concussion management plans

8/10/2019 Concussion Management Plans

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Sports Medicine

ILLINOIS HIGH SCHOOL ASSOCIATION

2715 McGraw Drive Bloomington, IL 61704

www.ihsa.org Phone: 309-663-6377 Fax: 309-663-7479

IHSA Protocol for Implementation of NFHS Sports Playing Rule for Concussions

Any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache,dizziness, confusion, or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by anappropriate health care professional.

The above language, which first appeared in all National Federation sports rule books for the 2010-11 school term, reflects a strengthening ofrules regarding the safety of athletes suspected of having a concussion, but not a revision in primary responsibilities in these areas. Previousrules required officials to remove any athlete from play who was unconscious or apparently unconscious. This revised language reflects anincreasing focus on safety, given that the vast majority of concussions do not involve a loss of consciousness. However, the revised languagedoes not create a duty that officials are expected to perform a medical diagnosis. The change in rule simply calls for officials to be cognizantof athletes who display signs, symptoms, or behaviors of a concussion from the lists below and remove them from play.

NOTE: The persons who should be alert for such signs, symptoms, or behaviors consistent with a concussion in an athlete includeappropriate health-care professionals, coaches, officials, parents, teammates, and, if conscious, the athlete him/herself.

Definition of a ConcussionA concussion is a traumatic brain injury that interferes with normal brain function. An athlete does not have to lose consciousness (be knockedout) to have suffered a concussion.

Behavior or signs observed indicative of apossible concussion Loss of consciousness Appears dazed or stunned Appears confused Forgets plays Unsure of game, score, or opponent

Moves clumsily Answers questions slowly Shows behavior or personality changes Cant recall events prior to or after the injury

Symptoms reported by a player indicative of apossible concussion Headache Nausea Balance problems or dizziness Double or fuzzy vision Sensitivity to light or noise

Feeling sluggish Feeling foggy or groggy Concentration or memory problems Confusion

This protocol is intended to provide the mechanics to follow during the course of contests/matches/events when an athlete sustains an apparentconcussion. For the purposes of this policy, appropriate health care professionals are defined as: physicians licensed to practice medicine inall its branches in Illinois and certified athletic trainers.

1. During the pre-game conference of coaches and officials, the official shall remind the head coaches that a school-approved appropriatehealth care professional will need to clear for return to play any athlete removed from a contest for an apparent head injury.

2. The officials will have no role in determining concussion other than the obvious situation where a player is unconscious or apparentlyunconscious as is provided for under the previous rule. Officials will merely point out to a coach that a player is apparently injured and

advise the coach that the player should be examined by the school-approved health care provider.3. If it is confirmed by the schools approved health care professional that the student did not sustain a concussion, the head coach may so

advise the officials during an appropriate stoppage of play and the athlete may re-enter competition pursuant to the contest rules.4. Otherwise, if an athlete can not be cleared to return to play by a school-approved health care professional as defined in this protocol, that

athlete may not be returned to competition that day and is then subject to the IHSA's Return to Play (RTP) Policy before the student-athletecan return to practice or competition.

5. Following the contest, a Special Report shall be filed by the contest official(s) with the IHSA Office through the Officials Center.6. In cases where an assigned IHSA state finals event medical professional is present, his/her decision to not allow an athlete to return to

competition may not be over-ruled.

Additional information regarding concussion has been made available to IHSA member schools and licensed officials and can be accessed onthe IHSA Sports Medicine website athttp://www.ihsa.org/initiatives/sportsMedicine/index.htm .
http://www.ihsa.org/initiatives/sportsMedicine/index.htmhttp://www.ihsa.org/initiatives/sportsMedicine/index.htmhttp://www.ihsa.org/initiatives/sportsMedicine/index.htmhttp://www.ihsa.org/initiatives/sportsMedicine/index.htm


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Return to Play (RTP) Policy

Background: With the start of the 2010-11 school term, the National Federation ofState High School Associations (NFHS) implemented a new national playing ruleregarding potential head injuries. The rule requires any player who exhibits signs,symptoms, or behaviors consistent with a concussion (such as loss of consciousness,headache, dizziness, confusion, or balance problems) shall be immediately removedfrom the game and shall not return to play until cleared by an appropriate health careprofessional. In applying that rule in Illinois, it has been determined that only certifiedathletic trainers and physicians licensed to practice medicine in all its branches in Illinois

can clear an athlete to return to play the day of a contest in which the athlete has beenremoved from the contest for a possible head injury.

Policy: In cases when an athlete is not cleared to return to play the same day as he/sheis removed from a contest following a possible head injury (i.e., concussion), the athleteshall not return to play or practice until the athlete is evaluated by and receives writtenclearance from a licensed health care provider to return to play.

For the purposes of this policy, licensed health care providers consist of physicianslicensed to practice medicine in all its branches in Illinois and certified athletic trainersworking in conjunction with physicians licensed to practice medicine in all its branches

in Illinois.

S orts Medicine

www.ihsa.org [email protected] Phone: 309-663-6377 Fax: 309-663-7479


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CommunityHighSchoolDistrict155

Head

Injury

Care

and

Return

to

Play

Guidelines

Injuriestotheheadareverydifferentthaninjuriestootherpartsofthebody.Itisknownthatan

adolescentssusceptibilitytoaheadinjury,specificallyaconcussion,isgreaterthanthatofan

adult.Additionally,thehealingtimeofanadolescentsconcussioncantakelonger.

District155understandsthesafetyandwelfareofourstudentathletesisaprimaryconcern.As

such,allDistrict155athleticcoaches,volunteerandpaid,willcompletetheNationalFederation

ofHighSchoolsConcussioninSportsWhatyouNeedtoKnowvideouponemployment.

Completionwillbemonitoredbytheschoolsathleticdirector.

Thereis

currently

no

concussion

proof

equipment

made

for

any

sport.

As

such,

the

following

guidelinesaretobefollowedbyDistrictpersonnelwhenastudentathleteincursaheadinjury.

SIGNS/SYMPTOMSCONSISTENTWITHACONCUSSION(INCLUDEBUTARENOT

LIMITEDTO):

SIGNSOBSERVEDBYSTAFF SYMPTOMSREPORTEDBYATHLETE

Appearsdazedorstunned

Isconfusedaboutassignmentor

position

Forgets

an

instruction

Isunsureofgame,score,oropponent

Movesclumsily

Answersquestionsslowly

Losesconsciousness(evenbriefly)

Showsmood,behaviororpersonality

changes

Cantrecalleventspriortohitorfall

Cantrecalleventsafterhitorfall

Headacheorpressureinhead

Nauseaorvomiting

Balanceproblemsordizziness

Double

or

blurry

vision

Sensitivitytolight

Sensitivitytonoise

Feelingsluggish,hazy,foggy,or

groggy

Concentrationormemoryproblems

Confusion

Justnotfeelingrightorisfeeling

down

ACTION

PLAN:

Ifyoususpectthatanathletehasaconcussion,youshouldtakethefollowingfoursteps:

1. Removetheathletefromplay.

2. Ensurethattheathleteisevaluatedbytheathletictrainer.


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3. Ifnoathletictrainerisavailable,theathletewillnotreturntopracticeorplay.Thecoach

willdecideif911shouldbecalled.Theparent(s)shouldbecalledandinformedoftheir

childscondition.If911iscalled,theathleticdirectororassistantathleticdirectorshould

becontactedimmediately.

4. Theathleteisnottobeleftalonefollowingtheinjury.Monitoringoftheathletefor

deteriorationis

essential

over

the

initial

few

hours

following

the

injury.

5. Givetheathletesparentsorguardiansafactsheetonconcussion.

6. Keeptheathleteoutofplaythedayoftheinjuryanduntilahealthcareprofessional,

trainedintheevaluationandmanagementofconcussionsstatestheathleteissymptom

freeanditsOKtoreturntoplay.

7. Notifytheschoolnurseoftheathletesconcussion.

8. Whenindoubt,sitthemout.

GRADUATEDRETURNTOPLAYPROTOCOL

Step

1:

Lightaerobic

exercise

to

increase

heart

rate

and

blood

pressure

in

the

brain.

Step2: Performmoderatetoheavycardioand/orsportspecificdrills.

Step3: Lightcontactwithnoheadimpactactivities.

Step4: Fullparticipationinpracticewithfullcontact.

Step5: Ifnosymptomsreturninstep4,ANDneurocognitivescoreshave

returnedtonormal(ifused),thentheathletewillbeclearedtoresume

playwithnorestrictions.

RETURNINGTOPLAY:

PriortoreturningtoANYphysicalactivity(includingphysicaleducationclass)the

athletemustreporttotheAthleticTrainerforfurtherevaluation.Theathleteshould

notparticipateinanyphysicalactivityuntilclearedbytheAthleticTrainingStaff.

Theathleteshouldreceivecognitiverestwhilesymptomatic.Exposuretoloud

noises,brightlights,computers,videogames,televisionandphones(includingtext

messaging)mayworsenthesymptomsofaconcussion.

Neurocognitivetestingmaybeusedasatoolprovidedthestudentathletehas

completedapretest.

Intheeventtheathletehassymptomsduringanyoftheabovesteps,thentheprocess

returnstothepreviousstepwithaminimumof48hoursofrestbeforeresumingthe

sequence.

Foralistofphysiciansfamiliarwithconcussionmanagementprogramsandneurocognitive

testing,pleasecontactyourCertifiedAthleticTrainer.December2010


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undee Crown High School

Concussion Management Protocol

Rosemarie Patrick, ATC

Dundee Crown High School

Compiled by

Brian Kosan, ATC, !"MT#P

Head Athletic Trainer, $MSA

Accelerated !ehabilitation Centers

!osemarie Patric%, ATC

Head Athletic Trainer, DCHS

Accelerated !ehabilitation Centers

$n Consultation with

Dr& "li'abeth M& Pieroth, Psy& D, ABPP#C

europsychologist

Midwest Center (or Concussion Care

Created )*+-

Revised 8/2014


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Table o( Contents

Signs and Symptoms of Concussion.............................................................................................

Concussion Se!erity Classification................................................................................................ "

#mmediate $ield %anagement....................................................................................................... "

Concussion Treatment................................................................................................................... "

#mmediate Referral #ndications...................................................................................................... &

Delayed Referral #ndications..........................................................................................................&

Dis'ualification Timeta(le.............................................................................................................. )

Return to Play Algorithm............................................................................................................... *


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P a g e +

$ntroduction

The purpose of this protocol is to clearly address the issue of concussion recognition and managementhere at Dundee Crown High School. #t shall discuss the definition of a concussion, the signs andsymptoms of a concussion, how the Dundee Crown Sports %edicine staff will e!aluate and classifyconcussions, concussion treatment, indications for physician referral, and return to play procedures.This protocol is deri!ed from the most recent e!idence(ased medical practice as well as from theconsensus and position statements from !arious professional medical associations. $urthermore, thisprotocol was produced in consultation (y a concussion specialist as a standing medical order.

e(inition o( a Concussion

A concussion is a comple- inury process affecting the (rain which is caused (y a direct or indirecttraumatic force on the head and/or neck. This inury process typically results in the rapid onset of shortli!ed impairment of neurological function. Howe!er, these impairments are generally functionaldistur(ances and not a structural inury as the impairments are caused (y meta(olic changes in the(rain. These impairments result in a gradually impro!ing set of clinical symptoms which are reported(y the patient and o(ser!ed (y others.0

Signs and Symptoms o( Concussion

Recognition of the signs and symptoms of concussion is the cru- of its diagnosis and management. Asymptom is something that is reported (y the patient1 whereas a sign is something o(ser!ed (ycoaches, parents, or medical staff. The signs and symptoms of concussion !ary from person to personas well as from incident to incident. A concussion should (e suspected if anyone or moreof thefollowing occur in conunction with some sort of traumatic force to the head or neck 0,2,3

Symptoms Reported (y Athlete Signs 4(ser!ed (y 4thers

Headache

5ausea or !omiting

Di66iness

7lurred, dou(le, or a(normal !ision

Sensiti!ity to light and/or noise

$atigue

$eeling 8foggy9 or 8out of it9

Change in sleeping pattern

Concentration or memory issues

Confusion

Person appears da6ed or stunned

Disorientation to place and/or time

Can:t recall e!ents (efore inury

Can:t recall e!ents after inury

;oss of consciousness

Sei6ure acti!ity

#t should (e stressed that one need not lose consciousness in order to incur a concussion1 rather, lossof consciousness occurs in only a(out 0?@ of cases.2 A direct (low to the head is also not necessaryin order to get a concussion. The (rain only needs to mo!e within the cranium and collide with thewalls of the skull. Therefore, an indirect force to the head like coming to a sudden stop (y colliding withanother person or o(ect can cause the (rain to mo!e and create a concussion. Concussion symptomscan (e immediate or delayed up to 2" hours.


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Concussion ".aluation and Classi(ication Algorithm

".aluation o( Concussion

Any athlete who is suspected of sustaining a concussion should (e immediately remo!ed from play and

not allowed to return to play until e!aluated (y a health care professional trained in the e!aluation and

management of concussions. 5o athlete should e!er return to play the same day they ha!e sustained a

concussion. The e!aluation of a concussion shall (egin as soon as the medical staff makes contact

with the athlete, whether that is on the field or on the sideline. A detailed history shall first (e taken in

order to determine mechanism of inury, orientation, memory integrity, and a symptom in!entory. A

medical e-amination will also (e conducted so as to gather !ital sign and neurological (aselines. 4nce

immediate life threats are ruled out and a concussion is suspected (y !irtue of findings listed in the

8Signs and Symptoms of Concussion9 section of this protocol, the staff shall utili6e the SCAT

assessment tool =located in Appendi- C> to document findings.0

#f the medical staff is not a!aila(le to complete an e!aluation of the athlete, the coaching staff should

remo!e the athlete from competition. #f the inury occurs at another school, that school:s sportsmedicine staff will take the place of the Dundee Crown High School Sports %edicine Staff.


