Aa three because of concerns about liquidity. Shares have fallen 60 this year amid criticism about accounting practices. Bridgestone has decided to bow with pep boys. T for pep boys. An offerhad accepted with bridgestone last week. Icon said he would raise his bid even further. Cahn said he would raise his bid even further. Three ships now operated by the coast guard sailed inside the china sea zone. Treatybound to come to japans defense in the event of an armed attack. Widespread misconduct, black bell and bribery among the potential crimes. The Opposition Labor Party said it was politically motivated, aimed at discrediting its ties with the union movement. We are seeing the hang seng down a third of 1 . The rest of the boards gaining. From our studios in new york city, this is charlie rose. Charlie rose we continue our examination of the magnificent human brain. Kids and young adults make nearly 250,000 emergency room visits each year as a result of brain injuries caused by sports. Our increasing understanding of this effect has ignited a National Discussion about the risks of contact sports. Tori turned down a full scholarship to play soccer after she suffered her fifth concussion. She joins me now to talk about her experience. Well also hear from a Remarkable Group of scientists. Dr. Eric kandel is a nobel laureate. I am pleased to have all of them at this table. Tell me about concussions among young people. Dr. Kandel this has emerged as one of the major Health Issues of our time. Why is that so . There is a general consensus that team sports is extremely advantageous for young people. 50 million americans participate in group sports. This is beneficial in two ways. From an athletic point of view, they learn early on that daily exercise is good for you. Many of them are likely to carry this forward for the rest of their lives. Ensuring them a healthier lifespan than they would otherwise have. There are also social values that come with it you learn from team sports a sense of honesty and fair play and teamwork. A downside emerged recently. At the very highest level, official football and soccer and basketball, there are traumatic brain injuries that are associated with the sports activities. Some of them can lead to extreme brain damage. This has become a National Issue president obama called a summit meeting on this inmate. It which he raise this issue. President obama concussions are not just a football issue. Young people made nearly 250,000 rain related emergency room visits. The total number of young people affected by this early on is probably bigger than we know. Dr. Kandel young people are particularly susceptible to traumatic brain injuries. It is the leading cause of death and disability in young people. We want to understand what this is about. What is a traumatic injury . The brain is angel agness oregon that is protected by being encased in a rigid bony skull. When we move about there is Minimal Movement in the brain. As a result of two kinds of forces there can be serious jarring of the brain. It moves rapidly backandforth within that enclosed space. It is separated from the skull by a fluid layer called the cerebral spinal fluid. Either by another skull hitting it, by hitting the ground, by hitting a soccer ball. There are inertial forces that dont involve any contact at all. It is like a whiplash injury or something banks into your body and can shake up the brain or if you fall on the ground it can shake up the brain. Often these forces interact with one another. There are significant consequences in peoples neurological states. Traumatic brain injuries fairy from being modest to being moderately severe. The modest injury falls into two categories. The vast majority recover within seven days. In some cases even with modest injury the recovery may take longer. With moderate or severe injury, the recovery takes longer. I was the factors that lead to this prolonged recovery . Young people are more susceptible. Prior concussions means it takes longer to recover it also is that if you have had one concussion, you are much more likely to have a second concussion. Is not only bad in itself what it does for the future of the athlete. Predictors of prolonged recovery. Amnesia and loss of consciousness are particularly profound ones. If you have those see you are likely to have a very prolonged recovery. The peak injury occurs during adolescence. From 12 to 18 or 19 years of age. There are important brain changes that occur during adolescence. Two key things that we will hear about our pruning and validation. The brain consists of nerve cells that make contact with one another through point of contact called synapses. The brain works by overproducing synapses. Is because of these processes going on that the brain is so susceptible to injury. One of the tragedies is that despite this enormous susceptibility we still dont have any pharmacological treatment for traumatic brain injury. It becomes all the more important to use other health measures. People who are the coaches with the trainers and the person in the game to realize what concussion has occurred. To immediately pull the athlete from the game. Not to let them return to the game on that particular day. They should not play again until they have been cleared by a health professional. This essentially essential. We brought together a really extraordinary panel. Tori was an outstanding Soccer Player and because of several concussions she has decided to give up competitive athletics. She now coaches Soccer Players to prevent them from having the kinds of difficulties she has had. Dawn comstock is here who is interested in the incidence of concussion or the kinds of circumstances likely to bring this out. Tom mcallister is interested in the cognitive behavior and the consequences of concussion. He is doing a longterm study of College Students who can see what the consequences are. Susan is interest in the brain