St. Lawrence University Sports Medicine Policy on Management of Mild Traumatic Brain Injury (MTBI)/ Concussion Safety Protocol

Transcription

1 St. Lawrence University Sports Medicine Policy on Management of Mild Traumatic Brain Injury (MTBI)/ Concussion Safety Protocol Definition: A mild traumatic brain injury (MTBI) or concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features that incorporate clinical, pathological, and biomechanical injury constructs that may be utilized in defining the nature of a MTBI include: 1) The result of either a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head. 2) Rapid onset of short-lived impairment of neurologic function that resolves spontaneously. 3) Neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury. 4) A graded set of clinical symptoms that may or may not involve loss of consciousness. 5) Resolution of the clinical and cognitive symptoms typically follows a sequential course; however, it is important to note that in a small percentage of cases however, post- concussive symptoms may be prolonged. 6) No abnormality on standard structural neuroimaging studies is seen. The following are treatment orders for the management of sport-related MTBI as seen by the Sports Medicine staff (Certified Athletic Trainers and team physicians) at St. Lawrence University: Preseason Education: 1. All student-athletes are provided the NCAA Concussion Fact Sheet for Student- Athletes prior to the start of their season through the Athletic Trainer System (ATS) (Appendix B) 2. All student-athletes must mark and sign each year that they have read and understood the St. Lawrence University Concussion Policy and Plan Form (Appendix A) in which they accept the responsibility for reporting the signs and symptoms associated with a possible MTBI to the Sports Medicine staff. In signing this form, all studentathletes also acknowledge that they have read and understood the NCAA Concussion Fact Sheet for Student-Athletes. 3. All Coaches, Team Physicians, Athletic Trainers, and Directors of Athletics are provided the NCAA Concussion Fact Sheet for Coaches at the start of the academic year. All Coaches, Team Physicians, Athletic Trainers, and Directors of Athletics will be educated regarding the seriousness of a possible MTBI, the use of this policy, and the NCAA policy disqualifying an athlete from play in the same day as a suspected MTBI. (Appendix C).

2 4. All Coaches, Team Physicians, Athletic Trainers, and Directors of Athletics sign an acknowledgement showing that they have read and understood the concussion material each year. a. All coaches and athletic administrators/directors of athletics will be educated regarding MTBI each year by filling out the St. Lawrence University Coaches Concussion Statement, documenting that they have read the NCAA Concussion Fact Sheet for Coaches and have watched the NCAA Concussion Education Video. (Appendix J) b. All associated health care professionals will be provided the St. Lawrence University Sports Medicine Policy on Management of Mild Traumatic Brain Injury (MTBI) annually. All Athletic Trainers and Team Physicians will fill out the St. Lawrence University Health Care Professionals Concussion Statement each year, documenting that they have read and understood the NCAA Concussion Fact Sheets for Student-Athletes and Coaches and the St. Lawrence University Sports Medicine Policy on Management of Mild Traumatic Brain Injury (MTBI) (Appendices B, C, & K). 5. The Certified Athletic Trainer (ATC) and team physicians agree on protocol for managing sport-related MTBI prior to the beginning of the athletic season. Specifically, upon evaluation of a sport-related concussion, the Sports Medicine staff will focus attention on: a. The athlete s recovery via symptoms b. Neurocognitive testing c. Postural-stability testing Pre-Participation Assessment: 1. All varsity student-athletes will receive a baseline concussion assessment utilizing the IMPACT software and St. Lawrence University Concussion Evaluation. 2. Baseline testing will be implemented ideally prior to the start of a sport athletic season using the Impact Concussion Assessment Software and the St. Lawrence University Concussion Evaluation (SCAT 3) (Appendix I) concussion evaluation tools. a. Brian Injury and Concussion History will recorded via: i. St. Lawrence Concussion University Evaluation (SCAT 3) ii. IMPACT Software iii. First Year/Transfer and Returning Athlete Pre-Participation Form iv. Health Center General Health History Form for all Incoming Students b. Symptom Evaluation will be recorded via: i. IMPACT Software c. Cognitive Assessment will be recorded via: i. St. Lawrence Concussion Evaluation (SCAT 3) ii. IMPACT Software

