Concussion Management Plan

Transcription

1 UNIVERSITY OF ALABAMA AT BIRMINGHAM University Athletic Department Concussion Management Plan July 2016

2 Table of Contents PURPOSE 3 DEFINITION OF CONCUSSION 3 EDUCATION 3 EVALUATION AND MANAGEMENT OF SUSPECTED CONCUSSIVE INJURIES 4 1) BASELINE ASSESSMENTS 4 2) INITIAL EVALUATION 5 3) REPEAT EVALUATIONS 6 4) GRADUATED RETURN-TO-PLAY 7 5) GRADUATED RETURN-TO-LEARN 7 6) PROLONGED SYMPTOMS 8 7) ATHLETES INJURED AWAY FROM THE PLAYING FIELD 8 8) VISITING ATHLETES 8 9) DIAGNOSIS AND CLEARANCE DETERMINATION 8 COMPUTERIZED NEUROPSYCHOLOGICAL TESTING AFFILIATION 8 SPECIALIST CONSULTATION 9 ADDITIONAL MANAGEMENT 9 CLINICAL JUDGMENT 9 REDUCING EXPOSURE TO HEAD TRAUMA 9 REFERENCES 9 APPENDIX A: UAB ATHLETIC DEPARTMENT CONCUSSION HISTORY FORM 10 APPENDIX B: SCAT 3 11 APPENDIX C: BALANCE ERROR SCORING SYSTEM (BESS) 12 APPENDIX D: CONCUSSION TESTING SUMMARY 13 APPENDIX E: UAB CONCUSSION RETURN-TO-PLAY PROTOCOL (UABRTPP) 1,3,8 14 APPENDIX F: CONCUSSION TAKE HOME INSTRUCTIONS 15 APPENDIX G: NCAA CONCUSSION FACT SHEET FOR COACHES 16 APPENDIX H: ACKNOWLEDGEMENT OF CONCUSSION EDUCATION 18 APPENDIX I: NCAA CONCUSSION FACT SHEET FOR STUDENT ATHLETES 19 APPENDIX J: STATEMENT OF STUDENT ATHLETE RESPONSIBILITY 20 2

3 Concussion Management Plan University of Alabama at Birmingham Athletic Department Revised July 2016 Purpose The purpose of the University of Alabama at Birmingham Concussion Management Plan (CMP) is to facilitate the provision of quality care of concussed student athletes via a standardized approach that aims to aid in a) early detection and comprehensive evaluation of concussive injuries, b) safe return to the classroom and to sport, and c) protection from excessive additive brain injury. Definition of Concussion The definition that will be utilized by University of Alabama at Birmingham Sports Medicine Staff will be the same one adopted by the 4 th International Conference on Concussion in Sport that convened in Zurich of Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include: 1. Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ''impulsive'' force transmitted to the head. 2. Concussion typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously. However in some cases, symptoms and signs may evolve over a number of minutes to hours. 3. Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies. 4. Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. However, it is important to note that in some cases symptoms may be prolonged. Education Coaches The Director of Athletics, or their designee, will distribute the CMP annually to all coaches. 4 The NCAA Concussion Fact Sheet for Coaches (Appendix G) is also distributed to the coaching staff. Coaches will meet with athletic director / head athletic trainer / team physician to review above materials. The coaches will acknowledge their acceptance and understanding of the policy and educational information by signature (Appendix H). 3

