By: Maria “Maggie” Florez-Cook MS, ATC, LAT

WHAT YOU NEED TO KNOW!

http://www.youtube.com/watch?v=EpT894xNqqc

http://youtu.be/kM9o2Kq7oT4

Concussion Management Team Removal from Play Waiver and Graded Protocol to Return to

Play Specific Education/Training for all HCP’s State Wide Tracking/Logging of Concussions

A concussion is a brain injury that is caused by a sudden blow to the head or to the body. The blow shakes the brain inside the skull, which temporarily prevents the brain from working normally.

Passing out.

Not being able to remember what happened after the injury.

Acting confused, asking the same question over and over, slurring words, or not being able to concentrate.

Feeling lightheaded, seeing "stars," having blurry vision, or experiencing ringing in the ears.

Not being able to stand or walk; or having coordination and balance problems.

Feeling nauseous or throwing up.

Irritability/Depression

Personality changes

“Old School” Term BELL RUNG/DING

Headache after impact is an indication of Concussion both mild & severe

Developing brain is most at risk!

Long term testing is available now!

SECOND IMPACT SYNDROME◦ Is condition in which the brain

swells rapidly and catastrophically after a person suffers a second concussion before symptoms from an earlier one have subsided. This deadly second blow may occur days, weeks or minutes after an initial concussion, and even the mildest grade of concussion can lead to SIS.

◦ The condition is often fatal, and almost everyone who is not killed is severely disabled. The cause of SIS is uncertain, but it is thought that the brain's blood vessels lose their ability to regulate their size, and therefore lose control over cerebral blood flow, causing massive swelling of the brain.

LONG TERM BRAIN INJURY◦ Confusion◦ Light sensitivity◦ Concentration ◦ Short term memory loss◦ Early onset of dementia,

Alzheimer's, Chronic Traumatic Encephalopathy (CTE)

Currently◦ Concussion Oversight

Team

◦ Any suspect of concussion out for the remainder of the game/practice

◦ May not return to activity until evaluated by Oversight team and has completed all return-to-play protocol

Only a medical professional has the ability to allow an athlete to return to play following a concussion!

Severe… seek emergency medical assistance

Danger Signs◦ Drowsiness or can’t be awakened◦ One pupil larger than the other◦ Headache that gets worse or doesn’t

go away◦ Weakness, numbness, or decreased

coordination◦ Repeated vomiting or nausea◦ Slurred speech◦ Convulsions or seizures◦ Difficulty recognizing people or places◦ Increased confusion, restlessness, or

agitation◦ Unusual behavior◦ Loss of consciousness (even briefly)◦ Moderate-Mild: remove from activity

The first 24 hours◦ No medications (except for

acetaminophen)

◦ Constant questioning regarding memory

◦ Awaken every 2 hours to monitor alertness (some disagree)

◦ Decrease use of loud music, bright lights, reading, watching tv, playing on the computer/ipod/video games

TAKE AWAY THE CELL PHONE!!!

Concussion Management 1. Recommended school modifications

◦ a. Notify Assistant Principal, School Nurse and Counselor of the student that he/she has MTBI

◦ b. Notify Counselor and Assistant Principal of post-concussion symptoms

◦ c. Student may need special accommodations such as limited computer work, reading activities, testing, assistance to class, etc. until symptoms subside

◦ d. Student may only be able to attend school for half days or may need daily rest periods until symptoms subside with physician authorization

2. Student must show no signs of post-concussion symptoms before return to play protocol begins.

3. Student will not return to full practice or competition for minimum of 7 days, unless cleared by physician.

4. The treating physician must provide a written statement to the parent and athletic trainer indicating that, in the physician’s professional judgment, it is safe for the student to return to play.

5. Student athlete and the parent/guardian have signed the form acknowledging the completion of the return to play guidelines which includes the understanding the risks associated with the student athlete’s return to play.

Be ideal to have baseline measures.

Released based on return to play protocol

Tests to be administered◦ CT scan/MRI◦ Cognitive test◦ Motor test◦ Agility testing

  Return to Play Guidelines Athlete must show no signs of post-concussion symptoms before return to

play protocol begins. 1. Athlete activity progressions (Athlete may participate in following

protocol and/or one similar based on school’s athletic Trainer’s preferred program)◦ a. Light aerobic exercise with no resistance training◦ b. Moderate aerobic activity with resistance training◦ c. Sport specific activity and Non-contact training drills◦ d. Full contact training drills can begin after minimum 7 days, (unless otherwise

released to do so by physician)◦ e. Return to full participation (pending physician clearance)◦ f. Note – Athlete activity progression continues as long as athlete is

asymptomatic at current level. If the athlete experiences any post concussion symptoms, stop physical activity until symptom free for 24-48 hours. Resume with phase or level in which they were previously asymptomatic.

2. Physician clearance 3. Athletic Trainer clearance

PROPER DOCUMENTS HAVE BEEN SIGNED & TURNED INTO THE ATHLETIC TRAINER (ms/hs)/SCHOOL NURSE (elementary)

Observed signs Zero minutes 15 Minutes 30 minutes/comments

Appears dazed or stunned

Is confused about events

Repeats questions

Answers questions slowly

Can’t recall events prior to hit or jolt

Can’t recall events after hit or jolt

Loses consciousness (even briefly)

Shows behavior or personality changes

Forgets class assignments or schedule

Physical symptoms

Headache or pressure in head

Nausea or vomiting

Balance problems or dizziness

Fatigue of feeling tired

Blurry or double vision

Sensitivity to light

Sensitivity to noise

Numbness or tingling

Pupils not responding properly

Cognitive symptoms

Difficulty thinking clearly

Difficulty concentrating

Difficulty remembering

Feeling slow

Feeling sluggish, hazy, foggy, or groggy

Emotional symptoms

Irritable

Sad

More emotional than normal

Nervous