3 d. Balance Evaluation will be recorded via: i. Modified BESS on St. Lawrence Concussion Evaluation (SCAT 3) e. More conservative treatment, as coordinated with a team physician, should be provided to the concussed athlete with a medical history of MTBI or related injury. The team physician determines pre-participation clearance and/or the need for additional consultation or testing. f. A new baseline concussion assessment six months or beyond will be considered for any varsity student-athlete with a documented concussion, especially those with a complicated or multiple concussion history. 3. All helmet equipment standards as set by the National Operating Committee on Standards for Athletic Equipment (NOCSAE) and the CSA (Canadian Standards Association) will be enforced by the Sports Medicine staff to help protect athletes from potential head injury. a. Helmet fitting guidelines as provided by the manufacturer for each helmet will also be enforced by the Sports Medicine Staff as well as Equipment Staff. b. The following sports will be carefully observed by the team ATC for signs of problems with a helmet: Football Men s & Women s Hockey Men s Lacrosse Baseball- batters and catchers Softball- batters and catcher c. Items to check with an athlete s helmet to assure safety include: Chin straps must be buckled No cracks or damaging chips in the helmet No damage to the facemask No missing screws/replace missing screws All clips are secured and/or replaced if needed The helmet is stable on the athlete s head with no movement The helmet appears to fit allowing for proper vision Presence of the appropriate equipment standard seal and warning stickers Recognition and Diagnosis of Concussion: 1. Medical personal with training in the diagnosis, treatment and initial management of acute concussion must be present at all NCAA varsity competitions in the following contact/collision sports: Men s and Women s Basketball; Coed Equestrian (Riding); Field Hockey; Football; Men s and Women s Ice Hockey; Men s and Women s Lacrosse; Men s and Women s Pole Vault; Rugby; Men s and Women s Skiing; Men s and Women s Soccer; Wrestling. St. Lawrence University does not participate at the NCAA level in rugby or wrestling. To be present means to be on site at the campus or arena of competition at St. Lawrence University. Medical personnel may be from either team, or may be independently contracted for the event.

4 a. Medical Personal is defined as a Certified Athletic Trainer, Emergency Medical Technician, and/or Team Physician. b. Emergency Medical Technicians are present at all Home Coed Equestrian (Riding) Competitions. 2. Medical Personnel with training in the diagnosis, treatment and initial management of acute concussion must be available at all NCAA varsity practices in the following contact/collision sports: Men s and Women s Basketball; Coed Equestrian (Riding); Field Hockey; Football; Men s and Women s Ice Hockey; Men s and Women s Lacrosse; Men s and Women s Pole Vault; Rugby; Men s and Women s Skiing; Men s and Women s Soccer; Wrestling. To be available means that, at a minimum, medical personnel can be contacted at any time during the practice via telephone, messaging, , beeper, or other immediate communication means. Further, the case can be discussed through such communication, and immediate arrangements can be made for the athlete to be evaluated. a. Medical Personal is defined as a Certified Athletic Trainer, Emergency Medical Technician, and/or Team Physician. 3. Any Student-Athlete with signs/symptoms/behaviors consistent with a concussion: a. Must be removed from practice or competition b. Must be evaluated by an athletic trainer, team physician, or Health Care Professional at the Health Center with concussion experience. c. Must be removed form practice/play for that calendar day if concussion is confirmed. 4. Clinical evaluation should include a primary survey, and thorough secondary survey with a history, observation, palpation, and special testing (stress tests, range-ofmotion testing, strength testing, neurological testing, and functional testing). a. The team ATC and Sports Medicine staff must be familiar with the signs and symptoms of a concussion, screening/evaluation tools, and must be able to differentiate between a MTBI and a focal traumatic brain injury (TBI). b. The team ATC and Sports Medicine staff must be familiar with guidelines for return to play, guidelines for immediate referral to the Emergency Department, guidelines for physician referral, and guidelines for disqualification as outlined in Appendix D. 5. Initial suspected concussion evaluation will include the following; i. Symptom evaluation/assessment, ii. Cognitive/memory assessment iii. Physical and neurological exam iv. Balance examination v. Clinical assessment for cervical spine trauma, skull fracture, and intracranial bleed. b. Examples of these tools are St. Lawrence University Concussion Evaluation (Appendix I), the Pocket Sport Concussion Assessment Tool 2 (SCAT2), and

