Concussion Training - 2016

1Concussion Training Webinar – June 2015

How to use this Training Module

• To navigate through this training module, click on the arrows at the bottom of the frame.


Concussion Identification Management

and Prevention for Schools


Purpose of Training Module• The purpose of this training module is to review the WRDSB

Concussion Management Protocol, which reflects the Ophea minimum standards required by the Ministry of Education.

• It is important for school staff to be familiar with the Concussion Management Protocol.


Before starting this training module download/print :

The “WRDSB CONCUSSION MANAGEMENT PROTOCOL - STAFF HANDBOOK”

Of particular importance are the following Appendices, which appear on pages 15 to 22.

1. Appendix A: Tool to Identify a Suspected Concussion2. Appendix B: Return to Learn Strategies and Approaches3. Appendix C: Documentation of Medical Examination4. Appendix D: Return to Learn/Return to Physical Activity Plan5. Appendix E: Documentation/Permission to Return to Learn/Return to Physical Activity6. Appendix F: Return of Symptoms7. Appendix G: Pocket Scat28. Appendix H: OSBIE Incident Report Form


Learning GoalsParticipants will:• increase awareness of concussions (definition, signs and

symptoms) and the seriousness of concussions;• become familiar with strategies for concussion prevention;• learn about and apply the WRDSB Tool to Identify a

suspected concussion;• learn about the management procedures for a diagnosed

concussion


What is a Concussion?

A concussion:• is a brain injury that causes changes in how the

brain functions, leading to symptoms that can be physical (e.g., headache, dizziness), cognitive (e.g., difficulty concentrating or remembering), emotional/behavioural (e.g., depression, irritability) and/or related to sleep (e.g., drowsiness, difficulty falling asleep).


What is a Concussion? cont’d.

A concussion:• may be caused either by a direct blow to the

head, face or neck, or a blow to the body that transmits a force to the head that causes the brain to move rapidly within the skull;

• can occur even if there has been no loss of consciousness (in fact most concussions occur without a loss of consciousness); and,

• cannot normally be seen on X-rays, standard CT scans or MRIs.


• Teachers/coaches/intramural supervisors must become familiar with the common signs and symptoms of a concussion.

• Note… Only a Physician/Nurse Practitioner can diagnose a concussion.

• But… Teachers/coaches/intramural supervisors can recognize signs and symptoms of suspected concussion and inform parents/guardians of the importance of evaluation by a Physician/Nurse Practitioner.

Common Signs and Symptoms


Initial Response – Suspected Concussion

Student:Receives a blow to the head, face or neck, or a blow

to the body that transmits a force to the head, and as a result may have suffered a concussion


Identification: Initial ResponseTeacher/Coach/Supervisor – If Student is Unconscious


Identification: Initial Response cont’d

Unconscious: Concussion Suspected• EMS transports student to hospital for medical

examination• Principal informs appropriate staff of suspected

concussion• Parent/Guardian is asked to complete and return

Appendix C –Documentation of a Medical Examination Form (see next slide)


Documentation of Medical Examination





A “Tool to Identify a Suspected Concussion” is used.

The teacher/coach/intramural supervisor completes the form.

Teacher/coach/supervisor: Conduct initial concussion assessment

using Appendix A – Tool to Identify Suspected Concussion

Conscious: Initial Concussion Assessment


Teacher/Coach/Supervisor – If Concussion Suspected and Student is ConsciousIdentification: Signs and Symptoms Present


Teacher/Coach/Supervisor – If Student shows NO signs or symptoms of ConcussionIdentification: No Signs and Symptoms Present


Implementation Identification Procedures

Check your knowledge in the following scenarios.



Scenario A:In a ball hockey game during Physical Education class, two students rush for the ball and collide. As Kate lunges and reaches for the ball in an attempt to shoot on goal, she slips and falls head first onto Satinder’s knee. Kate collapses onto the floor, lying on her side with eyes closed and motionless for approximately 30 seconds. She does not respond when students call her name. As you approach, her eyes open, she moans and starts to get up.See next slide for questions.



Determine if Kate should be suspected of having a concussion.

1. Which concussion pathway should you follow?a) Consciousb) Unconscious

See next slide for answers.


