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>

Mind Your Melon Invites

Youth Soccer Players and Their Parents to

Soccer Inspiration and Concussion Education Night

with Special Guest Briana Scurry

Legendary US Goalkeeper

World Cup Champion

and Two Time Olympic Gold Medalist

and ESPN Reporter and Parent Youth Coach, T.J. Quinn

Thursday, May 1, 2014
7 to 8 pm

BlueStreak Headquarters
80 Largo Drive
Stamford, CT

Sponsored by Shoreline Football Club

A Pro-Soccer, Upbeat Event for Players age 7+, Siblings and Parents from 7 to 8 PM

  • The Mind Your Melon Program doesn’t believe in scaring kids, but rather our objective is to help kids playing sports safer
  • Briana Scurry will share the joys of soccer and her struggles with concussions
  • T.J. Quinn from ESPN will speak about his youth sport experience and about being a youth sport coach for his kids
  • Katherine Snedaker, MSW, Concussion Educator, will provide concussion education with fun concussion education games like “Concussion Simon Says”
  • Local youth players and parents will tell their concussion stories
  • For FREE tickets for Shoreline Families and for $25 family tickets for general public click here

An inspirational Concussion Recovery Hangout with Briana from 3 to 4 PM (earlier in the day)

  • Briana and Katherine will meet and chat with youth athletes who have a concussion or post concussion syndrome – no sibs please
  • This quiet, supportive talk for players will last about 45 minutes – age 10+, please no siblings
  • Location TBA in Darien-Stamford
  • Please RSVP for FREE tickets click here Donations will accepted to cover costs

Please help support these events by purchasing…

  • SIGNED BALLS by Briana. Your child will be called up on stage to receive the pre-signed ball from Briana, and be thanked as a supporter. Suggested donation of $200 for a soccer ball for Briana will sign with your child’s name and hers before the event. Please buy balls here BEFORE the event click here
  • MEET/GREET BRIANA (MAX total of six families) Your children will meet and talk with Briana after the event from 8:15 to 9 PM on the second floor landing at BlueStreak. Dessert will be served. Briana will sign photographs which we supply. Suggested donation of $400 for one family up to 5 members. Please buy tickets click here

Briana Scurry was a goalkeeper for the United States women’s national soccer team for most of the years between 1994-2008, earning a record 173 caps for the United States. She started 159 of those games and finished her international career with a record of 133-12-14. She also earned 71 shutouts.

These events would not be possible without support of our sponsors
BluestreakInjureFREESoccerAndRugbyFairfield County Sports Commission and Shoreline Football Club

See all our websites for more information on Concussions.

  • SportsCAPP.com Youth Sport Concussion Education for Players-Coaches-Parents and Mind Your Melon, youth outreach program
  • PinkConcussions.com Info & Research on all Types of Female Concussions
  • TheConcussionConference.com Training for School Nurses-Staff-MDs-ATs on Return To School. Next event is May 7, 2014. Parents are welcome.

 

 

(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.

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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.

It is great news that 49 States have passed some level of “Return To Play” (RTP) concussion laws. Now it is my hope is that everyone’s attention will turn to the process by which concussed students return to school aka “Return To Learn” (RTL). Of the 49 States with RTP Laws, less than 25% of these states have any explicit inclusion of academic supports.

Since I am interested in the wide range of school concussion management plans that exist, I have been researching and summarizing the best “Return To Learn” resources that are currently available online for free.

I wanted to share these suggestions for RTL language in this blog post for anyone working to proposed a bill to update their state’s current concussion laws. To suggest some language for this effort, I have researched how number of states have handled Return to Learn and spoken with a number of experts in the field.

Please note all footnotes and credits – I do not take credit for creating any of the language below, but I merely have organized other experts’ words into sections with links back to original sources to further educate anyone interested in the topic to update their state’s laws.

