UCSF PLAYSAFE SPORTS MEDICINE

Transcription

1 Dear Parent/Guardian, Your son/daughter has been assessed by a certified athletic trainer (ATC) as having sustained a concussion. The following packet details how to manage a head injury of this kind. Please review and also discuss the instructions with your son/daughter. It is UCSF s recommendation to get an appointment with a physician* within 72 hours of the initial injury. *The CIF bylaw states that the licensed medical physician be trained in the evaluation and management of concussion injuries. The following packet includes: Acute Concussion Information Sheet - General concussion information including warning signs that warrant IMMEDIATE referral to a hospital/md and treatment guidelines for a concussion. Symptom Scales - Symptom scale sheets that the student-athlete is to fill out every evening to track their progress. - This score is to be reported daily to the athletic trainer. Return-to-Play Guidelines - Return to play progression following a concussion under the guidance of the athletic trainer. - Outlines the progression and when to follow-up for final clearance from an MD. Return-to-Play Physician Note - This document should be taken to your final doctor s appointment and completed by the doctor. - This note will serve as your permission to return to contact/competition activities. If you have any questions or concerns please feel free to contact your certified athletic trainer: Aubrey Yanda, MS, ATC Certified Athletic Trainer UCSF PlaySafe Sports Medicine Work: (563) Aubrey.Yanda@ucsfmedctr.org UCSF Orthopaedic Institute 1500 Owens Street, 2 nd Floor San Francisco, CA Phone: Fax: orthosurg.ucsf.edu

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3 Acute Concussion Information Sheet The student athlete has received a suspected injury to the head. Currently, there is no sign of any serious complications. It is expected that recovery will be rapid, but the patient will need monitoring for a further period by a responsible adult. Problems that can arise over the first hours are as listed. The student athlete should not be left alone and must go to a hospital at once if they: Have a headache that gets worse Have weak or numb arms or legs Can t recognize people or places Have repeated vomiting Behave unusually or seem confused: are very irritable Have seizures (arms and legs jerk uncontrollably) Are very drowsy or can t be awakened (woken up) Are unsteady on your feet: have slurred speech - - DO NOT use medications during the first 24 hours; Tylenol may be taken after the first 24 hours with parent permission. If you have any doubt or concerns, call or seek medical attention IMMEDIATELY. Return to Daily Activities 1. Get lots of rest. No late nights. 2. Take daytime naps or rest breaks if you feel tired or fatigued. Avoid caffeinated beverages. 3. Limit activities that require a lot of thinking. Studying should occur in 20 minutes increments with rest periods. 4. Drink lots of fluids and eat carbohydrates and protein to maintain function. 5. Avoid loud music and bright light as these may increase symptoms. 6. Driving should be avoided until permitted by a physician. 7. Absolutely no physical activity (PE, weight lifting or practice) until instructed by a physician or certified athletic trainer. Returning to School 1. School attendance may be modified to avoid provocation of symptoms 2. Inform teachers, school nurse, and administrators of your child s condition. 3. Extra assistance may be needed to help perform school related activities. ** It is strongly recommended that within the next 72 hours, the student athlete be evaluated by a licensed health care provider (Doctor- MD or DO) trained in the evaluation and management of concussions. Released care to (circle one): Parent Coach Fellow Parent Name: Parent Name: Parent Phone:

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11 Return to Participation Recommendations Following a Concussion I. It is suggested that concussed student- athletes be evaluated by a licensed health care provider trained in the evaluation and management of concussions within the first 72 hours after injury. II. III. IV. Any student- athlete who sustains a concussion should not return to any physical activity unless cleared by a license health care provider trained in the evaluation and management of concussions. Prior to returning to physical activity, the student- athlete should be symptom- free at rest AND should complete an incremental return to play program, completing each stage asymptomatically, for the indicated length of time (see Table 1). Per CIF Bylaw, No student- athlete will be allowed to return to practice/competition in the same day which they suffered concussion symptoms. V. All student- athletes must be cleared by a license health care provider trained in the evaluation and management of concussions prior to returning to contact activities/competition. Table 1: Return to play progression for concussion injury. Stage 1. Rest until asymptomatic (physical and mental rest). Stage 2. Light aerobic exercise (15 min. walking, stationary bike; <50% exertion). If asymptomatic progress to Stage 3. Stage 3. Sport- specific exercise (30 min. non- team, non- contact; running/cutting/footwork drills; <75% exertion). If asymptomatic progress to Stage 4. Stage 4. Non- contact training drills (Full practice, team non- contact or non- scrimmage activities; 75%- 100% exertion). If asymptomatic progress to Stage 5. Stage 5. Medical Clearance by a license health care provider trained in the evaluation and management of concussions. Student Athlete needs written doctor s note specifying return- to- play (RTP) clearance. Suggest attached UCSF RTP Form. Stage 6. Full contact training after medical clearance (Full Team Practice) If asymptomatic progress to Stage 7. Stage 7. Return to competition (Game play). PLEASE NOTE: - Progress one stage per day. Complete symptoms scale post stage activity. Return to the previous stage if the athlete experiences symptoms. - Resistance training should only be added in the later stages (Stage 5 or later). - A Concussion is defined as an impulse force to the head or body that results in a minimum score of 1 on the SCAT 2 Symptom Evaluation scale. - Student- Athletes exhibiting symptoms for >7 days should follow up with their physician for re- evaluation. Adapted from the consensus statement from the 3 rd International Conference on Concussion in Sport (2008). Clin J Sport Med May 2009.

12 Post Concussion Conditional Return To Play Form Athlete Name: Athlete Cell: ( ) Guardian Name: Guardian Cell: ( ) DOB: School: Sport: Date of Concussion: This is a form from the UCSF PlaySafe Program. Your patient has been diagnosed with a sports concussion. Please complete this form and return to the patient. The patient will bring the form to the athletic trainer at school to be included in his/her school sports medicine file RETURN TO SCHOOL CONSIDERATIONS (Please check all that apply) NO RETURN TO SCHOOL Return to School with restriction. Shortened Day. SUGGESTED RETURN DATE: Restrictions: Recommend hours per day until (date) Allow extra time to complete coursework/tests. Take rest breaks during the day as needed. No significant classroom or standardized testing at this time. FULL RETURN TO SCHOOL without restriction. PHYSICAL ACTIVITY STATUS NOT CLEARED - Return to this office. Date/Time: NOT CLEARED - Referred to: Neurology Neurosurgery Sports Medicine Physiatrist Other NOT CLEARED - Referred for Neuropsychological testing. CLEARED TO START NON- CONTACT SPORT PROGRESSIONS, MUST RETURN TO MD FOR FULL CLEARANCE. Please return to MD office for FULL CLEARANCE. Date/Time: CLEARED FOR FULL SPORT ACTIVITY, COMPETITION, AND PE ACTIVITY MD Name (print): MD Signature: Appointment Date: Clinic Phone #: