Is your child’s brain at risk by playing footy?
Airdate: 
Tuesday, March 11, 2014 - 20:30
Channel: 
SBS One

Professional sporting codes including AFL, NRL and Rugby have put a lot of effort into improving how they deal with concussions on the field.

But this isn't necessarily filtering down to the amateur and junior levels. And when it comes to kids, experts argue there’s even more to worry about.

Neuroscientist Dave Ellemberg says his research dispels the myth that children’s brains recover more quickly than adults. "The developing brain is actually more fragile to the impact of a concussion," Dr Ellemberg says.

Insight finds out what’s happening on footy fields across the country and what you should do if your child sustains a knock.

Presenter: Jenny Brockie 
Producer: Luan McKenna 
Associate Producer: Amanda Xiberras 
Associate Producer: Anna Watanabe 

Join the discussion by using the #insightsbs hashtag on Twitter, posting on our Facebook, or commenting below.

Web Extra: What is concussion? 

The word “concussion” derives from the Latin “concutere” meaning “to shake violently”. It describes the clinical condition resulting from injury to the brain following a head injury.

  • You do NOT have to be “knocked out” or unconscious to have a concussion However, if you have been knocked unconscious, then it is very likely you will suffer with a concussion.
  • However, if you have been knocked unconscious, then it is very likely you will suffer with a concussion.

What are the symptoms?

Neurologist, Professor Robert Cantu (author, “Concussions and Our Kids”), says symptoms fall into four categories:

  1. Somatic: Headaches, nausea, vomiting, balance and/or visual problems, dizzy spells, and issues such as sensitivity to light and noise.
  2. Emotional: Sadness to the point of depression, nervousness, and irritability.
  3. Sleep disturbance: Sleeping more or less than usual and trouble falling asleep.
  4. Cognitive: Difficulty concentrating, troubles with memory, feeling mentally slow or as if in a fog that will not lift.

What to do if your child is concussed

  • If you suspect your child has been concussed take them to a doctor. If they have been knocked unconscious, then take them to a hospital’s Emergency department.

  • Refrain from any activity that exacerbates symptoms. This may apply to both physical and mental activities. As well as sport and exercise, activities to avoid may also include reading and watching movies.

  • Your child should not return to play contact sport until all symptoms have past or until they are cleared by a medical professional.

  • It is important to let the school know about your child’s head injury. If the child is struggling with fatigue or concentration problems, they should be allowed time to gradually return to everyday activities.

To learn more, see this Sydney Children’s Hospital Fact Sheet.

For a doctor’s advice, here’s what Dr Dave Ellemberg, from the University of Montreal, has to say about the crucial role of proper recovery in protecting a child’s brain development after concussion:

Video: From the Insidermedicine.com website.

Transcript

JENNY BROCKIE: Welcome everyone, thanks very much for joining us. Nelson, you're 14, you play soccer in a Brisbane premier league and you're a goalie. How many times have you taken a big hit to the head?

NELSON REED-BANYARD: Um, about twice that I can say is a really big hit.

JENNY BROCKIE: And what do you define as a really big hit?

NELSON REED-BANYARD: I'm dizzy afterwards; I can't really concentrate when I'm at school and during the week most likely.

JENNY BROCKIE: Okay, you were knocked unconscious in a game last year. Now this is a picture of you that was taken just before that happened, you're the one, the goalie, in the red there. What happened next, just after that picture?

NELSON REED-BANYARD: Um, I made the save and the ball went towards the out line and as I was getting up one of my defenders tried to jump over me but his knee collided with the back of my head and I just dropped like a sack of potatoes. I remember trying to get up about three or four times but I had no centre of gravity, I just was too dizzy to get up.

JENNY BROCKIE: And how were you feeling?

NELSON REED-BANYARD: I honestly had no idea what was happening. I, I tried opening my eyes a couple of times and nothing really made sense - my vision was blurred and from tears and stuff like that.

JENNY BROCKIE: Now this happened early in the game?

NELSON REED-BANYARD: Um, probably halfway through the first half.

JENNY BROCKIE: Okay, and Lisa, you're watching as mum from the side lines, what did you see when it happened and what did you think?

LISA BANYARD: Um, I saw the ref stop the game, I saw his coach come over and I wasn't completely sure what had happened to him. They"¦.

JENNY BROCKIE: That must have been, as a mother, that must have been pretty terrifying to see your son like that, or had you seen it before?

LISA BANYARD: I knew that there was something pretty wrong and I remember thinking he got up and kept on playing and thinking well, it mustn't be that bad because they've kept him on the field. But talking to him after the game, that's when I realised how serious it was at the time.

JENNY BROCKIE: Okay, so you were still on the field at this time?

NELSON REED-BANYARD: Mm. I chose myself to stay on. My coach asked if I wanted to come off but I said I'll see how I am at half time.

JENNY BROCKIE: So the coach asked you, he didn't tell you to go off?

NELSON REED-BANYARD: He didn't tell me because, well at the time the laws of the game stated that now that when a player takes an injury to the head the referee has to stop the game to see if he's alright and to have him taken off the field to be treated. But before that - when it actually happened there was no such law, it was recommended but there wasn't such law.

JENNY BROCKIE: Was there a medic there?

NELSON REED-BANYARD: Um, there was. It's compulsory to have a medical staff there, but I think he's preoccupied with a different game because he didn't seem to come over and there was something happening on the other field.

JENNY BROCKIE: And did anyone on the field come over to you when it happened?

NELSON REED-BANYARD: My team mates came and asked if I was okay.

JENNY BROCKIE: Did you know who they are?

NELSON REED-BANYARD: No, I had no idea. They asked me if I'm ok - they asked me if I'm okay and I said 'who are you?’

JENNY BROCKIE: So you played on?

