Winnacunnet High School Concussion Protocol All coaches must take the NFHS Concussion course prior to working with students in their coaching season. Coaches must retake the course on even numbered years. A certificate of completion must be on file with the Athletic Director. All student athletes will take the ImPACT test prior to competition in their season on a bi-annual basis grade 9 and grade 11. New students, or students who did not participate in grade 9 or 11 must take the ImPACT test prior to their first season of participation. An athlete will be referred to the athletic trainer for an assessment if suspected of having a concussion. The athlete will then be referred to a physician for an evaluation. The athlete may not return to athletic participation, practice or play, until written notification is received by a physician. If the athlete experiences any signs or symptoms of a head injury after return to play, he/she must be removed from athletic participation and referred back to the physician who gave the original clearance. Once the physician gives permission to begin the return to play protocol, the parent must also sign off for the athlete to begin the return to play protocol. An athlete needs only ONE symptom to warrant removal from activity. CONCUSSION PROTOCOL STEPS FOR RETURN TO PLAY Once you are symptom-free, you may progress the following day to the next step. Day 1 is the day following the 1st symptom-free day! Day 1) NO activity, complete rest. Stay home from school and no school work or studying. Day 2) Light aerobic exercise such as walking or stationary cycling. No resistance training. Day 3) Sport specific exercise for example, skating and puck handling in hockey, running and ball skills in soccer (NO HEADING): football quarterbacks may resume sideline throwing. An important portion of this step is the addition of one set of low resistance or simple resistance training. Day 4) Resume non-contact training drills; for example, walk-through pass blocking for football linemen. Add additional sets and higher intensity resistance training. Day 5) Full contact practice after receiving medical clearance. Do not skip this important step. Day 6) Game play If any post-concussion symptoms develop at any stage, return to the physician, drop back to the previous level and try to progress again after 24 hours. No medications may be taken at any step of the progression. This is to prevent masking a more serious underlying condition! You must check in with your athletic trainer every day PRIOR to practice! Your trainer will give you a personalized copy of this paper on Day 1 with all of the dates listed for each specific day!
Head Injury Information A blow to the head can disrupt the normal function of the brain. Doctors often call this type of brain injury a concussion or a closed head injury. They may describe these injuries as mild because concussions are usually not life threatening. However, the effects of a concussion can be serious. After a concussion, some people lose consciousness or are knocked out for a short time, but not always -- you can have a brain injury without losing consciousness. Some people are simply dazed or confused. Because the brain is very complex, every brain injury is different. Some symptoms may appear right away, while others may not show up for days or weeks after the concussion. Sometimes the injury makes it hard for people to recognize or admit that they are having problems. The signs of concussion are subtle. Early on, problems may be missed. People may look fine even though they are acting or feeling differently. Because all brain injuries are different, so is recovery. Most people with mild injuries recover fully, but it can take time. Some symptoms can last for days, weeks, or longer. People with a concussion need to be seen by a Doctor. Signs and Symptoms Some of the symptoms of a concussion are: _ Low-grade headaches that won t go away _ Feeling light-headed or dizzy _ Increased sensitivity to sounds or lights _ Blurred vision _ Ringing in the ears _ Slowness in thinking, acting, speaking, or reading _ Getting easily confused _ Memory loss _ Difficulty paying attention or concentrating _ Neck pain _ Lack of energy _ Severe mood changes - feeling sad, anxious, or angry
Danger Signs In very rare cases, along with a concussion, a dangerous blood clot may form on the brain and crowd the brain against the skull. Contact your Doctor or Emergency Department right away if you have any of the following symptoms: Headaches that get worse Weakness, numbness, or decreased coordination Repeated vomiting The people checking on you should take you to an Emergency Department right away if you: Cannot be awakened Have one pupil (the black dot of your eye) larger than the other Have convulsions or seizures Have slurred speech Are getting more confused, restless, or agitated Recovery How fast people recover from a concussion varies from person to person. Although most people have a good recovery, how quickly depends on many factors. These factors include how severe the concussion was, what part of the brain was injured, their age, and how healthy they were before the concussion. Rest is very important after a concussion because it helps the brain to heal. You will need to be extremely patient because healing takes time. As the days go by, you can expect to gradually feel better. While you are healing, you should be very careful to avoid doing anything that could cause a blow to your head. On rare occasions, receiving another blow before a concussion has healed can be fatal. Here are some tips for healing: Get plenty of sleep at night and rest during the day Return to activities gradually, not all at once Avoid activities that could lead to a 2nd brain injury until cleared by the doctor Take only those drugs that your doctor has approved Rest your brain limit cognitive stimulation: TV, computer, video games
