Slide1Seeing the movie Concussion is like seeing the new Star Wars movie, Omalu: The Force Awakens without watching the six previous films.

So based on Matt Chaney’s history of football, here the six movies that need to be made to bring the universe back in balance.

Episode I: Head Injury: The Phantom Menace

Based in the Greek and Roman times, the first film features the earliest doctors who wrote about head injuries in gladiators and soldiers. Even without modern medical equipment, doctors could “see” the phantom menace of invisible brain injury. And in this film, the helmet industry begins their two thousand year odyssey to find a better way to protect the head.  

Episode II: Knights in Armor or The Attack of the Clones

The second film, set in the Middle Ages, stars knights who fight in “clone-like” shells of metal in competitive games and war. Over the centuries, the helmet changes form as craftsman try to use different shapes and materials to protect the warriors’ head. Despite massive changes in ships, weapons, and technology over time across the Star Wars Series, notice the Storm Troopers’ helmet stays the same shape much has been true in the last decades of football with only a change in color for this latest film. In space as on the earth, there is only so much one can do with a helmet but metallic paint does look cool even if it does nothing to protect the brain. 

Episode III: Football invented: Revenge of the Sith

In the third film, the game of football rises from the ashes of the Civil War. While heralded as the “All American Game” with war-like training to make boys into men, a dark side emerged as boys and men are wounded and killed in this new “battle” sport.

Coaches and doctors scramble to find balance between the light and the dark of football while the universe waits for a hero to save the day.

Episode IV: Teddy: A New Hope

President Teddy Roosevelt rises as the “New Hope” of football in the fourth film. Jedi Teddy wins the battle to save football with his new rules making football safer from the Dark Side (thus the Death Star is destroyed) and order is restored to the universe.  

Episode V: The Empire Strikes Back

However, in the fifth film set in the 1920-30s, the Dark Side is still present as scientists and doctors continued record brain damage in football players’ and boxers’ head injuries using terms like “Punch Drink,” Dementia pugilistica, and even CTE (Yes, the term was used before Omalu was even born). 

Despite the American Association of Pediatrics AAP twice clearly stating in 1957, and 1967, that football should be banned for children 12 and under, football’s popularity grows and this battle game expands to kids so we leave the film having to wait for the sequel.

Episode VI: Return of the Jedi

In the sixth film in the 1960-80s, the NFL rises to power towering over football seeking to control all aspects of the game. And like the real sixth Star Wars movie, this film is rather incestious as the family ties emerge and it is hard to see who is on which side?

(In the real sixth film, Luke finds out Darth Vader is his dad and Leia is is his sister… The same is true in the football saga. The team doctors on the NFL sidelines have internal conflicts over player health since the doctors are employees of the NFL.

Again, additional NFL rules changes are supposed to destroy the dark side of football (or the latest Death Star) and it seems to be the end of the conflict by the time the credits run. A tidy end to the saga?

Episode VII: Omalu: The Force Awakens

Not to spoil the real movie for you, but like every other action movie, our hero, Jedi Omalu, single-handily battles the re-packaged version of First Order or the new “Safer Football” NFL. But knowing the real history, it is hard to cheer on Omalu’s claims to be the first Jedi to have an epic battle with the Dark Side of Football. Also, missing in Concussion is Chris Nowinski who like Luke is left out of the seventh film.

Yes, Omalu found CTE in Webster’s brain while personally funded his quest, but the film’s lack of placing Omalu on the shoulders of those who came before him, leave one feeling that the film is telling less than the truth. That is unless the six missing movies are filmed…

A final note: It is very convenient for the Dark Side to have this new film which links the “discovery” of brain damage in football to 2002, the year of Omalu rather than an earlier date… say, 1894.

Yes, 1894… Not a typo.

“A 1894 New York Evening Post editorial ripped the incorrigible violence of college football, chiding the hypocrisy—or calculated rhetoric—of organizers and supporters who tried to label boxing the only barbaric pastime.” 

The Post opined:

“There is one characteristic of the new football which all those who promise us its reform seem to overlook, and that is that it is the only athletic sport which brings the whole bodies of the players into violent collision.

In short, is not the distinction between the ring and college football as played Saturday a distinction without a difference? Is not the attempt to make a [perceived] difference a bit of sophistry of which the champions of the game ought to be ashamed? It is true [the boxer] plays a game which consists in wasting his adversary’s strength so that he can no longer resist.

But how does this differ from college football? Is not the slugging of the enemy’s best men so as to close their eyes, strain their hips, break their noses, and concuss their brains, and thus compel them to withdraw from the field, exactly the pugilist’s policy?”

Read more of the truth: http://fourwallspublishing.com/BlogMChaney/?p=629

These three educational videos and app can provide you the motivation, the education and the tool YOU can use to help any child or adult with a possible concussion.

It is always best to have an athletic trainer be the first responder to a possible concussion, but without an AT, here is how a student, parent or volunteer coach can prepare:

Why you need to be educated?

Video recommended for middle and high school athletes, coaches and parents. Parents, please watch first before showing to younger children. 4 minutes

What you need to know?

Video recommended for all age kids plus coaches and parents. Video uses humor to educate. 4 Minutes

UPDATE: The term “Rest” used in the video is now referred to as “Reasonable Rest” or “Sensible Rest.” The outdated treatment plan of laying in a dark room for weeks at a time has been shown to increase anxiety, stress and add to the recovery challenge. Too much activity is also detrimental. Finding the sweet spot in-between is a joint effort of the concussion team consisting of the medical provider, family and school to assess and plan for each individual student.

 

How best to recover after a concussion (but watch it now)

Recommended for kids, parents and coaches by international experts, Dr. Mike Evans and Dr. Gerry Gioia.  11 minutes

 

THE APP to have on your phone when a possible concussion happens. Screen Shot 2014-10-23 at 1.09.29 PM

 

FREE SmartPhone App guides coaches and parents step by step on how to assess an injury and respond by providing current CDC guidelines on when a child should be removed from play and when to call 911.

This app is recommended for coaches to notify parents of a possible head injury based on the most current CDC information, and time and geo stamps the final report. This report is emailed from with the app from coach to parent, manager and team. The app also records information which will be useful for the doctors and parents at a later time to judge RTP and guide a recovery plan.

The app is available at the Apple® App StoreSM and Google Play.

 

My Review of the PAR CRR App is A+

Why would this help kids? After a possible head injury, this app guides coaches and parents on how to assess the injury and how best to respond by providing current medical guidance on when to call 911 or if the child should be removed from play. The app also records information which will be useful for the doctors and parents at a later time to judge RTP and guide a recovery plan.

Example of use: A youth sport athlete suffers a hit on the soccer field. The athlete is taken to the sideline, accessed with the app and the parent is emailed the information about the athlete with ACE care materials.

What is it? An app

Who uses it? Coaches or parents

When? At the first sign of any suspected head injury

To do what? After a possible head injury, coach or parent are led through set of questions about the child’s current signs, symptoms and behaviors. The user is given a set of conditions when to stop using the app and call 911, and if none of those conditions are met then to proceed to ask the athlete how he or she feels. The app records information which will be useful for the doctors. A summary of the answers to the question can be emailed to the parents with care instructions.

How do I get this app? Download on it on your smart phone from the app store

Who supplies the info? Coach or any adult

Cost? Free

Compliance? HIPPA and FERPA Compliant

Liability issues? Could decreases liability for coach and team

No Smart Phone?

I have developed a paper version of the app above for organizations who have members without smart phones. Dr. Gerry Gioia has reviewed and approved this paper form.

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Download CRR Non-Med Sheet1

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The product which is yet unnamed.

A carefully scripted unveiling of a “potential new technology” that “possibly could be a solution to prevent sports concussions” in “the future” was presented today in New York City to potential investors and various members of the press.

My intern, Alex, and I were delayed by traffic, and so unfortunately Dr. Julian Bailes was already part way into his talk when we arrived.

Why I was there

I was invited to the presentation and decided to attend to ask my signature question if females were being included in the research. Specifically, I wanted to know in the testing of this product were female athletes included, at what levels of development and how many females were included.

After the presentation and the modeling of the band by two male and two female athletes, I was able to ask my question sin the Q&A. But despite the fact two of four model athletes were females, I was told females were not being used in the sports research currently on-going to test the product.

At the end of event, I was given follow-up information by the company that females had been used during the safety trials in the lab test, and the company would address the lack of females in future sports studies in the field.

What I want to know from you

In the rest of this post I will try to explain the science of the collar as it was explained to us using a combination of my photos of slides, information provided by the event and some short videos I shot. I am interested to see any one knows if this concept has been tried in past?

I have learned from Matt Chaney’s research that much what is being presented as “new” such “Get head out of the game” techniques and “hit sensors” have all been tested in past decades, and are currently being recycled as new. If you have some additional information behind this concept, please comment below or email me?

NOTE: Video of today’s presentation will be posted on the company per the press release (posted at the end of this blog) and I will link this when it is available.

From the official press release…

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The stage today

Performance Sports Group Ltd. (NYSE: PSG) (TSX: PSG) (“Performance Sports Group” or the “Company”), a leading developer and manufacturer of high performance sports equipment and apparel, along with several leading medical experts today unveiled what the Company and presenting doctors believe could be a significant breakthrough in addressing mild traumatic brain injury (“mTBI”) in sports.

The potential breakthrough, a proprietary yet easy-to-use band worn on the neck, was unveiled during a presentation that featured leading experts in neurology and medical research.

Taking part in the presentation was:

  • Dr. Julian Bailes, Chairman of the Department of Neurosurgery and Co-director of the NorthShore University HealthSystem Neurological institute;
  • Dr. Gregory Myer, Director of Research for the Division of Sports Medicine at Cincinnati Children’s hospital;
  • Dr. Neilank Jha, Neurosurgeon and Spine Surgeon and Chairman of KONKUSSION; and
  • Dr. Charles Tator, Senior Scientist, Toronto Western Hospital.
  • Kevin Davis, CEO of Performance Sports Group
  • Mark Messier, six-time Stanley Cup winner and member of the Hockey Hall of FameDr. Gregory Myer mapped out the path the unnamed product has taken starting at the bottom working up this pyramid diagram.

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The first section, Biomimetics, covered the woodpecker and rams, then how helmets are limited to keep the brain from moving.IMG_1671

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“Studies demonstrate that helmets (with 3 inches of foam) reduce a 25 G football impact… to 24.5 G.”

How thick does the foam in a helmet need to be to reduce impact?

 

 

 

So if we cannot improve the helmet anymore, can we do something inside the brain to help?

This was core question for the rest of the presentation.

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Is it possible to reduce biomechanically induced damage to the brain?

 

 

 

 

Here is the Slosh Theory behind the collar.

Slosh is the movement of the brain, which is floating in cerebrospinal fluid inside the skull. When the head experiences an impact, or sudden, extreme movement, the brain sloshes inside the skull and can rotate or strike the inside walls of the cranium, often tearing brain fibers. The result of these impacts can produce mTBI.

The band is designed to address mTBI through the application of light pressure on the neck, which in turn mildly increases blood volume in the vein structure of the brain. This increase in blood volume is intended to minimize the sloshing of the brain inside the skull.

“This is the first solution to address mTBI from inside the skull,” said Bailes, a founding member of the Brain Injury Research Institute who is portrayed in the upcoming Sony Pictures film Concussion for his work to identify Chronic Traumatic Encephalopathy (CTE) in former professional football players. “By increasing the volume of blood in the cranial cavity, there’s less room for the brain to move which reduces the overall slosh effect which we believe reduces mTBI. The research results are very encouraging and we are excited to work with Performance Sports Group to continue the important research and bring this technology to market.”

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The video below shows what happens when left skull with the air space between the top of the skull and the yellow liquid — and the right skull with no air space — hit the wall.

Dr. Myers reported…

In two separate peer-reviewed research studies, which were published in the medical journals Neurosurgery and Journal of Neurosurgery, respectively, the researchers found an 83 percent reduction in the number of torn fibers in a standard concussion model when the band was utilized. In addition, Dr. Myer cited several other studies during the presentation that showed promising results for the band.

My video clip on…

  • “Nature’s Jugular Compression Device”
  • “Slosh Theory = Intracranial Solution?”
  • “Slowing down blood flow out of the brain to make a bubblewrap of the brain”

My video clip on…

  • Head ramming sheep
  • Rio Data to see if reduced concussions at higher altitudes (not any part of the collar study)
  • “Is this safe for kids wear?”

After the presentation, we could don collars and wear them for the rest of the event, if we wished. Our necks were measured, and we were given collars based on neck size.

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The bands arranged by size here starting at 11.

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Alex, one of the PINKconcussions interns, modeling the collar.

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(After the event, I was also able to discussing the need for the donation of more female brains to the nation’s brain banks with Dr. Bailes. See upcoming blog on this conversation.)

As I am on the third week of a concussion, the collar increased my headache in the few minutes I wore it. It wasn’t uncomfortable, but it did make my already present headache throb so it was uncomfortable.

At the end of the event, I did ask the models – students from Harvard – if they felt anything adverse wearing the collars. They said after the first few minutes they didn’t feel the collars at all and they had worn them a few hours.

Model Photos provided in the media kit – again females were shown wearing the collars.

