BELMONT ABBEY COLLEGE ATHLETIC TRAINING CONCUSSION MANAGEMENT PLAN. Revised September 7, 2016

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1 BELMONT ABBEY COLLEGE ATHLETIC TRAINING CONCUSSION MANAGEMENT PLAN Revised September 7, 2016

2 I. Introduction The Belmont Abbey College Athletic Training Department remains committed to ensuring the health and safety of its student-athletes. As a result of this commitment, a growing body of research supporting increased efforts to recognize and manage concussions, and a recent recommendation by the NCAA, Belmont Abbey Athletic Training has put in place the following policy to educate student-athletes, coaches, and college faculty about, recognize signs and symptoms of, and manage the return to play and return to learning following concussions. All guidelines in this management plan follow the current guidelines set forth by the National Athletic Trainers Association and the NCAA. II. Definition A concussion can be defined as the following: A change in brain function, following a blow to the head, which may be accompanied by temporary loss of consciousness, but is identified in awake individuals, with measures of neurologic and cognitive dysfunction A concussion may be accompanied by any combination of the following signs and/or symptoms: Headache Nausea or vomiting Dizziness Balance deficiencies Feeling slowed down Trouble sleeping Drowsiness Sensitivity to light or noise Loss of consciousness; blacking out Difficulty remembering events before OR after the concussion Difficulty concentrating or thinking Feeling or pressure in head Vision problems, including blurry and double vision Sense of fatigue Irritability, overly emotional, nervous, anxious, or other behavioral abnormalities Loss of appetite It is essential to recognize that each concussion is unique and individuals may present with different patterns of symptoms.

3 III. Mechanism of Injury It is important to recognize that mild traumatic brain injury may occur with or without the presence of an athlete being struck directly in the head. The following describe the different injury mechanisms: 1. Coup injury a forceful blow to the head resulting in injury to the brain at the point of contact. 2. Contrecoup injury a moving head hitting an unyielding object resulting in injury to the brain opposite the point of contact. Examples of these injury mechanisms include, but are not limited to: a soccer player colliding heads with a goalie, a wrestler having his head slammed against the mat, a lacrosse player being checked into the ground, a baseball player being struck in the head by a pitch or batted ball. IV. Athlete Education Prior to each season, a member of the athletic training staff will conduct a short presentation on the mechanisms of concussion, signs and symptoms of a concussion, and the tenets of this management plan including their return to play protocol. Student athletes will sign an acknowledgement that this information was presented to them and that they accept the responsibility for accurately reporting their symptoms to the medical staff in a timely manner. This acknowledgement will be kept on file with the medical staff as well as the institutional compliance coordinator. V. Concussion Evaluation Per NCAA recommendation, in no cases will an athlete that is suspected of having a concussion be returned to play/practice on the same day in which the concussion occurred. 1. Pre-Season/Baseline Evaluation a. Prior to the start of any practice or competition, all Belmont Abbey College Student-Athletes must have a baseline evaluation on file with the Athletic Training Staff. b. The baseline evaluation will consist of the following: i. Neuropsychological Testing (impact) quantifies athlete s cognitive status including reaction time, memory, and comprehension ii. Sport Concussion Assessment Tool 3 (SCAT3) provides a baseline score for the sideline evaluation tool to be used by the Belmont Abbey College medical staff 2. Sideline/On-Field Evaluation a. Athlete should first be evaluated using standard emergency management principles, with particular attention being given to excluding cervical spine injury. b. Athlete should be evaluated by the appropriate health care provider. Evaluation should not take place by a coach or game official. c. Any individual displaying symptoms of a concussion, following reasonable mechanism, will be withheld from competition. d. Initial assessment of the injury will be made using accepted concussion evaluation strategies.

4 3. Off-Field/Follow Up Evaluation a. Athletes who are diagnosed as having a concussion will be serially tested with a symptom tracking sheet and/or SCAT3 tool as appropriate to establish improvement in their condition. b. Athletes with a suspected concussion will be referred to a team physician for evaluation. c. Commencement of return to play protocol and clearance for return to play will be established by the team physician and will be carried out by the athletic training staff. This may include subsequent neuropsychological testing and office visits. d. Neuropsychological testing following an injury will occur once the athlete is symptom free and be used to confirm that there are no cognitive deficits prior to an athletes return to play VI. Return to Play Protocol Per NCAA recommendation, in no cases will an athlete that is suspected of having a concussion be returned to play/practice on the same day in which the concussion occurred. The exercise progression for an athlete to return to play following a concussion will begin once the athlete has been symptom free for 24 hours. The decision of when to start the return to play protocol will rest with the team physician. The specific activities contained within the return to play protocol may vary slightly between sports and between athletic trainers but will follow the following general progression: 1. Light aerobic exercise 20 minute stationary bike (10-14mph) 2. Moderate aerobic exercise 5 minute stationary bike (30s sprint; 30s recovery); 3x20 body weight circuit (push-ups, sit-ups, squats) 3. Sport-specific exercise shuttle run, plyometric activities, run through drills with no ball, no contact, moderate intensity 4. Limited controlled practice ensure all sport requirements are symptom free (unique positions, skill sets, etc.) 5. Full practice (athlete is not yet fully cleared at this stage) No more than two stages will be completed on the same day and symptoms will be monitored both during and following the activity. The athlete must remain symptom free for 24 hours following Step 4 in order to move to Step 5. If, during any of the stages of the progression, the exercise elicits symptoms, the athlete is returned to the previous stage of progression and may re-attempt the stage after they have been symptom free for an additional 24 hours. Prior to final clearance, the following THREE criteria must be met: 1. Successful passage of the return to play protocol as described above. 2. Return of cognitive measures to baseline. 3. No academic accommodations.

