What’s Missing in Youth Concussion Laws

by Tony Doran, Psy.D.
HeadFirst Concussion Care Program Director

A recent Fox Sports article discusses the youth concussion laws that have passed in all 50 states and the District of Columbia, but it also highlights some key elements that were missed.

Over the past five years, each state has modeled their laws after the State of Washington law in 2009, also known as “The Zackery Lystedt Law” after a high school athlete who suffered a life-changing concussion (pictured below, pre-injury and today, with his father).Zackery-Lystedt

Unfortunately, only 21 states have implemented all four key components of Washington’s law, which is considered the gold standard by many professionals:

1. REMOVAL FROM PLAY
This is pretty basic. The science and medical reasons for asking a child or athlete to leave a game or practice when a concussion is suspected is in place so a second and potentially more dangerous concussion does not occur. As of today’s writing, neither Illinois nor Wyoming requires the removal of an athlete from play in such a scenario. Arizona and South Carolina allow an athlete to return to play the same day if cleared by a physician.

When a child is suspected of having a concussion, it is a good idea to at least wait 24 to 48 hours after the injury to ensure that symptoms do not develop. Here at HeadFirst, as many as 40% of our patients develop symptoms one to two days after their injury.

2. EDUCATION
Fortunately, this is not as opposed as it was just three or four years ago. Coaches now realize the importance of receiving education about how to evaluate and treat a head injury. New York law requires not only coaches but also nurses, athletic trainers, and teachers to receive training on concussion and concussion management.

But New York is the exception and there are many states that don’t require education about concussion. Researchers and scientists also still need to do much in this area. Studies have not been completed on what coaches and athletic trainers know prior to training and what type of training is effective.

3. PARENTAL CONSENT
This is quite a basic component of the law which requires student athletes and parents to sign an informed consent stating they understand the dangers of the sport and that a concussion or traumatic brain injury is one of the risks involved in the sport.

4. MEDICAL CLEARANCE
Only 30 states have this element as part of their laws requiring clearance by a trained concussion healthcare provider prior to injured athletes’ return to play. Many laws and training programs also do not specify what training a concussion specialist needs or requires.

Even though these elements are a good first step, they’re still not enough to protect our children. A carefully designed return-to-learn plan is just as important in concussion recovery since academic demands can slow brain healing. Unfortunately, only two states—Nebraska and Virginia—have return-to-learn elements within their concussion guidelines. These procedures require a school to be notified if a student has sustained a concussion and then to give that student accommodations due to the injury.

Some states have even made unsuccessful attempts to add supplementary requirements to their concussion laws.

Oklahoma tried to add a section to their law that would mandate suspensions and punishments on coaches and athletic trainers who didn’t follow concussion guidelines.

Massachusetts attempted to add required neurocognitive baseline testing for all high school students.

And, Maryland tried to add a requirement of helmet sensors on high schoolers’ helmets before basic scientific research had been completed on the sensors or the meaning of a positive or negative sensor result.

HeadFirst-Doc-is-In

A number research studies continue to suggest the negative effects of alcohol (and other recreational drug use) after brain injury.

Alcohol is a neurotoxin — meaning alcohol kills brain cells — exacerbating the effects of a concussion. There is no recommended safe amount of alcohol or recreational drug use after a concussion. Even moderate amounts of alcohol for people with a concussion have been associated with increased deficits in memory, attention and balance.

Additionally, heavy pre-injury alcohol consumption is associated with poorer health outcomes and substance abuse post-injury. Many concussion patients report they are more sensitive to the effects of alcohol after injury. Even a small amount of alcohol after a concussion can impair judgment and increase the risk of a fall (and subsequent head injury).

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The AB and ZZZZZs of Sleep for Athletes: Get Your Rest Before Taking Your Baseline Test!

by Sherray Holland, PA-C
HeadFirst Concussion Care Provider

It is recommended to get a good night’s sleep on a regular basis, but how much is considered a “good” amount? How long do you sleep?  I am mainly asking high school and college athletes here. And I know sometimes it is easier said than done when you factor in homework, sports, other extracurricular activities….maybe even a job!

