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.

 

Press Release

For Release: Monday, November 2, 2013 

Launch of International Study of Male Athletes and Concussions

Study of Female Concussions Launches 2nd Study, to explore Male Athletes’ Experiences with Concussions

 

Contact:

Katherine Snedaker, MSW, PinkConcussions.com / 203-984-0860 PinkConcussions@gmail.com

Dr. Jimmy Sanderson, Clemson University / 864-656-3996 jsande6@clemson.edu

Norwalk, CT – Media attention and public interest in sports concussion injuries has been increasing at a rapid rate. As a result, it is important for researchers and concussion advocates to enhance research efforts on this very important topic. To provide some insight on female concussions, we launched a research study in October 2013, which focused on female athletes from all sports, and their past and present experiences with concussions. Via social media tweets & posts about the study, 652 women contacted us to participate. Of the 597 women who were eligible to participate and sent a link to the survey, 538 women completed the forty question online survey. This research study was also was designed to explore female verses male athletes’ experiences with reporting concussions, another salient avenue in the concussions dialogue, as many athletes do not report concussions willingly or are mis-diagnosed.

Now we are recruiting for a NEW IBR approved study of male athletes and their experiences with concussions in conjunction with our recent efforts to recruit female athletes to discuss their concussion experiences.

This research aims to explore reasons why male/female athletes would report or not report concussions and examine potential gender differences that can inform the athletic, medical, and academic communities.

Current and former male athletes are eligible for this study which will be conducted by researchers from Clemson University with the advocacy group, Pink Concussions. For this study, male athletes, age 18 and over, who are willing to participate can sign up now at PinkConcussions.com. Participants will be emailed a link to a twenty-minute online survey about their experiences with sports and non-sport concussions and reporting concussions.

The research also will investigate male/female athletes’ willingness to have genetic testing that may show links to the repair and recovery of brain cells after concussion. After finishing the survey, participants in the study can opt for an additional study and consider submitting DNA collected by a cheek swab to be tested for variants at the Apolipoprotein E (APOE) gene.  Testing for certain genes has previously documented an association between specific genetic factors and outcomes from injuries such as concussion.

Apolipoprotein E is a protein that is important in the repair and recovery of brain cells that have been damaged due to concussion. The clinical studies point to a relationship between certain genetic signatures and poorer overall concussion response. While additional evidence is needed to better understand the relationship between APOE status and concussion outcomes, the American Academy of Neurology introduced APOE testing into concussion management guidelines this year.

This research will be beneficial in shedding light on and male female athletes’ experiences with concussions and reporting concussions. We hope the results of this research will help further concussion research by focusing on the communicative element present in this issue, and the results of the study will be helpful for athletes, parents, administrators, physicians, and advocates.

Co-Researchers in this study are Dr. Jimmy Sanderson and Dr. Melinda Weathers in the Department of Communication Studies at Clemson University, along with Ms. Katherine Snedaker, MSW, of PinkConcussions.com.

# # #

For more information about this study, help in recruiting athletes or to participate in the study, please fill the contact form at PinkConcussions.com or contact:

Dr. Jimmy Sanderson
Clemson University
jsande6@clemson.edu
864-656-3996
 
Katherine Snedaker
PinkConcussions.com
PinkConcussions@gmail.com
203-984-0860

 

*Not a reason to not play the game, but THE reason to be an educated parent, player, coach and school.

About halfway through the fourth quarter in Saturday’s 60-6 loss to Arizona Lutheran Academy, Charles Youvella fell hard on his head. He eventually collapsed a couple of plays later. He died Monday at the hospital of a traumatic brain injury, reported the Arizona Interscholastic Association. And so another face add to the 2013 collection of dead boys from head injuries from football (see below).

Could he have died from a head injury while skateboarding?

Could he have died from a head injury while texting & driving?

Could he have died falling, while on drugs, climbing to spray paint his tag on a highway bridge?

Yes, Charles Youvella (pictured with his little brother) could have died doing a number of risky things that teenage boys can chose to do in their free time.  The question is, was he more at risk playing football than partaking in other activities that night?

The best estimate is that 20-25% of youth concussions occur in organized sports. This leaves the other 80% of head injuries outside of organized sports, and not broken down by cause in any meaningful way to compare against playing football.

But what upsets me in the media coverage is the following quote by Charles’ coach…

On the news video attached to the story of Charles Youvella, the football coach is interviewed and says, “There are a lot of unknowns. We, People, Everyone that I have talked to has never seen anything like this. So we don’t exactly know what happened. ”  http://www.abc15.com/dpp/news/region_northern_az/other/charles-youvella-update-hopi-high-football-player-dies-after-game-injury

ATTENTION — FOOTBALL COACHES, PLAYERS & PARENTS – KIDS CAN DIE PLAYING FOOTBALL… IT HAS HAPPENED BEFORE.  

