Ophea Return to Learn/Return to Physical Activity Plan. Prior to Any Incident Occurring (September)

Transcription

1 Ophea Return to Learn/Return to Physical Activity Plan Prior to Any Incident Occurring (September) Description Who is responsible Paperwork/Special Notes 1. Be able to react to an incident where a concussion is suspected. 2. Be able to identify the common signs and/or symptoms of a suspected concussion Principal/Teacher/Coach 1. Review Appendix D-1 Concussion Management Procedures: Return to Learn and Return to Physical Activity 2. Review Table 1: Common Signs and Symptoms of a Concussion (Appendix D-1 page 3) Page 1 of 16

2 Ophea Return to Learn/Return to Physical Activity Plan Responsibilities and Procedures When an Incident Occurs Description Who is responsible Paperwork/Special Notes Incident occurs where a suspected concussion is present Follow up of incident Teacher/Coach Parents/Guardians Medical Doctor/Nurse Practitioner Parents/Guardians Teacher/Coach 1. Provide appropriate care to injured student. Refer to Document D-1 Concussion Management Procedures: Return to Learn and Return to Physical Activity pages Use and Complete form Appendix D-2 Tool to Identify a Suspected Concussion 3. Provide Parents/Guardians with copies of TCDSB Form One Documentation of Medical Examination 1. Have child examined by a medical doctor or nurse practitioner. 1. Examine student and complete TCDSB Form One Documentation of Medical Examination 2. Inform school principal of the results of the examination by returning completed TCDSB Form One Documentation of Medical Examination 2. If no concussion diagnosed file form D-2 and TCDSB Form One in student s OSR no further action required. 3. If concussion diagnosed file form D-2 and TCDSB Form One in student s OSR and initiate Appendix D-4 Documentation for a Diagnosed Concussion Return to Learn/Return to Physical Activity Plan Principal 1. Inform all school staff (e.g., classroom teachers, physical education teachers, intramural supervisors, coaches) and volunteers who work with the student of the diagnosis; and, 2. File written documentation (e.g., TCDSB Form One Documentation of Medical Examination, parent s note) in the student s OSR. Page 2 of 16

3 Ophea Return to Learn/Return to Physical Activity When a Concussion is Diagnosed Diagnosed Concussion - Return to Learn/Return to Physical Activity Plan Collaborative Team Approach: It is critical to a student s recovery that the Return to Learn/Return to Physical Activity Plan be developed through a collaborative team approach. Led by the school principal, the team should include: the concussed student; her/his parents/guardians; school staff and volunteers who work with the student; and, the medical doctor or nurse practitioner. Ongoing communication and monitoring by all members of the team is essential for the successful recovery of the student. Step Description Who is responsible Paperwork/Special Notes 1 Rest: No activity, complete physical and cognitive rest. Duration: minimum of 24 hours The student s symptoms begin to improve continue to Step 2a (Return to Learn) The student is symptom free continue to Step 2 (Return to Physical Activity) Restrictions: NA as no activity is allowed Parents/Guardians Younger students must be monitored closely to ensure cognitive and physical rest are upheld. The parent/guardian must communicate the results and the appropriate step to resume by completing TCDSB Form Two: Step 1 Return to Learn before the student can return to school. Return to Learn Designated School Staff Lead: Once the student has completed Step 1 and is therefore able to return to school one school staff (i.e. a member of the collaborative team designated by the school principal) needs to serves as the main point of contact for the student, the parents/guardians, other school staff and volunteers who work with the student, and the medical doctor or nurse practitioner. Return of Concussion Symptoms If, at any time, concussion symptoms return and/or deterioration of work habits or performance occur, the student must be examined by a medical doctor or nurse practitioner. In this case parents/guardians must complete and return TCDSB Form 8 Return of Symptoms which will indicate which step student must repeat. This form must be filed in student s OSR. Page 3 of 16

