The Master s Academy Concussion Policy Ann Williams,M.S.N., R.N. Robert O Quinn, MS, ATC, LAT Updated 2/6/2018 Outline I. Abbreviated policy II. Introduction III. Prevention and Education IV. Recognition of Concussion and Mild Traumatic Brain Injury V. Treatment and Management of Concussion VI. Classification of Injury VII. Return to Play Protocol VIII. Academic accommodations
I. Abbreviated policy a. All athletes in high risk or moderate risk sports will be given ImPACT baseline testing at the beginning of the season. b. Any student suspected of having a head injury should see the school nurse or the athletic trainer immediately for evaluation. c. The certified athletic trainer or team physician will use proven testing procedures to determine if a concussion is present and the severity of the concussion. d. If the athletic trainer determines a concussion may be present, he or she will recommend that the athlete see a physician. e. The athletic trainer will contact the athlete s parent(s) regardless of the severity of the symptoms to explain what a concussion is and how to manage the athlete s symptoms in the days following the injury. The athletic trainer will also explain the school s policy and procedure for return to play after a head injury. f. If concussion exists, the athletic trainer and/or team physician will determine a mandatory rest period based on symptom severity and predetermined minimum rest time. g. The school nurse will contact the School Principal and all teachers who work with the student/ athlete to explain the injury. If teachers or school nurse notice any discomfort/ unusual behavior in the student, he or she will contact the nurse or athletic trainer. h. The student may be granted academic accommodations if requested by a physician. i. Once the athlete is completely without symptoms, scores within baseline levels on ImPACT test, and completes a mandatory minimum rest, the athlete may begin the return to play protocol under the guidance of the physician and athletic trainer and in conjunction with the athletic coach. j. Once an athlete successfully completes the return to play protocol without the return of symptoms, he or she may return to full participation without restriction. k. At the time the athlete returns to full unlimited athletic participation, no academic accommodations will be made. l. The student athlete and athletic coach should continue to be in communication with the athletic trainer regarding the athlete s health and continued recovery after the injury.
II. Introduction What is a concussion? A concussion is a traumatic brain injury that alters the way your brain functions. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination. Although concussions usually are caused by a blow to the head, they can also occur when the head and upper body are violently shaken. These injuries can cause a loss of consciousness, but most concussions do not. Because of this, some people have concussions and don't realize it. Concussions are common, particularly if you play a contact sport. But every concussion injures your brain to some extent. This injury needs time and rest to heal properly. Most concussive traumatic brain injuries are mild, and people usually recover fully. III. IV. Prevention and Education a. All high risk 1 student athletes will undergo baseline concussion screening in the form of ImPACT online tests. Time and resources permitting, moderate risk student athletes will also be tested. These tests will be administered at the beginning of each sports season by the certified athletic trainer. Tests will be conducted by the guidelines in which they were designed. b. The certified athletic trainer will hold an in-service for all coaches to discuss the risks associated with concussion and MTBI. This In-service will coincide with seasonal coaches meetings. c. The certified athletic trainer will meet with each high risk and moderate risk team to discuss concussions and associated risks. This meeting will take place at a time and location of mutual convenience in the first week of each sports season. Recognition of Concussion and Mild Traumatic Brain Injury a. Any athlete who is suspected of having any concussion or TBI, regardless of its severity, should be immediately evaluated by the certified athletic trainer. 2 (see section V Classification of Injury) 1 High Risk student athletes are those who participate in football, wrestling, and boy s lacrosse. Moderate risk athletes are those who participate in field hockey, soccer, basketball, girl s lacrosse, baseball, and softball. 2 If the injury occurs at an away game, the athlete will be removed from competition until he or she can be evaluated by the athletic trainer at that site. That athletic trainer will have the final decision regarding the athlete s immediate care.
b. Signs and symptoms of concussion may vary depending on the individual athlete, the severity of the concussion, and the mechanism of injury, the most common signs and symptoms that may be present at or after the time of injury are depicted in table 1 below. Headache Dizziness Trouble concentrating and/or confusion Ringing in the ears Nausea and/or vomiting Decreased balance Feeling dinged Other signs and symptoms may include See stars or lights Double vision Fatigue and/or sleepiness Sleep disturbances Loss of Consciousness Impaired conscious state Poor coordination Inappropriate emotion Seizure Slow to respond Vacant stare Personality chance Slurred speech Inappropriate playing behavior Decreased playing ability c. It is important to note that an athlete does not need to lose consciousness to have a concussion. If an athlete complains of headaches or has trouble concentrating the following day in school, it is likely that he or she has a concussion. V. Treatment and Management of Concussion a. Any athlete who is suspected of having any concussion or TBI, regardless of its severity, should be immediately evaluated by the certified athletic trainer.