mechanisms of concussions. She studies this not only in people in animal models walter is interested in seeing can we come up with treatments for this. Tori i started playing soccer was four years old and i immediately loved it. I played soccer since that day until i was a senior in high school. When i was 15 years old i had my first concussion. I didnt even know it was a concussion. I misheaded the ball and headed someone else. I got home and had a lot of headaches. I didnt even think that was a possibility. I know ahead and important game the next day so i decided to play anyway. Once i got to my game the next day it was a semi final in one of our state cup appearances. I fell to the ground and hit my head on the ground pretty hard. Once i got up i was confused as to where i was. But again setback for the quickly. My vision was extremely blurry. Everything was dizzy. I decided to keep pushing on. I went to the emergency room that night. It turned out i had whiplash in my neck and i did have a concussion i had to school and i was very moody they give me a muscle relaxer for my neck but other than that i just ate home with my mom. If there been some identification and everyone wouldve insisted i had five concussions. Dr. Kandel to what degree did you know there was something wrong but you didnt want to the field because the team depended on it. Tori i was so competitive that my passion was incredible for the game to where i didnt want to stop even if i knew something was terribly wrong. Dr. Kandel instead of leaving the field they stay there. Tori today i am a lot better but there things i still i still have two to three headaches a week. Sometimes i will have headaches for five days without a break. I both of my pupils are now not the same size all the time. It is very difficult for me to be in a lecture and be looking at the board and looking at the powerpoint and going back to my notes. That really stimulates my headaches. I am not under the care of neuroscientists. After my last one i have not had to go back to the doctor. Is unfortunate that all this had happened to me but i do think it is something that needs to be talked about and needs to be known. I am glad that i can help with that. Dawn at the High School Level alone there were a hundred and thousand concussions among Football Players. 160,000 were concussions among Football Players. 60,000 among girls Soccer Players. 45,000 among boys Soccer Players. Those are National Estimates based on National Injuries surveillance data. Over the last decade concussion rates have increased and dramatically over time area this is one of those times when some scary looking statistics might actually be something good. This rapid increase likely does not indicate true increases in the incidence of concussions. Most of the rule changes at the High School Level have actually proved to improve player safety. It actually shows the dramatic increases we have had in education and knowledge. Young athletes and their parents and the coaches have become more aware of the issue of sports related concussions. Awareness was originally generated because of high profile incidents at the professional level. It would be very difficult to find a parent of a High School Athlete that couldnt at least explain some of the symptoms of concussion. And recognize that it is an important injury that needs to be addressed. Concussion rates are significantly higher in competition that they are in practice. Part of this may be because athletes dont want to come out of the game. It is also because there are more athletes at the contact that occurs in competition. Invoice High School Ice Hockey competition rates are much higher than practice rates. A lot of it tends to be the activities associated with individual sports. Across the entire spectrum of all the sports, the most common record mechanism of concussion is athletes aptly contact. Many more instances of contact your much more likely to hit your opponent harder than you would hit a teammate in practice. Tom from a clinical standpoint, tori described it very well. As a result of the force and the mechanics, there is a disruption in brain function that is usually described as an alteration in the level of consciousness that simply means that people may have incomplete memory for the event. They may be confused or dazed as court tori described. They may have blurred vision and sensitivity to light and noise. Also problems with thinking. The good news is that most times these symptoms gradually resolve over several days or weeks. But we have known for a long time that there is a Certain Group of folks from home that is not the case. The symptoms can persist for a fair amount of time. The weight of the concussion happens in the way that the brain is designed. But it tracks very nicely exactly the kinds of symptoms that tori described. One can be from the brain hitting the inside of the skull and the areas in red on that slide the skull is great at protecting the brain from a lot of things. When this is moving out of phase with the skull itself. Theres a hostile environment in there. The brain gets damaged in those particular areas. Your even have to have that to have the damage or the injury that tori described. The very movement of the skull itself is a somewhat chilled at mismatch. What is not a uniform density. It can damage the delicate white matter fibers that connect one nerve cell to another. These are particularly delicate and so this kind of twisting action can damage that. It can damage the conductivity of the different brain functions. Putting it all together this image shows the brain regions that are most likely to be damaged. A set of perfect storm that kind of neuropsychiatric complaints this is illustrated on the image map. Brain regions that are responsible for the symptoms the tori described. Memory loss is a common complaint. This shows which brain regions are important in memory function. You