The following is a redacted version of a letter one mom of a concussed young football player recently sent to her state legislators in a Midwestern state:
Dear _________________:
As the mother of an eight-year-old who sustained a concussion during bantam football practice, I believe it is essential for the provisions of our state's youth sports concussion safety law to be applied to all children participating in contact and collision sports held on school grounds. The injuries which occurred on my son's team of approximately 25 third- and fourth-graders clearly demonstrate that concussion information is necessary for these players, their parents, and their coaches.
In less than two months, there were three concussions and one case of whiplash on my son's team, and all of these injuries occurred at practices, not games. The parents of the first boy who sustained a concussion told me his medical report indicated severe brain trauma (the doctors even suggested he wear a helmet to school), and that they had to obtain the opinion of a second doctor to get him cleared to play football again. It's my understanding that the third boy who sustained a concussion also had balance difficulties and was told he was out for the season. I believe the boy who sustained the whiplash injury reported some type of numbness or tingling in his arms. He was one of the larger players on the team, and was injured when he made a head down tackle against another large player. I was present while he was boarded and removed from the practice field by ambulance. Although he was initially kept down by one of the coaches, he was allowed to sit up before the ambulance arrived.
My son's injury occurred when he made a tackling error. He was matched up against a fourth grader who was older, bigger, and more experienced. He had been knocked down and had forcefully hit the back of his head earlier in practice while he was the ball carrier (one of his coaches helped him to his feet, but didn't check him for any signs of concussion). The second blow to the back of his head occurred towards the end of the two hour practice. He ran as fast as he could to make a hard tackle, but when he forgot to stay low, he clashed face masks with the ball carrier, rebounded quickly, and forcefully struck the back of his head against the ground.
It was the type of hit that was loud enough to get the attention of every parent watching practice. He made no attempt to get up on his own, but was hauled to his feet by a coach, set back a few steps, and allowed to cry hysterically as practice recommenced. I waited a few moments to see if he would be able to walk off the practice field under his own power, and then approached while trying to wave him towards me. It became apparent that he was unable to walk himself off the field, and I feared I would have to walk through the tackle drill to reach him. Luckily, a parent who coached games intervened and escorted him to me.
I walked my son towards where other parents were sitting, and asked another parent to help me look at his pupils. Once he was able to talk, he told me that his head and neck hurt. I could tell he was in pain, but wasn't sure what I should do. As time went by, his headache decreased in severity, so I took him home and asked him a series of questions from an internet site on concussions. I wasn't able to identify any signs of confusion or speech impairment, and decided to wait until the next day to call the pediatrician.
In the morning he told me he had a headache, but I couldn't see any outwards sign of pain. I didn't realize a dull ache was indicative of a concussion, and assumed a concussion headache would be more painful. I drove him and my other two children to school, and called the pediatrician from his classroom. Considering how long it took him to fully recover, I wish I had allowed him to stay home and rest [1]. I had no idea taking him to school could impede his recovery or exacerbate his symptoms.
My son's concussion did not seem as severe at first; however, he had vestibular system (eg. balance) problems, headaches, difficulty falling asleep, and fatigue for weeks and was not cleared to participate in gym for over two months. Due to his age and the length of his recovery, he is being withheld from any organized sport programs for the next few months.
When I signed my son up for football, I assumed the injury rate for such young players was relatively low due to their smaller sizes, and I was not aware of the current research on concussions. I had no idea that sustaining a concussion increased the odds of subsequent concussions. Additionally, I didn't realize that the damage from concussions is cumulative or that sub-concussive blows [2] could alter brain function and potentially lead to progressive degenerative diseases such as chronic traumatic encephalopathy (CTE) [3].
If I had been provided with concussion information at the beginning of the season, I would have been able to make better decisions. In fact, based on our family history, I most likely would have never signed my son up for the program. He has a paternal grandmother with Parkinson's disease and a maternal aunt with an advanced case of Multiple Sclerosis, a neurodegenerative auto-immune disease. If our family medical history hadn't been enough to dissuade me from signing him up, if I knew how damaging concussions and sub-concussive hits were, the emphasis the coaches placed on hitting as hard as possible during tackle drills would have caused me to pull him from the program. I did not like how practices were conducted, but didn't understand the danger my son was in. I had considered pulling him from the program, but was concerned he would feel like a failure and worried that the kids at school would tease him.
