CONCUSSION PREVENTION

Prepared for
National Collegiate Athletic Association
Indianapolis, Indiana

Prepared by
Ethan T Bell
Senior Research Consultant
Brain & Behavior Research Foundation

November 12, 2015

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 Brain & Behavior Research
November 10, 2015 Foundation
90 Park Avenue, 16th Floor
President Tom Smith New York, NY 10016
National Collegiate Athletic
Association
406 7th Street
Indianapolis, IN 56397
Dear Mr. Smith:
The attached report gives valuable information regarding the issues with
concussions in sports. Brain and Behavior Research Foundation believes that
this information will help in the protection of athletes. This information will
prove to be successful for the National Collegiate Athletic Association .
This report will examine the following information
The outcome of injury and the trauma it has on the athletes life
What is the treatment and the symptoms of a concussion
The injury in sport and how the right equipment can help prevention
The information in this report has been gathered together from only
secondary sources. A majority of the information comes from the Viterbo
University library database, of which gets its information from accredited
journals. Some of the other data compiled was from law groups and
equipment companies. Results of this report will increase knowledge on
concussions in sports, and would benefit the NCAA in keeping their athletes
safe.
Brain and Behavior Research Foundation would be happy to discuss this
further upon your request. My organization and I thank you for taking
interest in our research.
Sincerely,

Ethan T Bell
Senior Research Consultant

MEM:coe
Attachment

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 TABLE OF CONTENTS
EXECUTIVE SUMMARY......................................................................................... v

INTRODUCTION.................................................................................................. 1

BACKGROUND.................................................................................................... 1
Problem Statement....................................................................................... 1
Statement of Purpose...................................................................................2
Definition of concussion............................................................................... 2

DISCUSSION....................................................................................................... 2
Outcome of injury......................................................................................... 2
Trauma of the injury..............................................................................3
Impact on athletes life ........................................................................3
Treatment.................................................................................................... 3
Symptoms............................................................................................. 4
Doctors orders...................................................................................... 4
Injury in sports............................................................................................. 5
Prevention steps....................................................................................7
Sports equipment.................................................................................. 8

SUMMARY........................................................................................................... 9

CONCLUSIONS.................................................................................................... 10

RECCOMENDATIONS........................................................................................... 11

APPENDIX........................................................................................................... 13

REFERENCES...................................................................................................... 14

LIST OF FIGURES
FIGURE
1- Concussion Protocol.................................................................................5

2- Concussions in Sports..............................................................................6

3- NFL Concussion Comparison.................................................................7

4- NFL Concussion by Week.......................................................................12

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 EXECUTIVE SUMMARY
The National College Athletic Association can benefit by using the
information researched for this report. This report can also benefit the
National Football League and other leagues and organizations that provide
athletics. Ethan Bell, the senior research consultant at Brain and Behavior
Research Foundation, did this report. The information was gathered at the
request of the National College Athletic Association to provide clear
information on concussions and the advances in the prevention process.

The Brain and Behavior Research Foundations conclusion that concussions

are problems that steadily need to be researched is based on information
gathered from specific companys websites, medical and scholarly reviewed
articles.

The data showed benefits in the following areas:

The continuous research on concussions help increase the

information that the victims should know.

Benefits are organizations can compare their equipment and

medical knowledge to the information provided. If not up to par,
then they realize that changes need to be made.

Players safety is another benefit. This information lets players,

coaches, parents, and trainers know the steps and symptoms of
what a concussion is.

The Brain and Behavior Research Foundation brings these findings to you,
the National College Athletic Association, because it has the ability to help
keep athletes safe. Determining if more or revised rulings need to be made,
so that concussions are a thing in the past. Other organizations can also take
these recommendations to reach out, and help prevent concussions .

INTRODUCTION
Concussions are more than just a current head injury; the victims lives are
being affected by this head injury throughout the rest of their life. Parents
entrust their childs coach to watch over their child. Professional athletes
entrust their health to trainers and team doctors. Therefore, it is important to
analyze the following questions:

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 What is a concussion and is it serious?

How are the athletes treated after receiving a head injury?

How safe are the athletes using the equipment provided for them or
should there be more investments in the more advanced equipment
being developed?

The findings in this report provide basic information about what a concussion
is, as well as, what, what the victim, or person responsible for the athlete
should do if necessary. Once these questions are answered, concussion
knowledge can be improved and the safety and health of the athletes can be
improved.

BACKGROUND
Concussions are serious. They are a type of trauma to the brain. Injuries to
the head should not be taken lightly. Hits to the head, such as bumps, blows,
or jolts cause the brain to move rapidly back and forth and can cause a
concussion.

According to Smith (n.d.), concussions are invisible injuries with real

consequences. The jolt that could cause the human brain to accelerate or
decelerate too rapidly causes brain tissue to change shape, which stretches
and damages the brain (Smith, n.d.).

Sports equipment companies focus has been concussion prevention .

Continuously coming up with the next greatest technology that is intended to
prevent or reduce the injury. Mouth guards and helmets are the focus for
these companies. A mouth guard can reduce the impact that is caused by a
blow to the chin and helps to stop it from reaching the brain, which could
cause a concussion (Hickey, 1967). With how old that information is, helmet
companies, like Riddell and Xenith, continue to improve on their technology
to help prevent head injuries and continue to only get better. Introducing
technology where a helmets parts flex in order to reduce impact force
(Fuhrmeister, 2014).
Athletes, especially those who engage in physical sports, are put in an environment
where injuries often occur. However, not all sports are physical and injuries occur
less often or not at all. For example, baseball, football, basketball, and soccer
are the popular physical sports that young athletes get involved with early .
For those that are good enough get the chances to play professionally. In
these physical sports, you have to be careful that you can avoid being hit in
the head. Common jolts to the brain can be caused by a pitch in baseball,
receiving a head on collision with another football player, falling in a

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basketball game, smacking your head on the hard wood floor, or possibly
getting kicked in the head in soccer match.

Statement of Purpose

To find the advancements and the growth in the medical field, that are
helping athletes prevent or reduce concussions. This research report
reviewing, because findings that are based on the emerging data that is
helpful for the athletes that are victims. For example, the Tau proteins that
are being used to keep nerves in the brain together (Headbangers windfall,
2014). The value of this project is significant as it can help prevent future
head trauma by informing every one of the new inventions and
precautionary testing that need to occur after being hit in the head.

Concussion

One of the most sensitive organs in the human body is the human brain. It is
only organ that is surrounded by bone called the human skull. When athletes
receive injuries, like the ones listed above, all signs are point to a diagnosis
of a concussion. A concussion is classified as a serious injury to the brain
caused from a sudden acceleration or deceleration of the brain tissue (Smith,
n.d.).

According to Smith, the brain is elastic, wiggling around inside of the skull
and can change shape very quickly, because of that acceleration and
deceleration mentioned. In brain contains axons, which are inside the most
sensitive part of the brain or the white matter. These axons are quickly
stretched, during a concussion, and result in an injury. However, the axons
do not break apart when they are stretch quickly; inside of them are
neurofibrils, and inside of the neurofibrils are microtubules, which are what
are damaged.

A microtubule is a transportation system. Which the brain uses to transport

material back and forth throughout the axon. When the microtubule are
broken inside the axons, then they are gone forever, which causes a buildup
of the information that is trying to be sent (Smith, n.d.). This damage to the
microtubules is what Smith is saying a concussion.

DISCUSSION: OUTCOME OF INJURY, SYMPTOMS,

INJURY IN SPORT, AND TREATMENT
The results of this research indicate that concussions and other head injuries
need to be handled more cautiously. The research findings presented here
fall into three categories: (a) outcome of injury, (b) symptoms, (c) injury in
sport, and (d) treatment.

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 Outcome of Injury

The National Football League has been getting a lot of pressure for years now
about the injuries that players are receiving, and what happens to them after
their careers are over. Currently, the NFL has agreed to pay players that
have experienced dementia, Alzheimers, Parkinsons, Lou Gehrigs disease,
and other neurological problems (Kyros, n.d.). Right now, lawsuits are
averaged around $5 million per player.

There is also a similar lawsuit against Xenith, a football helmet company.

Nevertheless, the companys founder and doctor of medicine, Vin Ferrara,
continue to make advancements in his design and in his companys
technology to help make sure that concussions are outdated (Smith, 2014) .