Please find this post divided into four sections:

1. Colorado State’s Suggestions for Best Practices concerning RTL – a basic, concise version of RTL that could be used for any state’s Return To Learn bill

2. Additional suggestions from my research which could be added RTL section for a RTL bill

3. Sources and Additional Documentation for RTL bills and the additional suggestions in Section 2

4. List of RTL Resources for Parents, Teachers, Administrators, Healthcare Providers and Free Training Videos

_________________________________________

SECTION ONEA Colorado’s Law – a concise version of suggestions for RTL Law

Here is Colorado State’s Suggestion for Best Practices, with my suggestion for additional language in red:

Suggested Best Practices for Colorado’s Schools for Return to Learn

Note: These guidelines are not required by Bill SB 11-040 but should be considered:

SB 11-040 does not speak to the school district’s role in this section. Best Practice suggests that school districts create a Multi-Disciplinary Team Approach to Concussion Management including:

    • A seamless system of communication between school professionals, medical professionals and the family. Information must flow smoothly from within the school to outside the school so that the RETURN TO LEARN plan followed by RETURN TO PLAY decisions can be made safely.
    • A seamless system of communication among school professionals. Information must flow smoothly between the school athletic departments and the academic departments to ensure appropriate physical and academic adjustments during the recovery.

Best Practice suggests that a school create a concussion management system that is adequate and consistent for any student, elementary through high school, who has sustained a concussion regardless of the setting or mechanism.

Best practice also recommends that a school district create a system in which a student may receive a more intensive assessment and intervention, if the concussion does not recover in a reasonable amount of time. This may include formal accommodations and/or modifications of curriculum.

Taken with one modification page 9 from this source:

_________________________________________

SECTION TWO: Additional considerations which could be suggested to make a more robust RTL section for the CT bill

Here are some suggestions which could be included in RTL Bill:

1. Suggestion for Return to Learn to be completed BEFORE Return to Play

  • In concussion management, both RTP and RTL are common and important terms, but they are not parallel processes. 2 Student athletes are STUDENTS first. It is suggested that Return To Learn goals of “full school day with no accommodations” should be achieved FIRST before athletic returning to play guidelines are commenced.

2. Suggestions for Schools to have a Concussion Management Plan (CMP) in place

  • When a student returns to school following any injury, the school team’s responsibility is to (a) assess the needs, (b) design an intervention plan, (c) monitor the effectiveness of the plan, and (d) adjust and readjust until the student no longer has special needs resulting from the condition. Returning a student to school following a concussion is no different. It is suggested A “Return to School” Program should be accurately planned so any needed accommodations for the student begin as soon as the student returns to school.  This suggested “front-loading” of academic adjustments helps to avoid complications and prolonged recovery on the back end. The student will experience the ability to cognitively exert more and more each day, while flaring less and less symptoms.
  • During the recovery period, it is suggested that students should be monitored in an scheduled, concrete way by medical and academic staff in the school until the student is fully recovered. Concussion management plans will be different for each child and even for each concussion; and it is suggested any plan should be designed with that flexibility in mind. Note: Unlike Return to Play decisions, students don’t need to be “cleared” by a physician to return to school so doctor’s note and instructions may or may not be available in initial period of student’s return.

3. Suggestion for School Staff Training

  • Because students physically look well, it is not uncommon for teachers and other school officials to underestimate the difficulties that a student is experiencing and may downplay the need for cognitive rest. Education of teachers, counselors, and school administrators regarding the cognitive effects that a concussion may have on a student is important. 5 Educators are encouraged to seek out concussion accommodation training through the many resources available on the web and through continuing education programs.

_________________________________________

SECTION THREE: Documentation for updating Concussion Laws and the additional suggestion

 

Why does our state need to update our Concussion Law to Include RTL?

“A concussion is an academic injury, in the sense that it affects the capacity for learning,” said pediatric neuropsychologist Gerard Gioia at the Children’s National Medical Center in Washington. “There are rarely times in school when these concussion issues do not have some potential effect on a kid’s grades and academic pursuits.” 1

In the US, 48 States have now passed laws that call for physical rest following a concussion so called Return to Play Laws. In the rush to pass RTP laws, the student-athlete was viewed as an athlete first and less than 25% of these states has any explicit inclusion of academic supports in the RTP focused laws enacted from 2009-2013.7

In just the past few years, experts in the field of concussion have come to the realization that cognitive demands, much like physical demands, can worsen symptoms and can delay recovery (Majerske et al., 2008). 2

 

How can a Concussion affect Learning?

