with concussion/head-trauma that players could seek psychiatric treatment for, if they were aware that such behavior
Example:
Mood swings and depression can be related to head trauma

Suicide, Depression & Memory Loss
Sources: http://www.slate.com/articles/health_and_science/science/2012/05/junior_seau_s_suicide_are_concussions_responsible_.html; http://espn.go.com/nfl/story/_/id/7930585/nfl-junior-seau-suicide-raises-more-questions-nfl-handling-concussions-espn-magazine
Seau & Easterling
On April 19, 2012, Ray Easterling, a former defensive back for the Falcons killed himself with a handgun
Crucial Need for Concussion Awareness
Though research continues to grow on the subject, the lack of uncertainty and the
speculative and unscientific
status of the data at least in the eyes of NFL personnel, make the need for concussion awareness and research all the more crucial
Depression & Memory Loss

Easterling's Widow On Husband's Mental Health:
"He felt like his brain was falling off"
"He was losing control. He couldn't remember things from five minutes ago. It was frightening, especially for somebody who had all the plays memorized when he stepped onto the field"

CTE Can Lead To:
Depression
Memory loss
Dementia
Can cause victims to lose control of their impulses.
CTE Diagnosis Originally Rejected:
When forensic neuropathologist Bennet Omalu diagnosed the first cases of CTE in former NFL players, finding the syndrome in ex-Steelers Mike Webster and Terry Long, the NFL's experts disparaged work
In 2005, Elliot Pellman, then-chairman of the league's concussions committee, called Omalu's conclusions "speculative and unscientific," and three members of the committee publicly urged Omalu to retract his findings
Since Then:
CTE's "telltale tangles" found in the brains of 50+ dead athletes (i.e. boxers, NHL players, wrestlers and NFL players)

Junior Seau (former Patriots /Chargers linebacker) committed suicide with a shotgun in May of 2012 – commentators called it “a sobering wake-up call” for the league
The deaths of Easterling and Seau were an awful reminder of:
How dramatically the politics of pro football have slowed progress toward helping damaged retirees
How little we understand what's going on inside the brains of former players
Future of Neuroscience in the Law
Neurological Techniques Used In The Courtroom:
If medical experts can instruct jury on relevance of certain scans (i.e. SPECT technology in General Motors), perhaps (if agreement amongst experts can occur) techniques such as lie detection can be implemented in the courts as well (i.e. a jury could be instructed upon the validity of a neurological lie-detection technique, similar to a Daubert analysis)
Neurological Research And Imaging Techniques Include:
fMRIs, SPECTs, DTIs, and even Mind-reading technology (designed to pick up mal intent) (see Moreno article)
The Butler article also sugests that neuroscience may also be used to detect lying in the future

Pop Warner Participant Contract and Parental Consent Form
Do parents
actually inform
the child of such dangers?
Source: http://www.newsworks.org/index.php/local/behind-the-lines/61170-from-the-archive-anatomy-of-a-concussion
Source: Michael C., Anthony K., Erin R., Christopher M., Freddie F. A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion. Knee Surg Sports Traumatol Arthrosc (2013) 22: 235-246; http://www.choc.org/concussion/
Source: Finey v. General Motors, (Mich. App. 2003)
ESPN Sport Science: Concussions
SCAT3:
standardized tool for evaluating injured athletes for concussions and can be used to diagnose athletes ages 13+
SCAT3
Source: http://view.officeapps.live.com/op/view.aspx?src=http%3A%2F%2Fnjsportsmed.com%2Ffiles%2FConcussions_in_Sport.ppt
UCLA Research Testing
Research:
Research team from the University of Wisconsin-Madison and the Medical College of Wisconsin tracked 1332 high school football players from 36 schools during 2012 season
Process:
Participating players completed:
Pre-Season research questionnaire about injury history and demographic information
In-Season research collected by athletic trainers from schools on incidence and severity of concussions
Results:
Start of Study:
171 players (13%) told researchers they experienced sports-related concussions in last 12 months
Additional 115 players (8.6%) sustained concussions during 2012 season
Results:
No Statistical Difference between helmet brands
Custom Fit Mouthguards Prevent Concussions:
There WAS a
statistically significant difference
between wearing specialized mouth guards that were custom fitted
Should custom mouth guards be mandatory for high schools?

Source: http://www.sportsunlimitedinc.com/riddell-360-adult-football-helmet-with-360-2bd-lw-facemask.html
Source: http://abcnews.go.com/blogs/entertainment/2014/02/friday-night-tykes-reality-show-coaches-suspended/
Source: http://tv.esquire.com/shows/friday-night-tykes
The Future of Neuroscience And The Law
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