5 If ANY of these three criteria are not met, the individual will not be allowed to return to play. Final clearance for return to play will be granted by the team physician. If extenuating circumstances prevent clearance after the exercise progression is completed (team is on the road, etc.), a conditional clearance may be obtained, at the discretion of the team physician (ex. If the scores return to X and there are no symptoms with Y, he/she is cleared). VII. Return To Learn Guidelines Some athletes may require academic accommodations in response to their concussion and associated symptom presentation. The following guidelines will be considered when deciding what, if any, accommodations should be made: A. The accommodations MUST be recommended by the team physician and be accompanied by a letter of medical necessity. B. This letter MUST be turned in to the Academic Resource Center (ARC) so that the student-athletes professors may be notified and accommodations may be met. C. The student-athlete is expected to notify medical staff of their condition (as it improves or deteriorates), what accommodations they feel would help them complete their classwork, and whether or not additional accommodations are needed. The medical staff may evaluate the student-athletes ability to handle cognitive activity before making a recommendation to be excused from class. D. Specific accommodations are at the discretion of the team physician but may include but are not limited to excused absence from class or a modified schedule to allow cognitive rest, additional time on assignments, altered testing environment, and/or assistance with note taking (audio recorders, etc.) E. The student-athlete who is receiving academic accommodations WILL NOT be fully cleared until they are able to handle a full class load without them and have made arrangements to make up and missed work/assessments. F. Full return to academics and classroom activity will be based on a symptom free progression, just as in the return to play protocol. VIII. Other Considerations A. Emergency Referral and/or Neuroimaging It has been recognized that conventional neuroimaging (Brain CT or MR Brain Scan) contributes little to the evaluation process of concussion. Neuroimaging is most useful for identifying structural lesions within the brain. Emergency referral and/or neuroimaging will be considered in cases where there is mental status deterioration, prolonged presence of symptoms, or focal neurologic deficits. B. Loss of Consciousness (LOC) In cases where the athlete loses consciousness, immediate emergency referral may be called for. How this loss of consciousness affects the athletes return to play will be at the discretion of the consulting physician.

6 C. Other Concussion Modifiers There are many factors that may affect the management and return to play of an athlete s concussion. The relevant factors are displayed below: Symptoms Signs Temporal Threshold Co- or premorbidities Behavior Sport Factor Modifier Number, duration, severity Prolonged LOC, amnesia Frequency, timing, recency Concussion occurs with less force each time Mental health and/or attention disorders Dangerous style of play Contact and collision sports D. Second Impact Syndrome Second impact syndrome (SIS) is a condition wherein an athlete who has not completely recovered from a concussion receives a subsequent blow to their head. This second impact causes severe and rapid brain swelling which can lead to death within minutes and requires immediate medical attention. Given the grave nature of this condition, special attention will be given to the return to play decision and forms the rational for the statement that no athlete who exhibits concussion symptoms will be allowed to return to play/practice on the same day they received their concussion. XI. Coach Responsibility The coaching staff of the individual who has sustained a concussion has a unique responsibility to ensure a safe return to sport. It is the duty of the coaching staff to: A. Ensure that the athletic training staff is allowed to perform their assessment of individuals who may have sustained a concussion free of unnecessary pressure or influence to return the individual before they are ready. B. Not encourage athletes to hide or underreport symptoms in an attempt to hasten their return to play. C. Inform the medical staff of any changes in the athletes condition (both positive and negative) and to encourage the athlete to also report the same. D. Not require or encourage additional exercise or cognitive activity beyond what is recommended for the stage of recovery and/or return to play/learn that the athlete may be on at the time.

7 The following materials were consulted when formulating this management plan: Bey, T., Ostick, B. (2009). Second impact syndrome. Western Journal of Emergency Medicine; 10, Casa, D.J., Guskiewicz, K.M., Anderson, S.A., Courson, R.W., Heck, J.F., Jimenez, C.C., McDermott, B.P., Miller, M.G., Stearns, R.L., Swartz, E.E., & Walsh, K.M. (2012). National athletic trainers association position statement: preventing sudden death in sports. Journal of Athletic Training; 47(1), Guskiewicz, K.M., Bruce, S.L., Cantu, R.C., Ferrara, M.S., Kelly, J.P., McCrea, M., Putukian, M., & Valovich McLeod, T.C. (2004). National athletic trainers association position statement: management of sport-related concussion. Journal of Athletic Training; 39(3), McCrory, P., Meeuwisse, W., Johnston, K., Dvorak, J., Aubry, M., Molloy, M., Cantu, R. (2009). Consensus statement on concussion in sport: the 3 rd international conference on concussion in sport held in Zurich, November Journal of Athletic Training; 44(4), Runkle, D. (2010). Memorandum to NCAA head athletic trainers re: concussion management plan.

Departmental Concussion Guidelines

Concussion Plan Departmental Concussion Guidelines The following guidelines have been developed in accordance with Alabama A&M s Mission Statement and service goal of providing quality healthcare services