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Concussion worries cast shadow in World Cup year

England's Mike Brown is attended by medics during their Six Nations Championship rugby union match against Italy at Twickenham in London February 14, 2015. REUTERS/Toby Melville

By Justin Palmer LONDON (Reuters) - Rugby officials, fans and television executives revelled in a thrilling Six Nations championship finale but concerns surrounding concussion and its long-term impact on players continue to cast a shadow over the game. The sight of England fullback Mike Brown lying unconscious after a sickening blow to the head or the controversy that surrounded Wales winger George North being allowed to play on after appearing to be knocked out has re-ignited the concussion debate in a sport with bigger, faster players than ever before. Head injuries have long been a concern in America's National Football League, highlighted again this month when Chris Borland, a 24-year-old linebacker with the San Francisco 49ers, announced his retirement. A lawsuit brought by thousands of former NFL players, which is awaiting judicial approval, is expected to cost the league in around $1 billion and there are fears rugby union could follow down the litigation route. Concussion-related injuries in rugby have also claimed the careers of leading players, including England international Shontayne Hape, who won 13 caps between 2010-11 but was forced to retire last year after sustaining repeated concussions. English rugby in October announced changes to the way concussion is handled in the professional game with all players, coaches and officials needing to pass an online module designed to improve awareness and understanding. New concussion control measures are also set to be introduced at this year's rugby World Cup in England and Wales, including sideline video reviews by team-neutral doctors. World Rugby CEO Brett Gosper said the "macho attitude" of players toughing it out was changing amid growing awareness. "We have spent a lot of time educating players and using some of these high-profile incidents that we've seen... they have done more to raise the awareness of concussion than what we are doing ourselves," he told an industry forum last week. "The players are very concerned about the area of concussion and you can feel that culture change in these meetings where they want to protect themselves and if someone sees a player looking like they have a suspicion of concussion the player next to them will lead them off." Following the North incident the Welsh Rugby Union introduced a new proactive approach with video replays to aid medical staff while match doctors are also using video replays for suspected concussions in the southern hemisphere's Super Rugby this season. With the number of reported concussions in English rugby rising by 59 percent in 2013-14 -- Premiership club Saracens are trialling the use of head impact monitoring devices, research they hope will eventually produce evidence on "the long term effects of repeated concussion on a professional rugby player." World Rugby, too, is not standing idly by. The governing body's website contains a range of head injury and concussion educational resources and this week, as part of its "commitment to delivering evidence-based enhancements to player welfare and medical practices", it called for submissions for potential funded research projects. (Additional reporting by Martyn Herman; editing by Ed Osmond)