Answer:b) Unconscious Pathway• Key points to determine concussion pathway:

Kate lies motionless and unresponsive for approximately 30 seconds;

= loss of consciousness (physical sign on “Tool to Identify a Suspected Concussion”);



Staff take the following steps:


Scenario B:During an intramural soccer game, Reilly pushes Sam in an attempt to get the ball. Sam trips on a small rock hidden by the grass in the field and falls forward, smashing his chin on the ground. As you approach, Sam sits up and blood streams from the split in his chin. He panics, gets up and staggers towards you, almost falling again complaining of dizziness. During the Initial Response procedures, you learn that Sam is feeling dizzy and can’t remember the sport he was playing.See next slide for questions.



Determine if Sam should be suspected of having a concussion.

1. Which concussion pathway should you follow?a) Conscious – Concussion Not Suspectedb) Conscious – Concussion Suspectedc) Unconscious

See next slide for answer.



Answer:b) Conscious Pathway – Concussion Suspected

• Key points to determine concussion pathway: one or more signs/symptoms

observed/reported (i.e., he reported that he was dizzy); and

Sam responded incorrectly to one of the memory function questions (i.e., he didn’t know what sport he was playing)





Scenario C:During a tag game at recess, Louis is one of the last people to be caught. Faking to one side and sprinting away, he turns to check that Addison is not following him and runs into the basketball net pole. You are supervising the playground and hear the sound of Louis’ head hitting the pole. He pauses, shakes his head and then continues playing. Worried that he might have a concussion after such a hard collision, you call him over to question him. After using the Tool to Identify a Suspected Concussion you can’t find anything wrong with him.See next slide for questions.



Determine if Louis should be suspected of having a concussion.

1. Which concussion pathway should you follow?a) Conscious – Concussion Not Suspectedb) Conscious – Concussion Suspectedc) Unconscious

See next slide for answer.



Answers:a) Conscious Pathway - Concussion Not Suspected• Key points to determine concussion pathway:

Louis is conscious and never lost consciousness; No signs were observed nor symptoms relayed

from Louis; and Louis correctly answered the memory function

questions.





DiagnosisConcussion


Management Procedures for a Diagnosed Concussion

Principal informs school staff of concussion and establishes collaborative team identifying designated school staff lead

Parent/guardian: report back to school principal (e.g., Appendix D – Return to Learn/Return to Physical Activity Plan: Appendix E - Documentation for a Diagnosed

Concussion )

Return to Learn/Return to Physical Activity – Step 1 (home)

Student: complete cognitive and physical rest

Student:

Returns to School


Collaborative Team Manages Return to Learn and Return to Physical Activity

Collaborative Team is led by the school principal and includes:

• the concussed student;• her/his parents/guardians;• school staff and volunteers (e.g., coaches)

who work with student; and• the Physician/Nurse Practitioner .


Return to Learn/Return to Physical Activity – Step 1: Rest

Cognitive and Physical Rest at Home• Continues for a minimum of 24 hours until symptoms

improve or student is symptom free as determined by parent and student

“Given that children and adolescents spend a significant amount of their time in the classroom, and that school attendance is vital for them to learn and socialize, full return to school should be a priority following a concussion”Davis GA, Purcell LK. The evaluation and management of acute concussion differs in young children. Br J Sports Med. Published Online First 23 April 2013 doi:10.1136/bjsports-2012-092132 (p. 3)


Symptoms are Improving

Symptom Free

+

Student:Returns to School

Return to Learn – Step 2 (with symptoms)Student: requires individualized classroom strategies and/or

approaches, see Appendix B: Return to Learn Strategies/Approaches

Parent/Guardian: report progress to school principal (Appendix E)

Return to Learn – Step 2 (symptom free)

Student: begins regular learning activities

Return to Physical Activity – Step 2 (home)

Student: individual light aerobic physical activity only

Return to Learn/Return to Physical Activity


Return to Learn – Step 2 with symptomsStep 2: Symptoms are Improving• Collaborative team lead identifies student’s

symptoms and responses to learning activities• Develops appropriate strategies/approaches to

meet student’s needs• School staff and volunteers need to be aware of

student’s cognitive and emotional/behavioural difficulties

• GRADUAL return to school/learning


Return to Learn Strategies

Return to Learn Strategies/Approaches • Located in Appendix B, pgs. 16 and 17• Lists Cognitive Difficulties and

Emotional/Behavioural Difficulties that may be experienced by students


Return to Learn –Step 2 (cont’d)Symptom free

Step 2: Symptom Free • Parents/Guardians communicate that student is symptom free

and ready to move on to Step 3 – Return to Learn and Step 3 – Return to Physical Activity

Step 2: If student is symptom free after Step 1• Parents/Guardians communicate student is symptom free and is

returning to school• Student proceeds directly to Step 3 - Return to Learn and Step 3 –

Return to Physical Activity• Progress monitored by the collaborative team


Return of Concussion Signs/SymptomsConcussion signs/symptoms can reoccur during cognitive and physical activities• Student must be closely monitored for:

― return of signs/symptoms;― deterioration of work habits and performance.