b. The certified athletic trainer will evaluate the student athlete for orientation, anterograde and retrograde amnesia, concentration and information processing and any physical symptoms. c. The athletic trainer will contact the parent or guardian of the student athlete regarding the injury. The athletic trainer or school nurse will send home paperwork describing the injury and appropriate treatment and care that the student s family can do at home. d. For mild concussions, the athletic trainer or school nurse will counsel the athlete s parent or guardian. e. For moderate concussion, the athletic trainer will recommend that parents take their student athlete directly to their doctor s office or emergency room for further evaluation. f. For severe concussion, the athletic trainer will call 911 to have the athlete transported to the hospital immediately. If the athlete s parent or guardian is not present at the time of this call, a school faculty or staff member 3 will accompany the athlete to the hospital until his or her family arrives. VI. Classification of Injury a. There are many different guidelines for classifying the severity of a head injury. b. The following Grading System is one of the most widely cited guideline 4 Data Driven Cantu Grading System for Concussion Grade 1 (mild) No LOC or PTA PCSS < 30 minutes Grade 2 (Moderate) LOC < 1min, or PTA > 30 min < 24 h; PCSS > 30 min < 7 days Grade 3 (Severe) LOC 1 min, or PTA 24 h PCSS > 7 days Table 1. Post-Concussion Signs/Symptoms Checklist 5 Bell rung Depression Nausea Nervousness 3 School nurse, coach, athletic trainer, athletic staff member. 4 Cantu RC: post traumatic (retrograde/anterograde) amnesia. Pathophysiology and implication in grading and safe return to play. J Athl Train 36(3):244-248,2001. LOC-loss of consciousness; PTA-post traumatic amnesia; PCSS-post concussive signs and symptoms after the amnesia. 5 Sports Medicine. Oconnor, Sallis, Wilder, and St Pierre. McGraw Hill, 2005
Dinged Dizziness Drowsiness Excessive sleep Fatigue Feeling in a fog Feeling slowed down Headache Irritability Loss of consciousness Memory problems Numbness/tingling Poor balance Poor concentration Ringing in the ears Sadness Sensitivity to light Sensitivity to noise Trouble falling asleep Vacant stare/glassy eyed Vomiting c. Brain imaging such as MRI and CT scan are often performed on athletes who present with concussive symptoms. While these techniques will aid medical professionals in identifying brain lesions and hemorrhage, they are not used to diagnose concussions. An athlete with a negative CT scan can still have a concussion. VII. Return to Play Protocol a. Return to play will be at the sole discretion of the family/ team physician with advisement from the certified athletic trainer / school nurse. Information provided by the student athlete s private physician will be taken into consideration. Medical staff 6 has the final decision as to an athlete s clearance for return to play following a concussion. This staff reserves the right to be more strict (but never less strict) than a student athlete s family doctor, pediatrician, or Emergency Room personnel. b. Student athletes who are experiencing post concussive symptoms are encouraged to go home directly after school and be excused from practice. c. Guidelines for Return to activity after Concussion 7 Grade 1 st Concussion 2 nd Concussion 3 rd Concussion 1 Mild Return to play if asymptomatic for 1 week Return to play in 2 weeks (must be asymptomatic at that Terminate season; may return next season if 2 Moderate Return to play after asymptomatic for 1 time for 1 week) 1 month minimum; may return then if asymptomatic Terminate season; may return next year 6 Certified athletic trainer, team physician/school medical consultant, and school registered nurse. 7 Principles of Athletic Training; Ninth Edition. Daniel Arnheim and William Prentice. Brown and Benchmark: Madison, Wisconsin, 1997.
week asymptomatic for 1 week; consider terminating season 3--Severe 1 month minimum; Terminate season; if asymptomatic d. An athlete who sustains a concussion may not return to play if he or she is experiencing any symptoms. In the first few days after the injury, it is important to emphasize to the athlete that physical and cognitive rest is required! e. Once all signs and symptoms of concussion have cleared, the athlete may begin a return to play protocol. TMA uses a protocol endorsed by Florida High School Athletics Association. Rehabilitation stage Functional exercise at each stage Objective Date completed Initials 1. No Activity Rest; physical and cognitive Recovery Noted Above Singed Above 2. Light aerobic exercise Walk, swimming, stationary bike, HR<70% maximum; no weight Increase heart rate training 3. Sport-specific Non-contact drills Add movement exercise 4. Non-contact Complex (non-contact) drills/practice Exercise, coordination and cognitive load 5. Full contact practice Full contact practice Restore confidence and simulate game situations 6. Return to full activity Return to competition After completion of the steps above; Form 18, Page 2 must be completed by physician f. The athlete must report continued absence of symptoms in order to continue to the next stage of the protocol. If symptoms return during any phase of the RTP protocol, the athlete must report to the athletic trainer. The athlete will resume rest until symptoms clear, and then begin the protocol again. g. Although each phase will be monitored by the athletic trainer, the sport coach will develop specific exercise plan for each athlete returning from concussion. Ideally, the athletic trainer and coach will work together very closely to ensure that the athlete returns to play as quickly and as safely as possible. VIII. Academic Accommodations
a. When a student suffers a concussion of any grade, academic accommodations will be decided upon by the student s physician, the school nurse and the principal. Physician documentation is required. (See attached form TO BE COMPLETED BY PHYSICIAN) b. The accommodations will be decided upon by the physician with input from the school nurse, athletic trainer, and the student s principal. c. The primary goal in managing a student who has suffered a concussion is to allow for maximum brain rest. If a student is on an accommodated academic program, the athletic trainer, in conjunction with the principal and the current athletic coach, will decide if the student may attend and observe practices and games without participating. d. Once a student begins the return to play protocol, the academic accommodations will end. e. Students who suffer concussions must allow time for brain healing, both physically and mentally. Certain consideration must be given to students in the classroom. At the request of the school nurse and/or athletic trainer, and in conjunction with the Principal, students who have suffered concussion should be given extra time to complete homework assignments or be given limited homework until symptoms clear. At the request of a physician, and under the direction of the principal, students may need to reschedule exams, papers, and projects. f. Any absence that results from a concussion must be considered an Excused absence, along the lines of other types of illnesses. g. Upon a student s return to physical activity, that student will no longer receive any academic accommodations.