Over the past decade, an increasing public awareness about treating and preventing concussions, especially among younger rec league, school, and college athletes, has brought the issue out of emergency rooms and into living rooms. It now concerns not just coaches, but whole communities.

Weeks before UConn’s starting quarterback Casey Cochran made national headlines announcing he was leaving the team because of repeated concussions, the Newtown High School sports department scheduled a student-parent forum on concussions.

Little did Athletic Director Gregg Simon know that his planned info session would occur the evening after Mr Cochran made his potentially career-ending decision. Following that September 8 news, state officials stepped up efforts to make the public aware of new laws aimed at concussion prevention and treatment.

On September 29, Governor Dannel Malloy traveled to Staples High School in Westport where he commemorated the enactment of legislation that requires the State Board of Education to develop a plan aimed at reducing the number of concussions and addressing the proper procedures following concussions experienced by students during school athletics.

As mandated in Public Act 14-66, the concussion education plan will be used by local and regional boards of education, which will be responsible for implementing the plan using written materials, online training or videos, or in-person training. In addition, the law requires school districts to annually collect and report all incidences of concussions to the State Board of Education.

According to the governor’s office, 13.5 percent of high school students self-reported getting a concussion during sports.

The legislation requires that coaches immediately remove a student from participating in athletic activity when that student-athlete shows signs of a concussion or has been diagnosed with a concussion. To return, the injured student must receive written clearance from a licensed health care professional trained in the evaluation and management of concussions.

An advisory group convened by the State Department of Education is working to update the existing training course that pertains to concussions to reflect current science. The course is required in order to receive a coaching permit for intramural or interscholastic sports.

The group, which includes representatives of the Connecticut Interscholastic Athletic Association (CIAC), the Connecticut State Medical Society (CSMS), the State Department of Public Health (DPH), and the Connecticut Athletic Trainers Association (CATA), will similarly update the refresher training course and annual review materials.

Members of that group solicited and received input from various stakeholders, including the Connecticut Chapter of the American Academy of Pediatrics (AAP), the Brain Injury Alliance of Connecticut, and the Parents’ Concussion Coalition.

The legislation also establishes a legislatively convened task force to study occurrences of concussions in youth athletics and to make recommendations for possible legislative initiatives to address concussions.

NHS Advanced Protocol

It was revealed during the sparsely attended Newtown session that the local school district, and particularly Newtown High School, is already ahead of the game when it comes to responding to and addressing students who may be exposed to, or who have already suffered, concussions.

The forum was attended by featured speaker and Newtown resident Dr Neil Culligan, who practices with Associated Neurologists, PC, and is the founder and medical director of Danbury Hospital Stroke Center.

Dr Culligan told those attending the session that there are currently no effective tests for identifying whether a person has suffered a concussion, and that the condition remains difficult to diagnose. He did say that mounting evidence indicates, however, that after three concussions the likelihood for permanent brain damage and increased, long-term concussion-related symptoms will develop.

While medical practitioners used to grade the severity of concussions based on the extent of the hit, and whether the victim has lost consciousness, today “every concussion is serious.” He also empathizes with youth and scholastic sports organizers because concussions “have become a legal issue for kids injured in gym or playing youth sports.”

Responding to a question about protective “guardian caps” being employed among football players, he described the physiology of a concussion calling up the image of an egg yolk inside its shell.

“When a concussion occurs, the skull [suddenly] stops and the brain keeps moving,” Dr Culligan said. “Nobody has invented a helmet that will prevent that.”

Mr Simon said not a week goes by that he doesn’t learn about some new product with its makers touting its concussion-mitigating attributes.

“But there is no long-term data” related to device effectiveness, he added.

Data ‘Means Nothing’

High school Athletic Trainer Sabrina Byrne added that even some data being touted related to concussion-prevention equipment, particularly guardian caps, “means nothing.”

“Guardian caps may actually give a false sense of security,” Dr Culligan asserted. “Money would be better spent developing studies and the science to prevent and diagnose concussions.”

As the discussion turned to practices employed by local high school coaches and trainers, Ms Byrne discussed how every athlete, regardless of the sport, is being given a baseline test at the beginning of the year.

“Once that student takes a blow to the head, we compare their new test results to the baseline and if the student fails, they go straight to a neurologist,” she said. After immediately notifying parents about the situation, if they are not on hand when the injury occurs, the athletic department also brings school nurses and psychologists into the loop.

Each injured athlete must go through a five-week process of returning to the game, if appropriate, to give the brain a chance to rest and heal, Ms Byrne explained. The final seven days involves a structured system slowly reintroducing the athlete to progressively heavier practice regiments, before potentially retuning them to the game field.

Dr Culligan complimented the community, saying, “Newtown really has this down.”

For NHS athletes, from swimmers to the dance team and all other sports in between, the students receive the baseline concussion testing in their freshman and junior years as long as they remain active.

School psychologist Tom Brant noted that Newtown High School had impact testing long before most other schools, as well as a great team of professionals who were building their knowledge about, and response to, potential concussions, including school nurse Anne Dalton.

Ms Dalton said as soon as a student athlete is identified with a head injury, she goes to work developing and distributing a care plan that is shared with every one of the student’s teachers. Then, each affected athlete or student is supported through this multifaceted network of care, observation, and response.