May 29, 2012 Diana L. Malone, Ph.D. AIU Training & Consultation Coordinator

1. May 29, 2012 Diana L. Malone, Ph.D. AIU Training & Consultation Coordinator Concussion Management for Student Athletes“Safety in Youth Sports Act” P.L. 411 No. 101 Cl. 24

2. Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24 Signed into law on November 9, 2011 Effective July 1, 2012

3. Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24 Purpose of the legislation is to ensure the safety of student athletes 1) Includes certain requirements for: • Pennsylvania schools • Personnel who supervise schools’ student athletes • Medical personnel who support them 2) Establishes standards for managing concussions and traumatic brain injuries to student athletes

4. Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24 “Our hope is that this bill will reduce the risk of long-term damage for student athletes who suffer concussions or other brain-related trauma while participating in sports. By signing this bill, Pennsylvania joins 31 other states in establishing legislation.’’ Governor Tom Corbett PRNewswire-US Newswire

5. Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24 Facts • A concussion is a brain injury. • All concussions are serious and can occur in any sport. • Most concussions occur without loss of consciousness. • Children and teens are more likely to get a concussion and take longer to recover than adults.

6. Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24 Facts • 1.6 to 3.8 million sports related concussions in US per year. BIAA 2009 • Football is responsible for more than 250,000 head injuries in the United States. • In any given season 10% of all college and 20% of all high school players sustain brain injuries. • High school players also have a three times higher risk of getting a second concussion once they have had one. 2009 Brain Injury Research Institute

7. Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24 Facts • Approximately 10% of all contact sport athletes sustain concussions yearly. • Effects of concussion are cumulative in athletes who return to play prior to complete recovery. 2011 Sports Concussion Institute • Recognition/proper management when they first occur can help prevent further injury or even death. CDC

8. Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24 Requirements of the Law

9. Safety in Youth Sports Act Elements of PA Legislation • Section 1. Name (Safety in Youth Sports Act P.L. 411, No. 101, Cl24.) • Section 2. Definitions • Section 3. Concussion and Traumatic Brain Injury (TBI) • Section 4. Effective Date July 1, 2012

10. Safety in Youth Sports Act Elements of PA Legislation Section 2. Definitions “Appropriate Medical Professional” • Licensed Physician trained in the evaluation and management of concussions • Licensed or certified health care professional trained in the evaluation and management of concussions and designated by such licensed Physician

11. Safety in Youth Sports Act Elements of PA Legislation Section 2. Definitions “Appropriate Medical Professional” • Licensed Psychologist neuropsychologically trained in the evaluation and management of concussions or who has postdoctoral training in neuropsychology and specific training in the evaluation and management of concussions.

12. Safety in Youth Sports Act Elements of PA Legislation Section 2. Definitions “Athletic Activities” What activities are covered? • Interscholastic athletics • Contest or competition sponsored by or associated with a “school entity” • Includes cheerleading, club sports or activities sponsored by school affiliated organizations • Noncompetitive cheerleading • Practices and scrimmages

13. Safety in Youth Sports Act Elements of PA Legislation Section 2. Definitions “School Entity” A public school, school district, nonpublic school or private school in this Commonwealth other than a private or nonpublic school which elects not to become a member of the association.

14. Safety in Youth Sports Act Elements of PA Legislation Section 2. Definitions “Interscholastic athletics” All athletic contests or competitions conducted between or among school entities situated in counties of the second class, second class A, third class, fourth class, fifth class, sixth class, seventh class and eighth class.

15. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion & TBI • Educational Materials • Informational Meeting • Removal From Play • Return to Play • Training Course • Penalties • Youth Athletic Activities • Construction • Civil Liability

16. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (a) Educational Materials Department of Health, PA Department of Education & CDC websites offer guidelines & other relevant educational materials for students, parents, and coaches. • PA Departments of Heath and Education www.health.state.pa.uswww.education.state.pa.us • Center for Disease Control and Prevention http://www.cdc.gov/concussion/HeadsUp/youth.html

17. Keeping Quiet Can Keep You Out of the Game www.cdc.gov

18. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (a) Educational Materials • Parents and student athletes must sign acknowledgement of receipt and review of Concussion and Traumatic Brain Injury Information sheet.

19. Safety in Youth Sports Act Elements of PA Legislation The Pennsylvania Department of Education (PDE) sample Concussion Information and Acknowledgement Form which has been reviewed and adopted by the PIAA.

20. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (b) Informational Meeting • School entity may hold Informational Meetings prior to the start of each athletic season for all ages of competitors regarding: • concussions and other head injuries, • the importance of proper concussion management • and how preseason baseline assessments can aid in the evaluation, management and recovery process.

21. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion & TBI (b) Informational Meeting • In addition to students, parents, coaches and other school officials, Informational meetings may include physicians, neuropsychologists, athletic trainers and physical therapists. Video: Preston Plevretes Story http://espn.go.com/video/clip?id=5163151

22. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (c) Removal From Play

23. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (c) Removal From Play • Student athlete exhibits signs or symptoms of concussion shall be removed from play and practice

24. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (c) Removal From Play • Determination may be made by game official, coach, certified athletic trainer, physician, physical therapist, or other designated by school

25. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (d) Return to Play • Appropriate medical professional (as defined in the ACT) must evaluate and clear athlete Dr. Micky Collins, Director UPMC Sports Medicine Concussion Program

26. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (d) Return to Play • Appropriate Medical Professional (as defined in the ACT) must provide written clearance for return to participation

27. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (d) Return to Play • To help determine whether a student is ready to return to participation, an appropriate medical professional may consult any other licensed or certified medical professionals.

28. Safety in Youth Sports Act Elements of PA Legislation Pennsylvania Department of Education has developed a sample Return To Play Form

29. Recommended Procedures Return to Play Protocol The following graduated return to play is recommended: • Completion of a full day of normal cognitive activities without symptoms • Light aerobic exercise • Sport-specific exercise • Non-contact training drills • Participation in normal training activities • Return to play involving normal exertion

30. Recommended Procedures Return to Play Protocol • If concussion symptoms recur during the graduated return to play protocol, return to the previous level of activity that caused no symptoms

31. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (d) Return to Play • Baseline testing is recognized as valuable tool Dr. Mark Lovell, CEO ImPACT

32. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (e) Training Course • All Coaches must complete concussion management certification course annually. (Beginning July 1, 2012 for 2012-2013 school year) • A coach shall not coach any athletic activity until completing the required training course.

33. Safety in Youth Sports Act Elements of PA Legislation Certification Training for Coaches and Medical Professionals 3 Provider(s) approved by PA Department of Health • Center for Disease Control (CDC) • National Federation of State High School Associations (NFHS) • PA Athletic Trainers Association (PATS)ConcussionWise™ Pennsylvania:

34. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (f) Penalties for Coaches(Required July 1, 2014)

35. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (f) Penalties for Coaches (1) 1st violation – Suspension from coaching for remainder of season (2) 2nd violation – Suspension from coaching for remainder of current season and for the next season (3) 3rd violation – Permanent suspension from coaching any athletic activity

36. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (g) Other Youth Activities • The sponsors of youth athletic activities not specifically addressed by this act are encouraged to follow these guidelines.

37. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (h) Construction • Nothing in this act shall be construed to abridge or limit any rights provided under a collective bargaining agreement or Public Employee Relations Act.

38. Safety in Youth Sports Act Elements of PA Legislation Section 3 Concussion and TBI (i) Civil Liability (1) Except as provided under paragraph (2) nothing in this act shall be construed to create, establish, expand, reduce, contract or eliminate any civil liability on the part of any school entity or school employee. (2) Protection for Compliance - Any coach acting in accordance with subsections ( 3c ) and (3d)shall be immune from any civil liability.”

39. Safety in Youth Sports Act Elements of PA Legislation Section 4 Effective Date The “Safety In Youth Sports Act” shall take effect on: July 1, 2012.

40. Recommended Return to SchoolBest Practices Return to School Best Practices Protocol

41. Recommended Return to SchoolBest Practices • REST is the best “medicine” for healing concussions or other head injuries. • Impaired memory, attention span, concentration, processing speed significantly impact learning. • Exposing the concussed student athlete to the stimulating school environment may exacerbate symptoms and delay the resolution of symptoms needed for recovery.

42. Recommended Return to SchoolBest Practices Consideration of the cognitive effects in returning to the classroom is an important part of treatment . • After suffering a concussion/mTBI, a student may need Temporary Learning Support Accommodations: 1. Shortened school day 2. Take rest breaks as needed 3. More time for tests and assignments 4. Assistance with schoolwork

43. Recommended Return to SchoolBest Practices Temporary Learning Support Accommodations 5. Reduce time spent on the computer, reading, and writing. 6. Early dismissal from each class to avoid crowded hallways. 7. No standardized testing (PSSA, SAT, etc.) during the initial recovery window of 2-4 weeks.

44. Recommended Return to SchoolBest Practices BrainSTEPS School Re-Entry Program www.brainsteps.net • Consulting teams are available to secondary schools and families throughout Pennsylvania • The school should initiate a referral to the BrainSTEPS team if after 2 weeks return to school causes concussion symptoms to re-occur or if the student demonstrates uncharacteristic performance. • Teams work with local school staff to develop educational programs, academic interventions and systems for monitoring students AIU BrainSTEPS Consultants Jamie Moder, MHPE, CHES - AIU Adaptive Recreational Educational & BrainSTEPS Consultant Michelle Lubetsky,M.Ed., BCBA - AIU TaC, BrainSTEPS Consultant

45. Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24 Resources

46. CDC Initiatives on the Management of Concussion Heads Up: Brain Injury in Your Practice • booklet on diagnosis and management of TBI • patient assessment tool • care plan guide • fact sheets • CD with kit materials and TBI resources http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.html

47. CDC Initiatives on the Management of Concussion Heads Up to Schools: Know Your Concussion ABCs • Signs and symptoms checklists, posters, magnets, laminated cards • Fact sheets for school • nurses, teachers, counselors, parents http://www.cdc.gov/concussions/HeadsUp/schools.html

48. CDC Initiatives on the Management of Concussion Heads Up: Concussion in High School Sports http://www.cdc.gov/ncipc/tbi/Coaches_Tool_Kit.html

49. CDC Initiatives on the Management of Concussion Heads Up: Concussion in Youth Sports Online training for coaches • Fact Sheets for coaches, athletes, parents • Clipboards • Magnets • Posters http://www.cdc.gov/concussion/HeadsUp/youth.html

50. DOH ApprovedOnline Training Courses • CDC – Heads Up Online Training Course - Concussion - Traumatic Brain Injury - Injury Center http://www.cdc.gov/concussions/headsup/online_training.html • National Federation of State High Schools Association (NFHS)- Online “Concussion in Sports” training program.www.nfhs.org • PA Athletic Trainers Association (PATS) – Online ConcussionWisePennsylvania: ConcussionWise™ http://concussionwise.com/Pennsylvania