Willamette High School Sports Medicine

ConcussionManagement

Mission Statement: At Willamette High School, the athletic staff strive to provide the best possible health care for each student-athlete while striving to support each one to compete at his/her best in the classroom and on the field. In the case of injury, we work to return our student-athletes back to play as safely and as quickly as possible. Because our parents, teachers, administrators, coaches, and support staff value each athlete’s health as well as desire to see everyone on the field, we will continue to advocate for best practice to safely support our athletes.

OSAA Policy regarding Member Public School Responsibilities with Concussion Management:

  1. Suspected or Diagnosed Concussion:Any athlete who exhibits signs, symptoms or behaviors consistent with a concussion following an observed or suspected blow to the head or body, or who has been diagnosed with a concussion, shall not be permitted to return to that athletic contest or practice, or any other athletic contest or practice on that same day. In public school districts which have the services of an athletic trainer registered by the Oregon Board of Athletic Trainers, that athletic trainer may determine that an athlete has not exhibited signs, symptoms, or behaviors consistent with a concussion, and has not suffered a concussion, and return the athlete to play.Public school athletic trainers may also work in consultation with an appropriate Health Care Professional (see below) in determining when an athlete is able to return to play following a concussion.
  2. Return to Participation:Until an athlete who has suffered a concussion is no longer experiencing signs, symptoms, or behaviors consistent with a concussion, and a medical release form signed by an appropriate Health Care Professional (Physician (MD), Physician’s Assistant (PA), Doctor of Osteopathic (DO) licensed by the Oregon State Board of Medicine, Nurse Practitioner licensed by the Oregon State Board of Nursing, or Psychologist licensed by the Oregon Board of Psychologist Examiners) is obtained, the athlete shall not be permitted to return to athletic activity.

For the purposes of clarity, the term physician will refer to an appropriate health care professional as defined above.

What is a concussion?

A concussion is a brain injury in which trauma to the head results in a temporary disruption or alteration of normal brain function. The injury occurs when a person’s brain is violently rocked back and forth or twisted inside the skull as a result of a direct or indirect force. A concussion disturbs brain activity and should be perceived and handled as a significant injury. Proper healing and recovery time following a concussion are crucial in preventing further injury.

Student-athletes who are not fully recovered from an initial concussion are significantly vulnerable for recurrent, cumulative, and even catastrophic consequences of a second concussive injury. Such difficulties are prevented if the student-athlete is allowed time to recover from concussion and return-to-activity decisions are carefully made. No student-athlete should return to sport or other at-risk participation when symptoms of concussion are present and recovery is on-going. In summary, the best way to prevent difficulties with concussion is to properly manage the injury when it occurs.

Identifying concussions:

Signs (what is observed by others) and symptoms (what is reported by individual) after a direct or indirect blow to the head that indicate concussion include but are not limited to the following:

  • Appears dazed or stunned
  • Loses consciousness or “blacks out”
  • Trouble balancing or moves clumsily
  • Confused and/or disoriented
  • Can’t recall events before or after injury
  • Blank or vacant look
  • Abnormal behavior or mood changes
  • Answers questions slowly or is unsure
  • Dizziness
  • Headache or “pressure in the head”
  • Blurred or double vision
  • Difficulty concentrating or remembering
  • Slowed thought processes or feeling like “in a fog”
  • Nausea
  • Sensitivity to light and sound
  • Trouble sleeping

Recognition and Immediate Care:

If a student-athlete receives a direct or indirect blow to the head and exhibits any signs and/or symptoms that seem suspicious that he or she may have had a concussion.That athlete must be removed from all physical activity, including sports, academics, and recreation and evaluated. Parents and coaches are not expected to be able to “diagnose” a concussion. That is the role of an appropriate healthcare professional. When in doubt, sit them out!

When a coach suspects that a player has a concussion, follow the “Heads Up” 4-step Action Plan.

  1. Remove the athlete from play.
  2. Ensure that the athlete is evaluated by an appropriate health-care professional.
  3. Inform the athlete’s parents or guardians about the possible concussion and give them information on concussion.
  4. Keep the athlete out of play the day of the injury and until an appropriate health-care professional says he or she is symptom-free and gives the okay to return to activity.

The signs, symptoms, and behaviors associated with a concussion are not always apparent immediately after a bump, blow, or jolt to the head or body and may develop over a few hours or longer. An athlete should be closely watched following a suspected concussion and should never be left alone.

