Transcript Concussion Management Protocol

Concussion Management Protocol
Purpose: The purpose of this policy is to establish a protocol for
defining concussions, recognizing symptoms of concussions, and
determining the return to play of an athlete following a concussion at
Jefferson City High School.
Definition of a concussion
 According to the International Conference on Concussion
(2008)1, a concussion is defined as: a complex
pathophysiological process affecting the brain, induced by
traumatic biomechanical force. It can be caused by numerous
forces such as a direct blow to the head, face, neck, or
elsewhere on the body causing an impulsive force transmitted
to the head. Concussions usually result in impairment of
neurological function in a rapid onset and resolve
spontaneously.
Signs and Symptoms of Concussions (can
include but not limited to the following):
 Headaches
 Light headedness
 Emotional symptoms
 Amnesia
 Loss of consciousness
 Behavioral changes
 Slowed reaction times
 Drowsiness
Concussion
 If an athlete is suspected to have sustained a concussion:
 Athlete should be evaluated by the onsite medical personnel.
 If no medical personnel are available the athlete should safely be removed
from the playing field (only if no spinal injury suspected) and referred to a
physician.
 Following any first aid management, that medical team should assess the
athlete using SCAT2 concussion assessment tool.
 Once diagnosed with a concussion that athlete should not be allowed to
return to play that day.
Second-Impact Syndrome
 “Second impact syndrome occurs when a second, often minor,
injury occurs subsequent to a previous closed head injury that
has not completely cleared. The athlete develops rapid brain
swelling associated with collapse, rapidly dilating pupils, loss of
eye movement, and respiratory failure within seconds to minutes
of the second injury. The outcome is uniformly severe brain
injury or death. The only treatment is prevention.”
 – Taken from the MSHSAA Sport Medicine Handbook, 20102011.2
Management of a concussion
 The ImPACT program will be utilized to establish a baseline of the
athletes’ neurocognitive responses prior to each athletic season. Upon
sustaining a suspected concussion the athlete will be evaluated by the
Athletic Trainer and the physician using the ImPACT program.
Following the test and diagnosis of a concussion that athlete should have
complete physical and cognitive rest until symptoms have resolved. A
graduated return to play protocol has been outlined and recommended
by the International Conference on Concussion (2008)
Return to Play Protocol
Stage
Functional Activities
Allowed
Objective
No Activity
Complete Rest
Recovery
Light aerobic exercise
Walking, swimming,
stationary bike, HR
below 70%
Increase HR
Sport specific exercise
Running drills in soccer,
basketball, football
softball, volleyball, etc.
No head impact
Adding movement
Non-Contact drills
Progress to more
complex drills, passing
drills, progressive
resistance
Exercise coordination,
and cognitive load
Full Contact Practice
Following medical
clearance, participate in
normal training
Restore confidence of
athlete and allow for
assessment
Return to play
Normal game play
Return to Play Protocol
 Each athlete is different. The athlete will be evaluated 24 and 48
hours after the concussion has occurred. After the athlete is
symptom free, they will go through the above return to play
protocol. The key to the return to play is progressing in the
protocol symptom free.
Return to Play Protocol
 If any post concussion symptoms occur during a stage, the
athlete will be dropped back to the previous asymptomatic
stage, and progressed again after a further 24 hours period
of rest. There is no set return to play time. The athlete may
return to play in a minimal of one week or longer
depending on their progression of symptoms and activities.
Referral and Home Care
 The athlete should be referred for further medical examination
if he/she experiences any LOC, amnesia that lasts for more than
15 minutes, deterioration of symptoms, neurological symptoms,
increase in blood pressure, unequal or dilated pupils, or if
athlete is not stabilizing or conditions get worse.
Referral and Home Care
 Instructions, written and oral, should be given to the
concussed athlete and to a care giver if the athlete is
allowed to return home. The National Athletic Trainer’s
3
Association recommends that should an athlete
experience loss of consciousness (LOC) or prolonged
periods of amnesia, that athlete be woken up in the night
to check for deterioration of symptoms.
Multiple Concussions
 The MSHSAA Sports Medicine committee recommends that if
an athlete sustains 3 concussions during one season of play, that
athlete should be disqualified for that season and a thorough
examination should be performed before participating in an
another season.
Prevention of Concussions
 It should be noted that there is no evidence available that states
protective equipment will completely protect against a
concussion. However, protective equipment can be used to help
prevent and reduce impact forces to the brain.
Prevention of Concussions
 In athletics there is always going to be athletes that try to hide
their symptoms out of fear of losing playing time. Coaches, staff,
and parents should be educated on the dangers of disguising head
injuries and that all head injuries are serious.
Return to Play
 Dr. Michael Steenbergen is the recognized team physician at
Jefferson City High School in concussion management. All
Jefferson City High School athletes need to be cleared by Dr.
Steenbergen prior to their return to sports.
 There is a progression of return to play performed by Dr.
Steenbergen and the schools recognized athletic trainer from St.
Mary’s Sports Medicine Center.
 1. McCrory P., Meeuwisse, W., & Johnston, K., et al. Consensus
State on Concussion in Sport:
 The 3rd International Conference on Concussion in Sport Held
in Zurich, November 2008. Journal of Athletic Training. (2009).
44(4);434-448.
 2. MSHSAA Sports Medicine Manual 2010-2011