Responsibilities of the Parties Involved

Transcription

1 Jacksonville State University Concussion Management Guidelines (Revised 04/10/17) Responsibilities of the Parties Involved Athletes Jacksonville State University (JSU) student-athletes will be required to review these guidelines on concussion management. They will be educated by sports medicine staff about the signs and symptoms of concussion and about management and return-to-play decision-making. Student-athletes will attest that they will honestly and reliably report symptoms related to any head injury or suspected concussion to the sports medicine staff (athletic trainers, team physicians, consultants), whether their own or affecting teammates. All student-athletes are required to sign a concussion fact sheet on a yearly basis. Each student-athlete will receive at least one pre-participation baseline concussion assessment that includes brain injury and concussion history, symptom evaluation, cognitive assessment, balance evaluation which are all included in their preseason Immediate Post-Concussion Assessment and Cognitive Testing (IMPACT) and Balance Error Scoring System (BESS) baseline test. Student-athletes with a documented concussion, multiple concussion history, and those participating in contact/collision sports will be given a new baseline concussion assessment on a yearly basis. JSU studentathletes will avoid engaging in practice or play that increases the risk of head or neck injury, such as avoiding flagrant contact to head and neck, use appropriate protective equipment and abide by the customary rules of their sport. Coaches Educational resources will be made available to coaching staff on the signs and symptoms of concussion and about management and return-to-play decision-making. All members of the coaching staff shall sign and acknowledge that they have reviewed this concussion management document and will agree to appropriately refer symptomatic athletes for medical evaluation. Coaches will not return athletes to play if they exhibit any signs or symptoms of possible concussion without medical evaluation by the sports medicine staff. Athletic Trainers JSU athletic trainers and/or team physician(s) will perform sideline and training room evaluations of athletes displaying any signs of concussion. If the student-athlete is diagnosed with a concussion they will be withheld from competition and practice and not return to activity for the remainder of that day (NCAA Executive Committee Policy April 2010). Athlete safety will be of the highest priority. They will oversee computer-based Impact Baseline Neurocognitive Testing, BESS testing and in follow-up. The athletic trainers will perform serial assessments on concussed athletes and supervise the athlete with return-to-play activity progression. Management plans will be discussed with the athlete and the team physician(s). A JSU certified athletic trainer will be present and available at all NCAA varsity competitions in the following contact/collision sports: basketball, football, and soccer. To be present means to be on site at the campus or arena of the competition. To be available means that a minimum, medical personnel can be contacted at any time during the practice via telephone, messaging, , beeper or other immediate communication means. Further, the case can be discussed through such communication, and immediate arrangements can be made for the athlete to be evaluated.

2 Team Physicians Team physicians will perform athletic training room and/or office evaluations of student-athletes displaying any signs of concussion in collaboration with the athletic trainers and will provide onsite event care when available. Student-athlete safety will be of the highest priority. Balance Error Scoring System (BESS), standardized assessments (SCAT3) and appropriate neurocognitive testing (ImPACT) will be administered and reviewed by the team physicians and physical examinations will be conducted in a serial fashion. Management plans will be discussed with the athlete, the sports medicine staff, and with the Head Team Physician on an as needed basis. Clinical features of concussion A student-athlete sustaining a concussion may complain of a variety of different symptoms or may display unusual physical signs, behavioral changes or cognitive impairments. When in doubt, it is in the best interest of the athlete to assume a concussion, remove the athlete from participation and seek immediate medical evaluation by sports medicine staff before returning to play. A concussion is a significant brain injury and one that can have a significant impact on the health and well-being of student athletes. Delay in diagnosis and management can be associated with persistent deficits and psychosocial consequences. The Sports Medicine Staff is trained to evaluate and manage this important injury. Any student-athlete with signs/symptoms/behaviors consistent with concussion: must be removed from practice or competition, must be evaluated by an athletic trainer or team physician with concussion experience, and must be removed from practice/play for that calendar day if concussion is confirmed. JSU Department of Athletics is following the recommendations of the NCAA by providing education and improving the management of concussion injuries by stressing to players and coaches the importance of reporting concussion signs and symptoms. Concussions may cause long-term cognitive deficits and may even cause death if a second impact occurs before an initial brain injury has resolved. The student-athlete may not exhibit signs and symptoms of a concussion immediately. This concussion management protocol is designed to serve as a tool in the process of implementing or operating a concussion management protocol. Definition- Concussion As defined by the consensus statement from Zurich in 2012: Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. It is caused by either a direct blow to the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head. It results in rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, symptoms and signs may evolve over a number of minutes to hours. Neuropathological changes and the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury, and as such, no abnormality is seen on standard imaging. This results in graded onset of clinical symptoms. Resolution of the clinical and cognitive symptoms typically follows a sequential course. Signs and Symptoms of a Concussion include, but are not limited to: Headache or Dizziness Sensitivity to light

