IS SOCCER BAD FOR CHILDRENS HEADS?

Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer

Prepared by Margie Patlak and Janet E. Joy

Board on Neuroscience and Behavioral Health

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.



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Is Soccer Bad For Children's Heads?: Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer IS SOCCER BAD FOR CHILDREN’S HEADS? Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer Prepared by Margie Patlak and Janet E. Joy Board on Neuroscience and Behavioral Health INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C.

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Is Soccer Bad For Children's Heads?: Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. Support for this project was provided by an endowed gift from Rhoda and Bernard G. Sarnat and by the Institute of Medicine and the National Research Council. The views presented in this report are not necessarily those of the funding agencies. International Standard Book Number 0-309-08344-3 Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s home page at www.nap.edu. The full text of this report is available at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2002 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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Is Soccer Bad For Children's Heads?: Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health

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Is Soccer Bad For Children's Heads?: Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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Is Soccer Bad For Children's Heads?: Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer BOARD ON NEUROSCIENCE AND BEHAVIORAL HEALTH Kenneth B. Wells, MD, MPH, (Chair), Neuropsychiatric Institute, University of California, Los Angeles, California Nancy E. Adler, PhD, University of California, San Francisco, California Paul Appelbaum, MD, University of Massachusetts, Boston, Massachusetts William E. Bunney, MD, (emeritus) University of California, Irvine, California Howard Fields, MD, PhD, University of California, San Francisco, California Richard G. Frank, PhD, Harvard Medical School, Boston, Massachusetts Sid Gilman, MD, University of Michigan, Ann Arbor, Michigan Jerome Kagan, PhD, Harvard University, Cambridge, Massachusetts Herbert D. Kleber, MD, Columbia University and New York State Psychiatric Institute, New York, New York Beverly B. Long, MS, MPH, World Federation for Mental Health, Atlanta, Georgia Karen Matthews, PhD, University of Pittsburgh, Pittsburgh, Pennsylvania Bruce McEwen, PhD, Rockefeller University, New York, New York Kathleen R. Merikangas, PhD, Yale University, New Haven, Connecticut David Reiss, MD, George Washington University Medical Center, Washington, D.C. Rhonda J. Robinson-Beale, MD, Blue Cross/Blue Shield of Michigan, Southfield, Michigan Charles Zorumski, MD, Washington University, St. Louis, Missouri Staff Terry C. Pellmar, PhD, Board Director, NBH Janet E. Joy, PhD, Project Director John Rockwell, MS, Research Assistant (until May 2001) Amanda Hunt, PhD, NBH intern (June–August 2001) Joah Iannotta (until September 2001) Brian McQuillan, Senior Project Assistant (from December 2001) Catherine Paige, Administrative Assistant (from October 2001) Michelle Kipke, PhD, Board Director, BCYF (until August 2001)

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Is Soccer Bad For Children's Heads?: Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer ACKNOWLEDGMENTS The Board on Neuroscience and Behavioral Health thank Dr. and Mrs. Sarnat for providing the funds to supplement the National Academies’ support for this workshop. With their generous endowment, we were able to disseminate the content of the workshop through this report. We also thank each of the workshop speakers for their thoughtful, informative, and lively presentations. Their work has been and will continue to be instrumental in protecting our children’s futures by promoting safe sports policies. We extend special appreciation to the workshop chairs, Linda Cowan and Michael Johnston, for keeping the lively discussions focused and moving forward throughout the day. Many of the workshop participants responded frequently and faithfully to the fact-checking inquiries we sent during the preparation of the summary of the workshops, and we especially thank Jon Almquist, Trey Crisco, Ruben Echemendia, Kevin Guskiewicz, Albert Hergenroeder, David Hovda, James Kelly, Don Kirkendall, and Muriel Lezak for helping sort out the details. This project would not have been completed without the excellent and much-appreciated assistance of the Institute of Medicine staff. Amanda Hunt and John Rockwell did much of the background research for the project. Brian McQuillan was the White Knight who stepped in at the last minute to do a terrific job of handling the meeting logistics.

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Is Soccer Bad For Children's Heads?: Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Julie Gilchrist, M.D., National Center for Injury Prevention and Control, Centers for Disease Control, Atlanta, Georgia Stephen H. Hauser, M.D., Department of Neurology, University of California at San Francisco, San Francisco, California Mark R. Lovell, M.D., Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Richard Frank, Harvard Medical School. Appointed by the National Research Council and Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution.

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Is Soccer Bad For Children's Heads?: Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer CONTENTS     INTRODUCTION,   1     CAUSES OF HEAD INJURIES IN SOCCER,   3     PROBLEMS IN DETECTING CONCUSSIONS,   4     Definition and Symptoms of Concussion,   4     CONCUSSION IS A BRAIN INJURY,   7     STUDIES OF SOCCER AND FOOTBALL PLAYERS,   9     Helmets Are Not Designed to Prevent Concussion,   11     POLICY IMPLICATIONS,   13     Return to Play After a Concussion,   13     Education,   15     Athletic Trainers,   17     Heading,   17     SUMMARY,   18 APPENDIX A:   WORKSHOP AGENDA,   21 APPENDIX B:   SPEAKER BIOGRAPHIES,   23 APPENDIX C:   WORKSHOP REGISTRANTS,   26

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