Here at Willamette High School, we have an on-site athletic trainer who is present for home athletic events and practices. If a coach or parent suspects a concussion, please have the student-athlete evaluated by the athletic trainer in a timely manner. If this is not possible, please have the student athlete evaluated by a physician. If the AT is at a practice or competition and suspects a concussion, he or she will ask to evaluate the student-athlete if the student-athlete is not sent to him or her. If away at an athletic contest, the student-athlete should be evaluated by the host school’s AT before leaving the site. Our coach will contact the host team’s administration on site to locate the AT if not on the immediate site. The evaluation should be recorded and then shared with Willamette’s AT and the student-athlete’s physician.The AT will notify the concussion management team for further management of the concussion as necessary.

Initial sideline evaluation will include identification of a mechanism of injury, observation of signs, possibly Glasgow coma scale, Maddocks Score, and VOMS. After 10 minutes at a resting state, the rest of the Sport Concussion Assessment Tool – 3rd addition will be completed. This includes symptom evaluation, cognitive and physical assessment in particular of orientation, concentration, memory, balance, and coordination. This may include taking vital signs. Theseevaluation tools may also be used in the management and return to play decisions. ImPACT testing will also aid in return to play decisions and is discussed further later in this policy. If signs and symptoms of a concussion are present the student-athlete will be withheld from further competition and practice, monitored, and will not be allowed to return to play the same day. A parent/guardian of the student-athlete should be given further instructions after game or practice by the coach or AT.

Physician referral:

Any athlete with the following signs/symptoms present will be transported to the emergency room:

  • Decreasing levels of consciousness
  • Decrease or irregularity in respirations
  • Decrease or irregularity in pulse
  • Unequal, dilated, or unreactive pupils
  • Any signs/symptoms of associated injuries, spine or skull fracture, or uncontrolled bleeding
  • Mental status changes: lethargy, difficulty maintaining arousal, confusion or agitation
  • Seizure activity

A student-athlete may be referred to a physician the same day of injury if any of the following are present:

  • Memory loss lasting longer than 15 min
  • Increase in blood pressure
  • Cranial nerve deficits
  • Vomiting
  • Motor/Sensory/Balance deficits follow initial on-field or on-court evaluation
  • Post-concussion symptoms that worsen
  • Additional post-concussion symptoms as compared with those on the field
  • Student-athlete is still symptomatic at the end of the game

All student-athletes suspected of a concussion by coaches or parents or evaluated by the AT must provide a signed medical release by an appropriate health care professional (see OSAA policy) before returning to play. However, a signed medical release does not guarantee a return-to-play.

Management:

Willamette High School has formed a Concussion Management team to help the student-athlete and parent/guardians in managing this complex injury. The team consists of the athletic trainer, student-athlete’s physician, district nurse and health room assistant, school counselor, team physician, and administration. Once a student-athlete has been suspected or diagnosed with a concussion, the CMT will be notified either by the AT or the student-athlete’s counselor.

It will be the responsibility of the student and parent/guardian to implement the following instructions as necessary.Written or verbal instructions should be given to the parent/guardian by the coach or AT following the concussion or as soon as possible.

A student-athlete with a concussion injury needs to rest not only physically, but mentally as well. 80 to 90% of concussions resolve in 21-28 days. In effort to provide optimum recovery for our student-athletes suspected/diagnosed with concussion, WHS has adapted the following Return-to-Academics Progression from the Oregon Concussion and Management Program (OCAMP). Returning to mental activity too soon following concussion may worsen symptoms and prolong healing. Parents and guardians are encouraged to monitor symptoms the evening of and morning after the injury. If student is still symptomatic the next morning, we recommend keeping the student home from school and allowing no mental exertion. This includes homework, texting, social media, video games, TV, driving, social and extracurricular activities. Please schedule an appointment with student’s physician and take any necessary paperwork i.e. ImPact/SCAT results to the appointment. The below recommendations are also expected at this time.

-Physical rest from training, sports, PE classes, and other extracurricular activities until symptoms resolve and you are medically cleared by your physician and athletic trainer.

-Prioritize sleep and try for 9+ hours of sleep at night

-Maintain a normal diet and stay hydrated

-No prescription or non-prescription drugs without medical supervision.

Specifically:

No sleeping tablets.

Do not use aspirin, anti-inflammatory medication or sedating pain killers.

If these are not carried out by or are not needed by student then the CMT will suspend any temporary accommodations put in place by the CMT unless otherwise directed by a physician.

Return to Academics Progression:

As the student-athlete feels better and symptoms improve, parents/guardians may allow up to 30 minutes of mental exertion per day. When student-athlete is able to handle up to 30 minutes of sustained mental exertion without the worsening of symptoms, please have him/her return to school andcheck-in with school counselor prior to the first class to plan his/her Return to Academics Progression. The CMT does not expect a student-athlete to miss more than three days of school following a concussion and will need a physician’s note if more than one day is missed.

Once the student-athlete has returned to school, it is imperative that his/her counselor is seen. The counselor and student will determine theRTA, usually with assistance from the AT/ team physician, possibly the student-athlete’s physician.Any accommodations, either from the CMT or physician, will be communicated to the student’s teachers by the school counselor. Teachers should send any student-athletes they have received an email for to their counselor if they do not come to class with an RTA. This is also the time to set up a post-concussion ImPact test with the AT. Depending on symptoms, the student may need to attend half-days. We expect this to last no longer than 4 to 6 days unless otherwise directed by a physician.

When the student-athlete handles up to 60 minutes of mental exertion without worsening of symptoms, he or she will return to school full-time with minimal accommodations. Classroom testing can resume at this time, no standardized testing. Further post-concussion ImPACT testing should be done with the AT during this time and may be directed by the physician.

Once symptom-free and attending school full-time, a student-athlete may seek to be medically released to begin his or her Return-to-Play progression. Accommodations should be discontinued at this time.

In 10-20% of concussions, symptoms do not resolve after weeks, potentially months. If symptoms continue after 2-4 weeks, student should be evaluated by a specialist for additional services.

Return to Play Progression:

In order to begin a Return-to-Play progression a student-athlete must have the following:

  • Full-time at school with no temporary accommodations
  • A medical release from appropriate healthcare professional with signature to give the AT
  • Asymptomatic unless otherwise directed by team physician
  • A normalized ImPACT score unless otherwise directed by team physician

Return-to-play will occur in a step by step process. There is not a set duration for each step and it will be monitored by the AT and coach; rather the athlete must be symptom free at each step in order to progress to the next step. Even with a physician's release, the athlete must still be symptom free before beginning any physical activity and still must participate in the gradual return to play. A physician's note alone is not sufficient for returning an athlete to play but will allow them to begin the return-to-play progression shown in step two through five.

Step One: Symptom free day in class. Return to baseline function on GSC and a post-concussion ImPACT test. If a baseline score is not available for the athlete, a performance near normative baseline scores will suffice.

Step Two: Light exercise such as light jogging or riding an exercise bike. This could be while dribbling a ball for example. This needs to be light and will be limited to 15 minutes. We are simply trying to get a heart rate up and see if this recreates symptoms.

Step Three: Running full speed in the gym or on the field. Examples are sprints and more sport specific exercises with AT. Limited to 45 minutes.

Step Four: Non-contact practice. The athlete is allowed to participate in drills with as little contact as possible. Weight training can resume at this point. Limited to 60 minutes

Step Five: Full Contact Practice.

Step Six: Return to game/competition.

Additional Evaluative tools:

The athletic training staff currently uses a software program called ImPACT to aid in managing concussions. ImPACT is currently the most widely utilized computerized concussion testing program in the world and has been implemented effectively for high school, collegiate, and professional athletes. It was developed through research by neuropsychologists, neurologists, and physicians at the University of Pittsburgh Medical Center (UPMC). ImPACT stands for Immediate Post-concussion Assessment and Cognitive Test. It was developed to helps sports medicine clinicians evaluate recovery following concussion. ImPACT is a computer test that evaluates multiple aspects of neuro-cognitive functioning including memory, brain processing speed, reaction time and post-concussive symptoms.

Student-athletes who participate in collision and contact sports at Willamette High School take a “baseline” test prior to the start of their first athletic season and then every two years until graduated. This usually occurs during freshman and junior seasons but maybe occur another year depending on the student-athlete. The baseline test takes approximately 30 minutes and is done through the internet with adult supervision. Taking the baseline is like “giving your brain a physical” as it establishes a normal level of performance. This is not an intelligence test and the information is only shared between our athletic trainer, our team physician, and the student’s physician per request.

Post-injury testing should be completed 48 to 72 hours after the injury. If an athlete has not taken the baseline test, ImPACT has developed norms that can be used to evaluate the recovery process of a concussed student-athlete. While these norms can be used to monitor recovery, they do not replace the value of an athlete being compared to an individualized baseline test.

Collision and contact sports include: Football, soccer, basketball, cheer, water polo, wrestling, volleyball,baseball, softball, and pole vault.