UPPER PERKIOMEN HIGH SCHOOL

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UPPER PERKIOMEN HIGH SCHOOL Concussion Management and Return to Play Protocol Recognizing that sport related concussions pose a significant health risk for studentathletes, the Upper Perkiomen School

1 UPPER PERKIOMEN HIGH SCHOOL Concussion Management and Return to Play Protocol Recognizing that sport related concussions pose a significant health risk for studentathletes, the Upper Perkiomen School District Athletic Department has developed this protocol for the staff to follow in the event of a mild traumatic brain injury or concussion, sustained by a student-athlete. Traumatic brain injuries can cause many health and mental problems throughout life, and possible risk of death. Safety in Youth Sports Act The Safety in Youth Sports Act was enacted on July 1, In accordance with this law, the Upper Perkiomen School District has instituted the following policy: -Once each school year, all coaches shall complete the concussion management certification training course offered by the Centers for Disease Control and Prevention, the National Federation of State High School Associations or another provider posted on the website by the Pennsylvania Departments of Education or Health. A coach shall not coach an athletic activity until the coach completes the training course. -The school will hold an informational presentation or video presentation online prior to the start of each athletic season, for all competitors regarding concussions. -A student desiring to participate in any athletic activity and the student s parent or guardian shall, each school year, sign and return to the school an acknowledgement of their receipt and review of concussion and traumatic brain injury information. (See pages 4-7) This acknowledgement is available in the physical packet. -Once a student athlete has exhibited signs or symptoms of a concussion/traumatic brain injury he/she must be removed by the coach from participation and will not be permitted to return to activity that day. Any athlete who has sustained a concussion will not be permitted to return to sports until they have written medical release with no limitations from their physician. Any athlete that sustains a concussion must follow a stepwise return to participation. -Any coach who violates this policy will be suspended from coaching any athletic activity for the remainder of that season. For a second violation the coach will be suspended from coaching any athletic activity for the remainder of that season and for the next season. For a third violation, the coach will be permanently suspended from coaching any athletic activity - 1 -

2 Baseline Concussion Testing Athletes participated in contact sports, grades 9 thru 12, will undergo a baseline screening test used in conjunction with medical advice to assist in return to play recommendations. This baseline test is valid for two years. We perform pre-season baseline and post-concussion screening test using the ImPACT (Immediate Post Concussion Assessment and Cognitive Testing) software program to aid in the management of head injuries. The exam takes about 25 minutes and is non-invasive. The program is basically set up as a video-game type format. It tracks neuro-cognitive information such as memory, reaction time, brain processing speed and concentration. For example, in the word memory section, twelve words appear one at a time on the screen for about one second each. The athlete is then later asked what words were displayed. If a concussion is suspected, the athlete will be required to re -take the test. Both the baseline and post-injury test data is available for the athletes to bring to their physician to aid in the diagnosing of concussion, as well as making the return to play decision. Recognizing a concussion A concussion is caused by a bump or blow to the head or body that causes the head to move back and forth violently resulting in changes the way your brain normally works. Any blow to the head or body that results in the following symptoms should be treated as a concussion: Physical Cognitive Emotional Sleep Headache Difficulty remembering Behavioral changes Sleep more than usual Fatigue Difficulty concentrating Irritability Sleep less than usual Dizziness Feeling slowed down Sadness Drowsiness Photophobia Feeling in a fog Feeling emotional Trouble falling asleep Sensitivity to noise Slowed reaction times Nervousness Nausea Altered attention Anxiety Balance problems Amnesia Loss of Consciousness Vision difficulty - 2 -

