BOSTON (Reuters) - As Americans grow more aware of the risk of brain injury tied to football - the country's most popular sport - players and coaches are experimenting with the latest technology in a bid to make the game safer.
Advances in training have led to bigger, faster players who have made the high-impact sport more dangerous, particularly at the college and professional level.
Football fans have witnessed devastating instances of concussion-related brain damage and even death in players as young as high-school age. They include 16-year-old Ridge Barden, 16, who collapsed after a hit in a game in Phoenix, New York last October and later died at a hospital.
Such grim examples have spawned the first major efforts to redesign the football helmet since the 1950s, along with new rules for playing the game. The largest U.S. helmet manufacturers, as well as independent designers, are testing novel ways to cushion big and small blows to the head, or to provide immediate relief in the minutes after a major injury.
Gordon Powers, the coach of the Model High School football team in Rome, Georgia, saw how important it was to do more to protect players two seasons ago. He was sending more team members to the bench who were showing signs of concussion.
"We were losing a lot of players that couldn't play in the game on Friday night," Powers recalled. "We would do a drill and if a kid got up real slow, was a little groggy, here comes the trainer (who would say) ‘OK, that kid's going to be gone for a week.' We wanted to do something about it so the kids could continue to compete."
Model High last year became one of the first high schools to experiment with a helmet cover developed by The Hanson Group of Alpharetta, Georgia and Protective Sports Equipment of Edinboro, Pennsylvania. The cover, dubbed the Guardian, has 37 gel-filled pouches that fit over a helmet and cushion against helmet-to-helmet blows that are so dangerous that the NFL aggressively penalizes them.
Powers' team wore the helmet covers only in practice because they weren't sure local league rules would allow them to be worn in games. Hanson Group owner Lee Hanson said even that helps.
"If we can reduce a lot of the concussions that happen during practice and the compounding of all the hits over and over again, that's going to maybe save somebody's life or their brain and prevent future dementia," Hanson said.
Powers agreed: "The year before we used the Guardian, we had 10 to 12 kids that had to either miss a practice or two or even a game because of head-injury symptoms. And this year we had zero. So from that aspect, I'm sold on it."
Hanson sent out 600 samples for teams and players to test during the 2011 season and this year aims to sell about 200,000 of them, for about $60 a piece. None of the players that tested the Guardian last season reported a concussion, Hanson said, and testing by Wayne State University in Detroit found the product reduced the amount of shock felt through a helmet.
Research has shown that more than 4 million youth players are at risk. A 2011 study by Nationwide Children's Hospital found football players aged 6 to 17 are treated in hospital emergency rooms for about 8,631 concussions each year. Many more concussions may go unreported.
A separate study by the hospital found that football was responsible for almost half of reported concussions among high school athletes, above ice hockey, soccer and other sports.
One in five parents say they worry a great deal about their child suffering a concussion from playing football or another sport, according to a 2011 survey by Safe Kids USA, a non-profit group that aims to prevent childhood injuries.
Parents are also faced with the reality that even the best helmets available do not eliminate the risk. Laura Mason learned that lesson when her son, Zack, was diagnosed with a concussion in 2010 from a game in his sophomore year at Westborough High School in Westborough, Massachusetts. He was wearing a new helmet that she bought for him.
"He did take a head-to-head hit, he fell, but never passed out, never got dizzy, it was just like normal," Mason said. "The next day was a Sunday, he started having headaches, we didn't think too much about it till he went back to school on Monday and still had them. We called the pediatrician, brought him in and he says, 'I think he's got a concussion.'"
Her son missed much of the next three weeks of school, and didn't return to his full academic schedule for about four months. He skipped football season in his junior year, but intends to return to the game in the fall for senior year.
"I'll let him do it," Mason said. "I know my son. He's not a real rough player, he tends to step back a little bit more, so I'm OK with it."
At the pro level, the NFL allows players to choose any helmet they want that meets the standard set by the National Operating Committee on Standards for Athletic Equipment, a voluntary industry group.
