School and Organizational Consultation/Training
Are You and Your Child’s School Ready for Your State’s Concussion Law?
Youth sports participation has reached an all-time high as more children play sports at an early age and play them year round. Greater participation means greater risk of contact and brain concussion. The Centers for Disease Control and Prevention estimate that there are 1.6 to 3 million sports-related concussions per year. A concussion is any alteration in consciousness due to a strong blow or motion to the head. It is a traumatic brain injury. A 2010 study published in the journal, Pediatrics, showed that 50% of all Emergency Department (ED) visits were related to concussion and that 65% occurred in youth ages 5 to 18. This same study noted that between 1997 and 2007, ED visits for concussion DOUBLED.
In December, 2010, New Jersey became the 11th state to pass a sports concussion safety law. Since then all 50 states and the District of Columbia has some type of youth concussion law in place. The New Jersey requires all public and nonpublic schools, K-12 grades, to develop 1) an interscholastic athletic head injury safety training program, and 2) a written policy for school districts to address the prevention and treatment of sports-related head injuries.
The NJ Department of Education has required public and nonpublic schools to develop educational programs on head injury for school physicians, coaches, and athletic trainers to complete. School districts are also required to distribute educational fact sheets to parents/guardians of interscholastic athletes on a yearly basis and to obtain signed acknowledgements of the receipt of these fact sheets. School districts need to have a written policy with specific procedures to be followed when a concussion is suspected. These educational programs, policies, and fact sheets should be updated on an ongoing basis to reflect the latest knowledge and standards.
Importantly, the law requires that any student, who is suspected of having sustained a concussion, must be immediately removed from athletic play and cannot return to sports until evaluated by a licensed healthcare practitioner trained in sports concussion management. Students need written clearance from a doctor in order to return to play. This is especially important for youth who are vulnerable to Second Impact Syndrome, a rare but catastrophic immediate brain swelling that can result in death or severe neurological injury, which may occur when there is a second hit to the head before the youth has fully recovered from the first hit.
Many schools have gone beyond the basic requirements of the law to protect youth brains. These schools have introduced baseline neurocognitive concussion testing programs. In these programs, youth athletes take a short computerized test that measures memory, reaction time, processing speed, and attention skills to determine how they normally function. Then, if an athlete sustains a concussion, he or she is retested and the scores from the post-concussion test are compared to their baseline (normal) test scores. Especially for youth, a neuropsychologist or other neurocognitive specialist with expertise in understanding these tests can best interpret the differences in pre and post test scores. Test scores in addition to the results of a medical exam, physical exertional testing, such as by an athletic trainer, and the input of other concussion health team specialists help to determine when the youth is recovered. Importantly, concussion test scores alone should never be the determining factor for return to play.
Because of cost, staffing, space, and time constraints, baseline testing is usually available on a limited basis, most often for high school varsity athletes, which leaves out most of the youth population. To address this gap, many proactive club and league youth sports teams are providing baseline testing as part of their seasonal registration process. In addition, parents and athletes may obtain testing at credentialed sports concussion health center. Parents and athletes should ask if the testing program is overseen and guided by a neuropsychologist to be sure that a standardized test administration protocol is followed and that the test results are screened for validity.