Complete Packet - Kansas Sports Concussion Partnership

Transcription

When a concussion occurs:
“Any school athlete who has been removed from a sport competition
or practice session shall not return to competition or practice until
the athlete is evaluated by a health care provider licensed by the state
board of healing arts to practice medicine and surgery (MD/DO) and
the health care provider provides such athlete a written clearance
to return to play or practice.” — [Kansas House Bill 2182 - 2011]
Check list for getting athlete back into the game.
Once an athlete has experienced any type of potential head injury:
1. n Remove athlete from all activity.
2. n
n
n
n
n
n
Activate the enclosed concussion protocol.
Start use of SCORE Card 1 (Athlete’s Symptoms) and SCORE Card 2 (Medical Assessment).
Contact parent/guardian.
Give Education Guides to parent/guardian and student athlete to review.
Distribute Education Guides to appropriate personnel (coach, athletic trainer, school, physician).
Activate School Concussion Team to coordinate Return to Learn Classroom Rx (SCORE Card 3).
3. n Refer athlete for evaluation by a MD/DO.
n Send SCORE Cards 1 and 2 directly to athlete’s physician or through parent/guardian.
4. n MD/DO authorizes athlete to start Warm-up to Play (SCORE Card 4). It’s the Law!
n Start Warm-up to Play progression (SCORE Card 4).
n Return athlete to full activity if Warm-up to Play is completed symptom free.
Athlete: _________________________________________________________________________
n Parent/Guardian Contacted: Name ____________________________ Date ________________
Notes: ___________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Concussion Packet
A game plan for the education, recognition and
management of sports related head injuries.
Download additional packets and link to educational resources at:
Kansas Sports Concussion Partnership
A project sponsored by Kansas Medical Society
www.KansasConcussion.org
Getting the athlete
back in the game
Baseline Test
Give a pre-season test to assess athlete’s
normal pre-injury balance and brain function.
Signs & Symptoms No
of Concussion?
Return to Play
(if no other issues)
A concussion is the most common
form of head injury suffered by
athletes. It is a form of traumatic brain
injury that occurs when the brain is
violently jarred back and forth or
rotated inside the skull as a result of a
blow to the head or body. This can
“stun” the brain cells or even result in
their death. You do not need to lose
consciousness to suffer a concussion.
Yes
Remove athlete from play
ER and
consider CT
Yes Serious Concerns?
No
Start SCORE Cards
Any athlete in motion is at risk for a
concussion. This may occur in any
sport, to boys and girls alike.
Symptoms may appear immediately
or develop over several days. They
may last a few days to several
months and interfere with schoolwork and social life.
Give Athlete Concussion Guides and SCORE Card 1
Athlete’s Symptoms
Medical Assessment
SCORE Card 1
SCORE Card 2
Administered by medical
professional, coach, athletic
trainer, or designated school
official. Athlete takes SCORE
Card to medical exams.
Administered by physician
or medical professional.
Copy scores to Athlete’s
Symptoms SCORE Card.
Repeat assessments until no symptoms and normal.
Consider referral
to concussion
specialist
Do active
symptoms/
Yes
problems
continue?
Are school
accommodations
necessary?
Return to
Yes Learn
Start Warm-up to Play Yes
Physician Release Form 4
If any symptoms recur, stop and rest for
the day. Repeat step once symptom-free.
STEP 1
Increase heart rate
STEP 2
Add movement
STEP 3
Add coordination and cognitive load
STEP 4
Restore confidence and assess functional skills
No
Warm up completed.
Symptom free?
Yes
Release for
Practice &
Competition
Classroom Rx 3
Activate a Concussion
Management Team to
help coordinate
athlete’s safe return.
No
Consider referral
to concussion
specialist
A game plan for the education,
recognition and management
of sports related head injuries.
A project sponsored by
Is participation in
classroom normal
and all concussion
symptoms resolved?
Concussion
Recognition
Signs Observed by Others
• Appears dazed or stunned
• Is confused about assignment
• Forgets plays
• Is unsure of game, score or opponent
• Moves clumsily or has slurred speech
• Answers questions slowly
• Loses consciousness
• Shows behavior or
personality changes
• Cannot recall events prior to hit
• Cannot recall events after hit
Sypmtoms Reported by Athlete
• Headache
• Nausea or vomiting
• Balance problems or dizziness
• Double or fuzzy vision
• Sensitivity to light or noise
• Feeling sluggish or drowsy
• Feeling foggy or groggy
• Concentration or
memory problems
• Confusion
Kansas
Sports
Concussion
Partnership
Name _________________________________________________________________
n M n F Birthdate ______________
Sport/Team/School _______________________________________________________________________________________
Baseline Exam
Examiner _____________________________________________________________ Exam Date ______________________
Primary Care Physician ___________________________________________________ Phone _________________________
Prior Concussions: How many? ________ Most Recent: Date ____________ Length of Recovery_________________________
Symptom
1 Evaluation
2 Cognition/Balance Assessment
How do you feel now?
