1 Concussion Policy Implementation for the YMCA of MissoulaKeith Forkin Committee: Valerie Moody, Annie Sondag, Heather Habbe

2 History of LegislationBrain Injury Research Institute million TBI per year Number one cause of death for youth and young adults Zachary Lystedt Law (2009) Following concussion legislations All 50 State have some form of concussion policy Strength of these policies

3 Dylan Steigers Protection of Youth Athletes Act (DSPYAA)Three Aspects of the Law Education for coaches, parents, athletes Removal from play Medical clearance Shortcomings in the legislation Educational material? Coverage? MHSA sanctioned events “Team, club, entity, practice, tryouts, training exercises, sport camps”

4 Who is Impacted by Legislation?Concussion Legislation Concussion Policy The Athlete The Coach The Parent The Health Care Provider

5 YMCA of Missoula Concussion PolicyThree Components Education Coach Education is composed of online training and informational packet from Heads Up Concussion Parent Education is with registration forms Removal from play Dependent on parent and coach education Medical Clearance Referral Form with approved return to play

6 Implementation TimelineDecember 2015: Policy drafting process March 2016: Policy Implementation April 2016: Survey Round 1 April 2016: Coach Concussion Education April 2016: Spring Soccer Season Begins May 2016: Spring Soccer Season Ends September 2016: Coach Concussion Education September 2016: Fall Soccer Season Begins September 2016: Survey Round 2 October 2016: Fall Soccer Season Ends October 2016: YMCA meeting with UM AT October 2016: Research Process Begins

7 Research Methods Participants: Coaches and ParentsInstrument: Coach Survey, Coach’s Concussion Certification Form, Registration Forms for parents Procedures: Volunteer online survey (n=37) Data Analysis Coach Survey: Microsoft Excel, Composite Score, Linear Regression Registration Forms: Collected from YMCA files

8 Results Survey: Education Correlation Coach Education ComplianceComposite Score: 12.5/22 (SD 2.8) = 54% recognition (poor) Linear Regression: 0.18 (poor relationship) Coach Education Compliance Spring 2016: 44.1% (n=93) Fall 2016: 37% (n=73) Returning Coaches: 48.6% (n=35) Parent Education Compliance Spring 2016: 68.3% (n=840) Fall 2016: 67.1% (n=726) Actually YMCA Compliance?

9 Results Continued Survey: Signs and Symptoms Less obvious symptoms?Symptoms Analysis Actual Symptoms Scores (n=37) Vacant Stare 94.59% (n=35) Drowsiness 86.49% (n=32) Nausea/Vomiting 89.18% (n=33) Irritability 72.97% (n=27) Neck Pain 70.27% (n=26) Emotions Excess Sleep 75.68% (n=28) Sensitivity to Light 89.19% (n=33) Sensitivity to Noise Feeling in a Fog Balance Issues 83.78% (n=31) Fatigue Sadness 51.35% (n=19) Ringing Ears 81.08% (n=30) Distractor Symptoms Difficulty Breathing 37.84% (n=14) Pale Skin 40.54% (n=15) Muscle Spasms 43.24% (n=16) Black Eye 29.72% (n=11) Nose Bleed 35.14% (n=13) Jaw Pain 27.03% (n=10) Survey: Signs and Symptoms Cronbach Alpha: .829 (very good reliability) Composite Score: 9/14 (SD 2.4) = 64.3% Less obvious symptoms? High distractor selections?

10 Consequences AnalysisResults Continued Survey: Consequences Cronbach Alpha: .618 (moderate reliability) Composite Score: 3.4/8 (SD 1.2) = 42.5% High Selection of Distractor Consequences Necessity? Consequences Analysis Actual Consequences Scores (n=37) Dementia 81.08% (n=30) Dizziness 91.89% (n=34) Death Headache 89.16% (n=33) Brain Bleed 94.59% (n=35) Alzheimer's 72.97% (n=27) Parkinson's 45.95% (n=17) Distractor Consequences Stroke 48.64% (n=18) Neck Pain 62.16% (n=23) Blindness Jaw Pain 40.54% (n=15)

11 Lessons Learned Communication, planning and organization is essential to success Ensure appropriate personnel is in place Increase in work load Realize that small actions can have large impact! All YMCA’s in Montana now have a concussion policy in place YMCA is now one of the biggest advocates for changing the law DSPYAA just went to the Governor’s desk for approval! Don’t be afraid to reach out to organizations to offer assistance or see what assistance is needed

12 Questions?

13 References 1. Vos, Alekseenko, Battistin, et al. Mild Traumatic Brain Injury. European Journal of Neurology. 2012, 19: 2. McKee, Robert, Canta, et al. Chronic traumatic Encephalopathy in Athletes: Progressive Tauopathy After Repetitive Head Injury. Journal of Neuropathology. July 2009, 68(7): 3. Protect the Brain: Actively Researching Since Brain Injury Research Institute. Accessed on 11/25/2016. 4. Albuno, Senter, Adler, Herring, Asif. The Legal Landscape of Concussion: Implications for Sports Medicine Providers. Journal of Sports Health. 2016, 8(5): 5. Harmon KG, Drezner JA, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 2013;47:15-26. 6. Williamson, Gerhardstein, Cardenas, Michael, Theodore, Rosseau. Concussion 101: The Current State of Concussion Education Programs. Journal of Neurosurgery. May 2014, 75(4): 7. The Lystedt Law: A Concussion Survivor’s Journey. Center of Disease Control and Prevention. Accessed on 11/2/2016. 8. 63rd Legislature. “Dylan Steigers Protection of Youth Athletes Act.” 9. Shenouda, Hendrickson, Davenport, Barber, Bell. The effects of Concussion Legislation One Year Later- What Have We Learned: A Descriptive Pilot Survey of Youth Soccer Player Associates. American Academy of Physical and Rehabilitation. June 2012, 4: 10. Glang, Koester, Beaver, Clay, McLaughlin. Online Training in Sports Concussion for Youth Sports Coaches. International Journal of Sports Science and Coaching. 2010, 5(1): 1-12.  11. Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities among Persons Aged < 19 years- United States, Center of Disease Control and Prevention MMWR. 2011, 60(39):   12. Chrisman, Schiff, Chung, Herring, Rivara. Implementation of Concussion Legislation and Extent of Concussion Education for Athletes, Parents, and Coaches in Washington State. The American Journal os Sports Medicine. May 2014, 42(5):   13. Bagley, Daneshvar, Schanker et al. Effectiveness of the SLICE Program for Youth Concussion Education. Clinical Journal of Sport Medicine. September 2012, 22(5):   14. Eagles, Bradbury-Squires, Powell, Murphy, Campbell, Maroun. The Impact of a Concussion-U Education Program on Knowledge of and Attitudes about Concussion. The Canadian Journal of Neurological Sciences Inc. May 2016, 43:   15. Bramley, Patrick, Lehman, Silvis. High School Players with Concussion Education Are More Likely to Notify Their Coach of a Suspected Concussion. Clinical Pediatrics. 2012, 51(4):   16. Cremer. Examining the Role of Parents in Concussion Legislation Across the United States. ScholarWorks at University of Montana. 2016, 1-31.  17. McLeod, Schwartz, Bay. Sport-Related Concussion Misunderstandings Amoung Youth Coaches. Clinical Journal of Sports Medicine. March 2007, 17(2):   18. Carl, Kinsella. Pediatricians’ Knowledge of Current Sports Concussion Legislation and Guidelines and Comfort with Sports Concussion Management: A Cross-sectional Study. Clinical pediatrics , 53(7):