Concussion Identification, Management and Return to Play at North Hunterdon-Voorhees Regional HS District

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1 Concussion Identification, Management and Return to Play at North Hunterdon-Voorhees Regional HS District In tandem with the New Jersey Interscholastic Athletic Association and the National Athletic Trainers Association North Hunterdon-Voorhees Regional HS District will follow the following protocols in regards to concussion and head injury. According to the Centers for Disease Control and Prevention, at least 3 million sports and recreation related concussions occur in the United States each year. Concussions are a serious and growing public health concern, especially for students participating in contact sports. The competitive athletic culture of playing through pain or toughing it out puts student-athletes at serious risk of brain injury, disability, and death. Allowing a student-athlete to return to play before recovering from a concussion increases the chance of a more serious brain injury that can result in severe disability and or death. Currently many student-athletes, school personnel including coaches, parents/guardians, and others involved in interscholastic athletics lack awareness about prevention, identification, and treatment of concussions as well as when it is most appropriate for the student-athlete to return to play. The effects of concussion while not all preventable can be mitigated by prompt recognition and appropriate response. A concussion is a type of traumatic brain injury (TBI) caused by a direct or indirect blow to the head. The injury can range from mild to severe and can disrupt the way the brain normally functions. Sometimes concussions are called closed head injuries. An athlete does not need to lose consciousness to sustain a concussion. Sometimes symptoms occur right away and sometimes they develop over time. It can be hours, days or weeks after the injury. The North Hunterdon-Voorhees Regional HS District requires a baseline Impact neurocognitive test for each student-athlete for athletic clearance. If a concussion is sustained the student-athlete will need to re-take the Impact test. The student is required to return to an acceptable baseline-testing level for return to play. The student-athlete may need to be seen by the school doctor before returning to play. POSSIBLE SIGNS AND SYMPTOMS OF A CONCUSSION: Signs are observed by a member of the coaching staff, athletic trainer and/or physician and are not limited to: 1. Appears dazed, stunned or disoriented. 2. Forgets plays or demonstrates short-term memory difficulties (e.g. unsure of the game, score or opponent). 3. Exhibits difficulties with balance or coordination 4. Answers questions slowly or inaccurately. 5. Loses consciousness. 6. Demonstrates behavior or personality changes. 7. Is unable to recall events prior to or after the hit. Symptoms reported by the student-athlete to a member of the coaching staff, athletic trainer, parent, and physician includes but are not limited to:

2 1. Headache 2. Nausea/vomiting 3. Balance problems or dizziness 4. Double vision or changes in vision 5. Sensitivity to light or sound/noise 6. Feeling of sluggishness or fogginess 7. Difficulty with concentration, short-term memory and or confusion 8. Irritability or agitation 9. Depression or anxiety 10. Sleep disturbance (e.g. sleeping too much or too little) RETURN TO PLAY GUIDELINES: The North Hunterdon-Voorhees Regional HS District has a written policy that addresses incidents of suspected or actual concussion among participants involved in district programs. A student-athlete who is suspected of sustaining or who has sustained a concussion and or has become unconscious during an athletic event shall not return-to-play until (s)he meets all of the following criteria: 1. Immediate removal from play and no return-to-play that day. 2. Medical evaluation to determine the presence/absence of concussion. 3. When diagnosis of a concussion is present, the student-athlete will take a post-concussion Impact test after being asymptomatic for 7 days. 4. It is recommended that the student-athlete diagnosed with a concussion complete AT A MINIMUM, DEPENDING ON PAST HISTORY AND SEVERITY OF SYMPTOMS, a symptom-free week before initiating a graduated return-to-play exercise protocol. The North Hunterdon-Voorhees HS District believes that our student-athletes should be symptom free at rest, symptom free with activity, and cognitively symptom free before returning to play. The student-athlete must be monitored during this period for any reoccurrence of concussion symptoms. At this time the student athlete may need to re-take the post concussion Impact test to return to baseline levels. 5. If the student-athlete exhibits a re-emergence of any post concussion sign or symptoms once they return-to-play, they will be removed from exertional maneuvers and must return to his/her primary care physician or the team doctor for reevaluation. 6. If concussion symptoms reoccur during the graduated return-to-play exercise protocol, the studentathlete will return to the previous level of activity that caused no symptoms and then advance as tolerated. GRADUATED RETURN-TO-PLAY EXERCISE PROTOCOL: Step 1: No activity, complete physical and cognitive rest. (e.g. no computer work, video games, schoolwork when necessary, IPod or music directly into ear canals.) The objective of this step is recovery Step 2: Following medical clearance by both a family and school doctor and a passing score on the Impact post-concussion test, the athlete will complete the four day graduated return to play protocol. No games will be played until the full protocol has been completed. The athlete must remain symptom free before, during and after activity. The following are the steps of the graduated return protocol:

