Andrews ISD Concussion Management The Andrews Athletic Training and Sports Medicine Program has developed and implemented the following concussion management guidelines for the student athletes in Andrews ISD. This comprehensive guideline is consistent with current standards of care and appropriate medical practices for the student athlete who suffers a concussion in sports. Developed and implemented by the Concussion Oversight Team (COT), listed below, the following guidelines are designed to facilitate a safe return to athletic activities for the student athletes of Andrews ISD. The COT is committed to utilizing current standards and methods in its multidisciplinary approach to concussion management to include: ImPACT pre and post injury neurocognitive testing, SCAT5 symptom assessment tool, modified Balance Error Scoring System (BESS), Vestibular/Ocular Motor Screening (VOMS), and a progressive return to play protocol. CONCUSSION OVERSIGHT TEAM Dr. Derrick Randolf Team Physician Diane Lloyd, ATC, LAT Head Athletic Trainer Daniel Champagne, LAT Assistant Athletic Trainer CONCUSSIONS Sport related concussion (SRC) is a traumatic brain injury induced by biomechanical forces. Several common features that may be utilized in clinically defining the nature of a concussive head injury include: SRC may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head. SRC typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over a number of minutes to hours. SRC may result in neuropathological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies. SRC results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged. (The clinical signs and symptoms cannot be explained by drug, alcohol, or medication use, other injuries (such as cervical injuries, peripheral vestibular dysfunction, etc) or other comorbidities (eg, psychological factors or coexisting medical conditions).

(Consensus Statement on Concussion in Sport: the 5thd International Conference on Concussion in Sport held in Berlin, Oct. 2016. British Journal of Sports 2017 097699)

Some Signs and Symptoms of Concussion Headache









Appears dazed, stunned, confused

Nausea









Change in sleep pattern

Dizziness









Feeling foggy, sluggish







Problems with memory

Double or fuzzy vision





Ringing in the ears

Sensitivity to light or noise





Answers questions slowly

Balance problems

Signs and symptoms may arise over the first 24-48 hours. The athlete should not be left alone, should not drive a motor vehicle, and must go to a hospital at once if: Headache gets worse, athlete is very drowsy and cannot be woken up, athlete can’t recognize people or places, vomits repeatedly, behavior is unusual or seems very confused, very irritable, seizures occur (arms and legs jerk uncontrollably), athlete is unstable on feet, speech becomes slurred.

What if my child continues playing with a concussion? Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an increased risk of significant damage from a concussion for a period of time after that concussion occurs, particularly if the athlete suffers another concussion before completely recovering from the first one. This can lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with devastating and even fatal consequences. It is well known that adolescent or teenage athletes will often under report symptoms of injuries and concussions are no different. As a result, education of administrators, coaches, parents and students is the key for student-athlete’s safety. When in doubt, sit them out! Cognitive Rest When an athlete is exhibiting signs and symptoms of a concussion, research is showing that they need to have both physical and mental rest. We recommend that they do little or no computer work, no texting, no video games, and no TV or reading that creates a headache. We will contact the school nurse who will let the athlete’s teachers know that they have a concussion and may have difficulty with specific activities in the class and if possible to delay any testing or projects until the symptoms have gone away. However, recent research shows that very mild physical activity after the initial injury may speed up recovery, so that will be added to our treatment when appropriate.

Concussion Return to Play (RTP) Protocol Steps When an athlete grades 9-12 has a concussion, the athletic training staff uses a Graded Symptom Checklist (GSC), the ImPACT test (Immediate Post Concussion Assessment and Cognitive Test), balance testing (modified Balance Error Scoring System or BESS), and Vestibular/Ocular Motor Screening (VOMS) to track their recovery. Under the athletic trainer’s supervision, the athlete daily grades their symptoms with GSC, performs the VOMS components, and performs the modified BESS. Approximately three days after the injury the athlete takes the ImPACT test and will retest as needed. Many athletes grades 9-12 take the ImPACT test as a baseline during preseason in Aug. or as soon as possible during the school year, however not all athletes take the baseline test. After a concussion, their baseline score is compared with the post-concussion score. If they do not have a baseline, their scores are compared to national norms. Once their symptoms are absent for 24 hours, the athlete will need written medical clearance from a medical physician (MD or DO) to begin the RTP protocol. Once the RTP protocol is completed, the athlete will need written medical clearance from a medical physician (MD or DO) stating that it is safe for the athlete to return to play if the previous clearance did not indicate that (see form below). The parent/guardian will also need to sign a form (see below). Athletes in grades 7 and 8 follow the same steps except for the ImPACT testing. The following are the steps to be followed: 1. Evaluation of athlete determines concussion occurred. 2. Contact parent/guardian, provide educational material and discuss concussion signs/symptoms. School nurse contacted to provide notification to athlete’s teachers. 3. Daily self report on Graded Symptom Checklist, modified BESS test, and VOMS testing. 4. Take ImPACT test and measure against baseline or normative data (grades 9-12). 5. Once signs and symptoms have been absent for 24 hours and written clearance is received from an MD or DO physician, the athlete begins the Return To Play protocol designed by the Concussion Oversight Team 6. Cleared by physician (MD or DO) to return to sports participation if not already obtained. 7. UIL Return to Play Completion/authorization form signed by parent/guardian and returned to athletic trainer.

Return to Play Protocol (RTP) Following Concussion • •

Student-athlete shall be symptom free for 24 hours prior to initiating the RTP progression and has written clearance by a physician (MD or DO). Progress continues at 24-hour intervals as long as student-athlete is symptom free at each level. If the student-athlete experiences any post concussion symptoms during the RTP activity progression, the activity is discontinued and the student-athlete returns to the previous level when symptom free.

Level 1: Low levels of physical activity. Light aerobic activity (e.g. walking, light jogging, and light stationary biking). Should be 20-30 minutes, <70% max heart rate, no resistance training. Goal: Increase heart rate. Level 2: Sport specific exercises, non contact drills. No head impact activities. Body weight

exercises intermixed with aerobic activity. The athlete performs 6 laps of run/sprint the straights, jog the curves with 10 calisthenics performed before each lap (calisthenics: sit ups, squats, jumping jacks, pushups, pop ups, lunges). ImPACT test returns to normal. Goal: Add movement Level 3: Progression to more complex training drills, eg. passing drills in football. Non- contact physical activity, start progressive resistance weight training. . Goal: Exercise, coordination, and cognitive load. Level 4: Following written medical clearance from physician, participate in normal training activities. Goal: Restore confidence and assess functional skills. Level 5: UIL form turned in; return to normal competition.

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