MR. KOJO NNAMDIFrom WAMU 88.5 and American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Remember when football players wore leather helmets and no pads and were the same size as you and I? The game looks very different today, huge linebackers, high tech helmets and a lot more head bashing. But the American love affair with modern football is being challenged by new medical findings.

MR. KOJO NNAMDIConcussions that often go unnoticed or unreported can cause permanent brain damage. Both the NFL and the NCAA have new rules that begin to address head injuries. But in pro football's opening weekend, four players suffered concussions and a couple of them kept on playing. Not quite what the doctor ordered. Given these new concerns about lifelong brain damage, how do you feel about being a spectator and would you still let your kids play?

MR. KOJO NNAMDIOf course, you can call us at 800-433-8850 or join -- start the conversation if you want to, at our website, kojoshow.org. Joining us in studio is Keith Gill. He is director of the athletics and recreation at American University. Keith, good to see you again.

MR. KEITH GILLIt's good be here, Kojo.

NNAMDIJoining us from studios of the Washington Post is Sally Jenkins. She is a sports columnist for the Washington Post. Sally, good to hear you again.

MS. SALLY JENKINSGood to -- good to be here.

NNAMDIAnd joining us from studios of WBUR in Boston is Robert Stern. He is a professor of neurology and co-director of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine. Robert Stern, thank you very much for joining us.

DR. ROBERT STERNGreat to be here, Kojo. And thanks for doing this wonderful issue.

NNAMDILet's start with you, Robert. Concussions don't show up on x-rays and they're hard for coaches and trainers to identify on the spot. What exactly is a concussion?

STERNThat's a great way to start. A concussion is a metabolic and chemical change in the brain cells that don't necessarily represent actual visual damage or structural damage to the brain cells. It means that as a result of getting struck, your brain moves back and forth, rotated inside the skull, gets hit against the skull and all sorts of reasons can create a temporary change to the way the brain cells work.

NNAMDIConcussions are back in the news partly because of your research. Your center at Boston University has examined the brains of deceased athletes. What did you find?

STERNWell, what we found is amongst football players, around 12 out of 13 professional football players whose brains we have examined after they passed away, have had a disease called chronic traumatic encephalopathy or CTE. And CTE is a progressive degenerative brain disease that eventually leads to a full-blown dementia. It's very similar to Alzheimer's disease, but it's a distinct disease that, unfortunately, at this point, can only be diagnosed upon autopsy after someone dies. Early on, this disease causes some symptoms, including memory difficulties, depression, erratic behavior and impulsive behavior, impulse control difficulties. We've also found it in a hockey player, a professional hockey player who died.

STERNWe've also found it in other athletes, including amateur athletes, those who only played in college. And then, most strikingly, this past week we reported on the case of Owen Thomas. And Owen was a 21-year-old University of Pennsylvania football player, recently voted to be co-captain of the team and never had any history of known or reported concussions. And sadly, he committed suicide at the end of April this past year. And when we looked at his brain, we were quite stunned and surprised to see that his brain showed definite CTE.

NNAMDIInteresting that he was a college player because you found that it doesn't take a full-blown concussion to cause permanent brain damage. Repeated hits to the head -- which people start taking kids at the age of five or six, can have the same effect.

STERNThat's right. And that's the thing that we now really have to be focused on, that it's really not necessarily that -- the symptomatic concussions that can lead to long-term problems and eventually this progressive brain disease that leads to dementia. It can be those sub-concussive hits to the head. We're not sure yet what that magic combination is. And your listeners need to know that it's not everyone who experiences repetitive blows to the head that will go on to develop this disease. We don't know why some people get it and some people don't.

NNAMDIKeith Gill, you don't have to have been an NFL player to have had reported concussions and new studies showed college players took more hits in practice than in games. You played college football at Duke University. But has that changed the way teams practice now?

GILLI think it has. I think that the college football community is very slow to change. Obviously, you can see that in terms of the evolution, but I think that it’s something that people take seriously now. and I think you'll see that in pre-season practice, there's a lot less hitting than there certainly was when I played. There's a lot of kind of half-pads in those kinds of drills as well. But the unfortunate part of it is, there's still the violent aspect of it, the hitting. And in practice, that happens over and over and over again in the various types of drills and certainly just contributes to the problems that Dr. Stern just referenced.

NNAMDIIn a college game itself, the offense may run, what, sixty, maybe 70 plays. How many hits do you take per day in practice?

GILLWow. You know, in practice, you're probably taking a good maybe 100 hits, you know, depending on what you do. I mean, if you start in full pads with the Oklahoma drill, which is a one-on-one kind of just drill of just being physical and tackling and hitting, you know, you'll run through that maybe ten reps. And then, you'll do goal-line and then you also do 7-on-7 and inside drills so -- and it's really -- it is repetitive and everyone is doing it. At least in a game, you've got people who play less than others. But in a practice, you've got the whole team that really could be hitting at a high level.