3 Concussion Protocol There will be no return to sports on the same day an athlete is suspected of sustaining a concussion. The athletes parents will be notified of any suspected concussion by school personnel and will be given a HEAD INJURY FACT SHEET. (See page 8) Athletes will be referred to their physician (see concussion referral form pages 10-11) for any head injury that results in; loss of consciousness, loss of memory, concussion symptoms that linger into the next day, or any athlete whose post-injury ImPact test scores fall outside of the Reliability Change Index. Any athlete who is suspected of sustaining a concussion will be immediately removed from activity and not be permitted to return to sports the same day. Furthermore, any athlete that has sustained a concussion will not be permitted to return to sports until they have written medical release with no limitations from the athlete s physician. Additionally, any athlete who has sustained a concussion MUST follow the below stepwise progression. The athlete should be symptom free before beginning this progression. The athlete should complete each level and progress to the next if they remain asymptomatic both at rest and with provocative exercise. Rehabilitation Stage Functional Exercise 1. No activity Complete physical and cognitive rest 2. Light aerobic activity Walking, swimming, stationary cycling at 70% maximum heart rate; no resistance exercises 3. Sport-specific exercise Specific sport-related drills but no head impact 4. Noncontact training drills More complex drills, may start light resistance training 5. Full-contact practice After medical clearance, participate in normal training 6. Return to play Normal game play Each stage in concussion rehabilitation should last no less than 24 hours with a minimum of 7 days required to consider a full return to competition. If symptoms recur during the rehabilitation program, the athlete should stop immediately. Once asymptomatic after at least another 24 hours, the athlete should resume at the previous asymptomatic level and try to progress again. Athletes should contact their health care provider if symptoms recur. Any athlete with multiple concussions or prolonged symptoms may require a longer concussion-rehabilitation program, which is ideally created by a physician who is experienced in concussion management

4 BrainSTEPS The Brain Injury Association of Pennsylvania, under contract from the PA Department of Health and partnered with the PA Department of Education, has created the Child & Adolescent Brain Injury School Re-entry Program called Brain STEPS (Strategies Teaching Educators, Parents, and Students). Brain STEPS is working to make sure that those who provide educational support to children with brain injury have a good understanding of the effects of the injury, the resulting challenges, and supports and interventions that will help these students achieve educational success through graduation. Features of the BrainSTEPS program include: Education professionals, medical rehabilitation professionals, and family members comprise the Brain STEPS Teams. Team members receive ongoing training from local and nationally recognized leaders in the field of pediatric brain injury. Brain STEPS team members will be available to provide Brain STEPS 101 presentations, helping schools compensate for the lack of brain injury training in college teacher training programs. Team members can provide training and consultation regarding identification, school re-entry planning, IEP development, intervention selection and implementation, long-term monitoring of students and other issues professionals face in supporting students with brain injury. Ongoing training and support will be provided to the teams by the Brain STEPS Program Coordinator. Consultation is available to teams through the Brain STEPS Program, on a case by case basis by medical rehabilitation professionals. Any student-athlete that has sustained a concussion with symptoms lasting longer than four weeks will be referred to the BrainSTEPS team

5 UPPER PERKIOMEN HIGH SCHOOL Parent/Guardian and Student Athlete Concussion Acknowledgement Form The following information is being provided to parents and student athletes to increase the awareness of and recommended treatment for sports related concussions as required by Pennsylvania Act 101. Fast Facts A concussion is a brain injury and all are serious. Most concussions occur without loss of consciousness. Recognition and proper response to concussions when they first occur can help prevent further injury or even death. Children and teens are more likely to get a concussion and take longer to recover than adults. Approximately 10% of all contact sport athletes sustain concussions yearly. Effects of concussion are cumulative in athletes who return to play prior to complete recovery*. *2011 Sports Concussion Institute Recognition/proper management when they first occur can help prevent further injury or even death. Centers for Disease Control and Prevention What is a concussion? A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even a ding, getting your bell rung, or what seems to be mild bump or blow to the head can be serious. Concussions can occur in any sport or recreation activity. So, all coaches, parents, and athletes need to learn concussion signs and symptoms and what to do if a concussion occurs. How do you recognize a concussion? To help recognize a concussion, you should watch for the following two things among your athletes: A forceful bump, blow, or jolt to the head or body that results in rapid movement of the head. AND Any change in the athlete s behavior, thinking, or physical functioning. Athletes who experience any of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury. Any athlete that sustains a concussion should be kept out of play until a physician, experienced in evaluating concussions, says they are symptom-free and provides written medical clearance allowing a step-wise return to play. What are the signs and symptoms of a concussion? Physical Cognitive Emotional Sleep Headache Difficulty remembering Behavioral changes Sleep more than usual Fatigue Difficulty concentrating Irritability Sleep less than usual Dizziness Feeling slowed down Sadness Drowsiness Sensitivity to light Feeling in a fog Feeling emotional Trouble falling asleep Sensitivity to noise Slowed reaction times Nervousness Nausea Altered attention Anxiety Balance problems Amnesia Loss of Consciousness Vision difficulty - 5 -

