Transcripts For KQED Charlie Rose 20151201

Were to happen. When something happened to me, one, i dont think anyone noticed and i dont think they knew what the to do. Rose brain series sportsinduced trauma, underwritten by the sloane foundation, coming up. Rose funding for charlie rose has been provided by and by bloomberg, a provider of multimedia news and Information Services worldwide. Captioning sponsored by Rose Communications from our studios in new york city, this is charlie rose. Rose tonight we continue exploration of the human plain brain with sportsinduced trauma. Well focus specifically on young people. Kids and young adults make nearly 250,000 emergency room visit each year as a brain injuries from sports and recreation. Our increasing understanding of this traumas neurological effects have ignited a discussion about the risk of Contact Sports. Tori bellucci was an allmet Soccer Player in maryland, she turned down a scholarship in college after she suffered her fifth concussion. She joins us to talk about her experience. Also sign cysts, Walter Koroshetz of the National Institutes of health, Susan Margulies of the university of pennsylvania, Thomas Mcallister of the Indiana University scoostles medicine, dawn comstock of the university of colorado anschutz and, once again, dr. Eric kandel. He is, as you know, a noble laureate, bureau of of Columbia University and Howard Hughes medical investigator. I am pleased to have them here at this table. Tell me about concussions among young people. Sportsinduced trauma, this has emerged as one of the major Health Issues of our time. Why is that so . Let me put this in a bit of a perspective. There is a general consensus that team sports is extremely advantageous for young people. 50 million americans participated in group sports, in athletic competition. And this is beneficial in two ways. Athletic and social. From the athletic point of view, they learn early on that almost daily exercise is good for one, and many of them are likely to carry this forward for the rest of their life, ensuring them a healthier life span than they would otherwise. In additiono the physical values, there are also social values that come with it. One learns from team sports a sense of honesty, fair play, team work. These are very beneficial values that also help carry people through a lifetime. But a down side emerged recently, as you indicated. The medias called attention to the fact that at the very highest level, professional football, soccer, basketball, there are traumatic brain injuries associated with sports activity and some of them can lead to severe brain damage and that has made us worry whether or not were taking sufficient care of our young people to protect them from this, and this has become a national issue. President obama called a summit meeting on this in may in which he raised this issue. Could sri the tape, please. Concussions are not just a football issue. Young people made nearly 250,000 emergency room visits with brain injuries from sports and recreation. 250,000. The total number of young people who are impacted by this early on is probably bigger than we know. So as president obama made absolutely clear, young people are particularly susceptible to traumatic brain injuries, and traumatic brain injuries is the leading cause of death and disability in young people. So we want to understand, you know, what this is about. What is a traumatic injury about . The brain is a gelatinous organ that is protected by being encased in a rigid, bony skull. When we move about, there is minimum movement in the brain, but as a result of two kinds of forces, impact forces or inertia forces, there can be serious jarring of the brain as it is moved rapidly back and forth in this closed space. It is only separated from this bony inflexible skull bay fluid later called the cerebral spinal fluid. Impact forces are actually from physically bumping in against the skull either by another skull hitting it, by hitting the ground, by hitting a soccer ball. But in addition to this, there are inertia forces which dont involve any contact at all. Its like a whiplash injury in which somebody bangs into your body and can shake up the brain or when you fall on to the ground, it can shake up the brain and often these forces interact with one another and have significant consequences on peoples neurological states. The traumatic brain injury varies from being modest to being moderate or severe. The modest injury falls into two cargts. The vast majority of them are about 90 recoverable within seven days but, in some cases, even with modest injury, the recovery may take longer. With moderate or severe brain injury, the recovery takes longer. One of the factors that lead to this prolonged recovery, there are several. One is younger people are more sususmoresusceptible than older. A prior concussion means it takes longer to recover. One of the sad things of a prior concussion is if youve had one, youre more likely to have a second and if youve had two, youre much more likely to have a third or fourth. So concussion is not bad in itself but what it does for the future of the athlete playing, one of the predictors for these long recoveries besides prior concussion, there are also severe symptoms. Amnesia or loss of consciousness, particularly profound ones, if you have them youre likely to have a prolonged recovery. At what period are you both south susceptible for traumatic brain injury, both male and females, the peak injury occurs during adolescents occurring from about 12 to 18 or 19 years of age. Why is that so . Everyone who has had an adolescent child realizes there are important brain