5 Sport Concussion Assessment Tool 3 (SCAT3) (Appendix G and Appendix I). Post-Concussion Management: 1. Additional assessment of the cervical spine and cranial nerves will be performed to identify any cervical spine or intracerebral (focal TBI) injuries. The Emergency Action Plan will occur, including transportation for further medical care, for any of the following: a. Glasgow Coma Scale < 13 b. Prolonged loss of consciousness c. Focal neurological deficit suggesting intracranial trauma d. Repetitive emesis e. Persistently diminished/worsening mental status or other neurological signs/symptoms. f. Spine Injury 2. The ATC will monitor a patient s symptoms, and level of consciousness periodically during an evaluation. 3. A combination of screening tools will be implemented during a post-injury evaluation of an athlete who has experienced a concussion: a. Impact Concussion Assessment testing when the patient reports being symptom-free. b. St. Lawrence University Concussion Evaluation (Appendix I ) when the patient reports being symptom-free c. Symptoms will be recorded each day or whatever is reasonable until patient reports being symptom-free using the Graded Symptom Checklist (Appendix H) or ATS symptom scale. 4. The ATC and Sports Medicine staff will document all pertinent information surrounding the concussive injury, including but not limited to (1) mechanism of injury; (2) initial signs and symptoms; (3) state of consciousness; (4) findings on serial testing of symptoms and neurocognitive function and postural-stability tests; (5) instructions given to the athlete and caretaker(s); (6) recommendations provided by the physician and subsequent referrals; (7) date of the athlete s return to play; (8) relevant information on the patient s history of prior concussion and associated recovery patterns. 5. A potentially concussed athlete and if possible/reasonable another responsible adult (Parent, roommate, teammate, and/or coach) will be provided with home care instructions (Appendix E). 6. The St. Lawrence Student Health Center will be informed of all concussed athletes.

6 a. The potentially concussed student-athlete must be seen by a St. Lawrence University Physician, Nurse Practitioner, or Physician Assistant at the Health Center prior to return to play. b. Medical clearance will be granted in agreement between the team ATC and treating physician/nurse practitioner/physician assistant. 7. The coordinating physician/nurse practitioner/physician assistant and coordinating team ATC should secure referral options with a neurologist and neuropsychologist when appropriate due to past history, acute conditions, or postconcussive conditions. a. Follow-up care will be coordinated by the coordinating physician/nurse practitioner/physician assistant and team ATC. b. Evaluation by a physician for student-athletes with prolonged recovery in order to consider additional diagnosis and best management options. Additional diagnosis include, but are not limited to: i. Post-concussion syndrome ii. Sleep dysfunction iii. Migraine or other headache disorders iv. Mood disorders such as anxiety and depression v. Ocular or vestibular dysfunction Return-To-Play 1. Final determination of return-to-play is from the team physician or medically qualified physician designee of the Certified Athletic Trainers and Nurse Practitioners/ Physician Assistants. 2. Each student-athlete with a concussion must undergo the supervised stepwise progression management plan administered by a Certified Athletic Trainer (Appendix F). Return-To-Learn 1. The staff certified athletic trainers as well as the Head Athletic Trainer will be the point person within the St. Lawrence University Athletic Department to help navigate return-to-learn with the student-athletes. 2. A multi-disciplinary team will help navigate more complex cases of prolonged return-to-learn. This may include, but not limited to, the following people: a. Team Physician b. Certified Athletic Trainer c. Psychologist/counselor d. Office of Disability Services Representative e. Health Center Staff

7 f. Neuropsychologist Consultant g. Faculty Athletic Representative h. Academic Counselor i. Course Instructor(s) j. College Administrators k. Coaches 3. All decisions in the return to academic course work/return-to-learn will be in compliance with the ADAA. 4. There will be no classroom activity on the same day as a diagnosed concussion. 5. Each student-athlete will have an individualized initial plan that includes: a. Remaining at home/in their dorm if the student-athlete cannot tolerate light cognitive activity b. A gradual return to classroom/studying as tolerated 6. All academic accommodations/modification of schedule will initially be in place for 10 days and can be extended as needed. a. All information/academic accommodations will be coordinated by the staff athletic trainers and/or Health Center Staff through Disability Services. 7. Re-evaluation will occur by the team physician/ Health Center staff and certified athletic trainer if concussion symptoms worsen with academic challenges. 8. Re-evaluation will occur by the team physician and members of the multidisciplinary team, as appropriate, for a student-athlete with symptoms lasting longer two weeks. 9. Disability Services will be notified of a concussed athlete by a Certified Athletic Trainer and/or Health Center Staff in regards to cognitive rest and academic accommodations. a. All student-athletes must return to academics prior to their return to full physical activity. b. When appropriate, the length of cognitive rest will be agreed upon by the coordinating physician/nurse practitioner/physician assistant, certified athletic trainers, and student athlete. 8. Campus Resources will be engaged for cases that cannot be managed through schedule modification/ academic accommodations. Compliance with the ADAAA is required and should include at least one of the following: a. Learning Specialist b. Office of Disability Services c. The ADAAA Office.

