the line-up, penalize teams if a player must leave the game for any reason, including injury (USSSA Baseball, 2013, p. 10, Rule 7.02.D.1[c]). There are also anecdotal reports of players attempting to subvert pre-season baseline neurocognitive tests (Pennington, 2013).

Despite the increased attention to and recent proliferation of research on sports-related concussion, confusion and controversy persist in many areas, from agreement on how to define a concussion and the effects of multiple concussions on the vulnerability of athletes to future injuries, to when it is safe for a player to return to sports and the effectiveness of protective devices and other interventions in reducing the incidence and severity of concussive injuries (Wilde et al., 2012). Parents worry about choosing sports that are safe for their children to play, about selecting the equipment that can best protect their children, and, if a child does receive a concussion, about when is it safe for him or her to return to play or when it might be time to quit a much-loved sport entirely.

It is against this background that the Institute of Medicine (IOM) and National Research Council (NRC) convened the Committee on Sports-Related Concussions in Youth to review the science and prepare a report on sports-related concussions in youth from elementary school through young adulthood, including military personnel and their dependents (see Box 1-1 for the statement of task). The 17-member committee included experts in the areas of basic neuroscience, neuropathology, clinical expertise with head trauma in pediatric populations, sports medicine, emergency medicine, cognitive and educational psychology, psychiatry, bioengineering with an emphasis in pediatric biomechanics, youth sports organization representatives, active duty military training, epidemiology, statistics or statistical analysis and evaluation, and health communication (Appendix B). The committee was charged with reviewing the available literature on concussions, within the context of developmental neurobiology, regarding the causes of concussions, their relationship to impacts to the head or body during sports, the effectiveness of protective devices and equipment in preventing or ameliorating concussions, screening for and diagnosis of concussions, their treatment and management, and their long-term consequences. Specific topics of interest included

  • the subacute, acute, and chronic effects of single and repetitive concussive and non-concussive head impacts on the brain;
  • risk factors for sports concussion, post-concussion syndrome, and chronic traumatic encephalopathy;
  • the spectrum of cognitive, affective, and behavioral alterations that can occur during acute, subacute, and chronic posttraumatic phases;
  • physical and biological triggers and thresholds for injury;

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