Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697641667704.pdf (Australia)
Doug King BN PhD3 Auckland Bioengineering Institute, University of Auckland, New Zealand Date: 14th Feb 2023 Poyhida Youhorn Committee Secretary Standing Committee on Community Affairs Reference Committee The Senate Australia Please find enclosed my responses to the invitation to submit to the ‘Inquiry into concussions and repeated head trauma in contact sports” being undertaken by the Senate Community Affairs References Committee.
The responses provided are experienced in New Zealand where people who have a personal injury make an open access claim to Accident Compensation Corporation (ACC) at the time of seeking medical treatment from over 3,0000 registered health professionals throughout New Zealand.

The ACC is the New Zealand Crown entity responsible for administering the country’s no fault accidental injury compensation scheme.
The scheme provides financial compensation and support to citizens, residents and temporary visitors who have suffered personal injuries in New Zealand, this includes sports injuries.

When making a claim, information about the injury is collected using a standard ACC 45 injury reporting form to ensure levels of consistency for data recording and analyses.
The injured person (unless impaired) completes information about the activity surrounding the injury (e.g., location, activity prior, cause, narrative) along with their personal details (e.g., age, gender, ethnicity, contact details).

The registered health professional completes the form by providing information regarding initial diagnosis and other relevant medical information (e.g., surgical procedure).

The claim is then filed with ACC and details are entered into a central database.
ACC covers compensation for the injury (sporting or other) including medical treatment, income replacement, social and vocational rehabilitation and ancillary services (transportation and accommodation) as part of the rehabilitation.
1 ACC makes no disincentive for making claims nor are people risk-rated or penalised for the amount of claims they make.1 Personal injury coverage is guaranteed by ACC but this is offset by the restriction to sue for personal injury except in rare circumstances for exemplary damages.1 Unless otherwise indicated, these personal statements are what have either occurred to me or have been witnessed by myself as either a team medic, and/or a health professional and/or a researcher.
Often these roles have overlapped.

My research background into concussion has been undertaken on rugby union,2-10 rugby league,4, 6, 10- 19 Australian Football League,20-22 wrestling,23 netball24 and now I am involved with women’s football.

Concussions and repeated head trauma in contact sports at all levels, for all genders and age groups, with particular reference to: a.
The guidelines and practices contact sports associations and clubs follow in cases of player concussions and repeated head trauma, including practices undermining recovery periods and potential risk disclosure; In New Zealand, the ACC has incorporated the Concussion in Sports Group (CISG)25-29 consensus definition as the national definition of concussion for sporting activities undertaken by all amateur sports participants (https://www.accsportsmart.co.nz/assets/Uploads/Concussion-coach-guidebook.pdf).
This is similar for other sporting agencies such as New Zealand Rugby League (NZRL) and the Roller Derby Association New Zealand Inc. (RDANZI).

Other sporting organisations, such as New Zealand Rugby (NZR) are guided by their international bodies (in this case World Rugby Union [WRU]) and they do not follow the national guidelines but are advised to utilise the policy as stipulated by WRU.
The guidelines for the return-to-play (RTP) also vary with New Zealand Football advising that there are no mandated specific RTP requirements with players returning when they are symptom free, NZR advising that amateur players can return to play on the third consecutive Saturday from when the injury occurred (i.e.

19 to 20 days post injury) while other organisations (NZRL) requiring that players complete 21 days minimum and are required to be medically cleared.
NZR have advised that they will agree to national guidelines when every other sporting body follows NZR’s policy and guidelines.

This is despite research now identifying that players are not fully recovered in under 28 days from the day of the injury.9, 30 Doug King | DipNsg | BNsg | PGCertHSc(SportsMed) | PGCertHealSc(Resus) | PGDipSportsMed(credit) | MHealSc(credit) | DipFootball(FIFA) | PhD | PhD | PhD Concussions and repeated head trauma in contact sportsSubmission 79 b.
The long-term impacts of concussions and repeated head trauma, including but not limited to mental, physical, social and professional impacts; In research31 undertaken on retired elite and amateur rugby players and compared with retired non-contact players it was reported that, when compared between the groups: i. ii.

iii.

iv.

v. vi.

vii.

viii.


Retired elite rugby players reported more concussions across their playing career (5.9 ± 6.3) than retired amateur players (3.7 ± 6.3, p=0.022) and non-contact athletes (0.4 ± 1.0, p<0.001).

