It was recently brought to my attention that Indiana has joined the 38 other states in the US (as of May 2012) that have passed legislation regarding management of concussions. I have to admit, I wasn’t aware that Indiana joined the ranks until my sister told me about it. She then asked me this: “Why am I hearing so much about this lately? Is this a new thing, or am I just paying more attention to it?” I’m thinking the latter. Her only son is six, but it was recently decided that he would not be playing football this year. I can’t help but wonder if it has anything to do with my previous posts on concussion in young athletes, but I digress.

The first state to pass legislation on this matter was Washington, in May 2009. This law, and others that have followed, is intended to protect student athletes from long term consequences of concussion by preventing them from returning to play too soon after injury. The law mandates than an athlete younger than 18 years of age must be removed from play if he or she is suspected of having a concussion. The athlete must then be cleared by a medical professional trained in concussion management before returning to play. Parents, coaches, and athletes must be educated each year on the dangers of concussion as the third mandate of this law, which has been named the Lystedt law. It is named for Zackery Lystedt, who was permanently disabled at the age of 13 in 2006 from a brain injury sustained in middle school football. He sustained two head injuries in one game, and only sat out for 15 minutes after the first. The second caused bleeding in his brain and subsequently resulted in his disability. He was in and out of consciousness for many months, underwent a great deal of rehab, and still has difficulty with speech to this day. I had the privilege of hearing Zack speak at the American Academy of Physical Medicine and Rehabilitation (AAPM&R) annual assembly in the fall of 2010. He has a great spirit and determination to be sure other young athletes remain safe in their athletic endeavors.

Interestingly, the results of two surveys were published in the June issue of PM&R (a monthly journal from AAPM&R) regarding this issue. The results of the first survey, given to head football coaches and athletic trainers at various school systems in Washington, suggested that athletes at urban schools were more likely to be evaluated with the most up-to-date concussion evaluation tool versus those at more rural schools. All respondents of the survey reported being familiar with the Lystedt law. The second survey was performed in 2010, one year after the Lystedt law was passed, also in Washington. The authors asked youth soccer players’ parents, coaches, and officials about their understanding of the return to play guidelines. The authors reported that 90% chose to delay return to play if signs or symptoms were present and 85% were aware of the law, but only 73% knew that players had to receive written clearance before returning to play. Promising, but it seems as though there is still work to be done.

As mentioned previously, Indiana has passed similar legislation to the Lystedt law; it went into effect on July 1, 2012. It also requires the department of education to disseminate management guidelines and educational materials to schools for distribution. The fact that the majority of states are on board with this is obviously reassuring for parents “in the know,” so to speak. I personally find it encouraging, not only as a sports medicine physician, but also as an aunt of 7 active nephews.

In case you’re wondering, here are the states without legislation: Arkansas, Georgia, Mississippi, Montana, South Carolina, Tennessee, and West Virginia. Wyoming’s law is incredibly weak, and there are a few with legislation pending.