8 Reducing Exposure to Head Trauma 1. Reducing Head Trauma Exposure Management Plan: a. St. Lawrence University Athletics will adhere to the following to help reduce the amount of head trauma exposure: i. Inter-Association Consensus: Year-Round Football Practice Contact Guidelines ii. Inter-Association Consensus: Independent Medical Care Guidelines iii. Reducing gratuitous contact during practices iv. Taking a safety first approach to sport v. Taking the head out of contact vi. Coaching and student-athlete education regarding safe play and proper technique. vii. Athletics staff and student-athletes will continue to emphasize that purposeful or flagrant head or neck contact in any sport should not be permitted.

9 Appendix A: St. Lawrence University Concussion Policy and Plan

10 St. Lawrence University Department of Athletics Concussion Policy and Plan St. Lawrence University and the NCAA are committed to the prevention, identification, evaluation and management of concussions. The NCAA s Executive Committee has sought to develop a consistent association-wide approach to concussion management by adopting the following policy for institutions across all three divisions. Institutions shall have a concussion management plan on file such that a student-athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be removed from practice or competition and evaluated by an athletics healthcare provider with experience in the evaluation and management of concussion. Student-athletes diagnosed with a concussion shall not return to activity for the remainder of that day. Medical clearance shall be determined by the team physician or their designee according to the concussion management plan. In addition, studentathletes must sign a statement in which they accept the responsibility for reporting their injuries and illnesses to the institutional medical staff, including signs and symptoms of concussions. During the review and signing process student-athletes should be presented with educational material on concussions. In accordance with the foregoing, the St. Lawrence University Department of Athletics has adopted this Concussion Policy and Plan. Preparticipation Exam: The student-athlete shall accurately and completely report his or her medical history, including but not limited to any concussion history, prior to or during the preparticipation physical exam. If a student-athlete has a significant concussion history, the team physician or nurse practitioner may also request additional consultation and/or testing. Baseline Testing: St. Lawrence University Athletics will perform a baseline cognitive evaluation of all varsity student-athletes using the Immediate Post-Concussion Assessment and Cognitive Testing Program (ImPACT) and St. Lawrence Concussion Evaluation Form. Student-Athlete Education: St. Lawrence University will supply all student-athletes with educational materials that identify the signs and symptoms of concussions and notify the student-athletes of their obligation to report possible concussion-related illnesses and/or injuries to St. Lawrence University s medical staff. Student-athletes will annually be required to complete an acknowledgement form indicating that they have received this education and understand and accept their obligation to report their injuries and illnesses, including signs and symptoms of concussions, to the Department of Athletics medical staff. Acute Injury Management: When a student-athlete has signs and/or symptoms of a concussion or other head injury an evaluation will be conducted by a certified athletic trainer or team physician/nurse practitioner/physician assistant with experience in the evaluation and management of concussions and head injuries and they will make the return to play decision. If the result of the evaluation is the suspicion or diagnosis of a concussion the student-athlete must be removed from athletics activity for at least that day and further evaluated and monitored for changes in symptoms. If there is no certified athletic trainer or team physician/nurse practitioner/physician assistant with experience in the evaluation and management of concussions present and a concussion is suspected, the student-athlete should be removed from athletics activity for at least that day and report to the certified athletic trainer that they have concussion symptoms as soon as possible. If loss of consciousness occurs

