On June 28, 2011, Senate Bill 189 (ACT 314) was signed into law by Governor Bobby Jindal for the State of Louisiana. Entitled the “Louisiana Youth Concussion Act”, the bill was inspired by recommendations from the National Football League and their ongoing treatment of concussed athletes. Until recently, diagnosing a concussion has proven "tricky", with managing the sport-related concussion even more problematic. We now know that a concussion is a disturbance of normal brain function rather than a classic anatomical injury (skull fracture or brain bleed). Traditional medical testing (i.e. MRI and CT scans) do not diagnose a concussion and hence the problem; if our most advanced imaging exams cannot see this injury, then it must mean the brain is not injured. With the raised awareness of sport-related concussions through national media, this myth has slowly being disproved. Our local politicians have reacted similarly to other states to legislate the problem away. While ACT 314 gives the illusion that concussions will no longer occur as a result of its existence, in reality, the law is merely an awareness tool. The ultimate goal is to recognize concussions once they occur and TREAT them safely and appropriately. ACT 314 takes positive "baby steps" in this direction, but certainly will need more focus to accomplish its goal.

Act 314 states that “continuing to play with a concussion or symptoms of head injury leaves the young athlete especially vulnerable to greater injury and even death”. This is ABSOLUTELY true. But on a Friday or Saturday night when emotions are running high and the game is on the line, how do we convince the coaches, parents, or even the student-athlete that they have sustained a concussion. Unlike a broken bone or torn ACL, a concussion (functional brain injury) does not have a reliable imaging exam (CT scans and MRI) to confirm a diagnosis. The most current method for monitoring sport-related concussion involves neurocognitive testing of the brain (computerized testing evaluating the brain's workout ability). Unfortunately, this is relatively new across the country, only offered in certain areas, cost prohibitive for some school districts, and is not available for immediate use as a sideline evaluation tool (at least not yet). It is also done on a computer during "daylight" hours. One of the more common scenarios is for the emergency room physician to clear an athlete for "return to play" the night of a game based on a normal CT scan of the brain. This can be very inaccurate and scary information for a student-athlete and their parents to go home with. ACT 314 does not specify what type of medical professionals or parameters should be in place to PROPERLY diagnose and handle the concussion.

Act 314 also states that “it is in the best interest of the state to create a uniform education, training, and return-to-play protocol to be followed throughout the state.” This is a great idea. Unfortunately, there is no current “uniform education, training, and return-to-play protocol to be followed throughout the state.” There are still organizations unaware that the law even exists. In reality, education regarding concussion is fairly standard and generic and can be found on most internet sites; but it is the actual management of sport-related concussion that becomes problematic. Act 314 allows for a licensed athletic trainer who has “specific knowledge of the athlete’s condition” who can “manage the athletes graduated return to play.” While the bill claims it wants a UNIFORM process throughout the state, there are no guidelines for the licensed athletic trainer to follow to achieve this goal.

Act 314 requires that “the governing authority of each public and nonpublic elementary school, middle school, junior high, and high school shall, prior to beginning of each athletic season, provide pertinent information to all coaches, officials, volunteers, youth athletes, and their parents or legal guardian which informs of the nature and risk of concussion and head injury, including the risks associated with continuing to play after a concussion or head injury.” It also requires that “as a condition of participation in any athletic activities that the youth athlete and the youth athlete's parents or legal guardian sign a concussion and head injury information sheet which provides adequate notice of the statutory requirements which must be satisfied in order for an athlete who has or is suspected to have suffered a concussion or head injury to return to play. This is a tall task. Who is enforcing this process? Who is monitoring parents to ensure that they have received and signed the requested information?



As far as state of the art concussion management, the most current tool being utilized is computer based neurocognitive testing (we use IMPACT™ for the 29 schools under contract with CONCUSSION SOLUTIONS, LLC). Although this testing is not mandated by ACT 314, it certainly sets the highest standard of concussion management for the student-athlete and provides the most objective approach to concussion management. This is the same testing performed in the National Football League, National Basketball Association, and National Hockey Leagues. Not to mention thousands of athletes at the collegiate and high school level. This process can certainly be time consuming and costly especially at the high school level of athletics. There are numerous creative ways for schools to be able to afford the computer based neurocognitive program, but it requires priority. Unfortunately, the schools must now negotiate the unfunded mandate to absorb the cost of education and neurocognitive computer based testing. Once the actual neurocognitive testing in place, it requires a sports-related concussion management team that can interpret the data. Similarly to an MRI, if there is not a healthcare team/provider involved to guide the results, the study itself is difficult to interpret. Most medical teams consist of knowledgeable certified athletic trainers who have direct access to student-athletes and physicians trained in neuropsychology and proper modern concussion evaluation and management. Unfortunately, concussion management and computer based neurocognitive testing are very new fields of medicine and most practitioners have not yet been trained in the latest techniques. While Act 314 has the best of intentions of protecting young student-athletes in Louisiana, it will require some more specifics and direction before it can truly become effective.