Trauma

An athlete, who shows signs of a concussion that was caused by a blow to

the head, has suffered a concussion (Nationwide, n.d.). For most athletes,
these symptoms last only 10 days, but some can last up to several months.
There have been some cases where concussions have led to complaints of
the physical, mental, emotional, and behavioral symptoms, sometimes
known as post-concussion syndrome (Nationwide, n.d.).

In football, there are many positions that receive more trauma than others
do. Wide receivers and cornerbacks are two of the highest position to receive
concussions when it comes to concussions per position (see appendix 1) . The
second highest category of concussions per position are the running backs,
safeties, tight ends, and linebackers to be right behind them. The receivers,
tight ends, and running backs; being the positions that receive the ball on
every play. Encountered the defensive positions listed; safeties, cornerbacks,
and linebackers. All of this collision on a weekly schedule is what leads to all
of the injuries.

Impact

The retired players struggle in an everyday life style because of the

consistent blows to the head that they receive while playing, which led to
their long-term health problems (Kyros, n.d.). According to Kyros, the NFL did
not properly inform the players as to what would happen if they continued to
play with these injuries.

Boston University Center for the Study of Traumatic Encephalopathy has

discovered that CTE, chronic traumatic encephalopathy. A condition known
as a severe degenerative brain disease; was found in 14 of the 15 former
NFL players. All of these athletes had repeated concussions or sub-

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concussive blows to the head. CTE starts with mild memory loss, and then it
can progresses to symptoms of Parkinsons disease (Kyros, n.d.).

Treatment

Treating a concussion properly is one of the biggest steps athletes can do.
Listening to the doctors orders and realizing that the doctor only care about
the health of the athletes is their only interest. If an athlete experiences the
symptoms listened below, make sure that they receive a copy of Figure 1, to
go along with what their doctor issues them.

Symptoms

Every concussion is different from each other and each can present unique
symptoms. If a concussion is suspected, the athlete should be removed from
play immediately. Athletes should not return to play, if a concussion is
confirmed or even suspected. When in doubt, sit them out, can help avoid
further injury (Nowinski, 2015).

According to Nationwide Children and Pieroth, common concussion

symptoms may include:

Headaches
Dizziness
Balance disturbances
Memory loss or confusion
Difficulty concentrating
Sensitivity to light or sound

These symptoms may not be evident immediately after receiving the head
injury. This can make a concussion diagnosis even more difficult. The most
vulnerable period after receiving a concussion is the first two days. These
symptoms can last as long as two or more weeks. If an athlete returns to
play too soon and receives multiple concussions, the brain did not did not
have enough time to heal from the earlier injury, and this can lead to long-
term health problems (Pieroth, 2015).

Doctors orders

Athletes must be removed from play when a concussion occurs. The first
step is to recognize the injury and getting that athlete out of the game
immediately. It is the responsibility of parents and for keeping their youth
athletes safe from concussions (Oz, 2011). Prior research has shown that
coaches, trainers, and parents fail to identify most concussions, and this
keeps the injured athlete playing in the game for too long. Failing to notice

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the injury increases the risk of poor health outcomes. Poor health outcomes
include post-concussion syndrome, and second impact syndrome. Having the
proper coaching and training, removing the athlete from play and doing a
side-line test can help keep the players safer (Smith, n.d.).

Knowing when an athlete in medically cleared to return to the field is a major

factor. Knowing this can help athletes from getting hurt again and from a
prolonged recovery. The athlete should not return to play unless he or she is
under the proper supervision of a medical professional. If the return is
rushed, the athletes are at a greater risk for that prolonged recovery and can
potential have worse outcomes (Smith, n.d.). Figure 1 is the concussion
protocol to follow when trying to return to a sport or activity.

Figure 1

CONCUSSION PROTOCOL

Rehabilitation
Functional Exercise Objective
stage

1. No activity Rest Recovery

Walking, swimming, stationary Increase heart

2. Limited Activity
cycling. rate

3. Sport Specific Running. No head impact

Move around
Exercises activities

Progression to more complex Exercise,

4. Non-contact drills
training drills coordination

5. Full contact Restore

Normal training activities
practice confidence

6. Return to play Normal game play

(Smith, D. n.d.)

