Concussion Guidelines

The following evaluative procedure will be done after a primary survey has been completed to rule out other possible injury.

Initial Sideline evaluation during Game

Athletes sustaining head injuries will be assessed by the ATC using the modified SCAT 2 [Sport Concussion Assessment Tool 2: comprised of a Standardized Assessment of Concussion (SAC), a Graded Symptoms Checklist (GSC), and the Balance Error Scoring System (BESS)] at the time of injury. The components of the SCAT 2 will be used to determine return to activity once cleared by a physician. If the ATC suspects a concussion, the athlete will be removed from the game/practice and not return the same day.

  • In the event of an unresponsive athlete (loss of consciousness), the athlete will be transported via ambulance to a medical facility and referred to a qualified medical professional (MD, DO, CRNP). The ATC will follow the guidelines set forth in his/her school’s Emergency Action Plan. The ATC may also follow up with the referring medical professional (MD, DO, CRNP) following the athlete’s clearance.
  • In the event the responsive athlete’s symptoms worsen, the athlete will be transported via ambulance to a medical facility and referred to a qualified medical professional (MD, DO, CRNP). The ATC will follow the guidelines set forth in his/her school’s Emergency Action Plan. The ATC may also follow up with the referring medical professional (MD, DO, CRNP) following the athlete’s clearance.

The parents/guardian of the athlete will be contacted at the conclusion of the game/practice and home care instructions will be given to the athlete and his/ her parents. Instructions will also be given for the athlete to contact the ATC the following game/practice for a report of symptoms.

What is a concussion?

As per the SCAT2, a concussion is described as a disturbance in brain function caused by a direct or indirect force to the head. It can result in a variety of symptoms and often does not involve loss of consciousness. Concussion should be suspected if any one or moreof the following are present:

  • Physical symptoms (such as headache, dizziness or vomiting)
  • Physical signs (such as unsteadiness)
  • Impaired brain function (such as confusion or memory loss)
  • Abnormal behavior.

Return to Classroom

Temporary learning support accommodations may be needed and will be determined by the treating physician.

Return to Play Guidelines

Once a concussion has been diagnosed, the ATC will follow the Guidelines developed at the International Conference on Concussion in Sport held in Zurich, November 2008. An athlete will begin these Return to Play Guidelines once they are asymptomatic for 24 hours while performing daily activities and school work, and will successfully complete an ImPACT test with no significant change since baseline prior to returning to competition. The athlete must have written clearance from his/her physician to RTP. As per the Safety in Youth Sports Act, penalties must be imposed by the governing body of the school if the student athlete is returned to activity prior to being cleared in writing by a physician.

4.1 Graduated RTP Protocol:

Return-to-play protocol following a concussion follows a stepwise process as outlined in Table 1. With this stepwise progression, the athlete should continue to proceed to the next level if asymptomatic at the current level. Generally each step should take 24 hours, so that an athlete would take approximately 1 week to proceed through the full rehabilitation protocol once asymptomatic at rest and with provocative exercise. If any post concussion symptoms occur while in the stepwise program, then the patient should drop back to the previous asymptomatic level and try to progress again after a further 24-hour period of rest has passed.

Consensus Statement on Concussion in Sport: The 3rd International Conference on Concussion in Sport Held in Zurich, November 2009. McCrory et al Journ Athl Train2009; 44(4):434–448

Day

/ Rehabilitation Stage / Functional Exercise / Objective
0 / No Activity / Rest / Recovery
1 / Light Aerobic Exercise / Push ups, squats, swimming, cycling etc. / Increase heart rate
2 / Sport Specific Exercise / Running, Cutting, sprinting / Increase heart rate with added movement
3 / No Contact training drills / Throwing, kicking. Resistance training / Exercise, Coordination, with cognitive load
4 / Full Contact Practice / Normal practice routine / Allow athlete to return to normal activity prior to game play. Coach will assess athletes performance
5 / Return to Play / Full contact: game/competition

*in conjunction with the above grid, athletes may also follow a more detailed Return to Play protocol developed by the University of Pittsburgh’s Medical Center and ImPACT team physicians. If the athlete’s symptoms persist or worsen past 5 days they will be referred for medical evaluation.

ImPact Testing:

NASD is using the ImPACT System; the latest concussion management tool utilized by physicians and certified athletic trainers. The Immediate Post-Concussion Assessment and Cognitive Test, or (ImPact), baseline test will be conducted based on guidelines set by ImPACT, Coordinated Health, and the school district. In the event that an athlete sustains a concussion, severity and progression can be assessed based on a comparison between baseline scores and asymptomatic post-injury scores, as well as the SCAT 2 and all of its components; which will then determine return to play. Prior to return to activity, when the athlete is asymptomatic and their SCAT 2 testing is normal, the athlete may be ImPact tested as directed by the Certified Athletic Trainer. If you have any questions, please feel free to contact us.

Certified Athletic Trainer: ______

Office Phone Number: ______