The New York legislature has submitted the concussion management bill passed at the close of the legislative session to Governor Andrew Cuomo for his signature. The governor has until October 22 to sign or veto this legislation.
The concussion management bill was recognition by the New York legislature that concussions are serious issues with a potential for life long consequences. All concussions are brain injuries and must be treated seriously. The bill in very broad parameters requires school districts to set up a district wide concussion management program; requires education of students, coaches and parents on the dangers of concussions; mandates a 24 hour minimum period before youth athletes can return to play following a concussion; and requires medical clearance before a student with a diagnosis of concussion is allowed to return to play.
Many important decisions have been left by the legislature to the Commissioners of Health and Education to draft important implementing regulations. While the legislation is certainly an important first step in New York, the implementing regulations will be of prime importance in safeguarding the health and safety of athletes both before and after a concussion takes place.
The New York State Traumatic Brain Injury Services Coordinating Council, (TBISCC) which I chair, has previously submitted recommendations to the Commissioner of Health that would mandate base line neuropsychological testing of all athletes before they would be allowed to engage in athletic competition. This testing would be deemed to be preventive medical care and therefore would then be covered by a student’s health insurance, without any additional cost to the school district.
While baseline testing was not included as a requirement in the pending legislation, it certainly should be included in any regulations. It is only with the access to this type of testing that a professional involved in making a determination as to when it is safe for a student who has sustained a concussion has adequate information. Base line and retesting following a concussion enables the decision maker to compare an athlete’s cognitive performance before the injury has taken place with the athlete’s performance and recovery post injury. This type of testing has received almost uniform endorsement and is now being utilized by most professional and intercollegiate teams in all sports.
On Monday, the TBISCC held an important meeting in Albany with the goal of formulating additional recommendations and proposals to the Health Department to assist the commissioner in drafting regulations for implementation of the concussion management legislation. We heard a presentation from Dr. Brian Greenwald, M.D., Director of the Brain Injury Rehabilitation Program at Mount Sinai Medical Center in New York City, Dr. Kristen Dams-O’Connor, PhD, a neuropsychologist at the Mt. Sinai Brain Injury Program who is currently leading important sports concussion research at the medical school and university and Todd Nelson, Assistant Director of the New York State Public High School Athletic Association.
Each of these experts in concussions and concussion management has endorsed the prior recommendation of the TBISCC for baseline neuropsychological testing of all student athletes.
Additionally, each of these experts has made the following recommendations to the TBISCC for transmittal to the Commissioner of Health:
In addition to pre-season base line testing, a thorough and proper history must be obtained from the student and parent concerning prior head injuries, brain injuries and concussions.
- A student who has sustained a concussion should not be permitted to return to play until ALL concussion symptoms have resolved.
- Twenty Fours hours is simply not sufficient time for recovery from a concussion and a player who has sustained a concussion must be afforded more time for recovery and proper assessment to determine when it is safe to return to play.
- A concussed player can only gradually return to strenuous physical and mental tasks and must be continuously monitored during this process before a final return to play decision can be made.
- Performing well on a post injury neuropsychological test is only one element in the evaluation of when it is safe to return to play. A good performance on these tests does not mean that the athlete is symptom free and without significant pathology.
- In addition to no physical activity, educational accommodations must be made in the classroom for students who have sustained a concussion including reduced workload, limited test taking during recovery, assistance with assignments and note taking if necessary. Teachers need to understand and appreciate the signs and symptoms of a concussion and the vulnerability that students have following a brain injury
- Professionals responsible for return to play decisions must have experience and be adequately trained and skilled in concussion recognition and concussion management. Simply possessing a medical degree is not a sufficient qualification for making the important determination of when it is safe for an athlete to return to play.
- School districts must have educational programs for coaches, athletic trainers, teachers, students, and parents.
- When in doubt keep sit them out, must be the maxim for all.
Tomorrow, I will be going to New Orleans to participate in discussions at the North American Brain Injury Association (NABIS) annual meeting. On Friday morning, I am honored to have been invited to make a presentation to the society on concussion legislation and review the various approaches that have been taken in various states and discuss what further efforts need to be taken to insure the health and safety of our children.