changes that occur during adolescents and the two key ones which well hear about later on are called pruning and myelination. Pruning, the cells make contact with each other and the brain produces many more synapsis than it actually needs to make sure every possible contact is covered. But with adolescents, the brain matures, inappropriate contacts are gotten rid of. So those that are not functioning are gotten rid of to streamline and make the brain function as a highly efficient computation device. As the brain enlarges, we need speed of communication between one region and the other, thats mediated by long structures called axeons and theyre covered by myelin and myeliniation is the process. And the brain is susceptible to injury when this is going on. One of the tragedies is because of the enormous susceptibility, we still dont have any pharmacological treatment for traumatic brain injury and it becomes all the more incumbent to use other health measures, for people who are the coachers, trainers, athletes themselves and the person in the game to realize when the concussion has occurred to immediately pull the athlete from the game and not to let him return to the game on that particular day. In fact, they should not play again until they have been cleared by a health professional. So this is really absolutely essential. In order to really, you know, discuss these issues in depth, we brought together a really extraordinary panel. We begin with tori bellucci, an outstanding Soccer Player and, because of several concussions, she has decided to give up competitive athletics and she now coaches Soccer Players to prevent them from having the kinds of difficulties shes had, and shes going to describe to us directly what its like to have a concussion. We have dawn comstock who is interested in the incidents of concussionings and the circumstances to bring this out. Thomas mcallister is interested in the cognitive behavioral consequences of concussion and is doing a longterm study of College Students to see what the behavioral consequences is. Susan margulies is interested in the brain mechanisms of concussions and studies this not only in people but in animal models. And Walter Walter i koroshetz ig can we come up with treatments. So not only do we have a mainly Health Problem but we have a major health Flannel Panel and were in for a fantastic discussion. Rose thank you. Tori, what happened . I began playing soccer when i was four years old a little against my will. After my first practice, it was something i immediately loved and something i wanted to do all the time. So i played soccer. Since that day until i was a senior in high school and around when i was 15 years old is when i got my first concussion. I really didnt even know it was a concussion. I headed the ball and someone else. When i got home, i had a lot of headaches and trouble sleeping. I didnt think of the possibility of concussion, and i knew i had an important game the next day, so i decided to play anywayt. Once i got to my game the next day, it was the semifinals and one of our state cup appearances and i had gotten into a rough tackle and fell to the ground and hit my head on the ground pretty hard. Once i got up from the fall, i was kind of confused as to where i was, but i gained that back pretty quickly, but my vision was extremely blurry, my head was spinning, i was doesy, but knowing it was an important game, i decided to push observe. After i finished the game, i went to the emergency room, and turned out i had whiplash in my neck and a concussion. So i had to take probably a week off of school. I was very moody. I couldnt sleep. It was a very tough time for me. Rose were you under medical care at this time at all . No. When i went to the emergency room, they gave me a muscle relaxer for my neck. Other than that, i just stayed home with my mom. She took off work. Rose thats the problem there, not identifying the concussion. If, in fact, according to what youve already said, if there would have been some identification, everyone would have insisted she not play till it cleared up. You had how many concussions . Ive had five. Tot what dug did you know something was wrong but you didnt want to leave the field because you realized the team depended so much on you . I think at that point i would have tried to push through anything, no matter what my symptoms were. I was so competitive and my passion was incredible for the game to where i didnt want to stop even if i knew something was terribly wrong with me. Instead of leaving the field when they feel ill rose in the n. F. L. , a doctor exams anybody who thinks they might have a concussion as soon as they come off the field. So today, how are you . Today im a lot better, but i still struggle with things. With my workload at school, i have about two 2003 headaches a week. Sometimes ill have headaches for five days without any break. My eyes have been struggling since my last concussion which is almost two years ago. Both my pupils are not the same size all the time. So with that, its really difficult for me to be in lecture and be looking at the board and looking at the powerpoint and going back to my notes. That really stimulates my headache. Rose are you under the care of neuroscientists and physicians . Not anymore. I mean, after my last one, i havent really had to go back to the doctor. I have been telling them i still have headaches and probably troubleshooting every idea we have. Rose your case was not known. You were there with the obama summit and the president and you introduced the subject there. Yeah. Rose so youve become a part of the conversation without the impact of