U.S. laws mostly fail to guide youth students post-concussion

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U.S. laws mostly fail to guide youth students post-concussion

All 50 states govern young athletes' return to play sports, but just 8 states have 'return-to-learn' laws governing classroom accommodations
Brian Donohue

Concussion is clinically understood as a complex injury with emotional, behavioral, cognitive, and physical dimensions, but this understanding has not translated to multifaceted state guidelines for the return of injured youth to school and educational activities, a new study suggests.

Although all 50 states have created laws to address student athletes' return-to-play post-concussion, only eight have laws governing concussed students' return to the classroom, and those laws vary in scope, specificity and in delineating responsibility.

Dr. Monica Vavilala, the study's corresponding author, directs the Injury Prevention and Research Center at Harborview Medical Center.
picture of Dr. Monica Vavilala

The research, published today by Pediatrics, was conducted by investigators at the University of Washington and Seattle Children's Research Institute.

"The return-to-play laws were long in coming and have proved their value, but now we see that most states need to take that same level of concern into the classroom," said the study's corresponding author, Dr. Monica Vavilala. She is a professor of anesthesiology and pediatrics at the University of Washington School of Medicine, and directs the Harborview Injury Prevention & Research Center.

All eight states require the establishment of a "return-to-learn" protocol, yet only four include standards for the protocol's content, and these standards often lack mechanisms to assess efficacy or outcomes. 

For example, Virginia and Massachusetts mandate that schools make accommodations deemed appropriate by the injured student’s healthcare provider – which study authors called a poor standard, given primary-care providers' variable knowledge of concussion. Nebraska's law says a return-to-learn protocol must “recognize” the potential need for accommodations and monitoring by school staff, but provides no guidance to manage these processes. 

Only Illinois specifies that the return-to-learn protocol be consistent with Centers for Disease Control guidelines, the researchers found. 

None of the laws provides guidance about managing students with persistent post-concussive symptoms or when to end classroom accommodations. Nearly half of the laws are restricted to student-athletes, excluding students who sustained concussions outside of sports. 

In an accompanying, solicited commentary, Dr. Mark Halstead, a pediatric sports-medicine specialist at Washington University in St. Louis, and colleagues said that although increased public awareness is an immediate benefit of new legislation, return-to-learn legislation may be insufficient. They recommend that states' departments of education develop and implement training for educators, and help create guidance to pair with existing return-to-play policies.

Washington state passed the nation’s first return-to-play” law in 2009 in response to a devastating brain injury suffered by a 13-year-old football player.