A CONCUSSION IS A TYPE OF TRAUMATIC BRAIN INJURY THAT  HAPPENS WHEN THE BRAIN IS JOLTED OR HIT.

SHORT AND LONG TERM EFFECTS CAN INCLUDE HEADACHES,  DIZZINESS AND MEMORY LOSS.

PLAYING SPORTS IS ONE OF THE  MOST COMMON WAYS A YOUNG PERSON CAN BECOME CONCUSSED.

AND WHILE THERE ARE RISKS, THERE ARE ALSO PROTOCOLS TO  PROTECT THE HEALTH OF ATHLETES.

TONIGHT’S LIVE  BROADCAST AND LIVE STREAM OF KAKOU, HAWAII’S TOWN HALL,  START NOW.

¶¶  ¶¶ >> YUNJI: ALOHA AND WELCOME  TO KAKOU: HAWAII’S TOWN HALL, LIVE FROM THE HARRY AND  JEANETTE WEINBERG MULTI‑MEDIA STUDIO.

I’M YUNJI DE NIES.

FROM THE VOLLEYBALL COURTS OF HILO, TO THE FOOTBALL FIELDS  OF HONOLULU, SPORTS ARE A CORNERSTONE OF OUR COMMUNITY,  BUT WHAT HAPPENS WHEN THE GAME TAKES A DANGEROUS TURN—WHEN  THE ATHLETES WHO BRING US PRIDE AND EXCITEMENT FACE AN  INJURY THAT COULD IMPACT THEM FOR LIFE?

CONCUSSIONS ARE A GROWING CONCERN ACROSS SPORTS AT ALL  LEVELS.

A CONCUSSION IS A BRAIN  INJURY, CAUSED BY A BLOW TO THE HEAD OR BODY, THAT CAN  DISRUPT NORMAL BRAIN FUNCTION.

IN 2012, HAWAII PASSED ACT 262, A LAW DESIGNED TO PROTECT  YOUNG ATHLETES FROM THE DANGERS OF CONCUSSIONS.

UNDER  THIS LAW, ANY ATHLETE BETWEEN THE AGES OF 11 AND 19,  SUSPECTED OF HAVING A CONCUSSION, MUST BE  IMMEDIATELY REMOVED FROM PLAY AND CANNOT RETURN UNTIL  CLEARED BY A MEDICAL PROFESSIONAL.

THIS LAW ALSO  MANDATES EDUCATION FOR COACHES, PARENTS, AND SCHOOL  STAFF TO HELP RECOGNIZE THE SIGNS OF A CONCUSSION AND  ENSURE SAFE PLAY.

>> YUNJI: CONCUSSIONS ARE  OFTEN INVISIBLE BUT CAN BE DEEPLY IMPACTFUL, WITH  LIFELONG CONSEQUENCES.

SO, ARE WE KEEPING OUR ATHLETES SAFE?

AND HOW CAN WE BUILD A STRONGER, MORE INFORMED  COMMUNITY WHEN IT COMES TO BRAIN INJURIES IN SPORTS?

THAT’S WHAT WE’RE DISCUSSING TONIGHT.

KAKOU  MEANS ALL OF US, AS IN – WE ARE ALL IN THIS TOGETHER.

CONCUSSIONS AFFECT NOT ONLY THE ATHLETES THEMSELVES, BUT  ALSO FAMILIES, COACHES, AND COMMUNITIES WHO SUPPORT THEM.

WE WANT TO HEAR FROM YOU IN OUR DISCUSSION.

YOU CAN EMAIL  OR CALL IN YOUR QUESTIONS.

WE’RE ALSO STREAMING LIVE AT  PBSHAWAII.ORG AND OUR YOUTUBE PAGE.

IN OUR TOWN HALL, WE HAVE ATHLETES, CONCUSSION  SURVIVORS, MEDICAL PROFESSIONALS, AND  ADVOCATES WORKING TO ENSURE THAT OUR ATHLETES CAN STAY  SAFE WHILE PURSUING THE SPORTS THEY LOVE.

SO, LET’S BEGIN.

DR. RACHEL COAL PEDIATRIC SPORTS MEDICINE  PHYSICIAN KAPIOLANI BONE AND JOINT CENTER.

CAN YOU TELL US MORE DEEPLY ABOUT  WHAT A CONCUSSION SAND HOW THAT   PRESENTS IN AN ATHLETE.

>> CONCUSSION TEMPORARY   BRAIN INJURY THOUGHT ACCUSE SENSE.

MEANING INITIALLY, WE HOPE AND EXPECT   THAT IT SHOULD BE SOMETHING THAT PASSES  FAIRLY QUICKLY WITHIN THREE FOUR WEEKS.

HOWEVER, THERE ARE SOME PEOPLE WHO WILL HAVE  LASTING SYMPTOMS AND NEED FURTHER TREATMENT.

THE CLASSIC IS A HEADACHE.

IT CAN BE DIZZINESS, LIGHT   OR NOISE SENSITIVITY, NAUSEA OR VOMITING.

THREE QUARTERS OF CONCUSSIONS DO HAVE LOSS   OF CONSCIOUSNESS, VAST MAJORITY DON'T COME  WITH GETTING KNOCKED OUTMENT THOSE THAT DO   TAKE A LITTLE BIT MORE SERIOUSLY.

>>Lauren: TYPICALLY HOW LONG DO   THESE SYMPTOMS TEND TO RESOLVE?

>> AVERAGE FOR ADOLESCENT 3 TO 4 WEEKS.

TELL MOST PATIENTS EXPECT TO  START FEELING BETTER WEEK OR TWO.

LAST UP TO FOUR WEEKS, WILL BE VERY NORMAL.

>>Lauren: BRITTNEY EVANS SPEECH LANGUAGE SCIENCE   AND DISORDER JOHNSON A BURNS SCHOOL OF MEDICINE.

WHAT KIND OF COGNITIVE CHANGES CAN HAPPEN IN   SOMEONE WHO SUFFERS CONCUSSION TYPICALLY SPEECH LANGUAGE PATHOLOGIST, WE WORK WITH   THE COGNITIVE SKILLS, MEMORY MIGHT HAVE TROUBLE  WITH THEIR ATTENTION, STAYING FOCUSED IN CLASS.

PROCESSING NEW INFORMATION.

WORD FINDING ISSUES.

SO THOSE ARE SOME THINGS WE CAN KIND OF  SUPPORT THEM WITH IN THEIR RETURN TO SCHOOL.

AND LEARNING AND THEIR DAILY LIFE.

>>Lauren: WHAT DOES THAT THERAPY,   HOW DO YOU DO THAT?

>> TYPICALLY,   IN THE EARLY INITIAL STAGES, STILL RECOVERING  REALLY FOCUSING ON COMPENSATORY STRATEGIES   AND PROVIDING THEM ACCOMMODATIONS BECAUSE WE  DON'T WANT TO OVERLOAD THE BRAIN TOO QUICKLY.

WE MIGHT GIVE THEM, BE ABLE TO WORK WITH  THE TEACHERS TO PROVIDE ACCOMMODATIONS FORD   CLASSROOM TO MAKE THEIR LEARNING MORE EASY  AFTERWARDS, CONTINUING TO HAVE SYMPTOMS,   COMPENSATORY STRATEGIES FOR DAILY YOU LIFE.

SO MAYBE LIKE UTILIZING PLANNER MORE,   HELP WITH THEIR MEMORY.

OR LIKE WRITING THINGS DOWN,   USING AIDS TO STAY MORE ORGANIZED.

WE KIND OF DEVELOPED THOSE GOALS BASED   ON WHERE THEIR SPECIFIC SYMPTOMS ARE.

COGNITIVE SYMPTOMS CAN BE SO BROAD.

TAYLOR TO EACH INDIVIDUAL STUDENT.

>>Lauren: DR. JENNIFER KING PEDIATRIC   SPORTS MEDICINE PHYSICIAN AT HAWAII  PACIFIC HEALTH BONE AND JOINT CENTER.

I'M INTERESTED TO KNOW IF THERE'S A  DIFFERENCE YOU SEE IN HOW CONCUSSIONS   AFFECT SOMEONE BASED ON AGE?

YOUNG CHILD ADOLESCENT ADULT.

>> WORSE TIME TO GET HE CONCUSSION  FRESHMAN YEAR IN HIGH SCHOOL.

SO MUCH TRANSITION HAPPENS AT THAT AGE.

REALLY DIFFICULT FOR THEM TO JUST   INTEGRATE BACK INTO SCHOOL.

BECAUSE IT'S ALL NEW TO THEM.

WE WITH TALK ABOUT IT'S REALLY YOUNG AGE GROUPS,  ELEMENTARY SCHOOL, WE FIND THAT THEY ACTUALLY DO   REALLY WELL BECAUSE THEY HAVE ONE TEACHER.

THEIR ONE TEACHER KNOWS THEM REALLY WELL   AND NATURALLY WILL ACCOMMODATE THEM EARLY  PHASE OF CONCUSSION UNTIL THEY RECOVER.

>>MIDDLE SCHOOL TRICKY, MULTIPLE TEACHERS  SOMETIMES TEACHERS DON'T QUITE KNOW YOU AS   WELL, BUT THEY ALSO HAVE SO MANY MORE  STUDENTS THAT THEY'RE TAKING CARE OF,   IT'S HARD TO REMEMBER BECAUSE THEY DON'T HAVE  A SIGN ON THEM THAT SAYS I HAVE A CONCUSSION.

THEN IN THE HIGH SCHOOL AGES, THERE'S A LOT  OF SOCIAL THINGS THAT WE'RE DEALING WITH AS   HIGH‑SCHOOLERS IN GENERAL.

AND THANK GOODNESS WE HAVE   SEGUED WAY FROM THE COCOON THERAPY.

STAY IN DARK ROOM UNTIL FEEL BETTER.

IF YOU'RE A TEENAGER DON'T WANT TO BE  ROOM WITH PARENTS 24‑7 ACTIVE MANAGEMENT,   HOPING HIGH‑SCHOOLER AND MIDDLE  SCHOOLER, RECOVERY WILL BE FASTER.

>>Lauren: CAN YOU TELL US ABOUT COCOON  THERAPY AND WHY THERE'S BEEN A TREND IN   THE OTHER DIRECTION?

>> ABSOLUTELY.

SO CONCUSSION PENDULUM HAS SWUNG WIDELY.

SO WHEN I WAS IN TRAIN BEING WE SANG KIDS   IN SAME DAY, AS LONG AS THEY COULD TELL US WHICH  END OF THE FIELD THEY WERE ONE RUNNING TO WANTED   TO PLAY.

SEND THEM BACK IN.

LONGTERM EFFECTS  WHEN YOU DON'T MANAGE A CONCUSSION, WE NEED   TO PROTECT THESE KIDS GET SYMPTOM‑FREE UNTIL WE  GET THEM BACK TO SCHOOL TANDEN ANY KIND ACTIVE.

REALIZED IT WAS TAKING LONGER FOR THEM TO RECOVER.

PARTIALLY BECAUSE THEY WEREN'T DOING THEIR   NORMAL THINGS.

LOTS OF FOMO,   WITH MIDDLE SCHOOL AND HIGH‑SCHOOLERS.

HUGE GAP IN GETTING THEM BACK TO SCHOOL.

THEN SO OF COURSE, EVERY FEW YEARS, NOW  CONCUSSION CONSENSUS STATEMENT THAT COMES OUT.

AND THE MOST RECENT ONE, BIGGEST TAKE  HOME POINT WAS EARLY RETURN TO ACTIVITY.

OBVIOUSLY NOT BACK TO FOOTBALL GAME.

BUT GOING OUT FOR WALKS, GOING TO THE   GROCERY STORE, DOING SOME LIGHT ACTIVITY AS  TOLERATED, SO IMPORTANT IN THEIR RECOVERY.

>>Lauren: SEVERAL PEOPLE ON PANEL TONIGHT.

HAVE EXPERIENCED CONCUSSION.

DR. JAMIE HIGA SCHOOL CLINICAL PSYCHOLOGIST  EXPERIENCED MULTIPLE CONCUSSIONS COLLEGE   BASKETBALL PLAYER.

CAN YOU TELL US ABOUT YOUR  INJURIES AND WHAT IS HAPPENED IN THE TIME SINCE?

>> SURE.

YES.

SPEAKING OF COCOON THERAPY, THAT  WAS MY ERA OF CONCUSSION MANAGEMENT.

SO MY INJURY WAS IN 2011.

PLAYING BASKETBALL.

AND AT THAT TIME, IT WAS STAY IN  THE DARK ROOM UNTIL YOU GET BETTER.

I THINK WE WERE ALL JUST DOING  WHAT WE KNEW BEST AT THE TIME.

SO EVEN THAT'S BASKETBALL PRACTICE I WAS STILL  PARTICIPATING IN DRILLS AN WHICH IS NOT CONDUCIVE   TO POSITIVE RECOVERY.

BUT SINCE THEN, YOU  HAVE GRADUATED COLLEGE AND WENT TO GRAD SCHOOL   TO BECOME A PSYCHOLOGIST.

DID MY TRAINING IN COLORADO.

RECENTLY MOVED BACK HOME.

>>Lauren: WHO YOU WERE INJURED   IN THAT COCOON THERAPY ENVIRONMENT,  HOW LONG DID IT TAKE YOU TO RECOVER?

>> THAT'S A TRICKY QUESTION.

I SAY THAT IT'S TRICKY BECAUSE I DON'T   KNOW THAT I'VE EVER MADE 100% RECOVERY.

AND SO IT'S HARD TO GIVE US   SPECIFIC TIME FRAME ON THAT.

>>Lauren: CASEY WONG PHYSICAL THERAPY   SUFFERED SEVERAL CONCUSSION PLAYING SOCCER.

>> HARDEST TIME TO GET A CONCUSSION IS   WHEN YOU'RE A FRESHMAN IN HIGH‑SCHOOLER.

WHEN I GOT MY FIRST TWO RECOVERY REALLY ROUGH.

WHOLE YEAR LENGTH'S TIME.

OF PROGRESSING FORWARD AND   BACKWARD AND FORWARD AND BACKWARD.

I WAS IN AN ERA A LITTLE BIT   OF THE COCOON THERAPY.

RETURN TO PLAYING ABLE   TO GO BACK INTO MY SPORT AND HAVING THAT  EXPOSURE GETTING BACK OUT THERE SLOWLY.

REALLY SLOW RECOVERY BECAUSE YOU HIGHWAY  AT LOT OF SYMPTOMS WITH MY CONCUSSION.

I HAD EVERY ONE THAT YOU COULD PROBABLY LIST  ON THE BOOKS INCLUDED HEADACHES, DIZZINESS AND   I HAD LOSS OF CONSCIOUSNESS MY FIRST ONE.

AND I HAD THE DOUBLE VISION.

THAT TOOK LONGEST FOR ME TO RECOVER.

SPENT A LOT OF TIME PHYSICAL THERAPY ONE YEAR.

SHAPED WAY WANT TO DO WITH MY LIFE.

WRITING IN FRESHMAN YEAR OF CLASS,   WORE DO YOU SEE YOURSELF IN TEN YEARS?

SEE MYSELF PHYSICAL THERAPY TEN YEARS   HELPING OTHER PEOPLE THE WAY MAY  PHYSICAL THERAPIST HELPED ME.

>>Lauren: HERE YOU ARE.

AS YOU ARE HELPING NOW,   PATIENTS WHO ARE GOING THROUGH THOSE SAME THINGS.

WHAT KIND OF PHYSICAL THERAPY CAN BE EMPLOYED   TO HELP PEOPLE RECOVER FASTER?

>> I THINK SOMETHING THAT I VALUE   IN PHYSICAL THERAPY IS AS WELL AS WHAT I VALUED  WHAT I WAS WAS A PATIENT BEING THERE FOR YOUR   PATIENT EMOTIONALLY AND PHYSICALLY.

IMPORTANT FOR THEIR RECOVERY TO BE   ABLE TO RECOVERY LISTEN WHAT THEY HAVE TO SAY,  CONSTRUCT THEIR PLAN OF CARE WANT TO BE HOLISTIC   PHYSICAL THERAPY NOT FOCUS JUST PROBLEMS WHAT'S  IN FRONT OF ME VERY LIKE I DON'T KNOW THOU SAY IT,   BUT VERY STEP‑WISE PROGRESSION SOMETHING  THAT MATCHES HOW THEY'RE PROGRESSION.

SOMETHING SIMILAR TO MY CASE AS WELL.

>>Lauren: THANK YOU.

SOPHOMORE KEALAKEHE HIGH SCHOOL  HAWAII ISLAND CHEERLEADER.

YOU SUFFERED CONCUSSIONS.

WHAT HAPPENED AND HOW IT'S BEEN SINCE?

YEAH.

I GOT A CONCUSSION LIKE BACK IN AUGUST.

SO SIX MONTHS AGO, FROM CHEERLEADING.

BASE FLYER CAME DOWN AND ELBOWED ME IN THE HEAD.

FINE 24 HOURS.

DOESN'T GET SYMPTOMS UNTIL FIRST DAY OF PRACTICE.

I COULDN'T REALLY SEE.

COULDN'T REMEMBER MUCH OF IT.

EVERYTHING WAS BLURRY GETTING LIGHT‑HEADED DIDN'T  REEL REEL OF WHAT WAS HAPPENING.

TOOK A DAY   THE TRAINERS CALLED ME DOWN DURING SCHOOL  DID A EXAM TEST THING APPARENTLY I FAILED IT   REALLY BAD AN THOUGHT I WAS DOING WELL.

TOUGH JOURNEY IN AND OUT OF SCHOOL,   STAYING HOME, RESTING, STILL BATTLING SYMPTOMS.

AND IT'S BEEN QUITE A WHILE SO IT'S TOUGH.

>>Lauren: YEAH.

HOW WERE YOU ABLE TO MANAGE THAT AND   WHAT KIND OF THERAPIES ARE YOU DOING FOR THAT?

>> I TRIED TO MANAGE IT BY LIKE JUST TAKING   THE TIME TO REST WHAT I DON'T FEEL WELL, DOING AS  MUCH SCHOOLWORK I CAN WITHOUT OVERWHELMING MYSELF.

TRY TO DO SOME EYE ACTIVITIES AND MEMORY  GAMES THAT MY TRAINER HAS PROVIDE ME WITH.

AND MY MOM LIKES TO PLAY WITH ME.

SO IT CAN HELP IMPROVE MY MEMORY   AND TRY TO GET MY BRAIN BACK TO NORMAL.

>>Lauren: THANK YOU FOR SHARING THAT.

WE'RE TALKING TO YOU PERSON EXPERIENCED CONCUSSION  REEL RELATIVELY RECENTLY SOMEONED ONE LONG TIME.

RICH MIANO FORMER DEFENSIVE BACK.

KNOW VERY WELL PLAYED FOR SEASONS   THREE TEAMS IN FOOTBALL TEAM.

SPORTS COMMENTATOR.

HIGHEST LEVEL.

EXPERIENCED  ONE CONCUSSION IN THE NFL.

TELL US ABOUT YOUR EXPERIENCE, A LOT OLDER  THAN SOME OF THE PREVIOUS PEOPLE ON THIS PANEL.

NFL DURING MY INITIAL DAYS EVEN BACK KAISER HIGH  SCHOOL IN 1980, THROUGH THE UNIVERSITY OF HAWAII,   THROUGH FIVE YEARS THERE, TO 1985, NATIONAL  FOOTBALL LEAGUE FOR 11 SEASONS THROUGH '96,   SEEN INCREDIBLE IMPROVEMENTS IN TERMS OF  PROTECTION IN TERMS OF HELMETS, PROTECTION   IN TERMS OF HAVE TWO A DAY PRACTICES ANY MORE.

DON'T HAVE HITTING DRILLS WE USED TO HAVE.

ALL KINDS OF CHANGES ALL THOSE  OTHER THINGS BACK IN THE DAY.

WE JUST WE HIT EACH OTHER WITH OUR  HEADS ON CONTINUE BASIS AND THEREFORE,   CONCUSSION SOMETHING WE DIDN'T REALLY TALK ABOUT  DIDN'T REALLY WANT TO, ADMIT WE HAD SOMETHING THAT   NATURE PLAYING SPORT LIKE FOOTBALL.

COLLISION SPORT.

SO MUCH MORE EDUCATION AMONGST COACHES  PARTICIPANTS, AMONGST TRAINERS AND WE ARE SO   BLESSED STATE OF HAWAII TO HAVE PROBABLY THE BEST  IN TERMS OF TRAINING STAFF IN TERMS OF PROTOCOLS,   PROCEDURES, THEIR UNDERSTANDING AND KNOWLEDGE  WE HAVE HOW SERIOUS CONCUSSIONS ARE, THAT'S   TREMENDOUS TO SEE PROGRESSION THROUGHOUT THE  DECADES WHERE HE ARE NOW COMPARED TO WHERE   WE WERE THE 80s AND 90s.

TWENTY‑FIRST CENTURY.

IT'S ENCOURAGE ME TO BE PART OF THIS PANEL  BECAUSE I REALLY FEEL BLESSED TO BE PART OF   A STATE THAT CARES SO MUCH ABOUT THE YOUNG  ATHLETES AND IT'S COME A LONG, LONG WAY.

AND WE SHOULD BE VERY ENCOURAGED BY THE CONTINUED  EDUCATION THAT WE HAVE NEITHER STATE OF HAWAII.

>>Lauren: WHAT YOU'RE TALKING  ABOUT, WHAT I'M HEARING YOU SAY,   REALLY CULTURE SHIFT IN THE SPORT.

CAN YOU TELL ME ABOUT WHAT YOUR   UNDERSTANDING OF HEAD INJURIES AS A PLAYER, WHEN  YOU FIRST STARTED, AND NOW, WHERE YOU'VE COME,   AND HOW THAT'S CHANGED.

>> LITERALLY YOU IF GOT HIT HARD,   THERE WASN'T SOMEBODY IN THE BOX LOOKING.

THERE WASN'T SOMEBODY ON SIDELINE DOCTORS.

YOU HAD YOUR TRAINING STAFF.

WHATEVER AWARE OF THE VIOLENCE   OF THIS GAME THAT WE PLAY.

BUT NOBODY REALLY CARED.

THEY JUST WANTED TO MAKE SURE THAT YOU  COULD LINE UP AND PLAY THE NEXT SNAP.

DIDN'T CARE ABOUT YOUR SHORT  TERM HEALTH OR LONGTERM HEALTH.

I'VE BEEN BLESSED, GO TO GAMES FLORIDA,  TO BOSTON UNIVERSITY, TO SAN JOSE,   PSYCHOLOGISTS, THIS WHOLE CTE EDUCATION  WE'VE LEARNED, FROM THE LAWSUIT, LITIGATION,   HAS REALLY INCREASED KNOWLEDGE AND UNDERSTANDING.

AND SO IT'S LIKE I SAID EARLIER, COME SO FAR AND   IT'S SUCH A POSITIVE IT THING.

EVEN ITERATIONS OF FIELD TURF,   BECOMING SOFTER AND MORE LIKE NATURAL GRASS.

I WAS UNFORTUNATE TO PLAY AT THE UNIVERSITY OF   HAWAII IN TERMS OF COOK FIELD AT THE TIME.

THEN AT THE NEW YORK JETS IN ATLANTA   FALCONS PHILADELPHIA EAGLES.

PLAYED ON ASTROTURF NOT FIELD   TURF A LOT OF INJURIES HAD BECAUSE YOU'RE  HITTING YOUR HEAD ON THE SURFACE AS WELL   INJURIES HAPPEN WITH THE CONTINUAL CONTACT  TYPE OF SPORT THAT WE'RE INVOLVED IN.

SO VERY PLEASED IN THE DIRECTION AND  THE KNOWLEDGE AND THE UNDERSTANDING.

>>Lauren: IT IS SUCH A  DIFFERENCE YOU'RE DESCRIBING.

ONE OF THE PEOPLE FRONT LINES OF THAT IS BRENT  MORIKAMI COACHES GIRL'S SOCCER AND HAWAII RUSH.

WHAT ARE YOU STEPS YOU TAKE TO MAKE SURE  YOUR PLAYERS ARE STAYING SAFE NOT HAVING   A CULTURE ABOUT WHAT RICH WAS JUST TALKING ABOUT?

>> THINK WE'RE FORTUNATE JUST EDUCATIONAL PIECE.

OUR PLAYERS AND PARENTS ARE WELL  AWARE OF CONCUSSIONS HAPPENING NOW.

TOUGH PART TO BE HONEST ON THE SOCCER SIDE  OF THINGS THAT HEADING THE BALL IS BIG   FACTOR SOCCER COLLISIONS.

THERE'S NO PROTECTION.

BUT THEN HEADING OF THE BALL.

WHEN WE SEE A LOT OF ESPECIALLY ON GIRLS TSI,   GETTING CONCUSSIONS BECAUSE OF THAT.

AND SO SOCCER HAS DONE IS THEY'VE ELEVATED   AGE IN WHICH KIDS CAN START HEADING BALL.

WHICH ACTUALLY I FEEL LIKE MAKES IT A LITTLE   TOUGHER FOR THEM TO START PRACTICING  HEADING THE BALL AT OLDER AGE.

SO SCARED OF IT OR WASN'T PART  OF THE GAME AT A YOUNGER IT AGE.

SO AS WE SEE PLAYERS AT OLDER AGE ABLE TO HEAD  THE BALL, GETTING THEM USED TO THAT AND FEELING   CONFIDENT DO THAT WITHOUT GETTING INJURED.

>>Lauren: IS THERE A SAFE WAY TO DO THAT?

DO YOU THINK?

>> THINK HAS TO BE PART OF THEIR TRAINING.

JUST SOMETHING THAT IS IMPLEMENTED IN THE GAME  AND PLAYER IS NOT BEING ABLE TO HEAD IT CORRECTLY.

THAT TECHNIQUE CORRECTLY  HAS TO BE PART OF PRACTICE.

THEN AGAIN THAT BALANCE OF DOING IT TOO MUCH,  BUT DOING IT SO THAT THE PLAYERS ARE COMFORTABLE   WITH IT AND USING THE RIGHT TECHNIQUE.

>>Lauren: RICH DID MENTION THAT WE ARE ONE   OF THE STATES WITH STRICTEST STANDARDS  ONE OF THE PEOPLE AHEAD OF NATHAN.

CONCUSSION MANAGEMENT PROGRAM.

DEAN OF UNIVERSITY OF HAWAII   AT MANOA COLLEGE EDUCATION.

TALK ABOUT PROTECTIVE GEAR.

SHOW US TWO HELMETS YOU HAVE AND THE  KIND OF DIFFERENCE THAT CAN MAKE?

>> WELL, THE HELMET TECHNOLOGY  HAS CLEARED CHANGED OVER DECADE.

HIGH END VARSITY HELMET  THAT WAS USED RECENTLY USED.

YOU CAN TELL RECENTLY USED.

THE BASEBALL HELMET HERE IS   ALSO WELL USED.

PADDING IN HERE IS WHAT IS THE  CUSHION IN HERE THAT WILL PROVIDE YOU IMPACT   TO ABSORB SOME OF THE IMPACTS THAT OCCUR.

THIS PARTICULAR HELMET HERE FOR EXAMPLE,   WE USE THIS HELMET IN ONE OF OUR STUDIES HERE  AT UNIVERSITY OF HAWAII CALLED HOT 808 STUDY.

SENSORS IN THIS HELMET, THAT ACTUALLY MONITORS  THE AMOUNT OF IMPACT FROM AND POINT WAS CONTACT   ON YOUR HELMET PROVIDES REAL TIME DATA  WITH THE PLAYERS PLAYING IMPACTS OCCUR.

TRAINING STATE REQUIRES ATHLETIC TRAINERS IF  OUR SCHOOLS BIG THINGS FOR THE STATE AND FOR   THE COUNTRY, AND SO THIS ALLOWS US TO HAVE  REAL TIME DATA TO MONITOR TYPES OF IMPACTS   THAT THE PLAYER HAVE AT VARIOUS POSITION.

TECHNOLOGY CHANGED REAL TIME IMPACTS CAN BE   MONITORED ALMOST IMMEDIATELY FOR THE IMMEDIATE  REMOVAL OF THE PLAYER EVEN AT PRACTICE.

SO THIS VERY HIGH TECH STUFF.

>>Lauren: THIS KIND OF GEAR CAN'T CHEAP.

TO DO ALL STUDENT ATHLETES HAVE ACCESS TO THIS.

>> NO.

IT'S NOT CHEAP.

WE WERE VERY BLESSED TO HAVE   THE GOG FOUNDATION SUPPORT PURCHASING OF  THIS HELMET ACROSS THREE DIFFERENT SCHOOLS.

WHAT WE FOUND IS THAT IF YOU WERE THE  MONITORING OF HIT, IMPACTS, AND THE ACTUAL   RETRAINING OF THE WAY YOU TACKLE, OR BLOCK,  WILL CLEARLY DECREASE THE AMOUNT OF IMPACTS   THAT THE PLAYER WOULD EXPERIENCE.

OVER THE COURSE OF A SEASON.

SO WE ARE ABLE TO DO THAT.

COMES DOWN TO TRAINING.

COMES DOWN TO EDUCATION AND COMES DOWN TO KNOWING  SCIENCE OF HOW TO TACKLE AND HOW TO BLOCK AND   ALL OF THOSE THINGS THAT CAN PROTECT YOURSELF.

FROM INJURY.

FUTURE INJURY.

>>Lauren: INTERESTING,   ALREADY JUST EARLY ON IN OUR DISCUSSION,  WE HAVE EXPLORED HOW IT'S NUMBER OF SPORTS.

IT'S NOT JUST FOOTBALL AS  PEOPLE MAY TRADITIONALLY THINK.

HEARD ABOUT CHEERLEADER, SOCCER, BASKETBALL.

VIDEO SHOWS OTHER SPORTS YOU CAN HAVE INJURY.

STARTS WITH FOOTBALL OTHER SPORTS IN THIS VIDEO.

WHERE DO YOU TYPICALLY THESE INJURIES HAPPENING.

>> BIGGER SPORTS IN HAWAII BESIDE FOOTBALL, JUDO.

SURPRISE A LOT OF PEOPLE.

SEE THAT FINE DETAIL   NOVICE JUDO ATHLETES WHO ARE NEW TO THE SPORT,  EXCITED TO PARTICIPATE MAY NOT KNOW HOW TO LAND   PROPERLY PROTECT THEIR HEAD AND NECK AREA  ANOTHER SPORT WE SEE A LOT OF CHEERLEADING.

A LOT OF PEOPLE DON'T THINK OF THAT THAT  WE CAN SPEAK TO THAT HERE DIRECTLY TONIGHT,   BUT IN ADDITION, AGAIN, IT'S OFF OFF SURPRISING  FLYING IN THE AIR, BASES OR CATCHING.

SOMETIMES TUMBLING HAPPENS, MISSED THE LANDING.

SEEN IN ALL SPORTS.

