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
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