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Raising Awareness

As US Youth Soccer approves new concussion standards, Washington Youth Soccer President Doug Andreassen reports from the US Youth Soccer Workshop on progress made on concussion awareness in the last two years

Nearly two years ago, the Washington state legislature — backed by Washington Youth Soccer and other state youth sports, medical and mental health associations — signed the Zackery Lystedt Law, putting limitations on how and when a young person can return to play after suffering a brain injury.

At the time, the law put the state of Washington at the forefront of concussion awareness, at a time when too few people were talking about the long-term impact of brain injuries and the need to protect young athletes.

Two years later, concussions have become one of the most talked-about issues in sports — 14 states have passed laws similar to Washington's, and 35 others are currently considering concussion awareness legislation. In addition, US Youth Soccer recently approved concussion awareness standards for the entire organization, giving added protection to over 3 million youth soccer players nationwide.

A series of high-profile concussions in National Football League games brought the discussion out of the legislative chamber and into the mainstream media, helping to educate millions as to the long-term impact of concussions and removing the stigma attached to brain injuries in sports. The NFL passed new rules designed to limit concussions, star players began wearing helmets designed to give the brain greater protection on impact, and the United States government has considered national laws to regulate concussion education, awareness, evaluation and treatment.

It is with this in mind that approximately 150 youth soccer coaches, administrators, parents and volunteers gathered at last month's US Youth Soccer Workshop in Louisville, Ky., to observe and participate in a panel on the ImPACT of Concussions, chaired by Washington Youth Soccer President Doug Andreassen — an early and important advocate of the Zackery Lystedt Law — and including leaders from throughout the field of sports medicine and concussion research. Featured panelists were Jon Becker of the University of Louisville, Steven Broglio of the University of Illinois and Victor Coronado of the Center for Disease Control (CDC) in Atlanta.

PlayOn! caught up with Andreassen last week to talk about the panel, the progress in concussion awareness, and the next steps towards educating parents and coaches nationwide.

What was the main topic of the panel that you chaired in Louisville?

Andreassen: "Our main focus is, and has been, education and awareness. In this state, we are already covered by legislation, but the purpose of the panel was to try to increase awareness and advocacy to get the bill passed nationwide."

What kind of changes have you seen over the last two years as a result of the Zackery Lystedt Law?

Andreassen: "We've seen remarkable changes. The biggest is with regard to parent awareness. Kids lives have unquestionably been saved because there is now a policy in place to remove a youth athlete from the field in all sports who shows any symptoms of a brain injury — 'When In Doubt, Sit Them Out.' Most importantly, there has been a significant reduction in concussions reported, which is good news."

The NFL and national media have significantly raised the profile of concussion awareness over the last six months. How has that affected education and awareness at a youth level?

Andreassen: "We can't thank the NFL and Commissioner Roger Goodell enough for their work on concussions this year. Because of their efforts to increase awareness of the seriousness of concussions and their impact, the issue has been pushed to a national level. There isn't a day that goes by that you can't pick up your local paper and find information about concussions. What the efforts by the NFL, the NHL and other national organizations do is set a model for the youth leagues — youth football, youth hockey and certainly youth soccer — to follow."

What are the biggest roadblocks remaining towards increasing education and awareness of concussions?

Andreassen: "The biggest challenge is the challenge of fear — the fear that, if diagnosed with a concussion, a child might not compete in sports again. In fact, that's not the case. If it's managed correctly, a child who has suffered a concussion can continue to play sports the rest of their lives. It's the initial diagnosis and treatment that is key — it's when left untreated, and undiagnosed, that a concussion can have its most serious long-term affects.

"The second key is increasing funding for concussion awareness so that we can get materials out to parents about concussions and educate them on the importance of having their child sit so that the concussion can get better."

What were some of the main questions that attendees at the panel in Louisville asked of the experts on hand?

Andreassen: "The most common question was, 'When can my child return to play?' The answer is that it depends on each individual case. It depends on the number of concussions a child has had, the severity of the concussion, and the activity being performed. Once you have had one concussion, you become much more susceptible to future concussions. So, if your child has had two, three concussions — one parent said their child had eight — then the response and treatment becomes very measured and guarded.

"The second biggest question we had was, 'How does this affect my child's schoolwork?' What we're finding now is that children returning to school need special accommodations made for them — which is allowable under the Public Disability Act, which the current concussion laws fall under. 'Accommodations' could mean less testing, less homework — anything which causes a significant strain upon the brain, because that doesn't allow the brain to heal in a proper manner. Many times, children who suffer concussions can have memory loss or other diminished cognitive abilities for as long as six months or even a year — it's different in every case, and one of the things that makes education and awareness so important."

"Another important question was liability — some coaches were concerned that by taking action, they could make themselves liable. The Washington State concussion law, as it's written, actually says the opposite — if a child suffers a concussion and is allowed to play again before they have been medically cleared, and suffers another concussion, there is more liability than if that child had simply been removed from play after the first instance. We're not asking referees, officials or coaches to be doctors or get medical training, we're simply asking that if you see signs of a brain injury, or suspect that something might be wrong, then take the child out and get a medical opinion — again, 'When In Doubt, Sit Them Out.'

"Lastly, we were asked, 'What other activities should my child avoid after suffering a concussion?' The child should not be playing video games, should not be texting and should not be on the phone — it's questionable whether they should even watch TV. All of these activities cause further damage to the part of the brain affected by the concussion. Parents of children recovering from a concussion need to eliminate or at least greatly minimize all kinds of activities that over-stimulate the brain to help their children to rest, recover and heal."

What is the next step for increasing awareness?

Andreassen: "The next step is to educate the medical community. We have many doctors around the country who have not been properly trained in the specifics of evaluating and treating concussions. Hopefully by getting the national law passed, we can help to increase the awareness among parents, coaches and referees to remove children from play once a concussion is suspected, and then among the medical community to properly diagnose and treat a concussion that has occurred."

Where can people get more information about concussion awareness, prevention and treatment?

Andreassen: "We have a section on our webpage that includes many resources for parents, coaches and other individuals, including the signs and symptoms of concussions, educational videos, and an explanation of the Zackery Lystedt Law and how it affects youth soccer. In addition, the CDC's 'Heads-Up' program is a terrific resource for more information."

Washington Youth Soccer

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