3 Day 1: Resume LOW level of physical activity including Light aerobic exercise, which includes walking, swimming or stationary cycling, keeping the intensity <70% maximum percentage heart rate; no resistance training. The objective of this step is increased heart rate. Day 2: Resume MODERATE levels of physical activity. This includes Sport-specific exercise including skating, biking, elliptical, and/or running drills; no head impact activities. The objective of this step is to add movement. Day 3: Resume HEAVY NON-CONTACT physical activity. This includes Non-contact training drills involving progression to more complex training drills (e.g. passing drills) utilizing three planes of movement. The student-athlete may initiate progressive resistance training. There is no live play. Day 4: Resume CONTACT in CONTROLLED PRACTICE. Return to play involving normal exertional or game activity. This would be a full contact practice. After remaining symptom free throughout all of these steps the athlete would be cleared to return to their sport with no restrictions. Should symptoms reappear after any step, the protocol would reverse one day. (For example-if symptoms re-appeared after day 3 the student would move back to day 2 and repeat day 2. If symptom free after repeating day 2 the athlete would progress to day 3.) This statement was prepared with references from: Consensus Statement on Concussion in Sports3rd International Conference on Concussion in Sport held in Zurich, November2008. Clinical Journal of Sport Medicine, Volume 19, No. 3 May 2009, pp Concussion Identification, Management and Return-To- Play NJSIAA Policy Statement, NJSIAA Medical Advisory Board, March National Athletic Trainers Association Position Statement: Management of Sport-Related Concussion; Journal of Athletic Training 2004; 39(3): Additional Information from the New Jersey State Interscholastic Athletic Association (NJSIAA) I acknowledge that the Hunterdon-Voorhees Regional HS District Concussion Policy has been reviewed and accepted by myself and my son/daughter.

4 Sports-Related Concussion and Head Injury Fact Sheet and Parent/Guardian Acknowledgement Form A concussion is a brain injury that can be caused by a blow to the head or body that disrupts normal functioning of the brain. Concussions are a type of Traumatic Brain Injury (TBI), which can range from mild to severe and can disrupt the way the brain normally functions. Concussions can cause significant and sustained neuropsychological impairment affecting problem solving, planning, memory, attention, concentration, and behavior. The Centers for Disease Control and Prevention estimates that 300,000 concussions are sustained during sports related activities nationwide, and more than 62,000 concussions are sustained each year in high school contact sports. Second-impact syndrome occurs when a person sustains a second concussion while still experiencing symptoms of a previous concussion. It can lead to severe impairment and even death of the victim. Legislation (P.L. 2010, Chapter 94) signed on December 7, 2010, mandated measures to be taken in order to ensure the safety of K-12 student-athletes involved in interscholastic sports in New Jersey. It is imperative that athletes, coaches, and parent/guardians are educated about the nature and treatment of sports related concussions and other head injuries. The legislation states that: All Coaches, Athletic Trainers, School Nurses, and School/Team Physicians shall complete an Interscholastic Head Injury Safety Training Program by the school year. All school districts, charter, and non-public schools that participate in interscholastic sports will distribute annually this educational fact to all student athletes and obtain a signed acknowledgement from each parent/guardian and student-athlete. Each school district, charter, and non-public school shall develop a written policy describing the prevention and treatment of sports-related concussion and other head injuries sustained by interscholastic student-athletes. Any student-athlete who participates in an interscholastic sports program and is suspected of sustaining a concussion will be immediately removed from competition or practice. The student-athlete will not be allowed to return to competition or practice until he/she has written clearance from a physician trained in concussion treatment and has completed his/her district s graduated return-to-play protocol. Quick Facts Most concussions do not involve loss of consciousness You can sustain a concussion even if you do not hit your head A blow elsewhere on the body can transmit an impulsive force to the brain and cause a concussion Signs of Concussions (Observed by Coach, Athletic Trainer, Parent/Guardian) Appears dazed or stunned Forgets plays or demonstrates short term memory difficulties (e.g. unsure of game, opponent) Exhibits difficulties with balance, coordination, concentration, and attention Answers questions slowly or inaccurately Demonstrates behavior or personality changes Is unable to recall events prior to or after the hit or fall Symptoms of Concussion (Reported by Student-Athlete) Headache Sensitivity to light/sound Nausea/vomiting Feeling of sluggishness or fogginess Balance problems or dizziness Difficulty with concentration, short term Double vision or changes in vision memory, and/or confusion

