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Associated Press
Jeff McQuillan helps a six-year-old with a football helmet during registration and uniform fitting of the Cadet Football league at Ben Davis, Indianapolis, on July 7, 2012. Many are concerned about concussions in youth sports. With youth football registration in full swing across the Indianapolis area, the debate has reached living rooms as parents try to figure out how risks at the sport's highest levels translate to their children. Concussions occur when a hard blow jars the brain against the skull. They sometimes lead to permanent mental and physical damage, even death on rare occasions.

INDIANAPOLIS — It's inevitable. When people see 5-year-old Hank Senseny in action, they tell his mother he has football player written all over his 4-2, 62-pound frame -- a full six inches and 20 pounds bigger than the average boy his age.

Each time, she cringes.

"If mama has anything to do with it" -- and so far, she does --"we do not have a football player on our hands," Amber Kleopfer Senseny said. "I think years from now we're going to look back on this and it's going to be how we look back at cigarettes.

"I think that's how we're going to feel about little kids taking all these hits."

Moms aren't the only ones worried about the long-term effects of blows to their children's heads. Former NFL quarterback Kurt Warner recently voiced concerns about his kids playing football, and Tom Brady Sr. said he would have been "very hesitant" to let his son, now the star quarterback of the New England Patriots, play the sport growing up based on what is now known about concussions. And nationally, the number of youths taken in for emergency treatment for sports-related concussions has risen dramatically.

Concussions occur when a hard blow jars the brain against the skull. They sometimes lead to permanent mental and physical damage, even death on rare occasions.

Former NFL players' struggles with neurological issues recently have raised awareness about concussions, including speculation they contributed to the suicides of six-time All-Pro linebacker Junior Seau and Chicago Bears safety Dave Duerson. More than 2,000 former players are plaintiffs in a lawsuit that alleges the NFL failed to address the risks of concussions and concealed information from players.

The debate has reached living rooms as parents try to figure out how risks at the sport's highest levels translate to their children.

The younger a player is, the longer it takes for a concussion to heal and the greater the risk for long-term damage if subsequent concussions are suffered before the first is healed. Doctors think this is because the brain is still developing, which it does up to age 25.

Youth football organizations are moving to improve coaches' ability to recognize concussions and their understanding of the importance of keeping players off the field until they have been cleared to return by a trained medical professional. Some leagues are limiting contact in practice and others are offering free baseline testing to better determine when concussed players are safe to return. A greater emphasis is also being placed on helmets and properly fitting equipment.

Indiana and other states have adopted laws that mandate the treatment of concussions before players return to the field. Indiana's law covers high school players; other states have extended the rules to cover younger athletes as well.

"Sometimes we have ignored concussions in younger athletes and we now realize those athletes are most significantly affected," said Dr. Daniel Kraft, director of Riley Hospital for Children Sports Medicine at Indiana University Health and one of two doctors who helped push for Indiana's legislation. "I think coaches are making an assertive effort to do a better job of recognizing concussions and trying to get their athletes taken care of it all sports.

"That's a very good thing."

Many experts think football is safe at the youth and high school levels if proper precautions are taken, but conflicting research is being published.

"Everybody individually has to weigh the pros and cons whether it's the right thing for their children to play that sport," said Kraft, whose daughter suffered a concussion playing basketball but continues to participate. "But I don't think there is information out there yet that says that it is overwhelming that we should not have athletes play football.

"If I had a son, I would allow him to play."

The number of athletes 19 and younger going to emergency rooms with traumatic brain injuries -- mostly concussions -- rose 60 percent in a decade, from 153,000 in 2001 to 250,000 in 2009, according to a survey released last year by the Centers for Disease Control and Prevention. The study attributed the growth largely to increased awareness of concussion dangers.

Concussions are most prevalent in football, in which 5.4 million children ages 7 to 17 participated in 2011. But they are an issue for almost every sport.

Legislation went into effect July 1 requiring any Indiana high school athlete who sustains a head injury and experiences concussion-like symptoms to be removed from a practice or game. Players cannot return until being cleared by a health care provider trained in the evaluation and management of concussions. The Indiana High School Athletic Association had previously established an almost identical rule.

The law is based on Washington's Lystedt Law, which has been approved in 43 states and Washington, D.C., according to www.nflhealthandsafety.com. The law is named for Zack Lystedt, a 13-year-old middle school football player from the state of Washington who suffered a debilitating brain hemorrhage after sustaining two head injuries in one game in 2006. He nearly died and needed two emergency brain surgeries to survive. Lystedt graduated from high school in 2011, rising from his wheelchair with a cane to accept his diploma.

Dr. Stanley Herring, team physician for the Seattle Seahawks and Mariners, has been a leading advocate for the Lystedt Law and stresses that children can play football, or any sport, safely if concussions are recognized and treated properly.

"They are incredibly common," he said, noting more concussions occur from unorganized activities and car accidents than sports. "The great majority of high school kids that get concussed are better in a few weeks."

But a concussion "is not a 'ding' or 'getting your bell rung.' If there is any doubt, take them out," he said. "Coaches have an opportunity to save a life."

There is still much to be learned about the head injuries caused by athletics.