"We want our players to wear the best available equipment using the latest technology," NFL spokesman Brian McCarthy said in an e-mail. "We are encouraging all helmet manufacturers to continue to improve helmets."
The NFL's helmet sponsor Riddell regularly tweaks the padding and design of its equipment, while Xenith LLC's line of helmets use air-filled pads rather than foam. Other companies are testing more dramatic changes.
A New York-based startup company called Thermopraxis and Schutt Sports - the largest producer of football helmets - are working on a product called the Thermocrown.
Based on an idea developed by Brazilian neuroscientist Renato Rozental, the device is a bladder that can fit inside a player's helmet. In the event of a hard hit to the head, a trainer or teammate would attach a source of cooling gas to the bladder to lower the head's temperature and stave off damage.
The effect would be similar to applying an ice pack.
"A coach can initiate this in seconds," Rozental said. "The concept can buy time, up to four to five hours, to allow the patient to be transported from the field" to a hospital.
Independent industrial design engineer Michael Princip is working on the Bulwark, which features multiple plates on the helmet's exterior, instead of the single-piece design common today. It is intended to dissipate the impact of big hits and more frequent, smaller ones that are a part of the game.
Any of these designs would represent the biggest change in football helmet technology in decades. Helmets started as soft, leather caps in the early the 20th century, then gave way to plastic shells with foam padding and facemasks in the 1950s.
Research by Boston University's Center for the Study of Traumatic Encephalopathy, found evidence of the disorder in the brains of more than 50 deceased athletes. One of them, former NFL player Dave Duerson, shot himself in the chest in February 2011, leaving behind the request that his brain be studied.
Earlier this month, the NFL suspended New Orleans Saints head coach Sean Payton after he admitted to a "pay-for-pain" bounty system that awarded his players bonuses for knocking opponents out of the game.
While manufacturers and other inventors look for ways to make helmets safer, most admit equipment is not the only answer to prevent a worsening phenomenon.
The NFL has tweaked the rules intended to limit concussions. They range from changes in game play, including moving the kick-off line forward by five yards, to telling teams to keep players off the field if they show memory problems.
"Over the past year to two years, there has been a dramatic change in how the game is played, what's allowed, what's called, what we do at practices," said Stefan Duma, head of the Virginia Tech/Wake Forest University School of Biomedical Engineering and Sciences.
But U.S. football helmet testing standards have not significantly changed since 1980, when tougher rules on impact resistance intended to limit skull fractures took effect.
Hundreds of former players have sued the NFL and Riddell, alleging the league knew or should have known about the long-term dangers of concussion but allowed them to play anyway.
The major helmet manufacturers - Riddell, Schutt, the Rawlings unit of Jarden Corp and Xenith - have focused mostly on fit, to ensure the wearer's head does not rattle around like the clapper in a bell after a hit.
Fit is a challenge since most players wear helmets owned by their schools or teams that have been handed down for as many as 10 years. Helmets can cost from $100 for youth-sized models to as much as $375 for high-end ones worn by college players. School programs can usually afford to replace helmets only every few years.
"We're a big believer that every kid should have his own helmet," said Vincent Ferrara, a former Harvard University quarterback who founded Lowell, Massachusetts-based Xenith in 2004. The company charges $329 for its top-of-the-line X-1 helmets.
"We've been accused sometimes of being self-serving," he said. "But we look at all the other things that parents buy for their kids, including their sporting equipment, and we think football helmets should be right up there."
As a player, Ferrara suffered a concussion in the seventh grade that led his mother to pull him from the sport for a full season. After that, he was reluctant to admit when he was hurt.
"My history with concussions is probably fairly typical for players, one diagnosed and then a couple of others that probably could have been had I told anybody about it," he said. Now that his 10-year-old son plays the game, he has a different attitude: "I talk with him continuously about how you play the game and keeping your head out of the impact."
Reporting By Scott Malone; Editing by Michele Gershberg and Paul Simao