concussions. Which im really happy about. Its unfortunate all this had to happen to me but i do think its something that needs to be talked about and known so im glad i could help with that. Rose how prevalent are concussions among young people . More prevalent than people realize. At high school age, high schoolsanctioned reports, last year sf 0,000 concussions among Football Players, off0,000 among girl Soccer Players, 45,000 among boy Soccer Players and 20,000 each among Girls Basketball players and boys wrestlers, and those are National Estimates based on National Injury surveillance data. Over the last decade, concussion rates increased dramatically over time. Now, this is one of those times where some scarylooking statistics might actually be something good. This rapid increase over time likely does not indicate a true increase in the incidence of concussion. High School Athletes havent grown dramatically bigger and faster and stronger over the last decade and most of the rule changes at the High School Level in the last decade actually improved player safety. I think what this image actually demonstrates is the dramatic increases weve had in education, in knowledge. The Young Athletes, their parents, the coaches, the policymakers have become more aware of this issue of sportsrelated concussion. They recognize it more readily. Exactly. Rose is it across the spectrum of sports or primarily football, soccer, those Contact Sports . Well, i think awareness was originally generated because of highprofile incidents at the professional level, but now it would be very difficult to find a parent of a High School Athlete that couldnt at least explain some of the signs and symptoms of concussion and recognize that its an important injury that needs to be addressed. Another thing this image demonstrates is concussion rates are significantly higher in competition than in practice. Rose yes. And part of this may be because athletes, like tori, simply dont want to come out of the game, but its also because there is more events of athlete contact that occur in competition compared to practice. These differences between competition and practice rates vary dramatically by sport, however. For example, in Boys High School ice hockey, competition concussion rates are 13 times higher than practice concussion rates, while in girls softball, computation rates are only twice as high as practice rates. Rose how do you explain this . A lot of it are just the activities associated with individual sports. Across the entire spectrum of 24 sports i study, the most common method of concussion is athletetoathlete contact. So collision sports have more instances of athlete contact in competition. Rose and more in competition than practice. Correct. Youre much more likely to hit your opponent in a game than you would your teammates in practice. Rose let me turn to tom, then, and talk about what happens when there is a concussion. Charlie, from a clinical standpoint, i think tori described it very nicely, but, basically, as a result of the force and the mechanics that eric alluded to and well touch on further, there is a disruption in brain function that is usually described as an alteration in the level of consciousness, which simply means that people may have incomplete memory for the event, they may appear confused, dazed, astory described, and then thats often followed by a variety of other symptoms, such as headache, may have blurred vision, sensitivity to light and noise and dizziness are particularly common, along with headache. The other sort of major domain people will prescribe are problems with thinking and usually the big ones are problems with memory, attention and concentration. The good news is that most times these symptoms gradually resolve over, lets say, seven to ten days or perhaps several weeks. But weve known for a long time that there is a Certain Group of folks for whom thats not the case, and the symptoms can persist for a fair amount of time. Whats interesting is that the way that the concussion happens and the way the brain is designed and the skull is designed and so forth actually predict nicely the kind of symptoms tori described. You can see again two forms, one can be from the brain hitting the inside of the skull and the areas in red on that slide suggest the areas that are particularly vulnerable, and then whats important to know is its great the skull is great at protecting the brain from lots of things. But when you put the brain in motion and its moving out of phase with the skull itself, its rubbing up against somewhat a hostile work environment. You can see the cutaway, there are images or rough areas along the skull that make it more likely the brain is damaged in those particular areas, but you dont even have to have that in order to have the injury and symptoms tori described. I think just the very movement of the brain itself, eric described it as a somewhat gelatinous material and not of uniform density, so as the brain is moving, there are shearing forces that result, and that can damage the delicate white matter fibers or ax axons that connecte fiber to another. These are delicate so this twisting or action can damage that and damage the connectivity of the different brain functions. So putting it all together, the next image will show the particular brain regions which are, you know, most likely to be damaged, and what i think makes concussion and brain injury in general a sort of perfect storm for the kinds of neuropsychiatric complaints tori described, these images are showing the symptoms tori had. Memory is the common complaint. The next image shows which brain regions are important in