It was only after my son sustained his concussion that I realized children his age would always make tackling errors, and that if they were encouraged to hit as hard as possible, they would end up paying a big price for those errors. A price no child should be asked to pay. In October of 2011, a five year old football player "experienced a head injury that sent him to the hospital in critical condition [4] where he went into a coma." The Director for Trauma Services at Queens Medical Center, Dr. Caesar Ursic, "warns that a bump, blow or jolt to the head can do more than sideline a player for a season. ‘Some of the problems would be learning deficits, kids may not do well in school.'"
After doing some research on concussions and the dangers of sub-concussive hits, I became worried about the other boys on my son's team. I knew many of them had taken hard hits at practice, and that they hadn't been told to report [5] headaches or other concussion symptoms [6]. Some, like my son, may have had no idea about any concussion signs or symptoms. I wrote a letter to the football coach at the local high school to share my concerns.
When another boy sustained a concussion, I contacted the Superintendent of Schools. He told me he had been assured by the school district's attorney that their agreement with the bantam program shielded them from any liability other than for inadequate facility maintenance. He said it was the parent's responsibility to determine if a sports program was appropriate for their child and told me to take my concerns to the bantam board. Considering that parents weren't provided with any concussion information or even a roster of players, including their weights, ages, and experience levels, I'm not certain how parents were expected to make such a determination. Based on the number of players who were seriously injured and the emphasis placed on hard hits, I don't believe my son's team was appropriate for any child.
From what I've learned since my son's injury, I believe the bantam program was run in a manner which was conducive to injuries. My inexperienced son was placed on a team with players who had much more experience. Experience discrepancies made practice difficult for the volunteer coaches to manage. Two-hour full contact practices were scheduled for three nights a week. The third and fourth graders scrimmaged the fifth and sixth graders. Often, two games were scheduled for Saturday, with the second game being against a fresh team.
I didn't see the coaches spending much time instructing players how to tackle. Most practices were spent running the boys through the same tackle drill, with little to no feedback, except encouragement for hard hits. One coach often said "hit them so they can feel it." If a boy made a mistake and forgot to stay low and got hurt, then he would say "that's why you stay low."
Helmets weren't properly fitted or regularly checked. According to the helmet fitting instructions [7] at the USA Football web site, the helmet provided to my son was one size too large. My son's chin strap only had two attachment snaps rather than the recommended four. Parents and players were never instructed to check helmets for proper air inflation [8]. It was only after the third concussion that helmets were checked for proper inflation.
A recent study [8] indicates that a properly fitted football helmet is critical to minimize the risk of concussion and catastrophic brain injury. Based on the study's findings, "air bladder helmet liners pose an increased risk of catastrophic intracranial brain injury (subdural hematoma/cerebral edema), with 84% of the injuries of this type occurring between 1989 and 2001 involving air bladder helmets."
According to one of the study's authors, Joseph Torg, M.D. :
As we look at preventing concussions and minimizing risk, it is important to realize that it is the responsibility of the athletic director and head football coach to have policies that: Insure that each player has a properly fitted helmet and that a responsible adult supervises and oversees proper helmet air bladder inflation on a weekly basis.
My son's bantam football league did not provide parents or players with any information about concussions signs, symptoms [6], or the importance of not practicing or playing with a concussion. I never saw coaches check any of the players after hard hits, and players were encouraged to hit as hard as possible during tackle drills.
The lack of a program-wide concussion awareness, training, and management program appears unexplainable in light of a serious head injury suffered by a local high school player during a Friday night home football game in 2009 that required transport via Life Star helicopter to a regional medical center (an injury from which, thankfully, he has fully recovered).
