UNIVERSITY OF MASSACHUSETTS SPORTS MEDICINE PROGRAM Concussion Management Plan

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Alexander Francis
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1 UNIVERSITY OF MASSACHUSETTS SPORTS MEDICINE PROGRAM Concussion Management Plan University of Massachusetts Sports Medicine personnel will evaluate student-athletes with a suspected concussion as follows: Injury Management- The student-athlete will accept responsibility for reporting injuries and illnesses to the sports medicine staff (team physicians, certified athletic trainers) including the signs and symptoms of concussions. During the injury management agreement review and signing process at the beginning of the season, student-athletes are presented with educational material on concussions. Baseline Testing- Neuropsychological Assessment ImPACT testing will be performed for each student-athlete in the sports of baseball, basketball, diving, field hockey, football, ice hockey, lacrosse, pole vaulting, soccer and softball. Time of Injury- Symptom assessment /Orientation assessment Anterograde/retrograde amnesia assessment Concentration assessment Balance Assessment Recommendations- If the student-athlete exhibits signs of a concussion, he/she CANNOT return to participation until cleared through the procedures outlined below. Post-Concussion Follow-up (24-48 hrs. post injury) Symptom assessment Orientation assessment Anterograde amnesia assessment o loss of memory from time of injury to return of full, ongoing memory process Retrograde amnesia assessment o recall of events immediately preceding trauma Concentration assessment Balance Assessment Neuropsychological Assessment ImPACT Evaluation by Team Physician Note- Pertinent assessments will be repeated by the sports medicine staff every day until the student-athlete Self-Reports Asymptomatic, at which time the student-athlete will begin with Step 1 Concussion Recovery Procedures. There is typically 24 hours between steps and cases may be individualized.

2 Return to Play Protocol Sen. Doc. No Step 1: When student-athlete self-reports asymptomatic 1. Neuropsychological Assessment ImPACT Step 2: If student-athlete self-reports asymptomatic after Step 1 Cardiovascular exercise in controlled setting- Mode, duration and intensity dependent upon sport o Walking, swimming or stationary cycling, keeping intensity below 70% of perceived maximum heart rate; no resistance training concussed state / procedures until he/she Self-Report Asymptomatic (SRA) Step 3 If student-athlete self-reports asymptomatic after Step 2 Sport-specific exerciseso Sport-specific drills Keeping intensity below 70% of perceived maximum heart rate No resistance training o Interval Bike Ride and Body Weight Exercises o No head impact activities No helmet for football activities concussed state / procedures until they Self-Report Asymptomatic (SRA) Step 4: If student-athlete self-reports asymptomatic after Step 3 Shuttle Run, plyometric exercises, medicine ball throws, vertical jumps Non-contact training drills o Begin more complex training drills Resume wearing helmet for football Passing drills for football/hockey o No head impact activities o Begin resistance training exercises concussed state / procedures until they Self-Report Asymptomatic (SRA)

3 Step 5: If student-athlete self-reports asymptomatic after Step 4 Neuropsychological Assessment ImPACT Medical assessment by team physician for medical clearance Pending medical clearance, resume normal sport participation o Assess physical skills by coaching staff concussed state / procedures until they Self-Report Asymptomatic (SRA) Step 6: If student-athlete self-reports asymptomatic after Step 5 Normal game play Academic activities Symptomatic student-athletes may require active supports and accommodations in school, which may be gradually decreased as their functioning improves. Inform the student-athlete s academic support counselor, professor(s) and athletic health enhancement counselor of the studentathlete s injury, symptoms, and cognitive deficits. Student-athletes with temporary yet prolonged symptoms (i.e. longer than several weeks) or permanent disability may benefit from referral for special accommodations and services. Appropriate university personnel should be advised to monitor the student-athlete for the following signs: Increased problems paying attention/concentrating Increased problems remembering/learning new information Longer time required to complete tasks Increased symptoms (e.g., headache, fatigue) during schoolwork Greater irritability, less tolerance for stressors Appropriate university personnel should be advised to monitor the student-athlete for the recurrence of symptoms from physical exertion and mental exertion, such as: Reading Phone texting Computer games Working on a computer Classroom work Taking a test.

4 Until a full recovery is achieved, student-athletes may need the following supports: Time off from school Shortened day Shortened classes (i.e., rest breaks during classes) Rest breaks during the day Allowances for extended time to complete coursework/assignments and tests Reduced homework/class work load (it is best to specify for teachers the percent of workload that the student-athlete can reasonably handle, e.g., 50% homework load) No significant classroom or standardized testing at this time Physicians and academic support personnel, in concert with the team athletic trainer, should monitor the student-athlete s symptoms with cognitive exertion (mental effort such as concentration, studying, etc.) to evaluate the need and length of time supports should be provided.

5 Graduated Return to Play Protocol Sen. Doc. No Rehabilitation Step 1. No Activity 2. Light aerobic exercise 3. Sport-specific exercise 4. Non-contact training drills 5. Full contact practice 6. Return to play Functional Exercise at Each Step of Rehabilitation Complete physical and cognitive rest Walk, swim or stationary cycle for 20 minutes, keeping intensity <70% MPHR; no resistance training; Running or skating drills, or Interval bike ride and BW circuit, no head impact activities. Shuttle Run, plyometric exercises, medicine ball throws, vertical jumps and progress to more complex training drills for 15 minutes, e.g., passing drills in football and hockey; start progressive resistance training Following medical clearance, participate in normal training activities Normal game play Objective of Each Step Recovery Increase heart rate Add movement Exercise, coordination and cognitive load Restore confidence and assess functional skills by coaching staff This document reflects the current state of knowledge and will need to be modified according to the development of new knowledge. It provides a guideline to the healthcare providers involved in the management of sports related concussion. It is not intended as a standard of care and should not be interpreted as such. Individual treatment will depend on the facts and circumstances specific to each individual case.

6 Home Instructions for Concussion I believe sustained a concussion on. To make sure he/she recovers, please follow the important recommendations listed below. Additionally, please remind them to report to the athletic training room on at for a follow-up evaluation. Please review the following list. If any of the symptoms develop prior to the follow-up appointment with the athletic trainer, contact UHS or the local EMS. A decrease in the level of consciousness An increase in the severity of symptoms An increase in the number of symptoms Any weakness or numbness in the arms or legs Any difficulty with facial expressions or numbness of the face Any change in hearing, vision or balance Abnormal respiration (breathing), pulse or blood pressure Neck pain Seizures Vomiting If none of the above symptoms occur, please follow the instructions below: You may use acetaminophen (Tylenol) for a headache, but do not use any other medication unless instructed by a physician Use icepacks on the head and neck for comfort Eat a light diet It is okay to attend classes It is okay to go to sleep and get a full night s rest. There is no need to wake up every hour Do not take part in any strenuous activity until cleared by the athletic trainer or team physician Do not drink alcohol Do not eat spice foods or beverages

7 CONCUSSION FACT SHEET Signs and Symptoms of concussion generally fall into four categories: physical; cognitive; emotional; and sleep; and may include: Physical Headache Nausea Vomiting Balance problems Dizziness Visual problems Fatigue Sensitivity to light Sensitivity to noise Numbness/Tingling Dazed or stunned Cognitive Feeling mentally foggy Feeling slowed down Difficulty concentrating Difficulty remembering Forgetful or recent information Forgetful of recent conversation Confused about recent events Answers questions slowly Repeats questions Emotional Irritability Sadness More emotional that usual Nervousness Sleep Drowsiness Sleeping less than usual Sleeping more than usual Trouble falling asleep

Post Concussion Instructions and Return to Play Clearance Form. To: Parent/Guardian: Page 1. From:, at School

Post Concussion Instructions and Return to Play Clearance Form To: Parent/Guardian: From:, at School Name of School Representative* Name of School, Position of School Representative* Phone Number of School