“The effects of concussion on a student’s return-to-school experience are unique to each student. In most cases, a concussion will not significantly limit a student’s participation in school; however, in some cases, a concussion can affect multiple aspects of a student’s ability to participate, learn, and perform well in school. In turn, the experience of learning and engaging in academic activities that require concentration can actually cause a student’s concussion symptoms to reappear or worsen. Given this inter-relationship, and the way concussion effects can vary across students, academic adjustments need to be tailored to each student’s specific circumstances” 3

In concussion management, both RTP and RTL are common and important terms, but they are not parallel processes. 2

To date, there are no agreed upon formulas for return to learning (RTL). This is due largely to the fact that the return to school following concussion is an extremely individualized process 2

Students must receive academic accommodations that need to be adjusted by school personnel in collaboration with managing medical professional until full recovery.  The school psychologist and/or the school nurse are uniquely poised to facilitate the transition of a student with a concussion from the medical setting back to the educational setting. 2

Since a concussion is a medical event, and its recovery spans the home and school setting for 3 or more weeks, the management of the concussion is best accomplished by a seamless system of communication and collaboration among parents, the school, and the healthcare providers. 2

This multidisciplinary team approach to concussion management lends itself to consensus decision-making. It is best practice that the concussed student always returns to school with a signed release of information in place allowing for two-way communication between the school and the healthcare provider. 2

Many athletes will report increased symptoms with cognitive activities after a concussion, which makes intuitive sense because the concussion is a functional rather than structural injury of the brain. Athletes with concussion often have difficulty attending school and focusing on schoolwork, taking tests, and trying to keep up with assignments, especially in math, science, and foreign-language classes. Reading, even for leisure, commonly worsens symptoms. 10

To prevent exacerbation of the athlete’s symptoms and allow for continued recovery, “cognitive rest” is recommended. This rest may include a temporary leave of absence from school, shortening of the athlete’s school day, reduction of workloads in school, and allowance of more time for the athlete to complete assignments or take tests. Taking standardized tests while recovering from a concussion should be discouraged, because lower-than-expected test scores may occur.5,97 Test scores obtained while the athlete is recovering from concussion are likely not representative of true ability. Communication with school nurses, administrators, and teachers to be sure they understand these recommendations is imperative. 10

 

How can a school professional help a student recovering from a concussion?

A school professional can best support a student’s return to school and recovery by understanding possible concussion effects and providing the student with needed accommodations and support. Understanding concussion symptoms can help the student and members of the team identify individual needs of the student, monitor changes, and with proper permission, take action when necessary. This will help facilitate a full recovery and discourage students from minimizing the symptoms due to embarrassment, shame, or pressure to return to activities. 3

After reintegration into school, a student should be allowed adequate time to make up assignments, and the overall volume of make-up work should be reduced. Because students physically look well, it is not uncommon for teachers and other school officials to underestimate the difficulties that a student is experiencing and may downplay the need for cognitive rest. Education of teachers, counselors, and school administrators regarding the cognitive effects that a concussion may have on a student is important.10

 

How should schools respond to instructions from Health Care Providers?

“The contents of a note received from a physician may differ amongst providers. Some physicians will give detailed descriptions of academic accommodations suited to a particular student and his or her concussion, which can be easily followed by educators. Others may provide little or no details about the concussion. In the latter instance, educators should still help to determine if the student needs academic assistance, and if so, in what form.” 3

Note: Unlike Return to Play decisions, students don’t need to be “cleared” by a physician to return to school so doctor’s note and instructions may or may not be available in initial period of student’s return.

 

Who determines when the Student returns to school?

It is common for emergency departments to suggest the student not return to school until they have either been seen or been cleared by the healthcare provider. This recommendation often leads to a student being out of school for up to 1 or more week(s) while awaiting an appointment with a doctor, which may not be reasonable or necessary. It is also common for a medical professional to suggest the student not return to school until they are symptom-free. While it is true that an athlete must be 100% symptom-free before RTP, they do not need to be 100% symptom-free to RTL. The student may return to school when symptoms are tolerable and manageable, as long as the school makes appropriate adjustments for the student (the key point is that the school must understand concussions and necessary accommodations in order for the student who is still exhibiting symptoms to return to learn) 2

The school psychologist and/or the school nurse are the most skilled professionals at the school to help advise the parent and doctor when it is best to return the student to school. However, as the ultimate decision often/usually falls upon the parent, parents can utilize symptoms to determine when to safely return their student to school. 2