4 Ophea Return to Learn/Return to Physical Activity When a Concussion is Diagnosed Diagnosed Concussion - Return to Learn/Return to Physical Activity Plan The Return to Learn/Return to Physical Activity Plan is a combined approach. Step 2a - Return to Learn must be completed prior to the student returning to physical activity. Each step must take a minimum of 24 hours (Note: Step 2b Return to Learn and Step 2 Return to Physical Activity occur concurrently). Step Description Who is responsible Paperwork/Special Notes 2a 2b The student requires individualized classroom strategies and/or approaches to return to learning activities - these will need to be adjusted as recovery occurs At this step, the student begins regular learning activities without any individualized classroom strategies and/or approaches. This step occurs concurrently with Step 2 Return to Physical Activity. Return to Learn Teacher/Designated Member of Collaborative Team Teacher/Coach/ Designated Member of Collaborative Team Return to Physical Activity 1. Refer to Appendix D-1 Table 2: Return to Learn Strategies p Parent-Guardian: Must communicate to the school principal by completing TCDSB Form 3 Step 2a Return to Learn that the student is symptom free before the student can proceed to Step 2b Return to Learn and Step 2 Return to Physical Activity. All forms should be filed in student s OSR. 2 Activity: Individual light aerobic physical activity only (e.g., walking, swimming or stationary cycling keeping intensity below 70% of maximum permitted heart rate) Restrictions: No resistance or weight training. No competition (including practices, scrimmages). No participation with equipment or with other students. No drills. No body contact. Objective: To increase heart rate Duration: minimum of 24 hours Teacher/Coach/ Designated Member of Collaborative Team Parent/Guardian: Must report back to the school principal by completing TCDSB Form 4 Step 2 Return to Physical Activity that the student continues to be symptom free in order for the student to proceed to Step 3. Page 4 of 16

5 Ophea Return to Learn/Return to Physical Activity When a Concussion is Diagnosed Diagnosed Concussion - Return to Learn/Return to Physical Activity Plan Step Description Who is responsible Paperwork/Special Notes 3 Activity: Individual sport-specific physical activity only (e.g., running drills in soccer, skating drills in hockey, shooting drills in basketball) Restrictions: No resistance/weight training. No competition (including practices, scrimmages). No body contact, no head impact activities (e.g., heading a ball in soccer) or other jarring motions (e.g., high speed stops, hitting a baseball with a bat). Objective: To add movement Duration: minimum of 24 hours Teacher/Coach/ Designated Member of Collaborative Team Teacher/Coach/ Designated Member of Collaborative Team:: Must report back to the school principal by completing TCDSB Form 5 Step 3 Return to Physical Activity that the student continues to be symptom free in order for the student to proceed to Step 4. 4 Activity: Activities where there is no body contact (e.g., dance, badminton). Progressive resistance training may be started. Non-contact practice and progression to more complex training drills (e.g., passing drills in football and ice hockey). Restrictions: No activities that involve body contact, head impact (e.g., heading the ball in soccer) or other jarring motions (e.g., high speed stops, hitting a baseball with a bat) Objective: To increase exercise, coordination and cognitive load Duration: minimum of 24 hours Teacher/Coach/ Designated Member of Collaborative Team Teacher/Coach/ Designated Member of Collaborative Team: Must report back to the school principal by completing TCDSB Form 6 Step 4 Return to Physical Activity that the student continues to be symptom free in order for the student to proceed to Step 5. Page 5 of 16

6 Ophea Return to Learn/Return to Physical Activity When a Concussion is Diagnosed Diagnosed Concussion - Return to Learn/Return to Physical Activity Plan Step Description Who is responsible Paperwork/Special Notes 5 Activity: Full participation in regular physical education/intramural/interschool activities in non-contact sports. Full training/practices for contact sports. Restrictions: No competition (e.g., games, meets, events) that involve body contact Objective: To restore confidence and assess functional skills by teacher/coach Duration: minimum of 24 hours Teacher/Coach/ Designated Member of Collaborative Team Parent/Guardian: Must report back to the school principal by completing TCDSB Form 7 Documentation of Final Medical Examination that the student continues to be symptom free in order for the student to proceed to Step 6. 6 Activity: Full participation in contact sports Restrictions: None Teacher/Coach/ Designated Member of Collaborative Team All forms must be filed in student s OSR. Page 6 of 16

7 TCDSB FORMS

8 TCDSB FORM ONE Documentation of Medical Examination This form to be provided to all students suspected of having a concussion. For more information see Appendix D-1 Concussion Management Procedures: Return to Learn and Return to Physical Activity. (student name) sustained a suspected concussion on (date). As a result, this student must be seen by a medical doctor or nurse practitioner. Prior to returning to school, the parent/guardian must inform the school principal of the results of the medical examination by completing the following: Results of Medical Examination My child/ward has been examined and no concussion has been diagnosed and therefore may resume full participation in learning and physical activity with no restrictions. My child/ward has been examined and a concussion has been diagnosed and therefore must begin a medically supervised, individualized and gradual Return to Learn/Return to Physical Activity Plan. Parent/Guardian signature: Date: Comments:

