During a 2006 middle school football game, Zachery Lystedt suffered a pounding blow to his head. Like most 13-year-olds, Lystedt shook it off and returned to the game. However, that hit delivered more than just a few brief seconds of pain. Lystedst was suffering from a concussion and because it was undiagnosed, he was left with a life threatening brain injury and permanent neurologic damage.

Instead of fighting for the win, Lystedst was fighting for his life as he was airlifted to a nearby hospital and underwent a life-saving brain operation. Remaining in a coma for 30 days, Lystedst survived via a feeding-tube for 20 months and was unable to speak for almost the entire first year. It has taken him years to relearn speech, walk, and regain lost motor skills.

Lystedst’s unfortunate story inspired the Lystedt family to campaign to make sports safer for all athletes through concussion education and awareness. In 2009, the Zachery Lystedt Law was passed in Washington to increase safety and concussion awareness. Since then 43 other states have adopted similar concussion laws for youth athletes.

Now Ohio will join the bandwagon. Starting April 26, 2013 , House Bill 143, Ohio’s Return-to-Play law for young athletes, will go into effect. This bill was formed to ensure the safety of young athletes suspected of a concussion, increase awareness and education, and make sure athletes are safely guided back to play after suffering a concussion. (See Concussion FAQs.)

A concussion is a brain injury that may be caused by a direct blow to head, neck or anywhere else on the body that transmits an “impulsive” force to the head. Typically, a concussion results in transient neurologic impairment that resolves spontaneously; however, in the pediatric population, symptoms tend to blossom over hours to days. It is a functional damage, not a structural damage to the brain, so imaging such as CT scans and MRI’s usually look normal. Loss of consciousness is seen in less than 10% of concussion cases and should not be used as a guide to diagnose a concussion. (Check out STACK’s Concussion Awareness and Prevention Series.)

Headache is the most common symptom. Other clinical symptoms may include cognitive (feeling in a fog or daze, difficulty concentrating/remembering), emotional (sad, irritable, labile), sensitivity to light/noise, dizziness, poor balance, nausea or vomiting. Sleep disturbances are often experienced as well. Any athlete suspected of a concussion should be immediately removed from play and seek medical care.

Ohio’s House Bill 143 includes the following provisions for interscholastic sports:

• Mandate that parents and athletes submit a signed letter stating they received and reviewed a concussion information sheet.
• Coaches and referees involved in interscholastic sports must hold a PAP (pupil activity permit) issued by the Ohio Department of Education. The PAP includes a mandatory training program for concussion and concussion recognition.
• If an athlete displays signs and symptoms of a concussion during practice or a game, he or she must be removed from play by coaches, referees or officials.
• Student-athletes removed cannot return to play on same day.
• Athletes cannot return to play until evaluated and receive written clearance by a physician or other licensed health care provider approved by the school district.

This new law not only ensures that athletes suspected of a concussion are immediately pulled out of play, it also ensures that athletes are properly evaluated by a qualified health care professional prior to return. (See also Concussion Recovery and Baseline Testing.) Medical evaluation of an athlete’s symptoms will help safely guide return to activity. Some athletes benefit from time off school to recover. This allows adequate time for mental rest as well as physical rest. The length of time required for recovery and returning back to sports differs for each individual. A qualified health care provider can best assist the concussed athlete during the recovery phase. Above all, parents and coaches should never pressure an athlete to return to play. Allowing adequate time for the brain to heal is the best way to allow a safe return to play. Returning to sports before a concussion has resolved is dangerous. If another hit to the head occurs before an athlete has fully recovered, he or she risks suffering permanent neurologic damage.

Information sheets for parents, athletes and coaches, and referees regarding this new law are available at the website www.healthyohioprogram.org/concussion. This new law is for the safety and well-being of our young athletes.