UPDATED: Local School Policy Meets Stricter NJ Concussion Law

As the fall season hits its midway point for high school athletes, many athletic programs throughout the state are beginning to see the full effect of new legislation concerning concussions.

However, school officials in Bernards said a procedure already was in place, and the new law changes only the final steps in precautions taken before a player can return athletic participation following a concussion.

The overall statewide reaction from those in the medical field, sports arena, and the lawmakers themselves appears to be favorable, overall. However, doctors are cautioning against relying to heavily on newly incorporated testing, while those who created the bill are continuing to fine-tune the concussion law.

In December of last year, Gov. Chris Christie signed into law legislation that changed the way schools must deal with the prevention and treatment of concussions in student athletes. The bill came into full effect this school year throughout the state.

Bernards Township already had procedure in place, athletic director and school officials say

"We have been ahead of the curve on this," said Ridge High School's athletic director, Rich Shello. Although the previous procedures often were not quite as long in taking steps following a concussion, the school did not begin the gradual return to participation steps until the athlete had successfully completed the neuro-cognitive testing (ImPact Test) and been symptom free for seven days, Shello said in an email on Tuesday.

"The difference was that the return to play phase did not always require five days," Shello said. The school's procedure has been consistent with the National Athletic Trainers Association, Shello said.

Schools Superintendent Valerie Goger previously had outlined the steps that athletic programs take once a player is diagnosed with a concussion during a Board of Education meeting a few weeks ago, when the revised policy was introduced. It was adopted at Monday night's board meeting.

Goger agreed that the only difference in Bernards school programs now is that there is a five-day graduated exercise protocol following the previous steps taken following a concussion. "We previously followed the National Athletic Trainers guidelines which included a physician's clearance to return to play, seven days symptom free, and passing the ImPact Test," she said in an email on Tuesday.

In response to a question raised previously by School Board Member Mike Byrne, Goger said the district is required to have a physician at all varsity football games. However, she added on Tuesday, "We provide a physician at all varsity and JV football games."

Regarding the response on a broader level, “So far, we’ve had nothing but positive comments from coaches, kids, and parents,” said Assemblyman Patrick J. Diegnan, a sponsor of the bill from District 18 in Middlesex County.

The bill, A-2743, was introduced in May of 2010 and was sponsored by Assemblymen and an Assemblywoman from Middlesex, Essex, and Passaic counties.

Medical Field Sees Policy as Positive, But Has a Warning

Dr. Robert Monaco, the director of the sports medicine fellowship program at UMDNJ-Robert Wood Johnson Medical School and the director of sports medicine at Rutgers University, said that the new concussion policy is a good one.

“I think it helps to protect athletes in general; I think it's very good at high school and younger levels,” he said. “They’re guidelines. They’re not definitive things, but they do help serve as a reference to remind doctors, particularly those that don’t have experience with it, what should be done in most situations.”

Many schools have been incorporating ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) into their athletics programs in order to help protect student-athletes. Depending on how many students are tested, .

According to the ImPACT website, “ImPACT an be administered by an athletic trainer, school nurse, athletic director, team coach, teach doctor, or anyone trained to administer baseline testing.”

But according to Monaco, ImPACT, which relies on comparing how an athlete responds to various tests and questions after a potential concussion to how the athlete responded to those same tests and questions when not concussed, should not be the only thing considered when evaluating concussions.

“It’s a tool in your toolbox for evaluating,” he said. “The problem with ImPACT is you need to get good baseline information before the injury … this can be problematic in getting if students don’t take it seriously and if the test is not proctored properly … looking at the test after a concussion is not as accurate if good information is not obtained up front.”

Director of neurosurgery at Morristown Medical Center and co-medical director of the Concussion Center at Overlook Medical Center Dr. Jack Knightly also feels that ImPACT is only one part of evaluating concussions.

“Having a base line is better than having nothing,” he said. “Part of the problem is that everyone says, ‘my imPACT test is normal and I’m good to go.’ That’s only part of the problem … doesn’t matter whether in sixth grade or a six year veteran of the NFL.”

Knightly, who has been the director of the concussion center at Overlook since approximately seven years ago, says that how he treats concussions “is completely different than six years ago.”

He does believe, like Monaco, that the new concussion policy will have a positive effect.

“It fortuitously takes the onus of saying when the athlete can return to sports away from coaches, who may not be experts, and puts it in the hands of someone familiar with it; an independent party, so the kid is safe to return to the sport,” said Knightly.

Concussions, according to Knightly, can have surprising side effects like not doing well in school or not coping well with families. If a concussion goes untreated and an athlete sustains another concussion, the athlete can suffer from Second Impact Syndrome, which Knightly called “the nightmare effect of not treating it correctly.”

According to the Centers for Disease Control and Prevention, playing sports with a concussion can be fatal, one potential result, according to Monaco, of Second Impact Syndrome.

“The biggest treatment is recognition and removal,” Monaco said. “The biggest thing is recognition with coaches and parents. … The CDC [Center for Disease Control], just the other day started a new program to help coaches and parents understand … the biggest thing is early detection, and removal is really the key in treating these things.”

Guidelines Being Embraced, Similar to Other Athletic Guidelines

Kathy Kickish, the head athletic trainer at Sacred Heart High School, a private high school in Vineland, previously worked in Virginia and had to develop a concussion protocol to match New Jersey’s guidelines this school year.

“For the most part, I found the [state guidelines] to be clear,” she said, but she emphasized the importance of educating athletes, parents, and coaches, who may not be as familiar with the medical aspects of dealing with concussions. The CDC also calls for increased education of athletes and parents.

So far this year, Kickish has only seen three possible concussions, which all turned out to be false alarms, but still she tests athletes the day of the possible concussion and the day after. If found to have a concussion, the athlete will be out for a minimum of one week, depending on when the athlete can get clearance from a physician—specifically from a physician trained to test for concussions, which Kickish says is a vital part of the new guidelines from New Jersey’s concussion law.

At Fairleigh Dickinson University, head athletic trainer Tom Wilkinson has been incorporating a similar concussion policy for his college athletes for the past three years.

The NCAA policy, he said, is "really not a whole lot different with the state law they did with the high schools."

Wilkinson has had athletes kept out for up to one month due to concussion, and not just out of games, but also all practices and training. Once an athlete is cleared, Wilkinson gives them three days of reorientation to activity, which, he says begins with simple work outs and is increased day to day, until the athlete can return completely to a normal practice and game schedule.

Continuing to Improve Legislation

Diegnan said that because this was the first bill of its type, it is probably not perfect, and will likely need to be adjusted after a few years once legislators are able to see how concussion policies develop under the law. Already, another concussion law, also sponsored by Diegnan, among others, was developed to incorporate cheerleaders, a group that was left out of the original bill.

Diegnan said that cheerleading is actually one of the top four activities that lead to student concussions. He also said that there were three main goals when drafting the bills: First, to educate parents, coaches, and athletes about the dangers of concussions and how to spot the signs of concussion. Second, to make sure athletes are taken out of games or practices if even suspected of concussion. And third, to ensure that athletes must get cleared by both a doctor and athletic trainer before being allowed to practice or compete.

According to the concussion law, which cites the CDC, approximately 300,000 concussions per year are sustained from sports-related activity and approximately 62,000 of those concussions come from high school sports. The law is now in effect in all school districts in New Jersey.

More information on concussions is available on the CDC website.

The text of the bill, available online, calls for the Commissioner of Education and the Commissioner of Health and Senior Services to “develop an awareness program concerning the prevention, risk, and treatment of sports-related concussions and other brain injuries among student athletes,” as well as mandates that schools develop written concussion policies that must be in accordance with the bill’s procedural outlines, and mandates that students suspected of sustaining a concussion must be removed until given written clearance from a physician.

— Linda Sadlouskos contributed to this story.