Concussion Protection in Youth Athletic Activities Act (CPYAAA)

  • Overview
  • Information
  • Parents & Players
  • Coaches & Officials
  • Related Links

CPYAAA Overview

  1. If an athlete exhibits signs or symptoms consistent with a concussion, the athlete must leave the game, practice or activity immediately. This is Delaware law and is in place to protect your child. They should not re-enter play until seen and evaluated by a physician. (Do not try to judge the severity of the injury yourself)
    • When in doubt, the athlete sits out. Remember, it is better to miss one game than to miss the whole season.
    • If an athlete continues to play when he or she might have a concussion, there could be serious medical consequences, even death (Second Impact Syndrome).
    • Athletes should not be left alone, including but not limited to walking back to and/or waiting in the locker room.
    • If a concussion has occurred or is suspected the CDC advises that you ask your (child’s/teen’s) health care provider when they can safely return to other activities, e.g. school, drive a car and/or ride a bike.
  2. "Written Clearance from a qualified physician” for return to play after a potential concussion shall be from a MD/DO only.
  3. Each athlete and the athlete’s parent or guardian shall annually sign and return a concussion information sheet prior to initiating practice or competition.
  4. Each certified coach and on-site official shall complete concussion training once every two years. The National Federation of High Schools (NFHS) online concussion course “Concussion in Sports” is the approved training course.

State Council for Persons with Disabilities
Margaret M. O’Neill Building
410 Federal Street, Suite #1
Dover, DE 19901
Office: 302-739-3621
Fax: 302-677-7066

Concussion Information

“Concussion Protection in Youth Athletic Activities Act”

On June 30, 2016 the 148th Delaware General Assembly passed House Bill No. 404 as Amended by House Amendments 1 and 2 known as the “Concussion Protection in Youth Athletic Activities Act”. Governor Markell signed this legislation on 09/06/16 with an effective date of 09/06/17. See Title 16, Chapter 30, Section 3001L of the Delaware Code for full text.

A hard copy of Title 16, Part II, Chapter 30L Legislation has been provided for your convenience.

This Act requires that:

“Before an athlete may participate in an athletic activity, the organizing entity shall provide a concussion information sheet published by the Council to the athlete and the parent or guardian of the athlete. The athlete and the parent or guardian of the athlete shall sign a statement acknowledging receipt of the information sheet and return it to the organizing entity before the athlete shall be allowed to participate in the athletic activity. For recurrent or on-going athletic activity, the provision of the information sheet and return of the signed acknowledgment shall be completed annually.” Download a copy of the SCPD Concussion Information Sheet.

What is a Concussion?
xray image of the human skull with the center of the skull in red

A concussion is a common head injury, also known as a mild Traumatic Brain Injury (MTBI). It is an injury that results from a direct or indirect blow to the head, face or jaw causing an alteration of brain function which can become evident through a variety of related symptoms.

The damage to the brain during a concussion is caused by a sudden shifting of the brain inside the skull. This shifting can cause the brain to knock against the hard bone of the skull, causing bruising to your brain and damaging brain cells.

A blow to the head can also cause a rotational injury to the brain which can cause shearing of the brain nervous fibers which can alter brain function.

What to look for?

Concussions are hard to recognize as there is no visible injury to the structure of the brain. Recognition comes from various post-concussion symptoms that may affect an individual’s cognitive & physical abilities, emotions & moods, as well as sleeping patterns.

The following is a list of possible concussion related symptoms someone may experience if they have suffered a concussion.

Common Symptoms of Concussions Include:

  • Headaches
  • Dizziness
  • Neck pain
  • Nausea or Vomiting
  • Loss of balance
  • Poor coordination
  • Trouble focusing on objects or words
  • Poor concentration
  • Feeling “foggy”
  • Confusion
  • Amnesia, or poor memory
  • Blurred or double vision
  • Irritability or emotional changes
  • Ringing in ears
  • Slow to follow direction
  • Decreased playing ability
  • Easily distracted
  • Vacant stare
  • Drowsiness/fatigue
  • Difficulty falling asleep
  • Feeling “off” or not like oneself
  • “Flashing lights” or seeing “stars”
Is it a concussion?

