Transcripts For CSPAN3 Key Capitol Hill Hearings 20141010

We appreciate your arguments today, thank you. The court may call the next case. Over the next few hours we will show you congressional hearings on professional and student athletics. Up next house hearing from brain injuries from football, hockey and other sports. Then we will look at scholarships, sex assaults and whether student athletes should be paid. Earlier in year a House Sub Committee looked into brain injuries from football, hockey and other sports. Officials with the nfl and National Hockey league talked about how their industries address the issue. We will also hear from professional and student athletes. This hearing is about three hours. All right. I want to thank everyone for being here. We are now at the full Committee Ranking member, the gentleman from california joins us. We now have the ability to start our hearing. So ill introduce you after my statement and before you start your testimonies. So ill open with my opening statement. Morning jan. So good morning and welcome to this mornings hearing. Today its my hope to learn what steps are being taken to make Sports Participation safer for all athletes. Every day parents make choices about whether or not to let their son or let their daughter play soccer or what kind of mouth piece to buy their son for thinks first day of pop warner football. Unfortunately it seems like every day we hear about how participation in certain sports could be dangerous. Its easy to understand how what parents see in the news affects Youth Participation and sports. Case in point, earlier this year, president obama said publicly that if he had a son he wouldnt let him play profootball. Then the first lady wants us all to move. Seems to conflict. Messages. So. Now, we want a better understanding of the innovations being made by sports leagues, equipment manufacturers and the medical community to make all sports safer. One clear example is the nhl working to make hockey safer. Dating back to 1997 took the proactive step of joining a joint committee and also established a department of player safety at its headquarters, the first of its ingd kind for any professional league. U. S. A. Hockey and u. S. A. Football two organizations that help oversee youth sfort caleb porters in the United States ha. Safety information, education, proper techniques, u. S. A. Football which is endowed by the generosity of the nfl was the First National governing body to head up concussions in sports. Also engaged in providing youth with nontackling alternatives to develop their skills. Additionally u. S. A. Heads up Football Program encompasses six elements meant to make youth football safer including coach education and concussion recognize. Proactive actions are exactly what parents need in order to be insured Everything Possible is being done to keep their child as safe as possible while they are on the field or ice. Researchers are also hard at work. For sexample, dr. Dennis malfousi, who runs the university of nebraska brains, biology and behavior center, located inside the huskers stadium, has been developing an mri machine that could be used on game day to assess a head injury, this could be used to determine if a player suffered a concussion and if that player can return. Equipment manufacturers are making changes to helmet, foot guard and other equipment to reduce injuries. I feel confident given the recent rule changes and the Rate Technology is advancing, playing a contact sport today is likely safer than it has been in the past. However we must accept there is no silver bullet, no helmet or pad will prevent 100 of the injuries 100 of the time. We need to keep your kids safe while still promoting Youth Participation. In sports. This involves listening to how leaders in top tier researchers are partnering with nhl and nfl to make youth safer. These are the types of innovations needed to give parents assurance that all possible steps are being take tone improve the safety of their child on the field. Id like to thank our panelist for joining us today willing to answer our questions. Would especially like to thank the two doctors for making the trips to washington, d. C. From lincoln, neb northbourasknebras. I will now recognize Ranking Member jan from illinois. Thank you. This is a very important hearing on improving sports safety. I look forward to hearing from all of our witnesses on both panels about the perspectives, experiences, and proposals about how to make sports safer for everyone from children to professional athletesx athletes are continually becoming bigger and faster and stronger and despite some efforts to make sports safer must work remains. Hundreds of thousands of sports related traumatic brain injuries occur annually in the United States. Sports are the second leading cause of traumatic brain injury among people age 15 to 24 years old. Second only to Motor Vehicle accidents. He. We will here hear from high school athlete. His story should serve as a reminder that uj you sports injuries can have devastating and lasting consequences. We will also hear on this panel from an olympic champion forced out of her career after a traumatic brain injury almost four years. Her story illustrates that even our sports heroes are vulnerable to sports injuries. I thank you both for your courage and willingness to testify on this critical issue. Proball safety tragically committed suicide just over four years axg he shot himself in the chest to avoid any impact on his brain to allow science to study the brain trauma he suffered over his career. He suffered from a moderately advanced case of chronic traumatic disease linked to repeated blows to the head that could suffer memory loss and dimensionia. The impacts of brain trauma can become more severe over time. We will hear about the importance of taking athletes off the field of play as soon as there is suspicion of a brain injury and keeping them off until trained by a responsible individual. Final will he we will hear from the nhl and nfl and leagues responsible for mitigating brain injuries from their sport. I will like to hear what changes they will implement to reduce the risk of brain injuries moving forward. We should take reasonable steps to reduce the risk in sports. I hope we better understand what we can do to limit these risks. I yield back. Thank you very much. This time recognize the vice chairman of the committee. Thank you very much mr. Chairman and thank you for holding this extremely important hearing. I want to thank dr. James johnston who will be one of the witnesses who came to my office earlier this morning. Thank you dr. Johnston. Experts generally agree aa concussion ranges in seriousness from mild to dramatic. The centers for Disease Control states a concussion is caused by a blow to the head or body that causes the head to move quickly. According to the cdc, the sport thats reported the highest number of brain injuries are bicycle, football, play groungd activities, basketball and soccer. From 2010 through 2013 the Participation Rate of children in youth soccer and football dropped considerably. And some have pointed to the increased risk of tbi as a result of participating in these sports. Increased spot light has resulted in an increased amount of research in brain injuries as well as research on how to improve Sports Equipment in order to prevent such injuries from occurs. Nhl have required players to to wear helmets. Since 2009 all 50 states in the district off columbia have infliekt. This hearing will focus on what more can be done to prevent injuries in sports, in the youth level, amateur level and professional level and i look forward to the testimony of our distinguished panel. Thank you mr. Chairman. I have two and half minutes remaining. Any other member on the republican side who would like to speak with an opening statement. Does missouri play sports . On behal of the big ten i want to welcome rutgers. Thank you very much. Thank you very much mr. Chairman. Decades ago many thought head injury was serious only if a player was completely knocked out, unconscious or suffered a severe contusion after frequent painful blows even a young athlete could continue to play. But we now have strong indications that the effects of repeated brain trauma in sports, even though received during ones youth could accumulate with consequence thats are long term debilitating and even life threatening. They could stem from minor injuries injuries injuries. Researchers have found evidence of the disease cte when examining the brain tissue of dozens of decease the players. New technologies have shown the metabolic changes in the brain associated with concussions and sub conclusive blows. Brain injuries in sports could occur in a wide variety of situati situation. It is a complex matter. Requires addressing many interconnected issues. We have to take multi facetted approach on improved safety, i couldnt agree more. We need nor research. Methods can lead to earlier and more accurate diagnoseis. Better understanding of the risk factors and maybe better Treatment Options for brain injuries. Second doctors lead to associations, coaches, players, need to Work Together toest ashl lish health regulations, game rules and a sporting culture that reflects the seriousness of brain injury that puts the Athletes Health first. Third must pursue a better understanding of how this equipment might be improved. Three years ago congressmen butterfield and i wrote in calling for hearings about inadequate testing standards, and economic disparity regarding the safety of millions of athletes. We will touch on those issues today. Likely might hold a separate hearing on these matters. The National Football league tested today giving recent disputes. On this very topic. Unfortunately the late notification of the nfl testified made it difficult for us to secure players with this. Mr. Chairman todays hearing is important. I appreciate the Sub Committee review of sports related brain injuries and i look forward to working together. All of us on this issue in the months ahead. Thank you for holding the hearing and look forward to the testimony of the witnesses. Yield back my time. Still have a minute left. If gentleman in utah wanted to use it. I might just point out that moving physically and conditioning the body is not anywhere near dangerous as subjecting one self to brain injuries. Its interesting but the issue is we want kids to go out and play. We want them to join youth leagues. And we want sports but we want it to be as safe as possible. Absolutely. And to use your last 26 seconds, this is one of those where jan and i both i. We have Deputy Commissioner of nhl. Next to him executive director of u. S. A. Hockey. Then we have mr. Jeff miller, Senior Vice President Player Health and safety policy. National football league. Thank you very much for being here. And executive director u. S. A. Football. Then a face of brain injury within soccer. Former professional goal keeper. U. S. A. Womens National Soccer team. And we have another face from High School Level concussions. With that mr. Daily, you are now recognized for your five minutes. Thank you. I would like to thank the chairman and Ranking Members and Sub Committee members inviting me to testify today for the proHockey League. As its playing surface is kurnded by glass hockey is a physical game. At the nfl level. Is your mic on. It was. Our players and fans want us to be physical but more importantly safe. This including safe play and working together with the National Hockey league weve gone to elaborate lengths to do that. We are pleased to share with this Sub Committee some of the measures enacted. National Hockey League was the first to launch a comprehensive leaguewide program to evaluate players after head injuries. All players are required to under go preseason testing and will have preand post injury test results to determine when the player is safe or returns to relevant base line, allowing player to return to play. It was confirmed early on that nural psychological testing results had added value and should be taken into account along with player reported symptoms. The nhl and pa Concussion Committee have taken active steps regarding the diagnose and management and treatment of concussion, education regarding concussions and risks of returning to play before the recovery from a prior concussion is complete have been a core component of the nhl Program Since its inexception. Education is required to all officials. In addition to enforcing additional player rules, such as checking and high sticking, several new playing rules have been adopted to prohibit contact involving a players head. Current rule prohibits body contact with the head when the contact is orange otherwise avoidable. Changes this season. Fighting remains a small part of the game but its roll is diminishing. 