Concussion Management

http://ihsa.org/Resources/SportsMedicine/ConcussionManagement.aspx

 

Stakeholder's Responsibilities

http://ihsa.org/Resources/SportsMedicine/ConcussionManagement/StakeholderResponibilities.aspx

 

Concussion Protocols

http://ihsa.org/documents/sportsMedicine/Concussion%20Protocols.pdf

 

 

UTHS

Concussion Management Program

• Return to Play
• Return to Learn

 

 

Concussion Management Responsibilities

A concussion is a traumatic brain injury that interferes with normal brain function. An athlete does not have to lose consciousness (be “knocked out”) to have suffered a concussion.  Medical advances over the past decade, along with a national emphasis on raising awareness about concussions, have enabled sport organizations, including the IHSA, to draft or revise rules and policies aimed at player safety in all sports that reflect this growing body of information.  

School Responsibilities

IHSA member schools:

• Shall adopt a policy regarding student athlete concussions and head injuries that is in compliance with the protocols, policies, and by-laws of the Illinois High School Association.

• Shall provide information on their school’s concussion and head injury policy as a part of any agreement, contract, code, or other written instrument that a school requires a student-athlete and his/her parent(s) or guardian(s) to sign before participating in an interscholastic practice or competition.

• Shall use educational materials provided by the Illinois High School Association to educate coaches, student-athletes, and parents and guardians about the nature and risk of concussions and head injuries, including continuing to play after a concussion or head injury.

• Shall ensure compliance with the Return-to-Play (RTP) Policy of the Illinois High School Association.

• Shall develop RTP and Return-to-Learn (RTL) protocols for students at their school who have been diagnosed as having sustained a concussion in accordance with Illinois state law.

  Coaches Responsibilities

  Coaches:

• Shall be educated about the nature and risk of concussions and head injuries, including continuing to play after a concussion or head injury, and successfully complete an approved program prior to beginning their coaching responsibilities.  The IHSA shall make educational materials available at no charge to coaches through its sports medicine website.

• Shall immediately remove from participation or competition any athlete who is suspected of sustaining a concussion or head injury.

• Shall not allow an athlete who has been removed from participation or competition because of a suspected concussion or head injury to return to participation or competition until the athlete has met the appropriate RTP protocols.

   

  Athlete Responsibilities

  Athletes:

• Shall annually review, sign, and return to the school, a concussion and head injury information sheet prior to initiating practice or competition.

• Shall notify a coach if the athlete or a teammate exhibits signs or symptoms of a possible head injury.

• Shall abide by all appropriate RTP and RTL protocols.

  Parent/Guardian Responsibilities

  Parents/Guardians:

• Shall annually review, sign, and return to the school, a concussion and head injury information sheet prior to their student initiating practice or competition.

• Shall provide their student’s school with the necessary written consent in accordance with Illinois state law prior to their student’s return to participation following a concussion.

   

  Concussion and Return to Play Policy

   

  If an athlete sees a medical physician for a concussion or any other injury and is restricted from play by the physician, he/she must get a signed note from the treating physician clearing the athlete.  The note must be in the possession of the Athletic Trainer before the athlete may begin participating.  No exceptions. (No injury release of any kind from a Chiropractor will qualify unless initial restriction was from a Chiropractor for strictly a back-only injury.)

  Even if the athlete has a release from a physician after a concussion it is in his/her best interest to follow return-to-play protocol through the Athletic Training Room to insure a safe comeback to play, but is not mandatory if physician has  fully cleared the athlete.

   

  If an athlete does not see a physician for a concussion injury, he/she must work with the Athletic Trainer present before cleared for return to play.

  -After head injury or concussion symptoms, the athlete will heal most quickly by resting, eliminating all electronic usage, consuming healthy food/plenty of fluids, and if necessary also resting from academic activity for several days or as recommended by a physician.

  -After all concussion symptoms (headache, dizziness, nausea, sensitivity to light, blurry vision, mental “fogginess”, fatigue) subside and athlete is able to return to school and normal daily and academic function without recurring symptoms, return to play protocol may begin.