Retired elite rugby players had a higher overall negative mental health score (indicating poor mental health) than retired amateur players (p = 0.003) and non-contact athletes (p=0.006).
Retired elite rugby players had a lower overall positive score (indicating good mental health) than retired non-contact athletes (p=0.021).

Negative scores were highest and positive scores lowest in those reporting ≥3 concussions (p=0.008; p=0.040 respectively) or ≥5 concussions (p<0.001; p=0.035 respectively).

Reported symptoms for sleep disruption were more prevalent in retired elite rugby players than non- contact athletes, and in former athletes with ≥3 concussions (p<0.010).
There were no significant differences in alcohol score.

Global anger score and covert anger expression were higher in former athletes with ≥5 concussions (p=0.035; p=0.016).

20% of retired elite rugby players reported that they would not turn to anyone if they had a problem or felt upset about anything.
As a result of these findings, there were psychological signs of more adverse mental health, and sleep disruption, were consistently more prevalent in retired elite rugby players and in former athletes who reported a higher number of concussions.

Anger and irritability were more prevalent in former athletes with a history of ≥5 concussions.
These findings provide evidence to support strategies to address mental health and sleep disturbance in elite rugby code athletes, who are also less likely to seek help should they need it.31 In other research reporting on the long-term effects of repeated head trauma and concussion is mounting with The effects of repeated concussions being reportedly cumulative and permanent.32-40 These effects can vary from an increased risk of a repeat concussion (5.8 times), on-field loss of consciousness (6.7 times), confusion (4.1 times), and anterograde amnesia (3.8 times) with each subsequent concussion35, 36 through to decreased performance in attention, concentration, immediate memory recall and visual motor coordination.41 These effects can be more pronounced if the period between concussions is shorter and the effects are additive.39 Some,36-38 but not all,42 researchers have identified that athletes with multiple concussions report more symptoms and have a worse neuropsychological test performance than athletes with no history of concussions.
This might be reflective of the cumulative and additive effects of multiple concussions43 with resolution of the symptoms occurring over a period from several days to months to years, or they may be permanent.35, 36, 44 The debate about Chronic Traumatic Encephalopathy (CTE) has developed with some researcher reporting that multiple concussions may be linked with CTE,45, 46 but there is a paucity of published studies, and it is not possible to determine if there is a cause-and-effect relationship between concussions or exposures to contact sports.47, 48 CTE has been found in athletes as young as 18 years who have died with a history of concussions.49 Athletes with multiple concussions can have neurobehavioural manifestations of CTE, such as changes in memory, behaviour, personality, gait and speech, similar to Parkinsonism-type symptoms.45, 46 Although concussion has been described as a risk factor for CTE,50 what is not known is whether this may be caused by concussive and/or subconcussive events, the frequency of these types of events to occur for CTE to develop, and if there is a predisposition for only a small number of athletes to be at risk of having CTE.51 More studies are required to determine if there is a direct causal link between concussion and CTE,47, 48 at what age the nervous system is most susceptible to the effects of concussion, and whether proper management of concussion can reducing late-life neurodegenerative dementias.51 Members of the CISG does recognize a causal relationship between repeated head impacts and CTE52 and supported this view utilising the Oxford 2011 Centre for Evidenced Based Medicine Levels of Evidence to review the published literature.53 The Oxford criteria were developed for clinical decision making and not for determining causation by environmental exposure such as contact sporting activities.54 More recently it has been reported that, by evaluating the medical literature through the Bradford Hill criteria for causation, there is convincing evidence of a causal relationship between repeated head impacts and CTE.53 This is the same criteria that alerted the world to the causal association between cigarette smoking and the incidence of lung cancer.55, 56 As a result the authors reported that there is a need to align public health policies with the presumption that there is a causal link between repeated head impacts and CTE.
In addition, measures to minimize and eliminate repeated head impacts are the best way to prevent CTE and awareness of the risks should be identified and people made aware of this.53 A recent development as a result of research reporting on the increased risk of players for neurodegenerative disease57 was the introduction by the Scottish Football Association to ban headers a day before and after matches and the banning of heading to players under the age of 12 yrs.

old.
old.

Concussions and repeated head trauma in contact sportsSubmission 79 c. The long and short-term support available to players affected by concussion and repeated head trauma; Within the confines of New Zealand, people who have been identified as having a concussion and having ongoing symptomatic problems, can be referred to post concussion services.
These people must have been diagnosed as having had a concussion and this needs to be recorded on the ACC45 and have had this injury within the preceding year.