  • If symptoms prevent the student from concentrating on mental activity for even up to 10 minutes at a time, rest is required. The student should be kept home from school on total bed rest with no (or very limited) television, video games, texting, reading, homework, or driving. Parents should consult a healthcare professional if this state lasts longer than a few days. 2
  • If symptoms allow the student to concentrate on mental activity for up to 20 minutes at a time, parents should still consider keeping their student home from school, but total bed rest may not be necessary. Between periods of resting and napping, the student may engage in light mental activity, such as light reading or television, as long as these activities do not provoke symptoms. 2

Making the determination that an athlete is ready to begin implementing the graduated return to activity protocol is a medical decision. However, the school’s Concussion Management Team plays a critical role in deciding to return a student to activity—both academics and athletics. Communication among all members of the team is crucial. The school-based members of the Concussion Management Team will never clear an athlete to begin implementing the graduated return to activity protocol without the approval of the athlete’s health care provider. However, the Concussion Management Team has the authority to prevent a student from beginning activity if signs, symptoms, or behaviors of the concussion are still apparent in the academic setting or during physical activity.9

Once the student is ready to return to school, providing academic accommodations (e.g., extended time for tests, reduction of make-up work, rest breaks) can prevent exacerbation of symptoms and lead to a quicker and more successful recovery.

 

What is considered Best Practices for a School’s Concussion Team?

When a student returns to school following any injury, the school team’s responsibility is to (a) assess the needs, (b) design an intervention plan, (c) monitor the effectiveness of the plan, and (d) adjust and readjust until the student no longer has special needs resulting from the condition. Returning a student to school following a concussion is no different. 2

For schools who use RTI, Principles of Response to Intervention (RTI) as applied to TBI: Source: Colorado Concussion 8

  • Thoroughly understand and assess the problem
  • Apply a prescriptive intervention – early intervention is recommended
  • Assess whether the intervention is having it’s desired outcome – progress monitoring
  • Adjust: re-assess, attempt another intervention, progress-monitor: Adjust

This chart from Nationwidechildrens.org shows of what to do if increasing cognitive demand worsens symptoms. 6

Decision-Making flow chart 4

Footnotes:

Wall Street Journal article, “Concussions on the Field, Repercussions in School, ” April 19,2013 http://online.wsj.com/article/SB10001424127887324108204579022770562136360.html

National Association of School Psychologists ”Research-Based Practice - Return to Learning: Going Back to School Following a Concussion,“ By Karen McAvoy http://www.nasponline.org/publications/cq/40/6/return-to-learning.aspx

Majerske, C. W., Mikalik, J .P., Ren, D., Collins, M. W., Cmiolo Reddy, C., Lovell, M. R.,& Wagner, A. K. (2008). Concussion in sports: Postconcussive activity levels, symptoms, and neurocognitive performance. Journal of Athletic Training, 43(3), 265–274.

CDC http://www.cdc.gov/concussion/pdf/TBI_Returning_to_School-a.pdf

National Children’s http://www.nationwidechildrens.org/concussions-in-the-classroom

From the American Academy of Pediatrics Clinical Report Sport-Related Concussion in Children and Adolescents http://pediatrics.aappublications.org/content/126/3/597.full

Nationwide Children’s Hospital, “An Educator’s Guide to Concussions in the Classroom” http://www.nationwidechildrens.org/concussions-in-the-classroom chart

7 Gerry Gioia’s Presentation for The Institute of Medicine  https://docs.google.com/viewer?url=http%3A%2F%2Fwww.iom.edu%2F~%2Fmedia%2FFiles%2FActivity%2520Files%2FChildren%2FSports-Related-Concussion%2F4%2520Gioia%25202.pdf

8 Colorado Kids with Brain injuries https://docs.google.com/viewer?url=http%3A%2F%2Fcokidswithbraininjury.com%2Fckwbi%2Fwp-content%2Fuploads%2F2009%2F11%2FPrinciplesofRTI.pdf

9 Oregon Concussion Awareness and Management Program https://docs.google.com/viewer?url=http%3A%2F%2Fwww.ohsu.edu%2Fxd%2Foutreach%2Fprograms%2Fthinkfirst%2Fupload%2Focampguide.pdf