9 TCDSB FORM TWO Step 1 Return to Learn Completed at home. Cognitive Rest includes limiting activities that require concentration and attention (e.g., reading, texting, television, computer, video/electronic games). Physical Rest includes restricting recreational/leisure and competitive physical activities. My child/ward has completed Step 1 of the Return to Learn/Return to Physical Activity Plan (cognitive and physical rest at home) and his/her symptoms have shown improvement. My child/ward will proceed to Step 2a Return to Learn. My child/ward has completed Step 1 of the Return to Learn/Return to Physical Activity Plan (cognitive and physical rest at home) and is symptom free. My child/ward will proceed directly to Step 2b Return to Learn and Step 2 Return to Physical Activity. Parent/Guardian signature: Date: Comments: This form indicates student has completed Step 1 at home, is symptom free and is able to start Step 2a Return to Learn (i.e. The student requires individualized classroom strategies and/or approaches to return to learning activities - these will need to be adjusted as recovery occurs.)

10 TCDSB FORM THREE Step 2a - Return to Learn If at any time during the following steps symptoms return, parents must complete and return Form Five Return of Symptoms. Student returns to school. Requires individualized classroom strategies and/or approaches which gradually increase cognitive activity. Physical rest includes restricting recreational/leisure and competitive physical activities. My child/ward has been receiving individualized classroom strategies and/or approaches and is symptom free. My child/ward will proceed to Step 2b Return to Learn and Step 2 Return to Physical Activity. Parent/Guardian signature: Date: Comments: This form indicates student has completed Step 2 at school, is symptom free and is able to start both Step 2b Return to Learn and Step 2 Return to Physical Activity.

11 TCDSB FORM FOUR Step 2 Return to Physical Activity If at any time during the following steps symptoms return, parents must complete and return Form Five Return of Symptoms. Student can participate in individual light aerobic physical activity only. Student continues with regular learning activities. My child/ward is symptom free after participating in light aerobic physical activity. My child/ward will proceed to Step 3 Return to Physical Activity. Parent/Guardian signature: Date: Comments: This form indicates student has completed Step 2 at school, is symptom free and is able to start Step 3 Return to Physical Activity.

12 TCDSB FORM FIVE Step 3 Return to Physical Activity If at any time during the following steps symptoms return, parents must complete and return Form Five Return of Symptoms. Student can participate in individual sport-specific physical activity only. Student continues with regular learning activities. My child/ward is symptom free after participating in sport-specific physical activity. My child/ward will proceed to Step 4 Return to Physical Activity. Teacher/Coach/ Designated Member of Collaborative Team signature: Date: Comments: This form indicates student has completed Step 3 at school, is symptom free and is able to start Step 4 Return to Physical Activity.

13 TCDSB FORM SIX Step 4 Return to Physical Activity If at any time during the following steps symptoms return, parents must complete and return Form Five Return of Symptoms. Student can participate in activities where there is no body contact (e.g., dance, badminton). Progressive resistance training may be started. Non-contact practice and progression to more complex training drills (e.g., passing drills in football and ice hockey). Student continues with regular learning activities. My child/ward is symptom free after participating in sport-specific physical activity. My child/ward will proceed to Step 5 Return to Physical Activity. Teacher/Coach/ Designated Member of Collaborative Team signature: Date: Comments: This form indicates student has completed Step 4 at school, is symptom free and is able to start Step 5 Return to Physical Activity.

14 TCDSB FORM SEVEN Documentation of Final Medical Examination I, (medical doctor/nurse practitioner name) have examined (student name) and confirm he/she continues to be symptom free and is able to return to regular physical education class/intramural activities/interschool activities in non-contact sports and full training/practices for contact sports. Medical Doctor/Nurse Practitioner Signature: Date: Comments: This form indicates student has completely recovered from a diagnosed concussion as is able to return to full physical activity.

15 TCDSB FORM EIGHT Return of Symptoms My child/ward has experienced a return of concussion signs and/or symptoms and has been examined by a medical doctor/nurse practitioner, who has advised a return to: Step of the Return to Learn/Return to Physical Activity Plan Parent/Guardian signature: Date: Comments: This form indicates the student has had a return of concussion symptoms and must return to a previous step (as indicated above) in the Return to Learn/Return to Physical Activity Plan

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