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P a g e + &

a!aila(le is to get plenty of sleep, keep hydrated, and to maintain a healthy, (alanced diet. The use ofadditional e!aluati!e tools =SCAT, #mPACT> will (e implemented on a case (y case (asis.

#f a studentathlete is suspected of ha!ing a concussion, their parents will (e contacted and they shall(e sent home for o(ser!ation. The Dundee Crown Sports %edicine staff encourages families toconsider keeping their child home for at least 0 school day in order to promote mental rest. hile this

time out of school may put them (ehind in the shortterm, returning to the academic en!ironment toosoon can (e detrimental in the longterm. The student:s (rain may not (e a(le to operate at its highestcapacity in terms of processing speed, memory formation, and memory recall. Additionally, thecogniti!e load can potentially slow reco!ery. A simple analogy to consider is that thinking on aconcussion is like trying to run on freshly sprained ankle.

#n the past, people were told to awaken someone with a concussion e!ery 2 hours through the night.This practice has gone (y the wayside as it has (een determined to (e generally unnecessary anddisrupts the sleep that is so important to reco!ery. The patient should (e awakened at certain inter!alsduring the night onlyif it is specifically ordered (y a physician.2

All patients shall (e sent home with a head inury home care instructions sheet. The sheet summari6es

this section to the parents and also pro!ides information for monitoring the patient. The sheet isincluded in this protocol, and it can (e located in Appendi- 7.

$ndications (or Physician !e(erral

The decision for referral to a physician will (e (ased on se!erity of symptoms. The Dundee Crown

Sports %edicine staff will work with the parents to guide them on immediate referral to the emergency

room !ersus delayed referral to a physician trained in concussion management. Recommendations will

(e (ased on reported symptoms, physical findings and patient history.

$mmediate !e(erral $ndications

The following are e!aluation findings that, when present, the Dundee Crown Sports %edicine staff willstrongly ad!ise that the athlete (e seen that day (y a physician or in an emergency department 23

;oss of consciousness on the field

Amnesia lasting longer than 0&

minutes Deterioration of neurological function

Decreasing le!el of consciousness

Decrease or irregularity in respirations

Decrease or irregularity in pulse

#ncrease in (lood pressure


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This is the type of physician referral that is most likely to (e recommended. Delayed referral meansthat the family can wait and o(ser!e the athlete to see if any of the following indicators arise in the daysfollowing the inury (efore seeking a physician:s care23

Appearance of any of the indicators listed in the immediate referral section

Postconcussion symptoms worsen or do not impro!e o!er time

#ncrease in the num(er of postconcussion symptoms reported Postconcussion symptoms (egin to interfere with the athlete:s daily acti!ities =i.e. sleep

distur(ances, trou(le in school>

Any appearance of immediate referral indicators in the days after the incident means that the athleteshould (e taken to the nearest emergency department. Howe!er, the other delayed referral indicatorsdo not necessarily re'uire emergent e!aluation. $amily physicians are certainly an option for referral,(ut they may or may not (e !ery e-perienced in the management of concussions. The Dundee CrownSports %edicine staff can help arrange e!aluation with a concussion management specialist so as topro!ide access to local and high 'uality physicians trained in the most uptodate concussion treatmentstandards.

hile many of us may (e part of families with physicians and other highly 'ualified medicalprofessionals as parents or relati!es, the Dundee Crown Sports %edicine staff strenuously insists thatany indi!idual referred to a physician for a concussion e!aluation should (e seen (y an independentphysician. This position is intended to help protect all parties from ethical conflicts of interest.

!eturn to Play Criteria

Concussions take time to heal, and returning to play too soon can either seriously hamper reco!ery ore!en pro!e dangerous for the athlete. Two concussions too close together, especially in youngathletes, can result in the conditions known as PostConcussion Syndrome and Second #mpactSyndrome. PostConcussion Syndrome is when symptoms of a concussion continue to linger outside

of the normal reco!ery window, usually in the presence of e-ertion, and may impact daily li!ing.Although it is a rare complication, Second #mpact Syndrome causes rapid swelling of the (rain that ismost often fatal0,2.

is0uali(ication Timetable

#t is with these considerations in mind that the athlete can only return to play once certain milestonesand indicators are met. As mentioned in the 8#mmediate $ield %anagement9 section, a Dundee Crownathlete will never(e returned to practice or competition that day if a concussion is suspected. Theathlete will remain dis'ualified from competition until he/she has (een cleared to (egin the return toplay protocol (y all mem(ers of the sports medicine team.

!eturn to Play Algorithm

At this time, District ?? will (e implementing the use of #mPACT and Dundee Crown High School will(e (aseline #mPACT testing all student athletes. As stated pre!iously in the EConcussion TreatmentSection: of this document, #mPACT, SCAT and other assessment tools may (e utili6ed following asuspected head inury as an additional e!aluati!e tool. 4nce the athlete is asymptomatic at rest, theyshall (e allowed to progressi!ely work (ack to competition. There is a stepwise manner in which theymust progress, and at least a 2" hour period must elapse (efore mo!ing to the ne-t stage. The athletemay not mo!e on to the ne-t stage unless they demonstrate accepta(le a(ility at the current stage.Any recurrence of symptoms means that the stage must (e repeated after asymptomatic for 2" hours.The stages of progression are as follows03


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P a g e + *

Stage Functional Exercise Stage Objective

0. 5o Acti!ity Complete physical F mentalrest

Reco!ery

2. ;ight Aero(ic e-ercise alking, swimming, stationary

(ike G *?@ of ma- heartrate1

5o resistance training

#ncrease heart rate and test

e-ertion in a controlleden!ironment

. SportSpecific e-ercise Running, shooting, or skatingdrills

Add mo!ement with e-ertion

". 5oncontact trainingdrills

Progression to more comple-training drills1 may startprogressi!e resistance

training

-ercise, coordination, andcogniti!e load

&. $ullcontact practice $ollowing medical clearance,return to normal training

acti!ities

Restore athlete:s confidence1coaching staff assesses

functional skills

). Return to play 5ormal game play


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P a g e + O

3. Cantu RC. 8Posttraumatic Retrograde and Anterograde Amnesia3 Pathophysiology and#mplications in rading and Safe Return to Play.9 Journal of Athletic Training. 2??01)=>32""2"N.