NNAMDISally Jenkins, we have a national love affair with college and professional football, spending weekend afternoons in front of the television cheering as grown men run into each other. Now, the NFL is being criticized for not having taken head injury problems seriously enough over the year. Does the NFL deserve the rep?

JENKINSWell, I think the NFL is the target, the obvious target because they're the, you know, the wealthiest professional league, possibly, on the face of the earth. But I think it's important to recognize what Professor Stern was talking about. I mean, NFL players have been playing the game since they were seven or eight years old. And they've been playing it in leagues from the age of small boys forward where there hasn't been any recognition of the problem and there hasn't been a great deal of medical care.

JENKINSThere's a culture that says that you go back in the game and you play hurt. And so, I think, to make the NFL the focus is convenient, but not necessarily the most helpful thing we could do. The NFL is in position to do the most about it financially and from a research standpoint, from the standpoint of, you know, getting medical care for former players. But in terms of being the cause of the problem, I think they're really at the far end of the causal spectrum. I think the problem starts when these guys are eight years old.

GILLKojo, I think that, just piggybacking on Sally's point, the cultural piece is key because players want to play. And so it comes down from the coaches in terms of play hurt, suck it up, put a Band-Aid on it. And then, it also comes from the players, in terms of not wanting to let their teammates down that sometimes they make choices that may put them at risk when they're already injured.

NNAMDIAnd my grandson has been playing in Florida since he was seven years old so Sally is absolutely correct. They start taking those hits that early. If you'd like to join this conversation, call us at 800-433-8850 or you can send us an e-mail to kojo@wamu.org or tweet at kojoshow. Robert Stern, in July, the NFL unveiled a new poster that landed in locker rooms at the beginning of the season. It warns players about concussions, directs them not only to report their own symptoms, but those of teammates if they take a hit. What is the NFL's new stance on concussion and head trauma?

STERNWell, over the last 10 months or so, the NFL has made some major strides in their overall awareness and discussion about concussions and head trauma in football. Last year during the season, during the 2009 season, the NFL made unprecedented changes to the game mid-season to do things to assure than concussions were taken more seriously. Also, last year the NFL made a major turnaround in acknowledging that there is indeed a relationship between the hits taken in football and later-life dementia and other cognitive and mood changes. So the NFL has indeed made some major, major changes over the last year and are continuing to do so.

NNAMDII'd like to hear all of your take on this starting with you, Sally Jenkins. The first weekend of this year's regular NFL season two weeks ago, four players suffered concussions, Philadelphia Eagles quarterback Kevin Kolb and linebacker Stewart Bradley, Carolina Panthers quarterback Matt Moore, Giants tight end Kevin Boss. Commentators were appalled that after Bradley struggled to get up, took a couple of steps and fell helmet first onto the ground, he still wound up back on the field for a few more plays before being pulled from the game. First to you, Sally.

JENKINSWell, you know, football players are in the business of sacrificing their bodies in all kinds of ways. It's why they make the money they do. It's why their lifespan as a player is so short. The average player, I think, plays fewer than five years. You know, look at the way they sacrifice their knees. I mean, they wind up with arthritis. They wind up with all sorts of terrible health problems. But show me an athlete at the highest level who doesn't sacrifice their health. It's part of what they do. And I think that there's a major misconception on the part of the spectator that sports in general at the professional level is somehow supposed to be a healthful exercise. It's not.

JENKINSThe gritty reality of whether we're talking football, major league baseball, NBA, these are not healthful enterprises. The people who engage in them are sacrificing their bodies on a daily basis. It's their personal choice, to a certain extent. I don't know how you could prevent them from doing it. The ethic that says you go back out on the field and play in pain is as old as game -- you know, the game itself.

NNAMDIAs a matter of fact, Keith, I'm glad Sally brought up other sports because head injuries are getting all the attention right now. But athletes take risks all the time that endanger lots of other body parts, too. Is physical peril an unavoidable part of competitive athletics?

GILLI think it is. I think it is in terms of, you know, you're putting your joints in very odd positions. You're trying to battle for space and things get really awkward. And I just don't think there's any way around kind of putting yourself at peril. The best you can do is just try to prepare on the front end and make sure you're in the best shape you can and hopefully things work out and you stay healthy. But you're going to have injuries. You're going to have aches and pains. Football players are going to wake up on Monday morning during the NFL and be sore and feel like they were in a car wreck. And that's part of it. And just like Sally said, I mean, that's part of the game and it's not very healthy.