Youth programs that participate in USA Football or Pop Warner provide concussion information to parents, players, and coaches. A football coach from a local parochial school with whom I recently spoke said that his program has been providing concussion information for the past two years under a concussion policy [9] developed by the CYO with St. Vincent Sports Performance).My son's bantam program failed to follow any of the recommendations of concussion experts, such as the "7 Steps for Brain Safety" [10] promoted by the Sports Legacy Institute. The guidelines are simple and free, so that they can be readily adopted by any youth sports program. One of the simplest steps involves reducing the amount of time spent on full-contact drills, especially for younger players, who are more at risk of long-term brain injury from repeated sub-concussive blows to the head than teens or young adults.
The bantam program also doesn't follow any of the safety guidelines recommended by MomsTeam founder and long time sports safety advocate, Brooke de Lench. Her 12-point concussion safety checklist [11] establishes "goals towards which all of your youth sports programs should work. Implementing even one," de Lench says, will reduce the number and severity of concussions. Adopting and following them all, while it won't make youth sports a concussion-free zone, will make the sport as safe as it can reasonably be."
I attribute most of the problems at practice to a lack of appropriate training, procedures, protocols, guidance, and oversight. Bantam coaches tend to be fathers who volunteer for their sons' teams. They cycle through the program as their sons progress. New coaches are added to the program on a regular basis. These coaches need training and support, and the program needs to be monitored by school personnel to prevent over-zealous coaches from harming children.
School systems lacking the resources to train volunteer coaches could benefit from working with USA Football. Their online resources provide information on health and safety issues such as concussion awareness, equipment fitting, injury prevention, and heat and hydration (some of the issues addressed in the recent National Athletic Trainers' Association Position Statement entitled "Preventing Sudden Death in Sports"). Based on the cost information provided by one of their representatives, membership is affordable for both coaches and players. After successful completion of their on-line certification course, coaches can obtain a $1 Million General Liability policy good for twelve months from the date they complete the course.
Although I told both his teacher and the school nurse I suspected my son had a concussion the morning after his injury, and expressed concerns about recess, he was sent to gym class before his first concussion evaluation while he was still experiencing a concussion headache. He told me he wasn't able to run as fast as normal, and that he had been unable to do the flex arm hang.
Based on the evaluation form prepared by his pediatrician, he was supposed to have full academic accommodations [12], including a reduced workload and breaks for rest/naps. At the time of his injury, I often volunteered in his classroom, and didn't notice a material reduction in his workload, nor was he given any rest breaks. He struggled with his homework and often broke down while trying to complete it. He generally had enough energy to go to school, but wanted to rest once he got home. I arranged to bring him home an hour early so he could avoid recess and rest before attempting homework.
As his symptoms persisted, we stopped taking him to any activities outside of school. His television viewing and computer usage had to be strictly limited, and video game playing had to be totally eliminated.
When his headaches continued past the first few weeks, he was accused of lying by his principal. Since his vestibular system problems were only evident during postural stability testing, the principal doubted he truly had balance problems and decided to withdraw the limited academic accommodations previously provided.
I asked my son about his headaches each day and my notes clearly show they went away on the weekends and returned during the school week. As for the possibility of him lying about them, I had no reason to be suspicious. There were consistent patterns for likely triggers, such as tests and usage of a math software program in the afternoons. At eight years of age, however, it is possible that he misinterpreted mental fatigue as a mild headache. Regardless, based on other signs and symptoms, it was clear he was not fully recovered.
When I picked him up from school for his third concussion evaluation, his hair was drenched in sweat from trying to walk as many laps as possible during gym (he was not supposed to participate in any physical activities during gym). When he failed to show any balance improvement, his pediatrician said that his lap walking had most likely exacerbated his concussion symptoms, and that we wouldn't be able to tell if his balance had improved at rest until his next visit.
The following day, even though I sent an email indicating that his balance had not shown any improvement, during a conference with his teacher and principal, I was accused of failing to recognize that he no longer required academic accommodations. I was still upset about the lack of improvement in his balance, and found it frustrating that all of my concerns were brushed aside. I was told that with the beginning of the next school week, he could no longer leave early.