4 Student Athlete A one-page handout, Statement of Student Athlete Responsibility (Appendix J), which outlines the definition, symptoms and medical importance of concussion, is given to each incoming athlete. In addition, each athlete will receive a copy of the NCAA Concussion Fact Sheet for Athletes (Appendix I). This educational statement is signed by the athlete, acknowledging their review of the material and willingness to alert medical staff of concussion symptoms in themselves or teammates. 4 Annual concussion education will be provided to all student athletes via Power Point presentation and question/answer session, by a certified athletic trainer and/or team physician. 4 Sports Medicine Staff The UAB Sports Medicine staff (certified athletic trainers and team physicians) will also review the CMP annually and each member of the staff will acknowledge their acceptance and understanding of the policy by signature (Appendix H). 4, Athletic Director The Director of Athletics will also review the CMP annually, and acknowledge his/her acceptance and understanding of the policy by signature (Appendix H). Evaluation and Management of Suspected Concussive Injuries 1) Baseline Assessments a) Past history of concussion(s) is documented on the UAB Athletic Department Concussion History questionnaire that each student athlete completes as part of their pre-participation evaluation (Appendix A). b) A baseline assessment is recorded for each student athlete prior to the first official team practice. c) After the student athlete s first year, baseline testing will not be repeated unless directed by a team physician. d) Once a student athlete has been cleared to return-to-play following a concussion, a 6-month postconcussion assessment will be performed and used as the next season s baseline. Should this 6 month time period happen to fall over the summer break, the assessment will be performed once the student athlete returns to campus for the start of the new semester. e) Baseline assessment consists of the components listed below i) Symptom checklist SCAT3 Symptom Evaluation (S3SE), (Appendix B) ii) Cognitive assessment Sport Concussion Assessment Tool (SCAT3 TM ), (Appendix B) iii) Balance assessment - Balance Error Scoring System (BESS), (Appendix C) iv) Computerized Neuropsychological testing Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT ). f) After a concussive injury, the baseline assessments are repeated at appropriate time intervals post-injury. Testing is conducted under the same conditions as the baseline whenever possible. Results are to be recorded on the Concussion Testing Summary form (Appendix D). 4

5 g) Just prior to ImPACT administration, the athlete will be shown a document with brief examples of each component on the ImPACT test. This document is referred to as the ImPACT-Instructions. The goal of this extra instruction is to decrease test confusion and allow more accurate assessment of the student athlete s ability. h) ImPACT baseline assessments will be reviewed by a team physician online. If a baseline has been marked as invalid by the ImPACT program, the team physician will notify the certified athletic trainer (ATC) so provision can be made for re-administration of the test to the athlete. i) Clearance decisions for participation regarding concussion baseline testing and need for additional testing will be made by the team physician. 4 j) Of note, additional tests may be utilized at the discretion of the team physician. These are not intended to replace the previously named tests in section 1e but rather to serve as a supplement to the existing evaluation process. Examples of other measures may include vision performance assessment tools such as the King Devick Test (KDT), psychological distress measurements using the Brief Symptom Inventory-18 (BSI-18), measurements of fatigue utilizing the Pre and Post Test Exhaustion Rating (PPTER), vestibular system measurements such as accommodation, convergence and dynamic visual acuity, other objective balance measures, and additional neurocognitive and reaction time measures. 2) Initial Evaluation a) Assume a cervical spine injury is present until proven otherwise. This is especially important if the player is unconscious. Stabilize the head and neck, assess Circulation, Airway and Breathing, appropriately spine board (with adequate assistants) if needed and immobilize the neck. Proceed with emergency action plan as indicated. b) After C-spine injury has been ruled out in an athlete with a suspected concussion, remove the athlete from the field of play. c) In addition to C-spine injury, an emergency action plan will be followed for the following conditions: Glasgow Coma Scale < 13 Prolonged loss of consciousness Focal neurological deficit suggesting intracranial trauma Repetitive emesis Persistently diminished/worsening mental status or other neurological signs/symptoms d) Removal is typically performed by the supervising ATC but may also be performed by a coach or teammate if concussion suspected. e) After removal, evaluation will then be performed by the team physician or certified athletic trainer covering the event. Ideally this occurs at the time of the injury. f) The athlete will not be returned to play prior to this evaluation. g) Obtain a history of the injury, which may be from the student athlete him/herself or from teammates, coaches, or other witnesses of the event. Try to determine the mechanism and other details of injury. It can be helpful to review video footage of the contest or practice if available and practical. h) Perform SCAT3 TM and BESS within 0-6 hours post-injury and compare to the baseline scores i) If a diagnosis of concussion is made, the athlete will not return-to-play that day, as per NCAA guidelines 2,4 and Alabama State Law 6,7 5

6 j) In the event of a head injury, it is important to maintain a high index of suspicion for concussion as symptoms may not be obvious-- either to the student athlete or to others. That being said, teammates or others may note confusion or poor cognitive processing and functioning in the affected athlete (e.g, executing plays, etc.) and bring this to the attention of the medical staff. Moreover, a student athlete may not readily disclose concussion symptoms for fear of being removed from play. Finally, it also should be recognized that concussion symptoms may be delayed following an impact and that a concussion should be seen as an evolving injury in the acute stage. 1 k) No athlete with severe or unstable symptoms or findings will be released from medical care until appropriate evaluation and follow-up is obtained. l) Verbal and/or written Concussion Take Home Instructions (Appendix F) will be given to the student athlete and their roommate (or similar second person) to guide care at home until seen for further follow-up in the athletic training room or physician s clinic. m) Arrangements will be made to have a roommate, teammate, or similar person to monitor them overnight. n) The student athlete s academic advisor will be notified when modifications of classroom activities are indicated. 3) Repeat Evaluations a) Repeat evaluations of the concussed athlete are performed in the athletic training room or team physician s clinic and typically begin within hours. b) The SCAT3 TM, BESS, and ImPACT are repeated and compared to the baseline and initial evaluation scores. c) Prior to the first post-concussive administration of ImPACT, the athlete will be shown the ImPACT- Instructions. Prior to subsequent post-concussive ImPACT testing, the athlete may again be shown the ImPACT-Instructions if so requested by the athlete. d) Repeat evaluations in addition to the initial 0-6 hour post-injury testing (section 2, h) are to be performed at the time-points listed below at a minimum and at the discretion of the Sports Medicine Staff. i) SCAT3 TM, BESS, ImPACT hours post injury ii) S3SE daily until student-athlete is asymptomatic. Asymptomatic refers to scoring at or below baseline on the S3SE. iii) SCAT3 TM, BESS, ImPACT when allowed to begin Stage 1 of UAB Concussion Return-to-Play Protocol (UABCRTPP) (+/- 1 day) iv) SCAT3 TM, BESS, ImPACT when allowed to begin Stage 5 of UABCRTPP (+/- 1 day) Note: Some time-points may occur simultaneously. For example the hour evaluation (time-point i) may occur at the same time the athlete becomes asymptomatic (time-point ii) which may also be the same time the athlete is started on the UABCRTPP (time-point iii). e) Results are to be recorded on the Concussion Testing Summary Form (Appendix D). f) Any athlete experiencing prolonged recovery will be evaluated by a team physician, and referred to consulting physicians if necessary. 6

7 4) Graduated Return-to-Play a) Per NCAA guidelines 2,4 and Alabama State Law 6,7 there is no same day return-to-play for an athlete diagnosed with a concussion. b) A concussed athlete is allowed to return-to-play only after the thorough evaluation described above and completion of the UAB Concussion Return-to-Play Protocol (UABCRTPP). Final determination of return-toplay is from the team physician. c) The UABCRTPP is described in Appendix E. d) The UABCRTPP is a stepwise protocol starting with minimal cognitive, autonomic and vestibular activities in stage 1 and gradually progressing in incremental fashion to full return to competition over stages 2-6. e) Stage 1 of the UABCRTPP may begin after the repeat evaluation (see 3a above) of the concussed athlete if deemed appropriate by the examiner. f) The athlete should not attempt to progress from stage 1 to stage 2 of the UABCRTPP if the athlete has any worsening of symptoms with stage 1 activities. If worsening symptoms have occurred, a period of rest must pass before attempting stage 1 activities again. g) If any worsening of symptoms occur while in stages 2-6 of the UABCRTPP, the athlete should drop back to the previous asymptomatic level and try to progress again after a period of rest has passed. h) Progression through UABCRTPP stages should be documented on the Concussion Testing Summary form (Appendix D). 5) Graduated Return-to-Learn a) Return-to-Learn refers to resumption of cognitive activity such as attending classes, reading, studying, taking tests, and attending team meetings. b) Return-to-Learn begins with a period of relative cognitive rest and progresses in a stepwise fashion to more demanding cognitive activities. 4 c) There will be no academic activity on same day as concussion. d) If symptoms return, cognitive progression should be reassessed. 4 e) A concussed student athlete is allowed to return to cognitive activities at the discretion of the sports medicine staff after the thorough medical and testing evaluation described above and after consultation with the UAB athletic department academic team. f) The UAB athletic department academic team is a multidisciplinary group of individuals who can help coordinate and plan the student athlete s Return-to-Learn. g) This team typically consists of: i) Team physicians ii) Athletic trainers iii) Academic advisers iv) Learning specialists 7

8 h) As needed the team may also consist of: i) Psychologists/counselors ii) Neuropsychologists iii) Professors and Deans iv) Office of disability services representatives v) Coaches vi) Administrators i) Lead Learning Specialist in Student-Athlete Academic Services will serve as the point person to navigate athletes through the return-to-learn process. j) Return-to-Learn plans are individualized to fit the needs of student athletes returning to varied sports, courses and degree programs. 4 k) The individualized Return-to-Learn plan, including accommodations, will comply with the Americans with Disabilities Act Amendments Act. l) If symptoms are present for > 2 weeks, the athlete will be re-evaluated by the team physician/multidisciplinary team. 6) Prolonged Symptoms The majority (80-90%) of concussed athletes have symptom resolution within 7-10 days. 1 Athletes who have symptoms for longer periods may be treated with a multidisciplinary approach (see Specialist Consultation section). This management may include light exercise which does not produce worsening symptoms and is initiated with guidance from the team physician. 7) Athletes Injured Away From the Playing Field Student Athletes who suffer a concussion from non-sports related activities will also be treated according to the CMP. 8) Visiting Athletes Athletes from visiting schools under the care of UAB sports health personnel will be treated according to the CMP. 9) Diagnosis and Clearance Determination The final decision for diagnosis and clearance for return-to-play rests with the team physician. 2,4,5 Computerized Neuropsychological Testing Affiliation As suggested by the NCAA, institutions using computerized neuropsychological testing should have an affiliation with a neuropsychologist to help with test application and interpretation. 2 UAB will have a neuropsychologist on retainer to provide this service via phone consultation and electronic access to ImPACT testing results 8

9 Specialist Consultation UAB sports health staff may consult medical specialist to participate in the care of athletes with suspected brain injuries on an as needed basis. Typical consultants are: - UAB Department of Neurology for complex, unusual or prolonged cases of suspected concussion. - UAB Department of Neurosurgery - Ackerson and Associates for formal neuropsychological testing - UAB School of Optometry for vestibular/ocular therapy Additional Management Further work-up and treatment including additional neuropsychological or vestibular-ocular testing and/or therapy, advanced imaging, and/or medications and prescribed supplements may be used on a case-by-case basis. Clinical Judgment As with many medical conditions, no single clinical factor can be used to either diagnose a concussion or determine safe return-to-play after a concussion. Symptoms, clinical evaluation, diagnostic studies, and testing must all be weighed in the decision. In complex cases, the team physicians may confer with consultants to discuss management before final decisions are made. As stated previously, the team physician makes the final determination regarding diagnosis and return-to-play. 2,4,5 Reducing Exposure to Head Trauma It is important to emphasize ways to minimize head trauma exposure. Coaches and athletes will be responsible for taking a safety-first approach, and exercise proper technique during all activities. References 1. McCrory P, Meeuwisse WH, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport. Zurich. November Br J Sports Med. 2013;47(5): National Collegiate Athletic Association. Committee on Competitive Safeguards and Medical Aspects of Sports. NCAA sports medicine handbook Overland Park, KS. 3. Collins M, Lovell M, Troutman-Enseki C. Univ. of Pittsburgh Medical Center Sports Medicine Concussion Program Guidelines for Post-Concussion Rehabilitation. Presented at: Emerging Frontiers in Concussion: Advancements in Assessment, Management and Rehabilitation Pittsburgh, PA. 4. Concussion Diagnosis and Management. NCAA Inter-association Consensus Guidelines. July Independent Medical Care in the Collegiate Setting. NCAA Inter-association Consensus Guidelines. July Ala. Code 22-11E (2011 HB 108) 7. Ala. Code 22-11E (2012 HB 308) 8. University of Florida Return-to-Play Concussion Protocol 9

