Bettendorf Community School District (BCSD) Concussion Guideline

Transcription

1 Bettendrf Cmmunity Schl District (BCSD) Cncussin Guideline Fr the purpses f this guideline, the term athlete is defined as a Bettendrf Cmmunity Schl District (BCSD) student participating in extracurricular activities in which an annual pre participatin physical is required. This guideline is in place t prtect the safety f athletes wh have sustained a sprt related cncussin r mild traumatic brain injury (MTBI) in a BCSD spnsred extracurricular activity. N guideline can guarantee against future incidents. Hwever, this guideline is designed t return cncussed athletes t cmpetitive sprts in a manner that will reduce the likelihd f secndary injuries such as Pst-Cncussin Syndrme and/r Secnd Impact Syndrme. The guideline utlined belw ensures that there is adequate time and activity mdificatin necessary t allw the brain t heal befre a secndary injury can ccur. Definitin f Cncussin: Sprt Related Cncussin (SRC) is defined as a traumatic brain injury caused by bimechanical frces. Cmmn features used in clinically defining a cncussive injury include: 1. Cncussin may be caused either by a direct blw t the head, face, neck r elsewhere n the bdy with an impulsive frce transmitted t the head. 2. Cncussin typically results in the rapid nset f shrt-lived impairment f neurlgical functin that reslves spntaneusly. Hwever, in sme cases, symptms and signs may evlve ver a number f minutes t hurs. 3. Cncussin may result in neurpathlgical changes, but the acute clinical symptms largely reflect a functinal disturbance rather than a structural injury and, as such, n abnrmality is seen n standard structural neurimaging studies. 4. Cncussin results in a graded set f clinical symptms that may r may nt invlve lss f cnsciusness. Reslutin f the clinical and cgnitive symptms typically fllws a sequential curse. Hwever, it is imprtant t nte that in sme cases symptms may be prlnged. 5. Clinical signs and symptms f sprt related cncussin cannt be explained by pre-existing injuries such as, cervical pathlgy r vestibular impairment etc, drug, alchl, r medicatin use, r cmrbidities (such as psychlgical cnditins r existing medical cnditins) The preceding definitin is frm the Cnsensus Statement n Cncussin in Sprt 5th Internatinal Cnference n Cncussin in Sprt Held in Berlin, Octber Additinal Cncussin Infrmatin: Secnd Impact Syndrme (SIS) is als a very real cncern and can be ptentially catastrphic. Accrding t the Center fr Disease Cntrl and Preventin (CDC) a repeat cncussin that ccurs befre the brain recvers frm the first, usually with a shrt perid f time (hurs, days, r weeks), can slw recvery r increase the likelihd f having lng term prblems. In rare case, repeat cncussins can result in brain swelling, permanent brain damage, and even death. The CDC refers t this mre serius cnditin as Secnd Impact Syndrme. SIS in shrt is suffering a secnd MTBI r cncussin while the brain is recvering frm an initial MTBI r cncussin and thus ptentially leading t a higher level f brain damage and catastrphic cnsequences. SIS is believed t have been the cause f apprximately deaths ver the last decade. The risk f SIS is real, and fllwing a gradual return t play prtcl r guideline after sustaining a MTBI r cncussin can greatly reduce the chances f this ptentially life threating cnditin. In additin, with every MTBI r cncussin there is a risk f develping Pst-Cncussin Syndrme (PCS). Accrding t the May Clinic, PCS is a cmplex disrder in which a cmbinatin f pst-cncussin symptms may last fr weeks and smetimes mnths after the injury that caused the initial cncussin. Symptms f PCS may include but are nt limited t chrnic headaches, fatigue, sleep difficulties, persnality change, increased irritability, increased emtinal feelings, sensitivity t light and nise, dizziness, and deficits in shrt-term memry and general academic functining. PCS can be very disabling fr an athlete, and may be permanent in sme cases. The majrity f athletes wh experience MTBI r cncussin are likely t recver fully withut experiencing lng term detrimental effects f MTBI r cncussin. Chrnic Traumatic Encephalpathy (CTE) is a prgressive degenerative disease f the brain fund in individuals with a histry f repetitive brain trauma, including symptmatic cncussins as well as asymptmatic sub-cncussive hits t the head. Several retired prfessinal athletes have been diagnsed pstmrtem with CTE. Recent reprts have been published f neurpathlgically cnfirmed CTE in retired prfessinal ftball players and ther athletes wh have a histry f repetitive brain trauma. This trauma triggers prgressive degeneratin f the brain tissue, including the build-up f an abnrmal prtein called tau. These changes in the brain can begin mnths, years, r even decades after the last brain trauma r end f active athletic invlvement. The brain degeneratin is assciated with memry lss, cnfusin, impaired judgment, impulse cntrl prblems, aggressin, depressin, and, eventually, prgressive dementia.. As serius as CTE is, it has als been reprted that many frmer athletes shw n symptms f CTE r any ther neurlgical disrder and have sustained the same number f sub-cncussive hits t the head. The bttm line is CTE is real and can happen, but ne never knws until much later in life due t the nature f CTE s lengthy prgressin in the brain. Cncussin signs and symptms: Signs Dazed and cnfused appearance ( In a fg ) Slw, labred, r clumsy mvement Slw t respnd, prcess thughts, frmulate wrds Behavir/persnality changes (irritable, nervus, sad) Difficulty cncentrating Memry prblems Glassy eyes Symptms Headache Nausea/ Vmiting Dizziness r balance issues Blurry visin Sensitivity t light r sund Feeling sluggish r tired (fggy) Sleeping pattern changes (mre/less r difficulty sleeping) 1

2 BCSD Cncussin Guideline An athlete with signs and symptms f a cncussin, r an athlete believed t have sustained a MTBI, will be remved frm play as sn as pssible until evaluated and cleared by a qualified health care prfessinal specifically trained in cncussin evaluatin and management. The BCSD emplys Certified Athletic Trainers (ATCs), qualified in cncussin recgnitin, management, and treatment. The ATCs wrk under the BCSD Team Physician(s). If parents/guardians chse t take their student athlete fr evaluatin t ther health care prfessinals utside f the schl setting, it is encuraged that thse health care prfessinals evaluating and treating cncussins be qualified and trained in the area f cncussin and MTBI management. The ATCs and BCSD physicians maintain the right t determine return t play prgressin fr each athlete. All athletes with suspected cncussins will be remved frm cmpetitin/practice. They then will be evaluated by the ATCs r BCSD Team Physician and if determined t have cncussin the parents will be ntified. If thse health care prfessinals are nt available, the supervising cach r administratr will call the parents/guardians. It is suggested that the parents then take their sn/daughter t a family physician fr evaluatin r t the emergency rm if symptms are present. If anther medical prfessinal such as a MD/DO perfrm an evaluatin and prvide treatment, the athlete shuld bring dcumentatin f the diagnsis and recmmendatins t the ATCs. The qualified health care prviders rders will be reviewed and fllwed unless the BCSD Team Physician r the ATCs feel the athlete needs further evaluatin and screening r a mre cnservative apprach t the injury. The BCSD Medical Staff will act in the best interest f the athlete and the schl district. The District BCSD uses the Immediate Pst-Cncussin Assessment and Cgnitive Testing (ImPACT) sftware. ImPACT is a cncussin evaluatin tl that has been used by NCAA Divisin I schls and ther prfessinal sprts. Athletes will take a baseline test n ImPACT. The results f the baseline test are stred within the sftware. In the event f a suspected r diagnsed cncussin, the athlete will be given a pst-injury test. Scres will be evaluated by the BCSD Medical Team and cmpared t baseline results. This test acts as a tl fr the BCSD Team Physician and ATCs t use as a guide t safe return t play (RTP). ImPACT Tests will nt be the sle determining factr fr RTP decisins. All Bettendrf High Schl athletes participating in Ftball, Vlleyball, Basketball, Sccer Players, Wrestlers, and Cheerleading/Dance will be given the pprtunity t take the ImPACT Test. The BCSD als utilizes the King-Devick Test. The King-Devick is recgnized by many tp NCAA schls and the May Clinic as a reliable and quick tl t bjectively determine whether players shuld be remved frm play fr further cncussin evaluatin. This test will primarily be used in ftball, but may als be used in ther cntact sprts listed abve. This test requires baseline testing f the athletes prir t use n the field. The King-Devick test will nt be the sle determining factr fr the need fr cncussin evaluatin r remval frm play. If the athlete is deemed t have suffered a cncussin, the athlete will nt be allwed t return t participatin until cleared by the ATCs, BCSD Team Physician, r ther qualified health care prfessinal. The athlete must fllw the return t play (RTP) steps and prcedure as appears in this guideline. N student-athlete will be allwed t return t play withut fllwing the RTP steps and prcedure. Fllwing a cncussin, the athlete will be mnitred daily fr symptm checks by the athletic trainer r schl nurse. When the athlete demnstrates symptm reslutin, and a full return t academic schl and class wrk, a pst injury ImPACT test will be administered. The results will be cmpared t the athlete s riginal baseline scres. These scres will be evaluated by the athletic trainers. If there is n baseline test available fr cmparisn, the scres will be cmpared using a natinal data base standard and the students GPA. If a parent wuld like the scres made available t them t take t their family physician they can make a verbal r written request t the athletic trainer r athletic department. The BCSD Team Physician and the ATCs (wrking directly under BCSD Team Physician) will have ultimate return t play authrity. The BCSD Team Physician and the ATCs will take int cnsideratin all ther health care prviders qualificatins and directins and will make a determinatin as t the athletes return t play status. The BCSD Team Physician and the ATCs may agree t fllw ther health care prviders scripts r chse t verrule thse prviders if believed t be in the best interest f the schl district and athlete. The BCSD Medical Staff will nt verrule a restrictive nte unless the parents/guardians request a secnd pinin frm the BCSD Team Physician and will then fllw the BCSD Team Physician s findings and directin. The ATCs will nt verrule a cnservative r mre cautius nte in any circumstance. 2

3 Detailed Return t Play (RTP) Guideline Bettendrf High Schl and BCSD utilizes a return t play guideline fr safely reintegrating athletes t sprt and physical activity after cncussin. The return t play steps cnsists f 6 days f prgressive and mnitred physical activity. The athlete will start the prcess nce they are symptm free. The athlete will mve frm step t step until cmpletin f the guideline befre full return t play (RTP). If each step is passed withut symptm recurrence, an athlete culd ptentially return t full game participatin in 6 Days (See Table-1). Hwever, this is the best case scenari and is ften nt the case when dealing with cncussin and MTBI. If symptms resurface within any step/day during the RTP guideline, the athlete will repeat the previus day s physical activity requirements nce they are symptm free. BCSD persnnel, Team Physician, r the ATCs will try t cmmunicate as much as pssible with parents and ther physicians wh may have seen the athlete thrughut the RTP prcess. It is imprtant t nte that a Step des nt dente a day/24 hur perid as Steps culd take weeks and sme instances allw fr multiple Steps in the same day. Prgressin past Step 1 nly ccurs when an athlete is asymptmatic (reprts and shws n signs r symptms f cncussin r Pst-Cncussin Syndrme). An athlete will nt advance r prceed in the prcess with signs and symptms f cncussin. The athlete must als be fully engaged in all nrmal academic curse wrk as prir t the injury. If symptms ccur r persist anytime in the guideline the athlete may be referred back t BCSD Team Physician r family physician. If this ccurs the athlete will nt prgress any further in the RTP prcess. Step One An athlete culd remain in Step One as lng as symptms remain. If an athlete has an increasing number f cncussin signs r wrsening symptms the athlete may be referred back t a physician r t a specialist. If an athlete s symptms remain unchanged fr mre than 7 days, the athlete may als be referred back t a physician r specialist at that time. Athlete is initially evaluated by ATCs r BCSD Team Physician r qualified health care prfessinals and determined t have a cncussin r MTBI. If evaluated by a qualified health care prfessinal nt emplyed by the BCSD, dcumentatin and any ntatin frm that prvider shuld be shared with the BCSD medical staff. It is imprtant t understand that n matter what health care prvider evaluates the athlete they must still fllw the BCSD RTP Guideline written within this dcument unless agreed upn by the BCSD Team Physician. Once a cncussin has been determined by the ATCs r the BCSD Team Physician, the athlete will be remved frm all physical activity and mental exertin. The ATCs r the BCSD Team Physician may recmmend time ff frm schl t allw the brain t heal; this culd mean the absence f schl and classrm activities. The athlete will, at this pint, enter the BCSD Return t Learn Guideline. The ATCs will cmmunicate with parents/guardians, schl administratin, schl nurse, and teachers t reprt the athlete s cnditin and cgnitive abilities if necessary. Once the athlete is asymptmatic fr 24 hurs they will prgress t Step Tw and back in schl full time withut restrictin. The BCSD Team Physician and ATCs will err n the side f cautin if the 24 hur perid is in questin. The ATCs and BCSD Team Physician maintain the right t delay prgressin t Step 2 f this guideline. The 24 hur perid begins when the athlete ntes they are asymptmatic. If an athlete ges t bed with symptms and wakes the next mrning withut symptms, the 24 hur perid starts at the time when the athlete wakes withut symptms. Athletes will be asked t reprt symptm severity t the ATC, r Schl Nurse, by cmpleting an nline r paper Cncussin Symptm Checklist three times a day. 3

4 Step Tw Athlete may take a pst-injury ImPACT Test nce they have been asymptmatic fr a minimal f 24 hurs. The athlete must be asymptmatic prir t starting the pst-injury test. The King Devick test may als be used t determine the readiness t return t physical activity as an additinal pst-injury testing tl. If the Pst Injury ImPACT Test results are cmparatively equal t baseline scres and the athlete remains asymptmatic the ATCs r BCSD Team Physician will determine whether t prgress the athlete t gradual physical activity and the RTP guideline. If the athlete s scres are nt cmparatively equal r symptms increase during testing, the ATCs r the BCSD Team Physician will make a determinatin as hw t prgress the athlete. This may include anther day f rest, r 24 hur asymptmatic perid, befre prceeding t Step 3. The BCSD Medical Team maintains the right t determine whether r nt t prgress an athlete frm ne step t anther. The BCSD Medical Team will act in the best interest f the athlete and the district t prgress the athlete even if the athlete claims t be asymptmatic and/r their scre are cmparatively equal. This may ccur mre frequently in thse individuals with a cncussin histry r ther mental r cgnitive cnditins that may delay healing. Previus cncussin histry, ImPACT scres, medical evaluatin results, current medicatins the athlete may be using, and ther cgnitive r physical cmplicatins will be cnsidered in making the decisin t prgress the athlete in the RTP prcess. ImPACT scres are nt the sle determining factr in RTP prgressin. At any time the athlete exhibits the same symptm level r lingering symptms that prevent cmparatively equal scres n ImPACT r King Devick Test, that athlete may be referred back t the BCSD Team Physician r MD/DO f the parents/guardian chsing. At this time the BCSD Team Physician and/r BCSD Certified Athletic Trainers will make a determinatin hw t prgress the athlete. The athlete may prgress frm Step Tw t day ne f Step Three in the same day if they are asymptmatic and have cmparatively equal ImPACT scres. THIS IS THE ONLY SENARIO IN WHICH MULTIPLE STEPS CAN BE COMPLETED IN A PERIOD OF LESS THAN 24 HOURS. Step Three Athlete is ready fr mnitred gradual return t physical activity. An athlete will nt be permitted t pass multiple physical activity steps/days within a single 24 hur perid. If symptms resurface at any time during the prgressin, the athlete will autmatically step dwn t the previusly passed day f physical activity. They must asymptmatic fr apprximately 24 hurs prir t attempting the previus day s physical activity requirements r mental tests. Physician cnsultatin may als ccur if symptms present after any physical activity within the return t play guideline. Physical Activity Prgressin (By Days) Day 1 Light cardivascular exercise n statinary equipment - Heart rate t stay belw 70% f max heart rate. (If n symptms ccur within apprximately 24 hurs, the athlete may prgress t Day 2) Day 2 - High intensity cardivascular using a nn-statinary means, such as running r swimming. These activities may r may nt be specific t their sprt (If n symptms ccur within apprximately 24 hurs r, the athlete may prgress t Day 3) Day 3 Strenuus cardivascular wrkut which may be specific t psitin in sprt. If cntact Sprts, n cntact drills will be allwed but may participate in nn-cntact drills and resistance training. (If n symptms ccur within apprximately 24 hurs, the athlete may prgress t Day 4) Day 4 Return t nrmal practice. Full cntact allwed with n restrictins. Athlete is nt released fr game r cmpetitin play. The head cach and ATC will determine what cnditins must be present fr a practice t be cnsidered a full cntact unlimited practice. 4

5 Step Fur In this step the athlete will underg a final evaluatin and screening and be returned t full participatin withut restrictins. This may include a final ImPACT test. The athlete must cmplete a full cntact unlimited practice prir t being released t participate in any game r cmpetitin. Day 5 Full and Unlimited participatin in Games and Matches. Example - 1: Athlete cmpletes a STEP 3 - Day 2 wrkut and fllwing experiences increase symptms, the athlete will first wait until they are asymptmatic and then have t perfrm the Day 1 test again t prgress t Day 2. On the day f the repeated Day 1 test the athlete must be asymptmatic frm early mrning wake-up t time f test the same day. This means the athlete culd nt wake up the next day with a headache (symptms) and then prceed t try the repeated Day 1 cardivascular exercise in the afternn when the headache subsides. Physicians may be cnsulted if this ccurs. REFRENCES 1. McCrry, P., Meeuwisse, W., Dvrak, J., Aubry, M., Bailes, J., Brgli, S.,... & Davis, G. A. (2017). Cnsensus statement n cncussin in sprt the 5th internatinal cnference n cncussin in sprt held in Berlin, Octber Br J Sprts Med, bjsprts-2017.brgli, S. P., Cantu, R. C., Giia, G. A., Guskiewicz, K. M., Kutcher, J., Palm, M., & McLed, T. C. V. (2014). Natinal Athletic Trainers Assciatin Psitin Statement: Management f Sprt Cncussin. Jurnal f Athletic Training, 49(2), Brgli, S. P., Cantu, R. C., Giia, G. A., Guskiewicz, K. M., Kutcher, J., Palm, M., & McLed, T. C. V. (2014). Natinal Athletic Trainers Assciatin Psitin Statement: Management f Sprt Cncussin. Jurnal f Athletic Training, 49(2),

6 Summatin f Return t Play Guideline The fllwing infrmatin and chart represents the best case scenari after a MTBI r cncussin injury fr return t play status. Athletes must be asymptmatic t prgress past Day 1 (Step 1), and must cntinue t be asymptmatic thrughut the prgressin t Full Release. If an Athlete experiences symptms f cncussin at any time they will nt be allwed t prgress t the next step. If an athlete experiences symptms during Day 2 5, they will mve back 1 day and must remain asymptmatic fr apprximately 24 hurs fllwing cmpletin f the physical activity prir t mving frward again. At any time symptms may dictate an athlete t be mved back mre than ne day in the prgressin t ensure athlete safety. A referral back t a physician r specialist may als be necessary. In additin, the BCSD Team Physician r BCSD ATCs maintains the right t halt prgressin if it is determined t be in the best interest f the student athlete r BCSD. Table - 1 Pst-Cncussin Summatin f RTP Guideline BEST CASE SCENARIO Day 0 Cncussin Occurred Day 1 Pssible ImPACT Test Rest - N Physical r Mental Activity Day 2 ATHLETE IS ASYMPTOMATIC ImPACT Test Light Statinary Cardivascular Exercise <70% Day 3 Mvement Based Cardivascular Exercise Day 4 High Intensity Sprt Specific Drills (NO CONTACT) Day 5 Full Practice and Cntact Activities (NO GAMES) Day 6 Full Release All Activities GAME PLAY Mnday Tuesday Wednesday Thursday Friday Saturday Sunday Tuesday Wednesday Thursday Friday Saturday Sunday Mnday Wednesday Thursday Friday Saturday Sunday Mnday Tuesday Thursday Friday Saturday Sunday Mnday Tuesday Wednesday Friday Saturday Sunday Mnday Tuesday Wednesday Thursday Saturday Sunday Mnday Tuesday Wednesday Thursday Friday Sunday Mnday Tuesday Wednesday Thursday Friday Saturday STEP 1 -Preseasn ImPACT Testing Day 0 -Athlete Sustains, r is Diagnsed with Cncussin (Evaluatin by ATC r MD if Pssible) -Athlete Remved Frm Participatin Day 1 -Athlete Evaluated (Re-Evaluated) -Pssible Pst Injury ImPACT Test -Rest frm Mental/Physical activity STEP 2 Day 2 -Only if Athlete Asymptmatic (Remain at Day 1 Until Asymptmatic) -If Asymptmatic Pst Injury ImPACT Test STEP 3 Day 2 Cntinued -If Passed Pst Injury ImPACT Test Light Statinary Cardivascular Exercise <70% Max -If N Pass Re-Evaluate Factrs. Pssible N Exercise r Stay at Step 1 Day 3 -If Asymptmatic Higher Intensity Cardivascular Exercise with Mvement -If symptmatic Re-Evaluate and Return t Day 2 Day 4 -If Asymptmatic Prgress t Increase Intensity Sprt Specific Training (NO CONTACT) -If symptmatic Re-Evaluate and Return t Day 3 Day 5 -If Asymptmatic Full Cntact Practice (NO GAMES) -If symptmatic Re-Evaluate and Return t Day 4 STEP 4 Day 6 -If Asymptmatic FULL RELEASE NO RESTRICTIONS -If symptmatic Re-Evaluate and Return t Day 5 6