11 the student-athlete should be transported to the Emergency Room for further evaluation by a qualified medical professional. All student-athletes suspected of or diagnosed with a concussion will be evaluated by the Health Center before returning to play. Once the student-athlete is symptom free for hours the ImPACT test is administered and the return to play protocol is initiated. Each rehabilitation stage requires 1 day between each stage. Progression for return to play: Rehabilitation Stage: No activity Functional Exercises at this stage: Complete physical and cognitive rest Objective at this stage: Recovery Rehabilitation Stage: Light Aerobic Exercise Functional Exercise at this stage: Walking, swimming, or stationary cycling keeping intensity <70% MPHR; no resistance training Objective at this stage: Increase HR Rehabilitation Stage: Moderate Exercise Functional Exercises at this stage: Straight line running, treadmill, elliptical, moderate weight lifting session/resistance training. Objective at this stage: Increase HR Rehabilitation Stage: Sport-Specific Exercise Functional Exercise at this stage: Skating drills in ice hockey, running drills in soccer; no head impact drills Objective at this stage: Add movement Rehabilitation Stage: Non-contact training drills Functional Exercise at this stage: Progression to more complex training drills, eg, passing drills in football and ice hockey; may start progressive resistance training Objective at this stage: Exercise, coordination, and cognitive load Rehabilitation Stage: Full contact practice Functional Exercise at this stage: Following medical clearance, participate in normal training activities Objective at this stage: Restore confidence and assess functional skills by coaching staff Rehabilitation Stage: Full Activity, Full Clearance Functional Exercise at this stage: Full Activity Objective at this stage: Normal game play

12 St. Lawrence University Student-Athlete Illness, Injury and Concussion Reporting Acknowledgement Please read this form in its entirety, initial the boxes below to acknowledge your understanding and agreement with each item, and sign and date the form at the end. I understand that it is my responsibility to report all injuries and illnesses, including but not limited to all possible concussion-related injuries and/or illnesses, to my athletic trainer and/or team physician and I agree to do so. I understand and acknowledge that the ability of the St. Lawrence University Athletic Department to ascertain my true physical/mental condition, and thus my suitability to participate in intercollegiate athletic activities (including training, practice and competition) is dependent upon an accurate health history and a full knowledge of any past and present symptoms, complaints, injuries, aliments and/or disabilities experienced. I affirm that my full health history, including all of my past and present symptoms, complaints, injuries, ailments and/or disabilities, have been disclosed in writing to and discussed with the team physician and/or team athletic trainer and that I am not suffering from any symptoms, complaints, injuries, ailments and/or disabilities not so disclosed and discussed. I acknowledge and agree that all future symptoms, complaints, illnesses, injuries, ailments, disabilities and/or medical conditions, including without limitation re-injuries or aggravations of pre-existing conditions, must be immediately reported to the team physician and/or team athletic trainer, no matter how minor or insignificant I may deem them to be. Without limiting the applicability of the preceding sentence to all types of symptoms, complaints, illnesses, injuries, ailments, disabilities or medical conditions, I specifically agree that I will immediately report to the team physician and/or team athletic trainer any sign or symptom that might indicate the presence of a concussion. I recognize that St. Lawrence University will, and agree that it may, rely upon the disclosures made by me as described above in determining my fitness to participate in intercollegiate athletic activities (including training, practice and competition). I further acknowledge and agree that the team physician and team athletic trainer shall have absolute discretion to determine my fitness to return to participation in intercollegiate athletic activities (including training, practice and competition) following any symptom, complaint, illness, injury, ailment or medical condition, including without limitation a concussion, and any conditions, precautions or limitations on or in connection with such participation. The decision of such personnel in this regard shall be final and binding upon all parties, including without limitation me, the coaching staff of the team(s) on which I participate, and all other Athletic Department personnel. I have read and understand the St. Lawrence University Sports Medicine Policy on Management of Mild Traumatic Brain Injury. I have read and understand the NCAA Concussion Fact Sheet. After reading the NCAA Concussion fact sheet, I am aware of the following information: A concussion is a brain injury, which I am responsible for reporting to my team physician or athletic trainer.