NELSON REED-BANYARD: Yes.

JENNY BROCKIE: And you made that decision?

NELSON REED-BANYARD: Yes.

JENNY BROCKIE: Lisa, what did you think of Nelson at 13 being the person who made that decision about playing on?

LISA BANYARD: In discussion with your research staff, I got to know more of how serious that injury was. He didn't tell me everything at the time.

JENNY BROCKIE: Is that right? Why didn't you tell your mum everything at the time?

NELSON REED-BANYARD: Because she tends to worry a lot about things.

JENNY BROCKIE: So how important was it to you to keep playing?

NELSON REED-BANYARD: It was extremely important. It's - football is everything I care about, it's my life, I eat sleep and drink it.

JENNY BROCKIE: Your mum's got her mouth sort of wide open over here. Why are you looking so shocked?

LISA BANYARD: I thought you cared about your cat as well, you know.

NELSON REED-BANYARD: Priorities.

LISA BANYARD: Me.

JENNY BROCKIE: Okay, how were you for the rest of the game Nelson?

NELSON REED-BANYARD: Ah, I was dizzy. I wasn't playing as well as I normally did.

JENNY BROCKIE: And how were you after the game?

NELSON REED-BANYARD: Um, I was better than I was during. I pretty much slept on the car ride home and there's one time when we were going back because there a big stopping petrol station with McDonald's and a Red Rooster and everything and my mum said go inside and get a drink and so I did and I come outside and she's surrounded by a bikies, by a bikie gang and she's just chatting to them and I didn't know whether I was imagining this because of my concussion or she was actually talking to bikies.

LISA BANYARD: Can you edit that out? Campbell Newman will arrest me at the airport.

JENNY BROCKIE: Were you talking to bikies or was he hallucinating?

LISA BANYARD: No, I was, but it wasn't illegal to do it then.

JENNY BROCKIE: I'm not suggesting you did anything illegal. We're not here to talk about bikies, we've done a program about bikies, that's all over.

LISA BANYARD: They just turned up and"¦

JENNY BROCKIE: Okay.

LISA BANYARD: I can imagine how he thought he was hallucinating walking out of there and I'm just sounded by fifty Harley Davidsons and yeah.

JENNY BROCKIE: Okay, we're laughing about this but this was pretty serious, yeah?

NELSON REED-BANYARD: Yeah.

JENNY BROCKIE: And how long did the effects last for you?

NELSON REED-BANYARD: It lasted a couple of days into school because I couldn't really concentrate at school. I was, I was finding it hard to pick up new things at school and I just really didn't know what I was doing.

JENNY BROCKIE: Okay, Jackson, you're 16 and you have a contract training with the Cowboys, is that right?

JACKSON WEIR: Yes.

JENNY BROCKIE: How many big hits to the head have you had playing rugby and rugby league?

JACKSON WEIR: I've had one more serious one and I've had a couple of minor ones as well.

JENNY BROCKIE: Tell us about the serious one?

JACKSON WEIR: Um, well, it was like a big sort of front rower and then that's all I can remember. And then the last thing I remember after that is in the dressing room after the game.

JENNY BROCKIE: And this was in the early part of the game, this happened?

JACKSON WEIR: First half.

JENNY BROCKIE: So you can't remember what happened at all?

JACKSON WEIR: I can remember up till like seeing him right in front of me and then it's just all black.

JENNY BROCKIE: What happened then? Did someone come on - the trainer come on or someone come on to check you out?

JACKSON WEIR: Yeah, the trainer came on and checked me out and I can't remember what he said to me or anything but I'm pretty sure from what I've been told he was just asking me like where I was and everything and I answered the questions all correctly and he let me continue to play, but I can't remember anything.

JENNY BROCKIE: And don't remember any of it?

JACKSON WEIR: I can, the last, I can remember being sick in the dressing room after the game and that's it.

JENNY BROCKIE: So you can't even remember how you felt while you were playing?

JACKSON WEIR: I can't remember anything, it's just all like black. I can remember the whole like first bit before it but that's it.

JENNY BROCKIE: And what happened in the change room after the game?

JACKSON WEIR: I was just feeling, I had a migraine, I was feeling pretty nauseous and I was just, I threw up in the showers and then after that I just, I was just sitting down and one of the trainers was talking to me and stuff and then he helped, then I had a team mate and him help walk me out to my auntie and nan who were watching and he explained to them what to do with me when I get home. Like to try and keep me awake for another three hours or something, I think he said, before I'm allowed to go to sleep and, yeah.

JENNY BROCKIE: So you didn't see a doctor?

JACKSON WEIR: No, I didn't see a doctor.

JENNY BROCKIE: Dave Ellemberg in Montreal, you're a neuroscientist, you specialise in sport related concussion in children. From what you've heard of those two stories, would you have let Nelson and Jackson play a full game of football after a big hit to the head like that?

PROFESSOR DAVE ELLEMBERG, DEVELOPMENTAL NEUROSCIENTIST: Absolutely not. We know that actually immediately after any injury, that is as soon as we suspect that an athlete has been hit, either to the body or directly to the head, any hit that could have caused the brain to shake inside the skull, the athlete should be removed immediately from the game and in both cases that's not been done and that to me is quite worrisome. See an athlete who goes back to the game is even more fragile or at risk of getting another hit seven times and the second hit can actually have devastating effects. So it's really important that the athlete be removed immediately.

JENNY BROCKIE: What happens to a child's brain compared to an adult brain when they get a concussion, is there a difference?

PROFESSOR DAVE ELLEMBERG: Well, yes, there is a difference. First of all a concussion will cause a chemical storm in the brain, the brain will go and hit the skull, within the skull, which will cause compression and stretching of the brain matter, brain tissue, and that will cause actually tears within the connections among the neurons and that in turn will cause like this chemical reaction. Calcium will go into the neurons and cause this destruction, auto destruction of neurons. And what's important here is that, to remember that the child's brain is developing, it's establishing these contacts.