NNAMDIAnd, of course, American University is noted for its wrestling teams. You don't get involved in wrestling for the preservation of health, so to speak.

GILLRight. It's very physical.

NNAMDIRobert Stern, I didn’t get a chance to hear you comment on what happened the first weekend in the NFL season with all the concussions.

STERNYeah, I had very mixed feelings about what happened. I, too, was appalled that the players went back in to play after noticeable concussions. You listen to Troy Aikman on the air saying, oh, my God, what's going on? But at least they did get taken out for the second half, most of these players. And to me, the most important thing is that there was this outcry, something that you wouldn't have heard a year ago. I think that is definitely saying that we are in the midst of a culture change. People were aware that these players had their heads bashed and that they shouldn't have been playing. They're arguing about it, talking about it. We're now aware that our brains need to be taken care of.

STERNYou know, if I could add to that, that. You know, you were just discussing the other body parts and the issue to take care of the rest of our bodies or improve professional sports, that it's just a dangerous thing. Well, what about the kids? That's where this whole discussion needs to lead. Do we set a really good model for our children by saying, you know, tough it out, go back in? Well, one of the things that we have done through the years is in baseball. There's a pitch count in order to protect the young little league pitchers from over pitching and possibly hurting their elbows or shoulders, which is a very rare thing to happen. But I remember there when I was a coach, sitting there with a clicker in my hand, counting every single pitch. And as soon as someone reached 60 pitches, they were out.

STERNWell, something that we need to do is to realize that the brain also needs to be taken care of. What we need is something equivalent to that pitch count for the numbers of hits that are taken. You know, Keith was talking about, you know, a hundred hits per game. You think about linemen, linebackers, at youth levels in Pop Warner. Every play of every game of every practice, they're hitting their head against their opponent. We need to count those things and take them seriously.

NNAMDIWe have callers who'd like to join us. We're going to take a short break. When we come back, we will get to your calls. We still have a few lines open. 800-433-8850 is the number to call or you can send us an e-mail to kojo@wamu.org, a tweet at kojoshow or simply join the conversation at our website kojoshow.org. I'm Kojo Nnamdi.

NNAMDIWe're talking about the long term effects of concussions with Sally Jenkins. She's a sports columnist for the Washington Post. Robert Stern is a professor of neurology and co-director of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine. And Keith Gill is director of athletics in recreation at American University. We're taking your calls at 800-433-8850. But Robert Stern, Keith Gill has a question for you.

GILLDr. Stern, when I -- I used to work at Oklahoma before I came to American and one of the things that we were certainly using there is the head impact telemetry system to kind of measure head impact. And if a head impact went over a certain level, then the trainer was beeped and the person was kind of taken out of practice and kind of examined to see if there's a concussion. Would that be something kind of like the pitch count that you're referring to before we went to break?

STERNYeah, it definitely would. That's one method. It's a somewhat expensive method, but those accelerometers and other sensors that are able to be placed in helmets are a good starting point, where we can see the amount of g-force that the brain is taking and in different places in the head and use those to be able to say, this person's had enough for the day, they're out.

NNAMDIYou know, Sally Jenkins, the cultural sports that we talked about earlier, what pressure does that put on coaches? The culture has always been to tough it out, to play through the pain. No one wants to be seen as soft or weak. Does that make it hard for coaches to err on the side of caution when a player takes a hit?

JENKINSWell, absolutely. They're under a variety of pressures. They're under the pressure to earn their multi-million dollar salaries. They're the -- usually, the highest paid employee at the university level, if we're talking about college football. They're under, you know, enormous pressure to win, if they're in the NFL. There's a very short fuse on the part of some owners. There's a lot of revenue at stake. And a lot of times, they confuse short term interest with long term interests when it comes to players. And I would add that the -- frequently, you know, it really is the player himself who most wants to get back on the field. And trying to change that culture is the most important one. You know, I don't think this is a matter of a bunch of villainous coaches, you know, sending unwilling players back on the field. I think you're talking about a culture of men who've been taught from very small young ages to play hurt.

JENKINSAnd we've simply got to change that. And, you know, look, this goes all the way back to, you know, when Teddy Roosevelt was president and in the White House. His son was playing on the junior varsity at Harvard and had his nose busted in a game, I think, had blood pouring down his face and insisted on going back into the football game at Harvard and was, you know, acclaimed for it. You know, this is been going on in -- on football fields for a 150 years in this country. And it's not going to change overnight. We have to educate players to take better care of themselves.

NNAMDIAnd a part of this, Keith Gill, you're playing at Duke. You're playing with guys who you live with, practically. There's a certain bonding that takes place. As a player, do you feel you're letting your team mates, with whom you've bonded, down when you can't go back into the game?