The Official Press Release

Performance Sports Group and Leading Medical Experts Unveil First-of-its-Kind Technology to Address Mild Traumatic Brain Injury

Simple Device Worn on the Neck Shown to Reduce Indicators of mTBI in Independent Research Studies 

NEW YORK — November 17, 2015 — Performance Sports Group Ltd. (NYSE: PSG) (TSX: PSG) (“Performance Sports Group” or the “Company”), a leading developer and manufacturer of high performance sports equipment and apparel, along with several leading medical experts today unveiled what the Company and presenting doctors believe could be a significant breakthrough in addressing mild traumatic brain injury (“mTBI”) in sports.The potential breakthrough, a proprietary yet easy-to-use band worn on the neck, was unveiled during a presentation that featured leading experts in neurology and medical research. Taking part in the presentation was Dr. Julian Bailes, Chairman of the Department of Neurosurgery and Co-director of the NorthShore University HealthSystem Neurological institute; Dr. Gregory Myer, Director of Research for the Division of Sports Medicine at Cincinnati Children’s hospital; Dr. Neilank Jha, Neurosurgeon and Spine Surgeon and Chairman of KONKUSSION; and Dr. Charles Tator, Senior Scientist, Toronto Western Hospital. Kevin Davis, CEO of Performance Sports Group and Mark Messier, six-time Stanley Cup winner and member of the Hockey Hall of Fame, also took part in the discussion.“It was exciting to bring together such a renowned group of medical experts in the field of mild traumatic brain injury and have them agree that this technology – and the supporting science behind it – could be a step forward in addressing mTBI in sports,” Davis said. “As a leading manufacturer of protective sports equipment, we believe it is our obligation to do everything we can to help bring this exciting new technology to athletes around the world.”The band is the first technology of its kind that is intended to reduce mTBI internally by using the body’s own physiology rather than through the use of external protective devices, such as helmets. The band addresses the “slosh theory,” which was identified by Bailes, Dr. Joseph Fisher, Senior Scientist, Toronto General Research Institute; and Dr. David Smith, Visiting Scientist, Cincinnati Children’s Hospital and Medical Center as one of the key causes of mTBI.Slosh is the movement of the brain, which is floating in cerebrospinal fluid inside the skull. When the head experiences an impact, or sudden, extreme movement, the brain sloshes inside the skull and can rotate or strike the inside walls of the cranium, often tearing brain fibers. The result of these impacts can produce mTBI. The band is designed to address mTBI through the application of light pressure on the neck, which in turn mildly increases blood volume in the vein structure of the brain. This increase in blood volume is intended to minimize the sloshing of the brain inside the skull.“This is the first solution to address mTBI from inside the skull,” said Bailes, a founding member of the Brain Injury Research Institute who is portrayed in the upcoming Sony Pictures film Concussion for his work to identify Chronic Traumatic Encephalopathy (CTE) in former professional football players. “By increasing the volume of blood in the cranial cavity, there’s less room for the brain to move which reduces the overall slosh effect which we believe reduces mTBI. The research results are very encouraging and we are excited to work with Performance Sports Group to continue the important research and bring this technology to market.”In two separate peer-reviewed research studies, which were published in the medical journals Neurosurgery and Journal of Neurosurgery, respectively, the researchers found an 83 percent reduction in the number of torn fibers in a standard concussion model when the band was utilized. In addition, Dr. Myer cited several other studies during the presentation that showed promising results for the band.Performance Sports Group acquired the exclusive perpetual, worldwide license from Q30 Sports, LLC (“Q30”) in October 2015 to use its patent and technology assets in the development of products that are intended to address mTBI in sports and athletic activities. The Company has initiated the process of obtaining the necessary regulatory approvals from the United States Food & Drug Administration (FDA), Health Canada and other regulatory bodies in order to market and sell the band to athletes in the global marketplace.“There is more research that needs to be conducted and we are working with the relevant regulatory bodies to ensure we are following the appropriate and requisite steps to bring this technology to market,” Davis said. “Subject to completion of all the required testing, we would hope to potentially begin offering this product to athletes within the next 12-24 months.”To see a video of the entire presentation, visit www.performancesportsgroup.comAbout Performance Sports Group Ltd.Performance Sports Group Ltd. (NYSE: PSG) (TSX: PSG) is a leading developer and manufacturer of ice hockey, roller hockey, lacrosse, baseball and softball sports equipment, as well as related apparel and soccer apparel. The Company is the global leader in hockey with the strongest and most recognized brand, and it holds the No. 1 North American position in baseball and softball. Its products are marketed under the BAUER, MISSION, MAVERIK, CASCADE, INARIA, COMBAT and EASTON brand names and are distributed by sales representatives and independent distributors throughout the world. The Company is focused on building its leadership position by growing market share in all product categories and pursuing strategic acquisitions. Performance Sports Group is a member of the Russell 2000 and 3000 Indices, as well as the S&P/TSX Composite Index. For more information on the Company, please visit our website.Forward-Looking StatementThis press release includes forward-looking statements within the meaning of applicable securities laws, including with respect to the use of Q30’s patent and technology assets in the development of products that are intended to reduce the incidence of mTBI in sports and athletic activities, obtaining and maintaining approvals from the FDA, Health Canada and other regulatory bodies that are necessary to market and sell products applying the relevant licensed patent and technology assets, and successfully bringing to market products within the next 12-24 months that may have the ability to reduce the incidence of mTBI in sports and athletic activities. The words “may”, “will”, “would”, “should”, “could”, “expects”, “plans”, “intends”, “trends”, “indications”, “anticipates”, “believes”, “estimates”, “predicts”, “likely” or “potential” or the negative or other variations of these words or other comparable words or phrases, are intended to identify forward-looking statements.Forward-looking statements, by their nature, are based on current assumptions and estimates and are subject to important risks and uncertainties. Many factors could cause outcomes to differ materially from those expressed or implied by the forward-looking statements. Technology that may be considered medical devices are subject to complex regulatory approval processes, which are lengthy and the outcome of which is uncertain. Obtaining regulatory approval is subject to the discretion of regulatory agencies and there is no assurance that any device or product incorporating the Q30 technology will be approved by the applicable regulatory agency on a timely basis, or at all. Any failure or delay to obtain or maintain regulatory approvals could affect the manufacturing and marketing of products and our ability to generate revenue from such products, either of which could adversely affect our business and financial condition. In addition, the manufacture, marketing and sale of the technology will be subject to ongoing and extensive governmental regulation in each country in which the Company intends to market its products. Failure to comply with any of these post-approval requirements can result in a series of sanctions, including withdrawal of the right to market a product. Our success depends on, among other things, the value and reputation of our products or brands. Any new products that are not favourably received by consumers could damage our reputation. The lack of market acceptance of such products or our inability to generate satisfactory revenues from such products to offset their costs and investments could have an adverse effect on our business and financial condition. Furthermore, we cannot be assured that the technologies for which we have obtained licenses are adequately protected to prevent imitation by others. Additional risk factors are detailed in the “Risk Factors” section of the Company’s Annual Report on Form 10-K dated August 26, 2015 and in the Company’s first quarter report on Form 10-Q, which are available on EDGAR at www.sec.gov, on SEDAR at www.sedar.com and on the Company’s website.Furthermore, unless otherwise stated, the forward-looking statements contained in this press release are made as of the date hereof, and we have no intention and undertake no obligation to update or revise any forward-looking statements, whether as a result of new information, future events or otherwise, except as required by applicable law. 

While this settlement did not accomplished all the goals of the lawsuit, the door had been opened for change and improvement now the elephant in the room has been acknowledged. 

In a nut shell…

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From the NYTimes…

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                                                         To read the NYTimes article

 

And here are the settlement papers:

             FIFA_SettlementAgreement 2

Here are comments from attorney Derek Howard, lead attorney, from Big Win for American Soccer: Youth Concussions Settlement Makes US World Leader Posted Monday, November 9, 2015 at 9:00 pm ET/6:00 pm PT:

Co-Lead Counsel Derek Howard, representing the plaintiffs, said, “This is a big win for American soccer.” Howard, an attorney who has coached youth soccer in the San Francisco Bay area for three decades, said, “Teamwork gets results. By working together, the plaintiffs and US Soccer US will allow our country to lead the world in preventing concussions in soccer and educating coaches and parents.”

Here are quotes from two of the plaintiffs, two of five the women who made up the #TheFIFA5:

Plaintiff Rachel Mehr said, “I am happy to see that US Soccer is taking steps to protect the players and making the game safer than it was when I played.” The case is Mehr et al v. FIFA et al (14-cv-03879 PJH). It was filed August 27, 2014 in U.S.D.C. Northern District of California.

Plaintiff Kira Aka Seidel said, “In my eyes, ensuring the protection of developing minds is of the utmost importance. While there is always more that can be done to keep our youth safe, I am confident that this agreement will help reduce the risk of concussion on the soccer field and provide the necessary tools to properly address a situation in which a head injury occurs.”

From Chris Nowinski, Concussion Legacy Foundation Founding Executive Director formerly known as SLI:

“These guidelines are a major victory for the Safer Soccer campaign and a fantastic first step in making the world’s most popular sport safer to play for children,” said Chris Nowinski. “Together the supporters of the Safer Soccer campaign showed there is widespread support for the elimination of headers for children, and U.S. Soccer heard our message.”

From Dr. Bob Cantu, Concussion Legacy Foundation Founding Medical Director:

“We’re thrilled that progress is being made, but there is more we can do,” said Dr. Robert Cantu. “Research has shown that delaying the introduction of headers to age 14 would prevent over 35,000 concussions in middle school players per year. These new rules still leave many of those middle schoolers at risk, so we will continue to campaign to raise the age further.”

For more background on the lawsuit please read my blog posts.

Congratulation to so many people who worked for this change.

Norwalk, CT  On Monday evening, August 24, 2015, Mayor Harry Rilling, Norwalk Department of Health and Katherine Snedaker, will host The Norwalk Youth Concussion Summit at 7 pm at Norwalk City Hall in the Community Room. The summit will review how Norwalk has lead the state by taking a citywide approach to addressing youth concussions. This event is an opportunity for medical providers, youth sports leaders and school officials review the success of the Norwalk Concussion Guidelines, and discuss a plan for the coming school year as Norwalk officially becomes a “Concussion Care Connected Community.”

Along with political and school leaders from neighboring towns, following Norwalk Hospital and the Norwalk Public Schools administrators are scheduled to attend the summit:

  • Dr. Steven J. Adamowski, Superintendent of The Norwalk Public Schools
  • Michael J. Daglio, President of Norwalk Hospital and Senior Vice President of Western Connecticut Health Network
  • Dr. Benjamin Greenblatt, Chair of the Department of Emergency Medicine
  • Vicki Smetak, MD, Chair of the Department of Pediatrics at Norwalk Hospital

There will also be a dedication of the Norwalk Concussion Guidelines in the name of Jonathan Brown, a late resident of Norwalk who died in 2012, in the memory of his love for sports and for the message for young kids participating in any physical activities to never take a head injury lightly

There will be a review of Norwalk Concussion Project by Katherine Snedaker, Executive Director of the non-profit, Pink Concussions, and advocacy organization SportsCAPP, and a clinical update for medical providers by Patricia McDonough Ryan, PhD, from the Gaylord Hospital Center for Brain Health. The summit will conclude with a discussion of plans for 2015-2016 school year and the proposed IRB research study with Dr. Theresa Miyashita, Ph.D., ATC, PES, CES, Program Director, Athletic Training Education Program at Sacred Heart University.  

The meeting is free and open to anyone but please RVSP to Katherine Snedaker at Katherine@PINKconcussions.com to guarantee seating is available.

Norwalk was the first city in CT to enact concussion guidelines for organized youth sports programs which utilized Norwalk recreation facilities. The guidelines were created to close the loophole that exists in the current Connecticut Concussion Law which protects only public middle and high school athletes who play for their school-sponsored teams.  Only one out of every 11 Norwalk Students is covered by the state law. The Norwalk Guidelines increased protections to 6 out of every 11 students when it was passed in April 2015, by the Norwalk Rec & Parks and the Norwalk Common Council.

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Screen Shot 2015-04-30 at 10.47.39 AMFIFA and US National Soccer Organizations’ newest excuse (#5 if you are keeping count) to abandon any responsibility toward concussion is they do “n0t own the soccer fields.”

This is the latest development of #TheFIFA5 Lawsuit that pits three mothers and two female college students vs FIFA, soccer’s worldwide governing body—the Fèdèration Internationale de Football Association, soccer’s worldwide governing body and affiliated soccer organizations in the United States – US Soccer, US Club Soccer USCS, American Youth Soccer Organization AYSO, and California Youth Soccer Association, Inc, in the class action lawsuit filed on August 27, 2014. 

A second round of paperwork filed by FIFA and the US national soccer organizations adds a new twist to the “Concussions are not our problem” argument by arguing they don’t own the soccer fields to the claim of “no direct contact with players” thus powerless and landless, they have no influence over youth concussion policy.

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For a quick review of the the first round of Motions to Dismiss papers, the international or national soccer organizations stated they were NOT responsible to change any rules around concussion issues because:

  1. They “lack direct contact with the players.” THUS SHIFTING BLAME TO THE VOLUNTEER COACHES
  2. They “have no duty to make the game safer or to ameliorate risks inherent in the sport; their only duty is to not increase such risks. “ STATUS QUO IS STATUS QUO
  3. FIFA clearly states it “has no legal duty to Plaintiffs to prevent risks that are inherent in the sport, like those from heading a soccer ball.”  PARENTS – YOU KNEW THE RISKS FOR YOUR CHILDREN
  4. US Soccer states, “Legislature in each of those states has specifically addressed the issue of concussion management for youth sports, and none has imposed such obligations on an organization like US Soccer. Rather, like the Consensus Statement, the focus of the various state concussion laws is on educating and assigning responsibility to those individuals who have direct contact with the players to prevent a child suspected of having suffered a concussion from returning to play without first obtaining clearance from the child’s medical provider.” THOSE THE VOLUNTEER COACHES AGAIN…

And now a fifth reason:

      5. They don’t “own the soccer fields.”  THUS SUE THE TOWN AND THE SCHOOLS

These papers a chilling read as “not our responsibility” approach will do more to scare the volunteer coach away from working with kids than asking them to do 20 min online CDC training course as Norwalk has so successfully done. Norwalk’s City Concussion Plan has addressed concussion education and policy by using their ownership of the sports fields and gyms for the greater good of youth sports. Unfortunately, FIFA, US Soccer, US Club Soccer USCS, American Youth Soccer Organization AYSO, and California Youth Soccer Association, Inc, seem to believe they are powerless and blameless over a simple policy change which would make the beautiful game safer for all.

A new research study and a new defense by soccer organizations in the #TheFIFA5 lawsuit seem to confirm a citywide concussion plan maybe a very effective way to make sports safer for kids and lower liability for teams and city alike.

Highlights

  • ALL FOR ONE: Norwalk, CT successfully launches new citywide concussion plan for all youth sports
  • CONCUSSION LAWS WORK: Dr. Trojian published new study showing the positive effect of The Connecticut State Concussion Law
  • WE DON’T OWN THE FIELDS: Fifa and national soccer organizations’ new excuse to avoid taking a stand on youth concussion

All For One (City)

On April 15, 2015, Norwalk, CT became the first municipality in the country to enact a citywide Youth Concussion Plan governing all sports teams who use city and school fields/gyms. The plan was unanimously approved by the city council and the Norwalk Concussion Guidelines took effect on April 15, 2015, covering the over 6,000 youth players and 800 coaches who were not covered by the state’s concussion law due to a legal loophole. Based on the SportsCAPP model, I proposed the citywide plan to help youth sports teams to address concussions in young athletes and try to reduce liability exposure for coaches and the city.