These contacts, you know with the neurons, among neurons are that that are important to learn to memorise, to pay attention, to focus in school. And what we're actually doing is we're damaging the structure that's being put in place. And studies from my lab have actually shown that the consequences of a concussion during that age range of these guys in your studio from like 13 to 16 years are actually, these consequences are even worse than those suffered by adults, the developing brain is actually more fragile to the impact of a concussion.

JENNY BROCKIE: Okay, what's it like hearing that guys?

JACKSON WEIR: A bit scarier than what I was, what I first thought, like.

JENNY BROCKIE: Did you know that?

JACKSON WEIR: No, I didn't.

JENNY BROCKIE: Did you know that Nelson?

NELSON REED-BANYARD: No, I thought, I thought, I knew it was bad, I just didn't think it was that bad.

JENNY BROCKIE: Okay, and when you say you knew it was bad it hasn't made you think again about playing footy, or even about wanting to stay on the field?

NELSON REED-BANYARD: Oh, next time I think I should come off, but"¦.

JENNY BROCKIE: Okay. Dave, what is a concussion? I mean I think it's important to define what we're talking about here. What's a concussion compared to say a very painful hit to the head?

PROFESSOR DAVE ELLEMBERG: It's this very rapid whiplash that the head has which causes the concussion and what you need to know, what the kids need to know is that a first, even a single concussion will cause permanent changes to the brain.

JENNY BROCKIE: Noah, you're eleven?

NOAH ROBERTSON: Yes.

JENNY BROCKIE: And you've been concussed twice playing rugby union?

NOAH ROBERTSON: Yeah.

JENNY BROCKIE: How old were you when you got the first one?

NOAH ROBERTSON: I got both of mine last year and my first one, I went into a tackle and we're not sure, we're not 100 percent sure about like what really happened but, um, we think that I went in, but, um, I, he sidestepped and I only got one arm around and I ended up actually swinging around him and we think that a boot got me. And, um, after that I just remember the coach and my dad, the manager, coming on and asking me questions and"¦

JENNY BROCKIE: What was it like for you? Can you describe what it felt like?

NOAH ROBERTSON: It felt kind of, you only felt like you were half there, like you weren't really, yeah.

JENNY BROCKIE: Did anyone come over to you on the field?

NOAH ROBERTSON: Yes, the coach did and he asked me questions and, yeah, both times I went off and I ended up going to the hospital and they checked me out and, yeah.

JENNY BROCKIE: Angus, you're Noah's dad, you're also the team manager, is that right? Did you, what sort of state was he in?

ANGUS ROBERTSON: Look, he didn't lose consciousness.

JENNY BROCKIE: And you don't have to be knocked out to have a concussion.

ANGUS ROBERTSON: No, no, no.

JENNY BROCKIE: That's a common misconception too?

ANGUS ROBERTSON: But the loss of consciousness can be a little more worrying immediately. The first one wasn't so obvious but by, when any kid gets an injury the game's stopped, we attend to them, the welfare of the player is absolutely paramount. I must admit it's interesting hearing these guys' comments about the reaction and what happens afterwards. We're under strict guidelines when you come and do try rugby and so on, you get a concussion guideline booklet; managers go to a formal meeting at the beginning of every season and get told of what to do. Coaches have to be accredited and qualified. So as soon as we go through, not necessarily the SCAT guidelines and so on but those questions, what did you eat for breakfast, where are you, who are you playing, you know, you assess their condition. Um"¦

JENNY BROCKIE: But there is an option of keeping them on the field?

ANGUS ROBERTSON: No there's not.

JENNY BROCKIE: No there's not?

ANGUS ROBERTSON: No there's not.

JENNY BROCKIE: They have to come straight off?

ANGUS ROBERTSON: They have to come off.

JENNY BROCKIE: How did you feel about going to a hospital?

NOAH ROBERTSON: Well the first time I was like, yeah, I will go to hospital 'cause I'm kind of scared, like I've never had, experienced that before. But the second time, after knowing what I have to do at the hospital and how boring it is, I ended up actually kind of trying to dull down how bad it was.

JENNY BROCKIE: So you played it down?

NOAH ROBERTSON: Yeah, kind of.

JENNY BROCKIE: How much did you play it down? He's not listening, just tell me?

NOAH ROBERTSON: Well, not like to the point of trying to make him believe I didn't have one completely. But like saying oh, no, I don't feel very nauseous, my headaches not that bad and"¦

JENNY BROCKIE: When it was?

NOAH ROBERTSON: Yeah, just kind of saying that type of stuff.

JENNY BROCKIE: Gary Tunks, you coach and you referee junior rugby union. How hard is it for you as coach to work out whether a kid has concussion on a footy field?

GARY TUNKS: Look, I'm concerned about a couple of things I've heard tonight to be frank. With Jackson there with his league, he was clearly vomiting in the shower after the game. For me that's one of the things that we're looking for, is vomiting. We know that it's very serious when that happens. So for me, if I was coaching Jackson my recommendation would have been for him to go and see medical attention straight away.

JENNY BROCKIE: Did anyone recommend that?

JACKSON WEIR: Um, I'm pretty sure the trainers recommended that I go see a doctor or he said they'd just keep him, like rest him up and see how he goes and then like tomorrow, if he's not any better just go see a doctor or whatever.

JENNY BROCKIE: And you didn't want to do that?

JACKSON WEIR: I didn't really want to go and do it because, you know, I was thinking, oh big tough footballer, who wants to go to the doctor? But"¦

JENNY BROCKIE: See that's what I'm interested in kind of getting to, is just how difficult it is for you at this age as footballers to do that, you know, when you've got your team mates?