3 Fatigue or Drowsiness Sleep Disturbances Slow reaction time Nausea and/or vomiting Concentration problems Feeling Foggy, Dazed or Confused Sensitivity to light Blurred Vision Ringing in the ears Memory Loss Emotional Changes Sensitivity to sound The following educational activities will occur within the department: Student athletes will receive in their annual preseason compliance meeting, a presentation by a certified athletic trainer and a handout concerning the signs and symptoms of a concussion. The student athletes will be charged in that meeting to report any signs and symptoms of any injury or illness to the athletic medical staff. Coaches will receive in their annual CPR/AED/First Aid Training, a presentation by a certified athletic trainer and a handout concerning the signs and symptoms of a concussion. The student athletes will be charged in that meeting to report any signs and symptoms of any injury or illness to the athletic medical staff. All certified athletic trainers on staff will review this plan annually. Concussion related educational materials listing sign and symptoms will be posted in athletic training facilities on campus. Pre-Injury Baseline Athlete Assessments The Sports Medicine department will conduct pre-injury baseline assessments on all studentathletes. These assessments will be done before the student-athlete s first practice upon entering the intercollegiate athletic program. Subsequent testing will be performed as warranted. The testing assessment used will be an NCAA recommended system. Concussion Action Plan 1. Emergency Action Plan for all venues including concussion plan. 2. Coaching education regarding EAP and concussion plan. 3. Education of student-athletes regarding concussion, including signs and symptoms, prevention, and high risk sport activities at first of year meeting. 4. Pre-participation physical examinations performed for all entering student-athletes. 5. Signed student-athlete agreement regarding reporting of all injuries and illness, including signs and symptoms, prevention, and high risk sport activities at first year meeting. 6. ATC s available for practices and games, physician on-site/available for home events. 7. Documentation of baseline testing (e.g. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)), initial injury evaluation (SCAT3 and BESS) as well as daily symptom scoring Documentation (ATC and Team Physician) of initial and

4 subsequent evaluations, change in status regarding activities and final clearance to return to play and learn. Pre-Participation Exam: 1. Includes questions regarding modifiers: prior concussion history, learning disabilities requiring stimulant medications, migraines, seizure history. 2. Team Physician clinical evaluation addressing concussion history, symptom history, cognitive assessment, balance, and/ or other needed consultation or testing. 3. All at-risk sport athletes (Women s Soccer, Men s and Women s Basketball, Baseball, Softball, Volleyball, and Football) shall undergo pre-season baseline computer-based neurocognitive testing (ImPACT) and Balance Error Scoring System testing (BESS) in the training room as well as any athlete with a history of concussion. 4. Testing will also be available to any other athlete who wishes to have a baseline test. 5. Athletes with a history of concussion may undergo additional baseline screening questions, balance and/or physical exam testing at the discretion of the team Sideline Evaluation: 1. When an athlete has signs/symptoms of concussion, they must be removed from play and not allowed to return to play until evaluated by an athletic trainer or team physician with concussion experience. 2. An athlete with diminished or worsening symptoms, loss of consciousness, spectated spine injury, neurological deficits suggesting intracranial trauma, increased confusion, garbled speech, lethargy or extreme sleepiness, trouble using their arms or legs, neck pain, convulsions or seizure activity should be transported emergently by ambulance to the emergency room. Any athlete with neck pain should be treated as if a cervical spine injury is present, and the emergency procedures (cervical spine immobilization, emergency room transfer) initiated. Any athlete with a suspected skull fracture or intracranial hemorrhage should be treated as a 911 emergency and initiate emergency action plan. 3. If no ATC or Team Physician is available, and the student-athlete is having symptoms, contact the primary athletic trainer for the sport of the student-athlete to determine a plan for evaluation of the student-athlete. If they are unable to contact the JSU Sports Medicine staff, contact the Asst. AD for Sports Medicine at If ATC is on site and student-athlete is stable medically, then Sports Concussion Assessment Tool (SCAT3) will be used for evaluation of injured athletes. 5. If ATC and/or team physician on primary assessment determine the student-athlete has been concussed, the athlete cannot return to play or classroom activities that calendar day. The student-athlete and a responsible adult (parent or roommate) will be given oral and written instructions for care to be given between the time the student-athlete leaves the athletic training room and their return for re-evaluation. The oral and written instruction will address care and monitoring until the follow-up evaluation. Physician Evaluation 1. Timely referrals to team physicians will be facilitated by the athletic trainer(s) involved with the athlete. 2. Evaluations will consist of history and physical examination as well as any neurocognitive testing, imaging, balance testing or other testing deemed necessary. 3. Symptomatic athletes will not be returned to play or physical exertion.

5 4. Cognitive rest and academic modifications will be considered on a case-by-case basis. 5. The designated team athletic trainer and a team physician will perform serial reevaluations of the concussed student-athlete and document symptoms and findings per the usual JSU sports medicine protocols. o Additional diagnoses may include, but are not limited to: Post-concussion syndrome Sleep dysfunction Migraine or other headache disorders Mood disorders such as anxiety and depression Ocular or vestibular dysfunction 6. Follow-up neurocognitive testing will be performed at the discretion of the team physician and athletic trainer and data will be reviewed with the student-athlete and athletic trainer. 7. The management plan will be discussed amongst the athlete, athletic trainer and team physician throughout and will factor in data from the athlete s personal history, symptom score, physical findings and neurocognitive testing performance. Return to Learn Per NCAA mandate for concussion management, the following process will be utilized by the Department of Sports Medicine for returning student-athletes who have suffered a concussion to classroom and academic activities. It is important to note that each student-athlete and their particular injury case will be handled on an individual basis. As a general rule, the student-athlete will be integrated back into the academic aspect of their collegiate experience prior to returning to athletic participation. Instances in which a studentathlete might return to participation in athletics prior to physically returning to the classroom might include situations where the student-athlete becomes asymptomatic and completes the athletic return-to-play criteria during the weekend or during university holidays and breaks. The following guidelines will dictate student-athlete return to classroom and academic activities: 1. The certified athletic trainer responsible for the team in which the student-athlete participates, will be the primary contact for the student-athlete and the liaison between the academic staff member responsible for the team and the student-athlete in regards to returning to classroom activities. 2. The student-athlete will not be expected to attend classes or complete course assignments (i.e. online classes, group projects, homework, library, study hall, tutoring, etc.) while he/she is experiencing symptoms of concussion as measured using the SCAT3. The student-athlete should be excused from classroom activities on the same day as the concussion, at a minimum. 3. When the student-athlete is symptom free for a minimum of 24 hours, the student-athlete may return to class, but will be provided accommodations in regards to completing exams, quizzes, and assignments. The student-athlete will be expected to communicate with their course instructors in regards to gathering missed information and making up missed assignments, quizzes and exams. Accommodations must be in accordance with university regulations and in compliance with the Americans with Disabilities Act/Affirmative Action.

6 4. When the student-athlete completes and passes the ImPACT computerized neurocognitive test as determined by the team physician, the student-athlete may resume all normal course activities including making up exams, quizzes and assignments. Should the student-athlete regress and begin having symptoms again, the student-athlete will be removed from class activities and begin the return-to-learn process anew. The student-athlete will be referred for re-evaluation by team physician. 5. Course instructors for the student-athlete will be notified at the time of injury that the student-athlete will be missing classes as a result of the concussion. This notification will be relayed via campus mail or to the instructor from the Academic Advisor and will include documentation signed by the treating physician or supervising athletic trainer. 6. In concussion situations that cause a prolonged period that the student-athlete is incapacitated as a result of symptoms, and depending on the time of the semester the concussion occurs, (i.e. End of semester or during final exams) it may be necessary, in consultation with the course instructor and the academic advisor, to issue a grade of incomplete or a grade of X for the student-athlete with a plan for completion of the course requirements by an agreed upon time-frame by all parties. 7. It may be necessary to form an advisory committee in order that adequate accommodations are made for the student-athlete in the event of a significant time-loss, class-loss injury situation or in situations where the student-athlete does not recover as quickly as anticipated from the injury episode (>2 WEEKS). Along with referral to appropriate medical professionals, return-to-learn accommodations will be reviewed by a committee formed with the following individuals. a. Team Physician b. Neuropsychologist c. Full-time staff certified athletic trainer following the student-athlete case d. Academic Supervisor e. Senior Associate AD for Internal Affairs f. Representative from Student Support Services (SSLD)/Student Affairs g. Faculty Athletic Representative It will NOT be necessary that this committee be formed for EVERY concussion incident. Return to Play The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS) recommends that an athlete exhibiting an injury that involves significant symptoms, long duration of symptoms or difficulty with memory function should not be allowed to return to play during the same day of competition (NCAA Memorandum, April 29, 2010). Medical evaluation by sports medicine staff and appropriate use of neuropsychological testing (ImPACT) will be used as the basis for assessing when a concussed student-athlete may return to play. A collaborative approach will be used relying on input from the student-athlete, athletic trainer(s), team physician(s) and any consultant(s). Once an athlete is determined to be ready to resume activity, serial monitoring for the recurrence of symptoms will continue and a daily stepwise progression as advocated by the Zurich Consensus Statement on Concussion in Sport will be followed (Clin J Sport Med 2009;19(3): ). With any symptoms, the athlete will return to an appropriate level of asymptomatic participation and progress under the guidance of the sports medicine staff. 1. Complete physical and cognitive rest (goal = recovery and asymptomatic).

7 2. Light aerobic exercise without resistance training (goal = increase heart rate). 3. Sport-specific exercise and activity without head impact (goal = add movement). 4. Non-contact training drills with progressive resistance training (goals = exercise, coordination, cognitive load). 5. Unrestricted training (goals = restore confidence, assess functional skills). 6. Return to full participation. 5-Step Graduated Exertional Return to Play Protocol This exertional protocol allows a gradual increase in volume and intensity during the return to play process. The student-athlete is monitored for any concussion-like signs/symptoms during and after each exertional activity. The following steps are not ALL to be performed on the same day.. Exertion Step 1: 20 minute stationary bike ride (10-14 MPH) Progression depends on student-athlete remaining asymptomatic If symptoms return following exertion step 1, student-athlete must return to step #1 above and re-complete all testing listed. Exertion Step 2: Duration Approximately minutes with 5 min rest post session. o Body weight circuit that includes push-ups, lunges, sit ups, squats, step ups, superman s with 3 x 10 reps of each o Monitor symptoms o Progression depends on student-athlete remaining asymptomatic If symptoms return following exertion step 2, student-athlete must return to step #1 above and re-complete all testing listed once they are symptom free for at least 24 hours. Exertion Step 3: Advanced functional exertion: duration of 15 minutes with 5 minutes rest post session. o Sprints o Walking Lunges o Jumping Jacks o Sit-ups o Burpees o Push-ups o Planks o Monitor symptoms o Progression depends on student-athlete remaining asymptomatic If symptoms return following exertion step 3, student-athlete to step #1 above and re-complete all testing listed after they are symptom free for at least 24 hours. Exertion Step 4:

8 Controlled return to limited drills and non-contact practice and monitoring for symptoms If symptoms return following exertion step 4, student-athlete must repeat this step the next calendar day. If symptoms persist after two (2) consecutive days, the student-athlete must return to step #1 above and re-complete all testing listed. Exertion Step 5: Full sport participation in a practice If symptoms return following exertion step 5, student-athlete must repeat this step the next calendar day. If symptoms persist after two (2) consecutive days, the student-athlete must return to step #1 above and re-complete all testing listed. NO STUDENT-ATHLETE CAN RETURN TO FULL ACTIVITY OR COMPETITIONS UNTIL THEY ARE ASYMPTOMATIC IN LIMITED, CONTROLLED AND FULL-CONTACT ACTIVITIES, AND CLEARED BY THE TEAM PHYSICIAN. Reducing Exposure to Head Trauma While reducing may be difficult to quantify, it is important to emphasize ways to minimize head trauma exposure. Examples of minimizing head trauma exposure include, but are not limited to: Adherence to Inter-Association Consensus: Year Round Football Practice Contact Guidelines Adherence to Inter-Association Consensus: Independent Medical Care Guidelines Reducing gratuitous contact during practices Taking a safety first approach to sport Taking the head out of contact Coaching and student-athlete education regarding safe play and proper technique Attachments: 1. Concussion fact sheet for coaches 2. Concussion fact sheet for student-athletes 3. SCAT3 4. Concussion Acknowledgment Form: Coaches/Support Staff 5. Concussion Acknowledgment Form: Student-Athletes 6. Concussion Home Instruction Sheet 7. Certificate of Compliance

9

10

11

12

13

14

15 Jacksonville State University Sports Medicine Concussion Acknowledgment Form: Coaches/Support Staff Initial I have read and understand the NCAA Concussion Fact Sheet and JSU Concussion Education for coaches provided to me and have been given an opportunity to ask questions about concussions and anything I m not clear about regarding this issue. After reading the Concussion Fact Sheet, I agree the following to be true: Initial Initial Initial Initial Initial Initial Initial A concussion is a brain injury. I realize I cannot see a concussion, but I might notice some of the signs in the student-athlete right away. Other signs and symptoms can show up hours or days after the injury. If I suspect a student-athlete has a concussion, I am responsible for removing him/her from activity and reporting it to my teams athletic trainer. I will not allow any student-athlete to return to play or practice if I suspect that he/she has received a blow to the head or body that resulted in signs or symptoms consistent with concussion. I will encourage my student-athletes to report any suspected injuries and illnesses to the medical staff, including signs or symptoms of concussions. Following a concussion the brain needs time to heal. I understand that studentathletes are much more likely to sustain another concussion or more serious brain injury if they return to play or practice before symptoms resolve. I have read the signs and symptoms listed on the Concussion Fact Sheet. Printed Name Signature Date Witness Date

