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Concussion Bill Would Keep Kids Out of Class Until They Get Doctor’s Permission

Measure would require medical evaluation, school district plan before return to studies


High-school football players and their parents know that adolescent athletes who sustain a concussion need professional attention and time to recover before returning to the field. Now, a new bill being considered by the Assembly would require any student who suffers a concussion to be evaluated by a doctor or other healthcare provider and get written clearance before they can go back to school.

In addition, A-4207 would make the team in each district that deals with students with disabilities responsible for enforcing any limits on a student’s activities that were determined by the healthcare provider.

Assemblywoman Pamela R. Lampitt (D-Burlington and Camden) said she introduced the measure after a student’s parents brought to her attention that some districts didn’t have a plan to help children with concussions return to the classroom.

“It’s not a cookie-cutter sort of approach,” she said. “So we need individuals within the school system to be working with the parents and the physicians to set the right type of process and timeframe for our young people to go back into the classroom.”

To understand why such a careful approach to recovery is necessary, it helps to understand concussions and adolescent brain development.

Traumatic injuries to the brain upset normal brain activities, and it can take days or weeks for the brain to stabilize, according to Dr. Stephen G. Rice, a sports medicine doctor. Only 10 percent of those with concussions lose consciousness, but they experience a wide range of other symptoms, from confusion to difficulty concentrating and remembering to anxiety and depression.

All of these effects can be more difficult for children and in particular adolescents, according to Dr. Denise K. Aloisio, a pediatrician with Jersey Shore University Medical Center.

“It’s a time of tremendous brain reorganization,” she said. “For all of you who have teenagers and have yelled at them at some point or another: ‘Have you lost your mind?’ … They really have, about half of it,” Aloisio said.

Aloisio is referring to the fact that during adolescence about half of the brain’s synapses are “pruned.”

At the same time, the part of the brain that controls emotional response grows more quickly than the part that handles planning.

“We talk about making bad decisions. I doubt they’re even making the decision -- they just do,” she said.

The combination of a concussion and the unsettled state of development of teenagers’ brains means these injuries can disrupt development.

“If you don’t have the appropriate time to rest and don’t have the appropriate accommodations, it really can interfere with” optimizing and strengthening the connections in the brain, Aloisio said.

Rice noted that the daily tasks of attending school can “take energy that the brain needs to save, to repair itself,” said Rice, who directs the concussion center at Jersey Shore University Medical Center, where he also trains doctors to become sports-medicine specialists.

He noted that the understanding of this medical science has advanced rapidly in recent years, which is reflected in rapidly changing views on recovery from concussions in sports and, now, in the classroom.

Rice, whose been practicing sports medicine for 40 years, recalled a time in football when after “the first concussion, you’re out a week, the second concussion you’re out two weeks.”

Today, medicine is taking an individualized, carefully planned “return to play” guidelines for athletes. This approach led to the adoption of legislation in every state for student-athletes. The same process is currently playing out nationally for “return to learn” guidelines.

Rice said the law would lead to different members of a medical team, which may include psychologists and physical therapists, working in conjunction with a school team that includes principals, teachers, and guidance counselors.

Joanna Boyd of the Brain Injury Alliance New Jersey said the concussion bill is a significant step for the state in assisting young people in their recovery from concussions.

Assemblywoman L. Grace Spencer (D-Essex) said she would like to see pediatricians spreading more information about concussions to all parents, since many children may experience concussions without their parents’ knowledge. Rice responded that headlines about the National Football League have started to raise awareness of the issue -- as has the early retirement of San Francisco 49er Chris Borland.

“It’s definitely affecting how everyone is approaching injury and life,” Rice said.

Assemblywoman Elizabeth Maher Muoio (D-Hunterdon and Mercer) added that she had first-hand experience with a well-prepared district, after her 13-year-old son sustained a concussion. The school carefully monitored his progress before allowing him to engage in physical activities at school. “I’m 100 percent in favor of this bill,” she said.

The Assembly Women and Children Committee advanced the bill in a unanimous, bipartisan vote yesterday. The committee also voted for a bill that would extend the state mandate for children up to age 16 to wear helmets while bicycling, roller skating and skateboarding to cover 17-year-olds.

The mandate was extended to ice-skating, which raised concerns from Assemblywoman Caroline Casagrande (R-Monmouth). She is wary of any additional burdens for ice rinks, which already are expensive to operate. She also said she isn’t aware that there’s an existing problem with ice-skating concussions, but would research the issue further.

Rutgers University team physician Dr. Robert Monaco also expressed concern about adding helmets to figure skating, which would significantly alter the sport.

On the helmet bill, Rice added that there’s no evidence that helmets prevent concussions, although they are effective in preventing skull fractures.

Casagrande took the opportunity during the committee hearing on the concussion bill to ask Rice whether it was appropriate for young people to play football.

He said that preadolescents taught the proper techniques don’t face as much risk because they don’t have the weight or speed to generate dangerous force. But it’s a separate question for teenagers and adults.

“I think the whole sport of football is under an enormous challenge,” Rice said.

“So many of the professional athletes realize 30 years down the road that they just don’t have the brain they once had,” Rice said. “We don’t know the answer for football and I think parents are voting with their own intelligence whether it’s appropriate for their child or not.”

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