68 of the games played in last season have been completely free from fighting. In addition the number of major penalties assessed for fighting is down 15 from last season and down 31 from 200910 season. It would be the leagues intention to raise any changes regarding fighting directly with the National Hockey League Players association. Ultimately discipline is in the hands of the players safety. The first of its kind in professional sports. It monitors every one of our regular season games plus every playoff game antonio sure the leagues standards for safety and responsible play are being atd hered to. When the department determines standard has been violated discipline comes in way of fine. And video is shown. As we can see on a nightly basis players are avoiding play thats they no doubt would have engage in just a few years ago. The n the nhl along with nhl pa, are most recently adopting a rule to reduce head injuries. The league support and assistantance for youth and junior inage hockey players. The National Hockey league will be committed to the safety of its players. We firmly believe it is not only the right thing to do for our flares but for our business both in promoting participates at youth hockey and by maximizing interest at the professional level. I thank the chairman, Ranking Members and Sub Committee members for your time. Thank you. Mr. Oger you are recognized for your five minutes. Thank you. It is a privilege to discuss a issue that is top priority every day at u. S. A. Hockey that is the safety of our participants both on and off the ice. We have two particular leaders we wish to thank and who guide a great deal of our decisionmaking. One is our chief medical officer in rochester, minnesota. And the other is doctor in boston who is chair of our safety and protective Equipment Committee. That committee has been in existence at u. S. A. Hockey for 40 years and it is an Important Group helping guide our board in making its decision. We have a Risk Management committee which is concerned with the safety of the surrounding area. In 1999 we began an Organization Called serving the american ranks, or star, which is a trade organization for facilities focussing on a variety of aspects including safety issues. In terms of the safety of our participants we believe we affect the landscape through education, rules and rules enforcement, and Risk Management. Education related to safety happens on a ongoing basis at u. S. A. Hockey and utilize many avenue oohs to communicate. We have direct communicate with every home, player in our organization in our database. We are constantly in communication with them with bulletins and news. Our Coaching Education Program has long been heralded for golden education. Two seasons ago we added an online module which includes safety education. Officials play a Important Role as well and they receive education electronically in our certainty video clips and also in our recording system which tracks penalties to help us assess behavior trends. Over the years our posters have focused on concussion prevention and education, playing rules and our heads up, dont duck program, to name a few. We have modified our rules to adapt on an ongoing basis. In june 2011 we changed from body checking from pea wee to bantamweight level in 2013. Nobody seems to like but research on safety guided our board decision. It is worth noting two years late Hockey Canada followed our lead. Frds regarding equipment. Mission is to seek out and evaluate testing procedures for hockey equipment. It is a completely independent body of attorneys, doctors, manufacturers, testers and sports people. It validates the certification that the equipment they produce has been tested and meets the kwirmts of standards and has been an important part of our Safety Standards for 35 years. In the early 1990s we were one of the first youth organizations to require screening of all adults to have regular access to our youth participants. We follow up on 100 of calls we receive around the country of alleged abuse and our affiliations each have a coordinator that helps us as boots on the ground to help with safest possible environment for your participants. Our sport has more than doubled in the number of youth we have. As we continue to provide opportunities for our youth we know we have a responsibility to make the game as safe as possible and will only continue to grow if were successful in doing so. Thank you. Theres nothing more important to the nfl than the safety of our players. Commissioner goodell has stated he spends more time on health and safety on our sport than any other issue that comes before him. Football is vital in american life. Nearly 6 million kids play tackle or flag football across the country. Another 1. 1 million play in high school. 75,000 in college. Whether it is touch games in our backyards or friday Night High School games or saturday with college or hopefully plenty of people watching the nfl on sunday, monday and occasionally thursday, football plays a significant role in our life with that comes a great deal of responsibility and it is one we embrace. We understand the decisions we make at our level and far beyond that. I appreciate the opportunity to share our work with the Sub Committee. Football has always revolved and the rules have always changed. I will like to share the imin fact has had on our level. Its only been a couple years ago that we changed the kick off line at the nfl moving it forward fiver yards. We did that because we identified the kick off and kick off return is the single most dangerous play in our sport as related to the number of concussions. By moving it forward five yards we decrease the number of concussions on that particular play by 40 . That was the first year alone and that number has stayed steady in following years. You have seen a greater emphasis on eliminate crown in our game. You have seen penalties and suspensio suspensions. We are looking to change the culture of how the sport is played. We are encouraging them to lower the tackle. There are better ways to go about what theyre doing and were seeing results. In the past year the nfl has seen the number of concussions decrease by 13 . Decrease in helmet to helmet hits causing concussions down 23 in one year alone. Thats not a victory, its a trend and one we find encouraging but theres more work to be done as we begin to change the culture of the sport as it relates to that. We have other protocols. Theres one rule that governs us that medical concerns will always trump competitive ones so we have consultants on the side line, a concussion expert to help the Team Physician to treat the players. We have added athletic trainers. To make sure the players aare attended to appropriately. We have mandated side line protocols based on internationally accepted guidelines, we would expect nothing less. We know as we change the culture of our sport we have an impact. Two examples of that, one for u. S. A. Football you will hear from mr. Holingbeck in a homestand, their other offers include changing the game around the country literally as we speak. The popularity is tremendous and the nfl is a proud supporter of ufsz u. S. A. Football and will continue to be. In addition, the nfl used as an inspiration to a young child named zachary, a 13yearold youth Football Player in Washington State several years ago who suffered catastrophic injuries playing his sport, he returned too soon and he still struggles with the challenges that come from that. His advocates were able to pass a youth concussion law in Washington State which our commissioner said we will replicate in all 50 states around this country to make sure all youth sports are played more safely. That kids are removed from play should it appear they suffer from concussion and most importantly not return to play until being cleared by a medical professor. Just this past month were proud to lead in many of these states to get this done. As my time expires. Let me mention we have been proud to work with the cdc promoting concussion materials that have gone out to millions of skidkids and locker rooms. We have invested tens of millions in research. 30 million with the nih, the largest grant ever given. And 20 million have gone out to studying brain injuries. We are also working to develop better tools and find better ways to protect against concussion in the first place. These are on going issues and ones we think will yield significant successes. I apologize for exceeding my limit. I appreciate the time. This time mr. Hollenbeck. Thank you for the invitation to testify. U. S. A. Football creates and directs program that has important standards for youth and High School Football. We stand with expert who believe education changes behavior for the better. This is what were seeing through heads up Football Program which is already benefiting more than 25 of youth across the country in its first 14 months. We expect to double that this year. We advance safeties and lead fun and dynamic and instructional football initiatives for Young Players as well as a national noncontact flag Football Program. The remainder of my time will be showing a video of how heads up Football High School Pilot Program is improving player safety within the Public School system which earns high marks from parents, administrators in its first season. You will hear how this program is making a difference. Squeeze. Deep. There you go. Head up. Feet, feet, feet. Eyes up. Head up. The coaches have completely bought in and endorsed what were doing. Elbows tight and high. What we really didnt anticipate was how aggressive that the Coaches Association here in virginia went after it. Saw the need to make the game better and safer and they ran with it. Heads and eyes up. The days of smelling salt ammonia has passed. That is a good thing. I think it has standardized everything. It becomes a much more consistent way of teaching the game. This kind of instruction keeps my staff in line. Youre seeing a very distinct improvement and reduction in injury. I think that says a lot about the program. What this has really done, were hands on with the parents, teaching them the terminology. It brings a level of comfort to them. I think its really good that all the