Traumatic Brain Injury Prevention Requires a Comprehensive National Plan

Yes, concussions happen. It is part of the game, but we must implement initiatives to reduce the risk of injury, and prevent, preventable injuries.
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The goals of today's White House Summit on sports concussions must embrace a uniform national protocol to comprehensively tackle the issues related to sports concussion management. This is critical to avoid preventable brain injuries and manage the brain injuries that will unfortunately but inevitably occur. Though many coaches and parents fear the over-protective label, they have justification for their safety concerns.

Sport-related concussions have multiplied to epidemic levels. The Centers for Disease Control report almost 250,000 brain injury related emergency department visits each year by children and adolescents. The CDC has cautioned that this frightening statistic is a vast underrepresentation. The available data is limited to organized sports, omitting visits to private physicians, cases where traumatic brain injury is not the principal diagnosis and concussions that remain undiagnosed altogether. In extrapolating, the CDC estimates a more accurate approximation is between 1.6 and 3.8 million sports-related traumatic brain injuries each year. Unbelievable but true, this is a public health crisis that commands action on a federal level.

A concussion is a brain injury. One concussion alone is capable of producing a profound cascade of consequences that may affect a child's cognition, behavior, emotional development and educational achievement. Although all 50 states have finally enacted sports concussion management legislation there is a critical lack of uniformity. Different legislative compromises were necessitated to. As a result, vital safety requirements have been omitted jeopardizing the brains of our nation's youth. It is essential that President Obama's White House, Healthy Kids and Safe Sports Concussion Summit resolve the problems that have eluded state legislatures.

Meaningful regulations must protect all participants in youth sport leagues, both school and non-school sponsored. The District of Columbia's Athletic Protection Act encompasses school sponsored athletic activity, physical education classes, Department of Parks sponsored athletic programs and athletic programs under the auspices of either nonprofit or for profit organizations. This is a comprehensive and crucial approach that should be adopted nationwide.

An effective concussion management program must include mandatory and continuing concussion education including detection, protocols for suspected concussion, and the associated risks and potential consequences. All individuals responsible for player supervision, including coaches, assistants, trainers, and sporting officials must participate in required training. Mandatory concussion awareness programs must be instituted for all youth sports participants with written information to parents.

A clear definition of concussion and protocol for diagnosis must be established. Without consensus there can be no meaningful standard. Criteria must be unvarying regardless of school district, state or sport. Failing to have unanimity is a recipe for disaster.

Appropriate return-to-play guidelines must be established with a prudent and safe time periods. Though many people acknowledge the need for physical rest and recuperation, it is imperative to undertake the complex issue of cognitive rest. Concussion management legislation must incorporate return to learn practices and parallel educational support. Not all the signs of a concussion can be discerned immediately following an injury and some symptoms develop more slowly. At a minimum, no athlete should be allowed to return to play for at least one week following a concussion or suspected concussion, accompanied by proper school support upon return to the classroom. Clearance from a qualified medical professional trained in concussion recognition and management must be obtained.

An effective concussion management plan must require accurate records delineating the injury, the circumstances surrounding the injury, the signs and symptoms exhibited, all associated care, and return to play. This record must track the player throughout their academic career and be readily available for review in the event of future concussions.

Off-field assessment tools must be an integral part of a concussion management program. All athletic participants, regardless of sport, must undergo baseline neuropsychological testing at the beginning of every season with mandatory retesting integrated into the return to play/return to learn protocol. This is preventive pediatric medical care and should be covered by every health insurance policy.

Strategic legislation cannot shield the responsible supervisors from accountability if they expose our children to needless risk of injury. Safety rules must be enforced. Players who flagrantly violate these rules must be treated fairly but firmly.

Yes, concussions happen. It is part of the game, but we must implement initiatives to reduce the risk of injury, and prevent, preventable injuries. This national summit on the public health crisis of sports related brain injury and proposing meaningful safety standards is an important move in the right direction.

Michael V. Kaplen, Esq. will be an attendee at Thursday's White House, Healthy Kids and Safe Sports Concussion Summit

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