JACKSON WEIR: I didn't really want the doctor to say no, I don't want you to play this week, you know, miss next game, not allowed to go to training and stuff. And at that point I was like, I was getting pretty serious, like there was like some rep stuff coming up and stuff and so I didn't really want to risk being out of the game for a period of time.

JENNY BROCKIE: You didn't want to be out of contention?

JACKSON WEIR: No, exactly.

JENNY BROCKIE: Vicki Anderson in Melbourne, you helped set up a kids concussion clinic at the Royal Children's Hospital there. What are the guidelines around this, do you know, across the football codes?

PROFESSOR VICKI ANDERSON, PAEDIATRIC NEUROPSYCHOLOGIST: So AFL do have a set of guidelines that require kids to be taken off the field if they have a concussion and then to be rested for a certain period of time.

JENNY BROCKIE: So what's supposed to happen if a child is concussed on a football field, any football field?

PROFESSOR VICKI ANDERSON: Okay, so number one, if you've in a concussion you don't go back on that day, you're off for the day. It's sensible to seek medical examination and then you don't return to play or to school until you're completely symptom free. So the symptoms we've heard about already are headache, vomiting, dizziness is, balance problems, all of those problems need to have disappeared before kids really should even think about going back to even school, let alone going back to sport.

JENNY BROCKIE: Why school, why in particular in relation to the brain?

PROFESSOR VICKI ANDERSON: Well, I think for kids, particularly adolescents which is when most of these injuries happen, school is actually quite taxing and the studies that we've done show that if kids about go back to school too early they'll actually, they're at risk for relapsing so for their symptoms to increase again if they still have any symptoms at all.

JENNY BROCKIE: Dave, a set of guidelines called the Zurich Guidelines were drawn up last year, can you tell us about those and what they're supposed to apply to?

PROFESSOR DAVE ELLEMBERG: Yes, as soon as there's a doubt or we suspect that a child has been concussed he needs to be removed from the game. We have to understand that there are, sometimes in some cases there are no particular symptoms that can show up immediately after the injury. Some kids can present symptoms up to 24 to 48 hours after the injury so there's no test or symptom that guarantees that the child has been concussed, so we can't take any risk, that's the first rule.

The second rule is that the child can only go back, return back to the game once he's been cleared by a medical professional, by a doctor, and at least, there at least needs to be seven days after the injury for the child to go back, for the adolescent to go back, even if he's symptom free.

JENNY BROCKIE: Vicki, we don't want to overly frighten people here either, I mean we don't want to go too far the other way. I'd like to make sure we get a bit of perspective into this conversation and I'd like you to offer it for us.

PROFESSOR VICKI ANDERSON: Well I suppose one of the critical things to be clear about is that kids really do recover. So the majority of kids are perfectly fine functionally by the time two weeks has gone by. There's a very small handful that will go on to have problems for three months or six months but in 25 years I don't think I've ever seen a child who has had on-going problems into the future from one single concussion. So you know, I think that's really important to keep in mind.

JENNY BROCKIE: Dave, do you agree with that?

PROFESSOR DAVE ELLEMBERG: No, not really, because the issue is, the issue with sport is that kids will accumulate concussion. I agree with Dr Anderson that one concussion will likely not have permanent effects down the road but unfortunately like Noah, like these other kids on your panel, they accumulate two, three, four concussions and actually studies from different groups have shown that athletes who've accumulated three concussions or more are ten times more at risk to develop disorders in aging that resemble, that look like Alzheimer's.

JENNY BROCKIE: Vicki?

PROFESSOR VICKI ANDERSON: We've looked at a range of kids now out to 15 years post even very serious injuries and you know, they're doing really well and we've looked at their brains in a great deal of detail and I have to say that in a population based sample, rather than a very select sample such as Dave is referring to, we really don't find a large proportion or we find a tiny proportion of kids that have any abnormalities.

So I think, I think the jury's out and I think we still need a lot more evidence before we make predictions about the long term implications from concussion. I don't think we have the evidence to stop kids playing sport and cause them problems with quality of life and depression because they're not doing what they love. So you know, I think there's a lot more research needs to happen before we can make those kind of decisions for people.

JENNY BROCKIE: Tonight we're talking about the effects of concussion on kids who play football. Andy, you quit playing rugby league at 15 after a bad concussion in a match. What do you remember from that day?

ANDY BEDFORD: I don't remember a thing from that day. Oh, there was one, one thing that someone smashed a light in the change room and from the whole day that's the only thing I can remember and it was actually the day before - I've got no recollection of the whole day before either. So it was quite a bad one.

JENNY BROCKIE: Did you play the whole game?

ANDY BEDFORD: No, I couldn't, I couldn't go back on after. I was 15 so I'm not too sure of how long into the game it was but I was in no shape to keep playing.

JENNY BROCKIE: How many concussions had you had by the time you were 15?

ANDY BEDFORD: I think that was probably the third one, none related to football, it was just accidents with my brothers and stuff like that, so.

JENNY BROCKIE: And Andy, we've got some video of you getting hit a few years ago. Tell us what happened here?

ANDY BEDFORD: This was in the grand final and, yeah, I basically, it wasn't a very good technique, I kind of just rushed up and he stepped the wrong way and we had a bit of a head clash.

JENNY BROCKIE: We've got it in slow motion here.

ANDY BEDFORD: Yeah. So it wasn't too good and that was kind of typical for the knocks that I'd get. I don't know if it was a technique or what, but, yeah, that sort of thing where I'd cop a hit like that.

JENNY BROCKIE: How many concussions do you think you've had all together?

ANDY BEDFORD: I don't know, we had this discussion earlier, I'm not sure, I think it's probably ten or fifteen.

JENNY BROCKIE: And how have they affected you do you think, in a more general sense?