I sent my son to school for two full days even though I didn't think it was in his best interest because I thought I had no other choice. Due to mandatory attendance requirements, I didn't know if I had the right to bring him home early. For recess, he went to study hall along with the students who had failed to turn in their homework, and felt as though he were being punished. I was so concerned about increasing my son's school schedule before his balance improved and while he was still experiencing frequent headaches, fatigue, and difficulties falling asleep that I literally felt ill.
After having a discussion with a bantam board member and realizing she hadn't been made aware of my son's injury, I decided to contact the Superintendent again. Once he was made aware of the situation with my son's principal and teacher, they became much more cooperative.
Unfortunately, I believe the school's lack of appropriate concussion management protocols extended my son's recovery and exposed him to potential harm. Physical and cognitive rest is critical [1] to avoid an extended recovery, as a mother of a concussed teenager emphasized in describing her family's 14-month long journey through post-concussion syndrome, which she attributed in part to the lack of cognitive rest [13] in the days immediately after her daughter's concussion. Sending him to gym class before his first concussion evaluation also placed him in danger of sustaining a second concussion, which increases the likelihood of an extended recovery, permanent cognitive impairment, and even catastrophic injury or death from a condition called second impact syndrome [14]. The second concussion or impact doesn't have to occur on the football field. According to the Annual Survey of Football Injury Research report [15], an 11-year old youth football player most likely died in September 2010 from to a second impact sustained at recess:
I don't believe my son's teacher and principal would knowingly expose him to harm, however, their lack of awareness of the seriousness and potential long-term consequences of concussive injuries caused them to make decisions that were not, I believe, in his best interests. It is troubling that they were unreceptive to the concussion information I provided, and that they disregarded the evaluation and letter provided by his pediatrician. To ensure that no other child goes through what my son did, the state Department of Education should develop model concussion management protocols for implementation at all public schools.An 11 year old youth football player was injured in a game on September 3, 2010 and died on September 5, 2010. His injury in the game was diagnosed as a concussion. The injury that killed him happened during recess at his middle school when he accidentally hit his head while playing by the football sleds. Cause of death was possibly second impact syndrome.
A leading concussion expert, Dr. Robert Cantu [16], recently recommended [17] that youth under the age of 14 should not participate in contact or collision sports as currently played:
Early signs of CTE [3] in the brains of 17- and 18-year olds," says Dr. Cantu, "have been detected in the brains of kids who showed no symptoms when they were alive.
The young brains are more vulnerable, they're less myelinated (the protective sheath - myelin - that develops around neurons), the necks are weaker, the heads are bigger proportionately so the forces that accelerate the brain need not be as high to produce higher acceleration,' Cantu told Boston's WCVB-TV.
It's not just concussions that worries Dr. Cantu, its the accumulation of sub-concussive blows: ‘In fact, we've had a number [of brains] in our center who have had no recognized concussions at all, so its total brain trauma.'
‘We have millions of youngsters putting their heads into collision sports right now and we don't really know how safe this is for them,' Cantu said."
Scientists at Virginia Polytechnic Institute and State University are finding that some impacts experienced by children playing youth football are harder than they anticipated [18] they would be.
"'We're finding that, surprisingly, these kids are getting hit harder than we originally thought,'" said Ray Daniel, a doctoral student in biomedical engineering at the university. ‘In terms of measurements, these kids are seeing around 30 to 50 g, and the average impact for a college player is about 26 g. We didn't exactly expect to see 7- and 8-year-olds get college-level hits.'"
Based on Stone Phillips' "Hard Hits, Hard Numbers" report [19], there were six impacts over 80 g in the youth study, with one 100 g hit.
A study [20] reported in the June 2011 journal Pediatrics entitled "Epidemiology of Sudden Death in Young, Competitive Athletes Due to Blunt Trauma" concluded that, "Most of the fatal events reported here are potentially preventable, and our observations underscore the importance of developing more effective equipment design, return-to-play decision strategies, modified blocking/tackling rules, and greater attention to the education of coaches, trainers, parents, and athletes regarding the consequences of repeated head blows and concussions. The ultimate aspiration of reporting these data is the creation of a safer environment for young people on the athletic field."
A two-year study [21] by researchers at Purdue of high school football players suggests that concussions are likely caused by many hits over time and not from a single blow to the head, as commonly believed. Commenting on the study, Thomas Talavage, an expert in functional neuroimaging and co-director of the Purdue MRI Facility, said, "'The changes in brain activity we are observing suggest that a player is having to use a different strategy to perform a task, and that is likely because functional capacity is reduced. The level of change in the fMRI signal is significantly correlated to the number and distribution of hits that a player takes. Performance doesn't change, but brain activity changes, showing that certain areas are no longer being recruited to perform a task."
A 2011 Football Point of Emphasis issued by National Federation of State High School Associations (NFHS) states the following:
All coaches should undergo education and utilize available professional development tools regarding the signs and symptoms of concussion and the proper management of athletes with a suspected concussion. The NFHS offers the free course "Concussion in Sports: What You Need to Know" that is available at www.nfhslearn.com [22], and many states have developed their own education programs. It is incumbent upon coaches to lead by example in recognizing the seriousness of all suspected concussions.
The NFHS further states that: "Coaches and athletic trainers must use due diligence and care when fitting their athletes with that equipment, as well as instructing them how to correctly use such equipment." To emphasize the importance of a properly-fitted helmet, NFHS recently passed a rule [23] for 2012 requiring high school football players to sit out one play if their helmet comes off. According to Mark Drebelbis, an assistant commissioner of the North Carolina High School Athletic Association, "one of the most important aspects of concussion prevention is a properly fitted helmet [24]."
At the college level, the NCAA states its expectations [25] on player safety as follows:
Participation in intercollegiate athletics involves unavoidable exposure to an inherent risk of injury. However, student-athletes rightfully assume that those who sponsor intercollegiate athletics have taken reasonable precautions to minimize the risks of injury from athletics participation.
Coaches should appropriately warn student-athletes about the sport's inherent risks of injury and instruct them how to minimize such risks while participating in games, practices and training.
***
4. Acceptance of Risk. Any informed consent or waiver by student-athletes (or, if minors, by their parents) should be based on an awareness of the risks of participating in intercollegiate sports.
***
6. Minimizing Potential Legal Liability. Liability must be a concern of responsible athletics administrators and coaches. Those who sponsor and govern athletics programs should accept the responsibility of minimizing the risk of injury.
There are potentially serious complications of multiple or severe concussions, including second impact syndrome, post concussive syndrome, or post-traumatic encephalopathy. Though there is some controversy as to the existence of second impact syndrome, in which a second impact with potentially catastrophic consequences occurs before the full recovery after a first insult, the risks include severe cognitive compromise and death. Other associated injuries that can occur in the setting of concussion include seizures, cervical spine injuries, skull fractures and/or intracranial bleed. Due to the serious nature of mild traumatic brain injury, and these serious potential complications, it is imperative that the health care professionals taking care of athletes are able to recognize, evaluate and treat these injuries in a complete and progressive fashion. In April 2010, the NCAA Executive Committee adopted a policy that requires NCAA institutions to have a concussion management plan on file. (See information box on page 56.)
In July of 2011, the Ivy League released a Review of Concussion in Football report [26] that recommended the number of full-contact practices be limited to two per week to reduce hitting and keep players healthy. The report stated the following with respect to the education of high school and youth coaches:
Education to high school and youth coaches. It is hoped that with the increased awareness of and attention to concussions, an emphasis on proper injury management, improved technique, education and an overall reduction in hard hitting will trickle down to the youth levels.