GILLAbsolutely. I mean, I think there's two things that you have, is that you, one, you get separated from the team, like, anytime...

NNAMDIPhysically.

GILL...you're injured. If you're injured at practice, they just flip the drill down to the other end and leave you down there with the trainer if -- you know, or you're on the bike or you're always separated. And that's your support network. And I think that that's tough. But I think that there's also this, I need to do this for my team mates. And if you're in a locker room, particularly a football locker room, and your team mates think you're soft, that's one of the worst feelings that you can have as a player.

NNAMDIOn to John in Washington, D.C. John, you're on the air. Go ahead, please.

JOHNThank you, Kojo. My question probably is specifically for Dr. Stern. I was curious. I think boxing and football are the obvious sports that -- for head trauma. But has it been discovered that some other sports have the same type of issue? I think, specifically, maybe, like, the head butt in soccer or getting body slammed in Judo or anything like that. I'll take my answer off the air, thank you.

NNAMDIThank you for your call. Go ahead, please, Robert Stern.

STERNJohn, great question. You know, the brain doesn’t know what's causing the injury. They don't -- it doesn't know whether it's football or pro football or high school football. It doesn't know whether it's hockey or lacrosse or boxing. You're right that boxing and football have taken the brunt of the focus of the discussions. But any sport where there is repetitive blows to the head is going to be at risk for developing this disease, CTE. And any sport where there could just be occasional significant concussions are also very much to be concerned about.

STERNSo, you know, people ask frequently in soccer, is soccer a dangerous game? Well, soccer does have a very large number of true concussions. Symptomatic concussions from head to head hits, elbow to head hits, head to post hits. But people are concerned, what about that repetitive heading of the ball? And right now, the research is very inconclusive. We don't have any idea whether heading itself brings on enough repetitive force to the brain to result in this later development of the disease. But any sport where there's repetitive blows to the head is something that we need to be paying attention to.

NNAMDISally, before you go. Are changes in the way we approach head injuries in sports likely to come from the top down or the bottom up? Is there momentum from change coming from parents and coaches in youth sports?

JENKINSWell, absolutely. Well, first of all, we've got two bills in committees in the House of Representatives right now that are aimed at educating athletes and their parents and their staff, their coaches and their trainers about the concussions and how to care for concussions. So there'll be some governmental change coming. Second of all, I think, like Bob Stern has been describing, there's a huge awareness on the part of the NFL and the NFL's being great about getting that message out. And that will help change the culture probably more than anything.

JENKINSAnd finally, I think that adults -- you know, the adults who are supervising these athletes, you know, parents have to be probably more vigilant about making decisions about, okay, if your son is going to play football, make sure you know who he's going to play for. Make sure that you like and understand and approve of the coach that you're entrusting your son to. I mean, that's a huge component.

NNAMDIThis quick one before you go, Sally. What's the difference now with the synthetic turf grass that we're seeing a lot fields made out of now from high school onto the pros and the astro turf that was causing so many of the knee problems years ago. Any significant difference?

JENKINSYou know, I, frankly, don't really know. I do know that before concussions became an urgent health problem in the NFL, knee injuries were, of course, a huge problem in the NFL. A lot of teams had astro turf. A lot of teams knew that there were injuries associated with astro turf, that it was very hard on the knee. And you had situations, like, for instance, the New York Giants just went ahead and went to the expensive changing the field, primarily because the wife of the owner, Bob Tisch's wife said to him, how can you, in all good conscious, have an astro turf field when you know what the statistics are here?

JENKINSSo, you know, change comes in a variety of ways and the pressure to change comes from a variety of people. In that case, the owner's wife probably had as much to do with it as anybody. So, you know, teams -- on the team level, owners -- most of the owners in the NFL really do have the long term interest of the players at heart. I firmly believe that and I believe that the league is going to be the leader in this over the long term.

NNAMDISally Jenkins, thank you for joining us. Sally...

JENKINSThank you.

NNAMDI...Jenkins is a sports columnist for the Washington Post. Still with us is Keith Gill, director of athletics and recreation at American University. And Robert Stern. He's a professor of neurology and co-director of the Center for the Study of Traumatic Encephalopathy at Boston's University School of medicine. We move onto Tamara in McLean, Va. Tamara, you're on the air. Go ahead, please.

TAMARAHi, I have a nine-year-old son who's actually just started lower school at an area school that's really renowned for rigorous athletics. And it's, you know, a big part of why he wanted to go there. It's boy heaven, he loves it. I'm concerned because his dad and granddad both played football in high school and in college. And, Will, is -- has chosen football now as his sport. And I feel like it's really often more him -- and I don't know if that's because he knows how much dad and granddad value that toughness in him, but it's really often more his decision to go back on the field, I think, when he's been hurt or when, maybe, it's, maybe you should just rest for a minute, to see if he has been hurt.

