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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington.

Last week, NPR sports correspondent Tom Goldman reported on the growing problem of concussions in sports, what recent research tells us and what many trainers, coaches, parents and even doctors don't know. It's a problem for professional athletes and for pee-wee players as well. Up to 3 million kids get concussions every year, many while playing sports.

Since Tom's story has aired, responses and questions have poured in from across the country. Has your child ever had a concussion? How did the coaches handle it, and the school? Our number here in Washington is 800-989-8255, that's 800-989-TALK. E-mail is talk@npr.org. You can also join the conversation on our blog. That's at npr.org/blogofthenation.

Later this hour, Iran has captured a team of British sailors and marines and now says they've confessed to a violation of Iranian territorial waters. We'll talk with a former British marine who was part of a similar team that was seized and interrogated three years ago. But first, kids and concussions.

Margaret Hagberg's son Billy got a concussion while playing football on his high-school team last year. She joins us from the studios at WQED, a member station in Pittsburgh. Nice to have you on the program today.

Dr. MARGARET HAGBERG (Mother of Billy Hagberg): Thanks.

CONAN: And how's Billy doing?

Dr. HAGBERG: He's fine. He went to weight lifting this morning for football, and he has track this afternoon.

CONAN: So he's back playing football?

Dr. HAGBERG: Yeah, he played last season, no problems.

CONAN: Oh good, and explain to us how he got his concussion in the first place.

Dr. HAGBERG: Well, I should - I misspoke. He played this season no problems. Last year, he was playing as a freshman on the varsity team on special teams, which is a very big deal. If you have kids, you know what I mean, and he was tracking where the ball was going. It was away from the play of the ball.

He didn't see the kid from the other team, and it was a helmet-to-helmet hit. He was going forward and he got hit on the side of the head, and he was literally thrown off his feet almost in a somersault. I didn't see the hit, but I've seen the tapes of the hit. And he immediately got right up, finished the play on the field and jogged off.

The trainer asked him how he was. He said I'm fine, don't worry about me, and continued to play the rest of the game, didn't really have any problems with the play-calling or participating and never voiced any complaints. After the game, my husband asked him if he was okay. He said yeah, I'm fine, no problems, and that was Friday night.

The next day, he played in the JV game, so he got up at six and we had him at school at seven. He never complained of anything and played in the JV game and was starting to have a lot of problems. He was having trouble with his memory and play calling and, unbeknownst to us, had a pretty severe headache and nausea, and after the game went up to the coach and told him he thought he had a concussion. So that's how we learned.

CONAN: And the advice, as I understand it from Tom Goldman's story that he did with you, was from the coach, was well, you know, take it easy the rest of the weekend. And if there's a problem, talk to the trainer on Monday.

Dr. HAGBERG: Well, the coach at the game on Saturday told him to check in with the trainer on Monday. But when he came home, my friend, who happens to be our pediatrician, called me for a social reason and asked what the score of the game was. And I said oh, and by the way, Billy thinks he has a concussion.

And my husband and I didn't think too much of it. My husband had a concussion, was knocked unconscious in a football game in high school and, you know, three days later was back playing. And, you know, we thought we'd keep an eye on him over the weekend, give him some Tylenol, he'd be fine.

Fortunately, my pediatrician was more well-versed on the subject and asked a series of questions and immediately called the high school, and arrangements were made for Billy to be evaluated at the University of Pittsburgh Concussion Center.

CONAN: And then you found out that things were a little bit more serious than you'd thought. And I should explain you're not just Billy's mom, you're Dr. Hagberg, and your husband is a doctor as well.

Dr. HAGBERG: That's right.

(Soundbite of laughter)

Dr. HAGBERG: Didn't help us that weekend, though.

CONAN: It sure didn't, but it suggests that even MD's like yourselves aren't up to date on a lot of this stuff.

Dr. HAGBERG: Well, neither of us would have cause to see anyone with a concussion in the course of our practice, and so there wouldn't be any reason for us to know the current research. And initially, you know, we didn't know how severe the concussion is. You know, there was an evaluation, and it's an evolving process. And unfortunately, Billy continued to become worse over time, over many weeks.