can see that it maps onto that very nicely. Tori described some difficulties with schoolwork, they are described as not thinking as quickly decreased speed of information processing. If you look at areas of the brain relevant to executive function you can see they are vulnerable to concussions. Tori mentioned being somewhat moody, this is an enormously common complaint from people who have concussion and other types of brain injuries. The whole Psychological Health aspect is affected. If you are to design an injury that was designed to damage cognition and neurobehavioral functions, you really could have designed a better one unfortunately. What we know so far about how the brain is injured. Erica alluded to some of the regions that we know of. Folks that have had more than one injury take longer to recover. Younger athletes may take longer to recover. A link with other kinds of psychological issues. Struggles with those kinds of concerns in the past. There seems to be a connection. Not every injury that looks the same to us actually is the same. In terms of how the stresses and the strains affect different brain regions. There is some very interesting work suggesting that genetic factors may affect this. We might differ in terms of the genes that we have for Getting Better quickly or not. Walter our brains are always developing even in adult life. Connections are being made. This is much more dramatic during childhood. The changes that are occurring in the young brain are just so dynamic. The energy that the brain uses peaks in late childhood and adolescence. The blood flow peaks in late childhood and adolescence. As eric said, the brain is a massive computer where the connections are just tremendous and exuberant read the beginning. Connections that are not useful over time are taken away. Everyone is really worried about injuries that occurred during the developmental stages. As was mentioned, this is one of the latest things that is finished in the developing brain. The development of the wires goes on into your young 20s. That really determines the speed and efficiency of connections between different brain regions. It is a very dynamic time. Dr. Kandel the learning mechanisms in the adult brain are two kinds. The making of new connections and the retraction of connections. These of the things that are called into play during this phase. Amazing plasticity of the brain. Walter and the young brain changes are happening dramatically. If you think about how your brain develops and how your skills develop, you go through this tremendous advance in an executive function and planning. The teenage brain is questionable whether there is anything working in there and all. For a long time. Dr. Kandel the brain continues to change throughout life. But this is a spectacular representation of that. It gets rid of connections that are inappropriate or unnecessary. We dont know in detail the mechanisms that do this. Walter the areas most honorable are these temporal lobes and frontal lobe, the limbic circuit for emotion. All toris complaints fall right into the category of these symptoms. Susan sports the vast majority of impacts to the head of the result of a combination of linear and Rotational Movement of the head. Research shows that the Rotational Movement of the head causes the largest amount of sloshing within the skull. The distortion of those very delicate nerve fibers causes an interruption in their ability to communicate among different areas of the brain. Distortions in the brain cause serious brain injuries. As a bioengineer i use animals and i use computational models to look inside the head and make the relationships between the amount of brain distortion in the amount of disruption. We have a lot of research that has happened over the years about serious brain injuries. Those more subtle changes that occur in concussion, we really have very little understanding of how much distortion does it take to cause concussion symptoms. That research is very much under way. It is difficult to measure some of those subtle changes. Dr. Kandel some of these changes are not reflected in anatomical changes it can be difficult to pick up with conventional techniques. There could be no change in function at all. Susan animal models can really help us identify what distortions are enough to cause those concussion symptoms. We dont know that yet. There are number of Acceleration Sensors that are available on helmets and mouth guards. These sensors have been very helpful in helping us understand the range of accelerations that occur in real world scenarios. They help us to understand for one person the same scenario they can have different types of acceleration. The direction matters, the magnitude matters. It all contributes to that brain sloshing. Sensors cant tell us if he concussion has occurred. They can only tell us what the acceleration of that head was. We need the athletes to tell us about their symptoms. Dr. Kandel people respond to different injuries in the same ways. There are a number of settings so that brain. Susan we rely on people to report their symptoms. Tori shared with us the challenge that we have. We think that large accelerations or small accelerations, we dont even capture a complete understanding of the risk of acceleration that could occur. We need to have Something Like a next ready for a broken bone or a blood test. Dr. Kandel we need to encourage young people who are playing sports to be sensitive to their wellbeing and to report any discomfort that they feel. We have raised a generation to ignore anything in the middle of the game and to continue playing. We have to educate people not to ignore anything that bothers them. To call timeout and make sure that nothing serious is happening. This is enormously important when you consider the number of people that are involved. Dawn 10 years ago 8 of all the High School Athletes who sustained a concussion returns