CONCUSSION POLICY COMCUSSION POLICY

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CONCUSSION POLICY Approved by the Board of Directors March 30, 2017 COMCUSSION POLICY Water Ski and Wakeboard Ontario have taken steps to create an in

1 CONCUSSION POLICY Approved by the Board of Directors March 30, 2017 COMCUSSION POLICY Water Ski and Wakeboard Ontario have taken steps to create an in depth concussion policies and procedures to bring clarity and guidance to our athletes on concussion management Drew Laskoski R.KIN, Athletic Therapist, CAT(C)

2 About the author Drew Laskoski is a Certified Athletic Therapist, and a Registered Kinesiologist with over 27 years of clinical and field experience. He currently operates a Sports Medicine Clinic as well as a Concussion Management Centre in Newmarket, Ontario. Mr. Laskoski has been to the last two Canadian held Pan Am Games and most recently was part of the Medical team specifically for Water Skiing and Wakeboarding during the Toronto Pan American Games. He is the President of the Ontario Athletic Therapist Association and has sat on the Minor Traumatic Brain Initiative, a member of the Ontario Neurotrauma Foundation advisory committee on Concussion Clinic Guidelines and gave deputations at Queen s Park in support of Rowan s Law, the first Provincial Concussion legislation in Canada.

3 Water Ski Wakeboard Ontario This governing body feels strongly that Concussion is a serious health risk in our sports. As such, we have undertaken to establish clear guidelines and educational material that will help guide our athletes, coaches, parents, event organizers and healthcare providers with Best Practice through directed Policies and Procedures. These tenants will protect our athletes in competition and guide them to safe return to learn/work and sport in the event of concussion. We would like to acknowledge the Canadian Concussion Collaborative, Ontario Neurotrauma Foundation, Parachute Canada and the Ontario Athletic Therapist Association for the use of their materials as resources and direct input for this document. Concussion Policy and Protocol The Canadian Concussion Collaborative recommends that all sport organizations and sport event organizers implement a concussion management policy and procedures document. 1.1 Introduction The governing body is committed to maintaining the health of the community and believes that this document will be the foundation of this commitment to our athletes. 1.2 Concussion Policy Participating in the activities organized by the Water Ski Wakeboard Ontario (WSWO) can lead to better health across the country. Our activities, as do most physical activities, have an inherent risk of concussion. Water Ski Wakeboard Ontario recognizes that concussions are a significant public health issue because of their potential short and long term consequences. This document contains the protocols and tools to help prevent, recognize and properly treat concussions which may occur in our activities.

4 Therefore, the WSWO enacts: A) this policy and related protocols, and will endeavor to have all participants, coaches, event organizers, and parents follow all treatment protocols, return to learn/work protocols and return to play progressions. B) The WSWO will convene an expert panel consisting of the President, technical experts and first responder experts to meet to identify possible risk factors related to our sport and develop Sport Specific Policies or Protocols that will be added to this document. Such meetings will occur yearly for the first two years of this document to review and fine tune any aspects of this document that may become evident with real world experiences. Written protocol frequently need to be revisited to ensure the content remains relevant to the realities of competition and any outside influences. The proper treatment of a concussion is more important than participation in any sport/activity/work/school during the healing process.

5 1.3 Definitions In this policy, (i) Concussion means the definition of concussion from the 2017 Berlin consensus statement on concussion in sport: Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces' In plain language, a concussion: is a brain injury that causes changes in how the brain functions, leading to symptoms that can be: physical (e.g. headache, dizziness), cognitive (e.g., difficulty concentrating or remembering) emotional/behavioural (e.g., depression, irritability) or related to sleep (e.g., drowsiness, difficulty falling asleep) may be cause either by a direct blow to the head, face or neck, or a blow to the body that transmits a force to the head that causes the brain to move rapidly within the skull; can occur even if there has been no loss of consciousness (in fact most concussions occur without a loss of consciousness); and, cannot normally be seen on x-rays, standard CT scans or MRIs. (ii) Suspected Concussion means the recognition that an individual appears to have either experienced an injury or impact that may result in a concussion, or is exhibiting unusual behaviour that may be the result of concussion. (iii) Concussion Diagnosis means a clinical diagnosis made by a medical doctor or nurse practitioner it is critical that an individual with a suspected concussion be examined by a medical doctor or nurse practitioner.

