symptom-free for 24 hours and cleared by a physician. The intention of the law was to improve patient safety. However, the exclusion of one the most qualified types of health care providers (clinical neuropsychologists) from performing such evaluations can lead to patient harm by returning students too early (resulting in further neurological harm) or keeping them out of sports much longer than necessary (resulting in psychological harm).
Neuropsychologists specialize in objectively assessing the relationship between brain functioning, thinking, emotions, and behavior – all of which can be affected in the early phase of concussion recovery. This is done through a series of specialized tests, records review, interview, behavioral observations, and application of statistical knowledge. Neuropsychologists also have much more time to spend with their patients than physicians due to the nature of the evaluation.
Neuropsycholgists have been instrumental in developing published return to play safety protocols and have routinely made return to play decisions prior to the passage of this legislation. Neuropsychologists developed the most popular computerized cognitive assessment programs that are used to make return to play decisions, have played a leading role in researching concussion for the past 25 years, and have published textbooks on the topic. A neuropsychologist from New York (Dr. Thomas Kay) was the senior contributor of the American Congress of Rehabilitation Medicine’s operational definition of concussion. Nearly all major college and professional sports organizations include neuropsychologists in their concussion management program and most states that have passed similar legislation allow neuropsychologists make return to play decisions.
Concerns were expressed to the sponsors of this bill and the Governor’s office about the exclusion of neuropsychologists before its passage. Neuropsychologists were assured that neuropsychologists would still be able to play a role in these assessments that would be used by physicians. However, some school districts are only allowing return to play decision to be made from a specific list of physicians (e.g., pulmonologists, orthopedists, pediatricians) who do the entire assessment without any input from a neuropsychologist. If the child’s own pediatrician is not on the official list of providers, he/she may not be allowed to provide clearance to return to play.
Due to this potential safety issue and the new restriction upon a psychologist’s scope of practice, we urge parents and concerned citizens to contact Senator Hannon, Assemblywoman Nolan, Governor Cuomo, and their local representatives to tell them that you strongly support allowing psychologists to be included in a bill that allows them to make return to play decisions following concussion. as an update to this article, please see How New York Fumbled the Ball on Concussion Management.