As of end of April, all spring-season sports have successful trained their volunteer coaches using the online CDC training course. The Norwalk sports teams have almost unanimously responded with support, before and after the city vote, as they saw the potential benefits of increased safety and lowered liability . A few teams had fears of increased administrative work but were able to meet the deadline with less effort than they thought.

And this week at opening day and first team meetings, parents are given CDC fact sheets and/or emailed links to engaging, cartoon videos to educate the video-centric youth players. Parents and team managers alike have been pleased with the program so far as the first phase of implementation draws to a close.

Now as the season starts, coaches will be required to pull any athlete suspected of a possible concussion, notify parents, and only allow the athlete to RTP with a doctor’s note. The teams are also required to report any suspected concussions to parks and rec using the CRR a free concussion app or an paper form I created (to use until CRR hopefully creates a paper version).

Preparations are being made to hold a citywide medical training in July for all providers to update their practices in concussion evaluation and management because I expect more young athletes will seek medical care for possible concussions.

Concussion Laws Work

A new study shows that concussion laws do seemed to increase the number of athletes who seek medical care for their concussions. Dr. Thomas Trojian of Drexel University College of Medicine was lead author of a new study that showed a sharp increase in the number of youth athlete receiving medical treatment for sports-related concussions after CT concussion laws were passed in 2010. The findings are published in Springer’s journal Injury Epidemiology:

Dr. Trojian and his team’s study is among the first to investigate whether such a state law has had an effect on the medical system. They analyzed the emergency room records of two major trauma centres in Connecticut. A marked increase in the frequency of high school students being treated for sports-related concussions was found. This went up from 2.5 visits per month prior to the law being passed, to almost six per month thereafter. This suggests that the state’s sports-related concussion law has helped to improve the evaluation and detection of such injuries among high school students, by increasing obligatory emergency room visits.

Source: Trojian, T. et al (2015). The Effects of a State Concussion Law on the Frequency of Sport-Related Concussions as Seen in Two Emergency Departments, Injury Epidemiology . DOI 10.1186/s40621-015-0034-7

“We Don’t Own the Soccer Fields”

FIFA and US National Soccer Organizations’ newest excuse to abandon responsibility is they do “n0t own the soccer fields.”  This is the latest development in the second round of #TheFIFA5 Lawsuit that pits three mothers and two female college students vs FIFA, soccer’s worldwide governing body—the Fèdèration Internationale de Football Association, soccer’s worldwide governing body and affiliated soccer organizations in the United States – US Soccer, US Club Soccer USCS, American Youth Soccer Organization AYSO, and California Youth Soccer Association, Inc, in the class action lawsuit filed on August 27, 2014. 

A second round of paperwork by FIFA and the US national soccer organizations adds a new twist to the “Concussions are not our problem” argument by arguing they don’t own the soccer fields to the other claims of no direct contact with players thus they have no influence over concussion policy.

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For more on this, read “Excuse #5: We Don’t Own the Soccer Fields”

This continued “not our responsibility” approach by soccer will do more to scare the volunteer coaches away from working with kids than asking them to do 20 min online CDC training course as Norwalk has so successfully done.

Summary

Norwalk’s City Concussion Plan has addressed concussion education and policy by using their ownership of the sports fields and gyms for the greater good of youth sports. Unfortunately, FIFA, US Soccer, US Club Soccer USCS, American Youth Soccer Organization AYSO, and California Youth Soccer Association, Inc, seem to believe they are powerless and blameless over a simple policy change which would make the beautiful game safer for all.

1. WHAT IS THE PROBLEM? 

Our youngest child athletes by being coached by adult volunteers with little or no concussion education.

2. WHY IS THIS A PROBLEM?

Untrained coaches who do not know how to recognize and respond to a possible concussion, increase the risk of more serious injury for child athlete. Ignoring the signs of a concussion and not removing a child from play also increases risk of liability for coaches, teams and city/school (whoever owns the fields on which the sports are being played).

3. HOW CAN YOUTH SPORTS INCREASE SAFETY AND LOWER LIABILITY?

Three key elements need to be in place:

  1. Free resources for training/education via online training/videos, paper flyers, and smart phone apps
  2. Proper concussion policy
  3. A coach/parent/player concussion plan MUST BE MANDATED by the city and/or the sports organization

4. IS IT POSSIBLE TO MANDATE CONCUSSION TRAINING AND NOT UPSET COACHES?

Yes, programs which have done so report that coaches find the training of value to them.

5. WHERE HAS MANDATED COACH TRAINING BEEN SUCCESSFUL?

The BokSmart Program: A COUNTRY WIDE PROGRAM

  • 100% of Youth Rugby Coaches in South Africa are trained 
  • 78,000 coaches trained across the country in concussion education plus other first aid skills
  • 8 hour course – must be taken first BEFORE a coach can coach a game. Refs check training cards before each match
  • 100% of youth rugby players in the country now have trained coaches plus ALL INJURIES are tracked (KEY)

TCYFL – The Chicagoland Youth Football League: A REGIONAL PROGRAM

  •  42 Communities in the Chicago Metro area
  • 1857 coaches trained in concussion management using 90 min video
  • 100% of Injuries are tracked weekly using injury reporting software (KEY)
  • 360 teams all have at least 5 trained coaches
  • 8615 youth football players now have trained coaches
  • 180 games each weekend all covered by certified athlete trainers
  • 360 team’s practices are covered by safety player coaches
  • 0 the number of coaches who left due to the additional burden of concussion training
  • 2 parents complained the first year and none the second

The City of Norwalk: A CITY PROGRAM (VIA PARKS AND REC) – Start date April 15, 2015

  • 6,000 youth players
  • 700 coaches
  • 30 minute CDC Coach Training for all coaches, CDC fact sheets for parents/athletes
  • Affects five baseball leagues, two soccer leagues, citywide lacrosse league plus the town sponsored basketball, field hockey and football teams

6. BASED OF THE SPORTSCAPP.COM MODEL, WHAT ARE THE NORWALK CONCUSSION GUIDELINES?

  • User Groups or Organizations = mean any group or organization that has been granted permission to use any City of Norwalk recreation facility
  • Athletic Activities and/or Athletic Programs = all activities including practices, training, performances, scrimmage, games and other organized competitions involving athletic activities such as sports and dance

To use any City of Norwalk recreation facility, a “User Group” providing “Athletic Activities or Programs” to children (age 7 to 18) must:

  1. Educate Coaches, Parents, and Athletes: 
    • Inform and educate coaches, through FREE CDC ONLINE training
    • Educate athletes and parents and guardians about concussion via CDC concussion information sheet
  2. Remove From Play any Athlete who is showing signs, symptoms, behaviors of concussion
  3. Obtain Permission to Return to Play: An athlete can only return to play or practice after at least 24 hours and with permission from a health care professional
  4. Record and submit to Parks & Rec any concussions over the season

7. WHY IS DATA COLLECTION ESSENTIAL?

Only by collecting data can programs and policies be benchmarked and reviewed. All policy should be based on data.

8. HOW DO COACHES ACCESS FREE CDC ONLINE TRAINING?

9. PER THE CDC WEBSITE, WHICH ORGANIZATIONS SUPPORT THE CDC CONCUSSION TRAINING?

  • US Lacrosse
  • US Soccer
  • USA Baseball
  • USA Football
  • USA Rugby
  • USA Volleyball
  • YMCA of the USA
  • Amateur Athletic Union
  • Amateur Softball Association/USA Softball
  • American Academy of Neurology
  • American Academy of Pediatrics
  • American Academy of Physical Medicine and Rehabilitation
  • American College of Sports Medicine
  • American Medical Society for Sports Medicine
  • American School Health Association
  • American School Health Association
  • American Sports Education Program
  • Brain Injury Association of America
  • Brain Trauma Foundation
  • Center for Injury Research and Policy, the Research Institute at Nationwide Children’s Hospital
  • Children’s National Medical Center
  • Defense and Veterans Brain Injury Center
  • Emergency Nurses Association
  • Health Resources and Services Administration, EMS for Children
  • Health Resources Services Administration, Traumatic Brain Injury Program
  • Massachusetts Department of Public Health
  • Matthew Alan Gfeller Sport-Related TBI
  • Research Center, University of North Carolina at Chapel Hill
  • Mayo Clinic
  • MSU, Institute for the Study of Youth Sports
  • National Academy of Neuropsychology
  • National Alliance for Youth Sports
  • National Association of School Nurses
  • National Association of Secondary School Principals
  • National Council for Youth Sports
  • National Education Association
  • National Education Association Health Information Network
  • National Federation of State High School Associations
  • National Interscholastic Athletic Administrators Association
  • National Program for Playground Safety
  • National Recreation and Park Association
  • North American Brain Injury Society
  • Pop Warner Little Scholars, Inc.
  • President’s Council on Physical Fitness and Sports
  • Safe Kids Worldwide
  • Safe States Alliance
  • Sarah Jane Brain Foundation
  • Society of State Directors of Health, Physical Education & Recreation 
  • Sports Legacy Institute
  • University of Pittsburgh Medical Center, Sports Medicine Concussion Program

10. HOW OFTEN SHOULD THE COACHES TRAINING COURSE BE TAKEN?

Due to the quick pace of coaches aging through youth sports teams, SPORTSCAPP.com recommends this test be taken on a yearly basis.

11. CAN THE COURSE BE TAKEN IN A GROUP SETTING RATHER THAN ON SOLO ON A COMPUTER OR SMART PHONE?

Yes, this is ideal way to train and since a live Q&A session can provide sports’ specific experience. Some local football and lacrosse teams have already provided this type of training. But the course can also be taken by an individual anywhere there is internet access and a computer, iPad or iPhone.  

12. HOW CAN A CERTIFICATE BE GENERATED TO SHOW THE COACH TOOK THE COURSE?

  1. When the coach clicks on the course link, he/she will be asked to providIMG_8776e their full name before the course begin
  2. At the end of the course, the program will offer a certificate to print or download as a PDF or a palm card
  3. The certificate can then be printed and scanned then emailed to the team administrator. A PDF can simply be mailed

13. WHO SHOULD GET A COPY OF THE CERTIFICATE?

Documentation of the coach successfully completing the course should be:

  1. Kept by the coach accessible practices and games – saved on phone or paper
  2. Sent to the team or User Group or Organization and produced for verification of compliance by the Recreation Department prior to any permit or license being granted for the use of any City of Norwalk facility for each sport season
  3. There are plans which will be announced in the near future of a centralized registry

14. WHAT IS A FREE APP WHICH CAN INCREASE SAFETY FOR PLAYERS AND LOWER LIABILITY FOR COACHES? 

Screen-Shot-2014-10-23-at-1.09.29-PM-150x150CONCUSSION RESPONSE GUIDE + PARENT NOTIFICATION TOOL = ONE APP

This FREE SmartPhone App is recommend for coaches/parents to help a youth player with a possible head injury, and officially notify parents of the head injury based on the most current CDC information. With time and geo stamps on final report, the coach can officially emailed from the app to the parent, the manager and the team. The report records information which will be useful for the doctors and parents at a later time to judge RTP and guide a recovery plan

  • Why would this help kids? After a possible head injury, this app guides coaches and parents on how to assess the injury and how best to respond by providing current medical guidance on when to call 911 or if the child should be removed from play. The app also records information which will be useful for the doctors and parents at a later time to judge RTP and guide a recovery plan.
  • Example of use: A youth sport athlete suffers a hit on the soccer field. The athlete is taken to the sideline, accessed with the app and the parent is emailed the information about the athlete with ACE care materials
  • What is it? An app
  • Who uses it? Coaches or parents
  • When? At the first sign of any suspected head injury 
  • To do what? After a possible head injury, coach or parent are led through set of questions about the child’s current signs, symptoms and behavoirs. The user is given a set of conditions when to stop using the app and call 911, and if none of those conditions are met then to proceed to ask the athlete how he or she feels. The app records information which will be useful for the doctors creating a recovery plan. A summary of the answers to the question can be emailed to the parents with care instructions. 
  • How do I get this app? Download on it on your smart phone from the app store
  • Who supplies the info? Coach or any adult
  • Cost? Free
  • Compliance? HIPPA and FERPA Compliant
  • Liability issues? Decreases liability for coach and team. While it is always best to have an athletic trainer be the first responder to a possible concussion, this tool can direct a parent or volunteer coach to respond in a responsible way.

15. WHAT EDUCATION DO PARENTS AND ATHLETES NEED?

For coaches to be successful with concussion emergency plans, athletes and parents also need education on:

  • Current practice in proper injury prevention techniques and skills
  • The signs and symptoms of concussion = CDC Handouts – Links below
  • The procedure for notifying parents when an athlete has been removed from play for a head injury or suspected concussion = PER EACH ORG’s RULES

16. WHAT CDC RESOURCES EXIST FOR PARENTS AND KIDS? 

Information for Parents

Information for Athletes

17. WHAT ARE BEST FREE VIDEOS TO EDUCATE STUDENTS, PARENTS AND COACHES? 

Screen-Shot-2014-10-23-at-1.00.06-PM-150x150VIDEO #1: Why you need to be educated? 4 min Powerful Video (Note: Click link and scroll down half-way down the article to play the video of Peter Robinson talking about his son) Recommended for high school athletes, coaches and parents. Parents, please watch first before showing to your children. Link: http://www.theguardian.com/sport/2013/dec/13/death-of-a-schoolboy-ben-robinson-concussion-rugby-union 

Screen-Shot-2014-10-23-at-1.00.26-PM-e1414084615169-150x143VIDEO #2: What you need to know? 4 min Funny Cartoon Recommended for all age kids plus coaches and parents. – really well done and funny. Link: http://brain101.orcasinc.com/5000/ 

 

Screen Shot 2014-10-23 at 1.21.11 PMVIDEO #3: How best to recover after a concussion (but watch it now) – for kids, parents and coaches by Top Doctors Dr. Mike Evans and Dr. Gerry Gioia. Link: http://www.sportscapp.com/2014/08/28/best-concussion-video-of-2014-rtl/ 

 

 

18. IS THERE REALLY A LIABILITY RISK IN YOUTH SPORTS?

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19. HOW DID U.S. YOUTH SOCCER AND FIFA RESPOND TO A LAWSUIT DEMANDING A BETTER CONCUSSION PLAN

Here are some quotes from the Motion to Dismiss papers (attached below) from the current youth soccer lawsuit filed by FIFA, US Soccer, Defendant National Association of Competitive Soccer Clubs, Inc., d/b/a US Club Soccer (“USCS”), American Youth Soccer Organization (“AYSO”), California Youth Soccer Association, Inc.