Concussions are often difficult to diagnose, since they cannot be discovered through standard methods like x-rays and CT-Scans. Because of this, concussions are often called “invisible injuries”. Following a suspected concussion, it is recommended that an athlete consult a Medical Physician (Family GP or Sport Physician) as early as possible for medical evaluation. In 90% of all sports related concussions, athletes do not lose consciousness and most sport-related concussion injuries do not require emergency care. However, it is very important that athletes with a suspected concussion remain under close observation over the first few hours, and should not be left alone or allowed to drive.

What to do?
image of a young man with the words Concussions What to Do

If an athlete believes they may have suffered a concussion they need to tell someone! While the athlete may think they are ok, someone else will be able to give them an unbiased opinion of their state of mind.

In order to gain accurate information and diagnosis it is important that they visit a doctor or an individual trained in assessment and management of concussions. The doctor will be able to tell the severity of the athlete’s injury, as well as the proper steps to follow in order to allow the athlete’s brain time to heal.

In general, a concussion requires a lot of rest to decrease the workload on the athlete’s brain. Activities such as driving, watching movies, playing video games, and any physical activity all increase brain activity and blood flow which can affect the speed of recovery. Coaches should ensure that an athlete suspected of having a concussion:

  1. Avoid all sports activities.
  2. Ensure that the athlete is evaluated by a healthcare professional experienced in dealing with concussions as soon as possible. Do not try to judge the seriousness of the injury yourself.
  3. Inform the athlete’s emergency contact, i.e. parents or guardians about the possible concussion.
  4. The injured athlete should not return to sports activities until a Doctor, experienced in evaluating concussions, confirms they are symptom-free.
What to Watch For?

It is important to remember that we can manage this injury effectively if we follow some simple steps. The most important point to remember as a parent is that you need to be in control. It is as simple as ABC: A, Assess the situation; B, Be alert for signs and symptoms; and C, Contact a concussion professional who deals with concussions on a regular basis. Always ask questions and request clarifications of any points you may not completely understand.

  • First and foremost, the athlete needs rest. Rest gives the brain time to heal. This can mean missing some school and avoiding physical activities such as gym class, sports activities, exercise, weight training, recess, bike riding and wheeled activities (to name a few), until cleared by a doctor. The athlete may also need to stay away from loud, bright, crowded places and limit activities that require a lot of thinking (including school, work and driving) or visual attention (use of computers, tablets, smart phones, TV, texting and reading.
  • Be sure to inform anyone who may supervise or take care of the athlete after a concussion — babysitters, relatives, teachers, school officials, coaches and child care workers — so they can also ensure the athlete is following the doctor’s orders.
  • Allow the athlete to ease back into the daily routine slowly, with guidance from their doctor, one activity at a time — never all at once
Possible symptoms 24 to 48 Hours after a Concussion

If you are told that your child may have suffered a concussion, it is important that you keep them from returning to play or even practice. Throughout the first two days after the concussion, you should observe your child’s behavior with vigilant eyes. The list of symptoms below was taken from “What Are the Signs and Symptoms of Concussion?” from the Centers for Disease Control and Prevention.

If any of the symptoms appear, you should take your child to the emergency room in case a more serious brain injury has surfaced and emergency treatment is necessary:

  • Headache that progressively becomes worse
  • Weakness, numbness or decreased coordination
  • Repeated vomiting or nausea
  • Slurred speech
  • Drowsy appearance or cannot be awakened
  • One pupil is larger than the other
  • Convulsions or seizures
  • Cannot recognize people or places
  • Increasingly confused, restless or agitated
  • Unusual behavior
  • Loss of consciousness, for even a brief period of time
Possible Symptoms One Week after a Concussion

Although the first two days following a concussion are arguably the most important time to be watching your athlete’s behavior, you should continue monitoring for the entire week following a report of a possible concussion. If you notice any of the symptoms listed in the long-term symptoms section below, note the time, day and severity of the symptom, and notify your child’s athletic trainer or physician. The information will help them determine the severity of your child’s concussion and form a care plan before the child returns to play.

Long-term Symptoms following a concussion

Concussion symptoms will last for weeks (or even months) in roughly 10 percent of cases. The following list of symptoms, from “Concussion Policy: A Guide for Schools” by Phil Hossler and Michael Collins, concentrates on the three areas most often affected by a concussion: physical changes, cognitive changes (thinking and learning) and behavioral changes. Just as with the list of symptoms possible in the first week after a concussion, note the time, date and severity of any symptoms you see and communicate them to your child’s physician and athletic trainer.

Physical Changes

  • Headaches
  • Dizziness or lightheadedness
  • Vomiting/nausea
  • Numbness or tingling
  • Loss of balance, dropping things, tripping
  • Feeling worn out, exhausted, tiring easily
  • Drowsiness, excessive sleeping
  • Trouble falling asleep
  • Sensitivity to light or noise
  • Blurred vision
  • Ringing in the ears

Cognitive Changes

  • Confusion or feeling “in a fog”
  • Confusing time and place instructions
  • Having lower attention/concentration level
  • Forgetfulness/difficulty with memory
  • Easily frustrated with learning new material
  • Taking longer to complete homework
  • Difficulty organizing thoughts or words
  • Misunderstanding things or instructions

Behavioral Changes

  • Restlessness or irritability
  • Impulsive actions
  • Becoming upset or losing temper easily
  • Sad or depressed mood
  • Anxiousness or nervousness
Return to Play for Athletes

Under Delaware law, a child will require medical clearance from a physician before returning to play. A Return to Play (RTP) evaluation is designed to ensure that the child is fully healed, and typically involves post-injury neurological screening, balance and vision assessments.

What happens to the brain in a Concussion?
image illustrating physical, mental, emotional and sleep impacts of concussion

A direct or indirect blow to the head, face or jaw can cause the brain to accelerate, and then rapidly decelerate within the skull. This acceleration/deceleration motion can cause mechanical changes to nerve fibers within the brain, and in turn, alter several important metabolic pathways. Though injury is apparent given the spectrum of symptoms experienced by a concussed athlete, no structural damage is caused to the brain itself. That is, unlike with other sports injuries (like a fractured wrist or a dislocated shoulder) nothing is visibly “wrong” or abnormal on standard imaging studies such as X-rays, computed tomography (CT) or medical resonance imaging (MRI). This “invisibility” is part of the reason why concussive injuries have historically been largely overlooked and mismanaged by the medical system. We understand now that just because we can’t see the injury, doesn’t mean an injury didn’t happen.

A concussion, in simple terms, changes the way the brain functions. In most cases, this change is temporary and reversible. Sometimes, however, changes in physical, cognitive, emotional and behavioral functions are long lasting and devastating. Researchers are only now beginning to understand the impact this injury has on the brain and the way it works.

Current research suggests that the rapid stretch of nerve fibers within the brain during a concussive trauma results in the release of various neurotransmitters (signaling molecules within the brain), which trigger the initiation of a complex neurochemical and neurometabolic pathway. Ultimately, the brain starts to consume energy more quickly than it can replenish it, creating a generalized depression in brain metabolism. These changes take place within minutes of the injury and can last for hours or days before normalization occurs. This metabolic imbalance, along with other impaired physiological processes, is thought to contribute to the physical, cognitive, behavioral and emotional signs and symptoms typically seen in a concussed individual.

Additionally, when the brain is in this state of metabolic dysfunction, it is believed to be more vulnerable to subsequent trauma. That is, a relatively minor second blow to the head may produce more severe and irreversible changes in brain function. The physiologically altered brain is essentially weakened and less able to withstand or recover from a subsequent concussion. In this way, concussive injuries are thought to be cumulative, with progressively less force required to induce trauma to the brain each time (when occurring in close temporal relation). What’s more, the symptoms experienced may be completely disproportionate to the mechanism of injury. What would have been two “mild” head injuries join in a cumulative effect to form a more severe traumatic brain injury with longer-lasting impairment.

Parent/Player Concussion Information Form

A Printable version of the Parent/Player Concussion Information Form has been provided for your convenience.

Background:

Delaware law requires athletes under age 18 and their parents to review and sign this sheet prior to participation in covered activities sponsored by a club, league or association. Covered activities include football, rugby, soccer, basketball, lacrosse, field or ice hockey, martial or combative sports, wrestling, volleyball, gymnastics, baseball, softball, and cheerleading. This signed form should be given to the sponsoring organization prior to participation, and, for multi-year activities, on a yearly basis.

You can get detailed information about the law at our SCPD Website.

What is a concussion?

A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth. A concussion changes how the brain normally works. An athlete does not have to lose consciousness (black out) to get a concussion. A blow elsewhere on the body can cause a concussion even if an athlete does not hit his / her head directly.

Signs and symptoms of a concussion:

Concussions can affect children and teens differently. Below are common symptoms they might report or that might be observed. It can take days for symptoms to appear following the initial hit /fall.

Experienced by Children and Teens

  • Headache or “pressure” in the head
  • Nausea or Vomiting
  • Dizziness or balance problems
  • Blurred or double vision
  • Light or noise sensitivity
  • Ringing in ears
  • Difficulty concentrating or remembering
  • Confusion
  • Feeling slowed down
  • Feeling sad, irritable, or more emotional
  • Being tired, or a change in sleep
  • Just not “feeling right” or “feeling down”

Younger children may not be able to report symptoms, and so decisions should be based on adult observation.

Observed by Parents, Coaches, or Teammates

  • Loss of consciousness
  • Appears dazed or confused
  • Responds slowly / answers questions slowly
  • Change in behavior, mood, or personality, including irritability or aggressive
  • Can’t recall events prior to or after the hit/fall
  • Loses focus on current activities
  • Moves clumsily/ Appears off balance
  • Slurred speech
  • Is more restless or appears more tired than usual
  • Change in sleep pattern

 

What should happen if my child/teen might have a concussion?

The athlete must leave the game, practice or activity immediately. This is Delaware law and is in place to protect your child. They should not re-enter play until seen and evaluated by a physician. When in doubt, the athlete sits out. Remember, it is better to miss one game than to miss the whole season. If an athlete continues to play when he or she might have a concussion, there could be serious medical consequences, even death (Second Impact Syndrome). Also, if a concussion has occurred or is suspected the CDC advises that you ask your (child’s/teen’s) health care provider when they can safely return to other activities, e.g. school, drive a car and/or ride a bike.

Athletes should not be left alone. Concussions can have a more serious effect on the young, developing brain-whose development extends into young adulthood. Be aware that sometimes athletes try to hide their symptoms so that they can stay in play. Have your child seen by a physician, even if symptoms resolve. Do not try to judge the severity of the injury yourself.

To return to play:

Delaware law requires that your child be seen and given medical clearance by a physician before return to play. Your physician may either complete a form or supply a letter certifying clearance. Provide the form or letter to the sponsoring organization. If the physician limits school-related activities like classwork, driver’s education, gym and recess, you may wish to share the form or letter with the athlete’s school.

Additional websites:

If you have additional questions regarding concussion or concussion management, we recommend the following websites:

I affirm: (1) I have read the above information; and (2) if the athlete could not independently read it due to reading ability, I have shared its key points with the athlete.

_____________________________________________
Parent/Guardian signature

_____________________________________________
Parent/guardian printed name

_________
Date

I affirm: that I have read the above information or been told its key points by my parent/guardian.

_____________________________________________
Athlete signature

_____________________________________________
Athlete printed name

_________
Date

* We recommend printing and keeping a copy of this form for your records.

Coaches & Officials Training

In accordance with Title 16, Part II, Chapter 30L, § 3006L Coach and official training, the State Council For Persons with Disabilities adopted training standards that require every on-site official and coach to complete initial and periodic concussion training consistent with a 2 year schedule. On-site officials and coaches may begin their training immediately by going to the National Federation of High School Sports Learning Center (NFHS) and selecting register to set-up an account or sign-in if you already have an account prior to selecting the "Concussion in Sports" online course for your position.

This training is free. The trainee is required to register with the NHFS website, create a user name (email address) and password prior to selecting the course "Concussion in Sports applicable to this requirement. Completing the NFHS Concussion in Sports online training satisfies the CPYAA training requirements for individuals who are both coaches and on-site officials for two-years.

The course takes approximately 1 hour to complete and upon completion a certificate is available for download and printing. See sample attached. This certificate is good for two-years.

Your association should retain a copy for their records.

Related Links

The Center for Disease Control’s website also offers free information for parents, coaches, school and sports professionals on their “Heads Up” page. Available information includes training, customizable PDF sheets, mobile apps, videos, graphics, podcasts, and social media.

Read the Center for Disease Control’s Fact Sheet about Concussion and Brain Injury.

Concussion in Sports and Recreation
heads Up Logo image

If a concussion occurs during sports and recreation related activities, implement the HEADS UP action plan. Athletes with a suspected concussion should never return to sports or recreation activities the day of the injury and until a physician, experienced in evaluating concussions, says they are symptom-free and it’s OK to return to play.

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