13 A concussion can affect my ability to perform everyday activities, and affect reaction time, balance, sleep, and classroom performance. You cannot see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury. If I suspect a teammate has a concussion, I am responsible for reporting the injury to my team physician or athletic trainer. I will not return to play in a game or practice if I have received a blow to the head or body that results in concussion-related symptoms. Following a concussion the brain needs time to heal. You are much more likely to have a repeat concussion if you return to play before your symptoms resolve. In some cases, repeat concussions can cause permanent brain damage, and even death. Acceptance of Risk of Participation in Intercollegiate Athletics: St. Lawrence University, in compliance with NCAA guidelines, reminds its student-athlete of the inherent risks of injury during the intercollegiate athletic participation. St. Lawrence University, and its athletic administrators, coaches, and Sports Medicine staff, share the management of these risks by endeavoring to create a safe environment for competition. For their part, student-athletes are required to report their symptoms, complaints, illnesses, injuries, ailments, disabilities, and medical conditions to their team physician and/or their team athletic trainer and to adhere to their coaches, Athletic Trainers (and associated physicians ) health and safety instructions, including the rules of their sport, while participating in contests, practices, and training sessions to effectively reduce the risks of injury. By signing below, I represent that the items I have stated above are true and accurate and I understand and will abide by the terms and conditions of this acknowledgment. Signature of Student-Athlete Date Printed name of Student-Athlete By signing below, I represent that I have discussed the matters pertaining to this acknowledgment with my child, and the items stated above are true and accurate and I and my child understand and will abide by the terms and conditions of this acknowledgment. Signature of Parent/ Guardian if under 18 years old Date Printed Name of Parent/Guardian Signature of Parent/ Guardian if under 18 years old Date Printed Name of Parent/Guardian

14 Appendix B: NCAA Concussion Fact Sheet for Student-Athletes

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16 Appendix C: NCAA Concussion Fact Sheet for Coaches

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19 Appendix D: MTBI Management Guidelines for Return to Play An athlete is NOT permitted to return to play in the same day of sustaining a suspected concussion. Athletes should be asymptomatic at rest. Athletes should have returned to full academic course work. Athletes will follow the graduated return-to-play protocol over the course of 6 days or longer as outlined in Appendix F. All potentially concussed athletes will be evaluated by the team physician or the health care professionals at the Health Center. Guidelines for Immediate Referral to Emergency Department: The athlete should be transported immediately to the nearest emergency department if the following symptoms are experienced: Deterioration of neurologic function Decreasing level of consciousness Prolonged loss of consciousness Decrease or irregularity in respirations Decrease or irregularity in pulse Unequal, dilated, or unreactive pupils Any signs or symptoms of associated injuries, spine or skull fracture Mental status changes that continue to progress: lethargy, difficulty maintaining arousal, confusion, or agitation Seizure activity Focal neurological deficit suggesting intracranial trauma Guidelines for Same Day Physician Referral: On the day of injury if patient experiences any of the following: Prolonged loss of consciousness Amnesia longer than 15 minutes Increase in blood pressure Cranial nerve deficits subsequent to the initial on-field evaluation Repetitive Vomiting Motor deficits subsequent to initial on-field assessment Sensory deficits subsequent to initial on-field assessment Post-concussive symptoms that worsen Guidelines for Athlete Disqualification On the day of concussive event

20 Permanent disqualification should be discussed with the student-athlete, parents (if a minor), athletic trainer, and physician after 4 or more concussions that resulted in a slow recovery. Medical clearance will be granted in agreement between the team ATC and treating physician/health care professionals at the Health Center.

21 Appendix E: Home Care Instructions for the Patient

22 St. Lawrence University Home Care Instructions for Potentially Concussed Athlete I believe that sustained a concussion on. To make sure he/she recovers, please follow the following important recommendations: 1) Please remind to report to the Athletic Training Room on at for a follow-up evaluation 2) Please review the checklist below. If any of these problems develop prior to his/her visit, please get the patient to a physician immediately or contact the local emergency medical system as necessary. - Vomiting - Worsening headache/dizziness - Drainage of clear fluid from ears or nose - Increasing drowsiness, can t be awakened - Weakness of limbs or sudden loss of coordination - Loss of feeling in any area - Slurred speech - Becoming unresponsive - Unusual behavior changes - Seizure activity 3) It is OK for the patient to do the following: - Use ice pack on head/neck as needed for comfort - Eat a light diet - Go to sleep - Rest (no strenuous activity or sports) 4) There is NO need for the patient to do the following: - Check eyes with flashlight - Wake up every hour - Test reflexes - Stay in bed 5) DO NOT: - Drink alcohol - Eat spicy foods - Take ibuprofen, Motrin, or aspirin unless otherwise instructed - Exercise/ weight lift - Complete school work Disability Services was notified and academic accommodations were put in place. Health Center appointment was discussed and will take place on. Signature of ATC Date