  Return to Play Protocol:

• If the athlete has taken a baseline concussion test before season, he/she will be required to complete and pass the computer concussion testing before beginning physical activity.If there is no previous baseline test, the athlete will begin physical testing at the discretion of the Athletic Trainer.

• Physical activity will begin with a 15 minute stationary bike test (or other light activity).If symptoms return anytime during or after any portion of the physical activity the athlete should stop activity and may try again 24 hours after last symptoms subside.

• If no symptoms reoccur within 24 hours after the bike test, the athlete may begin non-contact practice the following day.(This may take more than one day depending on factors such as concussion severity, environmental conditions, equipment worn for sport, intensity of sport.)

• After completing non-contact practice the athlete must complete at least one full-contact practice before participation in a game/competition.

If symptoms return at any point during attempted return to play, the athlete must stop activity and may resume protocol 24 hours after last symptoms subside.  Most athletes return to full participation in 3-5 days after beginning protocol.

 

**It is not the intension of the Athletic Trainer or any other health care professional to keep an athlete out of participation unnecessarily.  It is the intension of the treating health care professional to keep the athlete safe and resume desired activity in a proper manner to minimize risk to the injured athlete and to other players.

**If determined necessary by the Athletic Trainer, additional clearance from a medical physician may be required after a concussion.  Please direct additional questions to the treating Physician or Athletic Trainer.

 

United Township High School Concussion Policy

Return to Learn (RTL)

 

In order to be in compliance with Illinois State Legislature (Youth Sports Concussion Safety Act: Public Act 099-0245) and Illinois High School Association (IHSA) policies, this Return to Learn (RTL) policy has been put in place.

 

Any athlete suspected of having a concussion must be evaluated by a physician for clearance.  In order to be in compliance with Illinois High School Association (IHSA) Policies and Procedures and the National Federation of State High School Associations (NFHS), that physician must hold MD or DO credentials and be licensed to practice in all of its branches in the state of Illinois.

 

Concussion Oversight Team (COT):

Jay Morrow: District 30 Superintendent

Carl Johnson: United Township High School Principal

Mark Gratton: Genesis Health System

Mark Pustelnik: United Township High School Athletic Director

Jen Webster: RTI & Section 504 Coordinator

Chaise Nache: United Township High School Nurse

Abby Demory: United Township High School Counselor, Students A-El

Jon-Mychel Nelson: United Township High School, Students Em-Lo

Stacey Drish: United Township High School, Students Lu-Rod

Pat Green: United Township High School, Students Roe-Z

Dawn Porter: Athletic Trainer

 

The UTHS Nurse will work in conjunction with the Athletic Trainer (AT) and the restrictions set forth by the doctor or symptom complaints of the student, or parent.  The UTHS nurse will be the liaison between the sports medicine team (AT, doctor) and the UTHS staff and UTHS counselor.  Health Insurance Portability and Accountability Act (HIPAA) and Family Education Right to Privacy Act (FERPA) are in place for all conversations (verbal and written) relating to the student and necessary accommodations.

 

From U.S. Department of Health and Human Services, Centers for Disease Control and Prevention: Returning to School After a Concussion: A Fact Sheet for School Professionals:

“A student with a concussion should be seen by a health care professional experienced in evaluating for concussion.  A healthcare professional should make decisions about a student’s readiness to return to school based on the number, type and severity of symptoms experienced by the student.  The healthcare professional should also offer guidance about when it is safe for a student to return to school and appropriate levels of cognitive and physical activity.  Once a healthcare professional has given permission for the student to return to the classroom, school professionals can help monitor him/her closely.  With proper permission, school professionals can confer on their observations with the family and other professionals involved in the student’s recovery.”

 

 

 

 

 

Short Term Classroom and School Modifications:

This is a list of short term modifications that can be made to accommodate a student recovering from a concussion.  This list includes a few ideas, but these ideas can be modified and amended as needed for the individual.  These modifications should come from the Physician the student is being supervised/monitored by, as well as the UTHS School counselors/parent/nurse/Athletic Trainer communications.  These recommendations should be individualized based on the symptoms of the student.

