Definition: The University of Nebraska Omaha Concussion Management Plan A concussion is a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the head. Not all concussions require the loss of consciousness to be considered a concussion. All concussions are potentially serious and may result in prolonged brain damage or death. Common Symptoms: Blurred vision Unusually Emotional Irritability Dizziness Loss of Consciousness Memory Sleeping more than usual Nausea Nervousness Easily distracted Personality Changes Poor Balance Fatigued Ringing in ears Sadness Feeling in a fog Sensitivity to light Seeing stars Head Ache Sensitivity to noise Vacant stare Vomiting Sleep Disturbances Purpose: In compliance with the NCAA, the concussion management plan must include annual student-athlete concussion education, a process for sports participation removal, a policy that guides return to play and return to learn, and proper medical clearance after a diagnosed concussion. This plan will also enable the athletic performance staff to consistently and systematically approach student athletes who have suffered a concussion. Concussion Education/Responsibilities: Student-Athletes: The University of Nebraska Omaha student-athletes must be truthful and forthcoming about illness and injury, both at the time of an injury as well as upon the emergence of any recurring or new symptoms. In conjunction with the annual preparticipation physical, student-athletes will sign a document acknowledging their responsibility to be truthful and forthcoming about symptoms of illness or injury. Annually, the University of Nebraska Omaha s athletic trainers will educate the University of Nebraska Omaha student-athletes specifically about concussions. As part of that education, each student-athlete will receive the NCAA Concussion Fact Sheet for Student-Athletes and will sign the Student-Athlete Concussion form acknowledging that: a. they have received and reviewed the NCAA Concussion Fact Sheet for Student- Athletes and participated in education related to concussions, and
b. they accept responsibility for truthfully and promptly reporting their illnesses and injuries to the sports medicine staff, including any signs or symptoms of a concussion, regardless of whether any such illnesses, injuries, signs, or symptoms are related to participation in intercollegiate athletics. Coaches and administrators: All University of Nebraska Omaha coaches and sport administrators will receive the NCAA Concussion Fact Sheet for Coaches and will sign the Coach s Concussion Responsibility Form, acknowledging that: a. they have received and reviewed the NCAA Concussion Fact Sheet for Coaches and participated in education related to concussions; b. they will encourage their student-athletes to report their illnesses and injuries to sports medicine staff, especially any signs or symptoms of a concussion; c. they will refer any student-athlete whom they suspect of sustaining a concussion to the proper medical authority; d. they have read and understand the University of Nebraska Omaha Concussion Management Plan, including the fact that Team Physicians (and, in their absence, athletic trainers) have unchallengeable authority to withhold a student-athlete from practice or competition, and that the Team Physicians have unchallengeable authority to determine concussion management, return-to-play, and medical clearance. Sports Medicine Staff: The University of Nebraska Omaha Sports Medicine staff, which includes Team Physicians and Athletic Trainers, will undergo annual training sessions on the diagnosis and treatment of head injuries and this Concussion Management Plan. Each member will sign a document acknowledging their understanding of the policy. Director of Athletics: The University of Nebraska Omaha Director of Athletics will receive the Concussion Fact Sheet for Student-Athletes and the Concussion Fact Sheet for Coaches prior to certifying the institution s Concussion Management Plan. The Director of Athletics written certification of the protocol serves as acknowledgement of receipt of the Concussion Fact Sheets. Preseason/Baseline: At the beginning of each academic/athletic year the University of Nebraska Omaha Sports Medicine staff will administer and document a baseline assessment to all freshman/transfers and those student-athletes who sustained a concussion during the previous academic year in conjunction with their pre-participation physical exam. The baseline assessment includes an evaluation of brain injury and concussion history, symptom evaluation using the UNO Modified SCAT 3, a balance assessment, and a baseline ImPact test. These baseline scores will be documented in each student-athlete s electronic medical record (EMR) and used as a reference point in the event a concussion is sustained or suspected. The Team Physician will then determine pre-participation clearance and/or the need for additional consultation or testing.
