Concussion rule changes favored in 1 Md. county

The board of education in Anne Arundel County Public Schools voted today to adopt changes to the district’s concussion policies, the Capital Gazette reports.

The draft rules provide for parents to be notified verbally and in writing if their son or daughter is injured at school. The changes also add a significant number of symptoms of traumatic brain injury and require coaches and physical education teachers in the county’s public schools to complete training every two years on recognizing concussion symptoms in students and treating them properly before professional medical care can be obtained.

The most significant change, though, involves the supervised “return to play,” or RTP, protocol, which progressively allows an athlete to resume physical activity after symptoms of a brain injury have become less severe over time.

“The biggest component of any concussion management plan is how to deal with returning students to play,” the Gazette quoted Greg Legrand, the school system’s athletic coordinator, as saying.

The rules add the following to the RTP protocol:

Once cleared by the LHCP to begin a supervised Return to Play (RTP) progression, the [certified athletic trainer] and/or coach shall track and monitor the student throughout each step.

Students whose symptoms return during the RTP progression shall be directed to stop the activity and rest until symptom free. The student shall resume activity at the previous step of the protocol that was completed without symptoms.

Students with persistent symptoms shall be referred to their healthcare provider for evaluation.

Our most recent report on concussions reminded readers that once nervous tissue is injured, it will not heal, per se, although symptoms may become less severe. The bleeding in the brain will stop eventually, but any tearing of the nervous tissue as a result of brain slosh is considered permanent damage.

“We’re talking about reconnecting the axons and dendrites of neurons that have become detached here; neurosurgeons just don’t do that because of massive barriers to success,” we wrote. “Right now, if some of the brain’s fragile connections break when the soft tissue gets sautéed in a hit, there’s no way to fix it.”

I’m not trying to stop football or anything, but I would like to see a better understanding of brain injury enter into the discussion in Anne Arundel County. The biggest component of any concussion management plan, as Mr Legrand called it, should not be the RTP protocol, because the brain has already been injured, possibly beyond repair. The biggest component should be prevention of the injury in the first place.

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Paul Katula
Paul Katula is the executive editor of the Voxitatis Research Foundation, which publishes this blog. For more information, see the About page.