Purdue researchers Tom Talavage, Eric Nauman and Larry Leverenz are studying football players at Lafayette Jefferson and West Lafayette high schools, and have found that players are impaired even if a hit doesn't cause a concussion. Many athletes performed worse on memory tests after absorbing repeated, less forceful hits, with the number of such blows loosely correlating to the level of impairment. The athletes, however, appear to recover after six months away from contact.

"But we really don't know if that recovery is 100 percent or 99 percent or 98 percent," said Talavage, a professor of biomedical engineering. "That is one concern. If you play for multiple years and you are only recovering at, say, 98 percent after five, six years, that is a pretty meaningful change."

Another big concern: It seems to take 6 to 7 months for full recovery.

"As we continue to move more and more toward year-round involvement in specific sports," Talavage said, "are you ever going to fully recover?"

In a more reassuring study, the Mayo Clinic recently conducted a long-term look at the issue, comparing high school football players in Rochester, Minn., from 1946-56 with non-athletes at the same high schools and found cases of dementia, Parkinson's disease and Lou Gehrig's Disease occurring at the same rate in both groups.

"We were a little bit surprised," lead author Dr. Rodolfo Savica, a neurologist, told The Times of Northwest Indiana. "We thought (the football players) would be more likely to develop these problems."

Savica said the study might well turn out differently if it followed players now. Players in the 1940s and '50s were slower and smaller, he said, and the era's weaker helmets may have discouraged players from leading with their heads.

Matt Senseny, Hank's father, doesn't completely agree with his wife.

He acknowledges there are legitimate concerns about playing football and will not push their sons into the sport. But Senseny, who is a senior attorney for the Social Security Administration, thinks the risk is outweighed by the lessons they could learn about teamwork.

Amber Kleopfer Senseny is concerned about the people teaching those lessons.

"A lot of leagues are run by dads that are well-meaning but have no understanding of safety and they're trying to get their kids to mimic what they see on Sunday Night Football," said Kleopfer Senseny, a senior associate director of gift development for the IU Cancer Center. "They don't understand those guys are trained to take hits like that and they have incredible protective gear."

An Indianapolis-based agency is working to ensure coaches nationwide understand and minimize the risks.

USA Football, created in 2002 as the official youth development program of the NFL and NFL Players Association, focuses on making practices safer.

The organization recommends -- though does not enforce -- teaching the fundamentals of safe contact, working from no-contact drills up to player-to-player contact. The goal is to limit the amount of contact in practice and teach players to see who they are tackling rather than launching themselves at opponents with the crown of their helmet.

"A fundamentally sound athlete is a safer athlete," said Steve Alic, director of communications for USA Football. "A well-trained coach teaches the game smarter and safer."

Teaching videos, filmed at the Indianapolis Colts' training facility, are incorporated into the organization's online tackle certification course and the curriculum for coaches and players at approximately 70 training events. More than 75,000 coaches have used the online coaching courses, Alic said.

USA Football isn't the only organization trying to address these issues. In June, Pop Warner announced it would not allow contact for two-thirds of each practice and eliminated drills that involve full-speed, head-on blocking and tackling from more than three yards away.

Leagues in Fishers and Westfield are offering baseline testing prior to the season. If a player suffers a concussion, he or she will take the test again, giving doctors and athletic trainers a better measure of when the athlete has recovered.

Properly following these new guidelines is often up to the individual coach, and league administrators stress that parents also take advantage of the educational opportunities and monitor their children during and after practices and games.

Scott Hiland has been ahead of almost everyone in this area. When he became Washington Township football commissioner 14 years ago, some coaches were holding practices five or six times a week for up to three hours each.. Using some Pop Warner studies, he enacted new limits: a total of three practices and games a week, with practices limited to 90 minutes.

Tackling in practice was all but eliminated, along with punt and kick returns in games after a Pop Warner study indicated those plays resulted in the most big hits. He prohibited traditional drills such as bull-in-the-ring, where a player stands in the middle of a circle of teammates and absorbs collisions.

"About 10 years ago, when the culture was different, I had people standing up telling me, 'This isn't real football. You're being soft on them,'" Hiland said. "I told them it wasn't about football, it was about safety.

"We've worked hard to create the culture that this is little league football; we're not winning the Super Bowl."

Michael Theisen had just successfully launched a punt when he was blindsided. The seventh grader at Noblesville Middle School trotted off the field but coaches noticed he seemed disoriented.

They benched him, and a trainer handed Michael's parents a list of concussion symptoms. His father, Chris, said they realized Michael needed to be rushed to the hospital.

"He walked in with help and instantly got into a wheelchair," Chris Theisen said in an email. "He didn't walk unassisted from that point forward for nearly a week."

In addition to a concussion, the blow caused spinal swelling. The swelling kept Michael in the hospital for five days, but the effects fully subsided within a couple of weeks.

Recovering from the concussion is taking much longer.

For two months, Michael was only able to attend school for a half-day.

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"Even months and months after my concussion, getting hit in the head with a ball or getting banged around a little bit, I was getting headaches," he said.

Six months after he was hurt, Michael was cleared to play club soccer this past spring. He considered playing football this fall but failed the ImPACT test, which measures recovery from a concussion. A neurosurgeon concurred that Michael shouldn't play now, but could if he wanted to after he fully recovered.

And therein lies the parental dilemma.

"If he never plays football again it wouldn't bother us," Chris Theisen said. "But he's a kid and he wants to play."

Information from: The Indianapolis Star, http://www.indystar.com