to play the same day. Now it is less than 2 . If you look at returning within a week, we also see dramatic differences. Compared to 2007. Dr. Kandel it is a good sign but even more could be helpful. Susan concussion is not this all or nothing phenomenon. We expect that a certain proportion of people might have a concussion. If there had moved with that acceleration. We represented with this risk curve that you can see here. At high rates of acceleration you are very likely to have a concussion. At low rates you are unlikely to have a concussion. This type of risk curve is very important and it probably changes with age and other circumstances. Helmets are designed to prevent Skull Fracture and serious brain injuries. They are not designed to prevent concussions. Technology has yet to identify a means that can prevent that sort of rotational acceleration. Helmets are very important but there is a demand for products to really help in this range where equipment can make a big benefit. You like to reduce the amount of head rotation that is seen. You would like also to produce amount contact the amount of head rotation. When the body continues to move if the head is firmly attached to the ground with a lot of friction there is a rotation of the head as the bodies continuing to move. A slipping service that allows the head to move along and move in a straight line. We need to slow down the rotation that occurs on impact. There are some Innovative Technologies that allow the head to slide. Those are only good for helmets. Were still struggling with how to protect these in on helmets sports. Charlie rose i just returned from a profile of a formula one race driver. They have a whole system to keep the head in place. Susan the level of fitness will have an important effect. That is why women may end up being at more risk than men if the next strength is not as strong as a male. There is steve fisher no that would limit work on their next strength the amount of head rotation is experienced is reduced. Tom theres a history of how these changes were made to the cars and it was to prevent exactly the kind of thing susan was talking about. These unbelievable impacts. The fact the could do that is a testament to the possibility. Susan after concussion, it is not like a bone fracture where is all over in an instant. It is the beginning of a progression of symptoms some of them lasting minutes or some hours are some days. The energy needs the change over time. This reparole blood flow that provides important nutrients to the brain. Oxygen if a repeated concussion occurs in the setting and the response to that very brain deformation could be dramatically different. In the same way that tori told us, that is completely consistent with an injured brain being on top of another injury and that is particularly devastating. We do know. The line is if in doubt, sit it out. The first risk multiplier is was there a previous concussion and how long has it been and how severe were those symptoms. The second risk factor is age. In the young brain, it is changing over time. We see that the energy needs of the young brain peak early on. The cerebral blood flow is high then. If those symptoms of concussion occurred just with a decreased metabolism and a decrease in blood flow. Just when the brain is needed most for development. These biological contributions add on top of the mechanical aspects. Dr. Kandel this is the most common cause of death in children. Susan youth and prior concussions move the risk higher for a given acceleration. We think that women may be at higher risk were not sure if the same tissue deformation causes a more profound response in women or if women will report their symptoms more. What we really need is those equivalence of the xrays of the blood tests. Dawn concussion rates very widely by sport and by gender. The concussion rate among girls Soccer Players is around 21 for 10,000, among Boys High School Soccer Players it is only nine. The concussion rate is twice as high comparing girls and Boys Basketball it is three times higher among girls than among boys. Tori you never know what it is going to be the last straw. That is what i had to quit. I could be ok right could be in bed for a year. I dont know what is going to happen to me so i dont think we can say how many is too much. My third concussion was probably my worst one. I went up for a header and to and hit the other player and i came down to the ground and hit my head. When i came to, i was very disoriented and confused but i realized where i was in i decided to keep playing. I didnt tell anyone because we had a semifinal coming. I kept its a myself because they really want to play. One day when i was at school i was eating lunch and i was hoping my jaw and i felt a crunching near my temple. I was very scared. I told my mom and we went to the doctor. I thought i had a Skull Fracture and returned out to be fluid surrounding the skull from the impact. After that i was probably out of school for two weeks straight. I dont think ive been the same ever since. My grades dropped. I was terribly depressed but i did not want to admit it. From the outside i mightve looked ok but when i got home i closed my curtains and i laid in bed. I did nothing else. It makes it difficult to know. Some of the athletes dont report symptoms until hours or perhaps a day or two later. They will have a game on friday night and they will come into the trainer on monday and say i still had some headaches and i feel little dizzy. Reporting is really problematic. Susan in the laboratory you know exactly what the head acceleration was. You can control the interval between the two of these. You can understand how many. Dawn our understanding of the rates of concussion in young people is dependent on data. Young athletes have so many choices to present to clinical care. When i was a kid my appearance told me i could go to the emergency room or suck it up. Now