10 PEDIATRICS Vol. 126 No. 3, September 1, 2010 pp. 597 -615 (doi: 10.1542/peds.2010-2005) http://pediatrics.aappublications.org/content/126/3/597.full

_________________________________________

 

SECTION FOUR: List of Resources for Parents, Teachers, Administrators and Free Training Videos

For Parents

For Schools to set up a Concussion Management Team

For Teachers

 

 

For School Nurses

For Healthcare Providers

 

 

 

 

 

Training Videos available for free online

Video: BrainSTEPS Presents: Concussions in the Classroom – Return to Learning

Pennsylvania’sBrainSTEPS Brain Injury School Re-entry Program by Brenda Eagan Brown, Program Coordinator eaganbrown@biapa.org

Video: Concussion In Iowa: Return to Learn Webinar 

 

Guardian Caps are being used on middle school and elementary students as young as third graders who playing tackle football in my area. Now Guardian only began shipping product in the Spring 2012, and so there is only one year of experience using these caps on high school age students. Before research is even begun on a large scale to test what effect this cap has on high school players, the product is now being worn on more vulnerable brains and smaller bodies of kids as young as third grade.

I wonder how these parents would feel if they were at an amusement park and their  8 year old child was offered an unproven safety device to wear on a roller coaster. They would be assured that other kids said the device felt good when they used it, but there was no scientific research that stated the device definitely worked or whether it caused any harm. Would parents agree to try an unproven safety device to see if it helped? And what about using their child as a test case? I believe it is rather frowned on to experiment with children as subjects.

Note: From the Guardian website, the cap weighs less than 7 oz.

What is the Guardian Cap?

      • Soft-shell football helmet cover
      • Reduces impact up to 33%
      • One-size fits all
      • Lightweight (<7oz)

From an mail from Mike Oliver, Executive Director and General Counsel of NOCSAE, to me on this topic:

“There is another potential confounder to the question and debate regarding the addition of things to helmets, whether external or internal, and that is the significance of the increase in total helmet weight, particularly with regard to youth football players.  NOCSAE has been working diligently to identify effective criteria that would allow us to create a football helmet standard unique to the youth player, and even with the best objective experts in the country, the only near consensus we have been able to develop is that there should be a limit to the mass of a helmet worn by young football players outside of scholastic or academic based programs such as middle school, junior high or high school regulated by the various state athletic activities associations.

From an investigation recently concluded by our technical director, we know that the average weight for a youth football helmet with face mask is 1600 grams or 56 ounces, and can be as light as 38 ounces.  Any item or combination of items weighing 6 ounces and added to a youth helmet can increase the mass by almost 20%.  If someone wants to sell a product that can add as much as 20% to the weight of a helmet for a youth player, they should be required to demonstrate with peer reviewed science that such added weight increases the level of protection in a measurable way AND does not increase the risk of injury. ”

 

Michael Oliver

Executive Director and General Counsel

NOCSAE®

11020 King St.,  Suite 215

Overland Park, KS 66210

913-888-1340

Fax 913-498-8817

 

“Commissioning research and establishing standards for athletic equipment, where feasible, and encouraging dissemination  of research findings on athletic equipment and sports injuries.”

 

NOCSAE Website

Dustin Fink Of The Concussion Blog reposted my blog on Guardian Cap from today, with his own thoughts and additions. Then Mike Oliver, Executive Director and General Counsel of NOCSAE, commented on our mutual blog on the liability issue.

From Mike Oliver in reference to Dustin’s and my blog post 

You have done an excellent job identifying and clarifying the issues associated with helmets and helmet add-on products.

As with most national and international equipment safety standards, the NOCSAE helmet standards are design neutral.That simply means that the standards define performance and function, and leave the decision as to how to achieve those ends to engineers and other experts most familiar with material design.

A typical football helmet involves very complicated interactions between the rigid exterior shell and the interior energy absorbing material, which relationship includes how much the shell flexes on impact, where and to what extent those flexing forces are transmitted to the padding underneath, and how the flexing of the shell itself acts as an energy absorbent component to the entire system.

Because even minor changes to any of those components can result in measurable performance changes (good or bad) in the system, NOCSAE standards mandate that such changes to a model require a separate and independent set of certification data when the manufacturer makes even minor changes in those components.

