Vermont's concussion law gets tougher with sideline coverage mandate

Subject of several studies presented at the recent meeting of RSNA, the effects of high school contact sports on brain physiology are beginning to be recognized by public policymakers.

Next July a key provision in what is considered to be one of the nation’s toughest concussion laws goes into effect when Vermont schools that sponsor collision sports such as football and hockey are required to have someone trained in concussion protocol present at every game.  

This sideline coverage mandate—which includes a training course provided online by the Centers for Disease Control and Prevention—is just one piece of the legislation passed in 2013. While many laws (such as Vermont’s old law) simply require getting concussed players removed from games, a doctor’s note to allow them to return to the playing field, and some minimal education about concussions, the Vermont law goes further, according to Alan Maynard, clinical associate professor of Rehabilitation and Movement Science at the University of Vermont, who helped craft the legislation.

For example, the law provides that family practice providers and pediatricians should be equipped with the latest return-to-play guidelines from the University of Vermont Medical Center. In addition, schools must have a concussion management plan in place detailing what takes place when a concussion occurs and what must happen before an athlete is cleared to play again.

“It definitely makes student-athletes safer, maybe even as much as the sideline coverage mandate,” said Maynard in an announcement from the University of Vermont. "Most states have laws with the three components in our old law, but not this part, which makes it one of the most comprehensive in the country.”

There has been increasing awareness over the last several years of the potential consequences of concussions suffered while playing collision sports, particularly as evidence mounts—at least among former professional football players—that playing football increases the risk of developing neurological conditions like chronic traumatic encephalopathy.

Now we’re seeing evidence that football players can show significant brain changes after a single season of play, even in the absence of a concussion diagnosis.

According to a study presented earlier this month at the annual meeting of the Radiological Society of North America, researchers using diffusion tensor imaging of the brain were able to determine that high school football players who experienced greater levels of head impacts in the absence of clinical concussion exhibited greater microstructural changes in the brain’s white matter than those players categorized as light hitters. Similar brain MRI changes have been previously associated with mild traumatic brain injury, tha authors noted.

The question still to be answered, according to study author, Christopher Whitlow, MD, PhD, an associate professor at the Radiology Translational Science Institute at Wake Forest Baptist Medical Center in Winston-Salem, N.C. is whether these changes in the brain are permanent and whether they are associated with changes in neurocognitive functions. 

Another paper presented at the meeting determined baseline and longitudinal differences in hippocampal subfield volumes between cohorts of non-contact sport athletes and contact sport athletes. Zeineh et al concluded that hippocampal subfield volumetry may reflect mnemonic components of sports-related cumulative mild traumatic brain injury.