TAMARAAnd so I'm wondering is there some sort of accessible science that I can point to, to these guys -- these football guys? Is there something that we can talk about that would be kind of graspable by a layperson in terms of, you know, why and why not to?

NNAMDIWhen you say -- when you say talk to these football guys, are you referring to your husband and your father-in-law?

TAMARAThey would claim that mantle proudly.

NNAMDIHere is Robert Stern, what's accessible to allow our caller, Tamara, to be able to have a conversation with her husband and father-in-law?

STERNWell, you know, the starting point, I think, to get the point across is that none of us within the science and within the medical field want to get rid of these sports. I am a huge football fan. I want to see these sports continue. So instead of coming at it saying, you know, football's lousy, we can't let our kid play. That's not going to move mountains. But there are some things that you can do by showing that people who have hit their heads repetitively through the game of football, including people who died early, like Owen Thomas at 21. Developed a progressive brain disease, that if Owen had lived, he would've become demented eventually.

STERNIt's possible that his suicide itself may have been brought on, in part, by the changes in his brain. You can show pictures of the brain tissue that our group examines that are so loud and clear showing disease in a brain that was caused solely by the repetitive blows to the head on the field.

NNAMDITamara, thank you very much for your call. You, too, can call us at 800-433-8850 or go to our website kojoshow.org and ask a question there. Keith and Robert Stern, a year ago on this program, we talked about developments in helmet technology for all levels of play. The helmets that offer the best protection can also cost the most. How widespread, as far as you know, starting with you, Keith, is the adoption of top line helmets and is this having any impact on the injuries?

GILLYou know, I think that right now it's really in the development phase and the study phase. Like I said, in Oklahoma, we were really testing kind of the head impact telemetry system and gathering that data to see if there were things that we could -- that would help us to treat concussions differently or recognize them earlier and those types of things. I know that Zenith has a new helmet out that's supposed to certainly help you, in terms of, I guess, the survivability of the hits as it relates to concussions.

GILLBut the one thing -- I felt like I would defer to Dr. Stern on this, but I don't know if we're ever going to have a concussion-proof helmet. And I think that some of it is going to be related to technique, behavioral change. Kind of going back to what the caller said. I think it is -- and what Sally said, it's important to know who your son or daughter is playing for and the fact of whether or not they're going to show enough care that when those signals, in terms of dizziness and blurred vision and all the things that come along with concussion systems are present, that they're going to sit them down and make sure that they seek the medical help that they need.

NNAMDICare to comment on the helmets, Robert Stern?

STERNYeah, I -- first of all, I completely agree with Keith on -- there are helmets available, like the Zenith helmet -- Riddell has one, Schutt's been working on one, that are indeed available. They're out there. They are too expensive, I think, for a lot of youth teams to employ at this point. But their goal is to absorb a large amount of the overall g-force that the head takes from a hit, maybe up to 50 percent of the overall force. And so it's one part of the picture. You know, remember concussions and concussion prevention is just the tip of the iceberg. What we have to do now is to focus on those repetitive sub-concussive blows to the head.

STERNAnd one way to do that is through helmet technology, by diminishing the overall exposure to that g-force to the brain. But there's other mechanisms of change that we can take immediately to action, such as limiting the amount of full contact practice in football and other sports as well. We need to do things to reduce the overall exposure to the brain of these repetitive blows.

NNAMDIHere is Gary in Washington. Gary, you're on the air. Go ahead, please.

GARYHi, recently I heard about a study that indicates there's been a significant increase in reported concussions among girls in the -- in youth basketball, to the point where it's greater than among boys. It was speculated that girls are more likely to see a doctor and thus, you know, there are more reported concussions. But anyway, I wanted to know what's being done to educate kids about symptoms of concussions and what to do about a concussion when they occur. Because if you want to change culture, the kids who play sports are most likely to be the people who are going to play and coach sports in college and in the pro ranks later on. They're also going to be the owners. So what's being done here?

NNAMDIIndeed, we did a show last year on high schoolers and we found out that soccer is number two in terms of concussions, lacrosse is number three. But here's Robert Stern.

STERNYeah, Gary, brings up several important issues. There is a recent study that showed that basketball is growing in the number of concussions and in fact, girls do have a much larger number of reported concussions in that sport. And it's grown tremendously. You're right. One of the things might be that girls report it more readily, that they don't have that same cultural impasse to say, I -- you know, I'm going to tough it out. They might tell their parents. They might tell the coach. They might go to the doctor and therefore if -- this is merely just an increased amount of reporting.