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Figure 1 has six different rehabilitation stages that athletes should follow in
order to return to play. Step 1 is zero activity; they will just be resting their
bodies. The next step moves along a little, into limited activities such as
walking, swimming, and stationary cycling. Once athletes are feeling
comfortable with step two, they are cleared to move on to step three, a more
active group of exercises, for instance, running. Step 4 involves more
complex training, which leads to Step 5, and back to full contact practices.
When the athletes can go through full practices and not have any issues,
then they are on the final step, and clear for games.

Injury in Sport

Sports can be very physical and rough on the body. Figure 2 shows the
amount of concussions diagnosed annually in sports from the ages 5-14 .
According to Figure 2, football, bicycling, and basketball are the highest rated
sports that athletes receive head injuries.

Figure 2

CONCUSSION IN SPORTS, ages 5-14

540000 504000

271000

648000 210000
134000

Football Baseball/Softball Soccer

Skateboarding Bicycling Basketball

(Stuart, 2003)

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Figure 2 lists the amount of concussions per sport, from the ages 5-14.
Football, bicycling, and basketball lead all other sports; each one of them
doubling the other three sports. This pie chart gives statistics on what sports
need to be focused on when athletes are younger. Figure 3 shows how
concussions have increased from the early 2000s to 2010, which shows
that the improvements in equipment and new rules are greatly
needed.

Figure 3

NFL CONCUSSION COMPARISON

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(Fetchero, 2011)

This figure shows that changes need to be made in the way that football is
being played. Figure 3 compares concussions in the NFL football season in

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2000 to 2010. In the year 2000, the NFL players received 36 concussions.
That number more than triples in the 2010 season, which had 114 total
concussions.

Prevent steps

High school and collegiate level has been doing research using head impact
sensors. These have shown that changes in practice style can reduce
injuries. Having age appropriate rules and workouts that strengthen the
athletes neck muscles can also reduce the number of concussions (Smith,
n.d.).

According to Orthopedic Specialists of North Carolina following, these six

steps could help reduce concussions:

Make sure the athlete is wearing a helmet that is appropriate for the
sport in which they are participating. The National Operating
Committee on Standards must certify the helmets for Athletic
Equipment (NOCSAE).
Make sure that the helmets fit in accordance to that sport. Helmets
must be worn properly at all times.
Try not to use the head as the focal point of contact. Athletes should
never lead with their head or helmet, when engaging with another
player.
Inform athletes of the proper way to make a tackle, teaching them to
lead with their shoulder.
Strengthen the neck muscles. If the athletes neck muscles are
strengthened, then the neck can absorb some of the blow and
decrease the impact to the brain.
Several helmet designs for football and hockey have been developed
with the intention of reducing concussions.

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Following these steps are a key way in keeping your players safe, and limit
the chances of a concussion and even further injury from happening .
Wearing the helmets that have been certified from the NOCSAE is important.
Coaches should not provide any other helmet for the players to wear. Along
with these helmets, they should be passed out to each player by the size of
the helmet, too the size of the players head. The helmets should not be too
loose on the players heads that they fall over their eyes when they put them
on.

Coaching players on the proper form of tackling is a major factor. During

practice, it is important to teach the players not to lead with their heads,
instead lead with their shoulder. Now this does not stop all contact that the
head will receive, so coaches should also imply workouts that strengthen the
neck muscles. The strengthening of the neck muscles can absorb some
impact and protect the brain.

Sports equipment

There is not a helmet that can prevent every concussion and athletes should
know this (Smith, n.d.). During this upcoming season, several college
programs will be using Riddells new SpeedFlex helmet and it is InSite Impact
Response System. These helmets are designed to disperse energy, which
reduces the risk of trauma. The InSite technology alerts the coaches and
trainers when a player receives a significant hit to the neck or head area
(Fuhrmeister, 2014). Players were able to start using the SpeedFlex helmet
at the start of the 2014 football season. Although they are new helmets, they
are receiving high praise from the players. For example, the Virginia Tech
football program has a football helmet rating system, and the Riddell
SpeedFlex is number two on the list. A list that contains 27 different types of
helmet, some from Riddell, Xenith and other brands.

SpeedFlex technology used in helmets. Some features:

Parts of the helmet are designed to flex. The flex technology reduces
the impact-force. This flex technology is made into the helmets shell,
face mask, and attached system.

A proper fit of the helmet is key. With the new ratchet-style chinstrap,
this snug fit is possible.

The interior was redesigned to conform to the shape of its users head,
which improves comfort and fit.

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 The new InSite technology inside each helmet measures the impact of
each hit. Measuring how violent the players head moves during contact
and the location of the impact.

When a player is tackled, a five-point sensor in the helmet liner

measures the contact. If the contact falls outside of an acceptable
range, the sensor sends out a wireless alert, which a staff member on
the sideline receives.

These technological advancements are going to go a long way in protecting

football players from concussions; being able to reduce the impact that an
athlete receives. By coming up with a helmet that has flex technology.
Disbursing the impact all around the helmet instead to just the impact point.

In addition, the inside of the helmet receives some upgrades as well.

Upgrades, such as the redesigned interior that forms to players head better,
which provides better comfortability. Inside of this new interior is the biggest
advancement to keeping the athletes safe. The InSite technology, which is
an impact system that measures the impact of each hit that the football
player takes, sends its reading to the trainers or coaches. This allows them to
see how bad of a hit it was by the readings. After seeing and understanding
these readings, trainers can take players back to the locker rooms for more
evaluations to see what the injury is.

SUMMARY
Concussions have made it hard for some organizations and equipment
companies, because there are always worry of being on the wrong end of a
lawsuit. Right now, the best example of this is the NFL and Xenith helmet
company. The athletes received long-term issues and these organizations
are the ones law firms are placing the blame. Even though most of the
athletes that receive concussions are only impacted for 10 or so days, there
are the cases where the trauma continues for months or even for the rest of
that athletes life.

It is important for everyone be involved with a concussion recovery, whether

it is the athlete, parent, coach, or trainer. All four should understand the
treatment process, and be on the same page. So that the player can return
to play as soon as possible, but at full health. Being able to recognize the
symptoms that will occur when an athlete receives a hit to the head. Pointing
them out to someone will help keep that athlete safe. Once realized that a
concussion is the problem, everyone has to follow the doctors orders.
Following the six step listed in Figure 1 can get the player back into the game

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as fast as possible. If abandoning the steps to soon, then lifelong issues can
occur.

Trying to prevent all of this from the beginning, is staying up to date on the
new sports equipment technology, and informing the athletes of the proper
ways of making contact with another player. With all the new designed and
technology that go into players helmets and shoulder pads, players should
never be left out on the field after taking a blow to the head to hard.

CONCLUSIONS
Football is a rough sport, the intensity of the game, and the physicality that it
requires can often be a tough toll on the players. The defensive players are
looking to hit the ball carrier as hard as they possibly can. The offensive
players are looking to avoid the defender by shifty moves or even try to run
through the defender. This shows that on both sides of the ball, there is
impact no matter what; and that is why it is important to realize the
following:

1. Players are often left unsafe when trying to make a play on the ball. For
example, when a wide receiver dives or jumps in the air for a ball. .

2. If they dive or jump then they have no way to defend themselves from
the defender.

3. The defenders look for the blow up hit. Not to necessarily the
offensive player, but to change the momentum of the game or to send
a message.

The NCAA and other organizations have already been making rule changes
over the past several years to make the games safer. For example, the
targeting rule in college football is the game changer. When a player
defender makes contact with another player, they cannot lead with their
head. If that player hits the helmet with their head, then it is considered
targeting, and they player can be thrown out of the game. In conclusion, it is
imperative that the success continues with the rules that make the game
safer. The success that sports equipment companies are having with their
new products and research advancement as discussed earlier.

Concussions and other head injuries have been on the rise for a while now.
With all of the lawsuits against organizations and the other sports leagues
coming up daily. Players are finally realizing exactly how far they are able to
push their bodies, and if they were pushed too far while they were playing. If
felt like they were pushed to hard then they go to their attorneys and their
doctor to see if there is long time damage from the blows. If so, then they
look for a settlement with the leagues or equipment companies.

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Some athletes, during the games, have too much adrenalin and do not
realize if they have taken too bad of a hit, so it is up to the referees, coaches,
and trainers to stay on top of the following to keep them safe:

New rules

Making the right calls

Enforcing sports equipment rules

Following those tips will keep the players safer, and will limited injuries. A
referee or coach cannot control everything or see every outcome, so injuries
will happen, but enforcing the rules and regulations makes a difference.