If a manufacturer had chosen to incorporate an external similar to the Guardian Cap into any of its models, it would have been required under our standards to develop and establish compliance with the standards for that new model, and would have been required to give that model a different name to distinguish it from others.

This is true even if the change or addition was an improvement to the helmet performance. That new testing data could encompass over 6000 separate impacts across 200 to 225 sample helmets, depending upon the total quantity of that helmet model being manufactured.

I did recently received a statement from Riddell indicating thatEach helmet and face mask model is certified by the manufacturer to meet NOCSAE performance standards. The manufacturer certification is void if the helmet or face mask is modified in any way. Riddell recommends against the use of any third party aftermarket accessories that alter the fit, form or function of the helmet or face mask as such modifications void the NOCSAE certification and render the helmet or face mask illegal for most organized play.

“Hey, mom, we have these new igloo caps in football and they reduced concussions by 80%,” reported a 5th grade, first-time football player to his mom in a local town in Fairfield County.

Two weeks ago a local paper ran a very misleading article concerning Guardian Caps in which the Guardian Cap was called “concussion caps” multiple times and the caps were “concussion prevention.” The reporter continued to summarize their use as ”It is probably overstatement to suggest the difference is getting hit by a truck as opposed to getting hit by a pillow.

Over the last two years, I have had “communications” with Guardian Caps about the way in the past they have marketed this product with sometimes less than factual detail, and so I called Guardian about this article. My concern was that now the flawed newspaper article was on the internet and would be googled and read by some parents as fact. Guardian said they did not supply any information to this reporter and they agreed it was poorly written piece, but there was nothing they could do about it.

The Guardian site now has a clear warning in the footer of every page;  ”*No helmet, practice apparatus, or helmet pad can prevent or eliminate the risk of concussions or other serious head injuries while playing sports. Researchers have not reached an agreement on how the results of impact absorption tests relate to concussions. No conclusions about a reduction of risk or severity of concussive injury should be drawn from impact absorption tests.”

Under the Science & Facts section of their website, Guardian has just one quote in the “What Experts are saying section,” with no author mentioned here other than the source is a October 10, 2012 blog post from “McGill University Physics Professor Review “Newton’s Cradle: Colliding Football Helmets: Physics 101″ ; and below the quote, Guardian has posted, ”This is an individual’s opinion and has not been substantiated by any scientific study.”

Guardian stated there was nothing they could do about the article so I then wondered what the high schools mentioned in the article knew of the issues around Guardian so I decided to contact those schools. I wanted to know if schools understood the limitations and the possible liability issues around using an add-on product and if they had notified the parents and the student athletes. I emailed the schools – see my original email and all source documents with links are below (thanks to several people on this list who reviewed and helped me with this effort).

My first concern was if the schools know Guardian Caps does not have scientific research to support that it can prevent or reduce concussion. No helmet or device attached to a helmet can prevent a concussion at this point in time. I supplied the schools with a number of advisories by NOCSAE have been issued on these products. Links below.

My second concern was regarding the potential liability to the school district by attaching this product (which is called a 3rd party add-on) to the football helmet. By using the Guardian Cap, schools may possibly void the helmet manufacture’s warranty and void the NOCSEA certification.  I provided the schools  the NOCSAE advisory that had been issued on these types of “3rd party add” products. This is an issue in Colorado and some Colorado schools who have been using the Guardian Caps since 2012, are considering banning its use.

What I discovered in contacting the schools is not only are high school students now wearing these caps, but in some places Guardian Caps are being used on middle school and elementary students as young as third graders who playing tackle football. Guardian only began shipping product in the Spring 2012, and so there is only one year of experience using these caps on high school age students. Before research is even begun on a large scale to test what effect this cap has on high school players, the product is now being worn on more vulnerable brains and smaller bodies of kids as young as third grade.

I wonder how these parents would feel if they were at an amusement park and their child was offered an unproven safety device to wear on a roller coaster. They would be assured that other kids said the device felt good when they used it, but there was no scientific research that stated the device definitely worked or whether it caused any harm. Would parents agree to try an unproven safety device to see if it helped? And what about using their child as a test case? I believe it is rather frowned on to experiment with children as subjects.