Some states have passed or adopted more comprehensive concussion legislation [27] and regulations:
There have been attempts to address the issue of concussions in youth sports at the federal level, and congressional hearings have been held. Two hearings were held by the House of Representatives, Committee on the Judiciary, regarding the "Legal Issues Relating to Football Head Injuries" in late 2009 and early 2010. According to the testimony [35] by Bennet I. Omalu, M.D., Co-Director, Brain Injury Research Institute, West Virginia University, in Part II of the hearing, "The brain cells of children who play football are more vulnerable to subconcussions and concussions. A child who plays football can be precluded from obtaining the full capacity of his cognitive and intellectual functioning as an adult."
In May of 2010 a hearing [36] was held on the impact of concussion on high school athletes, which addressed the need to train school personnel.
More recently, in October of 2011 the Senate Commerce Committee held a hearing [37] on youth sports concussions and safety equipment.
H.R. 469, the Protecting Student Athletes from Concussions Act of 2011 [38], has 34 cosponsors. The bill is designed to promote minimum state requirements for the prevention and treatment of concussions caused by participation in school sports. It addresses education of students, parents, and school personnel about concussions, and includes provisions regarding appropriate academic accommodations.
A New York Times article [39] by Ken Belson, "For N.F.L., Concussion Suits May be Test for Sport Itself," addresses the dozen plus lawsuits recently filed by former players and their wives. According to the article, the N.F.L. may argue that injuries sustained while participating in youth programs were responsible for the players' health problems:
A far murkier obstacle for the players is proving that the concussions they sustained in the N.F.L. caused their current health problems. It will be difficult to prove that any impairment is not a result of head trauma sustained while playing in high school and college.
Considering that early evidence of C.T.E. has been found in the brains of college and high school aged athletes [40], it is possible that brain damage resulting in denegerative diseases begins at the earliest youth levels.
Comprehensive on-line sources of concussion information for anyone wishing to learn more about concussions include the following:
Informative videos on concussions can be found on MomsTeam.com [43]
Expansion of Law and Development of Concussion Management Protocols
I appreciate your attention to the important matter of youth sports concussions. The impact of sports concussion and sub-concussive hits on youth athletes is an emerging field. I believe my son's experience highlights the need to (a) expand the coverage of our state concussion law so that it covers all youth athletes, and (b) implement concussion management protocols at all public schools.
At the very least, it is imperative that parents are provided with the information they need to make informed decisions about the athletic programs they allow their children to participate in. With our family history of degenerative brain diseases, I really needed to know about the dangers of concussions and sub-concussive hits before signing my son up for football. We owe it to all children to take the steps required to protect them from unnecessary brain trauma in youth sports. I hope our state decides to lead the way with respect to protecting our youngest and arguably most vulnerable athletes.
I've attached copies of email correspondence and doctor notes for informational and background purposes. Please feel free to contact me in writing, by email, or by phone with any questions or requests for additional information.
Respectfully,
A Concerned Mom
Editor's Note: About the author, Sharon van Kooten. On November 30, 2011, Ms. Van Kooten, a stay-at-home mom of three from Trafalgar, Indiana, reached out to us with a simple request; “I was hoping to obtain information regarding any safety limitations for bantam football practices.” As pioneers in concussion information and education, our founder Brooke de Lench and SR Editor Lindsey Barton Straus, JD provided her with countless hours of help and research. Her request was not unlike the thousands we have received over the years. Her letter to her state representatives was the product of several months of research on concussions and, while longer than most MomsTeam receives, is not atypical, and demonstrates that, despite substantial progress, concussion education, awareness, management and prevention still has a long way to go. It is the author's hope that her letter "can help other parents and also bring about some positive change." As she said in her cover e-mail to her state legislators, "I strongly believe current research is exposing the need to provide greater protections for all children participating in youth sports, both on the field and in the classroom. My goal is to help prevent unnecessary brain trauma for youth athletes and to facilitate their recovery if such trauma occurs. I appreciate your attention to the important issue of youth sport concussion prevention, recognition and management; including appropriate academic accommodations."