ANDY BEDFORD: In a general sense, I think my short term memory isn't fantastic and I don't know whether that's due to the hits that I copped playing footy or, I don't know whether it's just me, but yeah, my short term memory is definitely not fantastic.

JENNY BROCKIE: Dave Ellemberg, just tell us a little bit about what you know about the effect of repeated concussions, a little bit more about that, when people have multiple concussions?

PROFESSOR DAVE ELLEMBERG: The first thing is that we know that discussions do have a cumulative effect, that is a second concussion will add on to the damages, the damages caused by the first will be, you know, you'll have additional injuries and so forth and so on, to a level that after three to five concussions someone could develop what is called Post Concussion Syndrome. That is the symptoms that they feel immediately after the injury, don't go away or take much longer to go away.

JENNY BROCKIE: Vicki, what advice do you give to kids and to parents where there are multiple concussions in a child's history?

PROFESSOR VICKI ANDERSON: I certainly agree with Dave that more than one concussion, particularly when you get over three in a season, that's really concerning and as a mum I would not be keen for my child to be playing after that. I think one of the problems in the concussion area is that a concussion of a certain level of severity in one child will have different effects to the same concussion in another child. So you know, one person might have three concussions and be perfectly fine and another one might have one concussion and have really terrible problems. So it's very difficult to have a global rule for everybody, which is why we, why this area is so complex and difficult.

JENNY BROCKIE: Would you be advising, you know, all parents listening to this if they suspect a concussion to get their child to a doctor or to a hospital?

PROFESSOR VICKI ANDERSON: Absolutely, absolutely and even at the very least what that does is reassure them, it gives them information from the Emergency Department about how to manage their child's concussion, what to look out for in terms of problems. So it's that kind of reassurance, I suppose, that it gives, even if nothing else.

JENNY BROCKIE: Anthony, you took a bad hit to the head during soccer training when you were 19?

ANTHONY SQUADRITO: Yes.

JENNY BROCKIE: What sort of effects did that have on you? What were you doing that was unusual afterwards?

ANTHONY SQUADRITO: Oh, I had really bizarre symptoms actually. I got up and I was a little kind of out of balance initially, but then I got symptoms of crying uncontrollably so I was sitting down and I would start to cry and I didn't really know why. And then there were other instances where I would be laughing quite uncontrollably so I had these manic symptoms. And I also had a lot of difficulty speaking so I couldn't quite get any words out.

JENNY BROCKIE: Now you did you come off?

ANTHONY SQUADRITO: Yes.

JENNY BROCKIE: And what happened to the hospital? You had a CT scan?

ANTHONY SQUADRITO: Ah yes. So when we got to the hospital, triage assessed me, they did the normal tests like do you remember everything, what day is it, which I passed with flying colours and then they just observed me for several hours. And the symptoms didn't seem to go away and then they grew concerned that it might have been a bleed in the brain that was leading to these symptoms so they wanted me to have a CT scan.

JENNY BROCKIE: And what advice were you given by the doctor the next day?

ANTHONY SQUADRITO: I was kept overnight. The next day the doctor said look, we don't really know what's going on but you look okay now, so yeah.

JENNY BROCKIE: And were you okay by then, the symptoms had stopped or died down?

ANTHONY SQUADRITO: Yeah, the symptoms had stopped after about five or six hours but the next day I slept quite heavily.

JENNY BROCKIE: And what did the doctor tell you to do then, to just stay away from football?

ANTHONY SQUADRITO: He told me not to play because the grand final was on that week, this was on a Thursday - the grand final was on a Saturday. He said don't play on that game, well I played.

JENNY BROCKIE: You played?

ANTHONY SQUADRITO: And we also got referred to a neurologist.

JENNY BROCKIE: So you'd been referred to a neurologist but you still played the grand final.

ANTHONY SQUADRITO: Yeah.

JENNY BROCKIE: And what happened at the grand final?

ANTHONY SQUADRITO: Ah, I wore head gear and I came on and the first incident, I was playing soccer and the incident was a free kick and I was a defender so I had to head the ball and I headed the ball and about fifteen minutes later these symptoms came back.

JENNY BROCKIE: When you headed the ball?

ANTHONY SQUADRITO: Yeah. About fifteen minutes after that incident the symptoms came back and I didn't go to a doctor that time.

JENNY BROCKIE: And what about the neurologist, did you get to the neurologist?

ANTHONY SQUADRITO: Yes, he said it was quite bizarre, he hadn't seen something like this before and so he put my through a lot of tests. I think I went to an MRI on my brain and something here and I also had an, is it an EEG or an ECG?

JENNY BROCKIE: ECG, is that right? Dave, you'd know. EEG.

ANTHONY SQUADRITO: I had one of those tests. And yeah, so I had that test and it all seemed to come back pretty clean and so what we know now is we don't really know what's going on.

JENNY BROCKIE: Dave, what, I guess what this raises is how much do we know about the brain? I mean we've been having this discussion as though we know what causes problems and what doesn't. But there's a whole unknown here, isn't there, about the way the brain works and that we don't, we don't know the impact that some of these things have?

PROFESSOR DAVE ELLEMBERG: Absolutely. We still have, as Vicki said earlier, we still have a lot to learn and as she said, you know, a concussions, the consequences of a concussion can vary greatly from one individual to another. And so that's why at this time I feel that it's better for us not to take risks until we know more about the consequences.

JENNY BROCKIE: Gabby, you had a concussion four years ago?

GABBY BATES: Yeah, that's right.

JENNY BROCKIE: Playing Aussie Rules but you didn't realise straight away?

GABBY BATES: No.

JENNY BROCKIE: You didn't have the instant reaction these guys had. Tell us about what happened to you?

GABBY BATES: So um, so I was like 19 or so at the time and I was playing ruck, I was in the middle and it's kind of funny because we were both running for the ball, my two - us two team mates on the same team and I actually, you know, dived down and I've just seen it and we're both going for the ball. I've gone to just move and my head has actually gone straight into her nose and sort of lashed back. And at the time you know obviously as soon as there's a hit, there's any kind of injury, they sort of stop and the trainers and that will come out. But because I didn't really have any symptoms at the time I was like oh yeah, I'm fine, got up and yeah, right. They were more concerned with the actual person that had broken their nose. So for me"¦

JENNY BROCKIE: Because it was visible?

GABBY BATES: Yeah, it was visible, so it was visible. For me, you know, they did look at me but obviously I was showing no signs of actual concussion at the time. So I basically kept playing and it wasn't until I got back into the change room, I thought oh, I don't feel so good. And like I wasn't necessarily sick or anything like that but I had feelings of nausea and like I didn't really know where I was.

JENNY BROCKIE: How long after the hit was this?

GABBY BATES: So two hours or so afterwards.

JENNY BROCKIE: And so what happened, did you go to the doctor?

GABBY BATES: So we went down to the local hospital and I spent about ten hours on a hospital bed, but I wasn't allowed to actually sleep, although I wanted to sleep. So another six hours they'd watch me and yeah, after about ten hours, it was about 10 o'clock at night they said look, you know, you're fine now so discharged me, but since then I've noticed things over the last couple of years that I never had before the concussion.

JENNY BROCKIE: Like what?

GABBY BATES: I always find with like bright lights or if I'm on a computer long times I always get headaches, dizziness.

JENNY BROCKIE: Sorry about this?

GABBY BATES: Yeah, no, that's what I was going to say, but probably the biggest thing I noticed is my memory at times. You know, before the concussion I had a really, really good memory, I could remember a lot of things but now sort of long term I can't always remember things that I should necessarily remember before so.

JENNY BROCKIE: And were you found to have been concussed at the hospital?

GABBY BATES: Yeah, the hospital said I had delayed concussion at the time so. It was a very, very scary thought.

JENNY BROCKIE: Dave, what's going on here with delayed, with a delayed concussion impact like that, or delayed symptoms?

PROFESSOR DAVE ELLEMBERG: Yes, we, we don't know why exactly, but what we do know is that in about 30 percent of athletes symptoms can appear 24 to 48 hours after the injury, which brings us back to the fact that symptoms cannot be used on the sidelines as a way to diagnose a concussion. So what we really need to pay attention to is the hit, the impact. So when an athlete gets either a direct blow to the head or another kind of impact that could have caused a concussion we shouldn't take any risks because, because of cases like that where we know that symptoms could appear later.

JENNY BROCKIE: And we've heard again and again in research for tonight, people being told not to go to sleep, that they mustn't go to sleep. Why is that?

PROFESSOR DAVE ELLEMBERG: Yes. Well, it's really important because we want to be able to pay attention to the evolution of the symptoms. If the athlete goes to sleep immediately after the injury, perhaps the headaches can get worse or the athlete could fall unconscious within sleep and we wouldn't be aware of it. So it's really important to be able to keep track of the athlete and the evolution of the symptoms at least for six to twelve hours after the injury so make sure it's not a more catastrophic event. That is to make sure that there's no brain haemorrhage because if that were the case we need to, you know, rush immediately to the emergency and take care of that.

JENNY BROCKIE: Michael Lipman, you're a former English rugby international, you retired after being concussed more than thirty times, is that right?

MICHAEL LIPMAN: Yeah, that's correct, yeah.

JENNY BROCKIE: How old were you when you got the first one?

MICHAEL LIPMAN: The first one was around when I was about 15 at school, but those were kind of mild at first so I didn't really count them. But yeah, they started at 15 at a fairly light kind of level and as my career progressed, I started professing when I was 21 and finished when I was 32, they got worse and worse as the years went on.

JENNY BROCKIE: Tell us how they affected you throughout your career?

MICHAEL LIPMAN: Ah, well most of the time, whenever I actually collected a big concussion I'd take basically as long as I needed to, you know, to recover. Sometimes it was one week, sometimes it was two, three, and then they sort of escalated further and it took me three months to actually recover for one and then on my last one, which was my decision to retire, it took me for around six months to recover. To actually get symptom free was actually a hell of a difficulty.

JENNY BROCKIE: And we've got some pics here I think of you getting those concussions. Can you tell us how you were feeling when those things were happening?

MICHAEL LIPMAN: Oh yeah, sort of the best way to put it is probably the lights are on and no one's home. You know, you're totally dazed and confused, you just don't really know exactly what's happening.

JENNY BROCKIE: There are games you don't remember playing at all, like some of the people here?

MICHAEL LIPMAN: Yeah, there was a handful for sure.

JENNY BROCKIE: And did you ever play straight after getting concussed?

MICHAEL LIPMAN: Yeah, on numerous occasions I had, you know, it's the same sort of thing with the kids, the kids are going through, you know. It's very, very difficult to get someone who's young and ambitious and has got a hell of a lot of goals to achieve that they set out, trying to get them off the field and you don't want to let your team mates down at all so it's very, very difficult.

JENNY BROCKIE: Anthony, what did you want to say?

ANTHONY SQUADRITO: It’s very tough to hear, 'don’t go back on the field because you may get these disorders in fifty years’ time." It's very hard to then, because you know, being 50 and being 60 seems like a lifetime away but the grand final's next week so you think oh well, I'll just risk it and it probably won't happen anyway.

JENNY BROCKIE: What advice would you give these young guys?

MICHAEL LIPMAN: As a young guy, you virtually, you really need to be honest with yourself. You know, I mean you guys are young and impressionable and you've got your mates that you want to impress and do all that, but at the same time you've really got to listen to how your body's feeling and how your brain is because you're the only one that can make that decision.

JENNY BROCKIE: Well you went against medical advice in 2009 when you were told to retire?

MICHAEL LIPMAN: Yeah, I know, I know, that's true.

JENNY BROCKIE: Why? You weren't a kid then?

MICHAEL LIPMAN: I wasn't a kid then, no. Once again it just comes down to the fact that that's my, that was my career so that's your livelihood. I'm always the type of person that wants to do more and wants to succeed and I wanted to do that for my team mates and my friends and my family, and more importantly for myself because I always felt like I didn't really reach my ultimate level, the level that I wanted to get to.

JENNY BROCKIE: How are you now?

MICHAEL LIPMAN: I'm okay. I mean you have good days and bad days.

JENNY BROCKIE: What does that mean, what's a bad day?

MICHAEL LIPMAN: Well your memory's just very vague, you know, that's the best way to put it. Like the young lady at the front, if I stare at a computer screen for too long I just get completely, really bad headaches.

JENNY BROCKIE: Michael, you've been sitting listening to all of this and I've watched you as you've been listening to it and you've been quite emotional, I think, listening to some of it. Tell us why.

MICHAEL HEATON-HARRIS: What's been coming up for me listening to people speaking about it is that there's a lot of stuff gone through my life that's been unexplained and I never really understood why, um, I'd watch a movie and burst into tears and not really be able to comprehend why that was happening to me.

JENNY BROCKIE: And you were knocked out playing Aussie Rules thirty years ago?

MICHAEL HEATON-HARRIS: Yeah, I don't know exactly what happened but I got told later that I got an elbow to the face and we were both running side by side for the ball and I went to pick it up and that was the last thing I remember and the player was next to me, opposing player, and put his elbow back into my face and split me down the nose. And I was unconscious and taken off the field and I was in the club rooms.

JENNY BROCKIE: And it happened again, how many concussions did you have while you were playing footy?

MICHAEL HEATON-HARRIS: I took some pretty heavy knocks and so I continued to play even though those things had happened to me.

JENNY BROCKIE: What other things, what other problems have had that you think might be attributable to those knocks?

MICHAEL HEATON-HARRIS: When he talks about concentration and things like that, ability to concentrate on something and - and concentrate on the task to completion, I find it extremely difficult.

JENNY BROCKIE: Okay, you wanted to be tested about this and we had you tested the other day.

VIDEO PLAYED.

MICHAEL HEATON-HARRIS: I'm in two minds. I'm anxious to find out the results. And I'm probably a bit apprehensive because a part of me wants to know an answer and a part of me doesn't want to know an answer.

ALAN PEARCE, DEAKIN UNIVERSITY: You'd be used to this. It's second nature, really?

MICHAEL HEATON-HARRIS: Pretty much.

ALAN PEARCE: So, what it does, it just allows us to reliably identify the part of the brain that we need to stimulate.

MICHAEL HEATON-HARRIS: Memorising things and recalling things sometimes is a bit difficult.

ALAN PEARCE: This one is what we call working memory storage, now you have to keep that in working memory but that one is now eliminated. And it's either one of those two that has a token.

MICHAEL HEATON-HARRIS: OK.

ALAN PEARCE: And you've got to remember those two are out.

MICHAEL HEATON-HARRIS: OK.

ALAN PEARCE: Alright. This one is three boxes.

MICHAEL HEATON-HARRIS: Oh, bugger.

ALAN PEARCE: So three pins, right hand - helped with the other hand and you're going to do three rows. I'm going to time you for three rows. So as fast as you can.

MICHAEL HEATON-HARRIS: Ready.

ALAN PEARCE: Two, one, go!

MICHAEL HEATON-HARRIS: My fingers are starting to sweat now. Getting slippery.

ALAN PEARCE: Well done. Good. Alright. We're done.

MICHAEL HEATON-HARRIS: OK.

JENNY BROCKIE: Alan, how'd he go?

ALAN PEARCE: Well, the things we wanted to look at was the motor functions so we did the fine dexterity; we looked at reaction time with some movement time. We did some testing for short term learning and working memory and then we also did what is known as trans cranial magnetic stimulation to look at the underlying excitability of the brain. We did see changes in the reaction time and we also saw a greater inhibition in the brain using the brain stimulation technique which is what we've seen with all our footballers in the study I've completed.

JENNY BROCKIE: Okay, so there's a pattern you've noticed with footballers?

ALAN PEARCE: Yes.

JENNY BROCKIE: What is the study that you've done?

ALAN PEARCE: So the studies that we've done, we've looked at the effect of multiple concussions on elite AFL footballers and for this it was AFL or state based equivalent so VFL or WAFL. We compared them to a group of sub elite or amateur players who played various levels but still played regularly, and then we compared both those groups to healthy age matched participants who've never played contact sport or never got a concussion injury and what we found was very similar to what I was just mentioning to you about Michael, was that their brain's activity had been greatly sort of inhibited, even though they'd been concussed on average about twenty to twenty two years prior.

JENNY BROCKIE: I mean how do you know that some of those things might not have been for other reasons? I mean there might be an association but not necessarily a cause?

ALAN PEARCE: That's right. So the study is what we call cross sectional, it's not longitudinal, so we took a snapshot of these athletes who are recollecting their memories from twenty years ago. We need to really look at, I guess, multiple measures but"¦

JENNY BROCKIE: But it is important to point out it's a small study?

ALAN PEARCE: Absolutely, and it's only sixty people.

JENNY BROCKIE: And it's not causal, you haven't established a cause and effect?

ALAN PEARCE: No, no, it's only sixty people in the study so statistically it's showing some stuff but clinically we need a much larger sample.

JENNY BROCKIE: So if Michael's performance is lower in some area it might be for another reason?

ALAN PEARCE: Yeah, that's right.

JENNY BROCKIE: Theoretically?

ALAN PEARCE: That's right.

JENNY BROCKIE: Vicki, how can we know whether long term effects are actually caused by concussions rather than just associated with them?

PROFESSOR VICKI ANDERSON: I think the perfect study design is to baseline people, in particular kids.

JENNY BROCKIE: What does baseline mean?

PROFESSOR VICKI ANDERSON: So baseline means that, well you might go out and test a whole school full of children and then you, it sounds a bit kind of gory but you wait until they have a concussion and then you can follow them up and you can see whether they've actually got any deficits as a result of that injury and then you can continue to follow them up over time.

JENNY BROCKIE: Dave, tell us what you're doing in Canada about this and also what the US has done around junior football?

PROFESSOR DAVE ELLEMBERG: Yes. So actually in the USA right now all the states, have passed laws that actually have quite a bit of teeth with three elements. The first one is education. The law requires that all coaches, parents and kids be informed of concussions. The children, the parents, have to sign a consent form at the beginning of every season to make sure that they're aware of the consequences and aware of their role. The second part of this law indicates that as soon as there is a doubt, there is a suspicion that an athlete has been concussed he must be removed immediately from the game and third element is that he can only go back to the game once he is cleared by a doctor.

JENNY BROCKIE: Is there a danger of overreacting here? You know, kids have been playing football forever, is there a danger of overreacting and frightening people away from playing sport at the very time that we want our kids to be fit and we have problems with obesity and people aren't doing enough exercise?

PROFESSOR DAVE ELLEMBERG: Absolutely. We don't want to scare, and I see where you're going, of course we don't want to scare people away from sports. Quite to the contrary, we want to increase sport participation. But we just want to make sure that it's safe. But ultimately, we can't take our brains for granted.

JENNY BROCKIE: Does head gear help?

PROFESSOR DAVE ELLEMBERG: Head gear does not help. Head gear does not prevent concussions. Head gear does prevent more catastrophic injuries, that is - it will prevent the skull from being fractured but the concussion is an accident that happens within the skull.

JENNY BROCKIE: Michael Lipman, what eventually tipped you into retiring?

MICHAEL LIPMAN: You know, it's the constant living with the day in, day out of the symptoms constantly. Um, so the main factor was, you know, your inability to exercise. Every time you exercised your symptoms would escalate and you would just feel, you know, more and more nauseous and more feelings of just not right. So there was a time where I was - symptoms were really, really bad and then, you know, you wake up one day and you're like oh, you know, I feel good now and it's a very, very strange feeling. So that day I got on the treadmill and just started running and then I got off the treadmill and just went on the street and just started running. I ran about 15 K that day and just simply because I hadn't had that feeling for, you know, four or five months. My family and my sister and my mother were telling me to retire, so you weigh all that up and you think, what’s best for me now.

JENNY BROCKIE: Vicki, what would you like to see happen now? I mean as somebody who set up this clinic in a Melbourne hospital for kids with concussion, what do you think we should be doing in Australia?

PROFESSOR VICKI ANDERSON: We need to deal with the culture that, you know, you don't have to be tough to be cool and I think if you even look at the advertising around concussion and sport, often you're seen as a bit of a woos if you come off the ground and that really needs to change.

JENNY BROCKIE: And how do you weigh up the risk of kids playing sport, compared to the dangers of being inactive?

PROFESSOR VICKI ANDERSON: Oh, that's a really good question and I think, um, you know, there's medical issues around both of those. There's probably also some evidence around kids who aren't playing sport are more likely to be drinking heavily and taking drugs. So you know, there are some real advantages to sport in general that I think that we need to be careful not to throw the baby out with the bath water.

JENNY BROCKIE: Jackson, what would it take for you to stop playing footy? You want to play professional rugby league, don't you?

JACKSON WEIR: I know it's hard to say, it's been my dream since I was probably four years old. It would take a whole lot to stop me going on the field and playing the game that I love.

JENNY BROCKIE: And how do you feel after what you've heard tonight?

JACKSON WEIR: Um, it's scary to think that some of these, like these long term effects that can happen to you but also the stories of like it's not conclusive evidence as well.

JENNY BROCKIE: Will you be more careful do you think?

JACKSON WEIR: Yeah, I'm definitely going to take into consideration what they said, like taking a week off, two weeks off even, missing training that week after a concussion.

JENNY BROCKIE: What about missing a grand final?

JACKSON WEIR: Um, yeah, that's a different story, we'll see if it comes around.

JENNY BROCKIE: Nelson, what about you? How do you feel about what you've heard tonight?

NELSON REED-BANYARD: I understand it's important but I, I think that there's both sides to the argument and, um, it would take an incredible amount to stop me from playing.

JENNY BROCKIE: What about being more careful though when you get a hit, coming off?

NELSON REED-BANYARD: I'd, it depends on the circumstances.

JENNY BROCKIE: You're not going to do it, are you? You wouldn't want, every bone in your body is trying to tell me that you wouldn't want to come off still?

NELSON REED-BANYARD: Um, goal keeper is a crucial role on the soccer pitch. You're the only one. Say you're a defender, you can just put someone else there, but with the goal keeper you've got a specific set of skills and there aren't many people that like being goal keepers and"¦.

JENNY BROCKIE: And you're one of them?

NELSON REED-BANYARD: Yes.

JENNY BROCKIE: Thank you so much everybody for joining us tonight. It's been a really interesting conversation and special thanks to our guests too who have joined us from Montreal and from Melbourne, our thanks to you for your time tonight. And it is all we have time for here but we can keep talking on Twitter and Facebook, interested to hear what you think about the discussion here and what your experiences have been around kids' footy.