CONAN: And it turned out, in fact, that one of the things that made the condition worse was the fact that he'd gone on to play that second JV game the next day.

Dr. HAGBERG: Right, continued to play in the varsity game and played the next day. And he doesn't have a lot of accurate memory the next day, so we're not sure if he had any more hits. He's a linebacker, so he's tackling the whole time.

CONAN: And they don't necessarily tape all the JV games, so...

Dr. HAGBERG: I don't think so.

CONAN: And then it took 10 months before he fully recovered?

Dr. HAGBERG: Right, until he was medically cleared. That's correct.

CONAN: And during that time he was not able to go to school part of the time, couldn't concentrate, couldn't read.

Dr. HAGBERG: Well, he tried to go to school, but it was impossible. He had so many problems with nausea and headaches, sensitivity to light and sound. He wasn't able to sleep, which is one of the things that can happen. And after trying for about a week and a half, we were advised to pull him out of school.

So then he stayed home for about two weeks, but he really wanted to go back to school. And so he went back, went in late every day, I picked him up early, and it really was quite a while before he was able to tolerate a full day of school.

CONAN: All of this extremely difficult, especially for a very active teenage boy.

Dr. HAGBERG: Right.

CONAN: And during all of this time, what have you since learned? I mean, obviously the decision to let him play football again can't have been very easy.

Dr. HAGBERG: Well, you're absolutely right about that.

(Soundbite of laughter)

Dr. HAGBERG: I was not in favor of that but, you know, my husband and I reviewed the literature. We spoke with Dr. Collins, who was the person at the concussion center who managed Billy's case, and basically he's at no higher risk than any other kid playing football to sustain another concussion. But yes, playing football is, you know, there are kids that sustain concussions.

I must also add that he also played hockey. I convinced him to give up hockey, so...

(Soundbite of laughter)

CONAN: One out of two's not so bad.

Dr. HAGBERG: But yeah, this is a kid who'd been playing sports. You know, our team has a losing record, so it's not as if it's some kind of championship team, but he really identifies himself as a student athlete. He gets a lot of gratification and has lots of good friends on the team. He works hard. He'd gone in all summer working, lifting weights, doing drills to prepare. And in the end, I felt that, you know, based on the advice that we had received, that it would be safe for him to return, you know, as much as any other kid who plays football.

CONAN: Let's bring Tom Goldman into the conversation now. He's of course our NPR sports correspondent. His story on sports concussions, which aired last week, featured Margaret Hagberg and her son Billy. Tom, always good to have you on the program.

TOM GOLDMAN: Hi Neal. And hi Margaret.

Dr. HAGBERG: Hi Tom.

CONAN: And I have to ask you. It's of course not just the parents of the kid who learn a lot about concussions in this process. The schools and the trainers also need to learn about what's going on with kids and concussions.

GOLDMAN: Well, they do. And, you know, we should say that no one is blaming anything, as Margaret will tell you. No one is blaming anyone for any one thing. It seems to be, as I said in the story, that it was, you know, smart, well-meaning people who made mistakes, perhaps because they just didn't know. And as Margaret said to me, the information is out there. People aren't getting it.

The fact is is that Dr. Collins - Dr. Mickey Collins, who Margaret mentioned from the University of Pittsburgh Medical Center - says on-field management these days is a lot better than it's been in the past. But still, things are missed. And things are missed because in this case - it seemed to be - because Billy, for reasons that he feels guilty about, you know, didn't really tell the trainer what had happened or what he felt had happened. And so the trainer, you know, kind of went away.

Now some say the trainer could have, you know, pursued it a little more and asked a few more questions. But we should say that this school where Billy went was lucky in many ways. They had a trainer on the field. No state in the union requires a certified athletic trainer to be on the sidelines - not just for football, but for soccer, wrestling, basketball, lacrosse, field hockey, hockey, all these sports where kids get concussions. And that's a real problem.

The school also had the proper testing, this ImPACT test that Billy took over and over to assess his status as he was recovering. The school has access to that as well. About 1,000 in the country have that. So, you know, lots of people - there were omissions, there were people who missed things, you know, but this school was set up better than others, really.

CONAN: And Margaret Hagberg, I have to ask you, the reasons - at least quoted by Tom in his story - your son, you know, wanted to tough it out, didn't want to be seen to be - he was embarrassed enough by the hit without saying, you know, gee, I feel woozy. I need to come out of the game. Of course, he's going to feel guilty about that, but at the same time, he's, you know - it's not his fault.

Dr. HAGBERG: Well, I don't believe it's anybody's fault because the concussion occurred. The questions come in what happened after the hit. And that's - you know, in retrospect it's easy to be critical and say this should have been done or that should have been done. But I think it's unrealistic to expect the coach and the trainer to keep every kid in their eye during every play. I - my husband and I feel terrible that we didn't know more and ask more questions. If we had asked him more questions on Friday night, we never would have let him play on Saturday. But we didn't have that fund of knowledge available to us.

And even afterwards, when we realized he had a concussion and we looked up what was available to us - my husband's an orthopedic surgeon - we didn't even - we couldn't even find the information that Dr. Collins gave us. You know, subsequently, I've read everything that I could find on concussions. But it's amazing that even though the information's been out there for several years that it hasn't trickled down. And I would say most parents wouldn't know anything about it. The only people I found that knew anything about it were other parents in the school whose children had sustained concussions.

CONAN: Well, after we come back from a break, we hope to speak with some of them. We'll also be speaking with one of the country's leading experts on this injury. And we want to thank you, Dr. Hagberg, for speaking with us today and sharing your story. It is very helpful to other people. Appreciate it.

Dr. HAGBERG: You're welcome.

CONAN: Margaret Hagberg's son Billy got a concussion last year while playing football. She joined us today from the studios of member station WQED in Pittsburgh. We're going to be back with Tom Goldman and back with Dr. Gerry Gioia when we return from a break. If you'd like to join the conversation, 800-989-8255 - 800-989-TALK. E-mail is talk@npr.org. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. As young athletes get even bigger and stronger, more and more doctors worry that more and more kids will wind up with concussions. And they're trying to get the word out to parents, to coaches and trainers about how to handle sports concussions. We'll talk with a specialist in just a moment. Tom Goldman's with us. He's NPR's sports correspondent. You can listen to his MORNING EDITION report on concussions last week. There's a link at npr.org.

And parents, we hope you will join us. Has your child ever had a concussion? How about you? Did you have one? How did you handle it? How did the school handle it? 800-989-8255. E-mail: talk@npr.org. You can also read what other listeners have to say at our blog, npr.org/blogofthenation. And let me introduce Dr. Gerry Gioia. He's Director of Pediatric Neuropsychology at the Children's National Medical Center. He also directs the center's SCORE program. That stands for Safe Concussion Outcome Recovery and Education. He joins us from our bureau in New York City. Dr. Gioia, thanks very much for taking the time out to be with us today.

Dr. GERRY GIOIA (Director of Pediatric Neuropsychology at Children's National Medical Center): You're very welcome.

CONAN: And how do you know if somebody has a concussion?

Dr. GIOIA: Well, that's the question. Obviously, Billy's story certainly raises - the big issue here is recognition and awareness. And, you know, this is both a clinical problem, and it's also a broader public health problem in that I really think it's a shared responsibility. And when we're working with athletes in our clinic we, you know, we learn a lot from their stories and their situations. And many times the athletes themselves recognize that something's different, but often don't have the judgment at that moment to pull themselves off or to recognize it. Or they might, you know, not want to lose playtime.

You know, as we know, coaches may or may not be all that familiar, and I think in Billy's case they were actually quite fortunate to have an athletic trainer. But as you say, with many players on that field to be responsible for, or in a game where that athletic trainer may not be there. So, you know, we definitely believe that knowledge and awareness of this problem is central amongst a variety of individuals - the athletes, their teammates, parents, obviously the coaching staff, and hopefully athletic health personnel such as athletic trainers on the field - so that there can be that early detection and a very standard and, you know, appropriate clinical evaluation on the sideline with some very specific guidelines for not putting a player back in, you know, and then would be followed up afterwards.