coaches are learning proper techniques on how to teach these kids to do it right. Im so relieve they had are teaching them this at such a young age. I was never taught that. Zbl zblrz. He will come home and show us the techniques hes learning. The coaches not only employ the techniques but keep asking the kids to make sure theyre doing things correctly. It shows me they are really concerned about the kids. Im not worried if he will get hurt on the field because i know his safety is just as porn the. His safety is just as important to him as is it is to me. Its open the door to now all the programs, everyone is talking what are we going to do overall in a very positive light. We agree with the mission of u. S. A. Football ha is to allow our students to participate in competitive athletics but do it in a way that is healthy. I can say, heres what we have done. Heres what heads of football has brought to fair fax county. Its an opportunity for parents and kids and officials to get on the is same page to help kids. Thank you. Now briana, i appreciate you being here. You are recognized for five minutes. Thank you very much. Im had 2 years old. Im 42 years old. I served a goal keeper from 19942008. I set a record among female goal keepers. In the summer of 199 my 9 my 20 amazing teammates and my beat the hearts of america beat the shootout in front of 20,000 screaming fans. I made the single save before brandy took off her shirt. Yes, now, i bet many of you recall exactly where you were at that moment. It was the kind of event that transformed lives forever for the better. My passion and mission was soccer. My ultimate reward was living my dream and inspiring the dreams of countless others. Today im here before you to share my new mission with you. My new mission is to provide a new face and voice to those who have had and may suffer the long and difficulty recovery of a devastating brain injury and concussion. My life story reads like a script from Oprah Winfreys where is now. I have only recently begun to claw my way back to my life. On april 25, 2010, my life changed forever. During that day i played a womens professional game against the philadelphia independence and philadelphia and in that game i suffered a traumatic brain injury that abruptly ended my soccer career. That was four years ago. I struggled with intense headaches that were so bad that by evening all i could do is cry myself to sleep. I had to take naps on a daily basis because my sleep was so disrupted i couldnt concentrate and was very moody. I felt completely disconnected from everything and everyone. I was anxious and depressed. Every day. And i wondered if i would ever get better. I recently moved to d. C. To have surgery to eliminate severe headache thats plagued me daily. The treatment has worked but i still have lack of concentration, balance issues, memory loss and depression. I purposely and intentionally had my concussion recovery story documented by Media Outlets such as u. S. A. Today, Washington Post and brain light dot org. To bring attention to people like me. In november the number of concussions in soccer was second highest in United States with only american football having more cases. Additionally a recent article stated one of two female youth soccer players will suffer a concussion while playing. I feel the number of reported cases are likely under stated and didnt designate those who suffered multiple concussions like i have. Statistics like this have solidified the devastating and emotional toll that prolonged symptoms often cause that are too frequently dismissed. I sincerely hope that my presence here today will inspire increased awareness, understanding, and assistance to help the young sufferers across the country. I am grateful and humble to be invited to give this testimony. Thank you very much. That was powerful. This is our opportunity now. Each of us have five minutes to ask you questions. So let me ask you this one. I too was shocked to learn soccer had the second most concussions which is a really dominant youth sport. Are you seeing changes within soccer and unlike, theres an obvious top to bottom connection that we heard from the nhl and nfl, is anything like that occurring in soccer . Thank you for the question. I too was very surprised to read that statistic. I think it is so high in part because of the explosion of players that are playing soccer in the last ten years. Im not finding that soccer has completely grasped the situation like u. S. A. Football, u. S. A. Hockey have. Part of the season im here today is to shed light that soccer should be instrumenting different protocol like nhl and nfl are and hopefully the governing body for soccer which is u. S. Soccer will start to understand our great sport is in danger of having too many head injuries and something needs to be done about it and needs to be instrumented. Thank you. I think youre assessment of the game that you played and winning that championship over china, we all, at least i remember that one event. Thank you. It was a great game. Now, to mr. Miller and nfl has seriously under taken an effort to get the so called return to play guidelines adopted at allstate levels. Can you tell us more about what the guidelines the model law that was passed out in Washington State contained three primary elements. The first of which would be that parents and their kids would have to sign off on an education sheet, a notification about the risks, sign, and symptoms related to concussion before they were allowed to participate. The second was that a child who appeared to have suffered a head injury must be removed from play immediately. In other words, the coaches were asked to act conservatively. And finally, that a licensed medical provider who has training in the management and evaluation of concussions had to return every child to play. And that part was done in large part to eliminate the danger that was that zachary faced when he returned to play in the same game too soon. And all these laws are very new. I know that there are academics who are studying them to see their success. But i just know as one anecdote in washington, d. C. , the one that had the first one, in the years after the law was passed, they didnt see a single brain injury. In other words, blood on the brain of any single Football Player in the state of washington. And they had normally seen three or four significant brain injuries on an annual basis. Those were eliminated. Thats anecdotal. And more work needs to be done. I commend those states who are going back and making their laws more strict. Because they need to be expanded to the youth level. Many are high school only. They need to be expanded to recreational spaces so its not just schoolbased sports. And theres more that can be done, and there are those that are doing that and were happy to work with those. Thank you. Mr. Ogrean, have you seen a demonstrable reduction in concussion instances at usa hockey after implementing new techniques . We do not have the same statistical data that i think usa football has invested in. In fact, were talking to datalist, the same company, to do that sort of thing. We have any concussions are too many concussions. What we have focused on is research, education, and rules enforcement. The statement was made in someones opening remarks regarding the culture of certain sports, and obviously we know that a lot of sports at the youth level suffer from a misplaced, you know, macho attitude. A lot of coaches think they are coaching at the professional level and they are not. So changing that culture is very, very important. Weve been very, very strict about return to play rules. As scott used a phrase earlier this morning that i appreciate very much, and we adopt the same thing. And i think when youre talking about a grassroots sport, in our case, weve got 350,000 youth players and 2500 programs and that equates to about 25,000 teams. One of our big challenges is quality control. You cant get everybody to act the same way or to think the same way. But with our emphasis on head injuries and making sure the return to play decision is a medical decision and not a coaches decision, that the number is dropping. My time is over. So the Ranking Member, you are recognized for your five minutes. My granddaughter has played soccer since she could and now on a traveling team at high school. Shes 16. So im very concerned about what youre say iing and even more concerned when you say that soccer actually seems to lag behind other sports and there have been studies that have compared the rate of reported concussions for male and female athletes that tend to show that female athletes have a higher rate of reported concussions than male athletes in the same sports. What would you say that we need to do immediately . I mean, i really do worry about her now and what could happen. So what would your advice be to female athletes, female soccer players and to those who coach and treat them . I, too, find that. I think one of the things that needs to occur with soccer is officials, referees, coaches, need to take their heads out of the sand a little bit and realize this is something thats plaguing our sport as well. You start with the coaches. You teach the coaches the proper way and do certain drills to make sure that the coaches know how to teach it instead of just letting players run around out there and let the ball head them instead teach them how to head the ball. And improve the neck muscles. For females theyre not as strong as the male counterparts in heading. That needs to occur. There needs to be an understanding in education of what youre looking for when a head injury does occur. Let me ask you a question. I dont know if soccer is the only sport where you quite deliberately use the head. Is that an inherent problem . I dont necessarily think its an inherent problem, but obviously i think that scenario, when theres a ball in the air that youre going to head, that theres something highly probable that could happen. But i think if you teach it properly, youre going to have those head injuries no matter what you do, just like when you play the sport, youre going to have injuries that happen. But i think that certain things that happen during a heading situation isnt the only reason or only time when concussions occur. Mine in particular happened when i was playing in the goal, going for a lowball to my left. The player came from the right and hit me on the side of my head with her knee. That has nothing to do with heading. Head to knee, head to foot, head to post isnt part of that. Well, id love to get your advice as we move forward and anything that i can do outside of this body because i certainly worry about my granddaughter. Mr. Miller, i wanted to ask you a question. Retired nfl players face some of the most Serious Health challenges of any sport. Yet, benefits for former players are not on a par with Major League Baseball or the National Basketball Association Despite the fact the nfl has more than 9 billion in annual revenue. So, yes or no, does the nfl yet provide Lifetime Health insurance for former players who did not play under the current collective Bargaining Agreement . No. The players are able to continue their medical coverage when they leave the game, but theyre not provided lifetime medical coverage. In the most recent collective Bargaining Agreement with our Players Association, there were in excess of 600 million that went to the players who played pre1993 and added pensions and benefits. All of our programs are collectively bargained with our Players Association. So i think during each iteration of our collective Bargaining Agreements, youve seen changes and improvements made to the programs for retired players, including this year, for example this past cba, for example. A neurocognitive programming, screening program. I understand, but professional baseball and professional basketball do provide Lifetime Health insurance for former players. While i understand the nfls 88 plan, what could be the reason to not provide Lifetime Health insurance for former players . Well, like i mentioned, all of our programs, all of our benefits and all the policies are collectively bargained with the Players Association. So the improvements weve seen as far as care for retired players, whether they be the 88 plan, as you mentioned, which accounts for any player who suffers from a diagnosis of dementia, neurocognitive benefits, which help players joint and hip replacements, all of those are improvements and made available to players should they suffer from those issues. In addition to a number of other practices and programs, including help lines and our player care foundation, the Players Association has additional programs to help players who are in need at little or no cost. And those programs exist today. I yield back. Mr. Lance, youre recognized for five minutes. Thank you very much, mr. Chairman. Mr. Miller, the changes that youve made in recent years, the rules change, the increased penalties, suspensions for rule violations, reducing full contact practice days, can you share with the Committee Data you have that this, i hope, has had a positive impact on concussion incidents that might encourage leaders at other levels of football . Absolutely. Were happy to share with the committee, you know, some greater information that i can offer in my oral testimony. Certainly. But the most interesting number from my perspective is when you count up the number of all the concussions diagnosed in games and practices, preseason and preseason practices and postseason and postseason practices. You see a 13 decrease year over year. 13 each year . 13 between 2012 and 13. Very good. The emphasis has been on eliminating the use of the head in the game, especially helmettohelmet hits, which are a significant cause of the injury. And in those circumstances that weve been able to identify where two helmets collide, weve seen a decrease in the number of concussions by that cause by 23 in the past year. Theres a lot more work to be done. Those numbers could change year over year. I dont think anybody should rely upon one year data as some sort of conclusion. Im happy to go into that further with the committee if youd like to see more of the information. Thank you. I think we would. This is, of course, very helpful. I hope that the improvements continue. Mr. Hallenbeck, i believe your schools in 10 districts participated in your Pilot Program last year and that youre anticipating 500 to 1,000 that will participate this fall. Of course, i would imagine High School Football is the football that most of us have experienced, either through ourselves or through a child, in my case a son. And this is part of the american tradition. What are your plans for getting more school Football Programs at the High School Level to participate, and what does your outreach entail, and how do schools across the country learn about your program . I think the purpose of this hearing is multifaceted, and one of the purposes, i would hope, is to inform high schools across the country about your program as the video indicated occurs here next door in northern virginia. Thank you. First of all, one of the common themes were hearing, of course, is inconsistency. Football is probably the most fragmented of all youth sports. Even at high school there are significant challenges. What were trying to strive for through this headsup Football Program is consistent teaching. Consistent teaching of technique, consistent teaching of terminology. Now getting out to those staunchly independent youth programs. The good news is theyre actually being responsive. If its their superintendent, principal, athletic directors, theyre being asked, as was mentioned in the video, what are you doing about this . And you are doing the asking, or the parents and pta . Its a combination. Were talking to state associations, High School State associations. Were talking to Coaches Associations. Were talking directly to coaches. Were working with athletic directors. Were working with parent groups, National Ptas involved. Were looking at every conceivable channel to communicate this program and the importance of changing behavior. What im sharing is theres been a very positive response. That video by itself, and really the reason i decided to show it, has been incredibly influential. In addition, we now have the big ten, the pac 12, the big 12, the acc. Well eventually have the ncaa. Well have all College Conferences involved. Every one of their coaches will be involved with psas and things of that nature that help influence High School Coaches and High School Programs to embrace the heads up Football Program and help change behavior. Thank you. Let me say that if there is one message i wish to leave this morning in my five minutes of questioning is that i would hope that all of those involved at your level of football would examine what you are suggesting. Because after all, that touches virtually all of the american people, and i commend the panel for its testimony. Thank you, mr. Chairman. Thank you, mr. Lance. Id just editorialize, thats why we have nhl, youth hockey, nfl, youth football. Because it does seem that it trickles down. Whatevers set at the top, then it gets pushed down to the youth. So thats that was by design. The gentleman from utah is now recognized for your five minutes. Thank you, mr. Terry. Id first want to echo something mr. Waxman said in his opening statement. It may sound obvious, but its important we acknowledge this is a complicated issue. Theres a lot of complexities to this. Theres a lot we dont know about brain science. I think we all could agree that the notion that this is an issue that merits significant investment in research is really something and its beyond even concussions in sports. We got traumatic brain injury in terms of our soldiers in the field. This is a really important issue thats complicated and we ought to make sure we approach it in a thoughtful and comprehensive way. So mr. Chairman, thank you for scheduling this hearing today. I was going to ask mr. Miller, without taking too long because this is an openended question, but could you kind of walk us through the steps as information and research has brought more knowledge to the nfl, how has the league responded and how have you positioned yourself on these issues to address the issues of concussions . Just if you could walk us through some of the history of how its evolved in the organization. Happy to do it, and thank you for the question. I think the point that you made that the science has evolved on neurological issues, certainly neurogenerative disease, is one that the second panel, where theres a terrific expert lineup, can talk to. But we rely on the outside advice of very wellknown, wellrespected, probably internationally known neuroscientists to advise us to what the state of the science is and how best to go about changing our game to reflect that. So thats how we ended up adding creating a unified concussion protocol and returntoplay protocol for our sideline. Thats how we ended up with additional concussion experts on the sideline. This is based on the advice of outsiders who tell us this is the best way to handle your players, this is the best way to treat the game, and if you want a culture of safety, this is what you would do. We followed their advice strictly and meet with them very frequently. I noticed your title is Senior Vice President of health and safety policy. Is that position thats got to be a position that didnt exist 20 years ago. It did not exist 20 years ago. Im proud to be in that role. Its an exciting one. I know this hearing is on concussions, but since youre here, i got to ask you one other question that may be a little different topic. Over the last few years, ive communicated with the nfl about my concerns about the issue of Human Growth Hormone testing, and i know thats something that was raised in the last collective Bargaining Agreement effort, and theres an agreement to agree later, but that hadnt always come together as much. I know this is something thats important to the league. Can you give us an update on whats going on on testing for Human Growth Hormone . Sure. We appreciate the question. Unfortunately, we dont have Human Growth Hormone testing yet. The league has been ready, able, willing to pursue it, as you mentioned, since it was agreed upon in the collective Bargaining Agreement. Unfortunately, our Players Association has thrown up obstacles. Probably fair to say, if our perspective, excuses for a period of time. I think the testing goes to the integrity of the game, certainly. It also goes to the health and safety of the sport. You dont know where the stuff is coming from. You dont know whos giving it to a player or players, and you dont know what theyre putting in their bodies. Thats dangerous and also the wrong example to set. So this is an important issue for us and one that were sorry has not gotten accomplished yet. Thats an important issue to me. Thats why i wanted to raise it. I know its not the topic of this hearing, mr. Chairman, but since he was here, i had to ask the question. No, but if the gentleman will yield for one sentence. Yeah. I think thats why we wanted to have the Players Association here, too. Because that was a pretty strong criticism that you just made. It would be nice to have had the players as well to respond. Well, ill have to now interject. They were asked, and they declined. Yesterday. No, thats not accurate. They were contacted before yesterday. I want to reclaim my time for one more question, though, if i can. I got one more question for you. Where are these things going . I know when you try to crystal ball, its dangerous, because you never know, but where do you see things going over the next 5, 10, 20 years in terms of where technology is going to take us . Do you have some things about looking on the horizon that we can be looking forward to . Yeah, ill give you a specific example. As part of Scientific Research we entered into with ge, the worlds leader in diagnostics, we set aside what we call innovation challenges, two 10 million pots of money. The first was to promote new ideas on how to better diagnose concussion. There arent any objective tests now. Theyre all subjective analysis. We came back, we had people from 27 Different Countries around the world offer ideas. We eventually rewarded 16 of them so far. Biomarkers, blood tests, these sorts of things. In addition, we just completed another challenge that goes around protective ideas, how to protect the brain better. We had more than 40,000 people from 110 countries around the world visit the website. We had people from 19 Different Countries offer ideas on new protective equipment. Were reviewing those now. I think that because theres a lot more attention paid to this and hopefully were one of the actors that are catalyzing the science, that youre going to see changes in all of these places relatively soon. Okay. Appreciate that. Mr. Chairman, my time is up, so ill yield back. Thank you. The gentleman from kentucky is now recognized for five minutes. Thank