If concussion signs/symptoms return:• a medical examination is required

(Physician/Nurse Practitioner );• the parents/guardians complete Appendix F:

Return of Symptoms form.• Student returns to step as determined by

Physician/Nurse Practitioner


Return to Physical Activity – Steps 2 and 3

Symptom Free

Return to Physical Activity – Step 4 (school)Student: individual sport specific physical activity

only

+

Return to Learn – Step 3 (symptom free)

Student: begins regular learning activities

Return to Physical Activity – Step 3 (home)

Student: individual light aerobic physical activity only

Parent/Guardian: report progress to school principal (Appendix E)


Return to Physical Activity – Steps 5, 6 and 7Return to Physical Activity – Step 5

(school)Student: activity with no body contact

Parent/Guardian: report back to school principal - include written documentation from Physician or Nurse Practitioner to indicate the student remains symptom free and able to return to full participation (Appendix E: Step 6)

Teacher: inform parent of completion of Step 5

(Appendix E: Step 5)

Return to Physical Activity – Step 6 (school)Student: full participation in non-contact sports – full practice for

contact sports

Return to Physical Activity – Step 7 (school)Student: full participation in all physical activity

(including contact sports)


Question A

Alex has a few concussion symptoms, but is progressing well through the Return to Learn plan developed by the school. She would love to be active. When can she participate in DPA or intramural activities?



Answer to A DPAAlex can participate:when she is symptom free (has completed Step 2 of

Return to Learn Plan); After she has completed Step 2 of the Return to

Physical Activity Plan;If the DPA activities meet the criteria of Step 3 of

Return to Physical Activity Plan.


Answer to A cont’d

Intramural Sport/ActivitiesAlex can participate:when she is symptom free (has completed Step 2); After she has completed Steps 3-6 of the Return to

Physical Activity Plan;After examined and “cleared” for non-contact

physical activity by Physician/Nurse Practitioner .


Question B

After Step 1 – physical and cognitive rest, Ryan has no signs or symptoms. He desperately wants to play in the tournament this weekend. At which step can Ryan fully participate in the volleyball games (non-contact interschool sport)?



Answer B

Play in volleyball tournament? successfully completed Step 6 of Return to Physical

Activity Plan; examined and “cleared to participate” by a Physician

or Nurse Practitioner


Prevention

“…there is evidence that education about concussion leads to a reduction in the incidence of concussion and improved outcomes from concussion…”

(Delaney, Lacroix, Leclerc, & Johnston, 2000; Goodman & Gaetz, 2002; McCrea, Hammeke, Olsen, Leo, & Guskiewicz, 2004).

.


Prevention

• Curriculum Connections• Resources:

• Safety.ophea.net – Appendix C-5: Sample Concussion Prevention Strategies• Safety.ophea.net - The Generic Section and

sport/activity pages of all modules.• WRDSB Administrative Procedure XXXX• Off Campus Forms IS-04-F-1, IS-04-F-3 direct parents to

concussion awareness resources


Prevention Cont’d

Culture of Safety Mindedness When planning activities teacher/coach/intramural supervisor must:• be familiar with Board’s Concussion policy;• review with students;

• background concussion information, and• ways to minimize the risk of concussion around

the school and in physical activities and sports.


Culture of Safety Mindedness It is important for staff to:• Communicate the importance of disclosing all

injuries and symptoms• Communicate the danger of not reporting symptoms• Believe the student when they communicate their

symptoms

Prevention Cont’d


Prevention – Pre-ActivityPrior to physical activity and/or prior to the sport season teachers/coaches/intramural supervisors should:

• be knowledgeable of safe practices in the sport/activity, (e.g., rules and regulations and specific sport/activity pages in the Ophea Safety Guidelines);

• Be familiar with risks of concussion/potential injuries associated with the activity/sport and ways to minimize those risks.


Prevention – During Activity

Strategies that should be used during a unit of physical education and/or sport season or intramural activities:

• Teach skills and techniques in proper progression);• Encourage students/athletes to follow rules of play

and to practice fair play.


Questions?• Website: safety.ophea.net• Email: [email protected]

mailto:[email protected]