memory function. Fink you compare that to the other image, you can see it maps on to that very, very nicely. Tori, i think, described some difficulties with schoolwork, and lots of our athletes describe that. They describe it as not thinking as quickly, sort of decrease of speed information processing, socalled executive function, and if you look at areas of the brain particularly relevant to executive function, they map nicely on the regions that are vulnerable to con cuesive injury. And then i thought it was interesting, tori, you mentioned being somewhat moody, somewhat depressed. This is an enormously common complaint from people who have concussion and other type of brain injuries, so the Psychological Health as suspect is impacted. And brain regions are thought to be important. Once more, if you were to design an injury calculated to sort of damage cognition and neural behavioral symptoms, you couldnt have designed a better one, unfortunately. So the point of all this is, i think, the symptoms that we see follow very nicely from what we know so far about the mechanics of how the brain is injured. Rose do we know why some people recover better than others . Well, eric alluded to come of the reasons we know of. Folks who have had more than one injury tend to take longer to recover. Younger athletes may have a more prolonged recovery. There is also an interesting link between other kinds of behavioral and psychological Health Issues. So folks who have had struggles with those kinds of concerns in the past, there seems to be an interaction with it. And then as well hear from dr. Margulies, the bio mechanics, not every injury are the same in how they affect different brain regions and that may play a role. Very interesting work suggests genetic factors may impact this. So you and i might differ in terms of the genes that we have for Getting Better or not Getting Better after a concussion. Rose let me turn to walter and talk about how the young brain is different. Right, charlie, so i think our brains are always developing, even in adult life. New connections are being made. This is much more dramatic during childhood. The the changes occurring in the young brain are so dynamic. The energy that the brain uses peaks in late childhood and adolescence. The blood flow peaks in late childhood and adolescence. And as eric said, the brain is a massive computer where the connections are just tremendously exuberant right at the beginning. Then its molded over time by activity and experience to make us who we are. That molding period, as eric mentioned, is because connections that are not useful are taken away, the sna synaptic bruining and thats occurring at a peak during this time period. Everyone is worried about the injury that occurs during the developmental stage whence things are more dynamic. The myeliniation, the insulation and wires that connect different brain regions goes on into your 20s and that determines the speed and efficiency of connections between different brain regions. So its a very dynamic period of time were talking about today. You make a very good point, walter. The learning mechanisms consist of two kinds the growth of new connections, for example with learned fear, and the retraction of connections with when you want to ignore something. And these are the things called into play during the pruning. First you have the outgrowth. Then you have getting rid of it. Those are the important things. Amazing plasticity of the brain you see during that period. Little bits of things are happening when youre old like you and i but when youre young, its dramatic. Rose explain that to us again. You think about how your brain and skills develop over time, you go through this tremendous advances, you know, executive function and planning. You know, the teenage brain is you know, its questioning whether there is anything working in there at all, but, you know, over that period of time, it really changes, and this is the physical bay coifs l basis of that. Rose my brain is experienced than every influence so its different attend of every day. Absolutely. This is a spectacular reputation of that. How the brain can get rid of connections that rine appropriate or unnecessary is just marvelous, and we dont go in detail, we just know it occurs. Rose what parts of the brain are mosterle. The temporal lobes, the frontal lobes, the limbic scirkt for emotion, depression, and these executive functions which are planning, attention. So all toris complaints fall right down these particular brain regions. Rose nothing she said surprises you . No, ive heard this hundreds of times. Rose susan, what about the biomechanics . Well go back to the image eric has shown before. In sports, the vast majority of impact to the head, and tori described impacts to another player, to the ground, a combination of linear and Rotational Movement of the head. Researchers have shown the Rotational Movement causes the largest amount of sloshing of the brain within the skull. Tom had described how the distortions of those very delicate axons or nerve fibers in the brain, when theyre distorted, there is an interruption in their ability to communicate with the different regions of the brain. We do know big distortions in the brain cause serious brain injuries, but as a bioengineer, use animals and computational models to look inside the head and try to make the relationships between the amount of brain distortion and the amount of disruption of function. We have a lot of research that has happened over the about serious brain injuries. But those types of more subtle changes that occur in concussion, we really have very little understanding of how much distortion of the brain tissue does it take to cause concussion symptoms. So that research is very much underway and its difficult to measure some of those subtle changes that occur in concussions in animals. So were working towards doing that. One of the problems is some of these changes probably are not reflected in anatomical changes. There may be transient changes in the brain that will be difficult to pick up with conventional techniques. We know small distortionings call transient or no changes at all and larger can cause more structural and permanent damage. So animal models can help us identify what distortions are enough to cause the concussion symptoms but we dont know that yet. There are a number of Acceleration Sensors available on helmets, in patches, mouth guards, and these sensors have been very helpful in helping us understand the range of accelerations that occur in realworld scenarios and they help us to understand that, for one person in the same scenario, they actually have very different accelerations that may happen, and they help us to really appreciate the chance that someone, given that acceleration, the direction matters, the magnitude and how fast the head stops or starts moving all contribute to the brain sloshing. But sensors cant tell us if a concussion has occurred. Rose cannot . Cannot. They can only tell us what the acceleration of that head was. We need the alt leets to tell us about their symptoms. People respond differently. Rose seems like a critical point there is no way that you can determine whether a concussion has occurred . From a sensor. Rose from a sensor . That is right. The sensor will only tell us what acceleration has occurred in the head. But different people respond to this acceleration in different ways. Their skull may be different, the brain may be tougher. Or they may have had a previous concussion. Exactly. There are a number of settings of that brain that cause different symptoms for exactly the same acceleration. So woe rely on people to report their symptoms. So we dont capture a complete understanding of the risk of acceleration that might occur, so rewie need to have an xray for a broken bone, a blood test or something. Another issue emerged here. We need to encourage young people who are playing sports to be sensitive to their own well being and to report any discomfort that they feel. My generation were raised pretty much the way you described this, to ignore anything in the middle of the game and to continue playing. We have to educate people not to ignore anything that bothers us in a game, to call a time out and make sure that nothing serious is happening. Its a complete change, and enormous importance when you consider the number of people involved. 50 Million People are playing sports. Rose the idea is play through the pain. Thats what you did, kid. We saw dramatic change in 87, all the athletes that sustained concussion played the same day. In 20072008, played the same day. Now its less than 2 . If you look at returning within a week following guidelines, we also see dramatic differences. In 2007, 30 of high School Athletes returned to play within six days of their injury and now its less than 10 . So thats a good change. It certainly is a very good sign. Rose it should be zero. Yes. So we do know concussion is not this all or none phenomenon and that any particular acceleration, we expect that a certain proportion of people might have a concussion, have concussion symptoms if they head moved with that acceleration. And we represent it with this risk curve that you can see here. Were at very high levels of acceleration. Youre very likely to have a concussion. At very low levels of rotational acceleration, youre unlikely to cussion. And this type of risk curve is very important, and ill talkous with age and other circumstances. But when we think about equipment thats available to us, helmets are designed, actually, to prevent Skull Fracture and serious brain injuries. They are not designed to prevent concussions. And technology has yet to identify a means to really effectively reduce the rotational acceleration, that sloshing within the head thats happening in the brain itself. So at this point right now, helmets are very important Safety Equipment to wear to prevent serious head injuries and Skull Fractures. But there is a demand for products to really help in this range, this middle range where equipment can make a big benefit in terms of the injury risk for concussion. Rose what kind of equipment will prevent what kind of concussion . So you would like to reduce the amount of head rotation seen. You would also like to reduce on contact the amount of head rotation. When the head hits the ground and the body continues to move. If the head is firmly attached to the ground with a lot of friction, then there is a rotation of the head if the body is continuing to move. So a frictional surface, a slipping surface that allows the head to move along and move in a pallows to slow down or ramp don the deceleration that occurs when you hit another contact like an individual or a hard surface. We have the entire robert the entire front of our car to provide crush to slow us down when a frontal collison occurs. We need to slow down the rotation that occurs at impact. Rose whats the most likely way that will happen, do you think . There are innovative activities that allow the head to slide but those are only different for helmets. Were still struggling on how to prevent these. Rose its not right on target but close, i think. I just returned from a profile of a formula one race driver. Yeah. Thats to prevent the head from rotating. The level