6 1.4 Stages of Concussion Management A) The best method of Concussion Management is prevention. Competitors and event organizers must be educated that placing themselves at risk is the single greatest cause of concussion. It is imperative to be able to identify if conditions or tricks are too risky at the competitor s skill level. Athletes must learn to self-monitor practice and competition conditions. Coaches and event organizers must be accountable for recognition of potential risks and take every precaution to minimize those risks if possible. Education is a key to Concussion Management. Water Ski Wakeboard Ontario will see that every competitor, parent and coach receives annual education prior to the beginning of each season. Education must include the following topics: Physiology of a concussion Early recognition of signs and symptoms of a concussion Sports injury culture Sport-specific concussion prevention strategy Concussion Action Plan (CAP) Protocol In-season mandatory incident reporting to WSWO Return to learn/work protocol following concussion Return to play protocol following a concussion B) Prevention: Ensuring Safe Play-Concussion Prevention Strategies The WSWO requires that all activity within its purview follows the rules of the game and that the rules will be consistently enforced in order to effectively ensure safe participation. Sport-specific concussion prevention strategies as named in the CWSA Concussion Management and Protocol document will be implemented for all activity within competition and out of competition as well. C) Identification- Using the Concussion Action Plan (CAP) Water Ski Wakeboard Ontario requires that a Concussion Action Plan (CAP) be available and implemented at all sanctioned events in case of a concussion or suspected concussion. A Concussion Action Plan (CAP) will be an addition to an Emergency Action Plan (EAP) that must be in place at all competition venues and practice facilities. (EAP see Appendix 1) The CAP will provide appropriate direction to all individual. D) Documentation of Incident

7 The WSWO will use the Concussion Documentation Form to record the details of the incident and the athlete s progression through the stages of concussion management. (Appendix 1) Appendix 2 WSWC Incident Report (on WSWC website) Appendix 3 - Return to learn return to play form

8 1.5 Return to Learn/Work Protocol For our competitors that are still in school whether it is Elementary, High School, College or University, WSWO members injured during competition or during practice sessions are expected to follow WSWO protocol or they may defer to the posted Concussion protocol of their educational institution. Successful completion of that protocol while attending school will determine when the athlete may Enter into the WSWO Return to Sport Protocol. Should the athlete be injured outside of the school year, it is expected that the athlete and their family/legal guardians will follow the WSWO Return to Learn and Return to Sport Protocols. For those competitors that have graduated or left the Educational System in Ontario, they may have to defer to their employers return to work program. If no program is in place, the return to work program of WSWO is to be followed. Those athletes that work are suggested to follow the WSIB Return to Work Protocol as outlined in the Programs of Care-mTBI (minor traumatic brain injury) The WSIB POC has undergone extensive review to establish best practices. The Ontario Physical Education Safety Guidelines as developed by Ontario Physical Health Education Association (OPHEA) has developed an extensive Return to Learn program. The WSWO has adopted this document as the guiding document because of systematic review done by OPHEA and it has had the content approved by both the Ministry of Health and the Ministry of Tourism, Culture and Sport.

9 WSWO Return to Learn Protocol Return to Learn/Return to Physical Activity Plan (The actual form can be found in Appendix 5) This form is to be used by parents/guardians to communicate their child s/ward s progress through the plan and is to be used with Appendix C-1 Concussion Protocol: Prevention, Identification and Management Procedures. Step 1 Return to Learn/Return to Physical Activity Completed at home. Cognitive Rest includes limiting activities that require concentration and attention (e.g., reading, texting, television, computer, video/electronic games) The first 48 hours are key for complete cognitive rest. Physical Rest includes restricting recreational/leisure and competitive physical activities. (cognitive and physical rest at home) and his/her symptoms have shown improvement. My child/ward will proceed to Step 2a Return to Learn. (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: Step 2a Return to Learn 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. 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:

10 Step 2b Return to Learn Student returns to regular learning activities at school. Step 2 Return to Physical Activity Student can participate in individual light aerobic physical activity only. Student continues with regular learning activities. n light aerobic physical activity. My child/ward will proceed to Step 3 Return to Physical Activity. -4 will be returned to the teacher/coach/intramural supervisor to record progress through Steps 3 and 4. Parent/Guardian Step 3 Return to Physical Activity Student may begin individual sport-specific physical activity only. Step 4 Return to Physical Activity Student may begin activities where there is no body contact (e.g., dance, badminton); light resistance/weight training; non-contact practice; and non-contact sport-specific drills. -4 will be returned to parent/guardian to obtain medical doctor/athletic Therapist/Sport Physiotherapist/Nurse Practitioner diagnosis and signature. Teacher/coach/intramural supervisor signature: Medical Examination Physiotherapist/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/Athletic Therapist/Sports Physiotherapist/Nurse Practitioner Signature: Date: Comments:

11 1.6 Return to Play Protocol While the author of this document has outlined the general guidelines for return to play, it is in the Association s best interests to convene a special committee of experts to identify the specifics of WS or WB and how they can be incorporated to a more robust return to play protocol. If the Athlete has been attending a Concussion Clinic, the attending Athletic Therapist or Sports Physiotherapist may release the athlete to start the Return to Play protocol but only the Family Physician or Sports Medicine Doctor may give the final return to competition. (A list of Sports Medicine Physicians in Ontario is in Appendix 7.) If no such professional is available in your area, the coaches or technical staff may supervise these exercises. It is imperative that athletes be truthful in how their body reacts to this elevated level of physical activity. Returning to activity with symptoms present should be understood as a potentially dangerous and even life threatening event should another incident occur before all symptoms have gone away. 1. To start any return to play protocol, first and foremost, all concussion symptoms must be absent for a minimum of 24 hours. Athletes should be able to run for minutes at a comfortable pace without the return of any symptoms. 2. Having passed the first benchmark of Moderate Aerobic Activity, and having the availability of a Concussion Clinic specialist, a treadmill test which will increase exercising heart rate to a level of 70-75% training heart rate using the equation of 220- age x 70 or 75% will be the target heart rate. Once that Heart rate is achieved, exercising at that level for 5 minutes should be maintained. Continuous monitoring of any sign or symptom should be recorded and noted. If the athlete passes this test he/she may continue to the muscular training portion of the protocol. 3. Due to the nature of Waterskiing and Wakeboarding, athletes should be able to do 5-10 minutes of continuous weight training exercises that emphasize upper body strength and endurance.

12 4. Suggested exercises would be: I Bicep curls-dumbbell or barbell II Military Press III Triceps Kickback IV Static or Motion Planks V Pushups VI Sit ups or Exercise ball sit ups VII Walking Lunges VIII Star Jumps IX High knee side to side hops X Static rope hold in 90 degree sit position for 2 minutes 5. Ideally these exercises should be monitored by Athletic Therapists or Sport Physiotherapists in a clinical setting. 6. Specific to Waterskiing and Wakeboarding. Day 1 it is suggested that first session back in water be limited to simple towing activity with no tricks. 5-6 runs of simple slalom activity with no sharp cutting. May use some hard swimming to test cardiovascular fitness and head response to increased physical activity. (Note: If there has been an extended length of time to recover, day 1 may be just riding in the boat with Day 2 starting in water sessions.) Day 2 More runs 6-10 harder cutting slalom or simple air tricks Wakeboarding with no inversions tricks. Day 3 Full course practice sessions with various tow rope lengths or full WB tricks with Inversions. If no return of symptoms after three days of in water training, final sign off from Family Physician on return to Competition.

13 Appendix 1 Tool to Identify a Suspected Concussion This sample tool on the following page is a quick reference, to be completed by coaches/instructors/parents, to help identify a suspected concussion and to communicate this information to parent/guardian. Identification of Suspected Concussion Following a blow to the head, face or neck, or a blow to the body that transmits a force to the head, a concussion must be suspected in the presence of any one or more of the signs or symptoms outlined in the chart below and/or the failure of the Quick Memory Function Assessment. When an incident occurs, first, assess the danger to the student and the rescuer, and then check airway, breathing and circulation. Next observe for signs and symptoms of a concussion. See the following page for a check list of symptoms. If no signs or symptoms described below were noted at the time. Note: Continued monitoring of the person is important as signs and symptoms of a concussion may appear hours or days later (refer to #4 below).

14 An incident occurred involving (athlete s name) on (date).

15 1. Perform Quick Memory Function Assessment Ask the student the following questions, recording the answers below. Failure to answer any one of these questions correctly may indicate a concussion: What room are we in right now? Answer What activity/sport/game are we playing now? Answer: What field are we playing on today? Answer: What part of the day is it? Answer: What is the name of your teacher/coach? Answer: What school do you go to? Answer: *Questions may need to be modified for very young students and/or students receiving special education programs and services. 2. Action to be Taken If there are any signs observed or symptoms reported, or if the student fails to answer any of the above questions correctly: a concussion should be suspected; the student must be immediately removed from play and must not be allowed to return to play that day even if the student states that he/she is feeling better; and the student must not leave the premises without parent/guardian (or emergency contact) supervision. In all cases of a suspected concussion, the student must be examined by a medical doctor or nurse practitioner for diagnosis and must follow Appendix C-1 - Concussion Protocol: Prevention, Identification and Management Procedures. 3. Continued Monitoring by Parent/Guardian (and where appropriate, School Staff) Students should be monitored for hours following the incident as signs and symptoms can appear immediately after the injury or may take hours or days to emerge. If any signs or symptoms emerge, the student needs to be examined by a medical doctor or nurse practitioner as soon as possible that day. 5. Coach/AT/PT name: Coach/AT/PT signature (optional): Date: This completed form must be copied, with the original filed as per WSWB policy and the copy provided to parent/guardian. (Adapted from McCroy et. al, Consensus Statement on Concussion in Sport. Br J Sports Med 47 (5), 2013)

16 Appendix 3 WSWC Incident Report (on WSWC website) Appendix 2

19 Appendix 3 Return to Learn This form is to be used by parents/guardians to communicate their child s/ward s progress through the plan and is to be used with Appendix 6 Concussion Protocol: Prevention, Identification and Management Procedures. Step 1 Return to Learn/Return to Physical Activity Completed at home. Cognitive Rest includes limiting activities that require concentration and attention (e.g., reading, texting, television, computer, video/electronic games) The first 48 hours are key for complete cognitive rest. Physical Rest includes restricting recreational/leisure and competitive physical activities. physical rest at home) and his/her symptoms have shown improvement. My child/ward will proceed to Step 2a Return to Learn. 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: Step 2a Return to Learn 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. d 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: Step 2b Return to Learn Student returns to regular learning activities at school. Step 2c Return to Physical Activity Student can participate in individual light aerobic physical activity only. Student continues with regular learning activities. 3 Return to Physical Activity. Parent/Guardian signature: Date:

20 Step 3 Return to Physical Activity Student may begin individual sport-specific physical activity only. Step 4 Return to Physical Activity Student may begin activities where there is no body contact (e.g., dance, badminton); light resistance/weight training; non-contact practice; and non-contact sport-specific drills. 4 will be returned to parent/guardian to obtain medical doctor/athletic Therapist/Sport Physiotherapist/Nurse Practitioner diagnosis and signature. Teacher/coach signature: Medical Examination 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/Athletic Therapist/Sports Physiotherapist/Nurse Practitioner Signature: Date:

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

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