10 Appendix A: UAB Athletic Department Concussion History Form UAB Athletic Department Concussion History Form Name: DOB: _/_/_ How many years have you played this sport? Date: Sport: Education History please circle Years of education completed (excluding kindergarten): Other: Received speech therapy Yes No Attended special education classes Yes No Repeated one or more years of school Yes No Diagnosed with a learning disability Yes No Problems with ADHD or hyperactivity Yes No Handedness Right Left Ambidextrous Native language: English Spanish Other: Contact Sport History How many years have you played the following sports Boxing Field Hockey Football tackle Ice Hockey Lacrosse Martial Arts Soccer Wrestling Concussion History Number of times diagnosed with a concussion: Dates of each concussion: Number of concussions which resulted in loss of consciousness: Number of concussions which resulted in confusion: Number of concussions which resulted in difficulty remembering events after the injury: Number of concussions which resulted in difficulty remembering events before the injury: Total games missed as a result of all concussions combined: Treatment History please circle Treatment for headaches by a physician Yes No Treatment for migraine headaches by a physician Yes No Treatment for epilepsy/seizures Yes No History of brain surgery Yes No History of meningitis Yes No Treatment for substance/alcohol abuse Yes No Treatment for psychiatric condition (depression/anxiety) Yes No Diagnosis History Diagnosed with ADD/ADHD Yes No Diagnosed with dyslexia Yes No Diagnosed with autism Yes No Adapted from ImPACT demographic section 10

11 Appendix B: SCAT 3 11

12 Appendix C: Balance Error Scoring System (BESS) Name: Blazer ID #: Date of Injury: Time of Injury: AM / PM Date of Exam: Time of exam: AM / PM EXAM: (circle one) Baseline Post-Injury Sport: Examiner: Balance Error Scoring System (BESS) 1 Balance Error Scoring System Types of Errors 1. Hands lifted off iliac crest 2. Opening eyes 3. Step, stumble, or fall 4. Moving hip into >30 abduction, adduction, flexion or extension 5. Lifting forefoot or heel 6. Remaining out of testing position > 5 sec. NO SHOES. Barefoot or in socks 20 seconds at each position Each type of error can be counted more than once in each position Simultaneous errors count as 1 error 10 points maximum score in each position If <5 consecutive seconds of stability per stance then give max score of 10 Total possible score of 60 Total Score: Which foot was used for testing (i.e. non-dominant foot): Left Right 1 Guskiewicz KM, Perrin DH, Gansneder BM. Effect of mild head injury on postural stability in athletes. J Athl Train Oct;31(4):

13 Appendix D: Concussion Testing Summary Name: DOB: Sport: Current Concussion Date: Dates of prior concussions: Baseline Date 0-6hrs Date Date 24-48hrs Date Date Stage 1 Date/ Date Asymptomatic Date Date Date Date Date Stage 5 Date Date Date S3SE SCAT3 BESS ImPACT Date returned to competition: 13

14 Appendix E: UAB Concussion Return-to-Play Protocol (UABRTPP) 1,3,8 Rehabilitation Stage Description Autonomic Recovery + Vestibular/Ocular Recovery 1. Minimal activity Limit concentration activities including class and meetings. Exercise in quiet area, no impact activities (running, jumping). Balance and vestibular treatment by specialist (prn). Limit head movement/position change. 2. Light activity May attend class and meetings. May exercise in gym areas. Use various exercise equipment. Allow some positional changes and head movement. 3. Moderate activity Any environment ok for exercise (indoor, outdoor). Integrate strength, conditioning, and balance/proprioceptive exercise. Can incorporate concentration challenges (counting exercises, visual games) % max exertion. HR % max exertion. HR % max exertion. HR Stationary aerobic conditioning; bike. Static balance activities. Exercises that limit head movements (weight machines, squats/lunges with focusing). Core exercises without head movements. More progressive dynamic aerobic conditioning: elliptical, treadmill walking, progress to treadmill jogging. Balance activities with head movements. Resistance exercises with head movements (example: lateral squats with head movement). Low intensity sport specific activities. Core exercises with head movements (ex: side planks with arm /head turn, bicycles, Russian twists). Moderately aggressive aerobic exercise (intervals, pyramids, stair running). All forms of strength exercises. Dynamic warm-ups. Impact activities (running, plyometrics). Challenging positional changes (burpees, mountain climbers). 4. Non-contact sportspecific activity Continue to avoid contact activity, but resume aggressive training in normal sport environment % max exertion. HR Sport-specific activities avoiding contact. 5. Full contact practice Must be back to baseline in all testing. Initiate contact activities as appropriate to sport. Full exertion. 100% max exertion. HR 200. Full physical training activities with contact. 6. Return-to-Play Normal game play. + % Max Exertion calculated by formula {[(Max HR Rest HR) x %)] + Rest HR} with assumption that UAB athlete is 20 years old, Max HR = (220 age), and Rest HR =