of fitness will have an important effect, and that is one of the theories why women may end up being at more risk than men if the neck strength is not as strong as a male, and there is data to show that when women work on their neck strength that actually the amount of head rotation experienced by an impact is decreased. Rose the athleticism of these drivers is they work hours and hours and hours on strengthening their neck. Yes. You see them walk away from these horrendous crashes and thats only recently because there is a history of how the changes are made to the cars and it was to prevent exactly what susan was saying, deacceleration with these unbelievable impacts. There is a fact you can do that. And theyre available. In the next slide, we see, after a concussion a concussion is not like a bone fracture where its all over in an instant. Its actually the beginning of a progression of symptoms, some lasting minutes, some hours and some days. What we see is there are energy needs that change over time, the glucose metabolism, the cerebral blood flow which provides important nutrients to the brain and oxygen which is decreased after concussion, and if a repeated concussion occurs in the setting in an already compromised brain, then the response to the very same brain deformation could be dramatically difference. The way tori told us about her symptoms of a subsequent concussion or the next day when youve had a subsequent concussion, thats consistent of an injury on top of another injury and thats devastating with worsening and more longlasting symptoms. So if in doubt, sit it out. You should not go back into play until the symptoms are over. So the first risk multiplier, if you will, at the same level of acceleration would be was there a previous concussion and how long has it been and how severe were those symptoms of the prefers concussion. I would say the second risk factor is age. So in the young brain, in the next slide we see how the young brain is changing over time and we see the energy needs of the young brain peak early on and that the cerebral blood flow is high, then. If those symptoms of concussion occur just with a decreased metabolism and a decreased cerebral blood flow happen just when the brain is needing it most for development, you might understand there may be availability with prolonged symptoms that worsen over time. So these biological contributions add on top of the mechanical this is the most common cause of death in children. One of the factors that can increase risk with youth, the risk is higher for possibility of concussion. Women might be at higher risk for concussion. Were not actually sure if the same tissue deformation cause as more profound response in women or if actually women will report their symptoms more. Rose more likely to . Yes. So what we really need are those equivalent of the xrays or the blood tests. Rose one more evidence that women are smarter than men. laughter that transitioned to my second image which shows concussion rates vary widely by sport and gender. For example, you will see that the co concussion rates among gs Soccer Players is for every 10,000 girls playing high school soccer, 21 will sustain a concussion, where among boys its only 9. So its twice as high in girls compared to boys soccer. In comparing girls to boys basketball, its three times higher among girls than boys. Rose how many concussions is too many . You never know when its going to be the last straw and thats why i had to questions. As much i wanted to keep playing and say i got another one, i could be okay, or i could be in bed for a year. I dont know whats going to happen to me, so i dont think we can say how many is too much. Whats the most severe concussion youve had . What were the symptoms . My third concussion was probably my worst one. I went out for a header and misheaded once again, hit the other player and then i came down to the ground and hit my head. When i came to i never lost consciousness but when i came to, i was very disoriented, very confused. Once i realized where i was, i decided to keep playing. At that point, i didnt tell anyone 1 00 because the following weekend we had the state semifinals. I wanted to keep it to myself because i really wanted to play. One day when i was at school, i was eating lunch. I was opening my jaw and i felt a crunching on the side of near my temple. I felt a serious crunching. So obviously i was very scared. I told my mom and we immediately went to the doctor. They were very concerned and they couldnt really tell me what it was. So after i was checked out, they thought i had a Skull Fracture, but turned out it was just surrounding the skull from the impact. After that, i was probably out of school for two weeks straight, and i dont think ive been the same ever since. My grades dropped not significantly, but they did. I was terribly depressed, but i didnt want to admit it. So from the outside i might have looked okay, but when i got home, i closed my curtains, laid in bed, did nothing else. When i was in practice advising parents and student athletes, it was always, you know, learning from your experience. So what was the impact of your last concussion . How did it impact your life, your school work . Because the next one is going to be twice as bad. Rose right. And thats kind of the message i think people have to listen and make the reasonable choice. I guess i would throw in this one other thing which susan mentioned was the fact that its not just the number but its the queens and how close they its the sequence and how close they are in time. So there is one very rare event but its unfortunately a fatal event. Its called the