Beyond Legislation, REAP is the Next Step

a "How To" Guide for Concussion Management

by Karen McAvoy, PsyD

Director, Center for Concussion at Rocky Mountain Youth Sports Medicine Institute

April 3, 2011--As many states write and pass Concussion Laws, the focus on keeping our athletes safe has been elevated ten-fold. Legislation that requires

#1) education to increase recognition of a concussion

#2) removal from play for a “suspected” concussion

#3) return-to-play under the guidance of a health care professional

is the start to better catching and caring for our young athletes. We know that 80% to 90% of concussions heal well if recognized and managed early. So … congratulations to the states that are writing and passing legislation, keep up the good work!

An inherent challenge with legislation, however, is that each athlete takes approximately 1 to 3 weeks to heal from his/her concussion. So after legislation passes, the next most common question is…WHAT DO WE DO NOW? What happens next? What should a parent do; what should a school do; what should a health care professional do? These questions are best answered by the REAP Community-Based Concussion Management Protocol.

REAP – which stands for Reduce/Educate/Accommodate and Pace is a concussion management protocol written at a Colorado school district to fill in the gap between REMOVAL-from-play and RETURN-to-play. REAP is based upon the premise that good concussion management requires a Multi-Disciplinary Team. It outlines the responsibilities of 4 teams:

• Family Team -- typically the parent or guardian, the athlete
• School Team – Physical (typically the school nurse, the athletic trainer, the PE teacher, the coach)
• School Team – Academic (typically the school counselor, psychologist, teachers, administrator)
• Medical Team – (typically the Primary Care Provider, the Sports Medicine Doctor/Clinic)

REAP tells a parent, school and community … WHAT TO DO NEXT by teaching these essential elements:

REDUCE – First and foremost, a concussed athlete must REDUCE physical demands (to prevent further injury). Equally important, the athlete must also REDUCE mental demands. See the REDUCE page in the REAP Manual for the story of “Jake Snakenberg”, a young athlete who died of second impact syndrome at the high school where REAP was developed. He was the inspiration for REAP as well as the Colorado Concussion Bill, appropriately named the “Jake Snakenberg Youth Concussion Act”.

EDUCATE – Since the symptoms “tell the story ”, members on all of the 4 teams must understand the significance of the symptoms and should watch, rate and track symptoms regularly (see the Symptom Checklist in the REAP Appendix).

ACCOMMODATE – The young athlete is a student first and an athlete second, therefore, all teachers must know how to “dial down” the academic demands for the student during the recovery. The ACCOMMODATE page in the REAP Manual helps teachers understand how to reduce academic demands.

PACE – Finally, when the multi-disciplinary team members decide that the athlete is asymptomatic and is functioning back to his/herself at school and home (and with neurocognitive testing, if available), they can coordinate their input with the Medical Team. Per legislation, the health care professional (ie. the Medical Team) gets to decide when to start the athlete back through the graduated Return-to-Play steps (see PACE in the REAP Manual for the Zurich Guidelines), however, with the REAP protocol, this pivotal decision now gets to be based upon multiple sources of data from multiple perspectives (stakeholders).

R*E*A*P feels strongly that the more “eyes” on the concussion, the better chance for a safer recovery.

Recognition is Step 1. Removal from play is Step 2. Step 3 – Return-to-play? It happens with time - and REAP feels that it happens better when a family, a school and a community provider can pull together to help the athlete feel better faster and return to play/life safer. REAP is available free of charge at www.youthsportsmed.com.

Karen McAvoy, PsyD is the author of REAP. She has 20+ years experience in the field of brain injury, working in a school district and is now the Director of the Center for Concussion, a program of Rocky Mountain Hospital for Children.
REAP is a community-based program that can be replicated and implemented in any community, in any school district around the country.  Contact Dr. McAvoy for details.