The ceiling costs for this treatment is NZ$3,500 and there is an option for a return- to-work process if the recovery is prolonged.

Any reported concussion in excess of a year duration is declined from any support or rehabilitation services under the ACC scheme as people are deemed to have had recovered from a concussion by then.
In regard to the long-term support for players who report ongoing issues such as early onset dementia or other related neurological problems, there is no system in New Zealand that is funded to directly support this cohort with these issues.

As previously identified, if the injury is greater than 1 yr. prior then ACC does not recognise this as an acute injury.
As for repetitive head impacts, this is seen as a chronic or gradual onset injury, and this is also not covered within the ACC scope as outlined by the legislation.

As the primary sport in New Zealand in Rugby Union, this organisation is directly answerable to the World Rugby Union (WRU) and their policy statement is that there is no definitive evidence that repeat head impacts result in long term neurological.
Until this stance is amended then organisations such as the ACC will not amend their position for the recognition d. The liability of contact sports associations and clubs for long-term impacts of player concussions and repeated head trauma; Contact sports such as rugby union and rugby league require that all concussions that occur are reported through a notification process.
This is also stipulated by Sport New Zealand “Health and safety employee and volunteer handbook” where a notifiable event includes:  Death  An injury or illness that requires a person to have immediate treatment (other than first aid) including: o o o Amputation of body part.

Burns requiring referral to a specialist, registered medical practitioner, or specialist outpatient clinic.
Any of the following conditions that amounts to or results in permanent loss of bodily function, or temporary severe loss of bodily function: respiratory disease, noise-induced hearing loss, neurological disease, cancer, dermatological disease, communicable disease, musculoskeletal disease, illness caused by exposure to infected material, decompression sickness, poisoning, vision impairment, chemical or hot-metal burn of eye, penetrating wound of eye, bone fracture, laceration, crushing.
     Loss of consciousness from lack of oxygen.

Loss of consciousness, or acute illness requiring treatment by a registered medical practitioner from: absorption, inhalation, or ingestion of any substance.

Any harm that causes the person harmed to be hospitalised for a period of 48 hours or more commencing within seven days of the harm's occurrence.

A serious infection.


An unplanned or uncontrolled workplace incident that exposes a worker or any other person to a serious risk to that person’s health or safety, arising from an immediate or imminent exposure to, for example, a substance leak, an explosion or fire, an electric shock or a building collapse.

Page 7: Interestingly at no point does this handbook report concussion.
This highlights the level of awareness that the national sporting body places on concussion in New Zealand and that the duty of care by volunteers is not enforceable, but this has never been tested in the New Zealand court system to date.

As ACC provides a no-fault health insurance system for all accidents (workplace, home and sporting), there is no direct liability on sports associations and associated clubs for the effects of player concussions or repeated heads injuries in New Zealand.
In fact, under the Injury prevention, Rehabilitation, and Compensation Act 2001, the right for individuals to sue and claim compensatory damages for personal injuries has been removed.

However, individuals can still seek exemplary damages, but the plaintiff has to prove that the wrongdoer has acted with outrageous, flagrant, high-hand disregard for the individuals’ rights.

It is not necessary that the wrongdoer to have acted deliberately or with conscious recklessness.
In the case of a player receiving a concussive injury, or having died from second-impact syndrome where they have either returned too early from their concussion, or received another head impact following an unwitnessed initial concussive injury, often there is no team medic available to watch for these injuries or manage the return to play and this is left to the coach who does not have the training apart from what the national sporting organisation provides and this is typically a 5-10 minute talk at the beginning of the season.
For example, I have worked as the sideline medic with male rugby league and rugby union, female soccer, rugby league and rugby union for over 20 years.

In the case of rugby union, they have a person designated Concussions and repeated head trauma in contact sportsSubmission 79 as the team physio who reportedly has concussion assessment training but often this was passed to myself as a lot of teams had a person who wore the physio top but was not a physiotherapist.
For the other sports I was often the person who covered both teams as there was no medical assistance for these codes or genders.

In cases where there was a women’s tournament and this resulted in 8 teams playing at once, I was often the person in the middle of the field covering all four games medically.