second hit phenomenon. In the second hit phenomenon, the brain has not yet recovered, and the athlete goes out, hes a little bit dazed, maybe, not reacting normally, and that second hit causes another concussion, causes the brain to swell and that can be fatal. Its a very rare event, but it is, i guess, goes to susans point that closeintime concussions is probably the most dangerous thing. Rose becauses it causes the brain to swell. You damaged the brain and hit it again with the second damage. Even if you dont have brain swelling, the symptoms will be much worse and longer last aing. Tori told us each one was worse than the one before it. Rose is there a problem with accurate reporting . People may be aware there is an emphasis on baseline preseason testing of memory and concentration and if someone has a blow, if tori had been tested with these tests of memory and attention, might have been able to diagnose a concussion because her performance might have dropped a little bit. But its now at a point where some athletes know this and they will not try as hard as perhaps they might on the preseason evaluation, so that if they do have a blow or concussion, it will be more difficult to diagnose and, secondly, it will be easier for them to be returned to play before theyre, perhaps, ready. I think the other thing is part of the problem that we havent touched on here is not all symptoms occur right at the time of the injury. In fact, once you susan was describing Football Players with sensors in their helmets and measure the number of impacts and how hard they, are we findeth really way more complicated than we thought, sadly, in terms of trying to say thats the blow that actually resulted in the concussion. Part of it astory just gave a great example of is i let the head and i hit the ground and then, you know, in some sports, somebody else comes buy and knees you in the head as theyre trying to recover a fumble or something, so it can be three or four impacts in very quick succession, so it makes it difficult to know. Some athletes dont report symptoms till hours or a day or two later. They have a game friday night, come into the trainer monday and said, man, i didnt feel right over the weekend and i had headaches, still dizzy. So reporting is problematic. Thats where Animal Studies actually come into play because in the laboratory you know exactly what the head acceleration was and the direction. You can control the interval between two of these, and you can really try and understand whether how many, whats the critical number and the interval. And our understanding of the rates and patterns of concussions in Young Athletes is spendent on our sources of data. We get quite a bit of our data from clinical settings, but Young Athletes have so many choices to present to critical care. When i was a kid, i went to emergency room or was told to susuck it up till monday and goo the doctor. Now they can be treated in varying ways. We dont have a National Surveillance system capturing data on Young Athletes under high school age. We honestly dont know truly whats going on in that age group. There is another amazing thing walter can speak to and that is this is a major problem, yet i can think of very few areas of medicine where such serious damage can occur in which there is such ineffective therapeutic approaches available at the moment. Why is that so . Rose no treatment. Well, the problem has been, as people said around the table, we havent been able to see anything in the brain in these cases, and, so, its really been difficult for scientists to develop treatments. The animal models, you mean . Or the human condition. When you do an image of somebody with a concussion or ct scan or mri, usually you dont see anything. But science is being done which i think will lead to something. The first video that were going to see is an experiment done at the National Institutes of health and what theyve done is mounted a microscope that can see into the skull of a rodent, and you can see in real time what happens in this instance where there is a slight, tiny compression to the surface of the brain. On the left side you see the normal brain. On the right side with the compression, you can see theglial cells on the surface of the brain and the dark surface and the glial cells are responding. So on the left, the microgliia respond and plug the holes we saw develop on the previous video. Turns out there is a drug gluteothione prevents this process from occurring. Its what we call a free radical scavenger. So the brain uses oxygen for energy. The down side is oxygen used in the brain can produce these chemicals that if they get free can do a tremendous amount of damage and this drug stops it up. So free radical scavenging medications for concussions maybe coming down the road. With professional athletes, what some of the longterm consequences is including serious dementia coming out of repeated concussions. So this is a tricky situation to try and explain. Give me a little time for this one. What well see on the next slide speaks to what eric talked about which is the real concern that not only are these potentially relatively shortterm consequences to multiple concussions but there could be a possible longterm, very serious condition first described in boxes in the 1920s called dementia pugilistica. In that condition the brain becomes totally shrunking and the person severely demented. On the bottom panel, you can see a brain very difusely involved with this disease and the signature of the disease is a deposition of protein called tao in the neurons in the brain. Its also in the brain of alzheimers, dementia, progressive neural