you, mr. Chairman. Thank you for being here. Ms. Scurry, thank you for being here. That, quite honestly, might have been the only soccer game i ever watched from top to finish. It was about the time my daughter was interested in soccer, so we were watching. No pun intended with the top. Okay. No pun intended . That went over my head. Im sorry. But what a great sporting event. And its one of the great moments, and to be part of that is something special. I think it was special because it was just so much america. You were youthful, underdogs, grit, determined, and you brought up brandi chastain, not i and maybe a little exuberance. But it was a great moment. I appreciate you doing that and sharing. I played High School Football. Thats my claim to athletic prowess, i guess. But we practiced football in august. I remember one time in the south, 90something degrees. Were all running, water breaks. We run to the water break and some smart aleck kicks another guys foot, so he falls, knocks all the water over. The coach says, if you dont know how to handle that, were not going to have water today. That was over 30 years ago. That would never happen anywhere today. There was actually in louisville a young man who passed away on a football field, and the coach went to trial over it and turned out he wasnt convicted. So i think the awareness and stuff like what i described in my youth would never happen on a football field anywhere today. At least i hope it wouldnt. But we still have these injuries. I think, ms. Scurry, you talked about your injury being it wasnt heading. It wasnt changing tactics. It was just in soccer youre wearing cleats, short pants and a shirt. Somebody hits you in the side of the head with their knee and when you look i watch a lot of football. Of course, they now have targeting. If youre in college football, youre ejected from the game for targeting. A lot of the injuries youll see the quarterback gets knocked down and somebody hits him in their knee with the side of the head. I dont know how you deal with that. I know youre trying to do the techniques and tackling and heading the ball in the right way, but just the incidental things that happen because youre playing a sport going 100 miles an hour. Do you have any comments on that, ms. Scurry . Yes, well, thanks for the question. That is very relevant, actually, because my hit, when i watched it actually last night again on video, it doesnt seem to be a hit that would have taken me out of the game. As it was, i got hit and there was a few minutes later before i actually ended up coming out. There really there wasnt even a foul called, actually. So thats part of the problem, right . Sometimes a hit is a glancing blow, and it doesnt even really seem to be anything thats a big deal. But i think for me, my main focus is what is done after a hit occurs and to keep children and Young Players off the pitch after a blow occurs to assess them. Then determine whether theyre ready to go return to play or not. I think that is the key for me and why im speaking out about this because ive been around the country talking to different organizations, and im finding that kids are getting concussions five, six, seven in a very short period of time because theyre returning to play too soon. Thats where i think a lot of the awareness and education can help. Thank you. And mr. Miller, with that and you should do everything you can to stop the headtohead and so forth. But it seems because theyll play them on tv over and over. This is when somebody gets injured and theyre out. Like the knee of the lineman, like john runyon hits the side of somebody elses head. Its just incidental. I guess youre right. You cant really prevent that from happening, but its how you react to how that happens. I think thats right. One of the recommendations made by the Fourth International concussion conference in zurich was to look at the playing rules of the game. In our case, weve done that. I know other sports have done that as well. So you create the best possible situation. In a contact sport, there will be injuries, and there will be, you know, hits to the head and those problems will occur. So where that happens, we want to make sure were treating them appropriately. Thats where the focus shifts from prevention to appropriate treatment. Well, thank you. Im about out of time. I just want to say, ms. Scurry, i was sitting on the edge of the couch leaning and moving as they were shooting against you. Hopefully you felt my assistance and were able to help us both together win one for our team. Right . Absolutely. Thank you. I yield back, mr. Chairman. Very good job. Im glad to meet you. Thank you. Now the gentleman from maryland is recognized for five minutes. Thank you, mr. Chairman, and thanks for the hearing. And thanks to our panel. Mr. Hallenbeck, i had a quick question about whether the School Districts that youve been working with that have been implementing this, has that affected the, like, liability policies that they maintain as a jurisdiction . In other words, is there any trend towards them getting pushed by the Insurance Industry, for example . In other words, insurer would say, well, previously i would have provided liability coverage to your School District based on these measures or assurances that the district made with respect to how its conducting its sports program, but now that theres this program that enhances the safety of students and young people, we want to see that youve implemented that in your district or else were not going to provide the policy coverage or were going to charge you a higher premium. You can look at it the other way. You get a discount off your premium as a School District because youve implemented these kinds of measures. I ask that because i think that increased awareness of some of the risks from these sports injuries may lead to pressure in terms of liability on School Districts. Youll get some that may choose based on the premium that gets charged that to push the program out because they dont want the liability that comes with it. So i was just curious whether your program has whether youre aware of that kind of effect from the program or more generally aware of how the liability concerns intersect with some of these safety efforts that are under way. So thank you for the question. At the High School Level, we were literally on the front you know, oneyard line marching down the field. I will mention that were having very positive conversations with the state of maryland right now about participating in heads up football across the entire state. But we have a lot to do there. We have not seen anything from a liability concern, insurance concern with Fairfax County worked very closely with all their schools and School District about those issues. They told us and we checked ourself, they felt they had the appropriate coverage. However, to your point, at the youth level, were absolutely seeing insurance, the Insurance Industry at large and really the largest provider of casualty and Liability Insurance step forward and actually stated that if youth football leagues participate in the heads up Football Program, they would receive a discounted program and a more comprehensive coverage. So were absolutely seeing a positive response by the Insurance Industry, which of course has its merits. Thank you. I yield back. Mr. Ogrean, do you have is there any insurance liability issues at usa hockey . Yes, mr. Chairman, there are plenty of insurance liabilities. Unlike usa football, for example, which is much more decentralized than are we, our participants are all insured by us as a national organization. Whether its player Accident Insurance or whether its catastrophic insurance or whether its liability and even dno for all of our leagues, all of that is part of what our members pay us a membership fee for. Those claims or those premiums are obviously based upon the number of claims. So thats another business reason why its in all of our best interests to try to come up with every technique, every practice, every policy that we possibly can to make our game safer. The number one reason, of course, is the safety of the human beings playing our sport, but theres Good Business reasons for all of us to want to do Everything Possible to make the game safer. Thank you. Mr. Kenzinger, you are recognized for five minutes. Thank you, mr. Chairman. Thank you for your leadership in holding this hearing. All of you, thank you for being here and bearing through a bunch of politicians. I appreciate it. I appreciate the Diverse Panel thats gathered here and the important insights you guys are able to provide on the prevalence of concussions in sports. According to the cdc, 175,000 sportsrelated concussions impact youth athletes each year. I think todays hearing has been very constructive in helping us to move forward on understanding that and alleviating that. Ive read much about the legislative action taken across the United States to pass concussion laws. In my home state of illinois, similar legislation was passed in 2011 to require that education boards throughout the state work with the Illinois High School association to adopt guidelines that raise awareness of concussion symptoms and ensure students receive proper treatment before returning to the team. In addition, its encouraging that professional sports leagues and teams are taking steps to address concussions not only on their own ranks but also working with colleges and youth leagues to bring attention to the issue. Last year the Chicago Bears go bears kicked off a Pilot Program to provide certified athletic trainers at three High School Stadiums during Chicago Public football games. Such highprofile initiatives are important to combatting this issue, and i applaud the Chicago Bears for their leadership. Again, i find these steps to be promising, but were still confronted with staggering numbers of youth being impacted by sportsrelated concussions. Id like to ask just a few questions, maybe not take all five minutes, maybe i will. Lets talk about the equipment issue in terms of ill ask each of you to respond. Where are we at today in terms of what kind of equipment is being utilized to protect versus maybe where we were a few years ago . What kind of advances are yet to be made that were on the cusp of making or should make . And then is this packed by medical science . Is that going into this idea . So mr. Daly, ill start with you. I guess whatever you want to put into that subject would be great. Well, thank you for the question. Its a very important issue, obviously. The equipment is a very important issue and something were focused on jointly with our Players Association. We have a protective equipment subcommittee thats part of our joint health and safety committee. So we look at all aspects of equipment and how they, particularly as it relates to head injuries, how we can improve equipment and perhaps reduce the amount of head injuries we have. Weve passed some rules over time with respect to some of the equipment we had seen develop over the years with hard padding, both in the shoulder area and elbow area and those potentially causing head injuries. So weve mandated padding over those areas of players equipment. The helmet issue is a difficult issue, particularly in hockey, in terms of preventing concussion and one of the things were looking to work with our manufacturers on is research in terms of dealing with the Rotational Forces that can cause concussions, particularly in a sport like hockey, and whether a helmet can be designed to deal