ACUTE CONCUSSION EVALUATION (ACE) CARE PLAN Gerard Gioia, PhD 1 & Micky Collins, PhD 2 1 Children s National Medical Center University of Pittsburgh Medical Center 2 Patient Name: DOB: Date: Date of Injury: Age: ID/MR# You have been diagnosed with a concussion (also known as a mild traumatic brain injury). This personal plan is based on your symptoms and is designed to help speed your recovery. Your careful attention to it can also prevent further injury. REST IS THE KEY: You should not participate in any high risk activities (e.g., sports, physical education (PE), riding a bike, etc.) if you still have any of the symptoms below. It is important to limit activities that require a lot of thinking or concentration (homework, job-related activities), as this can also make your symptoms worse. If you no longer have any symptoms and believe that your concentration and thinking are back to normal, you can slowly and carefully return to your daily activities. Children and teenagers will need help from their parents, teachers, coaches, or athletic trainers to help monitor their recovery and return to activities. RED FLAGS: Call your doctor or go to your emergency department if you suddenly experience any of the following Headaches that worsen Look very drowsy, can t be awakened Can t recognize people or places Unusual behavior change Seizures Repeated vomiting Increasing confusion Increasing irritability Neck pain Slurred speech Weakness or numbness in arms or legs Loss of consciousness Returning to Daily Activities 1. Get lots of rest. Be sure to get enough sleep at night- no late nights. Keep the same bedtime weekdays and weekends. 2. Take daytime naps or rest breaks when you feel tired or fatigued. 3. Limit physical activity as well as activities that require a lot of thinking or concentration. These activities can make symptoms worse. Physical activity includes PE, sports practices, weight-training, running, exercising, heavy lifting, etc. Thinking and concentration activities (e.g., homework, classwork load, job-related activity). 4. Drink lots of fluids and eat carbohydrates or protein to main appropriate blood sugar levels. 5. As symptoms decrease, you may begin to gradually return to your daily activities. If symptoms worsen or return, lessen your activities, then try again to increase your activities gradually. 6. During recovery, it is normal to feel frustrated and sad when you do not feel right and you can t be as active as usual. 7. Repeated evaluation of your symptoms is recommended to help guide recovery. Returning to School 1. If you (or your child) are still having symptoms of concussion you may need extra help to perform school-related activities. As your (or your child s) symptoms decrease during recovery, the extra help or supports can be removed gradually. 2. Inform the teacher(s), school nurse, school psychologist or counselor, and administrator(s) about your (or your child s) injury and symptoms. School personnel should be instructed to watch for: Increased problems paying attention or concentrating Increased problems remembering or learning new information Longer time needed to complete tasks or assignments Greater irritability, less able to cope with stress
Symptoms worsen (e.g., headache, tiredness) when doing schoolwork ~Continued on back page~ This form is part of the Heads Up: Brain Injury in Your Practice tool kit developed by the Centers for Disease Control and Prevention (CDC). Today the following symptoms are present (circle or check). No reported symptoms Physical Thinking Emotional Sleep Headaches Sensitivity to light Feeling mentally foggy Irritability Drowsiness Nausea Sensitivity to noise Problems concentrating Sadness Sleeping more than usual Fatigue Numbness/Tingling Problems remembering Feeling more emotional Sleeping less than usual Visual problems Vomiting Feeling more slowed down Nervousness Trouble falling asleep Balance Problems Dizziness
Returning to School (Continued) Until you (or your child) have fully recovered, the following supports are recommended: (check all that apply) No return to school. Return on (date) Return to school with following supports. Review on (date) Shortened day. Recommend hours per day until (date) Shortened classes (i.e., rest breaks during classes). Maximum class length: minutes. Allow extra time to complete coursework/assignments and tests. Lessen homework load by %. Maximum length of nightly homework: minutes. No significant classroom or standardized testing at this time. Check for the return of symptoms (use symptom table on front page of this form) when doing activities that require a lot of attention or concentration. Take rest breaks during the day as needed. Request meeting of 504 or School Management Team to discuss this plan and needed supports. Returning to Sports 1. You should NEVER return to play if you still have ANY symptoms (Be sure that you do not have any symptoms at rest and while doing any physical activity and/or activities that require a lot of thinking or concentration.) 2. Be sure that the PE teacher, coach, and/or athletic trainer are aware of your injury and symptoms. 3. It is normal to feel frustrated, sad and even angry because you cannot return to sports right away. With any injury, a full recovery will reduce the chances of getting hurt again. It is better to miss one or two games than the whole season. The following are recommended at the present time: Do not return to PE class at this time Return to PE class Do not return to sports practices/games at this time Gradual return to sports practices under the supervision of an appropriate health care provider Return to play should occur in gradual steps beginning with aerobic exercise only to increase your heart rate (e.g., stationary cycle); moving to increasing your heart rate with movement (e.g., running); then adding controlled contact if appropriate; and finally return to sports competition. Pay careful attention to your symptoms and your thinking and concentration skills at each stage of activity. Move to the next level of activity only if you do not experience any symptoms at the each level. If your symptoms return, let your health care professional know., return to the first level, and restart the program gradually. 1. No physical activity Gradual Return to Play Plan 2. Low levels of physical activity (i.e., ). This includes walking, light jogging, light stationary biking, light weightlifting (lower weight, higher reps, no bench, no squat). 3. Moderate levels of physical activity with body/head movement. This includes moderate jogging, brief running, moderateintensity stationary biking, moderate-intensity weightlifting (reduced time and/or reduced weight from your typical routine). 4. Heavy non-contact physical activity. This includes sprinting/running, high-intensity stationary biking, regular weightlifting routine, non-contact sport-specific drills (in 3 planes of movement). 5. Full contact in controlled practice. 6. Full contact in game play. *Neuropsychological testing can provide valuable information to assist physicians with treatment planning, such as return to play decisions. This referral plan is based on today s evaluation: Return to this office. Date/Time: Refer to: Neurosurgery Neurology Sports Medicine Physiatrist Psychiatrist Other Refer for neuropsychological testing Other: Copyright G. Gioia & M. Collins, 2006 ACE Care Plan Completed by: Signature of a Parent/Guardian: Date: Date: According to NH Senate Bill 402, signed into law in 2012, permission of a parent/guardian is required for an athlete to return to play.