my nieces and nephews can go to an urgent care center, they could be treated by the athletic medical director, a pediatric concussion clinic. We dont have a National Surveillance system capturing the data on Young Athletes under the high school age. We dont know what is going on in that age group. Dr. Kandel theres another absolutely amazing thing. There are very few areas of medicine in which such serious damage can occur and such ineffective therapeutic approaches. Walter we havent been able to see anything in the brain in these cases. It has been difficult for scientists to develop treatments. With animal models or the human condition. When someone has a concussion with a ct scan or mri you usually dont see anything. The first video were going to see is an experiment that at the National Institutes of health. They have mounted a microscope they can see into the skull of a rodent. You can see in real time what happens in this instance where there is a slight tiny compression of the surface of the brain. On the left side of the image you see the normal size the image. You can see the cells on the surface of the brain. The greens cells are dying. The second video will be looking at the response to the deaths of these cells. These ugly looking things that look like jellyfish. It turns out that there is a drug that would give into the surface of the brain that completely prevents this process from occurring. It is a free radical scavenger. The brain uses oxygen for energy. Oxygen use in the brain produces these chemicals that if they get free to do a tremendous amount of damage. It may be glimpse as to what is coming down the road. Dr. Kandel with professional athletes some of the longterm consequences include serious dementia. Walter the real concern that not only are these shortterm consequences happening but there could be longterm very serious conditions they were first described in boxers in the 1920s. In that condition the brain becomes totally shrunken and the person becomes severely demented. You can see a brain that is very diffusely involved in this disease. The signature of this disease is the deposition of a protein inside the neurons in the brain. It is a very bad actor. It is also deposited there during alzheimers disease. We thought that this was a rare event the required tremendous exposures. Unfortunately what we found more recently is that the brains of the nfl Football Players often have very small deposits of this tower protein. This is not a professional football player. This is an 18yearold. We dont know the clinical consequences of these small deposits there are experiments now that show that this can spread. It spreads throughout the brain to cause very severe dementia. There are no pharmacological treatments that are approved for use. Until recently we were pretty convinced that everyone was going to get better after concussion in fairly short order. It was in a lot of effort made to develop pharmacological interventions. Of all the interventions i think we have touched on awareness before people get injured but educating folks about the nature of the injury such as the discussion weve had here. Being able to let people know in the first place, you had an injury that doesnt mean your life is ruined. The odds are that you are going to get better. Heres are some things that you might expect to see happen i hear some of the accommodations that you might want to make. The expectation is that youre going to get better. Setting expectations as opposed to catastrophes is really important and has been shown to be effective in terms of reducing symptoms. Charlie rose what should parents take away from this conversation . Dawn weve spent a great deal of effort on improving diagnosis but very little effort on primary prevention. Keeping kids from being injured in the first place. It is very important for parents to come away from this knowing that there are things they can do to protect their Young Athletes. There have been some pretty dramatic recommendations from National Sports bodies. The National Federation of High School Athletic associations talking about limiting the number of days a week that Football Players are allowed to participate in full contact drills. U. S. Soccer put out recommendations that athletes 10 and under should no longer be allowed to head to the ball in practice or competition. These are pretty dramatic efforts to try to keep kids safer. Tori my hope is that we can become more knowledgeable on this. I dont want kids to shy away from playing sports. I think that has turned me into the person that i am today. It has helped me with my character and by teamwork in my leadership. When something happens to me i dont think anyone noticed and if they did notice i dont think they knew what to do. Dr. Kandel president obama heard that you doing this program. He sent me a message saying he would like to have one of the final words. Can we play his tape . President theres more work to do. We need to have more information, that her equipment. Equipment. We need to have every parent and recognize the signs of concussions. Recognize how important it is to prevent injuries and to admit them when they do happen. We have to change a culture that says suck it up. Charlie rose thank you mr. President. Dr. Kandel this time we talked about physical injury. We will discuss how psychological consequences can produce serious damage to the brain. So poverty, brutal treatment of children by parents or by others. Even some aspects of inheritance can have significant psychological consequences that are really quite frightening. We will speak about that. Charlie rose thank you very much. Toshiba is gaining after the newspaper said it is planning to sell its Health Device unit. According to the report, fujifilm is one of the potential buyers. Toshiba says no caps off has yet been chosen. South koreas factory output unexpectedly fell. Exports suffered from weak demand