  • FIFA  and all the others named stated they “lack direct contact with the players.” SHIFTING BLAME TO THE VOLUNTEER COACHES
  • FIFA (and others) have no duty to make the game safer or to ameliorate risks inherent in the sport; their only duty is to not increase such risks. “ STATUS QUO IS LEGAL
  • FIFA (and others) clearly state it “has no legal duty to Plaintiffs to prevent risks that are inherent in the sport, like those from heading a soccer ball.”  YOU KNEW THE RISKS FOR YOUR CHILD.
  • US Soccer clearly states, “Legislature in each of those states has specifically addressed the issue of concussion management for youth sports, and none has imposed such obligations on an organization like US Soccer. Rather, like the Consensus Statement, the focus of the various state concussion laws is on educating and assigning responsibility to those individuals who have direct contact with the players to prevent a child suspected of having suffered a concussion from returning to play without first obtaining clearance from the child’s medical provider.”

Please open and read these papers:

20. IS IT REALLY POSSIBLE TO INCREASE SAFETY AND LOWER LIABILITY?

Yes, and please contact me if you have any doubts or questions.

There are also low cost smart phone apps to manage injury reporting and make parents email/children’s emergency information accessible to coaches on the field. Please contact me for more info. I have no financial ties with any of these companies.

While the new CT State Law requires all districts provide a number for concussions diagnosed in their students, the Norwalk School Concussion Project is going a step further and shedding the light on the various types of sport and non-sport concussions across our K-12 schools.

For the next semester, I want to breakout gym class concussions from the sports tally, and look for causes in the “home, but non-sports” concussions, especially in the high school girls.

All of this is possible because of the efforts of the Norwalk school nurses and ATs to track these students, and I am so grateful for their efforts.

Screen Shot 2015-03-10 at 5.13.54 PM

 

The first chart below explains which concussion this school year have been covered by the state concussion law (22 concussions in green) and the second chart shows the youth sports concussions (19 concussions in red) which will be covered by the Norwalk guidelines as of April 15, 2015. The 19 youth concussions so far this year were not covered under the state law and those athletes would not have any of the benefits of the state law.

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Reposted permission from http://concussionpolicyandthelaw.com/

The City of Norwalk, Conn. made history last month when the Norwalk Common Council voted 15 to 0 to approve Youth Sport Concussion Guidelines for its 6,000 youth athletes and 700 coaches who use municipal fields, gyms and facilities.

Connecticut’s Concussion Law only applied to Norwalk’s 1,145 high school athletes, meaning city guidelines were needed to extend the concussion protocol to the remaining youth athletes. To illustrate that point,

“Norwalk has set a new ‘standard of care’ for young athletes ages 3 to 18,” said Snedaker. “These guidelines are the most progressive for any city in Connecticut and maybe even in the United States.”Katherine Snedaker, a Norwalk resident and Executive Director of the non-profit PinkConcussions.com, told Concussion Litigation Reporter that 75 students in Norwalk public schools have reported concussions with 19 of them coming from non-school sports, which were not covered by the state law.

Snedaker, who was instrumental in getting the guidelines passed, said the guidelines will apply to all City of Norwalk-sponsored Athletic Activities and Programs and to those Athletic Activities and Programs operated or conducted by any user group or organization on or in facilities belonging to the City of Norwalk.

Athletic Activities and/or Programs can be defined as “all activities including practices, training, performances, scrimmage, games and other organized competitions involving athletic activities such as sports and dance.”

As of April 15, 2015, any sports team which wants to obtain a permit to use city fields, gym or courts must:

1.     Train Coaches and Educate Parents, and Athletes

a.     Train coaches, through FREE CDC online training

b.    Educate athletes and parents and guardians about concussion with FREE CDC concussion information fact handouts

2.     Remove From Play ANY Athlete who is showing signs, symptoms, behaviors of concussion

a.     REMOVE POSSIBLY INJURED PLAYERS showing the signs, symptoms and/or behaviors of a possible head injury

b.    Immediately notify parents of injury

c.     Request evaluation from a medical provider

d.    Hold out athlete from returning to play for at least 24 HOURS

3.     Obtain Permission to Return to Play
An athlete can only return to play or practice after at least 24 hours and with written permission from a health care professional

4.     Record Concussions and submit injury report via official online form to Rec & Park for all concussions

Snedaker said the guidelines are “win-win” for all involved.

“While no law can prevent a concussion, these guidelines will increase safety for children while lowering risk liability for coaches, leagues and the town,” she said. “It is a win-win for all.”

She hopes other cities in Connecticut will recognize their value.

“There are certain groups in our state, who are scared to have youth sports added to the state law. Norwalk’s success at passing the guidelines with all leagues supporting, and not one angry phone call, shows it can be done.”

**Update: I have now written John Sutter, President of US Youth Soccer, and asked him to remove this document and replace with current, best practices**

NOTE: My thoughts in red text below. Disclosure: I am parent and a social worker, not an athletic trainer or a doctor. From the parent’s eye, here are the obvious holes I see in this NEW Policy which was uploaded Feb 2015. Am I being too harsh? Let me know…

I do not have permission to post this. But since this important protocol is only supplied as a downloadable PDF (which you cannot link to), I needed to download it and repost it here.

The lawsuit against US Youth Soccer has merit I believe based this document alone…

US Youth Soccer Concussion_Procedure_and_Protocol_rev_2_15

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Concussion Procedure and Protocol

For US Youth Soccer Events

Concussion: a traumatic brain injury that interferes with normal brain function.  Medically, a concussion is a complex, pathophysiological event to the brain that is induced by trauma which may or may not involve a loss of consciousness (LOC). Concussion results in a constellation of physical, cognitive, emotional, and sleep-related symptoms. Signs or symptoms may last from several minutes to days, weeks, months or even longer in some cases.

CONCUSSION SIGNS, SYMPTOMS, AND MANAGEMENT AT TRAINING AND COMPETITIONS

Step 1:

Did a concussion occur?

Doesn’t ask if there was a blow to the body and head, jerking of the head?!?  With this protocol as spelled out, most kids on the team would have a concussion based on these descriptions alone.

Evaluate the player and note if any of the following signs and/or symptoms are present:

(1)   Dazed look or confusion about what happened.

(2)  Memory difficulties.

(3)   Neck pain, headaches, nausea, vomiting, double vision, blurriness, ringing noise or sensitive to sounds.

(4)   Short attention span.  Can’t keep focused.

(5)   Slow reaction time, slurred speech, bodily movements are lagging, fatigue, and slowly

answers questions or has difficulty answering questions.

(6)   Abnormal physical and/or mental behavior.

(7)   Coordination skills are behind, ex: balancing, dizziness, clumsiness, reaction time.

THE SECTION ABOVE IS MISSING: 

  • Repeats things 
  • Cannot call events before 
  • Cannot call events after
  • Feeling tired
  • Sensitivity to light
  • Numbness or tingling
  • Difficulty concentrating
  • Difficulty remembering
  • Feeling fogy/groggy
  • Feeling slowed down
  • Irritable
  • More emotional
  • Doesn’t feel right

AND NO MENTION OF WHAT TO DO IF THESE SIGNS ARE PRESENT? HOLD THEM OUT? PUTTING THEM BACK IN THE SECOND HALF AFTER A REST? THIS IS SUPPOSED TO BE THE “MANAGEMENT PLAN” AS STATED ABOVE.

Step 2:

Is emergency treatment needed?

This would include the following scenarios: WOULD THIS BE JUST ONE OF THESE OR MORE, AND IF IT IS AN EMERGENCY WHAT IS COACH SUPPOSED TO DO?

(1)   Spine or neck injury or pain.

(2)   Behavior patterns change, unable to recognize people/places, less responsive than usual.

(3)   Loss of consciousness.

(4)  Headaches that worsen

(5)   Seizures

(6)  Very drowsy, can’t be awakened

(7)  Repeated vomiting

(8)  Increasing confusion or irritability

(9)  Weakness, numbness in arms and legs

      THIS SECTION IS MISSING: 

  • One pupil largers than another
  • Slurred speech
  • Will not stop crying/cannot be consoled
  • Increasing restlessness

AND NO MENTION OF WHAT TO DO IF THESE SIGNS ARE PRESENT? HOLD THEM OUT? PUTTING THEM IN YOUR CAR AFTER THE GAME AND GO TO A HOSPITAL? THIS IS SUPPOSED TO BE THE “MANAGEMENT PLAN” AS STATED ABOVE.

Step 3:

If a possible concussion occurred, but no emergency treatment is needed, what should be done now?

Focus on these areas every 5-10 min for the next 1 – 2 hours, without returning to any activities: DOESN’T SAY “STAY OUT 24 HOURS” – JUST TWO HOURS?

THIS NEXT PART IS JUST STUPID – YOU ARE SUPPOSED TO CHECK THE KID 24 TIMES IN 2 HOURS AND HOW ARE YOU SUPPOSED TO CHECK THESE AS A PARENT OR A COACH?!?

(1)   Balance, movement.

(2)   Speech.

(3)   Memory, instructions, and responses.

(4)   Attention on topics, details, confusion, ability to concentrate.

(5)  State of consciousness

(6)  Mood, behavior, and personality

(7)  Headache or “pressure” in head

(8)  Nausea or vomiting

(9)  Sensitivity to light and noise

OK IN TWO HOURS, NOW DO WHAT?

Step 4:

A player diagnosed with a possible concussion may return to US Youth Soccer play only after release from a medical doctor or doctor of osteopathy specializing in concussion treatment and management. DOESN’T EVEN MENTION “STAY OUT 24 HOURS”

 

Step 5:

If there is a possibility of a concussion, do the following: LOTS OF DETAIL ON WHAT FORMS TO FILL OUT

(1)   The attached Concussion Notification Form is to be filled out in duplicate and signed by a team official of the player’s team.

(2)   If the player is able to do so, have the player sign and date the Form. If the player is not able to sign, note on the player’s signature line “unavailable”.

(3)   If a parent/legal guardian of the player is present, have the parent/legal guardian sign and date the Form, and give the parent/legal guardian one of the copies of the completed Form. If the parent/legal guardian is not present, then the *******KEY POINT BURIED team official is responsible for notifying the parent/legal guardian ASAP by phone or email and then submitting the Form to the parent/legal guardian by email or mail. When the parent/legal guardian is not present, the team official must make a record of how and when the parent/legal guardian was notified.  The notification will include a request for the parent/legal guardian to provide confirmation and completion of the Concussion Notification Form whether in writing or electronically.

(4)   The team official must also get the player’s pass from the referee, and attach it to the copy of the Form retained by the team.

References:

Kissick MD, James and Karen M. Johnston MD, PhD.  “Return to Play After Concussion.” Collegiate Sports Medical Foundation.  Volume 15, Number 6, November 2005. 2005 TEN YEARS AGO?!?! http://www.csmfoundation.org/Kissick_-_return_to_play_after_concussion_-_CJSM_2005.pdf.  April 22, 2011.

National Federation of State High School Associations.  “Suggested Guidelines for Management of Concussion in Sports”.  2008 NFHS Sports Medicine Handbook (Third Edition).  2008 77-82. THIS WAS WRITTEN IN THE DARK AGES: CONCUSSIONS WERE GRADED IN 2008

http://www.nfhs.org.  April 21, 2011. WHY 2011?!? It is a website which should updated?!?

AM I BEING TOO HARSH? HONESTLY, MY KIDS COULD WRITE A BETTER PROTOCOL FOR CONCUSSION SIGNS, SYMPTOMS, AND MANAGEMENT AT TRAINING AND COMPETITIONS. 

bigstock-Soccer-Ball-In-Goal-47239690 2For six months, I have been anxiously waiting to see how FIFA, US Soccer, US Club Soccer USCS, American Youth Soccer Organization AYSO, California Youth Soccer Association, Inc, would respond to the class action lawsuit filed against them on August 27, 2014,  This lawsuit pit three mothers and two female college students vs FIFA, soccer’s worldwide governing body—the Fèdèration Internationale de Football Association, soccer’s worldwide governing body and affiliated soccer organizations in the United State.

This lawsuit demands no financial rewards but only that FIFA and the soccer other organizations mentioned, make the following changes to their program:

  1. Implement up-to-date guidelines for detection of head injuries
  2. Implement up-to-date RTP after a concussion
  3. Regulation of heading by players under 17 years old
  4. Eliminate heading under 14 years old age groups
  5. Implement a rule change to permit substitution of players for medical evaluation purposes. (Currently, FIFA rules generally allow only three substitutions per game with no clear provision for head injuries. If an athlete bleeds, even from a scrape, removal is required, but no similar rule exists for concussions. FIFA provides no guidance on substitutions in youth games in the U.S.)
  6. Implement medical monitoring for soccer players who received head injuries in the past

Filed on January 30, 2015, Motions to Dismiss Papers by FIFA and the others make it very clear who should be held liable in future concussion lawsuits. Take a guess? No, flip through 1 or 2 of these.

I had hoped this soccer lawsuit would force the hands of these international and national leaders in soccer to produce a unified concussion plan for youth players. Instead I was sadden to read the responsibly being pushed down squarely upon the shoulders of the volunteer coach – the one with “direct contact” with the children. 

