Virginia’s New Concussion Law Protects Students by Keeping Up With Science

Virginia has just passed a law requiring school athletics programs to put student-athletes’ health first by staying up-to-date on the latest concussion science. While other states have laws about how schools handle traumatic brain injuries, this law takes it a step further.

Introduced by Delegate Dickie Bell in January and signed into law at the end of February by divisive Virginia Governor Ralph Northam, H.B. 1930 dictates that the Virginia Board of Education must update its guidelines and policies around concussions every two years. In a move that puts Virginia ahead of most other US states — not to mention putting students’ health ahead of winning games at all costs — there is now a law on the books that requires educators to stay current on the medical research around concussions.

The news comes at an uncanny moment, as a new study from Stanford University researchers suggests that concussions can cause damage to the brain that isn’t always detectable. In a paper published Tuesday in the journal Biomechanics and Modeling in Mechanobiology, the Stanford team writes that the corpus callosum, the bundle of nerves connecting the brain’s two halves, can experience trauma during mild traumatic brain injuries — better known as concussions. Damage to the corpus callosum is associated with physical coordination problems, a classic sign of a concussion. This damage isn’t often detected, though, since the type of scans doctors use to diagnose traumatic brain injuries doesn’t pick it up.

This research indicates that athletic trainers in high schools might need to learn more about diagnosing traumatic brain injuries to ensure that students aren’t going back to playing while they’re still experiencing the after-effects of a concussion. More broadly, it highlights how important it is for educators and policymakers to stay informed about medical research, even if doing so is not typically in their purview.

“Our results illustrate that injury to different brain structures can be produced through different mechanisms, and require different detection criteria, prevention strategies, and/or treatments,” they write. “By understanding mechanisms like those from this study, injury detection and prevention efforts can be focused on limiting specific high risk movements (e.g., a new helmet design to support the head in the coronal plane or redirect motion into another plane).”

Taking Input From Stakeholders

It’s not clear exactly how educators will vet the science on concussions, but the wording of the bill indicates that meetings with experts will help lawmakers employ scientific research to determine the best course of action:

That the Board of Education shall collaborate with the Virginia High School League, the Virginia Department of Health, the Virginia Athletic Trainers’ Association, the Virginia Physical Therapy Association, representatives of the Children’s Hospital of the King’s Daughters and the Children’s National Health System, the Brain Injury Association of Virginia, the American Academy of Pediatrics, the Virginia College of Emergency Physicians, the Virginia Academy of Family Physicians, the Virginia Association of School Nurses, a representative from a non-interscholastic youth sports program, and any other interested stakeholders that it deems appropriate to biennially update its guidelines on policies to inform and educate coaches, student-athletes, and student-athletes’ parents or guardians of the nature and risk of concussions, criteria for removal from and return to play, risks of not reporting the injury and continuing to play, and the effects of concussions on student-athletes’ academic performance pursuant to subsection A of § 22.1-271.5 of the Code of Virginia, as amended by this act.

In addition to soliciting input from medical professionals, putting a time requirement on school boards differentiates Virginia’s concussion guidelines from the rest of the US states, most of which share just one rule: a Return to Play law.

Return to Play Laws

In 2009, Washington state enacted the “Zackery Lystedt Law,” which was the toughest law of its kind in the US up to that point. This law says that a student-athlete suspected of having a head injury can’t keep playing until they’ve been evaluated by a health professional. In the decade since, all 50 states have implemented versions of so-called Return to Play laws, but in most cases, they haven’t gone much further.

Some states, like Alabama, have passed laws requiring coaches and trainers to undergo annual training in preventing and identifying concussions. There’s no clear requirement, though, for how the contents of that training is informed by the most current science.

Similarly, Utah passed a law in 2011 allowing school nurses to identify concussions. The law also forbids nurses from clearing students to return to sports unless they were specifically trained in diagnosing head injuries. In this way, it lowers the threshold for removing student-athletes from play and raises the threshold for them to return — putting precaution ahead of competition.

Going Further

Laws like these, which are meant to expand the authority of school officials to protect student-athletes, may also have some crucial shortcomings, though. As the new Stanford study shows, not all signs of traumatic brain injuries are immediately apparent.

In other words, while there’s an obvious benefit to authorizing nurses, coaches, and trainers to pull students from play, there’s also the glaring fact that these individuals, no matter how well-meaning and experienced they are, aren’t required to stay current on the state of medical research.

But now in Virginia, they will be. Perhaps other states will follow suit.