When mentioning that the player was concussed, I was often challenged as they were not hit in the head, did not lose consciousness, and just had a migraine.
In extreme cases where the player was, in my opinion, concussed and I have removed them from further exposure wither in the match or training environment, I have been yell at by the coach as they make that decision, not the medic; escorted off the field and told not to come back; received life bands from clubs (totasl of 5 now); had my equipment urinated through; been assaulted physically including being knocked out on the field; had threats to my children; had my car vandalised; and asked not to continue on as the team medic for the following season.
To many clubs, officials and coaches in the amateur game, winning is more important than player safety and welfare as they are judged on the success on the field, not the players health.
e. The role of sports associations and clubs in the debate around concussion and repeated head trauma, including in financing research; Although all sports associations are directly involved in repeated head impacts and concussions and a few financially healthy sports organisations do provide funding for research, there are concerns regarding how they distribute this funding and the requirements attached with this funding.
Some organisations require that the research findings are provided to them before any results are publicly available or openly discussed.

This may involve the removal of any ‘emotionally charged’ or ‘detrimental terms that may not be suitable for the promotion of the game in a positive light.

The ability to have academic freedom and the conducting of research rigor is there for limited and undermined by the actions of these organisations.
The requirements of having to be affiliated with an academic institution for the ability to apply for funding for sports injury research such as concussion limits the ability of people to apply for this.
Having been exposed to the effects of ‘the identification of negative findings’ in conducting research that was not funded by a sporting organisation, the supporting academic organisation was approached with requests to have the research recanted, the qualifications I was undertaken removed and to limit the activities of others involved in the research.
Although some of this did not occur, the sporting body in question had funded specific positions within the organisation and had specific personnel appointed to these roles limiting the ability for further research under that institution.

Other activities experienced have been the removal of position on panels and the threat of loss of employment if I was to continue with my research projects in activities that occur under that sporting organisation.
I have also had colleagues removed from their employment in the academic institutions, other suspended pending a full investigation then made redundant under a restructuring process and the availability of funding removed as being deemed “unsuitable” for funding within the scope of the academic institution.
f. The lack of a consistent definition of what constitutes ‘concussion’; Ever since concussion was described in the medical literature, there have been numerous attempts to establish a working definition.25, 26, 28, 58-66 The difficulty in identifying the true extent of concussion is there is no single universally accepted definition, 67, 68 and these injuries are often not reported69 or people may not be aware that they actually have a TBI.
Concussions have been reported to occur as a result of a direct blow to the head, face, neck or elsewhere in the body that results in an impulsive force transmitted to the head.27 But other forms of force can also result in a concussion occurring such as shaking of the body, anoxia or hypoxia as a result of strangulation, drowning or pressure applied to the throat or chest.68, 70, 71 In a review70 of screening tools, it was reported that no single tool covered all aspects of the possible mechanisms that may result in a concussion occurring.
As a result, the accuracy of concussion diagnosis may be limited.

It has been identified72 that despite patients reporting symptoms consistent with a concussion diagnosis, the diagnosis of concussion were frequently not recorded.72, 73 As a result, the true extent of concussion will be under-reported.
Concussions and repeated head trauma in contact sportsSubmission 79 The definition of concussion has changed over time,74 as universal agreement on a single definition has been difficult to reach.75, 76 the Concussion In Sport Group (CISG) considered a more inclusive and elaborative definition of concussion.25 This definition incorporated common concepts from different definitions of concussion that had been previously published, and did not consider loss of consciousness as an essential defining characteristic.77 Since the publication of the first CISG consensus statement and definition of concussion, variations of the definition have been produced;78-87 until a universal definition is used for identification and reporting of concussion, the true epidemiological incidence of concussion will not be identified.
The lay-person awareness of concussion is what they witness on the television or side-lines of sporting events.

This includes the player being witnessed to be unconscious on the field of play, having a convulsion (often called the fencing sign) and fumbling around after a direct knock to the head.
In research I have conducted on concussions in rugby union3, 6, 9 and rugby league,15, 16 it was identified that for every concussion that was witnessed, there were 10 concussive events that were not identified despite 3 team management members watching the game and all games being videoed.

This resulted in a concussive injury per team every game with only 2 concussions being witnessed in one season.
The definition utilised by that sporting code identified witnessed signs such as loss of consciousness, stumbling when standing up and obvious disorientation.

Other symptoms such as headaches etc., were not utilised and no assessment post- match was encouraged.
By implementing a routine where every player underwent a 1-minute rapid number reading assessment post- match, it was identified that players were being affected by what we termed ‘sub-concussive’ impacts that resulted in subtle but meaningful symptoms such as disruption to the eye movement called saccade’s and this assisted in identifying the actual incidence of concussion in this contact sport.
g. The prevalence, monitoring and reporting of concussion and long-term impacts of concussion and repeated head trauma, including in first nations communities; In New Zealand, all sporting codes are required to monitor and report concussions.