23 Appendix F: Progression For Return to Play Protocols for Contact and Non-Contact Sports Contact Sports (Basketball, Football, Ice Hockey, Lacrosse, Soccer) Non-Contact Sports (Alpine Skiing, Baseball, Crew, Cross Country, Field Hockey, Golf, Nordic Skiing, Riding, Softball, Squash, Swimming/Diving, Tennis, Track & Field, Volleyball) Rehabilitation Stage 1: No activity Functional Exercises at this stage: Complete physical and cognitive rest Objective at this stage: Recovery Rehabilitation Stage 2: Light aerobic exercise Functional Exercise at this stage: Walking, swimming, or stationary cycling keeping intensity <70% MPHR; no resistance training Objective at this stage: Increase HR Rehabilitation Stage 3: Moderate Exercise Functional Exercises at this stage: Straight line running, treadmill, elliptical, moderate weight lifting session/resistance training. Objective at this stage: Increase HR Rehabilitation Stage 4: Sport-Specific Exercise Functional Exercise at this stage: Skating drills in ice hockey, running drills in soccer, no head impact drills Objective at this stage: Add movement Rehabilitation Stage 5: Non-contact training drills Functional Exercise at this stage: Progression to more complex training drills, eg. passing drills in football and ice hockey, may start progressive resistance training Objective at this stage: Exercise, coordination, and cognitive load Rehabilitation Stage 6: Full contact practice Functional Exercise at this stage: Following medical clearance, participate in normal training activities Objective at this stage: Restore confidence and assess functional skills by coaching staff Rehabilitation Stage 7: Full clearance Objective at this stage: Normal game play

24 Appendix G: Pocket SCAT2 Card and SCAT3

25 Appendix H: Graded Symptom Scale Checklist

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28 Appendix I: St. Lawrence University Sports Medicine Concussion Evaluation

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31 Appendix J: St. Lawrence University Coaches Concussion Statement

32 St. Lawrence University Coaches Concussion Statement I understand that it is my responsibility to report all player injuries and illnesses to the athletic training staff and/or team physician I have read and understood the NCAA Concussion Fact Sheet for Coaches. I have watched and understood the NCAA Concussion Education Video. I have read and understood the St. Lawrence University Sports Medicine Policy on Management of Mild Traumatic Brain Injury (MTBI). After reading the NCAA Concussion Fact Sheet, I am aware of the following information: A concussion is a brain injury, which I am responsible for reporting to my team physician or athletic trainer. A concussion can affect an athlete s ability to perform everyday activities, and affect reaction time, balance, sleep, and classroom performance. You cannot see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury. If I suspect an athlete has a concussion, I am responsible for reporting the injury to the athletic training staff and/or team physician. An athlete will not return to play in a game or practice if they have received a blow to the head or body that results in concussion-related symptoms. Following a concussion the brain needs time to heal. Athletes are much more likely to have a repeat concussion if they return to play before symptoms resolve. In rare cases, repeat concussion can cause permanent brain damage, and even death. It is an NCAA Policy that any student-athlete with signs/symptoms/behaviors consistent with a concussion must be removed from practice or competition. By signing below, I acknowledge that I have read and understood all the above. Date Signature Printed Name Sport

33 Appendix K: St. Lawrence University Health Care Professionals Concussion Statement

34 St. Lawrence University Health Care Professionals Concussion Statement I have read and understood the NCAA Concussion Fact Sheet for Student-Athletes I have read and understood the NCAA Concussion Fact Sheet for Coaches. I have read and understood the St. Lawrence University Sports Medicine Policy on Management of Mild Traumatic Brain Injury (MTBI). By signing below, I acknowledge that I have read and understood all the above documents. Date Signature Printed Name Title

35 References: 1) Guskiewicz K, Bruce SL, Cantu, RC, Ferrara, MS, Kelly JP, McCrea M, Putukian M, Valovich McLeod T. National Athletic Trainers Association Position Statement: Management of Sport-Related Concussion. J Athl Train. 2004;39: ) McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport, 3rd International Conference on Concussion in Sport, held in Zurich, November Clin J Sport Med. 2009;19: