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Temple ISD Athletic Department

Guidelines for Concussion Management

Introduction

The Centers for Disease Control (CDC) estimates that there are approximately 300,000 cases of mild traumatic brain injury (MTBI) or concussions annually in the United States as the result of participation in sports. The Sports Concussion Institute estimates that 10 percent of athletes in contact sports suffer a concussion during a season. A 2006 report estimated that there were 92,000 cases of concussions in American high School sports annually, and that these rates seem to be increasing. Also of concern is the risk of repeated concussions and second impact syndrome to our young athletes. These two problems can have long lasting, and even terminal effects, on the individual. In order to have a standard method of managing concussions to Temple ISD athletes, the following guidelines are intended to serve as a written protocol for concussion management.

The UIL has adopted a new mandate voted on and passed by Texas State Legislature House Bill 2038. The bill is found under Chapter 38. Sub Chapter D of the Texas Education Code (TEC)

Definitions

Concussion or Mild Traumatic Brain Injury (MTBI) -A concussion or MTBI is the common result of a blow to the head or body which causes the brain to move rapidly within the skull. This injury causes brain function to change which results in an altered mental state (either temporary or prolonged). Physiologic and/or anatomic disruptions of connections between some nerve cells in the brain occur. Concussions can have serious and long-term health effects, even from a mild bump on the head. Symptoms include, but are not limited to, brief loss of consciousness, headache, amnesia, nausea, dizziness, confusion, blurred vision, ringing in the ears, loss of balance, moodiness, poor concentration or mentally slow, lethargy, photosensitivity, sensitivity to noise, and a change in sleeping patterns. These symptoms may be temporary or long lasting.

Second Impact Syndrome – Second impact syndrome (SIS) refers to catastrophic events which may occur when a second concussion occurs while the athlete is still symptomatic and healing from a previous concussion. The second injury may occur within days or weeks following the first injury. Loss of consciousness is not required. The second impact is more likely to cause brain swelling with other widespread damage to the brain. This can be fatal. Most often SIS occurs when an athlete returns to activity without being symptom free from the previous concussion.

Terms Associated with a Concussion-Bell ringer, Slobber knocker, Dinger, Buzzed, Rattled, Cobwebs, No one’s home but the lights are on. These are terms that can be used to describe or classify a concussion.

What can happen if my child keeps on 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.

Concussion Management

            Teach your child it’s not smart to play with a concussion. Rest is the key after a concussion. Sometimes athletes, parents, and other school or league officials wrongly believe that it              shows strength and courage to play injured. Discourage others from pressuring injured athletes to play. Don’t let your athlete convince you that they’re “just fine.”

            Prevent long-term problems. If an athlete has a concussion, their brain needs time to heal. Don’t let them return to play the day of the injury and until a healthcare professional, experienced             in evaluating for concussion, says they are symptom-free and it’s OK to return to play. A repeat concussion that occurs before the brain recovers from the first—usually within a short time             period (hours, days, weeks)—can slow recovery or increase the chances for long-term problems. 

            Temple ISD has developed a protocol for managing concussions.  This policy includes a multidisciplinary approach involving athletic trainer clearance, physician referral and clearance, and             successful completion of activity progressions related to their sport.  The following is an outline of this procedure.  Your son/daughter must meet all criteria in order to return to sport activity             after having a concussion.

1. All athletes who sustain head injuries are required to be evaluated by a physician who has been trained in the management of concussions. This includes athletes who were initially referred to an emergency department or urgent care.

2. The student will be monitored daily at school by the athletic trainer and/or school nurse.  His/her teachers will be notified of their injury and what to expect.  Accommodations may need to be given according to physician recommendations and observations.

3. The student will be given a neurocognitive test after the concussion.  Athletes in contact sports will have this assessment prior to their season to form a baseline.  Temple ISD Athletics utilizes SWAY software (HS Only) program for a cognitive and balance assessment for concussion protocol .  

4. The student must be asymptomatic at rest and exertion.

5. The student will start a progressive step-by-step procedure outlined in the RTP statement. The progressions will advance at the rate of one step per day.  The progressions are:

*No activity for at least 24 hours after injury and athlete is symptom free

1. Light aerobic exercise jogging/bike (10-15 min) (20%-30%)

2. Aerobic exercise with no resistance training (40%-60%)

3. Sport specific activity - weights, skills only

4. Non-contact training drills with resistance training (physician clearance)

5. Full contact training drills - UIL RTP form and Dr Note must be on file with AT.

            Note – Athlete progression continues as long as an athlete is asymptomatic at current activity level.  If the athlete experiences any post concussion symptoms, he/she will wait             24 hours and start the progressions at the previous step.

            Upon completion of the return to play protocol, the physician of record must provide a written statement that in the physician’s professional judgment it is safe for the athlete to             return to play.

1. Once the student has completed steps 1 through 5, Physician note on file, SWAY (HS only) Assessment, UIL Concussion RTP form has been signed by the parent and athletic trainer, he/she may return to their sport activity with no restrictions.

2. Athletes will need to check in AFTER completion of Day 5 for full clearance and complete final SWAY baseline test.

   
   

   Prevention Strategies

1. All headgear must be NOCSAE certified.

2. Make sure the headgear fits the individual.

3. For all sports that require headgear, a coach or appropriate designate should check headgear before use to make sure air bladders work and are appropriately filled. Padding should be checked to make sure they are in proper working condition.

4. Make sure helmets are secured properly at all times.

5. Mouth guards should fit and be used at all times. They also need to be checked throughout the season to maintain their integrity and proper function.

Evaluation on for Concussion/MTBI

1. At time of injury administer one of these assessment tests:

a. SWAY assessment

b. Sports Concussion Assessment Tool 2 (SCAT2)

c. Graded Symptom Checklist (GSC)

cd. Sideline Functional & Visual Assessments

e. On-field Cognitive Testing

2. An athlete does not return to a game or practice if he/she shows any signs and/or symptoms of a concussion or if a coach, athletic trainer, parent or other health care provider suspects a concussion.