16 Jacksonville State University Sports Medicine Jacksonville State University Concussion Acknowledgement Form As a student-athlete at JSU, I acknowledge that I have a direct responsibility to be honest and forthcoming by reporting all injuries or illnesses to the JSU Sports Medicine staff (athletic trainers or team physicians). I further understand and acknowledge that participation in my sport may result in a head injury or concussion. The Sports Medicine staff at JSU has provided me with educational materials regarding concussions and I have read them. Specifically, I agree the following to be true: initial initial initial initial I have read and understand the Concussion Fact Sheet provided to me and have been given the opportunity to ask questions about concussions and anything I m not clear about regarding this issue. A concussion is a brain injury, which I am responsible for immediately reporting to my athletic trainer or team physician. A concussion can affect my ability to perform everyday activities, and affect reaction time, balance, sleep, and classroom performance. If I suspect a teammate has a concussion, I am responsible for reporting it to my athletic trainer or team physician. Student Athlete Printed Name Student Athlete Signature Witness Date Date

17 Jacksonville State University Sports Medicine Concussion Information: Home Instruction Sheet Name: Date: You have had a head injury or concussion and need to be watched closely for the next hours. It is OK to: There is no need to: DO NOT: - Use Tylenol - Check eyes with a light (Acetaminophen) - Wake up every hour - Use an ice pack to head/neck for comfort - Stay in bed - Eat a light meal - Go to sleep - Rest (no physical activity) - Drink alcohol - Eat spicy foods - Drive a car - Use computer, text, watch TV, video games, read - Use Aspirin, Aleve, Advil, or other NSAID products Special Recommendations: WATCH FOR ANY OF THE FOLLOWING PROBLEMS - Worsening headache - Stumbling/loss of balance - Vomiting - Weakness in one arm/leg - Decreased Level of Consciousness - Blurred Vision - Dilated Pupils - Increased irritability - Increased Confusion - Difficulty focusing If any of these problems develop, call your athletic trainer immediately or 911. Athletic Trainer Phone: You need to be seen for a follow-up examination at AM/PM on. Recommendations provided to Signature Roommate or Friend Signature Recommendations provided by Signature *If you would like to seek academic accommodations, you can report to Academic Advisor.

18 Jacksonville State University Athletics Department Certificate of Compliance for NCAA Constitution and Pursuant to NCAA Constitution and this document shall serve as Jacksonville State University s certificate of compliance for our institution s concussion management plan for our Gamecock student-athletes. The attached plan includes, but is not limited to, the following: (a) An annual process that ensures student-athletes are educated about the signs and symptoms of concussion. Student-athletes must acknowledge that they have received information about the signs and symptoms of concussion and that they have a responsibility to report concussion-related injuries and illnesses to a medical staff member; (b) A process that ensures a student-athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be removed from athletics activities (e.g., competition, practice, conditioning sessions) and evaluated by a medical staff member (e.g., sports medicine staff, team physician) with experience in the evaluation and management of concussions; (c) A policy that precludes a student-athlete diagnosed with a concussion from returning to athletics activity (e.g., competition, practice, conditioning sessions) for at least the remainder of that calendar day; and (d) A policy that requires medical clearance for a student-athlete diagnosed with a concussion to return to the athletics activity (e.g., competition, practice, conditioning sessions) as determined by a physician (e.g., team physician) or the physician's designee. Jacksonville State University will submit its Concussion Safety Protocol to the Concussion Safety Protocol Committee prior to August 1st of each year. The attached protocol includes: a) Policies and procedures that meet the requirements of Constitution b) Procedures for pre-participation baseline testing of each student athlete; c) Procedures for reducing exposure to head injuries; d) Procedures for education about concussion, including a policy that addresses return-to-learn; e) Procedures to ensure that proper and appropriate concussion management, consistent with best known practices and the Inter-Association Consensus: Diagnosis and Management of Sport- Related Concussion Guidelines, is made available to any student-athlete who has suffered a concussion; and f) Procedures requiring that the process of identifying, removing from game or practice, and assessing a student-athlete for a possible concussion are reviewed annually. Athletics Director Printed Name Athletics Director Signature Date