Recognition & Evaluation: 1. If a student-athlete reports or displays any signs, symptoms, or behaviors of a concussion they will be immediately withheld from participation until further evaluated by a team physician and/or athletic trainer, who will make a determination of whether there is a basis for a suspected concussion. This evaluation will include, but not be limited to, a review of symptoms, a physical and neurological exam, cognitive testing, balance testing, and a clinical assessment for cervical spine trauma, skull fracture, and intracranial bleed. 2. A student-athlete with a concussion will be withheld from practice or competition for the remainder of that day. The athletic trainer or team physician making the decision will notify the coaching staff that the student-athlete will not return to athletic activity for the remainder of that day. 3. A student-athlete with a concussion will also be evaluated by a team physician in accordance with the severity of the symptoms. The evaluation will include a review of symptoms, memory function, balance/coordination testing, and neurocognitive testing (ImPact ). The timing and nature of any follow-up is at the discretion of the treating team physician. 4. Occasionally, student-athletes and/or athletic training staff may not be able to recognize the possibility of a concussion until hours or days after the initial occurrence. Under these circumstances, once a student-athlete reports or displays signs, symptoms, or behaviors that the UNO athletics staff member believes are consistent with a concussion, the staff member will inform the student-athlete s coach, as well as the team physician, and/or athletic trainer. At this point the normal evaluation and return-to-play procedures will be initiated. 5. If a student-athlete sustains a potential concussion outside of intercollegiate athletics, the student-athlete is responsible for truthfully and promptly reporting the injury to the athletic performance staff. At this point, the potential concussion will be managed in the same manner as a potential concussion sustained in intercollegiate athletics. Monitoring/Follow-Up Care 1. Once the student-athlete is deemed safe to be released from the care of the medical personnel, they may be released to a responsible individual that will be able to follow basic instructions to assist in the monitoring of the athlete. 2. Home Care Guidelines for Concussions (Appendix A) will be given to the studentathlete and an individual who will be caring for the concussed student-athlete. The name of the individual providing care as well as his or her relationship to the student-athlete will be documented in the medical database. The sports medicine staff will maintain close communication with the student-athlete following the concussion. 3. Student-athletes with a prolonged recovery shall be evaluated by a physician to consider additional diagnoses (e.g., post-concussion syndrome, sleep dysfunction,
migraine or other headache disorders, mood disorders, or ocular or vestibular dysfunction) and proper management options. Emergency Referrals: In the event that a student-athlete displays one or more of the following symptoms during an initial evaluation, a team physician and/or athletic trainer should activate the appropriate Emergency Management Plan for transportation of the student-athlete by EMS to the nearest Emergency Room: Glasgow Coma Scale < 13 Prolonged loss of consciousness Focal neurological deficit suggesting intracranial trauma Repetitive emesis Deteriorating level of consciousness Suspicion of spine or skull injury Seizure activity Deteriorating vital signs Vomiting Follow-up/Return to Play Progression: The follow-up and return to play (RTP) will follow 6 phases. The athlete will be reevaluated daily by the athletic trainer. The athlete will complete a post-concussion symptom score (PCSS, Appendix B) until asymptomatic. The RTP is not capable of beginning until the student-athlete is reporting asymptomatic. If after 1 week the studentathlete still reports symptoms or an increase in severity they will be referred to a medical care professional. Once asymptomatic the student-athlete will participate in the following: -UNO modified SCAT 3 and/or -ImPact Neuropsychological Assessment -Following asymptomatic testing wait 24 hours till RTP Must pass ImPact and/or UNO modified SCAT 3 by 95% baseline scores Phase One: -Complete rest for 24 hours -Physical rest at all times -Mental rest as tolerated -No text message, computers, or video games -Report to athletic trainer or team physician if symptoms worsen -Must be asymptomatic and have ImPact scores return to baseline for 24 hours prior to progression to the next phase
Phase Two: - Light cardiovascular activity -Heart rate must not exceed 70% Max Heart Rate - Must complete a PCSS before and after activity - In cases where student-athlete experiences return of signs and symptoms they must return back to Phase one Phase Three: -Sport-Specific activity (NO CONTACT) -Can include: -Functional drills, weight lifting, and conditioning -These activities should consist of no more than 50% of maximum -Must complete a PCSS before and after activity -Symptoms must be monitored before and after activity -In cases where student-athlete experiences return of signs and symptoms they must return back to Phase two Phase Four: -Non-contact participation in practice -Must complete a PCSS before and after activity -Symptoms must be monitored before and after activity -If asymptomatic will participate in the following: -ImPact Neuropsychological Assessment -In cases where student-athlete experiences return of signs and symptoms they must return back to Phase three Phase Five: -Return to full (contact) practice -Must complete a PCSS before and after activity -Symptoms must be monitored before and after activity - In cases where student-athlete experiences return of signs and symptoms they must return back to Phase four Phase Six: -Full Return to Play -Must have full medical clearance from Team Physician
Return-to-Learn: During the concussion management protocol it is important to also include a return-tolearn process as well. The athletic trainer and team physician will serve as the primary contacts to assist the student-athlete who is diagnosed with a concussion on return-tolearn issues. The team physician and athletic trainer will work with campus partners as appropriate, including but not limited to advisors from UNO s Student-Athlete Academic success office, other academic advisors, the Faculty Athletics Representative, the studentathlete s course instructors, the Office of Disability Services, the University Counseling Center, coaches, and athletic administrators. Implementation of the return-to-learn protocol must be compliant with the Americans with Disabilities Act Amendments Act (ADAAA). Each student-athlete who is diagnosed with a concussion will have an individualized plan that includes: a. No classroom activity on the day the concussion is sustained; b. Relative cognitive rest that minimizes potential cognitive stressors such as school work, video games, reading, texting, and watching television; c. A gradual return to the classroom and academic activities that may include modification of schedule or other academic accommodations for up to two weeks. At any point during the return-to-learn protocol, a physician can re-evaluate the studentathlete if he or she is not progressing. For any student-athlete who is symptomatic for more than two weeks, the athletic trainer and/or physician will work with the UNO Athletic Academic Success advisor to communicate with the Office of Disabilities and other campus partners to create a plan consistent with the ADAAA. Reducing Exposure to Head Trauma: While exposure to head trauma is inherent with many sports, the University of Nebraska Omaha Sports Performance Department is committed to reducing unnecessary exposure to head trauma. Coaches will conform to current best practices and recommendations for their sport in regards to reducing exposures to head trauma. This may include, but not be limited to: - Adherence to the Inter-Association Consensus: Independent Medical Care Guidelines - Reducing gratuitous contact in practices - Always taking a safety first approach to sport - Utilizing proper coaching techniques and student-athlete education regarding safe play