Do you need our help? Reach out to us at: editors @MomsTeam.com or for concussion information visit: www.Concussions.Smart-Teams.org
Links:
[1] https://momsteam.com/node/4176
[2] http://www.rochester.edu/pr/Review/V74N2/0303_football.html
[3] https://momsteam.com/node/3289
[4] http://www.khon2.com/news/local/story/Injury-causes-concern-over-contact-football-for/u5UF_r469UWY-D13IqXMdw.cspx
[5] https://momsteam.com/node/2987
[6] https://momsteam.com/node/149
[7] http://www.usafootball.com/health-safety/equipment-fitting
[8] https://momsteam.com/node/4427
[9] http://www.cyoarchindy.org/Docs/cyo_docs/2011 CYO Football Rules.pdf
[10] http://www.sportslegacy.org/policy-2/7-steps-for-brain-safety
[11] https://momsteam.com/node/163
[12] https://momsteam.com/node/3319
[13] https://momsteam.com/node/4359
[14] https://momsteam.com/node/208
[15] http://www.unc.edu/depts/nccsi/2010FBAnnual.pdf
[16] https://momsteam.com/node/93
[17] https://momsteam.com/node/3843
[18] http://news.medill.northwestern.edu/chicago/news.aspx?id=190524
[19] http://stonephillipsreports.com/2012/01/hard-hits-hard-numbers/
[20] http://pediatrics.aappublications.org/content/early/2011/06/16/peds.2010-2743.full.pdf html
[21] http://www.purdue.edu/newsroom/research/2012/120202NaumanFootball.html
[22] http://www.nfhslearn.com
[23] https://momsteam.com/node/4434
[24] http://blogs.newsobserver.com/prepsnow/high-schools-adopt-helmet-rule
[25] http://fs.ncaa.org/Docs/health_safety/2011_12_Sports_Medicine_Handbook.pdf
[26] http://www.ivyleaguesports.com/sports/fball/2011-12/releases/Football_Concussion_Report-July_2011.pdf
[27] https://momsteam.com/node/3015
[28] https://momsteam.com/node/3730
[29] https://momsteam.com/node/4053
[30] https://momsteam.com/node/3392
[31] https://momsteam.com/node/4054
[32] http://www.nj.gov/education/aps/cccs/chpe/concussions/policy.pdf
[33] http://www.cdc.gov/concussion/headsup/pdf/ACE_care_plan_school_version_a.pdf
[34] https://momsteam.com/node/3338
[35] http://judiciary.house.gov/hearings/printers/111th/111-82_53092.PDF
[36] http://www.sportconcussionlibrary.com/content/impact-concussions-high-school-athletes-gerard-gioia / http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_house_hearings&docid=f:56354.pdf
[37] http://commerce.senate.gov/public/index.cfm?p=Hearings&ContentRecord_id=3c1ac485-cac3-4d53-9b6a-3f781d32dc49&ContentType_id=14f995b9-dfa5-407a-9d35-56cc7152a7ed&Group_id=b06c39af-e033-4cba-9221-de668ca1978a
[38] http://www.govtrack.us/congress/billtext.xpd?bill=h112-469
[39] http://www.nytimes.com/2011/12/30/sports/football/nfl-faces-retired-players-in-a-high-stakes-legal-battle.html?_r=2&pagewanted=2
[40] http://www.sportslegacy.org/cte-concussions/cte-concussions-sli-legacy-donors/
[41] https://momsteam.com/node/305
[42] http://www.cdc.gov/concussion/HeadsUp/youth.html
[43] https://momsteam.com/health-safety/concussion-safety/videos
[44] https://twitter.com/ConcernedMom9
[45] https://momsteam.com/health-safety/every-state-has-youth-sports-concussion-safety-law
[46] https://momsteam.com/health-safety/concussion-signs-and-symptoms-physical-cognitive-emotional-sleep-related
[47] https://momsteam.com/cognitive-rest/cognitive-rest-after-concussion-critical
[48] https://momsteam.com/repetitive-brain-trauma-and-chronic-traumatic-encephalopathy-CTE-cause-and-effect-relationship-scientifically-premature
[49] https://momsteam.com/properly-fitted-football-helmet-simple-but-effective-way-to-reduce-concussion-risk-say-researchers