So it is a complex issue on the one hand, but knowledge and awareness is, I think, the bedrock to better identification, better recognition.

CONAN: And Tom Goldman, we don't mean to put the onus entirely on high schools and middle schools or even colleges. This is a problem that the National Football League, for example, is just coming around to recognizing.

TOM GOLDMAN: Certainly is, and that was actually what kind of got me involved in this whole process. There have been stories recently about NFL players -you're starting to hear stories about the long-term effects - what they say -because of multiple concussions: younger players with early signs of Alzheimer's disease, older players who are incapacitated. The New York Times recently had a report on players with dementia, including a long-time hero for Baltimore residents, tight end John Mackey, one of Johnny Unitas' favorite receivers in 1960's and 70's.

So yes, it's happening at the elite level. It's considered that the medical -you know, the awareness by athletic trainers and medical personnel is, you know, is best at the highest level, and that these players have the best care. There are still apparent problems, though, as far as, you know, what to do with players who suffer a concussion. There is the old ethic in football, as you mentioned with Billy, of toughing it out and getting in there and playing. Also, at the highest level, you have financial considerations. You have coaches or other personnel on the team that may want a player in there even if he's not ready.

CONAN: Hang up your phone there Tom, and we'll get some callers on the line here. 800-989-8255 if you'd like to join us. Let's begin with Sally - Sally calling us from Pennsylvania.

SALLY (Caller): Hi.

CONAN: Hi.

SALLY: Thanks for taking my call.

CONAN: Sure.

SALLY: I guess I just wanted to tell you I had sort of a mixed experience. My son had a concussion last fall, and we were lucky enough that we do have a trainer and she was aware of the ImPACT program. And I was able to do some follow-up on that, including talking to our athletic - or our activities director - such that our school is now going to get the program, which I think will be very helpful for the football team. But I also had an experience with our pediatrician, who knew nothing about concussions.

And I had a similar experience as Dr. Hagberg in terms of I didn't even know he had a concussion when it happened. Thankfully, our trainer followed up on it.

CONAN: Yeah, Dr. Gioia, getting that baseline exam - that turns out to be really important.

Dr. GIOIA: Well, it does, but I think the point that is being raised here is that we also need to educate our primary care and emergency care medical systems. The number of times that kids are just really missed by the primary care medical system is an issue. And even with a baseline test, if you don't recognize it and do something about it, it goes to waste.

CONAN: Sally, how's your son doing?

SALLY: He's fine. He recovered fairly quickly, but it was definitely a situation where - I mean, to this day, if he knew I were calling in he would be really annoyed because he thinks I'm making way too much of a big deal out of it.

CONAN: Yeah.

SALLY: He wants to pooh-pooh the whole thing, you know.

CONAN: Yeah, that's a problem, too. Sally, thanks very much for the call.

SALLY: Thank you.

CONAN: Bye.

SALLY: Bye-bye.

CONAN: Let's turn now to Grace. Grace is with us from Bethlehem, Pennsylvania, the...

GRACE: Hi.

CONAN: ...home of a lot of good football players.

GRACE: Hello.

CONAN: Hi. You're on the air. Go ahead, please.

GRACE: Oh great, thank you. Actually, this is a story about - it's me. I was a - I'm a nurse, and I was in a car accident. I'm a traveling nurse, and you would think that just like the doctors who are more aware, I was working, you know, as a visiting nurse for nurses and I was given - I had a concussion from my car accident, and there was a diagnosis that was given after my initial exam - it was a post-concussion syndrome. So I had a mish-mosh of symptoms of not being able to sleep, the depression, the irritability, the short-term memory loss. And then you would think that by working for nurses, especially a hospice nurse, that my boss would have been very compassionate, and she wasn't.

She said, oh, you've had a personality change. She put me on forced medical leave when you could tell that the whole system just did not understand head trauma. And I still have chronic daily migraines, even to this day. And I was wondering if you could talk about maybe the types of headaches - like, my headaches, I would describe them as hot. And I have an IM injection that I use in an emergency case. But I'm still being treated today, and my accident was in April.

CONAN: Mm-hmm. Dr. Gioia?

GRACE: It's coming up on a year.

Dr. GIOIA: Well, I won't claim to be, you know, a headache specialist, but certainly in the context of, you know, kids that we see with concussions, headache is one of the major symptoms...

GRACE: Yeah.

Dr. GIOIA: ...seen in, you know, 80 plus or minus percent. And certainly, if there is a predisposition to a headache ahead of time - that is, somebody either has a history of chronic headaches or even a family history of that where there's a predisposition, the concussion can really send that into a, you know, a pretty serious and longstanding, you know, chronic condition. So there are a number of studies that have looked at that. And those headaches, of course, can be quite disabling.

GRACE: But there is such thing as a post-concussion syndrome - the cluster of symptoms. Do you talk about those with patients you see? Do you see those?

Dr. GIOIA: Absolutely. Yes. I mean, post-concussion syndrome is really the -you know, the chronic ongoing presence of really any range of symptoms. And there's really four categories of symptoms that we think about. There's the somatic symptoms which headache, sensitivity to light and nausea, vomiting, you know, balance problems, those kinds of things.

There's the cognitive difficulties: the concentration and the memory difficulties and being able to process information slower. Then there's the emotional symptoms: the irritability, the sadness, the nervousness. And then the sleep problems. Some people sleep too - you know, more than usual, less than usual. Some have difficult falling asleep.

So really, what we know - that brain is the master computer responsible for, you know, our functioning in all those areas. And when it's impaired in this way, any range of those symptoms can take place.

GRACE: Wow, yeah.

CONAN: Grace, good luck.

GRACE: Thank you.

CONAN: Okay, thanks very much for the call.

GRACE: Thank you.

CONAN: Let's talk with - this is Jens(ph). Am I pronouncing that correctly, or is it Jens?

JENS (Caller): Jens, yes.

CONAN: Jens, go ahead please.

JENS: Yeah. Well, I just wanted to relate my story and kind of give a comment. In high school, as a junior, I played linebacker and center for a small school in Washington, and on a goal-line stand I tackled the running back at the knees and I was kneed right on the top of my head and played the rest of the game. This was maybe the first quarter, but with really odd synesthesia, smells, sights, difficulty concentrating on the plays, things like that. But I think my comment is that between the adrenaline and the machismo that goes into football, you know, you're trained to tough it out and, you know, play hurt and everything. We - it really complicates things. I didn't even think about coming out of the game.

CONAN: But Dr. Gioia, we should point out that certainly not all concussions, as we've heard about a car accident a moment ago, certainly not all concussions are sports-related. But do kids like Jens, do they tend to under-report?

Dr. GIOIA: Yes, they certainly do. And there was actually a nice study done by Dr. Mike McCrea up in Wisconsin with his colleague, Kevin Guskiewicz in North Carolina, where they asked high school athletes at the end of the season who had not reported their concussions the reasons for that. And one was that, you know, standard I don't want to lose playing time.

But the other problem was that athletes - or the other set of problems -athletes actually didn't recognize that the symptoms they were experiencing were that of a concussion. They didn't realize that they were serious enough for that. And so, we have an education problem here that compounds the fact that the athlete doesn't want to lose playing time.

And the CDC has put out a very, very nice tool kit for coaches, athletes and their parents that really allows or provides some good education on the types of symptoms, the possibilities and the risks associated without recognition. And they're materials that we use regularly at all levels, not just high school, but we use it with middle school, with elementary school coaches, parents, kids. So it's education, and having that material in front you can be quite valuable.

And again, I want to go back to the issue of the teammate. Many times, the teammates who are next to their colleague, whether it's in a huddle or on a soccer field or in a lacrosse game, or actually let's also bring up the competitive cheerleading and other areas where, you know, the injuries can occur, it's very important that those teammates take some responsibility for their friends and their teammates and recognize when something's not right with that individual, and really help them off the field and alert the coach, the athletic trainer or some responsible adult.

CONAN: Jens, how are you doing?

JENS: Fine. I didn't suffer any effects. I might have had a headache the next day. But beyond that, I didn't have any effect.