Picture this: You are eager to start your season.  Then your coach or athletic trainer tells you to take a baseline test. You may have heard about it from other students or not at all. Most schools and many organizations, including HeadFirst Concussion Care, are using the ImPACT® baseline test to measure the way an athlete’s brain functions, including cognitive thinking, memory and reaction time. The computerized test takes about 25 minutes to complete (as cited in Lovell, 2010) and is intended to give your coach, trainer, and provider a baseline measure of your normal brain function. In the unfortunate event of a concussion, you will take the ImPACT test over time (usually every office visit) to help your healthcare provider, coach, athletic trainer, and teachers make proper decisions for school and returning to play as you recover.

Getty Images

Getty Images

Okay, back to the subject at hand. Now it is the night before the baseline test. How long should you sleep? A recent study published in the American Journal of Sports Medicine reported that athletes who slept fewer than seven hours before the baseline performed worse on three of four ImPACT scores and reported more symptoms related to their brain injury (as cited in McClure, et al., 2014).

Here’s the bottom line: it is important to get enough sleep on a regular basis, aiming for more than seven hours. If you do not get enough sleep before your ImPACT test, it may not represent your academic ability at its best, especially if you have to go through the entire day and take it after school. Many times in the HeadFirst clinic, I have seen the results of a patient’s test after a suspected concussion better than his or her baseline!  Remember, this is a serious matter so make sure to put your best effort forward. I hope you found this helpful and would like to hear your thoughts.

Tips for Getting a Good Night’s Sleep

Having trouble falling or staying asleep? Here are some helpful advice for healthy sleep habits:

  • Keep a regular bedtime routine every night
  • Do not exercise or eat a heavy meal three hours prior to going to bed
  • Do not drink or eat foods with caffeine three hours prior to going to bed
  • Avoid naps. If you are tired and must take a nap, make sure it is a short nap and not close to your bedtime.
  • Rest and unwind before heading to bed. Avoid stimulating television shows or video games.
  • Make sure your room is quiet, comfortable, and without bright lights.
  • If you do not go to sleep after 30 minutes,  try reading , listening to music, or other quiet activities to encourage relaxation.

Ms. Holland typically works at HeadFirst Waugh Chapel clinic. She received her Bachelor of Science in Physician Assistant Studies/Certificate in Primary Care at Howard University. Ms. Holland is a Board-certified Physician Assistant and is a member of the American Academy of Physician Assistants and an American Academy of Physician Assistants Veteran’s Caucus Member.

A Message from Kelley – Fake Dr.’s Note

I recently read an article that made my jaw drop. It basically stated there are websites that will produce a fake doctor’s signature so an athlete will be allowed to return back to play. It really got me thinking; is the pressure in today’s society to “suck it” up and play greater than the potential risk of further injury?

I mean, this is your brain we’re talking about! I couldn’t believe students would take advantage of something like this. Then I realized the pressure to return to sports is huge.

When I first got my concussion my team would say, “we can’t wait to have you back”, and “practice isn’t the same without you”. It was killing me; I was missing so much of what I thought was a ‘crucial’ high school experience. I got to the point where I even  told the school’s Physical Trainer that I was “feeling a ton better” and expected resume regular activity within the next few weeks. In reality, I was feeling the same, if not worse.

At that point I didn’t realized the seriousness of what could have happened if I returned to play too soon. Now, being more educated on the subject, I can’t help thinking how stupid it was for wanting to go back. Maybe it was just a normal response from a normal teenager?  Maybe I just wanted to get back to normal and appear ‘super-human’, like an athlete on tv. Someone who could “tough-it-out” like a pro. I hate to think what could have happened if I had played before being cleared.  It makes me wonder what happens to athletes who play after being cleared by a fake doctor.

Concussion awareness and education is the only way for them to fully understand the impact of their choices.