Download Concussion - Protocol and Permission to Return

Winnacunnet High School Concussion Protocol
All coaches must take the NFHS Concussion course prior to working with students in their
coaching season. 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. 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)
Patient Name:
CARE PLAN
DOB:
Date:
Date of Injury:
Gerard Gioia, PhD1 & Micky Collins, PhD2
1
2
Children’s National Medical Center
University of Pittsburgh Medical Center
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.
Today the following symptoms are present (circle or check).
Physical
____No reported symptoms
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
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).
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.
Gradual Return to Play Plan
1. No physical activity
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
© Copyright G. Gioia & M. Collins, 2006
___ Other:
ACE Care Plan Completed by:
Date:
Signature of a Parent/Guardian:
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.