4. Holtsford S. 8Head Trauma.9 2009-2010 Southern Fo !alle" #$S S"ste% Standard &'erating(rocedures. Kuly 2??O3"0.

Appendi1 B 2 Home Care $nstruction Sheet


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Appendi1 C 2 Sports Concussion Assessment Tool 3 4SCAT35 /orm


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ampshire igh School


Jessica Forystek MS, ATC

Hampshire High School

Compiled by

Brian Kosan, ATC, NRMT!P

Head Athletic Trainer, "MSA

Accelerated Rehabilitation Centers

#essica $oryste% MS, ATC

Head Athletic Trainer, HHS

Accelerated Rehabilitation Centers

"n Consultation &ith

'r( li)abeth M( Pieroth, Psy( ', ABPP!CN

Neuropsychologist

Mid&est Center *or Concussion Care

Medically appro+ed by

Created -./0/

Revised 8/2014


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Table o* Contents

Signs and Symptoms of Concussion............................................................................................. 3

Concussion Seerity Classification................................................................................................ !

"mmediate Field Management....................................................................................................... !

Concussion Treatment................................................................................................................... !

"mmediate #eferral "ndications...................................................................................................... $

%elayed #eferral "ndications..........................................................................................................$

%is&ualification Timeta'le.............................................................................................................. (

#eturn to )lay Algorithm............................................................................................................... *


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) a g e + 3

"ntroduction

The purpose of this protocol is to clearly address the issue of concussion recognition and managementhere at Hampshire High School. "t shall discuss the definition of a concussion, the signs and symptomsof a concussion, ho the Hampshire Sports Medicine staff ill ealuate and classify concussions,concussion treatment, indications for physician referral, and return to play procedures. This protocol isderied from the most recent eidence-'ased medical practice as ell as from the consensus andposition statements from arious professional medical associations. Furthermore, this protocol asproduced in consultation and approed 'y a concussion specialist as a standing medical order.

'e*inition o* a Concussion

A concussion is a comple in/ury process affecting the 'rain hich is caused 'y a direct or indirecttraumatic force on the head and0or neck. This in/ury process typically results in the rapid onset of short-lied impairment of neurological function. Hoeer, these impairments are generally functionaldistur'ances and not a structural in/ury as the impairments are caused 'y meta'olic changes in the'rain. These impairments result in a gradually improing set of clinical symptoms hich are reported'y the patient and o'sered 'y others.1

Signs and Symptoms o* Concussion

#ecognition of the signs and symptoms of concussion is the cru of its diagnosis and management. Asymptom is something that is reported 'y the patient2 hereas a sign is something o'sered 'ycoaches, parents, or medical staff. The signs and symptoms of concussion ary from person to personas ell as from incident to incident. A concussion should 'e suspected if anyone or moreof thefolloing occur in con/unction ith some sort of traumatic force to the head or neck 1,,34

Symptoms #eported 'y Athlete Signs 5'sered 'y 5thers

Headache

6ausea or omiting

%i77iness

8lurred, dou'le, or a'normal ision

Sensitiity to light and0or noise

Fatigue

Feeling 9foggy: or 9out of it:

Change in sleeping pattern

Concentration or memory issues

Confusion

)erson appears da7ed or stunned

%isorientation to place and0or time

Can;t recall eents 'efore in/ury

Can;t recall eents after in/ury

a'normal eye tracking?

"t should 'e stressed that one need not lose consciousness in order to incur a concussion2 rather, lossof consciousness occurs in only a'out 1@ of cases. A direct 'lo to the head is also not necessaryin order to get a concussion. The 'rain only needs to moe ithin the cranium and collide ith thealls of the skull. Therefore, an indirect force to the head like coming to a sudden stop 'y colliding ithanother person or o'/ect can cause the 'rain to moe and create a concussion. Concussion symptomscan 'e immediate or delayed up to ! hours.


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) a g e + $

aaila'le is to get plenty of sleep, keep hydrated, and to maintain a healthy, 'alanced diet. The use ofadditional ealuatie tools >SCAT3, "m)ACT? ill 'e implemented on a case 'y case 'asis.

"f a student-athlete is suspected of haing a concussion, their parents ill 'e contacted and they shall'e sent home for o'seration. The Hampshire Sports Medicine staff encourages families to considerkeeping their child home for at least 1 school day in order to promote mental rest. Dhile this time out of

school may put them 'ehind in the short-term, returning to the academic enironment too soon can 'edetrimental in the long-term. The student;s 'rain may not 'e a'le to operate at its highest capacity interms of processing speed, memory formation, and memory recall. Additionally, the cognitie load canpotentially slo recoery. A simple analogy to consider is that thinking on a concussion is like trying torun on freshly sprained ankle.

"n the past, people ere told to aaken someone ith a concussion eery hours through the night.This practice has gone 'y the ayside as it has 'een determined to 'e generally unnecessary anddisrupts the sleep that is so important to recoery. The patient should 'e aakened at certain interalsduring the night onlyif it is specifically ordered 'y a physician.

All patients shall 'e sent home ith a head in/ury home care instructions sheet. The sheet summari7es

this section to the parents and also proides information for monitoring the patient. The sheet isincluded in this protocol, and it can 'e located in Appendi 8.

"ndications *or Physician Re*erral

The decision for referral to a physician ill 'e 'ased on seerity of symptoms. The Hampshire Sports

Medicine staff ill ork ith the parents to guide them on immediate referral to the emergency room

ersus delayed referral to a physician trained in concussion management. #ecommendations ill 'e

'ased on reported symptoms, physical findings and patient history.

"mmediate Re*erral "ndications

The folloing are ealuation findings that, hen present, the Hampshire Sports Medicine staff illstrongly adise that the athlete 'e seen that day 'y a physician or in an emergency department 4


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This is the type of physician referral that is most likely to 'e recommended. %elayed referral meansthat the family can ait and o'sere the athlete to see if any of the folloing indicators arise in the daysfolloing the in/ury 'efore seeking a physician;s care4


)ost-concussion symptoms orsen or do not improe oer time

"ncrease in the num'er of post-concussion symptoms reported )ost-concussion symptoms 'egin to interfere ith the athlete;s daily actiities >i.e. sleep

distur'ances, trou'le in school?

Any appearance of immediate referral indicators in the days after the incident means that the athleteshould 'e taken to the nearest emergency department. Hoeer, the other delayed referral indicatorsdo not necessarily re&uire emergent ealuation. Family physicians are certainly an option for referral,'ut they may or may not 'e ery eperienced in the management of concussions. The HampshireSports Medicine staff can help arrange ealuation ith a concussion management specialist so as toproide access to local and high &uality physicians trained in the most up-to-date concussion treatmentstandards.

