Concussions on Maryland’s Mind

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The Concussion Epidemic
Image: DebbiSmirnoff/iStockphoto

The rate of concussions resulting from high school sports in the U.S. has doubled in the last decade and poses a serious public health concern. State school systems and athletic associations across the country are scrambling to address the fears of parents and doctors alike, but not all proposed solutions are equal. Everyone agrees that schools need to have clear policies dictating when a student athlete who may have suffered a concussion should be removed from the game and when that player may return to athletic participation. What is not clear is who makes the initial decision to remove a player from the game and who determines when a player can safely return to participation?

Maryland State public health officials are aware of the concussion epidemic and had previously enacted regulations that requiring players to obtain clearance from a health care professional before returning to school athletic participation after diagnosed with a concussion. The legislation did not specify who was initially responsible for removing an athlete from a game when he or she is showing signs of a concussion. With the recent addition of temporary 180-day emergency legislation passed last month, Maryland legislators attempted to enhance safety measures by requiring coaches to take an online training to identify the signs of concussions and when to remove players from the field. Unlike many states and the neighboring District of Columbia school systems, the state of Maryland does not require schools to establish a cognitive function baseline for each player, which experts have deemed critical to an accurate diagnosis. High school coaches are not health professionals and should not be asked to make an initial medical determination after participating a 20 minute online training.

In order to establish this baseline and properly diagnose concussions, many professional, collegiate, and secondary school systems around the country are utilizing ImPACT  (Immediate Post-Concussion Assessment and Cognitive Testing) or similar services. Maryland Public Schools have fallen behind the curve on this movement despite the absence of any clear opposition to the policy. The State of Maryland needs to require individual baseline assessment and an approved concussion assessment tool as part of any school sports concussion regulation under consideration.

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3 Responses to “Concussions on Maryland’s Mind”

  1. rdsampson Says:

    This topic is quite emotionally charged, with strong feelings from athletes, coaches, medical professionals and parents. The long term consequences of multiple concussions as well as significant concussions has been well documented in recent years. I fully agree, that while the coaches are the ones on the side lines, they are not fully equipped to make clinical assessments, and they also may not be entirely objective, wanting the player on the field for the good of the team. This might tip the balance to put concussed players at risk. Thus utilizing a tool such as ImPACT which is objective and user friendly would enable critical decision making. Maryland does need to step up for the support of its young athletes, and require baseline testing as well as an approved concussion assessment tool for all school athletic teams.

  2. sarkarson Says:

    Thanks for the great post — this issue has recently become a hot-button issue in several states. The Massachustts Department of Health implemented a state concussion law one year ago that rolled out a program called “Head Strong” across all of the state’s school districts. While it remains to be seen whether the regulation has actually been effective in decreasing concussions or severity of concussions, it has been successful in shifting several athletics programs and school officials to viewing the issue as a public health issue rather than an isolated neighborhood or team issue. With the state collecting regular concussion-related data, school districts are also taking a look at their own numbers and assessing whether the measures they have in place are sufficient.

  3. sbfph Says:

    Thanks for posting! I have spent the last few years studying mild traumatic brain injury in both retired NFL players as well as returning soldiers and I could not agree with you more. Without baseline cognitive tests, all the regulations regarding return to play are ineffective. If you do not know an individual’s baseline cognitive function, it is almost impossible to assess if they have “returned to normal”. In addition, a lot of the regulations that are receiving publicity really focus on major concussions and are ignoring repeated low-grade trauma that comes from something like heading a ball for soccer from the ages of 5 – 19. While I don’t think it is the state’s role to regulate practices, I do think the state has a responsibility to provide education to parents and coaches. This can help families learn that for a youth recreation soccer league it is ridiculous for a practice to include heading drills.

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