Score the each symptom from 0 to 6.
none mild moderate
0
1
2
3
4
severe
5 6
PHYSICAL
Score
c ORIENTATION
Read these questions and check box if answered correctly: n What month is it? n What is today’s date?
n What day of the week is it? n What year is it? n What time is it now (within 1 hour)?
Score 1 point for each correct response (checked box). 5 points possible.
c IMMEDIATE MEMORY
Exam 1
Exam 2
Exam 3
Exam 4
Orientation Score
Exam 5
Read a list of five words and have athlete
Elbow
Candle
Baby
Finger
Basket
repeat back as many words as can be
Apple
Paper
Monkey
Penny
Hammer
remembered, in any order. Repeat the
same list again for the second and third
Carpet
Sugar
Perfume Blanket
Orange
trials. Have athlete repeat back as many
Saddle
Sandwich
Sunset
Lemon
Stick
words as can be remembered in any
order, even if they said the word before.
Bubble
Wagon
Iron
Insect
Plant
Complete all 3 trials regardless of score
on trials 1 & 2. Read the words at a
Score 1 point for each correct response. 5 points possible for each trial.
rate of one per second.
Total equals sum of all 3 trials. (15 pts. possible)
1. Headache
2. Pressure in head
3. Neck pain
4. Nausea or vomiting
5. Dizziness
6. Blurred vision
c CONCENTRATION
7. Balance problems
Exam 1
Exam 2
Exam 3
Trial I
/5
Trial II
/5
Trial III
/5
Immediate Memory Score
/15
Exam 4
Exam 5
COGNITIVE
A. Read a string of digits
4-9-3
6-2-9
5-2-6
4-1-5
1-7-3
Trial I
at a rate of one per second.
3-8-1-4
3-2-7-9
1-7-9-5
4-9-6-8
6-2-9-5
Have athlete repeat back the
Trial II
list of numbers in reverse
6-2-9-7-1
1-5-2-8-6
3-8-5-2-7
6-1-8-4-3
4-7-2-6-1
Trial III
order. If correct, score one
7-1-8-4-6-2 5-3-9-1-4-8 8-3-1-9-6-4 7-2-4-8-5-6 6-1-3-7-2-9
point and go to next trial
Trial IV
with one additional digit. If
A. Score 1 pt. if entire sequence per trial is correct. (4 pts. possible)
incorrect, score zero for that
Digits Backward Total
B. Score 1 pt. if entire sequence is correct. (1 pt. possible)
trial and subsequent trials.
12. Feeling slowed down
B. Have athlete recite months of year in reverse order:
Dec-Nov-Oct-Sept-Aug-Jul-Jun-May-April-Mar-Feb-Jan
8. Sensitivity (light)
9. Sensitivity (noise)
10. Fatigue or low energy
11. Don’t feel right
13. Feeling like in a fog
BALANCE ERRORS
14. Difficulty concentrating
Remove shoes, roll up your pant legs above the ankle (removing ankle taping).
This test will consist of three, 20-second timed tests from different stances.
15. Difficulty remembering
I. Double Leg Stance: Stand feet together, with hands on hips and eyes closed.
Maintain stability for 20 seconds. Count number of times that person moves out
of that position.
EMOTIONAL
16. Confusion
II. Single Leg Stance: Stand holding dominant leg off the floor a few inches and
maintain stability for 20 seconds with hands on hips and eyes closed. Count
number of times athlete moves out of that position. If they stumble, have them
open eyes and return to the start position and continue balancing. Start timing
when they are set and have their eyes closed.
17. More emotional
18. Irritability
/5
/1
/1
/1
/1
/4
Months in Reverse Order
/1
Total Concentration Score
/5
Dominant Foot: n Left n Right
Testing Surface: _______________
Types of Balance Errors:
• Hands lifted off iliac crest
• Opening eyes
• Step, stumble, or fall
• Moving hip into > 30˚ abduction
• Lifting forefoot or heel
• Remaining out of test position
longer than 5 seconds
III. Tandem Stance: Stand heel-to-toe with non-dominant foot in back. Weight is evenly distributed across both feet.
Maintain stability for 20 seconds with hands on hip and eyes closed. