At least a half-dozen states are considering measures that would toughen restrictions on young athletes returning to play after head injuries, inspired by individual cases and the attention the issue has received in the NFL.

Washington state led the way last year, passing what is considered the nation's strongest return-to-play statute. Athletes under 18 who show concussion symptoms can't take the field again without a licensed health care provider's written approval. Several other states, including California and Pennsylvania, have similar bills pending.

Elsewhere, the Maine legislature passed a law last year that creates a working group on the prevention, diagnosis and treatment of concussions in young athletes. In New Jersey, there's no state law to regulate how head injuries should be handled for athletes, but the legislature has allowed a commission to look into brain injury research.

"There's no doubt that the majority of the people believed it was time and that it was extremely important to do something like this," said Mike Colbrese, executive director of the Washington Interscholastic Activities Association. "The mantra for the movement has been, 'When in doubt, sit them out."'

These state-level efforts come as a congressional committee prepares to hold a forum in Houston Monday looking at how high schools and colleges deal with concussions. The same House panel has held hearings on head injuries in the NFL, and the NCAA recently endorsed the idea of requiring athletes to be cleared by medical personnel before returning to competition if they show concussion symptoms.

Estimates for the number of sports- and recreation-related concussions in the United States each year go as high as 3.8 million, according to the Brain Injury Association of America.

In Pennsylvania, state Rep. Tim Briggs has introduced a bill that also would require written clearance for an athlete to return to play. He says he hears "occasional comments that I'm going to scare parents from getting their children into different sports" — but that's about it as far as naysayers.

Micky Collins, assistant director of UPMC's Sports Medicine Concussion Program, says the measures being considered are a big step forward, but that even some medical personnel have a lot to learn about how to evaluate head injuries.