 

• Leaving class early to avoid busy and noisy hallways, increased time between classes for cognitive rest

• Extended test time

• Test modifications (multiple choice or verbal tests)

• Having another student take notes to avoid head and eye movement

• Decreasing time on computers, screens and looking at smartboards

• Decreased or modified homework load (smaller assignments)

• Decreased or modified class work load during the school day (reading, math problems, etc)

• Decreased or no physical exertion in PE, staying in nurses office during PE

• No “Behind the Wheel” until cleared by treating physician to drive

• A quiet place to eat lunch

• A quiet place to sit if symptoms increase throughout the day

• Half days (either mornings or afternoons)

• Seating away from windows

• Wearing sunglasses or a hat

• Modifications of physical classroom environment (lights off, temperature, changing seating assignment)

 

These modifications will be assessed (at minimum) on a weekly basis to ensure they are learning and to assess changes in modifications.

Communication between parent (guardian), student and the COT is an integral part of modifications.  If something isn’t working, we can’t fix it if we don’t know about it.  Constant communication at school and from the parent is necessary to adapt and change these modifications as the student recovers.

It is important to remember that every concussion is different.  While it may take one student 30 minutes to develop increased symptoms, it may take others shorter or longer to develop theirs with cognitive exertion.  These times can also vary day to day.  These can also be affected if the student has a diagnosed learning disability (LD) or ADD/ADHD.

 

 

Long Term Classroom and School Modifications:

From Returning to School After a Concussion: A Fact Sheet for School Professionals: “For most students, only temporary, informal academic adjustments are needed as they recover from a concussion.  However, a variety of formal support services may be available to assist a student who is experiencing a prolonged recovery.  These support services may vary widely among states and school districts.  The type of support will differ, depending on the specific needs of each student.  Some of these support services may include:”

• Response to Intervention Protocol (RTI)

• 504 Plan

• Individualized Education Plan (IEP)

 

While classroom modifications are an important step in recovery, students must also realize that keeping a regular schedule while not in school is also imperative.  It is also important to remember that following these same modifications at home (avoiding screens, computers, tablets, cell phones, television) are just as, if not more important.

 

To be in compliance with IHSA and the State of Illinois policy, the Acute Concussion Evaluation (ACE) Care Plan must be filled out by treating physician and returned to UTHS.

 

Once the student recovers and starts the Return to Play (RTP) process, these classroom modifications will cease.  Return to Learn (RTL) is the most important step in the concussion recovery process.

 

 

Return to Learn Plan (Example Plan)

Stage	Activity	Objective
No activity (Zone 1)	Complete cognitive rest-no school, no homework, no reading, no texting, no video games, no computer work (NO after school activities)	Recovery
Gradual reintroduction of cognitive activity (Zone 2)	Relax previous restrictions on activities and add back for short periods of time (5-15 minutes at a time)	Gradual controlled increase in sub-symptom threshold cognitive activities
Homework at home before school work at school (Zone 3)	Homework in longer increments (20-30 minutes at a time)- Essential content	Increase cognitive stamina by repetition of short periods of self-paced cognitive load
School re-entry (Zone 4)	Part of school after tolerating 1-2 cumulative hours of homework at home- Essential content	Re-entry to school with accommodations to permit controlled sub-symptom threshold increase in cognitive load
Gradual reintegration into school (Zone 5)	Increase to full day of school	Accommodations decrease as cognitive stamina improves
Resumption of full cognitive workload	Introduce testing, catch up on essential work	Full return to school, may commence return to play protocol

Information taken from “Importance of ‘Return-to-Learn’ in Pediatric and Adolescent Concussion” by: Master et al, Pediatrics Annuals, September 2012

 

 

Once Return to Play (RTP) protocol has started, the school accommodations cease. 

 

You cannot Return to Play (RTP) if you have not Returned to Learn (RTL).