6 Complete physical, cognitive, emotional, and social rest is advised while the student athlete is experiencing symptoms and signs of a concussion/traumatic brain injury. Minimize mental exertion, overstimulation, cell phone and computer usage, as well as video gaming and multi-tasking etc. Second Impact Syndrome (SIS) Second impact syndrome is a very rare condition in which a second concussion occurs before a first concussion has properly healed, causing rapid and severe brain swelling and often catastrophic results. Second impact syndrome can result from even a very mild concussion that occurs days or weeks after the initial concussion. Most cases of second impact syndrome occur in young athletes and this is why it is IMPERATIVE that if a student-athlete is suspected of having a concussion, he/she does not return to play until he/she is evaluated by proper medical staff. Symptoms of SIS include: Dilated pupils Loss of eye movement Unconsciousness Respiratory Failure Death In many cases, second impact syndrome is fatal. In those cases where it isn t fatal, you can expect the longterm effects to be similar to those of severe traumatic brain injury. Upper Perkiomen Concussion Protocol Return to Play Any athlete who is suspected of having a concussion will be immediately removed from activity and not be permitted to return to sports that same day. Any athlete who sustains a concussion will not be permitted to return to sports until they have written medical release with no limitations from the athlete s physician. Additionally, any athlete who has sustained a concussion MUST follow the below stepwise progression. The athlete should be symptom free before beginning this progression. The athlete should complete each level and progress to the next if they remain asymptomatic both at rest and with provocative exercise. Rehabilitation Stage Functional Exercise 1. No activity Complete physical and cognitive rest 2. Light aerobic activity Walking, swimming, stationary cycling at 70% maximum heart rate; no resistance exercises 3. Sport-specific exercise Specific sport-related drills but no head impact 4. Noncontact training drills More complex drills, may start light resistance training 5. Full-contact practice After medical clearance, participate in normal training 6. Return to play Normal game play - 6 -

7 Each stage in concussion rehabilitation should last no less than 24 hours with a minimum of 7 days required to consider a full return to competition. If symptoms recur during the rehabilitation program, the athlete should stop immediately. Once asymptomatic after at least another 24 hours, the athlete should resume at the previous asymptomatic level and try to progress again. Athletes should contact their health care provider if symptoms recur. Any athlete with multiple concussions or prolonged symptoms may require a longer concussion-rehabilitation program, which is ideally created by a physician who is experienced in concussion management. IMPACT Screening Test We perform pre-season baseline and post-concussion screening test using the ImPACT (Immediate Post Concussion Assessment and Cognitive Testing) software program to aid in the management of head injuries. Baseline tests are valid for two years. The exam takes about 25 minutes and is non-invasive. The program is basically set up as a video-game type format. It tracks neuro-cognitive information such as memory, reaction time, brain processing speed and concentration. For example, in the word memory section, twelve words appear one at a time on the screen for about one second each. The athlete is then later asked what words were displayed. If a concussion is suspected, the athlete will be required to re-take the test. Both the baseline and postinjury test data is given to your family doctor. The test data will enable your doctor to determine when return-to-play is appropriate and safe for the injured athlete. If an injury of this nature occurs to your child, you will be promptly contacted with all the details. Information about ImPact is available at

UPPER PERKIOMEN HIGH SCHOOL Concussion Protocol Acknowledgment By signing below, you acknowledge you have read and understand the previous information and protocols regarding concussions and have

8 UPPER PERKIOMEN HIGH SCHOOL Concussion Protocol Acknowledgment By signing below, you acknowledge you have read and understand the previous information and protocols regarding concussions and have watched the concussion presentation video on the Upper Perkiomen High School Athletic website under PARENT/STUDENT-ATHLETE CONCUSSION MANAGEMENT TRAINING PROGRAM. Please PRINT Student/Athlete Name Please PRINT Parent/Guardian Name Student/Athlete Signature DATE Parent/Guardian Signature DATE - 8 -

9 UPPER PERKIOMEN HIGH SCHOOL ATHLETIC DEPARTMENT Sharon Schoelkopf, ATC, Athletic Trainer Steven Perlstein, Athletic Director 2 Walt Road 2 Walt Road Pennsburg, PA Pennsburg, PA Phone # Phone # Head Injury Fact Sheet This is a medical follow-up sheet for your health and safety. Signs of a head injury may not appear immediately following trauma, but often hours after the injury occurred. The purpose of this fact sheet is to alert you to the signs and symptoms associated with significant head injuries. If you experience one or more of the following symptoms after sustaining a head injury, further medical help should be sought IMMEDIATELY. Difficulty remembering recent events or meaningful thoughts Severe headache, particularly at a specific location Stiffening of the neck Blood or clear fluid dripping from the ears or nose Mental confusion or feeling of strangeness Nausea or vomiting Dizziness, poor balance or unsteadiness Weakness in either arm or leg Abnormal drowsiness or sleepiness Convulsions Unequal pupils Persistent ringing in the ears Slurring of speech Loss of appetite Increasing pain in head or neck The appearance of any of the above symptoms may indicate that you have sustained a significant head injury that REQUIRES IMMEDIATE MEDICAL ATTENTION. Further Instructions Awaken every two hours at night and check for the above symptoms. Consume only clear liquids for eight hours. Do not take medication the first 24 hours unless directed to do so by a physician. If at any time there is a doubt about the wellbeing of the athlete, seek medical Attention immediately