STERNBut it also could be that girls have weaker upper body strength in necks that make it so when their heads do get hit, their brain jostles around inside their skull a little bit more. There are other issues as well, like, hormonal. But getting to the bigger issue of how do we make the culture change, be it for girls or for boys, it does have to start early. And going back to our previous discussion, it has to start from the top down and from the bottom up.

STERNEarly on, parents play a huge role. Parents need to be educated that concussions and these sub-concussive repetitive blows to the head have to be taken seriously. You know, just the basics, like you don't have to lose consciousness to have had a brain injury. Mild concussions are a brain trauma -- brain injury. So parents need to be brought into the discussion early. They need to be educated about concussion and sub-concussion, brain trauma. The coaches and athletic trainers have to be brought into the discussion early and educated.

STERNThere needs to be the top down approach from the role models in the NFL and the NHL to say, hey everyone, we need to now stop what we've been doing and take our brain seriously for all of us and especially for the youth who are now starting their wonderful involvement in these great sports. We need to do something to reduce the overall risk for later on disease.

NNAMDIHere's Alex in Falls Church, Va. Alex, your turn.

ALEXHi. I hate to detract from the current conversation flow, but I couldn't help but notice a correlation with the show that was on previous to you was covering a sports and a -- like a psychologist that had been looking at athletes and other people who seem to function really well under pressure and -- through anxiety. And that one of the findings in her studies showed that it was people who had a better ability to control their tendency to overanalyze things and to function in the now and to do as they should. And as -- I can't remember the name of the person on the show there, but as he was describing the symptoms of this CTE, one of the things that he listed was a lack of impulse control, where you just go as you would do naturally.

ALEXSo I wonder if there's any correlation, perhaps, for the really good athletes that may have CTE and being able to really be a clutch player or anything. Just an interesting comment that I thought with the previous show correlating with this one.

NNAMDIWell, before Robert Stern gives you the researcher's response, allow me to get the player's response from Keith Gill. Impulse control, is it really impulsive to just want to go back regardless of what happens to you?

GILLI certainly think there...

ALEXWell, that...

GILLOh, sorry.

ALEXWell, I was more meaning, like, wherein that when you're stepping up to plate as a batter...

NNAMDIYeah.

ALEX...or when you're making a big throw as a quarterback or catching that ball as a receiver, maybe you're in the tendency to allow your emotions and your thoughts to take, you know, to take precedence and you slip up. Whereas if you didn't have that ability to second guess it and you just did it, was what the previous show was talking about, clutch players having that ability.

NNAMDIRobert Stern and Keith, what Alex is talking about is the author who was on "The Diane Rehm Show," with guest host Katty Kay earlier named Sian Beilock talking about the book "Choke." But what are your responses to that, Keith?

GILLI just think, as a general rule, that if you've taken a blow that results in a concussion, you're probably going to have some -- certainly immediate diminished capacity. You're not going to be performing as good as you could be. And that's coming from someone who has had concussions and had -- did -- had memory loss and those kinds of things. But I'm sure, in some cases, that people have been able to rise up to the occasion and figure out a way to kind of get it done.

NNAMDIWhat do you know about the impulse control issue, Robert Stern?

STERNWell, impulse control problems are a definite issue when it comes to the disease of chronic traumatic encephalopathy. Parts of the brain that are responsible for controlling impulses and controlling erratic behavior are hurt. And therefore, one of the most prominent symptoms of this progressive brain disease is impulse control. And so what we see frequently in the people who have passed away with this disease where difficulties with substance abuse, with suicide, with just overall erratic behavior, doing things that were unable to be controlled.

STERNNow, does that relate at all to the successful player that your caller was bringing up? I have no idea. I just know that under normal circumstances, it is not a good thing to have poor impulse control and it can be evidence of a brain disease.

NNAMDIWe're going to take a short break. When we come back, we'll continue this conversation on long-term effects of concussions. If you've called, stay on the line. We will get to your call. If the lines are busy, go to our website, kojoshow.org, ask a question or make a comment there or send us a tweet at kojoshow or an e-mail to kojo@wamu.org. I'm Kojo Nnamdi.

NNAMDIWelcome back to this conversation on the long-term effects of concussions. We're talking with Robert Stern. He is a professor of neurology and co-director of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine. Keith Gill is director of athletics and recreation at American University. Keith, as director of athletics, tell us about what you do when athletes now come into the school that may have been different than what was done before as a result of what we know -- we now know about concussions.