SWIMMERS WHO MISREAD FLAGS HIT THE WALL.

SEEN GOLFER HIT BY A CLUB THAT WAS THROWN   ACCIDENTALLY BY SOMEBODY ELSE.

SO ACCIDENTS CAN HAPPEN ANY SPORT.

AND WE ALWAYS TELL OUR PATIENTS TO VALIDATE  THOSE SYMPTOMS AND MAKE SURE THAT THEY CONNECT   WITH THEIR ATHLETIC TRAINER OR THEIR COACH,  HAVE ADULT CHECK THEM OUT, DON'T GO BACK IN   UNTIL YOU KNOW FOR SURE YOU'RE SAFE.

>>Lauren: DR. KING, STRUCK ME IS THAT   SHE WASN'T REALLY AWARE THAT THIS HAD  HAPPENED TO HER UNTIL THE NEXT DAY.

HOW COMMON THAT?

>> IT'S PRETTY COMMON.

WE ACTUALLY CALL IT THE MONDAY MORNING CONCUSSION.

TAKE FOOTBALL FOR INSTANCE, BECAUSE THE VOLUME IS   HIGH, SOMETIMES YOU'LL SUSTAIN  A CONCUSSION FRIDAY NIGHT.

PLAYING FOOTBALL.

BUT THEN YOU KIND OF   CRUISE THROUGH THE WEEKEND AND SLEEP, EAT AND  KIND OF REST.

THEN YOU GO BACK TO SCHOOL MONDAY   MORNING AND YOU HAVE A KILLER HEADACHE.

BECAUSE NOW YOU HAVE TO USE YOUR BRAIN.

NOT UNCOMMON.

I WOULD IMAGINE HAD A CHILL NIGHT AFTER PRACTICE.

HAD TO DO SOMETHING COGNITIVE  GAVE HER THE SYMPTOMS.

>>Lauren: WHAT THAT WAS CONVERSATION LIKE?

HARD TO REMEMBER IN THE MOMENT.

REALIZED THIS HAD HAPPEN TO  DO YOU, WOULD YOU SURPRISED?

I WAS REALLY SURPRISED.

MOM CALLED ME RIGHT AFTER  CLASS, CAN YOU GO DOWN TO THE TRAINERS, PLEASE?

I THINK YOU MIGHT HAVE A CONCUSSION.

NO WAY.

I HAVE A CONCUSSION.

I'M FINE.

I DON'T FEEL ANYTHING WRONG.

FEELING A LITTLE SICK.

WENT DOWN AND DID ALL OF THESE TESTS  TOLD ME, HOW I FAILED ALL OF THESE   TESTS, THAT KIND OF MAKES SENSE NOW.

>>Lauren: NATHAN TALK ABOUT THOSE PROTOCOLS.

IF WE HAVE THAT HAPPENING, THAT FAR  LATER, WE ARE COACHES AND TEACHERS,   TRAINERS, TEACHERS TRAINED TO LOOK FOR.

>> TYPICALLY ARE THEY HOPEFULLY DURING THE   SCHOOL, PRACTICE DURING THE DAY.

SO HOPEFULLY, THEY ARE WILL BE   ABLE TO SEE IT ACTUALLY OCCURRINGER.

THAT'S WHERE EDUCATION FOR THE COACH   AND OTHER SUPPORT PERSONNEL THAT ARE THERE  EVEN YOUR OWN TEAMMATE, TO MONITOR AND TO   ACKNOWLEDGE AND TO RECOGNIZE THAT THERE  IS A, MAY BE PROBLEM HERE, TO REPORT IT.

PART OF THE CHALLENGE FOR SOME OF  OUR YOUNG PLAYERS IN HIGH SCHOOL   NOT WANTING TO REPORT THEIR CONCUSSIONS.

I THINK THAT HAS TO SLOWLY GARNERED SOME   ATTENTION.

RECENTLY.

FOR JUST TO PROTECT YOUR OWN TEAMMATE AND PLAYER.

YOUR PLAYERS TO AT LEAST REPORT IT AND   KNOWING VERY WELL THAT CHANCE OF THEM  RETURNING RIGHT AWAY WILL NOT HAPPEN.

AND THERE'S A LOT AT STAKE  FOR SOME OF THESE PLAYERS.

THAT ARE PLAYING HIGH SCHOOL ATHLETICS.

SO WE RECOGNIZE THAT.

WE TRY TO EDUCATE THEM.

TO MAKE SURE THAT QUICKER YOU REPORT IT,   QUICKER YOU CAN GET BACK INTO SOME KIND OF  PROTOCOL WHICH COULD VARY DEPENDING ON YOUR AGE.

AND DEPENDING SEVERITY ACTUAL IMPACT GET  BACK TO SCHOOL AND PLAY AS SOON AS POSSIBLE.

>>Lauren: TALK A LITTLE BIT ABOUT THAT TENSION.

YOU HAVE WORKED AS A COACH.

ABOUT MAKE SURE THE PLAYERS   ARE REPORTING THEIR SYMPTOMS.

BECAUSE MAYBE THEY REALLY WANT   TO GO BACK THE PLAY THE NEXT GAME.

>> COACHES THEY WANT TO WIN SO BAD,   SO MUCH INVESTED INTO BECOMING  SUCCESSFUL AT THE COLLEGE LEVEL.

MILLIONS OF DOLLARS.

HIGH SCHOOL LEVEL, PRIDE TO WIN.

BEING A COACH, WANTING TO REPORT A CONCUSSION  WHEN YOU KNOW NOT ONLY GOING TO LOSE THAT PLAYER,   FOR THIS POTENTIALLY REST OF THIS GAME COULD BE  SOME OF THE DOCTORS ALLUDED TO COULD BE A MONTH.

LONGER THAN THAT.

PROBABLY SOME HESITATION AND   TREPIDATION REGARDING REPORTING CONCUSSIONS  JUST BECAUSE YOU DON'T WANT TO LOSE THAT PLAYER.

I THINK MOST OF THE MOST OF US COACHED IN  THIS STATE AND HAVE GOT EDUCATION ON THE   SERIOUSNESS AND KNOW THE LONGTERM EFFECTS OF CTE  OR ANYTHING ELSE, ALZHEIMER’S DEMENTIA BASED UPON   COLLISION SPORT, IT IS BEST TO REPORT THAT  AND YOU MAY SUFFER THE CONSEQUENCES OF   LOSING THAT PARTICULAR ATHLETE, BUT IT'S MORE  IMPORTANT FOR THAT PERSON'S LONG TIME HEALTH.

>>Lauren: DID YOU FEEL PRESSURE  TO GO BACK INTO THE SPORT.

YOU HAD SEVERAL CONCUSSION.

DO GO BACK TO GAME PLAY.

DID YOU FEEL THAT TENSION.

>> I WOULD SAY YES BECAUSE I GOT MY SECOND   CONCUSSION PRETTY CLOSE TO MY FIRST CONCUSSION.

THAT WOULD BE DUE TO ATHLETIC TRAINER HAVING ME   PROGRESS PROTOCOL A LITTLE BIT TOO QUICKLY.

AND SO IMPACT OF RETURNING TO PLAY   BECAUSE I WAS ACTUALLY GOALKEEPER.

I NEVER HEADED BALL ONCE IN MY LIFE.

STILL GOT A CONCUSSION.

AND SO IMPACT OF JUST HITTING GROUND FROM DIVING,   THAT RESULTED IN MY SECOND CONCUSSION.

THAT'S WHY THE PROCESS OF RECOVERING FROM   THAT TOOK SO LONG OF THE TIME FRAME  BETWEEN THE FIRST AND SECOND ONE.

>>Lauren: HAVING SUFFERED TWO IN  A ROW, WHAT IS THAT DOES THAT DO   TO HAVE THEM BACK‑TO‑BACK LIKE THAT?

IMPACT OF THE SECOND ON THE FIRST?

>> YOU KNOW, I DON'T KNOW IF I WOULD  KNOW A DIFFERENCE BETWEEN MY EXPERIENCE   AND SOMEBODY ELSE'S EXPERIENCE.

>> COMPARING EXPERIENCES IS HARD.

EVERYONE MIGHT HAVE DIFFERENT SYMPTOM OR FEELING.

DEFINITELY, I FELT A LOT SICKER AND FELT A LOT   WORSE HAVING THE SECOND ONE I HAD TO GO  THROUGH A LOT OF PHYSICAL THERAPY TO HELP   WITH THE VESTIBULAR ASPECTS.

DIDN'T HAVE THAT INITIALLY.

ASPECT.

HAD BALANCE ISSUES AND THAT DOUBLE   VISION THAT WAS TALKED ABOUT BEFORE.

REALLY HAD AN IMPACT.

>>Lauren: TELL US ABOUT THE IMPACT  HAVING CONCUSSION CLOSE TO THE ONE.

SECOND ONE AFTER INITIAL ONE.

>> QUITE A BIT OF RESEARCH SO TO   SHOW EFFECTS ADDITIVE.

IF YOU HAVEN'T QUITE FULLY   RECOVERED FROM FIRST ONE, HAVE I SECOND ONE,  DID RECENTLY RECOVER ONLY BEEN A FEW WEEKS,   IMPACT OF THAT SECOND ONE NOT JUST PHYSICALLY  ON THE BRAIN, WAY THOSE BRAIN CELLS FUNCTION,   CAN BE MUCH MORE SEVERE SECOND TIME AROUND.

SO TYPICALLY, IN OUR PROTOCOLS.

IF WE SEE SOMEBODY HAVE A CONCUSSION COME BACK  TO SEE US SHORTLY THEREAFTER, MONTH OR TWO LATER   WITH ANOTHER CONCUSSION, WE'RE GOING TO TAKE  RETURN TO PLAY PROTOCOL MUCH SLOWER AND REALLY   TAKE MORE TIME TO MAKE SURE THEY'RE REALLY WELL.

OFTEN HOLD ATHLETES, FROM THAT PARTICULAR   CONTACT SPORT EVEN SIX MONTHS OR A YEAR  IF THEY'VE HAD A SERIES OF CONCUSSIONSED.

THREE IN ONE CALENDAR YEAR, HOW MANY IS TOO MANY?

DON'T HAVE THE ANSWER.

BUT WE KNOW THAT THERE'S A PATTERN  SHOWN THERE BODY NEEDS A REST.

>>Lauren: STAKE HOLDERS FAMILY TEAM AND FAMILIES.

WE ARE THOSE CONVERSATIONS LIKE WITH PARENT?

PARENTS WANTS TO PUSH THEIR  KID IN PLAY OR TAKE THEM OUT?

HOW DO YOU NEGOTIATE THAT PART?

>> I THINK WE ARE WELL‑SUPPORTED   HIGH SCHOOL LEVEL.

WITH ATHLETIC   TRAINERS AND PROBABLY A LOT MORE STRICT.

AT LEAST CONSCIOUS ABOUT PLAYERS WITH CONCUSSIONS.

AS COACHES WE'RE WELL AWARE AND EDUCATED AS FAR  AS CONCUSSIONS BEING VERY PREVALENT AND I THINK   WE HAVE TO ADVOCATE FOR THE PLAYERS AS WELL.

LIKE WHAT THE OVER SAID ON THIS PANEL.

OTHER SAID ON THIS PANEL.

MAKE SURE THEY'RE HEALED FULLY, RETURN   TO PLAY HAPPEN FASTER A LOT OF TIMES PLAYERS THAT  NEED TO TRAVEL, PLAYERS CHAMPIONSHIP, TOURNAMENTS,   AND THEM PLUS SOME OF THE PRESSURE FROM THE  PARENTS, WANTING TO GET THEM BACK IN THERE.

AND THEN YOU'VE GOT PARENTS  THAT ARE A LOT MORE CAUTIOUS.

AND DON'T WANT SON OR DAUGHTER TO RETURN TO PLAY.

VERY QUICKLY.

FOLLOWING PROTOCOLS.

GOT BOTH WAYS.

BUT AS COACHES, JUST TRYING TO FIND THAT MIDDLE  GROUND AND LOOK TO EXPERTS LIKE THE DOCTORS   TO ADVISE WHAT TO DO NEXT AND THEN AS COACHES,  JUST NEED TO IMPLEMENT RETURN TO PLAY PROCESS.

PROTOCOL.

>>Lauren:   WE ASKED ABOUT YOUR PERSONAL EXPERIENCE,  YOU'RE ALSO A PSYCHOLOGIST WHAT ARE SOME OF   THE MENTAL HEALTH IMPACTS OF THESE?

TALKED A LOT ABOUT THE PHYSICAL   CHALLENGES THAT CAN RESULT OF THIS.

BUT WHAT ARE SOME OF THE SORT OF   MENTAL HEALTH ISSUES THAT CAN COME UP.

>> SO WE DO SEE, ESPECIALLY WITH REPEATED   CONCUSSIONS, THREE OR MORE CONCUSSIONS INCREASED  RISK FOR ANXIETY, MODERATE TO SEVERE DEPRESSION,   AND THEN ALSO, TO ENGAGE IN SELF‑HARM BEHAVIOR.

ADDITIONALLY, IF YOU HAVE A PRE‑EXISTING MENTAL   HEALTH CONCERN BASELINE, SO ANXIETY OR DEPRESSION  BASELINE, THAT CAN CONTRIBUTE TO LONGER RECOVERY.

>>Lauren: DO WE KNOW WHY THAT IS IT?

>> I DON'T NECESSARILY KNOW IF WE DO.

I WOULD LOVE TO HEAR DR. KING  OR DR. KOHL'S THOUGHTS ON THAT.

I THINK PART OF THE CONCEPT WOULD BE AGAIN,  CONCUSSION BY DEFINITION IS CELLULAR INJURY.

INJURY.

CHEMICALS.

SO TO SPEAK IN THE BRAIN.

ANYTHING THAT ALREADY TAXES THE BRAIN CHEMISTRY,  ADHD, ANXIETY, DEPRESSION, CAR SICKNESS EVEN,   THINGS THAT WORK THAT BRAIN HARDER AT BASELINE.

PUT A CONCUSSION ON TOP OF THAT, CHALLENGE THOSE   CHEMICALS MORE.

GENERAL THEORY.

>>Lauren: UNDERGOING THROUGH THE SYMPTOMS,  CASEY WAS JUST SHARING, ABOUT BEING DIZZY   OR DOUBLE VISION, OR FEELING LIKE YOU CAN'T FINE  THE WORDS BRITTNEY WAS SHARING WITH US EARLIER,   ALL OF THAT HAS TO BE PRETTY FRUSTRATING.

STAND TO REASON THAT YOU WOULD MAYBE GET DEPRESSED   ABOUT THAT OR ABOUT THE PACE OF RECOVERY.

>> YEAH ABSOLUTELY.

WE DO CALL CONCUSSION GREAT MAGNIFIER.

WHATEVER IS THERE, GETS MAGNIFIED GREATLY.

AFTER CONCUSSION ANY INJURY, ESPECIALLY  WITH TEENAGERS NOT RECOVERED BY FOUR WEEKS.

GOING TO BE ANXIOUS AND DEPRESSED.

WORRIED ABOUT THE TEENAGE NOT.

TYPICALLY WHAT WE WOULD SEE TALK ABOUT  ACL INJURIES, CONCUSSION ACROSS THE GAMUT.

WE KNOW GET TO DO THAT FOUR WEEK MARK,  IF WE'RE NOT DOING ACTIVITY MANAGEMENT   OF WHATEVER THAT INJURY IS, THEY'RE  GOING TO GET ANXIOUS AND DEPRESSED.

>>Lauren: HOW LONG CAN KA THAT LAST.

>> UNTIL YOU GET THEM HELP.

EITHER GET RECOVERY, A LOT OF ANXIETY  AND DEPRESSION WILL FOLLOW THAT RECOVERY.

ACL INJURY, SET TIMELINE TO RETURN.

IMPLEMENT BEHAVIORAL HEALTH TACTICS   OR PLUGGED INTO ADULT.

>>Councilmember Waters:   TELL ABOUT YOUR EXPERIENCE.

>>Lauren: TELL US ABOUT YOUR EXPERIENCE WHAT   THIS IS HAS BEEN LIKE PHYSICAL LEVEL BUT ALSO  MANY OF THE FRUSTRATIONS YOU MIGHT BE FEELING.

>> PHYSICAL LEVEL, IT'S KIND OF HARD  BATTLING SYMPTOMS LIKE EVERY DAY.

AND LIKE SCHOOLWORK IT'S LIKE  BREAKS YOU DOWN A LITTLE BIT.

MENTALLY, I WANT TO LIKE FEEL BETTER AND  NOT HAVE THIS LIKE FEELING ALL THE TIME.

AND THEN ESPECIALLY WHEN SOMETIMES  FRIENDS OR PEOPLE ARE LIKE, WHY ARE   YOU STILL NOT FEELING WELL?

SHOULDN'T YOU BE BETTER NOW?

ARE YOU SURE?

THAT OR SOMETHING ELSE?

OR LIKE SOMEONE CALLING ME DUMB BECAUSE  DON'T HAVE THE SAME INTELLECT ANY MORE.

BECAUSE OF THESE SYMPTOMS.

THE I CAN'T FOCUS AS  MUCH AND IT'S HARDER FOR ME TO UNDERSTAND THING.

SO SOME THINGS IT DOES BRING ME DOWN AND SYMPTOMS  AND NOT BEING ABLE TO GO BACK TO PLAY, RIGHT AWAY,   OR BEING NOT ABLE TO PUSH EVERYTHING  OUT THERE LIKE I USED TO, BECAUSE OF IT,   IT DOES BRING ME DOWN A LITTLE BIT.

>>Lauren: I WOULD IMAGINE IT WOULD.

SOUNDS REALLY FRUSTRATING.

LET'S GO WITH YOU.

SOME OF THE STRATEGIES WHEN THE KIND  OF SYMPTOMS THAT SHE'S TALKING ABOUT   CAN'T FIND WORDS OR YOU JUST DON'T HAVE  IT RIGHT AS QUICKLY AS YOU DID BEFORE.

WHAT ARE THE TOOLS THAT YOU IMPLEMENT  TO GET OF SOME OF THAT BACK?

>> START WITH MOTIVATIONAL INTERVIEWING.

REVIEW NEW CLIENT OR PATIENT,   WANT TO KNOW WHAT'S IMPORTANT TO THEM.

WHAT AREAS OF THEIR SPECIFIC LIFE SO   WE CAN MAKE SURE WE TAILOR IT TOWARDS THAT.

FOR MEMORY, RESEARCH SPORTS USE OF COMPENSATORY   STRATEGIES OR EXTERNAL AIDS WHICH WOULD BE  USING YOUR SMARTPHONE TO ORGANIZE THINGS,   MAKING SURE YOU WRITE THINGS DOWN  AND IMPLEMENTING DAILY HABITS.

SO THEY BECOME ROUTINE.

AND SOMETIMES THAT IS JUST FOR THE SHORT TERM.

TO GET YOU THROUGH THIS HEALING PERIOD.

SOMETIMES PEOPLE USE THAT LONGER.

HEALING PERIOD, KIND OF USE AIDS IN A CERTAIN  SENSE, WRITE DOWN DOWN YOUR GROCERY LIST.

IMPLEMENT THAT NOT HAVE TO WORRY SO MUCH ABOUT  THE MEMORY AND NOT HAVE TO THAT TAXING SO MUCH.

THEN FOR ATTENTION DRILL BASED THERAPY WE CAN DO.

PRACTICE WITH YOUR SCHOOLWORK   OR SOMETHING LIKE THAT.

YOU HAVE TROUBLE PAYING ATTENTION FOR A LONG TIME.

WE MIGHT AMP UP THE AMOUNT OF TIME TO  KIND OF SEE HOW THEY THEY RESPOND INCREASE   BACKGROUND DISTRACTIONS, DIFFERENT  PROGRAMS THAT YOU CAN DO WITH THAT.

SOME EXAMPLES.

>>Lauren: DO WE KNOW COMMON   THESE INJURIES DATA TRACKING HOW MANY ATHLETES IN  HAWAII OR JUST NATIONWIDE EXPERIENCE CONCUSSION?

>> YES.

SINCE 2010, MAYBE A LITTLE BEFORE THEN,   H‑CAMP WAS CREATED, ALONG WITH HELPER DR. COAL AND  KING AND OTHERS WERE HE ABLE TO START TO TRACK,   BECAUSE OF THE NATURE OF H‑CAMP PROVIDING  BASELINE TESTING, PRIOR YOUR SEASON THROUGH   SOME KIND OF COGNITIVE TEST ONLINE TYPE SYSTEMS,  WE WERE ABLE TO HAVE ALL THE STUDENT ATHLETES,   DO BASELINE TESTING PRIOR TO THEIR SEASON.

IF THEY WERE SUSPECTED OF A CONCUSSION,   THEY GO BACK ON THE SYSTEM TO DO  POST TEST AND SOME COMPARISONS.

LONG STORY SHORT SINCE 2010, TRACK  CONCUSSIONS UNTIL BEFORE THE PANDEMIC AND   AT HIGH POINT I THINK IN 2013, 2014, WAS ABOUT  1200 CONCUSSIONS ACROSS THE STATE OF HAWAII.

ACROSS ALL PUBLIC HIGH SCHOOLS, ACROSS  BOTH CONTACT AND NONCONTACT SPORTS.

THEN ONCE H‑CAMP CAME IN, STARTED TO ACT  262, YOU MENTIONED, THEN THE EDUCATION,   TRAINING, AND THE IMMEDIATE REMOVAL ALL OF THOSE  CRITERIA PART OF LAW, BEGAN TO BE IMPLEMENTED.

AND THEREFORE, SAW A GRADUAL DECREASE IN   CONCUSSIONS OVERALL HERE IN THE STATE OF HAWAII.

SO WE HAVE DATA TO MONITOR, THAT WE MONITOR.

ON ANNUAL BASIS.

AND IT SEEMS TO BE THAT WE ARE, STILL THERE.

IT'S NOT TOTALLY GONE.

BUT WE HAVE A SUGGEST DECREASE IN THE TOTAL   OVERALL AMOUNT OF CONCUSSIONS AT THIS POINT.

WE'RE STILL IN THE HUNDREDS.

BUT CONSIDERING STATEWIDE, MALE, FEMALE  SPORTS, BOTH CONTACT, NONCONTACT SPORTS,   WE SILL STILL HAVE A LOT TO ADDRESS.

>>Lauren: YOU SHOOK YOUR HEAD WITH 1200 NUMBER.

WE LOVE THESE GAMES AND THERE IS SO MUCH  TO BE GAINED FROM BEING A PART OF A TEAM   AND TO BE ENGAGED IN THESE ATHLETICS.

HOW DO YOU SORT OF WRESTLE WITH THAT?

TRY TO MAKE THAT?

>> WELL, YOU NEVER   GOING TO MAKE SPORTS COMPLETELY SAFE.

BECAUSE WHETHER IT'S SOCCER, HEADING BALL,   JUST CHANGE THE RULES, OBVIOUSLY FOOTBALL, BEEN  SOME RULE CHANGES, AND I'M SURE RULE CHANGES IN   OTHER SPORTS TO MAKE IT SAFER, IT'S JUST KIND  OF PART OF LIFE AND HOW YOU DEAL WITH IT.

NOT TO PATRONIZE THE PANEL, SO BLESS IN THE  STATE TO SO MANY PEOPLE NOT ONLY CONCERNED   ABOUT POTENTIAL HEAD INJURIES HAVE KNOWLEDGE WITH  HEAD INJURIES LIKE MYSELF, WITH YOU LOOK AT NFL   DOES NOT WANT TO PLAY FIELD TURF.

DON'T WANT TO PLAY ON ANY KIND OF   ASTROTURF.

SYNTHETIC SURFACE.

REASON WHY STADIUM ARE LIKE   THAT BECAUSE THEY'RE MULTIPURPOSE STADIUMS FOR  CONCERTS DIFFERENT SPORT AND DIFFERENT EVENTS.

GRASS ISN'T OBVIOUSLY SAFER THAN MOST  FIELD TURF, OR ANY TYPE OF SYNTHETIC   SURFACES BUT THAT'S GOOD GRASSES.

LOOK AT THE STATE OF HAWAII,   SEE SOME OF THESE FIELDS THAT THESE  KIDS PLAY ON, IT'S AS HARD AS A ROCK.

AND THEN YOU SEE VERY FORTUNATE TO SEE KALANI  GET A NEW FIELD TURF AND ONE AT KAISER.

SOME THROUGHOUT WAIANAE HAS A NEW, BUT  AGAIN, THOSE THINGS WE'RE DOWN OVER TIME.

HAVE A LIFE SPAN 8 TO TEN YEARS.

CARPET AT YOUR HOUSE.

PADDING GETS LESS.

HARDER.

HITTING HEAD ON THE GROUND.

WE HAVE TO CONTINUE TO TRY TO   MAKE THE SURFACE MORE COMPATIBLE TO BE SAFER  FOR THESE ATHLETES AS WELL AS EQUIPMENT AND   ALL OF THESE OTHER PROTOCOLS THAT WE HAVE.

BUT HAWAII IS IN A GOOD PLACE BUT WE CAN STILL,   STILL A LOT OF IMPROVEMENT FOR OUR YOUNG ATHLETES.

>>Lauren: I MEAN, SO INTERESTING THAT YOU SAY THAT   BECAUSE EXACTLY WHAT CASEY WAS SHARING WITH US.

DID NOT HEAD ANY BALLS EXACTLY HOW SHE   WAS INJURED.

CAN YOU TELL US   ABOUT INVESTMENT THAT YOU THINK NEEDS TO BE  MADE TO THE FIELDS THEMSELVES AND TO THESE   FACILITIES SO THAT THESE THINGS CAN BE PREVENTED?

>> I THINK FOR WHATEVER SPORT, WE'RE INVOLVED IN,   ALWAYS LOOKING FOR THE BEST EQUIPMENT, BEST  FACILITIES, AND SOCCER COMPLEX OUT AT WAIPIO,   18 FIELDS OUT THERE, AND PRETTY  DIFFICULT TO MANAGE.

ALL GRASS.

BUT LIKE, WHAT RICH WAS ALLUDING  TO, MAY BE NOT BEST GRASS.

AND SO A LOT OF HIGH SCHOOL DID KIDS USED TO  PLAYING FIELD TURF AND BACK OUT AT WAIPIO,  PLAYING ON GRASS.

HARD OUT THERE A LOT CONCUSSIONS COME FROM   COLLISIONS FALLING ON GROUND OR LANDING ON GROUND.

HEAD THE BALL.

SPECIFICALLY SOCCER IF WE GET THE BEST  POSSIBLE GRASS THAT WOULD BE THE BEST   CASE MUCH OBVIOUSLY LOTS OF DOLLARS INVOLVED.

>>Lauren: I WANT TO BRING IN THE AUDIENCE.

BEEN GETTING NUMBER OF QUESTIONS FROM YOU  AT HOME OF THANK YOU SO MUCH FOR THOSE OF   YOU WHO ARE CALLING IN WRITING IN.

LET'S TAKE THIS ONE FOR DR. KING.

IT SAYS, ARE THERE MISCONCEPTIONS ABOUT SPORTS  CONCUSSIONS FOR EXAMPLE, IF YOU'RE NOT KNOCKED   OUT, IT'S NOT A CONCUSSION?

>> ABSOLUTELY.

SO IT RUNS WHOLE GAMUT NOT  KNOCKED OUT IT'S NOT A CONCUSSION.

WE KNOW, MAJORITY OF CONCUSSIONS  DON'T HAVE LOSS OF CONSCIOUSNESS.

THE OTHER IS HAPPEN GO TO THE  EMERGENCY ROOM AND THEY GET A CT SCAN.

MY SCAN WAS NORMAL.

I'M FINE.

HAVE TO HAVE THE CONVERSATION WHERE THE  SCAN IS JUST THE STRUCTURE, BUT THEN   CONCUSSION IS ACTUALLY THE FUNCTION OF THE BRAIN.

LOOKING AT A HOUSE, MIGHT LOOK STRUCTURALLY SOUND,   BUT INSIDE, TERMITES HAVE HAVE EATEN  AWAYED WOOD, ELECTRICITY NOT BE   WORKING WHAT HAPPENS WITH THE CONCUSSION.

NOT PLAYING FOOTBALL, SPORTS ARE SAFE.

I'VE HAD OUTRIGGER CANOE PADDLING  HIT BY THE AMA GET A CONCUSSION.

>>Lauren: THERE'S A COUPLE HERE.

RELATED TO HERE.

DO THE HISTORY OF CONCUSSION AFFECT WHEN IT'S  KUPUNA LATER AND IS THAT AN ISSUE FOR ANY KUPUNA   IN GENERAL, FROM CLAUDIO.

ANOTHER CALLER SAYING.

>> IS THERE ANY RESEARCH DONE ABOUT  FREQUENT CONCUSSIONS LEADING TO MEMORY   ISSUES OR EVEN DEMENTIA IN THE LONGTERM?

WHAT CAN WE EXPECT TO SEE LATER IN LIFE IF   WE SUFFER THESE EARLY?

>> I WOULD SAY THOSE   ARE THE MILLION‑DOLLAR QUESTIONS.

RESEARCHER STILL WORKING ON RIGHT NOW.

THERE IS EARLY EVIDENCE THAT REPEATED CONCUSSIONS,  KEAWALAU THAI THAT NOT ACTUALLY SURE HOW MANY   IS TOO MANY.

QUALIFY THAT.

WE DON'T HAVE HARD FAST NUMBER YOU'VE HAD SIX  CONCUSSION GOING TO HAVE LONGTERM PROBLEMS.

MAY BE SOMETHING ABOUT THE IMPACT YOU  MIGHT HAVE ONE REALLY BAD CONCUSSION.

AND THAT COULD CAUSE YOU LONGTERM PROBLEMS.

THERE IS EARLY EVIDENCE THAT EITHER REPEATED   CONCUSSIONS OR JUST THE RIGHT TYPE OF CONCUSSION,  YOUR GENETICS PREDISPOSING LONGTERM PROBLEMS.

SUBSET PEOPLE CONCUSSION COULD CAUSE LONGTERM  PROBLEMS AGAIN, I DON'T KNOW WHAT NUMBER THAT IS.

WE DON'T KNOW WHAT YEAR THAT MIGHT AFFECT YOU.

I TRY TO HAVE CONVERSATION WITH MY PATIENTS THAT   WE WANT TO GATHER AS MUCH EVIDENCE AS WE CAN  BUT SAME TOKEN DON'T WANT TO BE FEARFUL OF LIFE.

HAVE TO LIVE.

HAVE FUN.

ENJOY OUR SPORTS.

NOT GOING TO GIVE UP PADDLING FOOTBALL IF THAT'S  IT YOUR LOVE HAD ONE CONCUSSION PERHAPS.

IF YOU   HAVE FOUR, MAYBE WE SHOULD HAVE THAT CONVERSATION.

>>Lauren: CTE HAS BEEN A DISCUSSION   FOR FOLKS AREN'T FAMILIAR.

CAN YOU TELL US ABOUT WHAT WHERE THAT   CONVERSATION NOW NATIONAL LEVEL?

>> YEAH.

I GO BACK TO WHETHER IT'S PHILADELPHIA  EAGLES REUNION, NEW YORK JETS.

SEE SOME OF MY TEAMMATES LONG TERM EFFECTS CTE.

EFFECTS FROM CONCUSSION.

HEAD TRAUMA OBVIOUS WILL   HITTING EACH OTHER IN THE HEAD CONTINUOUSLY  IS NOT A GOOD THING FOR YOU LONGTERM.

TALK ABOUT KUPUNA, A LOT OF EVEN MY  FORMER TEAMMATES UNIVERSITY OF HAWAII,   LATE FIFTIES, EARLY OF SIXTIES, JOKE  ALL THE TIME ABOUT MEMORY LOSS AND NOT   REMEMBERING WHAT YOU ATE FOR BREAKFAST.

BEEN OVER A BILLION DOLLARS ALREADY UNDER   COMPENSATION FOR CTE PARTICIPANTSES  IN THE NATIONAL FOOTBALL LEAGUE.

THAT'S A CONTINUAL FUND BECAUSE  IT'S SUCH A SERIOUS PROBLEM.

AND IT'S THERE.

IT'S EVIDENT.

AND SAFER WE CAN CONTINUE TO MAKE FOOTBALL OR  ANY SPORT, OBVIOUSLY IT'S BETTER BECAUSE IT   DOES AFFECT YOUR LONGTERM ABILITY WHETHER IT'S  PLAYING WITH YOUR GRANDCHILDREN OR REMEMBERING   BASIC COGNITIVE FUNCTIONS.

>>Lauren: QUESTION HERE.

AFTER GETTING CONCUSSION  WHEN OKAY TO RETURN TO GAME?

AVERAGE WAIT TIME?

I WOULD IMAGINE VERY INJURY SPECIFIC.

>> INJURY SPECIFIC.

EARLIER MENTIONED NORMALLY GOING THROUGH   RETURN TO PLAY, RETURN TO SCHOOL PROTOCOL  AROUND 3 WEEKS, 21 DAYS.

DEPENDING ON AGE.

RETURN TO PLAY AFTER CONCUSSION,  NOT REALLY RECOMMENDED.

IT'S THAT RECOGNITION.

PLAYER, TEAMMATE OR TRAINER OR COACH CAN   RECOGNIZES IT AND HAVE THE PERSON NOT PLAY.

PLAYER OR TEAMMATE, RIGHT AWAY PROBABLY A   GOOD THING AS FAR AS ONCE THEY GO  INTO THE PROTOCOLAR ER STATE OF   HAWAII WE HAVE A CALLED RETURN TO PLAY PROTOCOL.

THAT WILL TAKE YOU 7 DAYS BUT EACH DAY, DO THINGS.

NOT LIKE YOU JUST STAY AT HOME AND LOCK UP.

REALLY EVERY DAY YOU CAN DO YOUR ACTIVITIES.

NOT LIKE SPORTS SPECIFIC ACTIVITY,  LITTLE LATER ON IN THE PROTOCOL.

THERE PROTOCOL THERE.

RETURNING TO PLAY RIGHT   AWAY IS I BELIEVE IS NOT RECOMMENDED.

>> CLARIFY THAT PROTOCOL STARTS WITH EVEN IF   YOU HAVE SYMPTOMS, WE WANT YOU BACK TO SCHOOL.

WE WANT YOU DOING YOUR SCHOOLWORK AT HOME   IF YOU HAVE HOMEWORK.

MODIFED, HELP YOU WITH  ADJUSTMENTS AND ACCOMMODATION.

SYMPTOMS 2 TO 3 DAYS START WALKING   DO THE LAWN, OTHER TASKS GO OUT TO MOVIES  WITH YOUR FRIENDS IF YOU CAN TOLERATE IT.

SYMPTOM DRIVEN.

WHERE THIS ACTUAL GETTING   BACK INTO MY SPORT ACTUALLY BEGINS,  IS NOT BASED ON CERTAIN TIME FRAME.

IT'S NOT ONE WEEK OR TWO WEEK OR THREE WEEKS.

REALLY BASED ON YOUR SYMPTOMS.

>> HOW ARE YOU FEELING?

CRITICAL PIECE.

SYMPTOMS ARE GONE, BACK TO YOUR BASELINE,  IF YOU NORMALLY HAVE HEADACHES, BASELINE,   CAN'T EXPECT TO YOU BE HEADACHE FREE.

BACK TO NORMAL HEADACHES.

WHEN YOU HIT THAT POINT, THAT IS WE CAN START  A PROGRESSIVE RETURN TO YOUR SPORT INCREASING   YOUR ACTIVITY AND INVOLVEMENT WITH YOUR TEAM.

>>Lauren: I WANT TO GO BACK TO WHAT RICH WAS   SAYING ABOUT THE CTE AND WITH YOU MENTIONED AT  SOME POINT, MAYBE STEP BACK FROM YOUR SPORT.

CAN CAN'T NECESSARILY DRAW A CLEAR LINE FROM  SOMETHING THAT HAPPENED TO YOU IN YOUR TEENS   TO THEN ALZHEIMER'S LATER YEARS WAS AT WHAT  POINT DO YOU SORT OF TELL FOLKS, THIS IS ENOUGH.

CHOOSE SOMETHING ELSE?

GREAT QUESTION.

WOULD   LOVE TO HEAR DR. KING'S TAKE ON IT TOO.

FOR ME IN MY PRACTICE, SEE IF THERE'S ANY CHANGES.

WHAT I MEAN BY THAT IS YOU MIGHT SAY YOU FEEL  NORMAL, BUT IS YOUR TESTING ALSO SHOWING,   BRAIN FUNCTION NORMALLY METABOLIC PROBLEM  WITH THE BRAINS AND CELLS FUNCTIONING.

DIFFERENT FORMS OF TESTING.

DR. HIGA CAN TALK ABOUT THAT.

NEUROPSYCHOLOGICAL TESTING, TEST  NOT ONLY HOW ARE YOU FEELING BUT   HOW ARE YOU THINKING, HOW ARE YOU FUNCTIONING?

IF WE SEE DEFICITS THERE, WE'RE NOT READY TO SEND   YOU BACK TO SPORT AND WE MAY WANT TO TALK ABOUT  THIS MAYBE SOMETHING TAKE UP NONCONTACT SPORT.

ED INTEREST IN TENNIS OR SWIM TEAM OR  SOMETHING DIFFERENT WE COULD SHIFT TO.

PIVOT.

LOVE IT HEAR KIND OF OTHER PEOPLE AS TAKE ON IT.

>> SO EXCITE BECAUSE THEY TOUTED THAT THIS  RECENT CONCUSSION CONSENSUS STATEMENT WAS   GOING TO HAVE RETIREMENT PIECE.

TO KIND OF HELP US WITH GUIDANCES   AS FAR AS WITH DO WE RETIRE ATHLETES.

AND OF COURSE, VERY GRAY RETIREMENT NEEDS   TO BE INDIVIDUALLY BASED AND NEEDS TO BE TEAM  DECISION BASED ON YOUR HEALTH CARE TEAM AND   FAMILY AND OWN INDIVIDUAL DECISION.

SO THAT IS KIND OF WHERE WE ARE.

BUT I THINK FOR US, RED FLAGS ARE NOT BACK  TO BASELINE, YOU KEEP HAVING SUBSEQUENT   CONCUSSIONS WITH LESS FORCE.

SO NOW, YOUR BRAIN CAN'T TAKE   AS MUCH FORCE ANY MORE.

TO SUSTAIN MORE SYMPTOMS.

THOSE ARE PROBABLY THE TWO  BIGGEST ONES WE LOOK FOR.

SEE THINGS OBJECTIVELY, EVEN REPORTING  TO US FEEL BACK TO NORMAL NOT DOING   THE THINGS THEY WERE ABLE TO DO BEFORE  CONCUSSION, STILL WANT THEM TO BE ACTIVE.

WE ARE SOME OTHER INTERESTS WE CAN  DO FOR NOW AND MIGHT NOT BE FOREVER.

DON'T KNOW WHAT TIME WILL DO AS FAR AS  RECOVERY.

BUT TO GET THEM INVOLVED IN   SOMETHING ELSE DURING THE TRANSITION PERIOD.

>>Lauren: LOVE TO HEAR YOUR THOUGHTS.

>> SURE.

JUST TALK ABOUT THAT NEUROPHYCH PIECE.

DR. COLE SPEAKING ABOUT WAS  NEUROLOGICAL TESTING A LOT OF TIMES.

WHEN WE SEE STUDENTS OR ATHLETES NOT  HAVING THIS TYPICAL RECOVERY COURSE.

2 TO 3 EXAMPLE NEUROPHYCH  TESTING.

PAPER/PENCIL TESTING.

A LOT OFF HOUR.

TAXING ON BRAIN.

8 TO 16 HOURS TESTING.

LOOKING AT INTELLECTUAL FUNCTIONING,   LOOKING AT, SHORT AND LONGTERM MEMORY,  EXECUTIVE FUNCTIONING, SUSTAINED ATTENTION.

MEASURING VARIOUS ASPECTS OF COGNITIVE  FUNCTIONING AND SEEING IF THERE ANY DEFICITS.

>>Lauren: HOW LONG AFTER THE INJURY CAN  YOU DO THAT KIND OF TESTING AND KNOW   THAT THERE IS SOME KIND OF RELATIONSHIP?

>> NOT NECESSARILY SPECIFIC TIME FRAME.

BUT WHAT WE WOULD WANT TO SEE IS THAT THE STUDENT  HAD ENGAGED IN SOME MEANINGFUL THERAPIES PRIOR.

AND SO MAYBE THIS IS ABOUT SIX  MONTHS MAYBE THAT'S A YEAR.

BUT YES, WE WANT TO MAKE SURE THAT WE GAVE ENOUGH  TIME FOR THE NATURAL PROGRESSION OF RECOVERY AND   THEN ALSO, THE REHAB COURSE AS WELL.

SO THAT PT OR THAT VESTIBULAR THERAPY.

>>Lauren: I WANT TO GO TO YOUR PERSONAL  EXPERIENCE BUILDING OFF WHAT RICH WAS SAYING   ABOUT PEOPLE EXPERIENCED A LOT OF HEAD TRAUMA.

YOU HAD SAID WHEN I HAD ASKED YOU ABOUT YOUR   RECOVERY, YOU'RE NOT SURE THAT WHERE THAT IS.

TELL US A LITTLE BIT ABOUT ARE YOU CONCERNED ABOUT   LONGTERM IMPACTS POPPING IN 20, 30 YEARS FROM NOW?

>> I THINK MAYBE BEFORE.

I WAS A LITTLE BIT MORE WORRIED ABOUT IT.

BUT NOW, I THINK, WELL, WHAT HAPPENED IS WHAT   HAPPENED IN REGARDS TO THE SYMPTOM.

I DON'T HAVE ANY RESIDUAL   SYMPTOMS OTHER PEOPLE HAVE.

SO I FEEL VERY FORTUNATE ASPECT.

I FEEL I HAVE BACK TO NORMAL NO HEADACHES OR DIZZINESS OR ANYTHING I WOULD   ATTRIBUT TOWARDS THOSE CONCUSSIONS FROM THE PAST.

FORTUNATE FOR ME, DR. KING HAD ME RETIRE EARLY   AFTER THREE CONCUSSIONS, SO I  THINK IN THE LONG RUN HELPED ME.

I'M VERY FORTUNATE FOR THAT ASPECT.

>>Lauren: HOW WAS AT THE TIME?

>> REALLY HARD FOR ME AT THE  TIME BECAUSE I WAS YOUNG.

THAT WAS 10 YEARS AGO NOW.

WHEN I HAD TO STOP PLAYING SOCCER.

AND YOUNG KID, YOUNG ATHLETE, IN HIGH  SCHOOL, SOCCER MEANT EVERYTHING TO ME.

I WAS PLAYING CLUB SOCCER.

FOR LIKE 3 TEAMS I THINK.

SO IT WAS A LOT.

I HAD PRACTICE FIVE DAYS A WEEK.

GAMES 2 DAYS A WEEK.

SOCCER 7 DAYS A WEEK.

PREPARED ME FOR SCHOOL SEASON.

I THINK IT WAS VERY HARD ON MY MENTAL   HEALTH AS WE WERE SAYING.

HARDEST PART FOR ME.

WAS THAT MENTAL HEALTH ASPECT OF TAKING  SOMETHING AWAY THAT I LOVED SO MUCH.

I THINK IT WAS REALLY HARD TO BECAUSE ALL  OF MY FRIENDS WERE INVOLVED IN THE SPORT.

I FELT AT TIMES VERY SAD AND LONELY.

DIDN'T GET TO HANG WITH THEM,   SEE THEM THE WAY THAT HE USED TO.

>>Lauren: MUST HAVE BEEN REALLY TOUGH.

SOUNDS LIKE BIG PART OF YOUR IDENTIFY.

>> RIGHT.

STEP ON THE FIELD WITH THE   BEST PLAYERS IN THE WORLD.

COMMON THING WHAT DO YOU WANT   TO DO WITH YOU GROW UP KIND OF SITUATION  I WANT TO BE A PROFESSIONAL SOCCER PLAYER.

>>Lauren: WHERE ARE YOU FEELING  ABOUT YOUR SPORT RIGHT NOW?

I KNOW IT'S BEEN SIX MONTHS.

SINCE THE INJURY.

IS IT SOMETHING THAT YOU'RE HOPING TO GET  BACK TO OR HOW ARE YOU NAVIGATING THAT.

>> I'M NOT LOOKING FORWARD TO  RETURNING TO CHEER LEADING.

NOT ONLY BECAUSE OF MY CONCUSSION, BUT THE  WAY MY COACHES AND TEAMMATES HANDLED THINGS.

AND OTHER THINGS THAT HAVE HAPPENED ON TEAM.

I AM LOOKING FORWARD TO DOING RUNNING   AND CROSS COUNTRY THINGS LIKE THAT.

BECAUSE IT'S HELPED ME WITH MY INJURY.

I FEEL LIKE I FEEL BETTER  AND LESS SYMPTOMS WHEN I RUN.

LOOKING FORWARD TO DOING THAT INSTEAD OF CHEER.

>>Lauren: CAN YOU TAKE THIS ONE FROM KIMO.

KAIMUKI, WITH FOOTBALL AND BASEBALL PLAYERS  PATTED ON THE HEAD, INCREASE CONCUSSIONS AND   LONGTERM EFFECTS?

HARD PAT ON HEAD?

>> YEAH.

DON'T SEE IT AS MUCH.

IMPACT AND THINK EVERYONE HEAD OR CRANIUM  OR BRAIN IS A LITTLE BIT DIFFERENT IN   TERMS OF CONTINUOUS HITS TO THE HEAD.

KIND OF SEGUE INTO OFFENSIVE LINEMEN.

DEFENSIVE LINEMEN.

HIT EACH OTHER'S   HEAD ALMOST 60 TO 70 TIMES A GAME.

SOMEBODY PLAYS MY POSITION, MAY HIT   SOMEONE IN THE HEAD MAYBE FIVE TO TEN TIMES.

IT'S OBVIOUSLY MORE IMPACTFUL TYPE OF IMPACT   FROM A SAFETY TO A RUNNINGBACK TO WIDE RECEIVER.

BUT THEY'VE DONE STUDIES AND SEEMS LIKE LINEMEN   OFFENSIVE DEFENSIVE LINEMEN, NOT AS  SEVERE, CONTINUOUS HITTING TO THE HEAD.

SUFFER ABNORMAL AMOUNT OF CONCUSSION AS WELL.

>>Lauren: I KNOW YOU MENTIONED THAT YOU   WERE NOT IN THAT SAME KIND OF POSITION.

NOT AS CONCERNED OR DID NOT SUFFER AS MANY HITS.

DO YOU HAVE THOSE SAME CONCERNS FOR YOURSELF.

>> EVERY DAY I THANK THE LORD PHYSICALLY ABLE   TO DO THE THINGS THAT I WANT TO DO IN LIFE.

DO WORRY NEUROLOGICALLY IN TERMS OF BEING   ABLE TO BE COGNITIVELY ABLE TO FUNCTION.

SO TREMENDOUS, TREMENDOUS CONCERNS REGARDING THE   AMOUNT OF HITS THAT I'VE TAKEN TO MY HEAD.

DELIVERED WITH MY HEAD.

SO IT'S A CONTINUAL BATTLE AND ONE  THAT ALMOST CAUSES ISSUES IN TERMS OF   NOT DEPRESSION BUT MORE ANXIETY TYPE OF  PROBLEMS THAT I THINK OF CONTINUOUSLY.

>>Lauren: OF COURSE, DR. HIGA, REALLY  SPEAK TO JUST HAVING SO MUCH UNKNOWN.

>> SURE.

ABSOLUTELY.

I THINK THE UNKNOWN OF THE INJURY MAKES IT REALLY  CHALLENGING FOR PEOPLE TO GRASP THEIR HEAD AROUND   AND UNDERSTAND WHAT THEIR COURSE  OF RECOVERY GOING TO LOOK LOOK.

ANXIETY PROVOKING.

>>Lauren: DR. KING, ABOUT PEOPLE NOT NECESSARILY   KNOWING THAT SOMETHING IS STILL WRONG, BECAUSE  IT'S INJURY THAT YOU CAN'T NECESSARILY SEE,   WHAT KIND OF STRESS DOES THAT ADD FOR PATIENT TO  HAVE TO SAY THAT I'M STILL SUFFERING FROM THIS,   EVEN IF IT'S NOT OBVIOUS?

>> RIGHT.

IT'S HUGE.

SO I THINK ONE OF THE   THINGS WE REALLY THINGS LAY THAT OUT VERY FIRST  VISIT TALK ABOUT THE FACT, YOU IF BROKEN BONE,   CAST ON EVERYONE KNOWS YOUR INJURED.

DON'T HAVE A CAST ON YOUR HEAD.

NOT KNOW YOU'RE INJURED.

VISIBLE INJURY.

GIVE THEM OWNERSHIP, TALK TO TEACHER TEACHERS  AREN'T GOING TO REMEMBER YOU HOOP TO A CONCUSSION.

HARD FOR A FRESHMAN TO SAY, I CAN'T DO  THIS WORK RIGHT TERUYA BECAUSE I HAVE A   INCLUSION IN MIDDLE OF CLASSROOM TRY TO BUILD  SOME STRATEGIES TO HAVE HAND SIGNAL TO THE   TEACHER I FORGOT THEY HAVE A CONCUSSION.

THINGS LIKE TO HELP THEM TO SHOW THEY ARE   SUPPORTED.

BECAUSE OTHERWISE, IT'S FEELS  VERY LONELY TO BE ABLE IN THAT POSITION.

>>Lauren: I WOULD IMAGINE ALSO BECAUSE  OF THE NATURE OF THAT, CAN BE ALSO   PERHAPS HARD TO ME WHEN YOU FULLY RECOVER.

HOW DO PATIENTS KNOW, WHAT ARE THE METRICS,   THERE ARE TESTS THAT YOU APPLY, BUT HOW  DO THEY KNOW WHEN THEY'RE ACTUALLY BETTER?

>> ONE THANK ADD TO TESTING FOR SPEECH,  STANDARDIZED TESTS AREN'T SPECIFIC COGNITIVE   LEVELS BECAUSE OF CONCUSSION.

SO HIGH FUNCTIONING.

NORMAL.

SOMETHING IS WRONG, TRY TO FOCUS   ON WHAT THEY'RE TELLING US VERSUS STANDARDIZED  TESTING.

OTHER TRICKY PAR IS DOING ANY TIF.

EMOTIONAL SYSTEM IT IS OVERLAP.

NOT GETTING BETTER ANXIETY MIGHT GO DOWN.

COGNITION MIGHT GO UP.

CAN'T FOCUS.

ALL CORRELATED WE'RE ALL ON BOARD WHAT THE  SYMPTOMS ARE, TO KIND OF EASE INTO THAT RECOVERY.

AND ANOTHER THING I SEE SOMETIMES IS LIKE  WE ALL HAVE THINGS SLIP OUR MIND SOMETIMES.

SOMEBODY MIGHT HAVE SOMETHING HAPPEN WHERE  THEY'RE IMMEDIATELY LIKE, OKAY MY GOSH,   I HAD A CONCUSSION.

MUST BE FROM THAT.

BRINGING MORE ANXIETY TO THE SITUATION.

TEAM EFFORT MAKING SURE WHAT THEIR BASELINE   AND HOW ALL OF THESE THINGS CAN BE SUPPORTED.

>>Lauren: GOES EXACTLY WHAT YOU WERE SAYING.

HOW DO YOU KNOW JUST FORGOT YOUR GROCERY LIST  OR SOMETHING YOU NEED TO TAKE MORE SERIOUSLY.

>> I'VE SEEN NEUROPSYCHOLOGISTS  IN THE LAST TEN YEARS.

NO BASELINE TESTING IN THE  NATIONAL FOOTBALL LEAGUE.

THERE IS IN THE NATIONAL HOCKEY LEAGUE.

YOURSELF AND I THINK KNOW THE ANSWER, CURIOUS.

MAY BE RHETORICAL, DO YOU BASELINE  TEST HIGH SCHOOL SPORTS YOU HAVE GOOD.

THAT'S A GOOD THING.

>>Lauren: TELL US ABOUT THAT.

WHAT KIND OF BASELINE TESTING IS DONE.

>> STUDENTS GET A BASELINE TEST IN   EITHER SOMETHING CALL AND EVEN COLLEGIAL LEVEL.

COLLEGIATE ATHLETES ALSO GETTING TESTED EITHER IN   TESTING CALLED IMPACT OR SOMETHING CALLED SWAY.

AND THESE ARE TESTS AGAIN,   THAT DR. HIGA HAD MENTIONED.

COMPUTERIZED BASED ONE.

SIMILARLY TESTING MEMORY.

REACTION TIME.

SOME OF THEM ARE TESTING BALANCE, RECOGNITION.

GOAL OF THIS IS TO HAVE BASELINE SCORE.

SO  THAT THEN IF SOMEBODY WERE TO INCUR INJURY,   WE CAN COMPARE THE TEST AFTER THEY'VE  HAD THE INJURY TO WHAT WE KNOW WAS   THEIR FUNCTIONING LEVEL AT BASELINE.

THAT IS IMPORTANT BECAUSE WE ALL HAVE   DIFFERENT SKILLS.

AND WHAT I'M GOOD AT,  MAY BE DIFFERENT THAN WHAT YOU'RE GOOD AT.

HAVING THAT TEST WE CAN SAY,  THEY TESTED THIS WAY BEFORE.

MAYBE THINGS ARE LOOKING GOOD.

I WILL POINT  OUT ONE IMPORTANT THING, WHICH IS TESTING   IS JUST ONE TOOL IN THE TOOLKIT.

WE DON'T REALLY ON THE TEST TO SAY,   THIS IS HOW WE KNOW YOU HAVE CONCUSSION.

OR THIS IS HOW WE KNOW YOU'RE READY TO GO BACK.

I THINK IT'S REALLY IMPORTANT TO TAKE  ALL OF THESE THINGS HOW THEY'RE FEELING,   WHAT THEIR TESTIMONY IS TO HOW THEY'RE  FUNCTIONING, INTO ACCOUNT AS WELL.

I WILL ADD ONE LAST THING.

I WANTED TO ADD.

WAS CAN SHE HAD MENTIONED THAT WE ALSO  WANT TO MAKE SURE WE ALWAYS LOOK AT   THE FACT THAT SOMETIMES SYMPTOMS AREN'T  CONCUSSION.

WE HAD TALKED ABOUT EARLIER.

I THINK THAT IS IMPORTANT BECAUSE I  ALWAYS EXPLAIN TO MY PATIENTS, LISTEN,   IF I'M ALL OF THESE CONCUSSION TREATMENTS  BUT PROBLEM IS SOMETHING ELSE GOING ON.

NOT NOURISHING WELL.

SKIPPING MEALS MOST COMMON SLEEP.

UP ALL NIGHT ON PHONES TEXTING FRIENDS, GO GOING  DOWN THE YOUTUBE RABBIT HOLE.

IF WE CAN SLEEP,   SYMPTOMS GO AWAY.

WASN'T CONCUSSION.

GIVING THEM HEADACHE.

FIVE HOURS SLEEP A NIGHT.

>> STUDENT ATHLETES THINK CONCUSSION TEST,  IT'S A BRAIN TEST NOT REALLY CONCUSSION TEST.

SO REMIND THEM, IF I GIVE IT TO YOU RESIDENT  THAT WAS IN THE HOSPITAL ALL NIGHT DIDN'T SLEEP,   THEY'RE GOING TO LOOK LIKE THEY HAD A CONCUSSION.

SO WE HAVE TO KEEP IN IN MIND TOO.

SOMETIMES CERTAIN LEVEL OF ANXIETY WHEN  THEY CAN'T PASS THE CONCUSSION TEST.

AND THEN WHEN THEY GET THE COACHING ON SLEEP,  DON'T BE HUNGRY, MAKE SURE GO TO THE BATHROOM   BEFORE YOU TAKE THE TEST, NOT RUSHING  THROUGH IT, PERFORM BETTER IN THE END.

>>Lauren: QUESTION HERE FROM ROBERT.

LET'S START WITH YOU.

ARE THE STUDENT ATHLETES EDUCATED ABOUT THE  DANGERS OF CONCUSSIONS AND WHAT TO LOOK OUT FOR?

WHAT YOU TOLD THIS WAS A RISK  BEFORE YOU ENGAGED IN THE SPORT.

>> YES.

NOTIFIED YEARS BEFORE AM MIDDLE SCHOOL.

MADE ME WATCH VIDEOS ABOUT IT.

I WAS THEN TOLD ABOUT IF MY FRESHMAN YEAR.

WHEN I TOOK THE IMPACT TEST.

THEY WENT THROUGH IT.

IT WASN'T TILL I ACTUALLY GOT MY CONCUSSION  THAT I REALIZED WHAT, THE SYMPTOMS WERE.

AND WHAT IT REALLY WAS LIKE.

I FEEL LIKE THEY PROBABLY COULD HAVE DONE A BETTER   JOB OF NOTIFYING COACH AND LETTING THEM HAVE A  TALK WITH ATHLETES BEFORE GETTING IN THE SPORT.

ABOUT WHAT DANGERS ARE AND  HOW CAN YOU GET A CONCUSSION.

>>Lauren: WHAT WAS YOUR EDUCATION LIKE ABOUT  CONCUSSION BEFORE YOU HAD ONE.

YOU KNOW,   I DON'T THINK IT WAS REALLY EMPHASIZED.

I JUST KNEW BEFORE PLAYING A SPORT WITH   SCHOOL, HAD TO TAKE A TEST.

BUT I FIGURED I THINK THEY   SAID IT WAS FOR CONCUSSION TEST I ASSUME.

I DIDN'T KNOW REALLY WHAT A CONCUSSION WAS   PRIOR TO INJURY.

VERY SIMILAR.

I DON'T THINK OUR EDUCATION WAS THAT GOOD ON IT.

TO BE HONEST.

>>Lauren: WE HAVE PROTOCOLS IN PLACE.

HOW DO WE MAKE SURE THEY'RE IMPLEMENTED   IN THOUSANDS STUDENT ATHLETES.

TENS OF THOUSAND ACROSS THE STATE.

SO IT'S HARD TO MAKE THESE UNIFORM.

>> STATE LAW HERE, WITH REGARD TO ACT 262,   THAT ANNUAL TRAINING, DOES OCCUR FOR STUDENT  ATHLETES, COACHES PARENTS AND STUDENTS.

ANNUAL THING THAT THEY ALL  SCHOOLS HAVE TO GO THROUGH.

ALSO THINK, REALLY HOW MUCH DOES THE  CONCUSSION EDUCATION OR AWARENESS   THUNK REALLY CHANGE OVER THE YEAR AFTER  YEAR TREATMENT STRATEGIES MAY CHANGE.

TECHNOLOGY MAY CHANGE SOME OF THE FEEDBACK  THAT WE'VE BEEN GETTING FROM SOME OF THE   PARENTS AND COACHES IN PARTICULAR, BECAUSE  H‑CAMP INSTRUMENTAL IN STARTING IMPACTS   BASELINE TESTING, IS THAT THEY SEE, HEAR  THE SAME INFORMATION OVER AND OVER AGAIN.

THERE'S NOTHING NEW.

PAY CLOSE ATTENTION MAY BE SOMETHING NEW.

THAT THEY CAN LEARN AND FACT  THAT REPORTING IS CRITICAL.

THINGS OF THAT NATURE THAT MAY HAVE  NOT HEARD THE FIRST TIME AROUND.

SO THAT IS PART OF OUR LAW HERE.

ALL SCHOOLS GO THROUGH IT AND USUALLY   TRAINERS OR THEIR ATHLETIC DIRECTOR OR SOMEONE AT  THE SCHOOL WILL HAVE A WORKSHOP OR SOMETHING FOR   THE PARENTS AND COACHES TO PARTICIPATE IN.

AND IT GETS MONITORED.

>>Lauren: SOUNDS SPORT AIRLINE SAFETY VIDEO.

SEEN IT AGAIN AND AGAIN DON'T REALLY LISTEN TO   THE FLIGHT ATTENDANT WHEN YOU GET ON A PLANE.

MAYBE THERE'S SOMETHING NEW IMPACT TESTING.

MULTIDISCIPLINARY APPROACH TO WHOLE TREATMENT.

RECOGNITION, RETURN TO SCHOOL.

TEST ALONE WON'T CUT IT.

ONE TOOL TO YOUR TOOLBOX, IT'S THE   MEDICAL DOCTORS COUNSELORS AT SCHOOL, TEACHERS AND  SCHOOLS EVEN SOME OF YOUR CAFETERIA STAFF WORKERS.

TO BE RECOGNIZING KID MAY FALL AT  THE SCHOOL AND EXPERIENCE CONCUSSION.

ONE REALLY KNEW WHAT DO OR WHAT IT WAS TAKES THAT  VILLAGE TO LOOK AT THIS APPROACH AND.

SHOULD BE   EDUCATED AND INFORMED AS TO WHAT HAPPENS.

>>Lauren: LET'S GO TO THE COACH.

HOW DO WE MAKE SURE MESSAGES ARE LANDING?

HOW DO WE MAKE SURE STUDENT ATHLETES AND PARENTS   AN IN THE COMMUNITY RECEIVING THAT INFORMATION.

>> HIGH SCHOOL LEVEL, ALL OF STUDENTS   AND FAMILIES HAVE TO WATCH THE VIDEOS.

AND UNDERSTAND THAT AND I THINK AS COACHES,   IT IS KIND OF OUR RESPONSIBILITY AS WELL TO HELP  OUR PLAYERS UNDERSTAND THAT CONCUSSIONS ARE REAL.

AND THAT IT IS OKAY.

IT PART OF THE GAME.