10 UPPER PERKIOMEN HIGH SCHOOL ATHLETIC DEPARTMENT Sharon Scholekopf, ATC, Athletic Trainer Steven Perlstein, Athletic Director 2 Walt Road 2 Walt Road Pennsburg, PA Pennsburg, PA Phone# Phone# Fax# Fax# Concussion Referral Form Date / / Dear Physician: has sustained a head injury while participating in for Upper Perkiomen High School and has been referred to you for evaluation. The following information provides some background on how we handle head injuries at Upper Perk, including our return to play guidelines and ImPACT testing. American Academy of Pediatrics Concussion Rehabilitation/Stepwise Return to Play Rehabilitation Stage Functional Exercise 1. No activity Complete physical and cognitive rest 2. Light aerobic activity Walking, swimming, stationary cycling at 70% maximum heart rate; no resistance exercises 3. Sport-specific exercise Specific sport-related drills but no head impact 4. Noncontact training drills More complex drills, may start light resistance training 5. Full-contact practice After medical clearance, participate in normal training 6. Return to play Normal game play Each stage in concussion rehabilitation should last no less than 24 hours with a minimum of 7 days required to consider a full return to competition. If symptoms recur during the rehabilitation program, the athlete should stop immediately. Once asymptomatic after at least another 24 hours, the athlete should resume at the previous asymptomatic level and try to progress again. Athletes should contact their health care provider if symptoms recur. Any athlete with multiple concussions or prolonged symptoms may require a longer concussion-rehabilitation program, which is ideally created by a physician who is experienced in concussion management

11 ImPACT Screen Testing We perform pre-season baseline and post-concussion screening test used in conjunction with medical advice to assist in return to play recommendations using the ImPACT (Immediate Post Concussion Assessment and Cognitive Testing) software program to aid in the management of head injuries. The exam takes about 20 minutes and is non-invasive. The program is basically set up as a video-game type format. It tracks neuro-cognitive information such as memory, reaction time, brain processing speed and concentration. For example, in the word memory section, twelve words appear one at a time on the screen for about one second each. The athlete is then later asked what words were displayed. Please find your patient s baseline test attached. We conduct post-concussive tests 1-3 days after a concussion (you will find this attached if it has been administered). We continue to test the athlete until their scores fall back within the Reliability Change Index. Please note that this program is used only as a tool in making return to play decisions. Additional information about ImPACT can be found at As you know Second Impact Syndrome is a potentially fatal condition if an athlete sustains a second concussion before completely recovering from the first. This is why we are especially cautious with head injuries at Upper Perk. Thank you for your assistance, and if you have any questions, please feel free to contact us. Sincerely, Sharon Scholekpf, ATC, sschoelk@upsd.org Certified Athletic Trainer Steven Perlstein, Athletic Director sperlste@upsd.org Comments: Please indicate your diagnosis and treatment plan below: Physician s Diagnosis: Return to Activity (please check one): The athlete may return to play when asymptomatic for days and then must follow the above AAP Stepwise Return to Play The athlete did not sustain a concussion and may return to play: / / The athlete is to see me again before returning to play. Additional comments: Physician s name (please print): Address: Phone: Physician s Signature: By signing above you acknowledge that you are experienced in the recognition and management of concussions pursuant to the Pennsylvania Safety in Youth Sports Act

12 UPPER PERKIOMEN HIGH SCHOOL Concussion Management and Return to Play Protocol Page 1 Safety in Youth Sports Act Page 2 ImPACT Testing Page 2 Recognizing a Concussion Page 3 Concussion Protocol Page 4 BrainSTEPS Page 5-7 Parent/Guardian Student Athlete Concussion Acknowledgement Form Page 8 Concussion Protocol Acknowledgment Page 9 Head Injury Fact Sheet Page Concussion Referral Form

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