GILLYeah. Now, it's part of a physical that every student athlete comes -- that goes through when they return to school. We have baseline testing for concussions so we're testing as they come in and particularly in basketball, field hockey, lacrosse, soccer, volleyball and wrestling, sports where there can be a lot of head-to-head collisions or hard balls that could hit you in the head and cause concussions and those kinds of things. And I think it's been really important to make sure that we're, you know, checking in that regard. We also make sure that all of our students are educated on concussion symptoms, what they look like, what they feel like, so that they can report either on their teammates or on themselves.

GILLAnd when a student has a concussion, we've probably had three or four concussions this year, primarily in men's soccer, we have an instruction sheet that explains to them, hey, these are the symptoms you need to watch out for. And we try to give it also to their roommate so that there's someone there that knows what needs to happen and what needs to go on. And I think that that's been helpful in terms of the education. It's certainly increased since I've been in college.

NNAMDIRobert Stern, we got this e-mail from Kay in Dallas, Tex. It says that I mentioned Lou Gehrig earlier this hour, which I did. Kay wants to know, "How does Lou Gehrig relate to all of this? This discussion is about concussions from football injuries. Gehrig played baseball. Did he get hit in the head by a line drive or something?"

STERNHmm. Yeah. It opens up a whole other issue that our group has been studying and that is a new disease that my colleague Dr. McKee and our group discovered called chronic traumatic encephalomyelopathy, which is a mouthful. And what it is, is it's a subtype of a motor neuron disease like ALS or Lou Gehrig's Disease. And what we found was that repetitive head trauma in sports can indeed lead to this ALS-like disease. And so where does Lou Gehrig come into it? Well, Lou Gehrig died of ALS. And unfortunately, his brain, along with the rest of his body, was cremated, so we'll never be able to examine it to know what he had when we look at his brain tissue.

STERNBut how does it all relate? Well, Lou Gehrig was a football player first at Columbia University where he did have his head hit over and over again. And then, as a baseball player, he had at least five or six known pretty significant concussions where he did get hit in the head with a ball, with a bat, and he would get back up and continue to play that very same day. So it would not be surprising that Lou Gehrig might have developed a disease that is associated with perhaps other sports like football or hockey or soccer where there's more known head trauma.

NNAMDIAnd two e-mails that are in a way related. One from Katie in Arlington. "Listening to this conversation, I find myself wondering if there's any relationship here to shaken baby syndrome." And another from Carolyn in Waldorf, Md., "Please ask your guest if the use of trampolines or moon bounces poses any risk for damage of children's brains. I've wondered about this for a while. It seems like the child's fragile brain would be knocking against the hard inside surface of the skull. Is it safe? Is there research on the risks?" Robert Stern?

STERNThe easy answer is there is no research on the risk. The more complex answer is anything that we do to our brains that result in repetitive blows to the head or perhaps that juggling of the brain inside of the hard skull might indeed result in some long-term impact. So are moon bounces and trampolines a potential problem? Boy, I would hate to say yes, at this point. They're too much fun. We don't know. We don't know what it is about any of these activities exactly, in terms of making specific guidelines and recommendations right now, other than doing whatever we can to reduce the unnecessary repetitive blows to the brain.

NNAMDII'd like to go to Gena in Wheaton, Md. Gena, you're on the air. Go ahead, please.

GENAYes. Good afternoon. I'm Gena Warren. I'm the vice-chairman of the Capital Beltway League in Montgomery County, D.C., Charles County and Prince George's County. And one of the things that we're doing in the Capital Beltway League is educating our coaches what's appropriate for young children. Our kids are out there from 6 years old to 14, 15 years old. We have partnered with USA Football, who is a representative of the NFL in youth football, and they've got a new program going with -- it's called Heads Up Concussion in Football.

GENAOne of the things they do is certify our coaches in drills appropriate -- age appropriate drills, recognizing the signs of a concussion, educating parents. I'm not always the most popular person in the Capital Beltway League. Because when the kids are out there and I see them get hurt, we sit them out. And there's just no argument. When the kids are out there, they're our kids. Just like my son, my grandson, my daughters, they're all ours and we have a responsibility to them. And like I said, it is difficult educating the coaches, especially the coaches that have been out there for years. And Sally was exactly right when she said there's pressure on them to man up and return to the game.

GENABe a man. I've seen it, you know. I've seen it. I've heard it and that's one of the things that the Capital Beltway League is becoming proactive and not reactive in dealing with youth football and...

NNAMDISo you don't have, Gena, a lot of coaches and a lot of parents in your face, so to speak, because of this?

GENANot as much as I did five years ago. You know, we -- there were a lot -- back then, there were a lot of coaches that were -- I've been coaching for 20 years and before you were born and I know -- and, you know, he just needs to get out there and be a man. And, you know, they also get pressure from their parents. And that's what surprised me, I think, more than anything else, the parents, you know, forcing the kids to go back out. And I think kids just don't want to play anymore. They need to be involved in something, especially in this day of video games and thumb exercises.