with those more effectively than it currently does. Thank you, sir. Mr. Ogrean . I think mr. Daly answered the question pretty well for our sport. Theres a great deal where we rely on the National Hockey league to be the leader. A lot of what they do is of benefit to us in a trickledown fashion. As i mentioned in my opening testimony, we do have a safety and protective Equipment Committee of 40 years standing. They do look at a variety of issues. The face mask, for example, is something that is mandatory. In youth hockey. It is not in the National Hockey league. Though, the shields for incoming players are now a standard. Im going to cut you off just because of time. Football helmets were designed to prevent against skull fractures. They do a fabulous job of that. They were not designed to protect against concussion. So that sort of technology or design, i know that the helmet manufacturers are working on it. Were not there yet. The league is doing what it can to inspire that, especially with our partnership with ge and underarmour to get new ideas around that. The other thing we do is we do regular helmet testing in concert with our friends at the Players Association so we can inform our players of which helmets are working best. And mr. Hallenbeck . Or ms. Scurry . Trickledown effect is important. The only thing id add is were working now closely with the sport and Industry Fitness Association and their council. So were getting insight from them and working together. On how we can improve things. And ms. Scurry . As you know, we dont wear equipment in our sport, but i want to commend your state for their Illinois Youth Soccer Association is taking a real lead in concussion awareness. I actually just did an event in chicago last weekend for the association and talking about concussions. So your organization is doing a great job. But in terms of equipment for my sport, we dont really have anything right now that is wildly used but hopefully in the future there could be something to help. Great. Thank you. Mr. Chairman, ill yield back. Gentleman from West Virginia is recognized for your five minutes. Thank you, mr. Chairman. I had to slip out for another meeting. So maybe some of these questions have been asked. Help me out on this a little bit. One is, is there anything that we can learn from the Defense Department with concussion injuries that were hearing from when we talk to our troops that come back . Im just wondering if theres some way were all talking to each other to help out on that. Mr. Miller . Im happy to take that question. Were very proud of our relationship weve fostered over the last couple years with the u. S. Army in specific. Memorandum of understanding that went back a couple years that covers a variety of different things. Weve gotten current and retired players together with returning active Service Members to talk about cultural issues. What is it about football or what is it about the military that makes it very difficult for somebody to remove themselves from play or certainly in the case of military from a battle . We found a great deal of reticence on behalf of both populations, sort of a shared reticence to remove themselves from their comrades or teammates. It instills a question as to how you get somebody to tell their teammate or tell their colleague, hey, you dont look right, you should get off the field. So weve learned a lot from that. Let me just add briefly, we meet regularly with the army to talk about the research theyre doing from a scientific perspective. We share our agenda. We share the ideas we have. And they do with us as well. Its proven to be a very cooperative and beneficial relationship thus far. Okay. Anyone else want to add to that about our military . The second question has to do with states have Workers Compensation programs to deal with the various disorders and injuries. Black lung in my state, its treated in a way that people dont have to take legal action to get help through the Workers Comp Program. Is that something that would be a benefit here in this program for injuries . We have a friend of mine has spent quite a few years in litigation with the nfl over this matter and just thinks its such a cumbersome and we also have a east coast Hockey League team in our city. We see some of the injuries, and we hear from some of the players and coaches about that injury. Is there a time we should have a Workers Comp Program for brain injuries . Should that be included in something . Theyre not required to follow litigation to get help. If i may, my case actually is a workers comp case. Ive gone through workers comp to get the different doctors, to see different techniques that will help me. That is part of my situation and part of the reason why its taken so long. Because every time something is suggested or recommended, i have to go back to Insurance Companies to get permission to do it. Sometimes it takes a hearing to get everything moved forward. So maybe streamlining that somehow would be of great help. Also, in your previous question, you talked about how can we help the military Service People who have tbis. For me, one of the best things, i think, would help is more psychological side and testing depression, anxiety and panic attacks to make sure that each person who comes back from military who has tbi gets help in that area, the emotional side of it, not just the physical. That would be very helpful, i think. Thank you. Any other thoughts . Well, Workers Compensation laws are really different jurisdiction by jurisdiction including for us in canada where professional athletes are specifically excluded in most Workers Compensation laws. Its certainly a mechanism that an increasing number of our athletes are using in cases where they have debilitating injuries from their playing careers. So would you so what was your recommendation then . Youre saying yes . Well, again, i guess what id say is i think its generally available to our former athletes currently, the Workers Compensation protection. I guess what were hearing is different from that. Thats why i want to raise it. But thank you for your comments about that. I yield back the balance of my time. The gentleman yields back. Mr. Bilirakis from florida, youre recognized for five minutes. Appreciate it very much. Thank you very much for holding this very important hearing. I wanted to specifically thank ms. Scurry for really speaking out. I really appreciate it. Makes so much of a difference. Thanks for your sacrifice. Youre going to make a real difference in kids lives. I also want to ask i want to get back to the protective gear, the helmets, what have you. How does the youth and we can ask all of you how does the youth helmet, the protective gear compare as far as safety, quality to the nfl and nhl . I mean, can you give me an opinion on that . So im certainly no expert on exactly how that compares. My understanding is there obviously is not the standard bearer and they set the standards and certainly all the helmets out there have to pass that standard. I think the manufacturer would say they go above and beyond that. How it compares to an nfl helmet, generally speaking, the youth helmet is lighter, but the padding and so forth is appropriate. I dont want to suggest im defending them. I dont know the exact details. I know its sufficient based on standards and so forth. Many of the kids, though, the players, youth players, by 10 and 11 and 12 years old, theyre transitioning into what might be considered high school or adult helmets. Theyre getting the best available. The other thing i would add is certainly i am aware that the technology is improving in helmets and shoulder pads and football equipment generally. Definitely improving. Mr. Miller . Sure. We worked on a program with the Consumer Product Safety Commission, our Players Association, and some others recently that we would put money towards reconditioning older helmets for youth leagues. Certainly leagues that have, you know, Budget Constraints as many do probably dont get around to updating their helmets or what they call reconditioning them frequently enough. So we put a fair amount of money into that program in coordination with the cpse. I know scott at usa football runs an equipment football grant as well. So addressing those needs. We know a new helmet is better than an old one. We know a reconditioned helmet is better than one that hasnt been. Most important of all is that coaches learn how to fit the helmets. Thats going to be the number one safety peace to the equation as it relates to kids. And so were aware of these issues and were trying to make a difference there as well. So in your opinion, are the youth helmet or high School Helmet is not as safe as the nfl, but you have a program to help. Is that correct . Yeah, i dont know about the comparison the quality might not be as good. I dont know about the comparative safety of the helmets. I suppose thats probably a question can i talk to you about this particular program . Of course. I know parents where the kids play High School Football and the parent will purchase a better quality helmet for the child. You know, concern about the kids that dont have the the parents dont have the money to purchase that. So very important. I would appreciate working with you on this. Every kid deserves the proper equipment. If theres an existing Grant Program out there, id like to hear about it. Also can, i hear from the hockey hockey as well . Sure. At the youth level, i think the helmets are just as good as the National Hockey league. The only difference is size. They have to be certified by the hockey equipment certification council. Theres a threeyear Expiration Date on every helmet. You cant use a helmet thats more than three years old. Very good. Nhl . I would first echo mr. Millers comments. Helmets in our sport as well are principally designed to prevent skull fractures, theyre not principally designed to prevent concussions. Sometimes they can disperse forth in a way thats not their principle purpose. We also have regulations we make available to our equipment managers and players with respect to frequent replacing of helmets. So each player is essentially asked to replace his home helmet at least once a season. His road team helmet at least two times a season because were worried about ageing effects and degradation that accompanies travel requirements for our team. So frequent replacing of helmets is a priority for our league as well. Are the coaches educated . Do they know which size fits the child . Have they been briefed on those particular issues . Because thats so very important. Youth sports, hockey and football. They are. I agree with mr. Miller that it is its a big difference maker, you know, in the helmet doing its job, but its a pretty fundamental part of what a coach has to do to make sure the players on his team all have the proper equipment and are wearing it in the right way. I would just add that thats a cornerstone of our headsup Football Program, equipment fitting. Frankly, at the youth and High School Level, we found they dont know how to properly fit equipment. Its a very important element within the program. Thank you very much for including that. As far as, you know, the youth, of course, the nfl, hockey stars, what have you, baseball, basketball, theyre looked up to by our children. As you know. Do yall have programs where you can speak that speak maybe go to the schools, Football Players go to the schools and speak on these particular issues . Yeah, one of the our active players are by and large terrific at this