Dr. Shahal Rozenblatt, Clinical Neuropsychologist, New York

NYTimes- States Taking the Lead Addressing Concussions

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As dozens of state lawmakers consider legislation to improve awareness and treatment of concussions in youth sports, the movement is resembling a music style or weather pattern: what started in the Pacific Northwest is wafting across the United States.

Last year Washington and Oregon passed the first concussion-specific laws covering scholastic sports. Each mandated education for coaches, immediate removal from play of any athlete suspected of a concussion in a game or practice and proper medical clearance before that athlete could return. Washington’s in particular named after Zackery Lystedt, a teenager who in 2006 sustained a serious brain injury playing football is a template for other states formulating similar legislation.

The trend will get a name next week when the Zackery Lystedt Brain Project is formally announced at the Super Bowl. Spearheaded by the Sarah Jane Brain Foundation and the American College of Sports Medicine, the initiative will continue those organizations push for states to enact laws similar to Washington’s. Florida, Massachusetts, New Jersey and New York are among those with bills in the works.

We are going to get maybe 24 states passing the laws or making serious headway this year, said Patrick Donohue, founder of the Sarah Jane Brain Foundation. The national organization focused on youth brain injuries is named after his 4-year-old daughter, who was seriously injured when shaken by a nurse as an infant.

Donohue added: Washington’s law is a work of art, and it took almost two years, but they’ve already done the hard work. We don’t need to take two years in every state.

The laws cover youth sports beyond football; other contact sports, particularly girls soccer and basketball, have recently been recognized as breeding grounds for concussions that often go ignored or are mistreated.

About 1.2 million teenagers play high school football in the United States, with another three million participants ages 14 and younger. Dawn Comstock of Ohio State University, the primary researcher tracking youth sports injuries nationally, said youth football players sustained about 140,000 concussions per year, with as many as 40 percent of them returned to the field sooner than modern guidelines would suggest.

Youth sports concussions will be the primary focus of a House Judiciary Committee forum on Monday in Houston, the third gathering of the committee to examine brain injuries in football. The first two dealt mostly with what experts considered the subpar treatment of concussions in the N.F.L., which responded by adopting several new procedures to improve concussion management particularly barring a player suspected of having a concussion from returning to the same game or practice. An anticipated trickle-down effect followed. The N.C.A.A. announced that it would consider similar measures, and more states started looking at adopting laws like those in Washington and Oregon.

One of those is Florida, where Gov. Charles J. Crist Jr., a Republican, not only plans to push for a Lystedt-type law in his state, but also to espouse its purpose to his fellow governors at their national meeting next month.

A challenge for many states, particularly rural ones, will be finding the medical personnel to comply with the laws. State Senator Daniel L. Squadron of New York, a Democrat and the sponsor of his state’s bill, said that requiring doctors on every sideline was distractingly costly for this first step.

We are in a world where certain communities have the resources or knowledge of these issues, and others don’t, and it’s catch as catch can, Squadron said. The first piece is make sure that coaches catch the signs early to help prevent these injuries. And then make sure there’s an independent medical professional making the return-to-play decision so that you don’t have the issues of someone related to the team making the decision. Frankly, it makes life easier for the coaches and trainers.

The federal government is considering ways to ease the financial burden. The federal Concussion Treatment and Care Tools Act, which would amend the Public Health Service Act, commits about $10 million to ensure proper prevention, diagnosis and treatment of sports-related concussions in U.S. high schools and middle schools.

The money is expected to principally defray costs of education programs and neuropsychological testing for athletes.

As the National Football League bolsters its own concussion treatment programs, many parents are wondering if enough attention has been devoted to concussions in school sports, said Senator Robert Menendez, Democrat of New Jersey, who is sponsoring the bill. We want to make sure that the most advanced strategies are being implemented for our high school and middle school athletes.

Most of the movement will have to come from the states, however, because of their more direct control over education. Representative Linda Sanchez, Democrat of California and one of the House Judiciary Committee’s biggest supporters of concussion reform, said that their hearings were meant to bring about change well beyond the N.F.L. level.

I haven’t abandoned the idea of legislation at the congressional level if there’s something that can be done I’ve been trying to think of something that can be uniform across all 50 states, Sanchez said. But the awareness that we’re seeing now at the state level, that definitely was a motivating factor in having the hearing.