15 Appendix F: Concussion Take Home Instructions Concussion Take Home Instructions University of Alabama at Birmingham You have a brain injury called a concussion. A careful medical examination has been performed and no serious complications have been found. It is recommended that you have short term monitoring by a responsible adult/teammate while you are away from the athletic training facility in case new or worsening symptoms occur. Listed below are instructions and important points to follow while at home: Signs to watch for: - Changes in behavior - Worsening headache - Vomiting - Double vision - Dizziness - Numbness and tingling anywhere in the body - Excessive drowsiness - Slurred speech Things to AVOID: - Drinking alcohol - Driving a car, scooter, or any motorized vehicle - Doing strenuous activities - Crowds - Taking certain medications: o Aspirin, Aleve, Ibuprofen or other antiinflammatories (i.e. Celebrex) o Sedating pain killers - Video games, loud music, TV/movies Things that are OK or that you should do: - REST - Apply ice to injured areas - Eat nutritious meals - Take Tylenol (Acetaminophen) as directed - Drink plenty of fluids (Gatorade and water) If any of the above signs to watch for or any other problems occur, or if you have any questions please contact your athletic trainer and/or go to the Emergency Department immediately. Additional comments: Athlete s Name: Athletic Trainer: (ATC s Signature): Signature: Date: Phone #s: 15

16 Appendix G: NCAA Concussion Fact Sheet for Coaches 16

17 17

18 Appendix H: Acknowledgement of Concussion Education I acknowledge that I have received concussion education in the form of concussion fact sheet and have had an opportunity to answer questions with appropriate Sports Medicine Staff. In addition, I have reviewed the UAB Concussion Management Plan. Team/Department: Name Signature Date 18

19 Appendix I: NCAA Concussion Fact Sheet for Student Athletes 19

20 Appendix J: Statement of Student Athlete Responsibility What is a CONCUSSION? A concussion is a brain injury caused by a blow to the head, face or elsewhere on the body with a force transmitted to the head. Concussions can result from hitting a hard surface such as the ground or floor, from players colliding with each other or from being hit by a ball, bat or other sporting equipment. Facts about CONCUSSION 1. A concussion is a serious brain injury 2. Concussions can occur without loss of consciousness or other obvious signs 3. Concussions can occur from blows to the body as well as to the head 4. Concussions can occur in any sport 5. Athletes can still get a concussion even if they are wearing a helmet 6. Recognition and proper response to concussions when they first occur can help prevent further injury or even death Signs and Symptoms of CONCUSSION include 1. Headache or pressure in head 2. Nausea or vomiting 3. Balance problems or dizziness 4. Double or blurry vision 5. Sensitivity to light and /or noise 6. Feeling sluggish, hazy, foggy or groggy 7. Concentration or memory problems 8. Confusion 9. Sensation that one does not feel right Why knowing you have a CONCUSSION is important Most concussions resolve but some concussions can lead to chronic symptoms such as headache, decreased memory, sleeping problems or personality change. Rest, avoiding another blow to the head and following the advice of your medical staff are critical in helping you recover as fast and as safely as possible. Sustaining another concussion prior to recovery from the first increases your chance of long-term symptoms. There have been reports of death with a second concussion in younger athletes. It is very important for you to report any concussion symptoms as described above to your athletic trainer or team physicians at the time of injury. This includes alerting the medical staff to symptoms in your teammates if you notice these. Statement of Student Athlete Responsibility I accept responsibility for reporting all injuries and illnesses to the University of Alabama at Birmingham Athletic Department Medical Staff (athletic trainers and team physicians) including any signs and symptoms of CONCUSSION. I have read and understand the above information on concussion. I will inform the supervising athletic trainer or team physician immediately if I experience any of these symptoms or witness a teammate with these symptoms. Signature of Student Athlete: Printed Name: Date: NCAA. Concussion a fact sheet for coaches NCAA. Concussion a fact sheet for student-athletes UAB Concussion Management Plan