Concussion Management Protocol

1
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.

2
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.

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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

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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.

5
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,
  2010-2011.2

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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)

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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
8
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.

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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.

10
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.

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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 Trainers Association3
  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.

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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.

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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.

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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.

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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. Marys
  Sports Medicine Center.

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• 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