In my non-legal opinion, the Motions to Dismiss papers, in nutshell, state that none of the international or national soccer organizations are responsible to change any rules around concussion issues because:

1. They “lack direct contact with the players.” THUS SHIFTING BLAME TO THE VOLUNTEER COACHES

2. They “have no duty to make the game safer or to ameliorate risks inherent in the sport; their only duty is to not increase such risks. “ STATUS QUO IS STATUS QUO

3. FIFA clearly states it “has no legal duty to Plaintiffs to prevent risks that are inherent in the sport, like those from heading a soccer ball.”  PARENTS – YOU KNEW THE RISKS FOR YOUR CHILDREN

4. US Soccer states, “Legislature in each of those states has specifically addressed the issue of concussion management for youth sports, and none has imposed such obligations on an organization like US Soccer. Rather, like the Consensus Statement, the focus of the various state concussion laws is on educating and assigning responsibility to those individuals who have direct contact with the players to prevent a child suspected of having suffered a concussion from returning to play without first obtaining clearance from the child’s medical provider.”

These papers a chilling read for I think this “not our responsibly” approach will do more to scare the volunteer coach away from working with kids than asking them to do 20 min online CDC training course. Sadly, this fear-based response will not help to make a sport I love any safer for our kids. There is no reason to fear concussion safety education unless you fear knowing CPR or the Heimlich Maneuver, too?

Just as parents and older teens take the safe boating course before they head out for a day on the water, all adults and older teens heading out to play land sports should take the 20 minute, FREE, online CDC Coaches Training for the sake of their own liability.

Don’t wait for FIFA to lead the way… Just take the CDC course and go coach youth soccer!!

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His name is Carson Barry and he is 12 years old. Carson has been researching concussions for over two years since his brother, who suffered several hockey concussions, committed suicide.

Carson lives in Butte, Montana, and plays on a youth hockey team. He is the youngest of four brothers; and in this photo from 2009, the boys sitting left to right are Tanner, Cullan, Travis, and Carson.

Born into a hockey family, Carson was on skates by the age of two and as soon as he was old enough, he began to play youth hockey like his older brothers had done. In this photo, Carson, age 2, being helped by brother, Cullan, and his mom, Christine. This day was Carson’s first time on skates.

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I first learned about the Barry Family from Christine Barry’s post on TheConcussionBlog.com, Sept. 17, 2011:

Our son, Cullan Barry, died from suicide May 13, 2011. He was a hockey player and had received a concussion on Feb 26, 2011; but in Dec 2009, he also had been sent to the hospital by ambulance following an illegal hit in the back that sent him down like a rag doll. They did a CAT scan of his head said it was fine and focused on his knee that had hit the boards. He was off the ice for six weeks with the knee injury but had ongoing migraines. No doctor every told us that ongoing migraines could be tied to a brain injury form the hockey hit, no doctor ever told us to watch for such things. 

His grades dropped he had difficulty with insomnia with fatigue, with concentrating on things like English and math, but we kept thinking his migraines were food-related. Now I believe the headaches, insomnia, and fatigue were all related to that big hit injuring his brain and other hits in hockey continuing to injure his head. However, doctors assured us the CAT scans were fine. 

At the Feb. 2011 (ER visit), the ER doctor did not even come into the room to check him and just told the nurse what to do and say. We were given standard do not play for couple weeks and he was released with no discussion of symptoms to look for of ongoing brain trauma. Cullan had a migraine the night he died. I think ER doctors need to be greatly more informed about concussions and parents of athletes need this information about post concussion syndrome, brain injuries caused by multiple impacts over time. 

I reached out to Christine, Carson’s mom, to hear more about her son, and we spoke on the phone about Cullan’s life, his tragic death and wondered what role concussions may have played in his decision to take his life. We promised to stay in touch.

Christine wrote me in the Fall of 2013, and asked me to participate in her youngest son’s science fair project. I offered to help Carson with the project which was a Facebook survey about suicide and contact sports.

From: Christine 

Subject: Science project results

Date: March 21, 2014 at 11:00:29 PM EDT

To: Katherine

Dear Katherine,

Thank you for your help with Carson’s survey.

Carson won a blue ribbon for 5-6th grade science projects, a gold medal for behavioral science projects, an award for best 5-6th grade science projects, and an award for top ten science projects out of 482 5-8th grade projects at the Montana regional science fair. He is only in 5th grade so was too young to go to the state science fair. 

So thank you for your responses to his survey.

I have included the graphs of his results which he, I and evidently the judges found jaw dropping:

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The best of all this is he is already planning what he wants to do for next year which is he wants to get helmet sensors and measure how hard an impact can cause a concussion and how hard of an impact would cause kids to report symptoms to coaches or parents. He wants to use his hockey team, 10-12 year olds. This would give impact results on much younger kids as most research is on college or pros and would also give some insight into reporting tendencies of children in sports. 

So do you have any ideas about what helmet sensors would be the best? There are several out there including one that has a phone app to alert when a kid may have had too hard of a hit or need a concussion eval.

Thank you,

Chris

I was excited to see if I could help Carson and reached out to some sensor people I knew. But first, I asked Carson to write me a letter explaining what he wanted to accomplish so I could pitch his project to some sensor companies. These research-grade sensors are extremely expensive and I needed evidence that this 12 year old was a serious researcher and not like my own kids who just hit my sample sensors with baseball bats.

Here is a letter I received from Carson explaining his project:

Reducing Suicide Risk by Reducing Brain Injuries and Concussions

My name is Carson Barry and I have been researching concussions and a possible link to suicide for my school science projects for the last 2 years. I am 11 years old and I go to Silver Bow Montessori School in Butte Montana.

My interest in this research started after my brother committed suicide at the age of 17 following a series of concussions he had in an 18 month period. My family and I have felt his death was related to the concussions. We lobbied the Montana legislator to pass a concussion education and return to play law in our state.  We hosted a concussion education and safe play clinic at our hockey rink last fall. 

photo (7)Last year for my fourth grade science project I surveyed 3 high school hockey teams about whether players had experienced concussions, how many concussions, what symptoms they had and how long it took for them to be symptom free.  I found 27 players who had concussions or a whole hockey team.  Contrary to what my brother had been told by doctors who treated him that it would take about 2 weeks to heal from a concussion, I found it was taking the hockey players an average of 3- 6 months to be symptom-free and several players were still having symptoms after a year. I also found that 67% of the players reported that they had thoughts of self harm while recovering from their concussions.

The fact that 67% of hockey players recovering from a concussion had thoughts of self-harm seemed very alarming. I thought someone needed to research whether a brain injury was a suicide risk. So this year for my fifth grade science project I put a survey on Facebook asking people who had lost a loved one to suicide if that person had a previous brain injury and if they had played a contact sport where they could have had an unreported or misdiagnosed concussion. My results found that 70% of the suicides had a previous brain injury. When I added in suicides who had played a contact sport the number jumped to 84%. This again was alarming. I felt that if these athletes could better identify when their brain is injured,  better report their symptoms, or be better treated for the injury these deaths could be prevented.

For my science project next year, I would like to research what force or impact it takes to cause a concussion in youth athletes. I want to compare the impact force to when and what symptoms a player reports. I want to see if players tend to under report or brush off symptoms compared to when an impact sensor says they should be evaluated.  I would like to use helmet sensors on my PeeWee hockey team (ages 10-13).  Then I would like the players to fill out symptom checklists after a game and for the next week.  Most impact helmet sensor research has been done on college or pro athletes and I think it is the younger athletes’ brains who are more fragile. I think my findings can help players protect their brains and reduce their risk of suicide.

I was wondering if your organization could help me get helmet sensors for my project. My hockey team will have 10-12 players next season.

I can be reached at my Mom’s e-mail at 

Thank you very much,

Carson Barry

image001With Carson’s letter in hand, I reached out to Danny Crossman CEO of Impakt Protective to see if his company could loan Carson research-grade quality sensors. Danny agreed to help and would able to loan Carson some sensors when the UPMC researchers were finished with their project thus Carson’s project was set for the fall of 2014.

Working with sensors is not easy for adults, and Danny cautioned me this would be a difficult project for a young researcher:  

“Carson should know that studying one team of 10-12 years olds (15-20 kids) wont yield a lot of data (usually 2-3 hits over 40g per contact game) and certainly won’t yield a lot of concussions (probably 3-5 per season at most).”

But Carson was determined, so the now the wait for the sensor began.

In October, we got the good news from Danny…

From: Danny

To: Christine

CC: Katherine

Subject: RE: Good news

Date: Mon, 27 Oct 2014 12:04:29 -0400

20 Shockbox sensors will ship out to you this week for Carson to use. They are used (during a University of Pittsburgh hockey study) and  will come with chargers and user cards. They are the HD-R (research) version and are equipped with a gyro to measure rotation (this is an estimate since it is hard to do accurately) and a 3-axis accelerometer to measure linear peak g (this is the standard measurement for head impacts). 

I was so excited for Carson to have the chance to fulfill his dream project and I wanted to stay in the loop so I asked Christine and Carson to send me photos and progress reports on the project.

From: Christine 

To: Katherine 

Subject: RE: sensors

Date: November 4, 2014 at 8:23:48 PM EST

I am sure he would love to send you updates, it would be good for him to log as he goes for his project IMG_0476anyway. He was cute as we were driving home from school, he saw a UPS truck and said “Oh I bet they have my sensors, hurry Mom we have to get home!” And indeed they arrived about 30 minutes later. [The photo is Carson with the newly arrived sensors.)

After a great deal of work learning how to use [including charging, syncing, recording data, and understanding the results] the sensors and convincing adults and kids to participate in the project, Carson used the sensors for 7 games total for his project. Not once did a ref ask about themIMG_0474 so refs didn’t even really noticing them. I did not tell the refs prior to games they were wearing them and I was a bit leary of refs questioning them but they did not seem to even notice. I did ask the MAHA board if they could wear them in league games, they asked if they enhance performance? I had to explain them to the board and then they said no problem.

IMG_0475Here are some of the boys right before they head to ice, right after putting sensors.

[For more about the Carson’s results, stay tuned to my next post]

Carson worked very hard on his project and his efforts paid off. Last week, Carson won a blue ribbon and a gold medal at his school science fair then top fifth/sixth grade science project and $50 at regional fair. There were 450 projects at the fair of which half of those fifth/sixth grade projects so he did very well said his proud mom.

Carson goes to a Montessori school and presented his project to the whole school on last Thursday. The whole school was impressed with his work.

IMG_0545IMG_0553Note the red hat that Carson is wearing in the picture. This hat belonged to his brother, Cullan. Carson’s mom can rarely get Carson to take the hat off and is getting very tattered now. Carson’s grandfather bought the hat for Cullan when he went to a USA hockey conference. Carson has adopted it and worn it quite religiously since Cullan died.

Carson promised his mom he would take it off when speaking to the judges, but as you can see  in the photos he wore it both before the judges came and has it right back on after they left.

I look forward to hearing the next report from the Montana State Science fair to see how many more people are touched by this amazing young researcher. 

Carson will be presenting his project at state fair on March 16 and  17; and March 17 happens to be Cullan’s birthday.

[If you want to congratulate Carson, please leave a comment below and I will forward to his mom]

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Mayor Harry Rilling, Katheine Snedaker, Jerry Petrini and Wyatt Machette at a press conference announcing new concussion guidelines for Norwalk youth sports. Photo Credit: Casey Donahue

My city of Norwalk, CT, made history this week when Norwalk Common Council unanimously approved Youth Sport Concussion Guidelines extending concussion education and training for the 6,000 Norwalk youth athletes and 700 coaches who use town fields, gyms and facilitiesI believe this is the most progressive in the United States a new “standard of care” for young athletes age 3 to 18. I am truly grateful and thrilled to have accomplished this with such a broad ban of supporters.

While no law can prevent a concussion, these guidelines will increase safety for children while lowering risk liability for coaches, leagues and the city. These benefits were obvious to the City of Norwalk who unanimously approved Youth Sport Concussion Guidelines for the 6,000 youth athletes who use town fields, gyms and facilities. The current state law only protected Norwalk ’s 1,145 high school athletes. There was no opposition to the vote as all major Norwalk youth sports organizations supported the new guidelines.

These guidelines were necessary as the Connecticut State Concussion Law of 2010 (updated in 2014) only protected the 1,145 public high school athletes who played for their school teams, not the 6,000 youth athletes and their coaches. Under the new guidelines, any team using municipal facilities must adhere to this new standard of care.

Norwalk youth sports organizations and city government agreed expanding these safety guidelines to all age children was a “no-brainer” and clearly a win-win situation for everyone – increasing safety for an additional 6,000 children while lowering risk liability for coaches, leagues and the city. 

Before the vote was taken, public pledges of support for the new guidelines were given by: 

  • Norwalk Junior Soccer Association
  • Norwalk Youth Football and Cheer
  • Norwalk Cal Ripkin Baseball
  • Norwalk Little League
  • Norwalk Lacrosse Association

As of April 15, 2015, any sports team which wants to obtain a permit to use city fields, gym or courts must:

1. Train Coaches and Educate Parents, and Athletes:

a. Train coaches, through FREE CDC online training

b. Educate athletes and parents and guardians about concussion with FREE CDC concussion information fact handouts

 

2. Remove From Play ANY Athlete who is showing signs, symptoms, behaviors of concussion

a. REMOVE POSSIBLY INJURED PLAYERS showing the signs, symptoms and/or behaviors of a possible head injury

b. Immediately notify parents of injury

c. Request evaluation from a medical provider 

d. Hold out athlete from returning to play for at least 24 HOURS

 

3. Obtain Permission to Return to Play: An athlete can only return to play or practice after at least 24 hours and with written permission from a health care professional

 

4. Record Concussions and submit injury report via official online form to Rec & Park for any concussions over the season

The Norwalk Daily Voice

Norwalk Makes History With New Concussion Guidelines For Youth Sports

by Casey Donahue 02/27/15 

NORWALK, Conn. – Norwalk has become the first city in the state to approve a concussion program for its youth sports designed to protect injured kids and prevent them from further …  Read more

BEFORE A CONCUSSION 

In 8 minutes, here is the motivation, education and a FREE tool YOU CAN USE to help any child or adult. It is always best to have an athletic trainer be the first responder to a possible concussion, but without an AT, here is how a parent or volunteer coach can prepare:

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Why you need to be educated?

4 min Powerful Video scroll down half-way down article to see video about Ben

 

 

 

Screen Shot 2014-10-23 at 1.00.26 PMWhat you need to know?

4 min Funny Cartoon for kids and adults

 

 

 

Screen Shot 2014-10-23 at 1.09.29 PMHow can you be prepared?