In 2009, I bought my 6th grade son who had suffered two concussions a $250 “concussion proof” helmet for lacrosse to “protect him against concussions” as the sales clerk promised this new helmet would do. He lasted twenty minutes in a practice before illegal hit sent him backwards and he hit his head on the ground for his third concussion. I sent my son back into a contact sport thinking he was protected. Based on the marketing language on the box and the sales clerk, I made a decision to let my son play. Marketing is not the same as scientific research.

I believe that parents and children using the Guardian Cap should be notified by their schools in writing and sign-off they understand the limitations and liabilities surrounding this product. 

From my experience, these schools have staff who promote and believe in concussion education, and I believe the staff ordered these caps in an effort to help, not hurt kids. But have these caps been oversold to coaches and parents as “concussion caps” as the article states? And there is also concern from some ATs and experts in the concussion field that children will be less likely to report concussion symptoms because they believe they are protected or believe it would be wimpy to report if they have on something meant to reduce concussions. Will parents will be less likely to take their children to doctors if they believe this covering can protect their child’s brain? What about possible neck and spine injuries as helmets with the caps collide? The answers are unknown. It will remain to be seen whether this product helps, hurts or has no impact in this informal experiment with these athletes, some of whom are only 8 years old.

Katherine Price Snedaker, MSW

www.PinkConcussions.com

www.SportsCAPP.com

203.984.0860

______________________________________________________________________________________________________

My letter to the schools involved

Dear School,

I am writing to you because I am concerned about the Guardian Caps helmet covers, which per an article in the Stamford Advocate, your football team is currently using as a “safety device” in practice. In addition to being a parent of two sons who have suffered concussions, I am also concussion educator who has spoken locally and nationally on various concussions issues, including recently presenting at Institute of Medicine(IOM)/National Research Council (NRC) on concussions in youth sports (see my bio below). I had the honor of speaking at your school last spring to two upper school Psychology classes on the topic of concussions and was very impressed with your students. I have spoken to your AT and other staff in the past and have been impressed by your concussion policies.

However, after reading the flawed article about Guardian Caps in the Stamford Advocate, http://www.stamfordadvocate.com/sports/article/Concussion-caps-making-the-scene-at-HS-football-4776651.php I felt it was important to share with you the following information concerns safety and liability issues. I know from experience that liability is an important issue to address in a school as my father was superintendent of schools for 29 years and a private school headmaster for 8 years. I am also working with the press to write a follow-up story to correct serious errors in this story.

My first concern with this product is that athletes or parents might falsely believe that this product can help prevent or reduce concussions. No helmet or device attached to a helmet can prevent a concussion at this point in time, and this “safety” device does not have scientific research to support that it can prevent or reduce concussions. A number of advisories have been issued on these products including:

•                June 2012 NOCSAE “warns parents and athletes about protective equipment concussion claims”  http://nocsae.org/wp-content/uploads/2012/10/NOCSAE-Consumer-Warning-News-Release-06-15-12.pdf

•                2012 NFHS Statement on these products “has not been able to form a definitive conclusion as to whether a number of such products are, on balance, beneficial or detrimental”: http://ciacsports.com/site/?p=1534

•                NY Attorney General issues concussion alert including use of concussion “safety” products: http://online.wsj.com/article/APbecd319ec23e42c4bc79b826f600d2fa.html

•                Guardian Cap after the NOCSAE http://www.nfl.com/news/story/0ap1000000223873/article/guardian-cap-caught-in-catch22-after-nocsae-statemen

The leaders in the concussion community have been following claims made by the company which makes Guardian Caps, beginning before its first delivery in April 2012. There have been issues with the company and sales representatives making claims about the caps which were not substantiated by any research, which over the last year, Guardian has tried to rectify.  The Guardian site now has a clear warning in the footer of every page;  ”*No helmet, practice apparatus, or helmet pad can prevent or eliminate the risk of concussions or other serious head injuries while playing sports. Researchers have not reached an agreement on how the results of impact absorption tests relate to concussions. No conclusions about a reduction of risk or severity of concussive injury should be drawn from impact absorption tests.”

In their science section on their website, after one researcher explains how the cap might work, they post this warning, “This is an individual’s opinion and has not been substantiated by any scientific study.”

My second concern is regarding the potential liability to your school district by attaching this product (which is called a 3rd party add-on) to the football helmet. By using the Guardian Cap, schools may void the helmet manufacture’s warranty and void the NOCSEA certification. Please consult with your legal team to see your district is comfortable with the use and possible consequences of using this 3rd party add-on.Please see helmet companies’ response below.

•                The August 2013 Nocsae advisory on 3rd party add-ons:  http://nocsae.org/wp-content/uploads/2013/08/NOCSAE-Add-on-Fact-Statement-8-7.pd

Some Colorado schools have been using the Guardian Caps since 2012 and are considering banning its use. From http://www.denverpost.com/ci_23772337/guardian-cap-controversial-ruling-may-mean-end-use :

After a Denver Post story last week,  about the growing use of the Guardian Cap, the National Operating Committee on Standards for Athletic Equipment issued a statement that read, in part: “The addition of after-market items by anyone that changes or alters the protective system by adding or deleting protective padding to the inside or outside of the helmet, or which changes or alters the geometry of the shell or adds mass to the helmet, whether temporary or permanent, voids the certification of compliance with the NOCSAE standard.”

Soon after, CHSAA issued a news release, warning coaches and athletic directors “considering the use of third party add-on accessories (at practices) to work through their risk  managers and attorneys. The liability that schools face can be affected by the use of these accessories.”

I would be more than happy to meet with you and anyone else to discuss these issues. While I cannot give legal advice, I am a national expert on the topic of concussions and I can provide some background and sources to help you in making a decision regarding the use of Guardian Caps.

 

Sincerely,

Katherine Snedaker

 

Katherine Price Snedaker MSW

www.PinkConcussions.com

www.SportsCAPP.com

203.984.0860

Schutt Helmets’ Position

In this statement to Moms’ Team, Schutt Helmet specifically advises purchasers of its helmets “alterations, additions or component deletions or removals you make to the helmet may void [its] warranty and could adversely affect the protective capabilities of the helmet.”http://www.momsteam.com/nocsae-ruling-third-party-helmet-add-ons-generates-controversy?page=0%2C3 .

Robert Erb, CEO of Schutt, said that while “We work with a number of inventors and outside companies to help them understand helmet impact dynamics, we do not certify or approve the use of third party products in our helmets. We make the best protective gear and prefer that nothing be added or subtracted from the manufactured product. When it leaves our facility, it is fully compliant with NOCSAE and other regulatory bodies, and it is fully insured and warranted. A company that seeks to alter the helmet in any way needs to do its own certification under NOCSAE standards and needs to fund its own insurance. This is no different than after-market automotive or electronic enhancements.” http://www.momsteam.com/nocsae-ruling-third-party-helmet-add-ons-generates-controversy?page=0%2C3#ixzz2dx9N0bgO

 

My work in the Concussion Field

In February 2013, I was asked to present in Washington to the Institute of Medicine (IOM)/National Research Council (NRC) Commission on “sports-related concussions in youth” on the topic of the concerns of parents with respect to sports-related concussions in youth, as well as the issues and challenges faced by the families of concussed players. As a medical social worker, I have helped guide the recovery process for over hundred children with concussions and their families as they re-entered school and team sports. I have also co-founded and consulted with several CT concussion clinics in Fairfield County and have run support groups for kids with Post Concussive Syndrome.

Since 2008, I have been working as concussion educator for youth sports via SportsCAPP (Sports Concussion Aware and Prepared Program) through public speaking, social media and consulting in the NY Metro Area. Our Youth to Youth Program, MIND YOUR MELON, takes high school athletes who have healed from concussions to speak to groups of middle and high school students. This program benefits middle school kids as they learn about concussions as well as help the athletes find a positive way to share and view their concussions. I have run a number concussion education events for the community and educational programs for schools and camps. Launched in 2010, SportsCAPP.coman education hub website, created to deal with the loop hole in the Connecticut Concussion Law to help recreational teams, town leagues and private schools use free resources to create concussion policy and bring awareness into their programs for players, coaches and parents. TeamConcussion.org was created in 2010, to be a social media/web create a variety of support groups  for teens with concussions to connect with other “healed” teens thru Twitter, Facebook, Instagram. In 2013, PinkConcussions.com was created an info hub for research, resources & answers for female concussions from sports, accident, abuse or military service.