topic. One of the elements we included or offered up to usa football as part of their heads up Football Program was actually what we call an ambassador. So for leagues that were early adopters of the program, they would get visits and consultation with a retired nfl player. Were trying to encourage our clubs with great success, by the way. Theyve really done a terrific job of embracing in their communities the youth leagues and others so theyre around the facility more. That they interact with coaches, trainers and certainly players, which obviously the star quality of it brings attention to it, which was part of the motivation in first place. But we have found our retired players thrilled to participate and really active and helpful to the end that you suggest. The gentlemans time has expired. So if any of you want to answer that question, youll have to do it by writing. And brings me to the point that oh, you have a question. Im sorry. Recognize the gentlelady from virgin islands. Thank you. And thank you, mr. Chairman. Sorry im late. I was at another hearing downstairs. Mr. Miller, id like to ask you this question. Many tens of thousands of helmets are used every year that are more than ten years old. I understand that the nfl participated in a program initiated by the Consumer Product Safety Commission by donating money that would go towards new helmets for youth Football Players in lowincome communities. I really want to commend the nfl for this initiative. Of course, its going to cost a lot more money to get to the point where virtually all kids around the country who play football no longer wear old helmets that are likely degraded or obsolete. Im pleased to know of your donation to the cpse initiative because it strikes me as an acknowledgment that wearing an old helmet when playing football is not advisable. A statement from the nfl that would be very influential. We have also heard reconditioning those under ten years old is important to ensure the proper foam density and that other degraded parts of the helmet are replaced. So i wanted to ask you the following questions for a yes or no answer. I guess thats why im sitting in chairman dingells seat. We realize that many issues are subject to negotiations, but can the nfl commit to supporting prohibiting helmets on the field that are over ten years old . In the youth space . Youre talking specifically about youth football prohibiting helmets that are older than ten years there . Yes. You know, i plead not enough familiarity with the issue. I know there are a couple of states who have taken that step and wed be happy to work with you to pursue it. The prime place, as you mentioned, we work with in promoting newer, refurbished helmets is with the cpse or through usa football, who has a Grant Program as well. So the first question is committing to supporting prohibiting helmets on the field over ten years old. Could you commit to supporting a policy position that helmets more than ten years old present an unacceptable safety risk, thats a position taken by most of the helmet industry. If thats the position of the helmet industry, i see no reason wed have a concern with that. It sounds appropriate. They strongly recommended that their helmet should be disarded after ten years. Can the nfl support a policy position recommending that helmets be discarded after ten years . We would certainly support that helmet companies and how they advise people to use their products. Weve also heard stories of players using beatup lucky college helmets or adjusting their helmets by removing padding in the helmets for comfort. Will the nfl commit to support a policy position that all players who wear helmets that are reconditioned properly . All of our players have choices in which helmets they use, as long as they pass the certification body and theeds. Thats part of the Players Association and players have to use helmets that meet the standards nt and reconditioned properly and appropriate padding . Sure. The nfl players helmets are reconditioned regularly and our equipment managers work with the players to make sure that their helmets are in good working order. Thank you, mr. Chairman. People are settling in. This is unintended part of our hearing today where were dealing with neuroscience and medical research and physics. Well, physics when dr. Gay arrives. So panel two, i will introduce you from mr. Cleland on down, mr. Cleel end is the director of advertising practices at the federal trade commission. We have ian heaton, Student Ambassador for the National Council on youth sports safety. If i might editorialize i think jan did a great job juxtaposing a face of tbi and concussions on each panel. Ian as a High School Lacrosse player is that face for the more scientificbased panel. So thank you, ian, for taking your day away from school. I know how tough it is to be pulled out of school and come testify before Congress Just like a normal high school student. Then dr. Robert graham, chair committee on sports related concussion in youth at the institutes of medicine. Dennis malfeese, director of the center for brain biology and behavior at the famed university of fnebraska. Thank you, doctor. Dr. James johnston, assistant Professor Department of neurosurgery at the university of alabama birmingham, star of screen. Dr. Tim gay, ph. D. Professor of atomic, monlecular and optical fizz ibs university of nebraska. Dr. Joia, ph. D. Division chief neuropsychology childrens medical hospital. Not quite up to the level of university of nebraska, we have the harvard medical school. Thats just humor. Professor yeah. Professor of psychiatry and radiology at brigham and Womens Hospital harvard medical school. Thank you for being here for a very impressive and esteemed panel of scientist and experts. Mr. Cleland, youll start. Youre recognized for your five minutes. The green light is on. Is that better . Thank you. Im richard cleland, im assistant director of advertising practices at federal trade commissions, bureau of consumer protection. Im pleased to have this opportunity to provide information about the actions weve taken over the past few years with respect to concussion protection claims, claims that implicate Serious Health concerns, those potentially affecting children and young adults are always a high priority at the commission. The commission strives to protect consumers using a variety of means. First and foremost the agency enforces section five of the federal trade Commission Act which prohibits deceptive or unfair acts or practices. Interpreting section 5, commission determined a representation, omission or practice is deceptive if likely to mislead a consumer acting reasonably under the circumstances and it material likely to affect the consumers conduct, choice or decision about a particular product at issue. The commission does not test products for safety and efficacy. It does require an advertiser have a reasonable basis for all objective claims conveyed in an ad. The commission examines specific facts of the case to determine the type of evidence that will be sufficient to support a claim. However, when the claims involve health and safety, the advertiser generally must have competent and reliable Scientific Evidence substantiating that claim. As awareness of the dangers of concussion have grown Sporting Goods manufacturers have begun making concussion protection claims for an increasing array of products. These include football helmets and mouth guards but also include other types of products. In august 2012, the commission announced a settlement with makers of brain pad mouth guards. The Commission Complaint claimed it lacked a reasonable basis for the claims that mouth guards reduced the risk of concussions, particularly those caused by lower jaw impacts and falsely claimed Scientific Evidence proved the mouth guards did so. The final order in that case prohibits brain pad from representing any mouth guard or other equipment designed to protect the brain from injury will reduce the risk of concussions unless the claim is true and substantiated by competent, reliable Scientific Evidence. In addition the commission sent out warning letters to nearly 20 other manufacturers of Sports Equipment advising them of the brain pad settlement and warning them they might be making deceptive concussion claims about their products. Ftc has monitored these websites and working with them as necessary to modify their claims on their sites and in some cases ensure that the necessary disclosures are clear and prominent. Continues the survey for reduction claims and alert advertisers who are making potentially problematic claims of our concerns and the need for appropriate substantiation of such claims. Commission staff investigated concussion reduction claims made by three major manufacturers of football helmets. Ridell Sports Incorporated and zenith llc. In these matters the staff determined to close the investigations without taking formal action by which time all three companies had discontinued the potentially deceptive claims or had agreed to do so. Those cases are discussed in greater detail in the commissions written testimony. The commission plans to continue monitoring the market for products making these claims to ensure that advertisers do not mislead consumers about the products capabilities or the science underlying them. At the same time we are mindful of the need to tread carefully so as to avoid inadvertently chilling research or impeding development of new technologies and products that truly provide concussion protection. The commission appreciates the committees interest in this very important area as well as the opportunity to discuss our agencys effort to ensure that the information being provided to consumers, in particular to the parents of Young Athletes, is truthful and not misleading. Thank you. Thank you. Ian, you are recognized for your five minutes. Chairman terry, Ranking Member schakowsky and members of the subcommittee, thank you for the opportunity to share my story today. My name is ian heaton and im here for Student Ambassador National Council on youth sports safety. Im also a senior at Bethesda Chevy Chase High School in bethesda, maryland. I was playing in a lacrosse game when i sustained a serious head injury which we later discovered was my third concussion. Until then i did not appreciate what a great life i was living. I got good grades in challenging classes, played High School Lacrosse, was working on my Second Degree black belt in martial arts, had a job i loved teaching tae kwon do. Performed in my schools Jazz Ensemble and combo and had an active social life. It was over in a split second. My concussion left me with only 5 of normal cog nitty activity and i was almost immobilized. Ive spent 2 1 2 years recovering and at times have ever wondered if i would ever get that life back. It has been a long, slow process. At first all i wanted to do was sleep. Noise, light, even moving my eyes caused headaches and nausea. I was enrolled in the Childrens Hospital Score Program that dr. Goy a will describe later where i received ongoing cog nitty evaluation and treatment for symptoms. After missing school for two weeks, i tried to go back but was unable to function. The frustration of trying to focus on lectures, moving through the pandemonium of the halls and constant sensory bombardment made a Normal School day impossible. However, through my school i eventually enrolled in a home teaching program. With the help of tutors and family, was able to complete my semester course work at my own pace. I