CONAN: And Tom, I think you...

JENS: I would echo that kids don't necessarily know when they've had a concussion. I think maybe there's kind of a range of head bumps all the way up to a concussion. And you get your bell rung occasionally in football and you assume that it will go away. And sometimes it doesn't. And you don't know when it's, when it's severe enough to be a concussion, and maybe that's education.

CONAN: Tom, I heard you try to get in there.

GOLDMAN: Right. And maybe this is jumping ahead too quickly, but I think it's an important thing to talk about, perhaps Dr. Gioia can do that. When we're talking about the problems of education, about educating teammates, about educating trainers, I think it's also important, and specifically with children, you know, it's important when you're recovering from concussion what I've learned is that physical activity should cease to help the brain recover, but also cognitive activity as well. And for kids, that involves going back to school.

And that's one of the problems that Billy really encountered with some teachers. In that some teachers, they don't see a cast on a kid's leg or arm, and they think, well, they're not hurt because they look fine if they've had a concussion. But it's very difficult, and it's a problem I'm sure Dr. Gioia has encountered with his patients of how to get them back into school and how not to make them think too much at first, that kind of thing.

Dr. GIOIA: Yes, it's, you know, when we identify these issues, we look for what are called exertional effects. And that is when there is physical activity, it's increasing your heart rate, it's pumping blood through the brain. When you're concentrating, again, you're increasing blood flow to the brain really at a time when the brain is trying to slow itself down, repair really that electrophysiological problem that's going on there, really the electrochemical process that's really thrown out of kilter.

And by overexerting mentally or physically, we actually see an exacerbation of symptoms and the potential for a prolonging of the injury and the symptoms. And it's a, you know, on the one hand, we don't want to be excluding kids from life's activities, but at the same time we have to manage them very, very carefully.

CONAN: We're talking with Dr. Gerry Gioia and Tom Goldman. You're listening to TALK OF THE NATION from NPR News.

And Dr. Gioia, what advice can you give parents about what to do proactively and what to do when they think their child may have had a head injury?

Dr. GIOIA: Well, let me point parents to the CDC's Web site. The materials that I mentioned, the coach's tool kit, including handouts for parents and for athletes, as well as trainers and coaches, are on the CDC's Web site at cdc.gov. And if you go under the injury prevention center, the coach's tool kit are there, you can download Word documents, PDF's. You can actually view online the video that gives, again, information about this.

So there are lots and lots of resources there. And I would strongly encourage parents to do that. And, you know, we also, as Dr. Hagberg had mentioned, her school has available to them an athletic trainer. And not all schools, many schools don't. And I want to put in a very strong plug for adopting athletic trainers in the schools, both private and public, as well as even at the recreational leagues. That's another area we haven't even talked about.

CONAN: And Tom Goldman, just before we wind up here, the reaction to your story has been enormous. What kind of questions have you been getting, what kind of response?

GOLDMAN: Well, a lot of the things that, you know, some of our listeners have had talked about here. A lot of people who are amazed that the information is out there and it's not getting through. There are efforts to do that but it's obviously, you know, kind of - it's been a bit of a hidden problem, not for people who've gone through this with their kids. And with more and more kids playing sports, kids getting bigger and faster, as you said earlier, the problem is going to compound, it seems.

CONAN: Tom Goldman, thanks very much for your time. Thanks for your stories.

GOLDMAN: You're welcome.

CONAN: NPR's sports correspondent Tom Goldman with us from his home in Portland, Oregon. Our thanks also to Dr. Gerry Gioia, director of the Pediatric Neuropsychology Program and director of the Safe Concussion Outcome, Recovery & Education - SCORE - Program at Children's National Medical Center who is with us today from our bureau in New York City. Dr. Gioia, I know you're very busy. We appreciate your time.

Dr. GIOIA: Oh, thank you for the invitation.

CONAN: When we come back from a short break, a British marine who is captured and interrogated by Iran in 2004 tells us about his experience, including a mock execution. Now Iran holds 15 of his fellow service members. We'll talk to him about it.

I'm Neal Conan. You're listening to TALK OF THE NATION from NPR News.

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