The expression of sheer surprise  is echoed over and over again when a youth football player dies. HOW COULD THIS HAVE HAPPENED?!? A person can die a lot of ways –  driving a car, jumping out of a plane, cleaning a gun. Tragedy happens. But the utter surprise that football can be a cause of death in youth players is a sign we need to have more education for parents, and need to start now with the parents of elementary age children.

I think football parents should sign waivers that they understand the risks in football for fatal injuries, sign off that they have been educated about concussions, sign off that they are aware of the medical care that is available on the field for practices and games, and sign off that they understand what insurance coverage a school has if there is a need for catastrophic medical care.

Could anything have been done (from what little we know about head injuries) to help Charles? From this report, it appears at first glance nothing could have been done (except not to play football).

The injury came during the fourth quarter, when Arizona Lutheran held a big lead.

On that play, Youvella caught the ball between two defenders and was tackled, but the senior wide receiver/running back then quickly got back up.  

“It was a clean tackle,” Wallace said. “There was no helmet to helmet. But Charles came down on his back and his head and (there was) a whiplash affect. But Charles jumped up like he always does and gave the ball to the ref. There were no signs of dizziness or anything like that. If he doesn’t feel right, he’ll motion to the sidelines, but he didn’t (motion to the sidelines) on that play.”

Two plays later, with 7:28 remaining in the fourth quarter, Wallace spotted his son on the ground.

“He (Youvella) was trying to get back up,” Wallace said. “He was responsive and wanted to get up. He was asking me to get him up, but I wanted him to lay still. He was asking his coach to get him up. But we said, ‘Let’s check you out.’ I know my son, and you could tell something was wrong.”

Youvella was then taken to St. Joseph’s Hospital and Medical Center, where, with family members surrounding him, he passed away.  http://www.aia365.com/insiders/jgarcia/3719/youvella-s-father-son-was-larger-than-life

Would Charles have lived if he had not stayed in the game and instead was taken off the field after the hit to be checked?

Could a personal spotter (like those in the press boxes FOR EACH NFL PLAYER) have caught the whiplash movement and called the medical team right away?

Could Charles have raised his hand to be checked?

We don’t know if Charles was educated about concussion warning signs; but even with player education, is an impaired player with a brain injury capable to stop himself mid-game and seek help? How many high school teams even have personal spotters for players much less a medical team?

There is so much we don’t know. But what we do know is your child can die from head injuries playing football...THIS HAS HAPPENED BEFORE THIS YEAR FIVE TIMES. And how many more faces will it take for this reality to sink into the minds and hearts of football parents and coaches.

Please make educated decisions about your child’s coaches – ask about your team’s concussion education. Make sure your school has funds for ATs at every practice/every game. Hire the best sideline medical care your school can afford. Overall, be educated consumer about your child involvement in the game of football.

Boys who have died so far this year from football head injuries…

Good News…

The IOM and the National Research Council formed an expert committee to review the science of sports-related concussions in youth from elementary school through young adulthood, as well as in military personnel and their dependents. The committee’s report recommends actions that can be taken by a range of audiences – including research funding agencies, legislatures, state and school superintendents and athletic directors, military organizations, and equipment manufacturers, as well as youth who participate in sports and their parents – to improve what is knows about concussions and to reduce their occurrence.

The report finds that while some existing studies provide useful information, much remains unknown about the extent of concussions in youth; how to diagnose, manage, and prevent concussions; and the short- and long-term consequences of concussions as well as repetitive head impacts that do not result in concussion symptoms.

 

Bad News…      There is no mention of any funding.

Good News…   Here is who sponsored the IOM Report:

Bad News?   Here is who the IOM Committee recommends to lead the effort…

Interesting neither group helped sponsor the study?

NCAA is not well thought of by many concussion field. In March, I had a face to face conversation with Mark Emmert NCAA President where I asked about limiting full contact practice in the NCAA schools to match the NFL and Ivy Schools reduced schedule, and he told me there wasn’t enough evidence and there needed to be more studies before he felt he could act. I am wondering if the many lawsuits are helping to motivate him to move on something here?

I am going to contact the NFHS and ask how they see their role in the future. Here is what the NFHS said.

Good News…   We now have a National Sports Concussion Coalition.

Bad News… This coalition was not mentioned in the IOM Report.

So in summary…

Good News... This week we do have two new reports – a very informative the IOM Concussion and Youth Sports Report with ideas and recommendations along with the new road map for schools in APP report on Concussions and Schools.

Bad News… There doesn’t seem to be any funding mentioned in either report to fund any of these recommendations.