Free SmartPhone APP for all coaches and parents to download now

 

 

 

AFTER A CONCUSSION

This 10 minute video is the best guide for how to recover created by Dr. Mike Evans and Dr. Gerry Gioia, published August 2014.

 

I have expressed my displeasure before on this blog of the slow nature of NFHS to respond to the concussion issue. I will let the documents speak for themselves and check out my good friend, Dustin’s blog.

For the guidelines themselves, click link below:

NFHS announces guidelines on football full contact

For Dustin’s thoughts see http://theconcussionblog.com/2014/11/13/nfhs-develops-concussion-guidelines-for-football/

And here is the official Press Release…

NATIONAL FEDERATION OF STATE
HIGH SCHOOL ASSOCIATIONS

NEWS RELEASE

NFHS Concussion Task Force Recommendations to be Discussed by State Associations for Implementation in 2015

FOR IMMEDIATE RELEASE​Contact: Bob Colgate

INDIANAPOLIS, IN (November 13, 2014) — The National Federation of State High School Associations (NFHS) has finalized its position paper from the NFHS Concussion Summit Task Force, which met in July to develop recommendations for minimizing the risk of concussions and head impact exposure in high school football.
The recommendations, which have been shared with the 51 NFHS-member state high school associations, and approved by the NFHS Sports Medicine Advisory Committee (SMAC) and the NFHS Board of Directors, will be discussed by state associations at the NFHS Winter Meeting in early January for implementation in the 2015 football season.
The 24-member task force, which featured medical doctors, athletic trainers, high school coaches and key national leaders in high school sports, developed nine fundamentals for minimizing head impact exposure and concussion risk in football. They were designed to allow flexibility for state associations that collectively oversee the more than 15,000 high schools across the country that have football programs. As a result, each state high school association will be developing its own policies and procedures for implementation in the 2015 season.
Many of the recommendations focus on reducing the amount of full contact, including limiting the amount of full contact in practices during the season.
The Concussion Summit was the latest effort by the NFHS to minimize risk for the almost 7.8 million student participants in high school sports. In 2008, the SMAC advocated that a concussed athlete must be removed from play and not allowed to play on the same day. For the past five years, all NFHS rules publications have contained guidelines for the management of a student exhibiting signs, symptoms or behaviors consistent with a concussion. In 2010, the NFHS developed on online course – “Concussion in Sports – What You Need to Know” – and about 1.7 million individuals have taken the course through the NFHS Coach Education Program at www.nfhslearn.com.
The “Recommendations and Guidelines for Minimizing Head Impact Exposure and Concussion Risk in Football” position paper is posted on the NFHS website at www.nfhs.org.

About the National Federation of State High School Associations (NFHS)
The NFHS, based in Indianapolis, Indiana, is the national leadership organization for high school sports and performing arts activities. Since 1920, the NFHS has led the development of education-based interscholastic sports and performing arts activities that help students succeed in their lives. The NFHS sets direction for the future by building awareness and support, improving the participation experience, establishing consistent standards and rules for competition, and helping those who oversee high school sports and activities. The NFHS writes playing rules for 16 sports for boys and girls at the high school level. Through its 50 member state associations and the District of Columbia, the NFHS reaches more than 19,000 high schools and 11 million participants in high school activity programs, including more than 7.7 million in high school sports. As the recognized national authority on interscholastic activity programs, the NFHS conducts national meetings; sanctions interstate events; offers online publications and services for high school coaches and officials; sponsors professional organizations for high school coaches, officials, speech and debate coaches, and music adjudicators; serves as the national source for interscholastic coach training; and serves as a national information resource of interscholastic athletics and activities. For more information, visit the NFHS website at www.nfhs.org.

MEDIA CONTACTS:​Bruce Howard, 317-972-6900
​Director of Publications and Communications
​National Federation of State High School Associations
​bhoward@nfhs.org

​Chris Boone, 317-972-6900
​Assistant Director of Publications and Communications
​National Federation of State High School Associations
​cboone@nfhs.org

SEE UPDATE

soccer-ball-300x200This summary is based on information posted on the Hagens Berman S Shapiro LLP website and is my unofficial review of the lawsuit I have hash tagged as #TheFIFA5. NOTE: I am not a lawyer, and am merely outlining the suit as I read it. I welcome comments and thoughts.

On August 27, 2014, a Class-Action Lawsuit Filed Against FIFA, U.S. Youth Soccer Over Concussions made headlines. This lawsuit pits three mothers and two female college students vs FIFA, soccer’s worldwide governing body—the Fèdèration Internationale de Football Association (FIFA)—and affiliated soccer organizations in the United States

  • US Soccer Federation
  • U.S. Youth Soccer + American Youth Soccer (over 3 US million child and adolescent soccer players)

Note: In 2013, FIFA reported $1.386 billion in revenue.  The 2014 World Cup brought FIFA $1.2 billion from U.S. broadcasters. This lawsuit states FIFA has failed to enact the policies and rules needed to protect soccer players. FIFA and the others mentioned…

  1. Failed to adopt effective policies to evaluate and manage concussions, at all levels of the game
  2. Lacked of effective policies poses a greater danger to women and children players, who may more vulnerable to traumatic and long-lasting brain injury
  3. Ignored medical community called for changes over a decade ago
  4. Ignored simple, best-practice guidelines, which have been updated three times since the initial international conference on concussions (FIFA even hosted)

FIFA has made progress…

  1. With Concussion Marketing and policy materials, which tout a commitment to player safety
  2. By implemented policies to address other health threats (cardiac arrest and performance-enhancing drugs)
  3. Hosted 2012 concussion conference that updated concussion guidelines

This lawsuit demands FIFA and others mentioned…

  1. Implement up-to-date guidelines for detection of head injuries
  2. Implement up-to-date RTP after a concussion
  3. Regulation of heading by players under 17 years old
  4. Eliminate heading under 14 years old age groups
  5. Implement a rule change to permit substitution of players for medical evaluation purposes. (Currently, FIFA rules generally allow only three substitutions per game with no clear provision for head injuries. If an athlete bleeds, even from a scrape, removal is required, but no similar rule exists for concussions. FIFA provides no guidance on substitutions in youth games in the U.S.)
  6. Implement medical monitoring for soccer players who received head injuries in the past

Crossed posted on PinkConcussions.com

The new 2014 CT Concussion Law applies to students K-12 as well as athletes.

Is your school ready with updated policies/practices for the 2014-15 year?

TINY_FINAL.3

The Concussion Conference: 2014 Connecticut Concussion Law & Research-Based Best Practices for K-12 Schools

Wednesday, Sept 24, 2014
Hosted by Quinnipiac University Medical School, North Haven Campus
Produced by Katherine Snedaker, LMSW
Sponsored by Gaylord Center for Concussion Care

Register at TheConcussionConference.com

Opening Remarks ESPN’s TJ Quinn
Keynote “Sports Concussions: What do we really know?”  Anthony Alessi, MD

Presentations from Medical, Academic, Legal and Athletic Concussion Experts for all levels of school staff

Administration Superintendents, Principals, Headmasters, Business Managers, ADs, Heads of Pupil Services
Athletic Dept. Staff ADs, ATs, Coaches
Clinical and Academic Staff School RNs, Guidance Counselors, Psychologists, Social Workers, ATs, Teachers

Schedule All Participants can come partial, half or full day

Continental Breakfast    7:45 AM
Administration Sessions  8 AM -10 AM
Athletic Dept. Sessions  8 AM-12 PM
Clinical/Academic Sessions  8 AM-4:30 PM  

Questions Katherine Snedaker 203-984-0860 Katherine@SportsCAPP.com

Speaker Final

Guest post by Jamie Lyall

Australia — It was rather telling that when Dr Alan Pearce was asked on Monday whether he would be attending the forthcoming Australian Football League concussion workshop, he replied, “What workshop?”

Over the past year, Pearce’s research at Deakin University, Melbourne has brought the struggles of several former AFL and rugby league stars to the Australian public, and so thrust sports concussion into the limelight Down Under.

The cognitive impairments and short-term memory problems suffered by the likes of ex-Carlton midfielder Greg “Diesel” Williams and Test-level forward Ian Roberts are well-documented – both have featured prominently on national television – while, more worryingly, Pearce found that their amateur counterparts are liable to exactly the same symptoms minus the corresponding level of medical care and financial security.

It is surprising then that while the wise medics and scientists of Australian Rules football come together to talk concussion this week, the man whose findings brought the entire debate to a head in Australia will be sat alone in his office on the other side of Melbourne’s sprawling concrete jungle. He may as well be on the moon.

But perhaps we shouldn’t be so surprised; we’ve seen this before, after all.

The closed-shop, suppressive nature of the AFL’s handling of the concussion debate finds worrying resonance in the path trodden by their transatlantic cousins in the National Football League for many years.

The Australian administrators have tried desperately to distance themselves from the Stateside furore, and the findings made by Boston University’s team of researchers, who have posthumously diagnosed degenerative brain disease in hundreds of former athletes.

But a brilliant investigative report by ABC’s Wendy Carlisle last week revealed the true extent of the AFL’s deficiencies. She found that their official definition of concussion was false. That their flagship research programmes only began in 2012, had collected no data as yet, and were not in their fifth year of running as the body had claimed in its annual reports. That Associate Professor Paul McCrory, the man recognised as Australian Rules’ concussion expert-in-chief, had not published an original research article in over a decade.

Carlisle didn’t have to do much digging to scrape away the façade of PR progressiveness churned out to the masses and reveal the lingering beast of rejection and denial that lurked beneath, head wedged firmly in sand.

The AFL was not best pleased by what it saw as an affront on its treasured brand. Tough, I say.

Covert conferring between those almost exclusively funded by the body itself of or by one of its constituent clubs is exactly what the administrators must avoid. The debate shouldn’t be hemmed in, restricted to the nods, murmurs and consensus among researchers voting with their grant money.

McCrory in particular is renowned in the science community for discounting ideas and methodology proposed by new research groups, on the grounds that he once undertook similar investigations with far more primitive equipment and came up with nothing. Yet his comments regarding media hype and sensationalism reek of irony given it is his views that fuel much of the coverage.

The likes of McCrory and Associate Professor Gavin Davis, another member of the AFL working group who shares the increasingly flawed logic inherent in the former’s position are emerging as little more than water-muddying mouthpieces. Davis especially has blasted the Boston research – just months after leading concussion campaigner Chris Nowinski had addressed the body and the Players’ Association – during an unsavoury radio interview with Roberts.

Funded directly or indirectly by the AFL, they tell their research paymasters just what they want to hear in the face of mounting evidence to the contrary. Their stance grows more untenable with each passing weekend, each damning report, each player that returns to football concussed, each former hero battling through middle-age with a brain that cannot cope with simple, everyday tasks.

It is no fluke that in the days after Carlisle’s report was broadcast, the AFL dished out a spin-laden press release detailing their plans to screen and scan the brains of retired players in their much-vaunted MRI machine.

The study format itself appears encouraging and is certainly long overdue. The announcement was merely another indicator of the AFL’s determination to avoid accepting the true risks posed by head injury, and so its failure to look after those its success as a sport depends upon.

By Jamie Lyall

Jamie is a 20-year-old sportswriter based in Scotland, specialising in rugby union and soccer, and with a special interest in investigating, reporting and commenting on sports concussion.

Twitter @JLyall93

jamie.lyall@hotmail.com


Guest post by Peter Robinson

An account of the events by Peter Robinson, father of Benjamin Robinson who died at age 14, after playing a school Rugby game.

29th January 2011

  • Whilst playing in a schools Rugby Union match, Benjamin is accessed 3 times for Concussion and allowed to play on, finally collapsing in the final minute unconscious.

31st January 2011

  • Benjamin does not recover and his Life Support is switched off his organs are donated and in fact go on to save 5 other lives.
  • Initial report describes it as a freak accident.
  • Initial Cause of Death Diffusal Axonal Head Injury.

20th July 2011

  • Karen Benjamin’s Mother meets Professor Jack Crane State Pathologist in N. Ireland.
  • A copy of the Match Video given to family as the police did not analysis the video this was done by myself and it was found to be vital during the inquest in proving that Benjamin had indeed played a full half with Concussion.  Benjamin had been involved in a tackle at the start of the first half he remained on the ground for 1 minute 38 seconds, he was treated by the coach who pulled him to his feet and allowed him to play on.  (It is this incident that we later find out to be where Benjamin had been knocked out).
  • Second Impact Syndrome is discussed, Professor Jack Crane, Professor Brian Herron and Professor Stephen Cooke believe that Benjamin’s injuries are consistent with Second Impact Syndrome, family are informed of this by professor Crane, he advises the family that if Benjamin had been removed from play after the first concussion and protocol had been followed he would probably still be alive today.

Initial Police Investigation fails to establish what happened to Benjamin during the match.

October 2011

  • At a chance meeting by Karen with Mathew Davidson (a team mate) whilst at Benjamin’s grave, discloses that he believed Benjamin had been knocked out during the game.

As a result of the family insistence other statements were noted from a few of Ben’s teammates who stated that Ben had been confused and could not remember the score of the game, a spectator of the game also provided a statement in which he stated that he heard the Referee say Ben should come off now.   The noting of statements from all the players was prevented as the school felt that this was too traumatic for the boys to revisit the events of that day.

An adult member of the opposite team was first to attend to Ben when he collapsed, when he was asked for a statement he declined, the police advised Karen (Ben’s mother) to take the statement herself.

The family decide to instruct a solicitor Gabriel Ingram to try and support the Coroner’s investigation and speak for the family at the Inquest.

We are informed that the School will have a Barrister present to represent them.

30th August 2012 to 6th September 2012 – Initial Inquest – 1 day set aside, family request further time (Inquest actually lasts 6 days)

  • Inquest begins we hear evidence about Benjamin being treated on the pitch, at no stage was he removed to be assessed.
  • Referee gave evidence in which he said Benjamin appeared dazed but he had not heard of Scat 2 PCRT and indeed a year later still did not have a copy.
  • Ben’s coach was also the medic and linesman. Ben had been checked for concussion at least 3 times. (3 occasions that can be seen on video and 1 more confirmed in witness statements).
  • Inquest adjourned as the Coroner asked for further time to establish if other witnesses would come forward.

I re-examine the video and have it slowed down, it becomes very apparent that Ben had suffered a concussion at the start of the second half, throughout the second half of the video he is seen to stagger and hold his head and appears confused.