5 What Should a Student-Athlete do if they think they have a concussion? Don t hide it. Tell your Athletic Trainer, Coach, School Nurse, or Parent/Guardian. Report it. Don t return to competition or practice with symptoms of a concussion or head injury. The sooner you report it, the sooner you may return-to-play. Take time to recover. If you have a concussion your brain needs time to heal. While your brain is healing you are much more likely to sustain a second concussion. Repeat concussions can cause permanent brain injury. What can happen if a student-athlete continues to play with a concussion or returns to play to soon? Continuing to play with the signs and symptoms of a concussion leaves the student-athlete vulnerable to second impact syndrome. Second impact syndrome is when a student-athlete sustains a second concussion while still having symptoms from a previous concussion or head injury. Second impact syndrome can lead to severe impairment and even death in extreme cases. Should there be any temporary academic accommodations made for Student-Athletes who have suffered a concussion? To recover cognitive rest is just as important as physical rest. Reading, texting, testing-even watching movies can slow down a student-athletes recovery. Stay home from school with minimal mental and social stimulation until all symptoms have resolved. Students may need to take rest breaks, spend fewer hours at school, be given extra time to complete assignments, as well as being offered other instructional strategies and classroom accommodations. Student-Athletes who have sustained a concussion should complete a graduated return-to-play before they may resume competition or practice, according to the following protocol: Step 1: Completion of a full day of normal cognitive activities (school day, studying for tests, watching practice, interacting with peers) without reemergence of any signs or symptoms. If no return of symptoms, next day advance. Step 2: Light Aerobic exercise, which includes walking, swimming, and stationary cycling, keeping the intensity below 70% maximum heart rate. No resistance training. The objective of this step is increased heart rate. Step 3: Sport-specific exercise including skating, and/or running: no head impact activities. The objective of this step is to add movement. Step 4: Non contact training drills (e.g. passing drills). Student-athlete may initiate resistance training. Step 5: Following medical clearance (consultation between school health care personnel and studentathlete s physician), participation in normal training activities. The objective of this step is to restore confidence and assess functional skills by coaching and medical staff. Step 6: Return to play involving normal exertion or game activity. For further information on Sports-Related Concussions and other Head Injuries, please visit: I acknowledge that the New Jersey State Interscholastic Athletic Association (NJSIAA) Sports- Related Concussion and Head Injury Fact Sheet has been reviewed and accepted by myself and my son/daughter.

AYSA Concussion/Serious Injury Policy 2013

AYSA Concussion/Serious Injury Policy 2013 Although it is the beautiful game, soccer is one of the leading sports when it comes to its players sustaining concussions. In conjunction with the 2011 Pennsylvania