As previously described, the incidence depends upon the definition and the types of monitoring being undertaken.
By using witnessed concussion as the definition, then the incidence is likely to be up to 10-fold less than what is actually occurring.6 Working in a healthcare emergency environment, no concussions are reported to the sporting organisation, they are recorded on the relevant ACC documentation and lodged with all other injuries, and often concussions are overlooked if they are not directly reported by the person presenting to the Emergency Department.
In a study88 reporting on the costs of brain injuries over a five-year period (2011-2016) in New Zealand, there were 95,261 total claims lodged with ACC costing (inflation adjusted to 2022) a total of NZD$1,272,329,084 (AU$247,981,502) averaging NZ$254,465,270 ± NZ$30,927,287 (AU$23,1714,802 ± AU$28,162,233) per year.
In this study88 it was identified that sports brain injuries accounted for less than a 20% of the total calms and 5.1% of the total costs with a population incidence of per 150.7 per 100,000 total population or 10,288.4 per 100,000 sports participants (based on SportsNZ participation data).

In addition, the costs of sports-related brain injuries were NZ$90,861,947 (AU$82,738,434) for five years, averaging NZ$18,172,390 ± NZ$4,397,005 (AU$16,547,687 ± AU$4,003,891) per year.
For a population of 4 million people, this equated to one sports-related head injury every 300 minutes or every 5 hrs on average.
Given that upwards of 50% of all concussions are either not reported, nor recognised, and 28% - 36% are never reported,89-91 then the costs are likely to double to what was reported, and the incidence is closer to 301.5 per 100,000 total population or 20,576.9 per 100,000 sports participants in New Zealand with one sports-related concussion occurring every 150 minutes or 2.5 hrs.

on average.
on average.

h. Workers, or other, compensation mechanisms for players affected by long-term impacts of concussions and repeated head trauma; As previously advised, under Injury Prevention, Rehabilitation, and Compensation (IPRC) Act 2001, the Accident Compensation Corporation (ACC), administer the no-fault compensation scheme in New Zealand.

They are bound by the Act as to what they can recognise and compensate for.
As the effects of repetitive head impacts, are deemed to be of a gradual process (IPRC S24 – as below), in that the effects of repetitive impacts are not immediately identified and occur from repeat exposure to the cause.

The list of the occupational diseases that are recognised under the IPRC Act 2001 is limited to 42 and none of these identify any neurological or dementia related disease process.
Injury Prevention, Rehabilitation, and Compensation (IPRC) Act 2001 24 Cover for personal injury caused by work-related gradual process, disease, or infection: exclusion for events occurring outside New Zealand before 1 April 1974 (1) A person does not have cover for a personal injury caused by a work-related gradual process, disease, or infection if— Concussions and repeated head trauma in contact sportsSubmission 79 (a) he or she suffers the personal injury because, before 1 April 1974, he or she performed a task, or worked in an environment, in the circumstances described in section 30(2); and (b) he or she performed the task, or worked in the environment, outside New Zealand; and (c) he or she was not ordinarily resident in New Zealand when he or she performed the task or worked in the environment (whether or not he or she is ordinarily resident in New Zealand on the date on which he or she suffers the personal injury).
30 Personal injury caused by work-related gradual process, disease, or infection (1) Personal injury caused by a work-related gradual process, disease, or infection means personal injury - (a) suffered by a person; and (b) caused by a gradual process, disease, or infection; and (c) caused in the circumstances described in subsection (2).

(1A) Subsection (1)(c) is subject to subsection (2A).
(2) The circumstances are – (a) the person - (i) performs an employment task that has a particular property or characteristic; or (ii) is employed in an environment that has a particular property or characteristic; and (b) the particular property or characteristic – causes, or contributes to the cause of, the personal injury; and (i) (ii) [Repealed] (iii) may or may not be present throughout the whole of the person’s employment; and (c) that, if the particular property or characteristic is present in both the person’s employment tasks or environment and non-employment activities or environment, it is more likely that the person’s personal injury was caused as a result of the employment tasks or environment rather than the non- employment activities or environment.
(2A) However, even if it is established that a claimant’s personal injury was caused in the circumstances described in subsection (2), the Corporation may decline the claim if the Corporation establishes that the risk of suffering the personal injury is not significantly greater for persons who – (a) perform the employment task than it is for persons who do not perform it; or (b) are employed in that type of environment than it is for persons who are not.
As can be seen by S30: 2A of the IPRC Act 2001, as there is no acknowledged direct causal link between concussion, repeated head impacts and the effects of these such as early onset dementia and chronic traumatic encephalopathy (CTE), there is no compensation for this group of people.
This is despite the paper reporting on Applying the Bradford Hill Criteria for causation to repetitive head impacts and Chronic Traumatic Encephalopathy identifying convincing evidence of a causal relationship between repeated head impacts and early onset dementia / CTE, but this has not been accepted by the international contact sports organisations.