palsy and other conditions. We thought this was require that tired tremendous exposures. Unfortunately, what we found more recently, is the brains of the n. F. L. Football players often have very small deposits of this tao protein, and you can see that in the middle panel, but this is an 18yearold football player, not a professional. Now, what we dont know is what is the clinical consequences of these small deposits of tao. We are worried because there are experiments that show tao can spread. So one theory is these are the beginning stages and the tao spreads throughout the brain to call severe dementia. But we dont know how frequent it is. We dont know if the spread occurs in everyone. But certainly thats the biggest fear. No pharmacological treatments. At this point there arent any approved for use. And part of that is that, you know, up until recently we were pretty convinced pretty much everybody was going to get better after a concussion on fairly short order. So there wasnt a lot of impetus directed towards trying to develop pharmacological interventions. Rose whats the psychological effect. I think educating folks about the nature of the injury such as the discussion here at this table. Rose thats the Important Role tori plays. Thats exactly right, and being able to let people know, in the first place, you had an injury, that doesnt mean your life is ruined, in all likelihood most i mean, the odds are you will get better, but here are some things you might expect to see happen and here are some of the accommodations you might want to make, but the expectations is youre going to get better. So setting expectations instead of cay t. S. A catastrophizing is. Rose what should parents come away from . Weve spent a great deal of effort on improving diagnosis, management and looking for potential treatment modalities. Weve spent very little effort on primary prevention, keeping kids from being injured in the first place. I think its important for parents to come away from this knowing there are things they can do to protect their Young Athletes. Rose and some question about changing the rules of the game . Yeah, there have been some pretty dramatic recommendations from National Sports bodies over the past couple of years. U. S. A. Football, pop warner, National Federation High School Associations have put out strong recommendations about limiting the number of days a week that young Football Players are allowed to participate in full contact drills. Just yesterday, u. S. Soccer put out recommendations that athletes ten and under should no longer be allowed to head the ball in either practice or competition while playing soccer. Those are pretty dramatic efforts to try to keep kids safer and healthier by keeping them from sustaining the concussion in the first place. Rose what else your hope . I hope that we can become more knowledgeable on this. I dont want kids to shy away from playing soccer or playing sports because i think thats turned me into the person that i am today and its really helped me with my character and my teamwork and my leadership, but i want us to know what to do if something were to happen. When something happened to me, i dont think if anyone noticed and if they did i dont think they would know what to do. Rose so summing this up, what else should we know . Well, president obama heard that youre doing this program. Rose yes. And he sent me a message saying hed like to have one of the final words. So can we play his tape . So there is more work to do. Weve got to have better research, better data, better Safety Equipment, better protocols. We have to have every parent, teacher and coach recognize the signs of concussions and need more athletes to understand how important it is to do what we can to prevent injuries and to admit then when they do have one. We have to change a culture that says you suck it up. Rose thank you, mr. President. Well continue exploration next time. Tell me what were going to do. This time, we spoke about physical injury, sportsinduced head trauma. Next program well discuss how psychological consequences, psychological environments can produce serious damage to the brain. So poverty, brutal treatment of children by parents or by others, even some aspects of inheritance can have significant psychological and brain consequences that are really quite frightening. So were going to speak about the psychological parallel to this physical trauma. Rose thank you very much for coming here. Thank you for having us. Rose thank you. Well see you for the next episode. See you then. For more about this program and earlier episodes, visit us online at pbs. Org and charlierose. Com. Captioning sponsored by Rose Communications captioned by Media Access Group at wgbh access. Wgbh. Org rose funding for charlie rose has been provided by and by bloomberg, a provider of multimedia news and Information Services worldwide. Formation services worldwide. Announcer this is nightly Business Report with Tyler Mathisen and sue herera. Combating climate change. Business executives commit billions of dollars to Clean Energy Projects as leaders from across the globe begin two weeks of highstakes talks. Critical weeks. Why the events of the next few days could say a lot about the direction of the economy. And skip the malls. More americans go online for black friday, and that could mean big changes for traditional retail. All that and more tonight on nightly Business Report for monday, november 30th. Good evening, everyone. 150 world leaders, the largest to ever stand together, are meeting in paris for historic talks on climate change. The goal to draw up new plans to reduce carbon emissions