The Zackery Lystedt Brain Project (ZLBP) is a joint initiative of the Sarah Jane Brain Foundation and the American College of Sports Medicine. The national effort was publicly announced during Super Bowl week in Miami on February 3, 2010.
The goal of the Zackery Lystedt Brain Project is to advance three core principles throughout the country dealing with youth sports concussions through public awareness, education and training, legislation and advancing research to prevent, identify and treat these brain injuries.
The three core principles of the Zackery Lystedt Brain Project are:
(1) To educate and verify that all youth athletes, their parents and coaches understand the risks associated with sports concussions/head injuries/brain injuries/”mild” TBI;
(2) Identify and protect youth athletes so when there is a suspicion of a sports-related brain injury, they will be immediately removed from play or practice;
(3) All youth athletes must be medically evaluated and cleared by a licensed healthcare provider trained in concussion evaluation and management before they can return to play or practice.
Core Principles of Youth Sports Concussion Legislation
Christopher Giza, MD
Gerard A. Gioia, PhD
SJBF Steering Committee
Introduction
Concussions are one of the most commonly reported injuries in children and adolescents who participate in sports and recreational activities. A concussion is caused by a blow or motion to the head or body that causes the brain to move rapidly inside the skull, resulting in neurobiological dysfunction. This dysfunction commonly includes altered mental status, physical symptoms (such as headache, fatigue and dizziness), cognitive problems (such as memory disturbance and slowed thinking), emotional changes (such as irritability or sadness) and difficulties with sleep. Concussions can occur in any organized or unorganized sport or recreational activity and can result from a fall or from players colliding with each other, the ground, or with obstacles. Concussions occur with or without loss of consciousness, but the vast majority occur without loss of consciousness. The risk of catastrophic injuries or death increases when a concussion is not properly evaluated and managed. Continuing to play with a concussion leaves the young athlete potentially vulnerable to greater injury, longer recovery times, long-term functional deficits, or even death.
In an effort to improve the safety measures for youth athletes, a host of states in the US have introduced legislation to address the problem of concussions in youth sports. The states of Oregon (Max’s Law) and Washington (Zackery Lystedt Law) passed legislation mid-year in 2009. Since that time, a growing number of states have written legislation related to aspects of improving sports concussion management. To promote efforts to improve youth sports concussion management via these legislative efforts, a collaboration has been established between the Sarah Jane Brain Foundation (SJBF), American College of Sports Medicine (ACSM) as well as youth sports organizations (e.g., US Lacrosse, USA Football), and the National Federation of State High School Associations (NFHS). This collaboration offers a unique network of individuals across youth sports, brain injury, and sports medicine to provide guidance to states in their legislative efforts.
Three Core Principles
In examining the current legislation, and in considering the current state of the research and clinical guidance with respect to the evaluation and management of sport related concussions in youth, three Core Principles are proposed: 1) Education, 2) Identification/Protection and 3) Medical Evaluation.
Core Principle 1. Education of Key Stakeholders
The first Core Principle – education – is fundamental and clear in all of the legislative efforts. There is strong acknowledgement that a gap in knowledge and awareness exists amongst the key stakeholders with formal education as a solution. These stakeholders include the coach, parent and youth athlete, officials, and school administrators. Education focuses on developing a working understanding of what a concussion is, recognizing its signs and symptoms, understanding the risks of not taking action, and knowing the appropriate steps to take when a concussion is suspected. A number of established training materials and programs currently exist for this specific purpose. An additional feature to the legislation is an education/ training verification process. For example, a post-test and certificate would be provided to the coach for completion of the training program. For the parent and youth athlete, a signed statement of completion and acknowledge of the concussion management program has also been proposed.
Core Principle 2. Identification and Protection of the Youth athlete
Equipped with the necessary knowledge of concussion signs, symptoms, and risks, Core Principle 2 gives rise to an action step - the coach, parent, and/or youth athlete must recognize the suspected concussion, and protect him/her from further harm by removal from the athletic event.
Core Principle 3. Appropriate Medical Evaluation and Return to Play
Once the youth athlete is removed from play, Core Principle 3 requires an appropriate evaluation by a licensed heath care professional (LHCP) trained in the evaluation and management of concussion. The youth athlete is not allowed to return to practice or game play until receipt of a written evaluation and ‘clearance’ (i.e., full recovery criteria have been met).
Terminology:
While the specific definition of the following terms is subject to some debate, for the purposes of the Core Principles, the terms concussion, head injury, brain injury and mild TBI should be considered interchangeably.
Optional Points: Potentially beneficial points for consideration (good ideas but not ‘mandated key points’):
¨ Regular recertification of concussion education may be a valuable component of Core Principle 1.
¨ Education of school officials, nurses, counselors, and teachers may also be beneficial to identify concussed students and to facilitate recovery. This point is thus related to all 3 Core Principles.
Caveats and exceptions (details to be considered in discussions about sports concussion legislation):
¨ Situations may arise when a suspected concussion evaluated immediately by a Licensed Health Care Professional turns out not to be a concussion.
¨ Although seemingly self-evident, the LHCP that provides written clearance must be the one who actually evaluated the athlete.
¨ The precise definition of a LHCP may include different clinical specialties, but as a minimum should include only licensed clinical professionals with appropriate training/ experience in sports concussions/mild TBI.