i.
i.

Alternative approaches to concussions and repeated head trauma in contact sport, and awareness raising about its risks; One alternative approach to the care and management of concussion has been the use of head and neck cooling on players with a diagnosed concussion.
Laboratory studies have identified that brain hypothermia, with its broad and pleiotropic effects, presents as the most potent neuroprotection technique available to date.92-94 The use of brain hypothermia has been well established in selected clinical conditions including hypoxic ischaemic neonatal encephalopathy95 and anoxic brain injury due to cardiac arrest.96, 97 By utilising a selective head-neck cooling device (Catalyst™ Cryohelmet) for the therapeutic management of symptoms associated with concussion, it was observed that most pronounced result was an immediate reduction in post-injury event clinical symptoms in both male and female players who wore the head-neck cooling device.
Players who did not elect to use the head-neck cooling device, demonstrated no change in symptom scores over the same duration.

Females recorded a similar symptom score in all the symptom scale clusters when compared with males for both the selective and no head-neck cooling groups.
However, they did record a higher severity in most, but not all of the symptom clusters which was similar to previous studies.98-100 The findings from the NZ study101 suggest that short duration, active head-neck cooling immediately after a concussion may aid in acute phase recovery.

The concept is biologically plausible given that temperature is an established regulator of neuronal functionality.
Hyperthermia can impair cerebral autoregulation and that Concussions and repeated head trauma in contact sportsSubmission 79 directed hypothermia can restore CBF and encourage cerebral heat clearance.102, 103 The study101 findings supported those from Walter et al.,104 who reported that immediately following administration of 30 minutes of selective head-neck cooling, there was a marked improvement in CBF and the vast majority of concussion participants reported a partial resolution of symptoms, predominantly physical symptoms including headache and dizziness.
The average wear time in the NZ study101 was approximately 20 minutes which was shorter than a previous study93 that used 60 minutes to achieve an average of 1.8°C (range 0.9 to 2.4°C) decrease in brain temperature.

Subsequent studies105-107 have utilised the Spartan Cooling System (Welkins EMT Temperature Management System, Welkinsmed, Downers Grove, Il, USA).
This system comprises a conditioning unit containing propylene glycol attached by an umbilical tubing to a headset facilitating cooling or heating by circulating the propylene glycol, enabling temperature ranges from -20°C to 54°C.108 The major finding with all these studies was that ice hockey players attaining concussions and receiving selective head–neck cooling immediately (within 15 mins) postinjury had a notably more rapid recovery to full game play than those receiving a standard concussion management protocol.
In the most recent study,107 the cooling time was longer at 45 minutes to achieve normalization of brain temperature (from 38.5°C to 36.4°C), with shorter cooling times being associated with a prolonged return-to-play.

The appropriate dosing and duration of selective head-neck cooling needs to be studied further.

j.
j.

International experiences in modifying sports for children; and Research in youth sports is limited with some studies only reporting single teams over a single season or with limited match exposure.

However, despite this, research that has been conducted on concussion in youth sports have reported that: a.

There is evidence that concussion is predictive of violent behaviour and subsequent injury in the year following the concussion in 13-14 year old Australian school children;109 b.
A history of concussion negatively impacts on a person’s life chances across a range of social and educational measures;110 c. Head impacts in under 11-year-olds playing rugby league are of a similar severity to those sustained by college American football players;17 d. Youth rugby has a significantly higher rate of concussion than any other contact or collision team sport;111 and e. Girls take longer to recover from concussion than boys;112 To date, no modifications of sport in New Zealand has occurred in relationship to the concussion aspect.
The sporting field sizes, and game durations have been in place for many years under international guidelines.

k. Any other related matters.

Concussions and repeated head trauma in contact sportsSubmission 79 References 1.

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26.

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