finally returned to school in december but was still far from recovered. I have spent the 2 1 2 years since my concussion slowly regaining organizational skills, the ability to learn and retain information and, most important, my personality. During this time, my friends and family learned to recognize the signs that meant i needed to shut down from any mental or physical activity for a day or two. These relapses were particularly tough and discouraging and meant i had to drop a class, miss a band trip to chicago, among other things. The worst was when i had a crash and could not go to my first concert, the red hot chili peppers. The friend i gave my ticket to really owes me. The spring after my injury, i was medically cleared to return to sports but made the hard decision i would not play lacrosse or other intensive sports again. I know that a lot of people recover and return to play, but the possibility of another concussion means i could lose everything again just like that and not come back the next time. I now look at my recovery as something that has made me stronger but i know that im one stronger but i know that im one of the very lucky ones that had the resources and medical attention i needed and a School System that is aware of concussion issues and provided an unusually high level of support. It is not over yet. My recovery continues. But my outlook is positive and im excited about the future as i prepare for college. Im thinking about becoming a High School Math or science teacher. I now have a hard question. What can be done to create a safer sports environment and ensure when injuries do occur, the support for full recovery is available. We cant do away with youth sports. I played baseball, travel soccer and league and High School Lacrosse. Being on those teams not only gave me a healthy outlet but taught me important lessons. Sports are one of the best parts of growing up and becoming a strong adult. They teach us that if we work hard, well become skilled and proud of our accomplishments. They teach us how to be part of a team, have pride and success and learn the lessons of defeat. They teach us sometimes we have to quit thinking of ourselves and think of the good of the team. For these and many other reasons, i hope that steps can be taken so that future Young Athletes have these opportunities. There are two important things i think would make a big difference. The first is to change the cultures of hitting hard to take out a good opponent rather than playing to win through skill and brushing off injuries to get back into the game. While better equipment may decrease injuries, it is coaches, parents and players who have too back away from the need to win at all costs, or fear the losing status on the team to be out for an injury to be willing to recover fully before returning to play. It will take a while. If youth and professional sports are to survive, these attitudes must be embraced. Second, when injuries do occur, we must have a way for qualified personnel to quickly assess injuries on the field, have players get immediate attention, and then support recovery through schools and medical institutions. These are the things that were done for me and are the reason ive been able to return to normal. As a Student Ambassador for ncyss, the message i hope to give Young Athletes are this. You think youre invulnerable. You take risks and brush off injuries because you think you will recover quickly from anything that happens. You wont. Dont be a hero, especially when it comes to your head. Its the only brain youll have, and your personality is who you are. Its not worth a couple of seasons of glory to lose the opportunity of a lifetime. Thank you. Very good. Dr. Graham, you are recognized for five minutes. Thank you very much. Chairman terry, Ranking Member. My name is bob graham. I served as the chair of institute of medicine sports related e and youth study. As you have my testimony before you and i think copies of the study itself, i will just try to take these minutes to give you a summary. The institute of medicine is part of the National Academy of science chartered to provide advice on very scientific issues. We were specifically empaneled to look at the evidence about the causes and consequences of concussion in youth and military the state of diagnosis management, role of Sports Equipment and regulation. We have 17 members on our committee. We worked in 2013. Dr. Molfese, who will follow me, was a member of that committee. We came with just six recommendations. The first was that the cdc needed to establish a better mechanism for National Surveillance to comprehensively capture incidents of concussions. Youve heard a number of figures about the concussions in one sport or another. We know what the incidence is when they are measured. We do not know where they are not measured or more closely watched. We need to have that baseline to know and as we take corrective measures, the success were having on decreasing the incidence of concussion. Number one, better epidemiology. Number two, couple of recommendations related to research. We need nih and dod to look more specifically at what metrics and markers are for concussions. How do you assess the severity of a concussion. How do you find diagnostically whether or not an individual has had a concussion. Right now its largely based on observation and selfreport. Are there physiologic markers used to give us better documentation when the concussion has actually occurred perhaps without the individual knowing it or it being observed. Secondly we need nih and dod to look at more carefully longitudinally at the short and longterm consequences of discussions. We heard testimony in this panel, prior panel, individuals who had one or more concussions. What are the longterm sequela. That gives us a sense about not only, again, epidemiology of the problem were dealing with but what treatments and interventions may be and what rehabilitation may be. Fourth recommendation to the ncaa and National Federation of state and High School Associations to look at age appropriate techniques and roles and playing standards. Again, first panel talked a little about that, mostly at professional level. Change the manner the sport is practiced and the rules of engagement in the sport that may decrease risk of concussion. One example of hockey area where they changed the level where they allowed bodychecking and felt they saw a decrease in concussion. We think that same sort of examination should take place at the college and elementary and High School Level to see whether or not they can have the same impact. The fifth recommendation had to do with a better study of what the role may be for protective equipment. The first panel talked a lot about that. The committee had a number of questions about that. Our Committee Found that there was very little evidence that helmets protect against concussions. A lot of data in that. Some of the other panelists talk about that. You may come away with equivalence degree in physics this morning. Its a complicated issue. There are a number of suggestions. We certainly dont recommend you not use helmets. They do protect against bone injury and softtissue injury, but the suggestion that a helmet itself may decrease the incidence of concussion, the evidence does not appear to be there to us. We think that the nih and dod again have a role looking more specifically at what we may be able to do. Our final recommendation was changing the culture and the way concussions are viewed. This is a significant injury. Athletes need to be encouraged to report, take themselves out of the game. Coaches and parents need to be encouraged to say for your own protection you need to be removed and give yourself a chance for recovery. Thank you very much. Thank you, doctor, youre recognized for five minutes. Thank you, mr. Chairman terry and members of the subcommittee for this opportunity. If we could have the slides. So i think the earlier group talked about the number of if you can go ahead and put that on power point. A number of sports where the rate of concussion is high. There are, of course, differences in rates for men and women. Dr. Gay will talk about some of that in terms of weaknesses of womens next relative to mens next now. That puts them perhaps at risk of concussion. Next slide. Concussion accounts for in the United States roughly about 75 of traumatic brain injuries. It is a brain injury. There is damage to the brain. Theres a discussion about whether its permanent or temporary. In the military the rate is 77 . So turns out that youth sports are a good model for also looking at concussion in terms of the military. In fact, most of the military concussions occur in situations most like they do with the rest of america. Some certainly occur in theater, but the majority occur outside of theater, in accidents prone to experience. Next slide. If we look at brain injuries overall, estimates these are all estimates, of course, and they vary across the literature. Were looking at somewhere probably in the neighborhood of 4 million traumatic brain injuries in the United States. A sobering part of that is our birth rate in the United States is also about 4 million. This does not account other ways children are exposed to head injuries. Perhaps a disciplining irate parent that slaps a child that creates Rotational Movement can, in fact, produce a concussion. Those, we suspect, are unreported. Recovery is pretty quick. Anywhere from a few hours to a few days. Some will persist two weeks even out to six weeks, but roughly about 20 seem to persist beyond that time. Next slide, please. This is a slide on some data under review. It will give you a sense, these are data recorded using brain electrical activity. A net of 256 electrodes that fits on the head in about 10 seconds or so. We present in this case a series of numbers. One number at a time. All the College Athletes had to do was simply say whether the number they currently see matches or does not match a number that occurred two positions earlier. And on the left side those orbits, circles you see, colored circles, on the left for match and nonmatch, these are images of the brain electrical activity on the scalp recorded from those electrodes between 200 and 400 milliseconds. 2 for. 4 of a second after the number appears. The schematic on the right shows you the head position. A very rapid brain response. For those athletes who have no history of concussion, we see clear difference in the electrical activity for match versus mismatch. We see red, various shades of blue from the front of the head to the back of the head. On the right, though, these are individuals with a concussion history of one to two years earlier, not current. Yet at 204 milliseconds, the brain cannot discriminate whether those two numbers are the same or different. They also might get these tasks correct but takes them roughly 200 milliseconds longer, 200 synapses. Processing speed is low. After two years one might suspect thats a permanent change. Next slide. Yeah. So in terms of critical scientific gaps, some of these we do, dr. Graham talked about. How does concussion affect the brain in the short and longterm. We really dont have much information about that. Whats the dose requirement. Dr. Graham talked about that. To produce concussion, postconcussion syndrome. Cte. How can we reliably objectively know when the brain is injured and more importantly, fully recovered. We have no ways to do it. Lots of individual differences from one person to the next. We think there are genetic