RECOMMENDATIONS
With the right training, they can immediately realize that the player has
received a concussion, take that player out of the game, and then to the
hospital. When the player has been given his or her diagnosis then they
follow every step that the doctor has given them. If following everything their
doctor said, then they will be on a good path to return to play as soon as
possible.

1. No activity
2. Limited activity
3. Exercises, sports specific
4. Non-contact drills
5. Full contact practice
6. Return to play

The same steps that are listed in Figure 1 are the best way to fix the problem
if a concussion occurs. Then making sure that they do not return to play too
soon and ignore the steps, because that could lead to the more extreme
cases and pro-longed health issues.

It is important to have the safety of every athlete as the number one priority,
when they are on the field. When a player goes down, then every coach,
trainer, and parent should be prepared with the right training and knowledge
to determine an injury. As shown in Figure 4, more concussions happen
towards the end of the season because of the continuous hits to the
players heads.

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 Figure 4

NFL CONCUSSIONS BY WEEK

14

12

10

0
3

(Fetchero, 2011)

Figure 4 shows how the players come into the season healthy, and have the
lack of head injuries. As the season went on though, the concussions started
to build up more and more. By time the playoffs came around, week 17, the
concussions were at their highest point.

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 APPENDIX

(Breslow, 2014)

REFERENCES
Breslow, J. (2014, February 4). FRONTLINE. Retrieved November 24, 2015,
from http://www.pbs.org/wgbh/frontline/article/what-weve-learned-
from-two-years-of-tracking-nfl-concussions/
Fetchero, S. (2011, March 7). NFL: Will the Rate of Concussions Increase If
the Season Extends to 18 Games? Retrieved November 28, 2015, from
http://bleacherreport.com/articles/629467-will-the-rate-of-concussions-
increase-if-the-nfl-extends-the-season-to-18-games

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Nowinski, C. (2015, May 8). Playing Fast and Loose With Concussions Can
Ruin Lives. Retrieved November 19, 2015, from
http://concussionfoundation.org/learning-center/concussion-response

Fuhrmeister, C. (2014, March 28). New Riddell SpeedFlex football helmet pits
technology vs. concussions. Retrieved October 22, 2015 from
http://www.sbnation.com/college-football/2014/3/28/5547618/riddell-
speedflex-helmets-insite-technology
Headbanger's windfall. (2014). Newsweek Global, 162(22), 1-7.

Kyros. (n.d.). NFL Injuries. Retrieved November 16, 2015, from

http://www.footballinjuryclaims.com/?campaign-
id=70160000000Et6R&lp=landing/footballinjuryclaims.com&src=googl
e&medium=search&campaign=nfl&adgroup=legal-
injury&ad=55108458225&network=search&kw=nfl
%20%2Blawsuit&matchtype=b&sitetarget=&aceid=&adposition1t1&g
clid=Cj0KEQjw75yxBRD78uqEnuG-
Nationwide Children's. (n.d.). Concussions in sports. Retrieved October 22,
2015 from http://www.nationwidechildrens.org/concussions-in-sports

Pieroth, E (2014) NorthShore. Concussion symptoms and treatment.

Retrieved October 22, 2015 from
http://www.northshore.org/neurological-institute/centers-and-
programs/concussion-and-head-injury-program/
Orthopedic Specialists of North Carolina. (n.d.). Tips on Concussion
Prevention. Retrieved from http://www.orthonc.com/concussion-
clinic/tips-concussion-prevention
Oz, M. (2011). Playing defense. Time, 177(4), 52.

Pieroth, E (2014) NorthShore. Concussion symptoms and treatment.

Retrieved October 22, 2015 from
http://www.northshore.org/neurological-institute/centers-and-
programs/concussion-and-head-injury-program/
Smith, C. (2014). Hard knocks. Forbes, 194(3), 66-70.

Smith, D. (n.d.). Concussion Legacy Foundation. Retrieved October 20, 2015,

from
http://concussionfoundation.org/learning-center

Stuart, M. (2003). The macho factor. Retrieved November 24, 2015, from
http://whyfiles.org/190sport_injury/4.html

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