September 2013

Inquest resumes 1 year later.

  • Coroner concludes that the cause of death is Second Impact Syndrome, possibly the first recorded case of this in the UK, she recommends that changes are made to ensure this never happens again, she writes to the Education Minister for Northern Ireland and the IRFU.
  • Family decide to campaign for change throughout the UK.
  • Contact by email to all UK Education and Ireland Ministers asking to meet with them.

19th September 2013

  • Scottish Minister is first to respond and agree to highlight the issue by issuing a leaflet to all schools and sporting bodies in Scotland, this is issued in January 2014.
  • Agree to use “Concussion can be fatal “and” If in doubt sit them out “ slogans.

15th October 2013

  • Northern Irish Minister and Sports Minister meet family, very positive meeting.
  • Agree lessons need to be learned from Ben’s death.
  • Also agree to slogans in Information leaflet to pupils.

16th October 2013

  • Family travel to Dublin and meet IRFU, speak about children being the high risk group, ask that mandatory training be introduced to schools re coaches.
  • Separate information re children in other words age appropriate.
  • Request that information re Concussion should have the words “ CONCUSSION CAN BE FATAL”

12th November 2013

  • Chief Medical Officer in N.Ireland Mr Michael McBride writes to all GPs warning of the dangers of Concussion and especially Second Impact Syndrome.

November 2013

  • Meeting with Welsh Minister for Education, highlight the Dangers of Concussion and the failings re Ben’s death.

25th November 2013

  • Meeting with Chris Bryant Labour MP re Concussion in Sport also in attendance is Sam Peters from Daily Mail (Paper now running Concussion Campaign) Dr Willie Stewart on conference call.

27nd January 2014

  • Telephone conversation with Southern Irish reps from Education Department re Dangers of Concussion, they will liaise with N.Ireland counterparts re information on Concussion.

22nd January 2014

  • Scottish Government officially launch Concussion in Sport Leaflet to all schools.

4th March 2014

  • Attend Westminster re Concussion in Sport roundtable, chaired by Chris Bryant MP, also in attendance Dr Willie Stewart, Dr James Robson, Chris Nowinski, Lewis Moody, Rory Lamont,  Baroness Tanni Grey-Thompson and Reps from  FA, RFU, and Boxing.
  • Ben’s family also attend meeting with representatives from the English Education Department.

30th April 2014

  • N. Ireland Launch Recognise and Remove Leaflet, Poster and Pocket Recognition Tool, nearly 800,000 leaflets, 16,000 Posters and 26,000 Pocket Recognition Tools. Government working on e-learning modules.  Stated that they would review awareness and if need be to introduce “Ben’s Law.”

Late Spring 2014

  • Welsh Government they are currently working on leaflet and are being advised by Dr Willie Stewart, the leaflet soon to be published.
  • Southern Ireland Government also in talks re Concussion Leaflet.
  • We are waiting on Chris Bryant’s MP findings from the Concussion in Sport round table.

TINY FINAL

One Day Concussion Management Training for School Nurses, School Staff and other Professionals who work with Concussed Students

The Concussion Conference 2.0

Wednesday, May 7, 2014  from 8 a.m. to 4 p.m.

Quinnipiac University School of Medicine | 370 Bassett Road | North Haven, CT

Due to the overwhelmingly positive response from 78 School Nurses, 25 MDs, and 25 ATs who attended the Jan 2014 Concussion Conferences and requests for more concussion management training, this new conference includes both:

  • Advanced training with case studies for those who attended the 1st conferences to return for a higher level of study
  • Basic foundation sessions for new participants

This conference will provide basic and advanced concussion management training for:

  • School nurses
  • School psychologists
  • School guidance counselor/social workers
  • School special education directors
  • 504 Coordinators
  • Athletic Trainers
  • Physicians, PAs, and APRNs

See Flyer May2014 Concussion Conf_@QU(4)

Speakers for The May 7 Concussion Conference include nationally known experts and panels of local concussion professionals comprised of pediatricians, physical therapists, neuropsychologists, and advocates of brain injury prevention and athletic training education: Dr. Tricia McDonough-Ryan, Dr. Thomas Trojian, Katherine Snedaker MSW, Dr. David Wang, Dr. Mike Lee and the team of experts from Gaylord Center for Concussion Care, Representative from CATA; Deb Shulansky from Brain Injury Alliance of CT (BIAC); Brain Injury attorney and BIAC Board member Paul A. Slager; Charlie Wund, Founder & President Agency for Student Health Research; and Dr. Karissa Niehoff, The Executive Director at CT Association of Schools and CT Interscholastic Athletic Conference

Register now at TheConcussionConference.com  – Early bird pricing until Monday, April 7

Event produced by Katherine Snedaker, PinkConcussions.com and SportsCAPP.com

Co-sponsored by Gaylord Center for Concussion Care

Each participant will be trained and will leave with a framework and materials needed to create a Concussion Management Team. The purpose of the CMTeam is to handle the 80% of concussions that resolve in the first month, based on research and nationally recognized best practices.  For concussions that last beyond the 4 week period, academic accommodations will be taught which can be created in an IEP or a 504 plan for those students. Early Morning Sessions are split between: Foundation for First Time Participants

    • Concussion 101 for School Staff and Medical Providers
    • Concussion’s Impact on School: Strategies and Adjustments in the First 3 Weeks
    • Time to Retire? Factors in a teen’s decision to retire from contact sports

Advanced Case Studies for Participants from 1st conference or Concussion Professionals

    • Presentation of Case Study #1: A case from Gaylord Center for Concussion Care
    • Presentation of Case Study #2:  A case from Dr. Ryan and Kim Zemo, Social Worker

Late Morning and Afternoon Sessions for All Participants

  • Existing Models of Concussion “Return to School” Plans in the USA and CT
  • The Timing of Return to Learn (RTL), “Buffalo Protocol,” Return To Play in Student Athletes
  • Beyond the Diagnosis: Eyes, Balance and Gait
  • Post Concussion Syndrome: Depression, Isolation and Identity Loss, CTE Fact & Fiction
  • Post Concussion Syndrome: Academic Modifications After One Month, Home Life Support
  • New Research on “Does Concussion Education Work” and Concussion Resources
  • The Past: State of CT Concussion Law and Development of Module #15
  • The Present: CIAC’s Concussion Policy and Connecticut Law

Continuing Education Credits

  • Gaylord Hospital is an Approved Provider of Continuing Nursing Education by The Connecticut Nurses’ Association, an Accredited Approver by the American Nurses’ Credentialing Center’s Commission on Accreditation. CNE application is pending for this program.
  • This program has been submitted to The Commission for Case Manager Certification for approval to provide case managers pending clock hours.
  • This activity is pending approval from the National Association of Social Workers.
  • Program pending CME Activity approval via CT AAP.

Register now at TheConcussionConference.com To participate as a conference sponsor or exhibitor, please contact Katherine at 203.984.0860 or Katherine@PinkConcussions.com         <May2014 Concussion Conf_@QU(4).pdf>

(This post is a letter I sent to the State of Connecticut’s Children’s Committee on March 6, 2014)

Why are our most vulnerable children by being coached by adults with the least knowledge of concussion? 

Based on medical science and longer recovery rates for younger children, trained coaches are needed to coach elementary and middle school aged athletes. My sons suffered their first concussions on school grounds in 6th and 7th grade.

From my experience, many kids have their first concussion while they are middle school age playing youth sports, not in high school sports. These early mismanaged concussions set a poor framework for further concussions in high school. Connecticut needs to enact a law for all schools (all ages) to record head injuries to learn the scope of this issue and set policy based on sound data.

But there is solution available now that will turn this tide… Concussion education which is simple, effective and free

In 8 minutes, here is the motivation, education and the tool YOU CAN USE to help any child or adult with a possible concussion.

I also want to share with you the article below where YET another state has a bill to address youth sport coach concussion issue. Connecticut has a choice to be with the leaders or the followers on this issue.

Please don’t let two years of work to enact youth sport concussion laws go to waste? We will be back next year and the year after until Connecticut protects its youngest and most vulnerable athletes.

The CDC coach’s training only takes 20 minutes. A brain injury can last a lifetime. 

Please join the other states leading the way for children’s safety and enact youth sport concussion training for coaches.

Thank you,

Katherine Snedaker, MSW

Virginia Bill Could Require Youth Coaches to Get Training for Concussions

If a child gets a concussion while playing on a public school team, the coach has to pull the player from the game and he or she can’t come back until cleared by a doctor. But for recreational leagues, there are no guidelines. So, if a child suffers a brain injury while playing, there’s no set way to deal with it.

“There’s no reason kids should be more safe playing for school then they are playing for rec league,” said parent Wendy Etz.

The General Assembly is trying to change that. A new bill could require coaches to get training on concussions.

“I think it’s important for coaches to know, because they’re often the first line of defensive if you will,” said Anne McDonnell of the Brain Injury Association of Virginia.

McDonnell lobbied law makers in 2010 to change the rules for public schools, and she thinks it’s about time the same happens for rec leagues.

If the law passes, coaches will be trained to identify when a hard fall is something more serious—like a concussion.

“Well, obviously no one wants the children to be injured, and I think this would help people detect the injuries quicker and maybe prevent a long-term injury or disability,” said Robert Hodges of the Chesterfield Basketball League.

This means parents might have to pay more, but most of them say they wouldn’t mind.

“I played high school and college sports, so to make sure that they are safe, that’s going to be priority number one for me absolutely. Money wouldn’t be a problem,” said parent James Hargrove.

Lawmakers are still working on the bill. If both chambers agree, they’ll vote before session ends.

http://www.wric.com/story/24823463/new-bill-could-require-youth-coaches-to-get-concussion-training

Good Afternoon Representative Urban, Senator Bartolomeo, Representative Betts and Senator Linares and the distinguished members of the Children’s Committee,

For the record, my name is Katherine Price Snedaker, and have a Masters Degree in Social Work and live in Norwalk, CT. I am speaking today as a parent and the founder for PinkConcussions.com – an organization which focusing on female concussions – and SportsCAPP.com – a youth sport concussion educational organization.

I am here to testify in support of HB 5113, AN ACT CONCERNING YOUTH ATHLETICS AND CONCUSSIONS. But before I continue, I want to take this chance to show you how powerful, simple and free concussion education is right now. I have listed below three websites which will take you in total 9 minutes to view. In 9 minutes I believe I can motivate, educate and prepare you to help any child or adult who has a possible concussion.

Why http://www.theguardian.com/sport/video/2013/dec/13/concussion-sport-death-ben-robinson-video

What you need to know http://brain101.orcasinc.com/5000/

How to be prepared http://www4.parinc.com/products/Product.aspx?ProductID=CRR_APP

From a personal and professional prospective, concussions have changed my life. In and out of sports, I have suffered many concussions. Based on my double digit concussion history, I was accepted in BU CTE Legacy Study 2 years ago and on my death my brain will studied for signs of CTE.

As a mother, watching as my two sons’ lives affected by concussions. Despite having three sons for years in youth sports, the only concussion education I ever had was from an article in US Lacrosse magazine, yet that one article motivated me to take the correct steps to have my son checked by a doctor when he was concussed at school recess. One son now 14 suffered two concussions, my other son now 17 has suffered ten concussions – one at school recess, two on the school bus, two in youth sports. He was a straight A student – a few years of perfect scores on the CMTs – and in a matter of hours, was reduced to a child who couldn’t read more than two lines of text. One night when he was healing from the first concussion, I asked if he wanted chicken or steak for dinner, he started to cry and said he didn’t know how to decide. Now as junior, he is back in honors classes but cannot still suffers with weekly headaches and issues with executive functioning. Just a few minutes of concussion education, a article, a flyer and iPhone app can make the difference in how a parent responds to their child’s possible head injury.

As youth sports coach for boys for five years, I just didn’t see head injuries on the field. But after concussion education and with the free PAR CRR app designed by Dr. Gerry Gioia on my iPhone, in one year alone, I pulled at five youth players from games as a parent and as a coach, and assessed they needed to “sit it out and see a doctor.” All five players I pulled were later diagnosed by their MDs with concussions, and that is how I was convinced that sideline concussion education really works.

Now as mental health expert in concussion field, I attend the NFL’s Concussion Health & Safety Meetings and have spoken to Commissioner Roger Goodell, and the CEOs of US Lacrosse, US Hockey, Little League, USA Cheer, and American Youth Soccer. These leaders are very aware of need for safer sports and the liability issues of concussions facing youth sport. Some organizations have already educated all their coaches and others are preparing to move in that direction as time and resources allow. I also was invited the Institute of Medicine present to them on the effects of concussions on youth athletes and their families. This committee issued the IOM federal report on youth sport concussions this past fall. Through these experiences, I have been able to view concussions from a national prospective, and I truly believe:

  1. Concussion Education must be expanded horizontally from middle and high schools coaches to include students, parents and school staff on concussion facts and the consequences of not reporting head injuries. Education must be mandatory for parents. I know from years of experience, parents do not attend concussion events unless they are required for their children to play a sport.
  2. Concussion Education must be expanded vertically down from the high school to youth sports which include elementary and middle school age students, coaches, parents include youth sports organizations in a non-prescriptive way. This is not the huge burden it is made out to be. There is a free 20 minute course on the CDC website for coaches to take at home and print a certificate which can be given to their sports team. The CDC has free flyers for sports teams to use for parent and athletes.
  3. Communication must be improved between coaches, school nurses, athletic trainers, parents and medical providers. Again this is possible with free technology available today for Connecticut schools and sports leagues – it must be smart-phone based, real-time, tracable and be FERPA and HIPAA Compliance.
  4. Data must be collected at local, regional, state levels on all student-athlete injuries to evaluate the effects of the current law, any changes to the law, and for research to direct future policy. Our current data is weak on all aspects of concussions. Data is essential and I believe the key to collecting data is streamlined, app-based, paper-free, smart-phone apps.

So much has changed in the six years, I have been studying concussions. As this science is in its infancy, I would urge the committee to pass law that is flexible as I believe many the “facts” of today will need to be modified in the future. Connecticut led the way in the first round of concussion legislation in 2010, and will return to the leadership role when this bill becomes law in 2014. Thank you for your time.