GENAIt is important that the kids are out there in, you know, involved and -- but we have a responsibility to take care of them. Like I said, this has been one of my pet peeves. We just talked to Kelly Legg, who's a clinical athletic trainer at Children's Hospital, and they're instituting a program now where they're contacting all the youth sports organizations in the D.C. area, you know, in the entire metro area, and trying to develop a partnership. USA Football, all of our commissioners and chairmen went out for a conference in Ohio, in Canton, where one of the biggest workshops was the one -- the Heads Up Concussion Awareness in football.

NNAMDISo attention is clearly being paid. Gena, I'm afraid we're running out of time very quickly. But thank you very much for joining. Gena Warren is vice-chairman of the Capital Beltway League. That's a youth football league in Washington D.C. and Maryland. We move onto Len in Frederick, Md. Len, you're on the air. Go ahead, please.

LENHi Kojo. Two quick comments. One is, if I were a parent, I would caution against allowing my son or daughter to do headers without a helmet and also to do headers in practice.

NNAMDIWhat do you feel about that, Robert Stern?

LENAnd the second...

NNAMDIOh, I'm sorry. Go ahead, Len, you have...

LENWell, my second point is, Larry King had a great show on the brain last week with an expert in West Virginia who had a lot of good data. But that expert then said that people recover from concussions and I would say he should have -- they appear to recover because you cannot -- right now, I don't think there's any mechanism that can determine whether your -- whether there's been that subtle brain damage to axons and neurons.

NNAMDIRobert Stern?

STERNThe first question about headers and whether we should do anything about it, we just don't have the science to know at this point. So we can't make any real formal recommendations based on science when it comes to heading the ball in soccer. When it comes to the issue raised about concussions recovering, yes, indeed, concussions do recover. That's almost one of the definitions of concussion. If left alone and rested appropriately, concussions will recover. However, what we're seeing with this disease called CTE, it's not the concussion that's not recovering.

STERNIt's not just this cumulative amount of brain damage. It's a disease that gets set in motion earlier in life from those repetitive blows to the head that doesn't start developing until later and doesn't start showing its symptoms until years or decades after the person stopped playing their sport.

NNAMDIRobert Stern, I suspect a lot of listeners would like to know, would you allow your child to play football or to head a soccer ball?

STERNWell, my oldest son played football in high school, was a pretty darn good football player. He is now a junior at Yale and doing pretty well, but he's not playing football. My other son is a terrific soccer player and just headed two goals last weekend. Do I cringe? Would I want my son to be playing college football right now? No. The -- it always comes down to what would I want my kids to be exposed to and that is a team, a coach, a trainer, a philosophy that says we're going to do whatever we can to make these kids safe. It's not an all or nothing thing.

STERNFootball has fantastic benefits. Soccer, lacrosse, hockey, they all have fantastic benefits. It's how we do it. And, you know, Gena's group at the Capital Beltway League is doing it the right way, educating, educating, educating. Getting the coaches, the athletic trainers, and like she was saying, the parents onboard so they can understand what to do to make these games safer, not to get rid of them.

NNAMDIAnd I'm afraid, that's -- well, let's try to get one more call in quickly. Steven in Gaithersburg, Md. You've got about ten seconds, Steven.

STEVENOkay. I think it's our -- pretty much our society and how we're telling our kids, you know, in search of the big scholarships to play hyper-aggressively. I see in JV girls' sports in particular, a lot of elbows being thrown. It's kind of the gladiators in the coliseum. A kid gets nailed and we're all, ooh, on the edge of our seats. So I think we really have to educate, you know, let's play with sportsmanship. Aggressiveness, but not, you know, cheap shots and cheating just for the sake of winning. And I think that's why we're seeing a rise...

NNAMDIWell, I'd like you to know, even though we're running out of time, that Robert Stern believes that even though people can play aggressively, the three-point stance for linemen in professional football is something that Robert Stern is, at least, thinking about trying to get rid of, right?

STERNYeah. It's one of many possible things. We don't know. We don't have any science that says the three-point stance should be gotten rid of, but there are things like that that can be changed. The amount of full-contact practice during the week. There are so many things that we can do to keep the game aggressive, keep it competitive.

NNAMDII'm afraid we're out of time. Robert Stern is a professor of neurology and co-director of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine. Keith Gill is director of athletics and recreation at American University. Keith, always a pleasure.

GILLThank you.

NNAMDIRobert Stern, thank you for joining us.

STERNThank you very much, Kojo.

NNAMDIAnd thank you all for listening. I'm Kojo Nnamdi.