Dhile many of us may 'e part of families ith physicians and other highly &ualified medicalprofessionals as parents or relaties, the Hampshire Sports Medicine staff strenuously insists that anyindiidual referred to a physician for a concussion ealuation should 'e seen 'y an independentphysician. This position is intended to help protect all parties from ethical conflicts of interest.

Return to Play Criteria

Concussions take time to heal, and returning to play too soon can either seriously hamper recoery oreen proe dangerous for the athlete. To concussions too close together, especially in youngathletes, can result in the conditions knon as )ost-Concussion Syndrome and Second "mpactSyndrome. )ost-Concussion Syndrome is hen symptoms of a concussion continue to linger outside

of the normal recoery indo, usually in the presence of eertion, and may impact daily liing.Although it is a rare complication, Second "mpact Syndrome causes rapid selling of the 'rain that ismost often fatal1,.

'is1uali*ication Timetable

"t is ith these considerations in mind that the athlete can only return to play once certain milestonesand indicators are met. As mentioned in the 9"mmediate Field Management: section, a Hampshireathlete will never'e returned to practice or competition that day if a concussion is suspected. Theathlete ill remain dis&ualified from competition until he0she has 'een cleared to 'egin the return toplay protocol 'y all mem'ers of the sports medicine team.

Return to Play Algorithm

At this time, %istrict 3@@ ill 'e implementing the use of "m)ACT and Hampshire High School ill 'e'aseline "m)ACT testing all student athletes. As stated preiously in the Concussion TreatmentSection; of this document, "m)ACT, SCAT3 and other assessment tools may 'e utili7ed folloing asuspected head in/ury as an additional ealuatie tool. 5nce the athlete is asymptomatic at rest, theyshall 'e alloed to progressiely ork 'ack to competition. There is a step-ise manner in hich theymust progress, and at least a ! hour period must elapse 'efore moing to the net stage. The athletemay not moe on to the net stage unless they demonstrate accepta'le a'ility at the current stage.Any recurrence of symptoms means that the stage must 'e repeated after asymptomatic for ! hours.The stages of progression are as follos14


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) a g e + *


1. 6o Actiity Complete physical G mentalrest

#ecoery

.


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Certi*ication and ndorsement

This protocol has 'een complied to conform to the most recent eidence-'ased medical practice andthe standards as set forth 'y my profession. The directies contained therein ill 'e adhered to 'y

myself or any other athletic trainer acting on my 'ehalf. Any deiation for this protocol shall occur onlyupon ritten orders 'y a physician. This protocol ill undergo an annual reie, and it shall 'e reisedas needed.

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKJessica Forystek MS, ATCHead Athletic Trainer, Hampshire High School

Appendi2 A! Re*erences

1. McCrory ), Meeuisse D, Johnston L, et al. 9Consensus Statement on Concussion in Sport4The 3rd"nternational Conference on Concussion in Sport Held in urich, 6oem'er @@N.:

Journal of Athletic Training. @@O2!!>!?4!3!-!!N.2. Puskieic7 LM, 8ruce S3?4N@-O*.


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) a g e + O

3. Cantu #C. 9)osttraumatic #etrograde and Anterograde Amnesia4 )athophysiology and"mplications in Prading and Safe #eturn to )lay.: Journal of Athletic Training. @@123(>3?4!!-!N.

4. Holtsford S. 9Head Trauma.: 2009-2010 Southern Fo !alle" #$S S"ste% Standard &'erating(rocedures. July @@O4!1.

Appendi2 B 3 ome Care "nstruction Sheet


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Appendi2 C 3 Sports Concussion Assessment Tool 4 5SCAT46 $orm


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Huntley High School Concussion Policy Information and Sign-off

A concussion is a brain injury. It is caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with the force

transmitted to the head. A concussion can range from mild to severe and disrupt the way the brain normally works. Even though most

concussions are mild, allconcussions are potentially serious and may result in complications including prolonged brain damage

and death if not recognized and managed properly. Even a ding or a bump on the head can be serious. You cant see a

concussion and most concussions occur without loss of consciousness. Signs and symptoms of a concussion may appear right after the

injury or take hours or days to fully appear. If your child reports any symptoms of a concussion, or if you notice the symptoms or

signs of a concussion, seek medical attention right away.

Symptoms Reported by Student-Athlete Signs observed by others:

Headache

Nausea

Balance problems or dizziness

Blurred, double, or fuzzy vision

Sensitivity to light or noise

Fogginess or grogginess

Drowsiness or sluggishness

Concentration or memory problems

Confusion

Loss of consciousness

Appears dazed

Confused about play/assignment or forgets play/assignment

Unsure of game, score, or opponent

Clumsiness

Slowly responds to questions

Slurred speech

Behavior or personality changes

Cant recall events prior to or after injury

Seizures or convulsions

Vacant facial expression

What can happen if my child keeps on playing with a concussion or returns too soon?A student-athlete with the signs/symptoms of a concussion should be removed from play immediately. Continuing to play with the

signs/symptoms of a concussion leaves the student-athlete vulnerable to greater injury. There is an increased risk of significant

damage from a concussion for a period of time after a concussion occurs, particularly if the student-athlete suffers another concussion

before completely recovering from the first one. This can lead to prolonged recovery, or to severe brain swelling (second impact

syndrome) with devastating and even fatal consequences. Student-athletes sometimes fail to report injury symptoms. Concussions are

no different. Education of administrators, coaches, parents and students is the key to the safety of student-athletes.

Return to Play (RTP) PolicyAny student-athlete suspected of suffering a concussion should immediately be removed from play. No student-athlete may return to

play after a concussion without medical clearance, regardless of how mild it seems or how quickly symptoms clear. Close observationof the student-athlete should continue for several hours. IHSA Policy states that a student-athlete removed from an interscholastic

contest or practice due to a possible concussion, and not cleared to return to that same contest or practice, is required to provide the

school with written clearance from either of the medical professionals listed below.

1. Physician licensed to practice medicine in all its branches

2. Certified athletic trainer working in conjunction with a physician licensed to practice medicine in all its branches

In accordance with Public Act 097-0204, all IHSA member schools are required to follow this policy.

Inform the coach if you think your child may have a concussion. It is better to miss one game than to miss the whole season.

When in doubt, the student-athlete sits out.

For current and up-to-date information on concussions you can go to:

http://www.cdc.gov/ConcussionInYouthSports/.


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.D. Jacobs igh School


Christopher Thorson, ATC

Jacobs High School

Compiled by

Brian Kosan, AC, !"#M$P

Head Athletic rainer, %MSA

Accelerated "ehabilitation Centers

Christopher horson, AC

Head Athletic rainer, JHS

Accelerated "ehabilitation Centers

%n Consultation &ith

Dr. #li'abeth M. Pieroth, Psy. D, ABPP$C!

!europsychologist

Mid&est Center (or Concussion Care

Created )*+-

Revised 8/2014


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able o( Contents

Signs and Symptoms of Concussion............................................................................................. 3

Concussion Severity Classification................................................................................................ 4

mmediate !ield "anagement....................................................................................................... 4

Concussion Treatment................................................................................................................... 4

mmediate #eferral ndications...................................................................................................... $

%elayed #eferral ndications..........................................................................................................$

%is&ualification Timetable.............................................................................................................. '

#eturn to (lay Algorithm............................................................................................................... )


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Concussion #aluation and Classi(ication Algorithm

#aluation o( Concussion

Any athlete +ho is suspected of sustaining a concussion should be immediately removed from play and

not allo+ed to return to play until evaluated by a health care professional trained in the evaluation andmanagement of concussions. 6o athlete should ever return to play the same day they have sustained a

concussion. The evaluation of a concussion shall begin as soon as the medical staff ma0es contact

+ith the athlete, +hether that is on the field or on the sideline. A detailed history shall first be ta0en in

order to determine mechanism of inury, orientation, memory integrity, and a symptom inventory. A

medical e-amination +ill also be conducted so as to gather vital sign and neurological baselines. 5nce

immediate life threats are ruled out and a concussion is suspected by virtue of findings listed in the

9Signs and Symptoms of Concussion: section of this protocol, the staff shall utili7e the SCAT3

assessment tool >located in Appendi- C? to document findings.1

f the medical staff is not available to complete an evaluation of the athlete, the coaching staff should

remove the athlete from competition. f the inury occurs at another school, that school;s sportsmedicine staff +ill ta0e the place of the Jacobs High School Sports "edicine Staff. =nless the medicalstaff on site directs that the athlete be ta0en to the hospital, the athlete shall report to the AthleticTraining 5ffice upon their return to school for a more thorough medical evaluation.

Concussion Seerity Classi(ication

There is considerable debate in the sports medicine community as to +hich, if any, classificationsystem to use. =nfortunately, there is no consensus on system utili7ation as no single system isempirically proven nor fits every individual every time. t also needs to be stressed that theseclassifications historically +ere primarily used for initial management and they have not been positivelycorrelated +ith recovery time.

Concussion Management and reatment

%mmediate /ield Management

Any suspicion of concussion +ill dis&ualify that athlete from return to play that day. They shall continueto be monitored by the medical staff through the rest of the event. The athlete;s family +ill be notified ofthe situation. The indications for referral to a physician or emergency department +ill be discussed +ithfamily at this time. #efer to the 9ndications for (hysician #eferral: section of this protocol for ane-planation of these indicators.

Concussions +ith loss of consciousness shall be treated as a medical emergency. A high inde- ofsuspicion shall be upheld in these athletes. =pon arrival at the athlete;s side and initial evaluation

sho+ing loss of consciousness, the cervical spine should be immobili7ed, assure air+ay patency,address any immediate life threats, and B"S should be activated per the Jacobs High SchoolBmergency Action (lan. These patients shall be transported to the hospital via ambulance in order toreceive further medical care and evaluation4.

Concussion reatment


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( a g e * $

available is to get plenty of sleep, 0eep hydrated, and to maintain a healthy, balanced diet. The use ofadditional evaluative tools >SCAT3, m(ACT? +ill be implemented on a case by case basis.

f a studentathlete is suspected of having a concussion, their parents +ill be contacted and they shallbe sent home for observation. The Jacobs Sports "edicine staff encourages families to consider0eeping their child home for at least 1 school day in order to promote mental rest. Dhile this time out of

school may put them behind in the shortterm, returning to the academic environment too soon can bedetrimental in the longterm. The student;s brain may not be able to operate at its highest capacity interms of processing speed, memory formation, and memory recall. Additionally, the cognitive load canpotentially slo+ recovery. A simple analogy to consider is that thin0ing on a concussion is li0e trying torun on freshly sprained an0le.

n the past, people +ere told to a+a0en someone +ith a concussion every hours through the night.This practice has gone by the +ayside as it has been determined to be generally unnecessary anddisrupts the sleep that is so important to recovery. The patient should be a+a0ened at certain intervalsduring the night onlyif it is specifically ordered by a physician.

All patients shall be sent home +ith a head inury home care instructions sheet. The sheet summari7es

this section to the parents and also provides information for monitoring the patient. The sheet isincluded in this protocol, and it can be located in Appendi- 8.

%ndications (or Physician "e(erral

The decision for referral to a physician +ill be based on severity of symptoms. The Jacobs Sports

"edicine staff +ill +or0 +ith the parents to guide them on immediate referral to the emergency room

versus delayed referral to a physician trained in concussion management. #ecommendations +ill be

based on reported symptoms, physical findings and patient history.

%mmediate "e(erral %ndications

The follo+ing are evaluation findings that, +hen present, the Jacobs Sports "edicine staff +ill stronglyadvise that the athlete be seen that day by a physician or in an emergency department


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This is the type of physician referral that is most li0ely to be recommended. %elayed referral meansthat the family can +ait and observe the athlete to see if any of the follo+ing indicators arise in the daysfollo+ing the inury before see0ing a physician;s care


(ostconcussion symptoms +orsen or do not improve over time

ncrease in the number of postconcussion symptoms reported (ostconcussion symptoms begin to interfere +ith the athlete;s daily activities >i.e. sleep

disturbances, trouble in school?

Any appearance of immediate referral indicators in the days after the incident means that the athleteshould be ta0en to the nearest emergency department. Ho+ever, the other delayed referral indicatorsdo not necessarily re&uire emergent evaluation. !amily physicians are certainly an option for referral,but they may or may not be very e-perienced in the management of concussions. The Jacobs Sports"edicine staff can help arrange evaluation +ith a concussion management specialist so as to provideaccess to local and high &uality physicians trained in the most uptodate concussion treatmentstandards.

Dhile many of us may be part of families +ith physicians and other highly &ualified medicalprofessionals as parents or relatives, the Jacobs Sports "edicine staff strenuously insists that anyindividual referred to a physician for a concussion evaluation should be seen by an independentphysician. This position is intended to help protect all parties from ethical conflicts of interest.

"eturn to Play Criteria

Concussions ta0e time to heal, and returning to play too soon can either seriously hamper recovery oreven prove dangerous for the athlete. T+o concussions too close together, especially in youngathletes, can result in the conditions 0no+n as (ostConcussion Syndrome and Second mpactSyndrome. (ostConcussion Syndrome is +hen symptoms of a concussion continue to linger outside

of the normal recovery +indo+, usually in the presence of e-ertion, and may impact daily living.Although it is a rare complication, Second mpact Syndrome causes rapid s+elling of the brain that ismost often fatal1,.

Dis0uali(ication imetable

t is +ith these considerations in mind that the athlete can only return to play once certain milestonesand indicators are met. As mentioned in the 9mmediate !ield "anagement: section, at Jacobs athletewill neverbe returned to practice or competition that day if a concussion is suspected. The athlete +illremain dis&ualified from competition until he/she has been cleared to begin the return to play protocolby all members of the sports medicine team.

"eturn to Play Algorithm

At this time, %istrict 3@@ +ill be implementing the use of m(ACT and Jacobs High School +ill bebaseline m(ACT testing all student athletes. As stated previously in the FConcussion TreatmentSection; of this document, m(ACT, SCAT3 and other assessment tools may be utili7ed follo+ing asuspected head inury as an additional evaluative tool. 5nce the athlete is asymptomatic at rest, theyshall be allo+ed to progressively +or0 bac0 to competition. There is a step+ise manner in +hich theymust progress, and at least a 4 hour period must elapse before moving to the ne-t stage. The athletemay not move on to the ne-t stage unless they demonstrate acceptable ability at the current stage.Any recurrence of symptoms means that the stage must be repeated after asymptomatic for 4 hours.The stages of progression are as follo+s1


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1. 6o Activity Complete physical G mentalrest

#ecovery

.


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Certi(ication and #ndorsement

This protocol has been complied to conform to the most recent evidencebased medical practice andthe standards as set forth by my profession. The directives contained therein +ill be adhered to by

myself or any other Athletic Trainer acting on my behalf. Any deviation for this protocol shall occur onlyupon +ritten orders by a physician. This protocol +ill undergo an annual revie+, and it shall be revisedas needed.

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKChristopher Thorson, ATCHead Athletic Trainer, Jacobs High School

have revie+ed this document, and find it to be reasonable and medically sound. This standingmedical order is to be used as the Jacobs High School concussion recognition and managementprotocol. This order is to be follo+ed by all licensed Athletic Trainers and Athletic Training students

serving at Jacobs High School. %eviation from this order can only be made +ith a +ritten physician;sorder.

KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK


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( a g e * L

Appendi1 A$ "e(erences

1. "cCrory (, "eeu+isse D, Johnston M, et al. 9Consensus Statement on Concussion in SportThe 3rdnternational Conference on Concussion in Sport Held in Nurich, 6ovember @@O.:

Journal of Athletic Training. @@L244>4?43444O.2. Pus0ie+ic7 M", 8ruce S


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Assess the athletes

symptoms to determine

if he/she should be

transported for

emergency management

Remove the

athlete from play

and closely

monitor symptoms

Next Steps Arrange an appointment to see the appropriate

health care Provider (Pediatrician, Family

Physician, or Concussion Specialist)

Post-Injury testing using ImPACT should be don

within the first 24-72 hours following the injury

Testing can be scheduled by calling:

The

Centegra Screening/Concussion Hotl

(815) 759-4342

Follow the Athletic Trainers as they manage the return to play process. The athletemay return to play when the follow criteria are met:

1) permission from a health care professional,

2) following completion of an incremental staged return to play process (see below),

3) the athletes ImPACT testing has returned to their baseline results

RETURN TO PLAY CRITERIA

Each step should be separated by at least 24 hrs without symptom reoccurrence.

If reoccurrence of any of the signs or symptoms of concussion happen at any step, the athlete

drops back to the previous step.

For persistent or concerning symptoms, consider further evaluation by a Neurologist

No physical

activity; rest

until athlete is

asymptomatic

Light aerobic

exercises

Sport specific

training

Non-contact

drills

Full Contact

drills (pending

assessment

and scores)

What to do in the Event of a ConcussionIf you have any

suspicion that your

athlete has sustained a

concussion, they may

not reenter

Return to pla

Rest the BrainLimit computer use, video

games, television

Stay Home

No academic/

mental activity

Stay Home

Light

academic/

mental activity

(30 minutes of

concentration)

Back to School

Part Time

2-3 classes

with

Modified

academics

School Part Time

4 classes plus

lunch or study

hall

Modified

academics

School Full-

Time

With modified

academics

School Full-

Time

No

modification

in academics


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Woodstock High School Sports MedicineConcussion Evaluation & Management Policy

3.

Evaluation

-t is the %TCs primary o!ective to rule out cervical spine involvement and determine the

severity of the head in!ury# -f at any time the student athlete losses consciousness" activate EMS#-f at any time the student athletes symptoms significantly increase" activate EMS# The %TC will

evaluate the integrity of the student athletes cranial nerve function & cervical myotomes#

Evaluate the athlete using Sports Concussion %ssessment Tool and 6raded Symptoms Checklist#

7nce the evaluation is complete and assessment is made the %TC will contact the parent or

guardian of the student athlete to inform them of the situation and medical treatment options" or

home care instructions# The student will e sent home with.parent will e provided with

Centegra Health System Sports Concussion Program folder

* Post!+n,ury/-ollow!up Care

% student who is deemed concussed y a Certified %thletic Trainer must receive physician

clearance prior to returning to activity# Students will e recommended to take the -mP%CT

Post/-n!ury Test in the Wellness Center at Centegra Health System M7) 3" Suite %" 8929 :oty

;oad" Woodstock" -llinois


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Woodstock High School Sports MedicineConcussion Evaluation & Management Policy

;epeating stages or completing additional workouts will not advance the student through the

protocol faster# 35 hours must lapse etween each stage# -f the onset of any post/concussion

symptoms occurs at any point during the return to play process" the parents will e notified? the

student must rest for 35 hours and restart the return to play protocol# -f symptoms arise again" theclearing physician will e notified and the student will need physician clearance again efore

eginning the return to play protocol#

)eturn to play protocol:

Stage -unctional E0ercise Stage 1",ect

@ight aeroic e,ercise Walking" swimming" stationary

ike A B92of ma, heart rate? $oresistance training

-ncrease heart rate and test e,ertion in

a controlled environment

Sport D specific e,ercise ;unning" shooting" or hitting drills %dd movement with e,ertion

$on/contact training drills Progression to more comple,

training drills? may start

progressive resistance training

E,ercise" coordination and cognitive

load

ull D contact practice ollowing medical clearance"

return to normal training activities

;estore athletes confidence? coaching

staff assesses functional skills

;eturn to play $ormal game play

+llinois High School 2ssociation )eturn to Play Policy

FHouse )ill 322" which recogni+es the dangers associated with head in!ury and concussion"ecame effective on Guly 1" 3211# The legislation also reuires -HS% memer schools to adopt a

policy regarding student/athlete concussions and head in!uries that is in compliance with the

protocols" policies" and y/laws of the -HS%# -nformation on the schools concussion and headin!ury policy must e a part of any agreement contract" code" or other written instrument that a

school reuires a student athlete and his or her parents or guardian to sign efore participating in

practice or interscholastic competition#

% student athlete who is suspected of sustaining a concussion or head in!ury in a practice or

game shall e removed from participation or competition at that time#

WHS Sports Medicine

0pdated 12.34.15


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Community Unit

School District 200High School

ConcussionProceduresContributors:

Accelerated Rehabilitation CentersCentegra Health Systems


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Community Unit School District 200 High School ConcussionManagement

Before injury occurs

Student athlete is Impact Baseline concussion tested (highly recommended, but subject to

parent/guardian consent!

"est is #alid $or t%o years!

Injury occurs

A coach, o$$icial, parent, or student athlete notices that a student demonstrates signs, symptoms

or beha#iors consistent %ith a concussion (such as loss o$ consciousness, headache, di&&iness,

con$usion, or balance problems!

"he o$$icial, parent, or student athlete immediately in$orms the coach o$ the suspected injury!

Student is immediately remo#ed $rom the game or practice!

Athletic "rainer responds on site!

I$ Athletic "rainer is not on site, coach %ill call Athletic "rainer or Athletic 'irector $or $urther

instruction!

Athletic Trainer intervention

'etermine se#erity o$ head injury

Contact parent/guardian and )S i$ necessary as determined by Athletic "rainer or on*site

super#isor!

In$orm the parent/guardian o$ situation and need $or student athlete to be e#aluated and cleared

$or return to play by student athlete+s physician!

Athletic trainer %ill gi#e parent/guardian a copy o$ the baseline concussion consent $orm $rom

Centegra! arent can submit this $orm to the treating physician so they are a%are that Impact

Baseline testing %as completed and %ho to contact $or results!

Athletic trainer %ill also in$orm parent that Impact ost*Injury Concussion "est can be scheduled

at Centegra Health Systems -.*- hours a$ter injury occurs, by calling (012 23*.4.-, selectprompt 1!

arent should in$orm Athletic "rainer i$ ost*Injury Impact "est is scheduled at Centegra!

Student Athlete %ill not start the return to play protocol or physical education class until cleared

by the athlete+s physician!

Follow-up treatment and return to play

IHSA Return to lay (R" olicy states, 5in cases %hen an athlete is not cleared to return to play

the same day as he/she is remo#ed $rom a contest $ollo%ing a possible head injury (i!e!, concussion,


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the athlete shall not return to play or practice until the athlete is e#aluated by and recei#es %ritten

clearance $rom a licensed health care pro#ider6 listed belo%:

hysician licensed to practice medicine in all its branches7 or

Certi$ied athletic trainer %or8ing in conjunction %ith a physician licensed to practice

medicine in all its branches!

"here is a step*%ise manner in %hich they must progress, and at least a -. hour period must

elapse be$ore mo#ing to the ne9t stage! "he athlete may not mo#e on to the ne9t stage unless

they demonstrate acceptable ability at the current stage! Any recurrence o$ symptoms means that

the seuence must be restarted!

Impact test can be repeated a$ter the injury occurs by calling Centegra Health Systems at (012*

23*.4.-, select prompt 1! Impact post*injury test results assist the treating hysician andAthletic "rainer in ma8ing decisions about the return to play process!

lease note: A student can be impact post*injury tested more than once and %on+t begin

return to play process until cleared by their treating hysician! In addition, i$ parent

chooses to schedule post*injury concussion test at Centegra Health Systems, results o$ the

post*injury test must also be re#ie%ed and ha#e returned to baseline be$ore beginning the

return to play process!

Return to play protocol:

Stage Functional !ercise Stage "#ject

;o Acti#ity Complete physical and mental rest Reco#ery

?@o$ ma9 heart rate7 ;oresistance training

Increase heart rate and test e9ertion in

a controlled en#ironment

Sport speci$ic e9ercise Running, shooting, or hitting drills Add mo#ement %ith e9ertion

;on*contact training drills rogression to more comple9

training drills7 may startprogressi#e resistance training

9ercise, coordination and cogniti#e

load

ull contact practice ollo%ing medical clearance,

return to normal training acti#ities

Restore athlete+s con$idence7 coaching

sta$$ assesses $unctional s8ills

Return to play ;ormal game play

$ome %are instructions for %oncussions

%ommon Signs and Symptoms

&hysical: headache, #isual problems, nausea/#omiting, $atigue, di&&iness, sensiti#ity to light or

noise, balance problems, numbness/tingling!


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%ognitive: $eeling mentally $oggy, $eeling slo%ed do%n, di$$iculty remembering, and di$$icultyconcentrating!

motional: irritability, sadness, more emotional, ner#ousness!

Sleep: dro%siness, sleeping less than usual, sleeping more than usual, trouble $alling asleep!

''See( Immediate %are if: ''

$eadaches worsen -- una#le to #e awo(en -- una#le to recogni)e people -- vomiting

*hat to do ne!t:

=atch your athlete closely! I$ any o$ his/her symptoms seem to be getting %orse or more

8eep sho%ing up, they should be ta8en to the mergency Room immediately!

Deep your athlete uiet and rela9ed! )inimi&e stimulation such as "E, computer, phone,

#ideo games, etc! =hen doing home%or8, ha#e him/her complete it in short time periods

%ith $reuent brea8s!

Four athlete needs sleepG Sleep is the best %ay $or the brain to reco#er! Fou can chec8 on

him/her throughout the night i$ you %ould li8e to, but i$ they appear to be sleeping

peace$ully, let them sleepG

+our athlete,s concussion care can #e managed through the Athletic irector at yourstudent,s school. /any times the needs of the athlete re0uire them to see a physician.

If this is the case1 #e sure to see a physician who has #ac(ground (nowledge in

concussion management. If you need a recommendation please call your child,s

Athletic irector

School:

In$orm the teachers, counselor, and administrators about your child+s injury and symptoms!

Sometimes a child may bene$it $rom ta8ing a $e% days o$$ to rest as it %ill help in reco#ery!

=hen appropriate, ha#e the student chec8 in %ith the Athletic "rainer on the $irst day

he/she returns!

"ell the !! teacher and coaches o$ the injury as they %ill be re$raining $rom acti#ity! Students %ho e9perience symptoms o$ concussion o$ten need e9tra help to per$orm school*

related acti#ities and may not per$orm at their best on classroom or standardi&ed tests!

Athletic "rainer can recommend that student be %ithheld $rom physical education class i$

concussion suspected and reco#ery not complete based on return to play protocol results!

"he injured person should not participate in A;F high ris8 acti#ities that might result in head

injury until e9amined and cleared by a uali$ied health pro$essional!

It is normal $or the child/teenager to $eel $rustrated, sad, and e#en angry because they cannot return

to sports or recreation right a%ay! ollo% the right steps and your athlete %ill reco#er and there

%ill be no lingering e$$ectsG lease call your Athletic 'irector i$ you ha#e any uestions orconcerns!

/edical Facilities


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Centegra ;euro*Rehabilitation and Concussion Clinic (012 42*-@@

Crystal

concussion management plans

Documents