AND ALL INJURIES ARE PART OF GAME.

I THINK.

WHEN PLAYERS GET HURT, THEY DON'T WANT TO REPORT  IT.

SAID IN THE BEGINNING SO MUCH AT STAKE JUST   GET UNDERSTAND THAT'S OKAY AND THEY'LL GET  ANOTHER OPPORTUNITY OR AT LEAST LOOKING OUT   FOR THE BETTERMENT OF THEIR ENTIRE LIFE.

SHORT TERM OR LONG TERM.

AND BUT IT IS SCHOOL PROTOCOL TO HAVE  THESE STUDENTS AND THEIR FAMILIES WATCH   THESE CONCUSSION VIDEOS AND THEY SIGN OFF ON IT.

I KNOW SCHOOLS VARIOUS PROCEDURES DOING ALL AS   A TEAM OR VIDEOS ARE JUST POSTED  ON THE SCHOOL ATHLETIC WEBSITE.

BUT THE SCHOOLS DO HAVE THESE PROTOCOLS IN PLACE.

>>Lauren: I WANT TO GO BACK TO YOUR EXPERIENCE.

WHETHER YOU WERE IT TOLD THAT  YOU SHOULD NOT PLAY ANY MORE.

WAS THAT DECISION YOU GOT TO MAKES A FAMILY  OR INDIVIDUAL, OR WAS IT SIMPLY YOU'RE   NOT ALLOWED TO PLAY ANY MORE.

>> HOW IT THAT ACTUALLY WORK?

GO TO THE DOCTOR.

>> USUALLY, I FEEL LIKE   WE HAVE THE DISCUSSION IN THE ROOM AND  I DON'T THINK I WANT TO PLAY ANY MORE.

OKAY, WHAT DOES THIS LOOK LIKE FOR YOU NOW?

HOW ARE YOU FEELING IN SCHOOL?

HOW ARE YOU FEELING ABOUT YOUR SPORT?

AND NOW THAT THIS IS CONCUSSION NUMBER X,   DO YOU FEEL LIKE THAT CONCUSSION WAS EASIER  TO GET COMPARED TO CONCUSSION NUMBER ONE?

AND SO JUST ASKING A LOT OF QUESTIONS  AND IF I REMEMBER CORRECTLY,   HAVE TO LOOK AT MY NOTES DON'T REMEMBER  FOR SURE U I WANT TO SAY YOU AND YOUR   MOM WERE LOOKING I THINK WE'RE DONE WITH SOCCER.

YOU AND YOUR MOM, I THINK WE'RE DONE WITH SOCCER.

I DON'T THINK PEYTON WAS INVOLVED.

>>Lauren: WAS THAT YOUR PARENTS DECISION   OR WAS IT REALLY YOUR DECISION?

>> I THINK DR. KING STEPPED   OUT OF THE ROOM FOR A SECOND.

MOM JUST TALKED TO ME AND SAID, I THINK THE   BEST THAT YOU DON'T PLAY SOCCER ANY MORE.

YEAH, I THINK SO.

THAT WAS OUR AGREED UPON THING.

DR. KING CAME BACK INTO THE ROOM   I THINK YEAH, THAT WAS IT.

>>Lauren: WOW.

YOU SAY THIS MANY YEARS LATER GRATEFUL FOR THAT.

>> YES.

>>Lauren: TELL US ABOUT THAT.

>> LOOKING BACK NOW AFTER TALKED ABOUT TODAY, AND   LOOKING AT ALL THE OTHER FOOTBALL PLAYERS WHO HAVE  IMPACT UPON IMPACT, I'M SURE DIDN'T PLAY FOOTBALL   AND I WOULDN'T PLAY FOOTBALL YOU ABOUT WITH THE  IMPACT OF LANDING FROM DIVING, CONSTANTLY OVER AND   OVER ON THE HARD SURFACE, VERY SIMILAR SITUATION.

SO I'M VERY GRATEFUL TO HAVE LIMITED AMOUNT   OF CONCUSSIONS RATHER THAN UNKNOWN.

INFINITE POSSIBLY AFTER MAYBE EVERY DIVE.

IMPACT TO MY HEAD.

>>Lauren: HAVING THOSE CONVERSATIONS, AS A DOCTOR,   HAS TO BE HARD FOR ALL THE REASONS CASEY LAID OUT.

SO MUCH PART OF OUR IDENTITY, PLAYED IN THREE   CLUBS IN ADDITION TO SCHOOL TEAM.

SOCCER 24‑7 YEARS OF THAT.

RIGHT?

>> RIGHT VERY   DIFFICULT.

I THINK AFTER YOU'VE BEEN IN PRACTICE  IT FOR A WHILE YOU CAN JUST FEEL THAT SHIFT   DEFINITELY FROM THE PARENTS ABOUT HOW IMPORTANT  THEIR RANKING OVERALL HEALTH VERSUS SPORTS.

AND IN THE END, LIKE PARENTS WANT THIRD  KIDS HAVE TO HAVE GOOD HEALTHY LONG LIFE.

COMES TO SHIFT AND YOU CAN FEEL THAT SHIFT CHANGE  WITHIN THE FAMILY, THAT IS USUALLY WHEN I TRY TO   SLIDE IN THE CONVERSATION.

AND I THINK BY THAT POINT   YOU ARE THERE AND READY I.

MATTER TRYING TO FEEL OUT PARENTS.

I DO, ON THE FLIPSIDE, I  HAVE PATIENTS THAT ARE LIKE.

I DON'T CARE.

I WILL DIE BY FOOTBALL.

AND THEN THEY WILL GO TO URGENT CARE  AND GET CLEAR TO RETURN TO PLAY.

HAPPENS TOO AND THOSE ARE  THE ONES THAT I WORRY ABOUT.

ONE OF MY FAVORITE COLLEGIATE FOOTBALL  PLAYERS WHICH IS WHY I DO WHAT I DO,   WAS MY FAVORITE SWEETEST GUY ON THE TEAM, AND THEN  ENDED UP NOT HAVING A GREAT CAREER IN THE NFL.

>>Lauren: YEAH.

TELL US ABOUT WHAT THOSE CONVERSATIONS   ARE LIKE FOR YOU AS A DOCTOR.

>>  >> I THINK AS PHYSICIANS WE NEVER  ENJOY GIVING BAD NEWS TO PATIENTS OR   HAVING THOSE DIFFICULT CONVERSATIONS.

AFTER SO MANY YEARS, YOU DO HAVE SOME   PRACTICE READING YOUR AUDIENCE A LITTLE BIT.

SOMETIMES I AM THE BAD GUY AND I AM OKAY   WITH THAT ROLE IF THAT MEANS I'M  PROTECTING YOU IN THE LONG RUN.

IF RICH HAD THAT THOSE CONVERSATIONS WITH  PHYSICIAN YEARS AGO, IT MAY HAVE CHANGED WHAT   YOU CHOSE TO DO OR HOW YOU CHOSE TO PLAY.

I TRY TO BE THAT PERSON.

WHERE WITH ALL INTEGRITY, I SPEAK  ABOUT THIS IS WHAT I DO KNOW.

THIS IS WHAT WE KNOW IN THE RESEARCH.

THIS IS WHAT WE DON'T KNOW.

BECAUSE OF THOSE UNKNOWNS I  DON'T THINK YOU SHOULD GO BACK.

AND I CANNOT IN MY OWN GOOD CONSCIOUS, CLEAR YOU.

YOU ARE WELCOME FOR FIND A SECOND   OPINION ENCOURAGE PEOPLE TO DO SO.

I KNOW I'M NOT THE ONLY CONCUSSION   PHYSICIAN ON ISLAND.

ONLY A FEW OF US.

I ENCOURAGE THEM TO EVEN SEE DR. KING OR ANOTHER  ONE OF OR PARTNERS AND GET ANOTHER OPINION.

ALWAYS WELCOME THAT.

IN THE END, I MAY NOT BE PERSON TO CLEAR YOU.

I THINK WE'VE HIT MY NUMBER.

>>Lauren: THERE'S A QUESTION HERE.

RICH, DIRECTOR SPORTS MEDIA COMMENTARY.

DO YOU THINK SPORTS IMMEDIATE COMMENTARY   IMPROVED OR DOWN PLAY IT?

FROM FANS?

SEEMS LIKE YES WE MORE  ABOUT IF AND ACKNOWLEDGE IT.

SOCIETY WANT TO SEE PLAYERS KEEP  GOING SO MUCH MONEY ON THE LINE.

SO MUCH PRESSURE ON THE PLAYERS.

>> YEAH, I THINK WE'VE BEEN IN THAT SCENARIO KANOA   AND MYSELF MANY TIMES, WHEN YOU OBVIOUSLY WANT TO  WHEN YOU HEAR OFFICIAL BASICALLY SAY, TARGETING OR   HEAR AN OFFICIAL, UNNECESSARY ROUGHNESS, AND THEY  EJECT PLAYERS AND THERE'S SOME CONTROVERSY WHETHER   THAT WAS A TARGETING CALL OR WHATEVER ELSE, WE  TRY AS MEDIA MEMBERS TO ERR ON THE SIDE CAUTION.

TOM BRADY AND OTHER PEOPLE TALKING  ABOUT THE GAME BECOME SOFTER WE   PLAY AT TIME MORE LIKE GLADIATORS.

BUT IT'S ALL FOR THE SAFETY THE GAME   YOU THINK AS MEDIA MEMBERS HAVE TO REALIZE  THAT'S SOMEBODY'S CHILD.

SOMEBODY'S FUTURE.

BE SOMEBODY'S HEALTH POTENTIAL.

IF THERE IS IF WE ARE ERRING ON   THE SIDE OF CAUTION, GOOD THING.

>>Lauren: QUESTION FROM LAWRENCE.

SCHOOL FORBID A STUDENT PLAYING  SPORT FOR THEIR OWN GOOD?

WHAT ROLE DOES SCHOOL HAVE.

>> HIGH SCHOOL LEVELS ATHLETIC   TRAINERS HAVE A LOT OF INPUT.

BUT CLEARLY,  WE HAVE TO DECISION WITH THE PARENT AND   CONSULTING WITH HEALTH CARE PROVIDERS  THAT PLAYER MAY OR MAY NOT INTERACT WITH.

SCHOOL LEVEL ALONE, IT WILL BE VERY  DIFFICULT FOR THE ATHLETIC DRAIN TRAINER   PERSON IN PARTICULAR OR ATHLETIC TRAINER OR  TEACHER OR ADMINISTRATOR TO MAKE THAT CALL.

WE WOULD CERTAINLY RECOMMEND THAT  THEY SEEK THE PARENTS INPUT ALONG   WITH THEIR PRIMARY HEALTH CARE PROVIDER.

IN GETTING THAT ROBUST KIND OF INFORMATION.

IN ORDER TO MAKE THAT INFORMED DECISION.

>>Lauren: WE'VE BEEN FOCUSING A   LOT ON IT'S REALLY EXTREME CASE.

FOLKS NEED TO BE PULLED OUT OF PLAY.

BUT WHAT I ALSO HEARD TONIGHT IS THAT THERE ARE A  LOT OF PEOPLE WHO GO THROUGH THIS AND CAN RETURN.

IT'S NOT NECESSARILY CAREER ENDING EXPERIENCE.

WHAT HAVE YOU SEEN IN TERMS OF WHAT CAN BE   DONE AFTER CONCUSSION THAT THE MAJORITY OF, I  WOULD HOPE, MAJORITY OF PATIENTS CAN RECOVER   AND DO PLAY, IF NOT SPORT OR ANOTHER ONE.

MAJORITY OF PATIENTS DO FULLY RECOVER.

SO WE'RE KIND OF THAT LIAISON DURING  THAT PERIOD TO KIND OF MAKE SURE THEY'RE   GETTING THAT SUPPORTS THAT THEY NEED.

PARENTS HAVE LONGER TIME RECOVERING.

PATIENTS HAVE LONGER TIME RECOVERING.

WORK WITH THEM LONGER AND WHO THEY CAN HAVE   THE SYMPTOMS EASE AND ACCOMMODATIONS  THAT THEY'RE ABLE TO USE IN THEIR   DAILY LIFE NORMAL LIVE DAILY LIFE AGAIN.

>>Lauren: WHAT YOU DO SEE RECOVERY MOST PART.

>> I THINK MAJORITY OF PATIENTS  DO MAKE A TYPICAL RECOVERY.

THEY DO RETURN TO THEIR BASELINE LEVELS.

THEN THERE ARE SOME THAT HAVE LASTING EFFECTS.

THAT IS WHERE THE COMPENSATORY  STRATEGIES COME INTO PLAY.

>>Lauren: I KNOW THAT WE'VE ASKED YOU  A LOT WITH YOUR PERSONAL EXPERIENCE.

INTERESTED IN IT CAN YOUR EXPERIENCE PHYSICAL  THERAPIST OTHER SIDE.

WHAT IS IT LIKE FOR YOU   WHEN YOU HELP SOMEONE THROUGH THIS?

UNFORTUNATELY I HAVEN'T SEEN   PATIENTS WITH CONCUSSIONS.

TREATED OTHER THINGS BUT NOT YET.

CONCUSSIONS.

>>Lauren: OKAY.

MAYBE DOWN THE LINE.

>> YEAH.

MAYBE DOWN THE LINE.

>>Lauren: WHAT ABOUT THE TWO DOCTORS?

I WOULD LIKE SOME PERSPECTIVE.

WE HAVE TALKED ABOUT SOME PRETTY EXTREME OUTCOMES.

BUT FOR THE MOST PART, START WITH YOU.

WHAT DO YOU SEE?

>> THE VAST,   VAST MAJORITY OF CONCUSSIONS GET WELL.

WITHOUT UNDUE KIND OF INFLUENCE FROM NEEDING   THERAPIES, EXTRA EFFORTS, VAST MAJORITY DO  WELL IN A TYPICAL TIMELINE 3 TO 4 WEEKS.

PUT OUT THAT INFORMATION, WHILE THIS  IS INJURY THAT WE TAKE VERY SERIOUSLY   AND WE HAVE CONCERNS OF COURSE, THAT THERE  IS GREAT HOPE THAT IF YOU GET A CONCUSSION   I DON'T WANT TO PEOPLE SPENDING THEIR ENERGY  AND ANXIETY THAT THEY'RE NOT GOING TO GET WELL.

THE VAST MAJORITY OF PEOPLE GET WELL AND THEY  DON'T NEED A LOT OF INTERVENTIONS SOMETIMES JUST   NEED TO FIX THEIR SLEEP AND LIFESTYLE INVENTIONS.

WELL UNUSUALED.

WELL HYDRATED MANAGE THEIR STRESS.

WELL NOURISHED.

EXERCISE IS WE CALL MEDICINE FOR CONCUSSION.

PART PRESCRIPTION FOR TREATING   CONCUSSION EXERCISE.

KEEP IN NONCONTACT.

CARDIOVASCULAR EXERCISE.

2 OR 3 DAYS AFTER THE INJURY.

VAST MAJORITY OF PEOPLE WILL DO GREAT.

>>Lauren: EXACT OPPOSITE COCOON CONCEPT.

WHAT WE'RE SEEING IN THE MAJORITY OF  YOUR PATIENTS PUT IT IN PERSPECTIVE.

LAST YEAR BETWEEN THREE OF US SAW  400 CONCUSSIONS IN OUR CLINICS.

TRACK THEM OVER THE PAST TEN YEARS RETIRED  FIVE PEOPLE.

REALLY RARE TO RETIRE ATHLETES.

USUALLY WE DO GET THEM RECOVERED AND  THAT HAS GROWN OVER THE COURSE OF TIME.

SO YOU USUALLY, WE LOOK FOR WHAT  I CALL LITTLE SPEED BUMPS THAT   ARE GETTING IN THE WAY OF RECOVERY.

SO SOMETIMES IF THEY NECK SPRAIN IN   ADDITION TO THE CONCUSSION ADDRESS THAT PIECE.

OTHERWISE KEEP GET HEADACHES FROM HE NECK PAIN   EYE TRACKING IT OFF, AFFECT THEIR READING  TAKE NOTES AND IF WE DON'T RETRAIN THAT   SYSTEM FASTER, THEY JUST GET FRUSTRATED  NOT BEING ABLE TO READ OR TAKE NOTES.

BALANCED TYPE OF ISSUES, GET  FRUSTRATE NEVER GOT CAR SICK BEFORE.

GETTING CAR SICK ALL THE TIME.

THAT IS VERY TRAINABLE THING.

I'M SO GLAD BRITTNEY IS HERE BECAUSE OUR  MULTIDISCIPLINARYICALLY CLINIC INCLUDES   SPEECH LANG THERAPIST.

VESTIBULAR.

GOOD SAYING CONCUSSIONINGS ARE LIKE SNOWFLAKES.

NO TWO THE SAME.

STRATEGIC ABOUT WHAT WE NEED TO  ADDRESS AND DO EXPECT FULL RECOVERY.

>>Lauren: GIVEN EVERYTHING THAT WE'VE HEARD HERE  TONIGHT WHAT WOULD SAY I DO OTHER STUDENT ATHLETES   MAY HAVE EXPERIENCED WHAT YOU EXPERIENCED TONIGHT?

>> I WOULD PROBABLY JUST SAY, GETS BETTER.

YOU'RE NOT GOING TO HAVE IT FOREVER.

MOST OF THE TIME PROBABLY  NOT GOING TO HAVE IT FOREVER.

JUST I GUESS, DON'T THINK OF THE BAD SIDE.

LOOK AT THE BRIGHT SIDE.

MORE NEGATIVE YOU THINK ABOUT  IT, LONGER IT'S GOING TO LAST.

STAY FRIEND AND FAMILY.

DON'T BE ALONE.

MAKES IT MORE DIFFICULT.

>>Lauren: TALKED ABOUT SOME OF THE HE  IMPROVEMENTS SEE IF FIELD AND EQUIPMENT.

WHAT DO YOU SEE MISSING PIECE HERE?

REACH MORE IMPROVEMENTS WHAT ARE WE   NOT DOING THAT WE NEED TO.

>> TRICKY YES.

I WOULD JUST SAY TRICK YES TRYING TO  GET ATHLETES TO BE AS FIT AS POSSIBLE.

TRICKY QUESTION.

MENTALLY AND PHYSICALLY.

EVERYTHING IS AS STRONG AS IT CAN BE.

KNOW SOMETHING IS NOT RIGHT NEED TO GET CHECK OUT.

NOT THE NECK.

IT IS BRAIN GOING ON, TRYING TO MAKE SURE   THAT ATHLETES ARE SLEEPING, ARE THEY EATING WELL.

AND RECENTLY HAD A STUDENT ATHLETE THAT HAD A   CONCUSSION, HAD TO TALK TO HER AND THE PARENTS AND  MAKING SURE THAT MAKE SURE SHE'S SLEEPING WELL.

EATING WELL BECAUSE I DON'T WANT HER SAYING  THAT IS SHE HAS A HEADACHE BECAUSE OF THESE   OTHER THINGS.

OTHER FACTORS.

BECAUSE I HAVE HEADACHES.

I HAVEN'T HAD A CONCUSSION.

IN A LONG TIME.

SO JUST MAKING SURE YOU ARE THAT WE'RE   TAKING CARE OF OUR BODY AS BEST AS POSSIBLE.

SO WE CAN IDENTIFY WITH SOMETHING IS WRONG.

>>Lauren: THERE'S ANOTHER VIEWER QUESTION HERE.

ED THE DOCTOR.

WITH ATHLETES LIKE SIMONE BILES TALKING  ABOUT MENTAL HEALTH, DOES THAT TALK WAY   SOME OF THE STIGMA?

INVISIBLE INJURY.

MENTAL HEALTH PIECE IS VERY IMPORTANT.

>> MENTAL HEALTH EVOLVED OF THE INCLINED   TO DISCUSS MENTAL HEALTH.

DEPRESSION AND ANXIETY.

SIMONE BILES IS CHAMPION OF THAT.

WONDERFUL.

ESPECIALLY WITHIN THIS REALM  OF CONCUSSION AND SPORTS.

WHERE WE TYPICALLY WANT TO  SEE OR WE'VE ALLUDED TO.

TOUGH PERSON CULTURE OF SPORTS.

IMPORTANT TO INCORPATE MENTAL HEALTH ASPECT.

>>Lauren: DO THE STATE ROLE APPLY TO BECAME  TEAMS OTHER LEAGUE SPORTS OUT OF SIDE OF SCHOOL?

BASEBALL TEAMS.

>> STATE LAW ACT 262 STARTS AGE 11 I THINK TO 19.

SO THAT IS THE YOUTH LEAGUES IS ONE AREA THAT AS  FAR AS H‑CAMP IS CONCERNED, REALLY TRYING TO HARD   TO REACH, VERY DIFFICULT TO REACH ALL THE ENTIRE  YOUTH PROGRAMS ACROSS THE STATE OF HAWAII.

TALKING VERY LIMITED CREW AND RESOURCES.

HOWEVER, WE DO HAVE ONLINE CAPABILITIES   THAT PARENTS CAN ACCESS VIA WEBSITE  AND THAT'S IS ONE WAY WE'RE ABLE TO AT   LEAST GET THEM EDUCATED IN SOME RESPECT.

AS FAR AS LAW IS CONCERNED, LOOKS AT 11.

FROM 11 ON.

BUT THERE   IS IT SOME CONCERNS THOU THAT WE'RE LOOKING  AT MIDDLE SCHOOLS TO DO THAT IMPACT TESTING.

DOING FEW MIDDLE SCHOOLS HERE.

ARER BUT CLEARLY, YOUNGER AGE WILL CERTAINLY   THEY WE WOULD NEED HAVE TO A LOT OF MORE EDUCATION  AWARENESS COACHES USUALLY PARENTS VOLUNTEERING   WHERE ARE THE WORKERS?

CHILD AND FRIEND.

UP TO SPEED WITH REGARD TO THE LATEST INFORMATION   AND THE CONTEXT OF THE CONCUSSIONS.

>>Lauren: YOU'RE RIGHT.

MY SON IS SIX.

PLAYS BASEBALL.

AND WE STARTED IN NINE.

JUST DADS REALLY JUST   DEPENDS WHO HAPPENS TO SHOW UP AND BEEN TAUGHT.

>> YOUTH LEAGUES REACHING OUT TO US.

GOING OUT TO   DO TRAINING ACROSS THE STATE AND PROVIDING  THEM INFORMATION AND IT'S FREE OF CHARGE.

SO THAT'S NOT LIKE THEY HAVE TO PAY ANYTHING.

GO OUT THERE AND AND PROVIDE THAT INFORMATION.

BECAUSE IT'S SO CRITICAL FOR THEM TO RECEIVE IT.

PARTICULARLY ON THE NEIGHBOR ISLANDS.

AS OPPOSED TO JUST NOT BEING OAHU‑CENTRIC.

TRY TO GET OUT THERE TO ALL ISLANDS.

>>Lauren: STRIKES ME HEARING FROM DR. HIGA AND  DR. KING AND DR. COLE, THAT IT REALLY, THEN YOU.

IT IS SORT OF THIS MULTIFACETED APPROACH.

THINK OF CONCUSSIONS VERY  PHYSICAL.

OBVIOUSLY IT IS.

ALL OF THESE DIFFERENT BAY WAYS TO APPROACH ITER.

SOMEONE INJURED, WHAT DO YOU WANT THEM TO   REMEMBER IN TERMS WHAT KIND OF  RESOURCES THEY SHOULD SEEK OUT?

>> I THINK LOOK FOR THE THINGS AREN'T  JUST PHYSICAL.

HEADACHE, YOU CAN FEEL IT.

VERY OBVIOUS.

NOTICE OTHER THINGS THAT HAVE CHANGE.

LIKE IS YOUR MENTAL HEALTH DIFFERENT?

ARE YOU HAVING MORE TROUBLE IN SCHOOL   THAN YOU WOULD BECAUSE YEAH, SOMETIMES PEOPLE  DON'T THINK THAT CAN CORRELATE TO A CONCUSSION.

MILD INJURY.

SO IT'S NOT THAT SERIOUS.

US BEING ABLE TO HELP GIVE THOSE EARLY  INTERVENTIONS CAN HELP THEM FROM HAVING   LIKE A SPIRAL INTO SOMETHING WORSE.

>> I'M INTERESTED, START WITH YOU.

SAME QUESTION THAT I ASK THE COACH.

WHAT DO YOU THINK IS THAT MISSING PIECE?

YOU TALKED ABOUT HOW WELL HAWAII IS DOING.

RELATIVE TO OTHER PLACES.

WHAT COULD WE STILL DO BETTER?

>> I GET IN TROUBLE BECAUSE OPINIONATE THE PERSON.

ESPECIALLY IT COMES TO MEDIA  REGARDING YOUTH FOOTBALL.

TACKLE FOOTBALL.

WHAT AGE SHOULD YOU START?

YOU CAN TEACH SOMEBODY TO YOU TACKLE.

IN A LATER STAGE OF THEIR DEVELOPMENT.

SO I JUST FIRMLY BELIEVE THAT YOUNG PEOPLE  SHOULD NOT BE HITTING HEADS UNNECESSARILY.

AND FLAG FOOTBALL.

PYLON.

ALL OF THESE THINGS.

THERE ARE CERTAIN   PARENTS AND KIDS THAT WANT TO PLAY AT EARLY AGE.

SO IT'S ONE OF THOSE DEALS WHERE COACHES TEACHING   PROPER TACKLING, IF THERE'S PROPER PROTOCOLS.

USUALLY NOT A TRAINER, PARENTS USUALLY NOT   WELL INFORMED, SO FOOTBALL IS  GREATEST GAME IN THE WORLD.

GIVEN ME EVERYTHING THAT I HAVE.

BUT AT THE SAME TIME, YOUTH FOOTBALL   LEGISLATION THROUGHOUT COUNTRY AT DIFFERENT  AGE, WE'RE VERY TOUGH PHYSICAL STATE AND HAWAII   SO PROUD OF ITS KIND OF FOOTBALL UPBRINGING  OR WHATEVER ELSE, THAT'S A SENSITIVE ISSUE.

BUT I DO BELIEVE THAT'S UP TO THE PARENT.

BUT BE BE VERY CONCERN AND INFORM AS POSSIBLE   CHILD IS TAKING TOO MANY HITS TO HEAD.

YOU SEE SOME KIND OF NEUROLOGICAL ISSUES.

>>Lauren: IS THERE AN AGE THAT  YOU THINK IS THE RIGHT THRESHOLD?

>> AGAIN, I PROBABLY HAVE  SAID 12 AT CERTAIN TIMES.

TEN, 14.

WHATEVER ELSE.

BUT AGAIN, YOU'RE NOT GOING TO BAN THE SPORT  COMPLETELY.

I DON'T THINK IT SHOULD BE BANNED.

MAKE SURE THAT'S TAUGHT PROPERLY.

THERE'S BEEN SO MUCH ADVANCEMENT IS NOT   ONLY EQUIPMENT, BUT TACKLING PROCEDURES.

AND PRACTICE PROTOCOLS.

IT'S I THINK EVERY PARENT'S DECISION.

TOUGH DECISION BECAUSE WE DO LOVE THAT SPORT.

AND PEOPLE POLYNESIA IN  PARTICULAR, LOVE TO PLAY FOOTBALL.

LOVE THAT PART OF GAME.

>> IDEALLY, FOOTBALL WOULD BE ONE SEASON.

AND NOT ALL YEAR‑ROUND.

THAT WOULD BE THE OTHER THING.

BASQUE ABLE TO PLAY MULTIPLE SPORTS  CROSS TRAINS YOU AND DECREASE YOUR   RISK OF OVERALL INJURY TO BEGIN WITH.

TODAY, SAW YOUNG ATHLETE THAT HE PLAYS CONTACT   FOOTBALL ALL YEAR‑ROUND BECAUSE ONCE ONE LEAGUE  FINISHES, THERE'S ANOTHER LEAGUE READY TO START.

INCREASED EXPOSURE OVER TIME.

IF AT ANY AGE, DOING CONTACT FOOTBALL,   IT WOULD JUST BE IDEAL THAT'S ONE SEASON.

>>Lauren: GOOD ADVICE.

>> I WOULD SAY IN SHORT TERM, IT'S AS FAR AS WHAT  COULD BE DONE, IS TAKING A CONCUSSION SERIOUSLY.

IN OTHER WORDS, IT DOES HAPPEN.

OFTENTIMES, FOLKS WE LEARNED OUR RESEARCH OVER THE   YEAR, SOMETIMES UNLESS IT HAPPENS CLOSE TO YOU,  VERY CLOSE TO A FAMILY MEMBER, THE SEVERITY OF IT,   YOU BEGIN TO REALIZE HOW IMPORTANT IT IS.

SO I  THINK THE SERIOUSNESS OF TAKING CONCUSSION CAN DO,   IN AS FAR AS HARM, WITHOUT THE PROPER CARE, I  THINK IS SOMETHING THAT WE CAN STILL WORK ON.

AND IT'S JUST ABOUT CONTINUOUSLY GOING OUT TO  SPREAD THE WORD OF THE IMPORTANCE AND CONTINUED   EDUCATE PEOPLE AND PROVIDE NECESSARY CUTTING EDGE  INFORMATION THAT WE AT H‑CAMP AN OTHERS WORKING   WITH DR. KING AND COLE AND OTHERS, RESEARCH WE'RE  GENERATING LOCAL, RESEARCH HERE, CAN BE APPLICABLE   STUDENT ATHLETES IN THE STATE OF HAWAII.

>>Lauren: EVERY YEAR NEW CROP OF PEOPLE COMING UP.

EDUCATION HAS TO JUST CONTINUE.

>> IT HAS IT CONTINUE.

YES.

VERY IMPORTANT.

I THINK.

WE'RE HERE FOR THE LONG RUN   H‑CAMP IS A ONE RICH WAS SAYING AS FAR AS STATE,  RICH WAS SAYING VERY PROGRESSIVE WE ARE VERY MUCH   STATE FUND HERE FOR THE LONG RUN.

FOR THE LONG HAUL.

WE'RE THEY'RE HELP.

>>Lauren: THANK YOU SO MUCH.

THANK YOU TO ALL OF YOUR GUESTS FOR BEING TONIGHT.

THANK YOU HOME WROTE IN OR GAVE  US CALL PART OF TONIGHT'S HALL.

APPRECIATE IT.

WE’LL BE BACK WITH ANOTHER  KAKOU IN APRIL FOCUSING ON THE FUTURE OF FIREWORKS, AFTER THE  DEADLY INCIDENT IN ALIAMANU ON NEW YEAR’S  EVE.

AERIAL FIREWORKS HAVE BEEN ILLEGAL IN  HAWAII FOR YEARS, AND THE DANGERS ARE WELL DOCUMENTED,  SO WHY ARE THEY STILL SO RAMPANT?

JOIN US FOR AN IMPORTANT CONVERSATION ON ILLEGAL  FIREWORKS.

I’M YUNJI DE NIES,  GOOD NIGHT.

ALOHA.