 

Katherine Snedaker

Additional Material The Children’s Committee requested I submit:

 

If you are a coach and want a training course, here is a excellent 20 min one that generates a certificate with your name at the end:

http://www.cdc.gov/concussion/HeadsUp/Training/index.html

Research I recommended for the committee:

Example #1

While this study is over a year old, I believe the data is still very valid and plays into everything that was discussed at the public hearing yesterday.

http://consumer.healthday.com/head-and-neck-information-17/head-injury-news-344/parents-may-be-taking-concussion-symptoms-too-lightly-survey-669524.html#.UxBkYn5hxMQ.gmail

Parents May Be Taking Concussion Symptoms Too Lightly: Survey

Many don’t seek medical evaluation for children or themselves after head injuries

FRIDAY, Oct. 12, 2012 (HealthDay News) — Only half of U.S. adults who thought they or their children might have a concussion sought medical treatment, a finding that suggests many people do not understand the seriousness of a potential concussion, a new survey finds.

Not thinking the symptoms were serious enough or assuming they just had a headache were the main reasons people did not seek treatment for their own possible concussions. Three in five parents cited the same reasons for not taking children with head injuries to a doctor.

Seven of 10 respondents incorrectly identified symptoms of concussion, according to the American Osteopathic Association’s online survey of more than 1,300 people. The findings were presented at an AOA meeting held in San Diego this week.

Only about one in four children suffered a possible concussion while playing either a school-related or non-school-related sport. The survey also found that children who suffer a head injury while playing sports may be more likely to be evaluated by a medical professional than those who are injured at home.

More than eight in 10 parents in the survey said their children were evaluated by a medical professional, coach or event personnel after they suffered a head injury while playing sports.

Men were more likely than women to report that they had suffered a concussion at some time in their life. Men and respondents aged 18 to 29, however, were most likely to say they did not seek treatment after a head injury because they did not believe the symptoms were serious enough.

About 40 percent of adults said they had suffered a concussion playing sports, making sports the most common cause of concussion in adults. About 30 percent of adults said they had suffered a concussion as the result of accidents at home and away from home.

People of all ages need to understand the seriousness of head injuries and see a doctor if they suspect a concussion, said Dr. Jeffrey Bytomski, an osteopathic family physician and head medical team physician at Duke University Medical Center in Durham, N.C.

“People don’t seem to realize how serious a bump or blow to the head can be,” Bytomski said in an AOA news release. “It might not seem that serious at the time because they didn’t lose consciousness or bleed, but this could be a traumatic brain injury and needs to be evaluated by a medical professional.”

Symptoms of concussion can include: pain in area of the head injury, dizziness, nausea or vomiting, confusion or inability to focus, and slurred or incoherent speech.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Example #2

A series of studies released Feb 27 that finds that despite a youth-sports concussion law and extensive coach education about concussions, 69 percent of student athletes surveyed in Washington State still played with concussion symptoms.

High school athletics coaches in Washington State are now receiving substantial concussion education and are demonstrating good knowledge about concussions, but little impact is being felt on the proportion of athletes playing with concussive symptoms, according to the two studies published in the American Journal of Sports Medicine.

Among the 778 athletes surveyed in a second study released today, 40 percent reported that their coach was not aware of their concussion.

Below you’ll find a press release detailing the studies.

FOR IMMEDIATE RELEASE

New studies indicate concussion education for high school coaches is not making student athletes safer

Seattle, February 25, 2014 – Washington State’s Zackery Lystedt law is helping to educate high school athletics coaches about concussions, but new research finds that 69 percent of student athletes that were surveyed still played with concussion symptoms.

High school athletics coaches in Washington State are now receiving substantial concussion education and are demonstrating good knowledge about concussions, but little impact is being felt on the proportion of athletes playing with concussive symptoms, according to two studies published this month in the American Journal of Sports Medicine.

The first study, released February 7, surveyed 270 coaches from a random sample of public high school football, girls’ soccer, and boys’ soccer in Washington State. Nearly all answered concussion knowledge questions correctly and the majority said they felt very comfortable deciding whether an athlete needed further concussion evaluation.

However, among the 778 athletes surveyed in a second study released today, 40 percent reported that their coach was not aware of their concussion, and 69 percent of the athletes reported they played with concussion symptoms.

Only one third of athletes who had experienced symptoms consistent with concussions reported receiving a concussion diagnosis.

Washington’s law is named for Zackery Lystedt who in 2006 suffered a brain injury following his return to a middle school football game after sustaining a concussion. He and his family, along with medical personnel, lobbied the state extensively for a law to protect young athletes in all sports from returning to play too soon.

“Six years after the passage of the nation’s first concussion law, educating coaches about concussions does not appear to be strongly associated with the coaches’ awareness of concussions.  Too many  athletes are still playing with concussion symptoms,” explained the studies’ principal investigator Frederick Rivara, MD, MPH, professor and vice chair of the Department of Pediatrics, and division chief for General Pediatrics at the University of Washington.

The studies also identify a crucial gap in knowledge for parents and athletes. Under the law, parents and athletes are required to sign a form alerting them to the dangers of concussions. The majority of coaches reported that they provided athletes with at least some instruction on concussions, including reading materials, videos or websites, but nearly one-third reported not providing athletes with any additional information.

For parents, the education they received from coaches was even less: Nearly 60 percent of coaches reported not providing parents with any additional concussion education, other than asking them to sign the legally required form.

“Given that concussions are difficult to diagnose, and often require either an athlete or a parent to report symptoms, educating these groups is an essential part of preventing athletes from playing with symptoms and risking a second potentially serious brain injury,” Rivara said.

“The Lystedt law was designed to improve identification of athletes with concussion and thus prevent athletes from continuing to play with concussive symptoms, risking further injury. Perhaps someday we can design laws that prevent concussion, but this would likely require different methodology, such as rule changes,” explained study author Sara P. Chrisman, MD, MPH, acting assistant professor in the Department of Anesthesiology and Pain Medicine Department of Adolescent Medicine Seattle Children’s Hospital.

Now that Mississippi has passed a youth concussion law, all U.S. states have a law aimed at preventing youth brain injuries in sports.

To learn more about the law in Washington and its requirements, as well as the laws across the country, visit http://lawatlas.org/preview?dataset=sc-reboot.

The articles, “The Effect of Coach Education on Reporting of Concussions Among High School Athletes After Passage of a Concussion Law” and “Implementation of Concussion Legislation and Extent of Concussion education for Athletes, Parents, and Coaches in Washington State,” are available online through the journal: http://ajs.sagepub.com/.

This research was funded by a grant from the Robert Wood Johnson Foundation’s Public Health Law Research program. For more information on the project and its findings, visit:http://publichealthlawresearch.org/project/evaluation-law-mandating-reporting-concussions-high-school-athletes

Example #3

Effectiveness of a State’s Youth-Concussion Law Studied http://blogs.edweek.org/edweek/schooled_in_sports/2014/02/paper_evaluates_effectiveness_of_washington_states_youth-concussion_law.html via @educationweek

Effectiveness of a State’s Youth-Concussion Law Studied

BRYAN TOPOREK FEB 18, 2014

Now that Mississippi Gov. Phil Bryant has signed his state’s youth-concussion legislation into law, every state has some form of youth-concussion legislation.

Are those laws actually changing behaviors? That’s what a new paper published online earlier this month in The American Journal of Sports Medicinesought to determine.

For the paper, the authors surveyed 270 public high school football, girls’ soccer, and boys’ soccer coaches in Washington state—the first state to implement youth-concussion legislation (the Zackery Lystedt Law)—from 2012 to 2013. They asked coaches about the amount of required concussion education for coaches, parents, and athletes, and also evaluated the coaches’ knowledge of concussions.

All but three of the coaches said they were required to undergo concussion education (98.9 percent), and 198 were unable to coach until completing such training (74.4 percent). Of the 264 coaches who answered a question about the frequency of their concussion education, 248 said they had to complete it annually (93.9 percent).

In terms of the modalities in which concussion education was provided, 243 of 267 coaches engaged in at least two different forms (91.0 percent), ranging from written, video, PowerPoint, tests, or in-person sessions. More than 80 percent of the coaches (225 in total) utilized a video from the Washington Interscholastic Activities Association, and over 200 coaches took a test from the association (78.1 percent).

Athlete and parent education, on the other hand, was far less extensive than that of the coaches, according to the survey’s findings. Per the terms of the Lystedt Law, all parents and student-athletes must sign a concussion information form before the athlete is allowed to participate in sports. However, only 241 coaches said they required their athletes to sign the form (89.3 percent), while 218 of 263 said they required the same from parents (82.9 percent).

A number of coaches did not provide any further concussion education beyond the form, with 79 of 268 not doing so for athletes (29.5 percent) and 147 of 254 giving parents no additional information (57.9 percent). Of the coaches who did provide additional education, 96 only utilized one modality for athletes (35.8 percent), and 66 did the same for parents (26.0 percent).

In terms of the coaches’ scope of concussion experience and education, 96.2 percent said they were at least somewhat comfortable determining whether an athlete needed further concussion evaluation. Roughly 75 percent of coaches had at least one athlete sustain a concussion in the most recent season (from when they were surveyed), and 42.5 percent had anywhere from two to five athletes sustain a concussion. Just over half the coaches had heard of the term “graduated return to play,” which is the recommended step-by-step return process for any student-athlete who sustains a concussion.

Ultimately, the results “suggest that concussion education requirements for coaches are being closely followed by public high schools ” in the state, the authors conclude. They expressed concern about the limited extend of parent and athlete concussion education, but note vague language in the Lystedt Law itself likely played a role.

This paper represents the next major frontier in youth-concussion legislation. Now that every state has a law, it’s up to researchers to determine how effective each law is in terms of shaping behaviors.

If a law isn’t working as it should, it’s up to the state lawmakers and those responsible for enforcing each law to ensure that schools begin following the requirements more closely. Coaches, parents, and athletes also must shoulder the responsibility of demanding and following laws that keep student-athletes safe.

Katherine Price Snedaker,  MSW

203.984.0860
Katherine@PinkConcussions.com
@PinkConcussions
@SportsCAPP
Concussion Education Advocate
Concussion Mental Health Social Worker
Mom of Two Sons with Multiple Concussions
Founder, PinkConcussions.com
Founder, SportsCAPP.com
Founder, TheConcussionConference.com

Scroll down through the lines below until you see the one’s highlighted in red and see why most students with concussions would not qualify for a 504 plan. At the present time, general consensus is that most student concussions resolve in around a three week time frame. Note: everything known presently in the concussion world is subject to change.

SOURCE: Protecting Students With Disabilities

Frequently Asked Questions About Section 504 and the Education of Children with Disabilities

STUDENTS PROTECTED UNDER SECTION 504

Section 504 covers qualified students with disabilities who attend schools receiving Federal financial assistance. To be protected under Section 504, a student must be determined to: (1) have a physical or mental impairment that substantially limits one or more major life activities; or (2) have a record of such an impairment; or (3) be regarded as having such an impairment. Section 504 requires that school districts provide a free appropriate public education (FAPE) to qualified students in their jurisdictions who have a physical or mental impairment that substantially limits one or more major life activities.

12. What is a physical or mental impairment that substantially limits a major life activity?

The determination of whether a student has a physical or mental impairment that substantially limits a major life activity must be made on the basis of an individual inquiry. The Section 504 regulatory provision  at 34 C.F.R. 104.3(j)(2)(i) defines a physical or mental impairment as any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological; musculoskeletal; special sense organs; respiratory, including speech organs; cardiovascular; reproductive; digestive; genito-urinary; hemic and lymphatic; skin; and endocrine; or any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities. The regulatory provision does not set forth an exhaustive list of specific diseases and conditions that may constitute physical or mental impairments because of the difficulty of ensuring the comprehensiveness of such a list.

Major life activities, as defined in the Section 504 regulations at 34 C.F.R. 104.3(j)(2)(ii), include functions such as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working. This list is not exhaustive. Other functions can be major life activities for purposes of Section 504.  In the Amendments Act (see FAQ 1), Congress provided additional examples of general activities that are major life activities, including eating, sleeping, standing, lifting, bending, reading, concentrating, thinking, and communicating.  Congress also provided a non-exhaustive list of examples of “major bodily functions” that are major life activities, such as the functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions.  The Section 504 regulatory provision, though not as comprehensive as the Amendments Act, is still valid – the Section 504 regulatory provision’s list of examples of major life activities is not exclusive, and an activity or function not specifically listed in the Section 504 regulatory provision can nonetheless be a major life activity.

 

34. How should a recipient school district view a temporary impairment?

A temporary impairment does not constitute a disability for purposes of Section 504 unless its severity is such that it results in a substantial limitation of one or more major life activities for an extended period of time. The issue of whether a temporary impairment is substantial enough to be a disability must be resolved on a case-by-case basis, taking into consideration both the duration (or expected duration) of the impairment and the extent to which it actually limits a major life activity of the affected individual.

In the Amendments Act (see FAQ 1), Congress clarified that an individual is not “regarded as” an individual with a disability if the impairment is transitory and minor.  A transitory impairment is an impairment with an actual or expected duration of 6 months or less.

35.  Is an impairment that is episodic or in remission a disability under Section 504?

Yes, under certain circumstances.  In the Amendments Act (see FAQ 1), Congress clarified that an impairment that is episodic or in remission is a disability if it would substantially limit a major life activity when active.  A student with such an impairment is entitled to a free appropriate public education under Section 504.

40. What is the difference between a regular education intervention plan and a Section 504 plan?

A regular education intervention plan is appropriate for a student who does not have a disability or is not suspected of having a disability but may be facing challenges in school. School districts vary in how they address performance problems of regular education students. Some districts employ teams at individual schools, commonly referred to as “building teams.” These teams are designed to provide regular education classroom teachers with instructional support and strategies for helping students in need of assistance. These teams are typically composed of regular and special education teachers who provide ideas to classroom teachers on methods for helping students experiencing academic or behavioral problems. The team usually records its ideas in a written regular education intervention plan. The team meets with an affected student’s classroom teacher(s) and recommends strategies to address the student’s problems within the regular education environment. The team then follows the responsible teacher(s) to determine whether the student’s performance or behavior has improved. In addition to building teams, districts may utilize other regular education intervention methods, including before-school and after-school programs, tutoring programs, and mentoring programs.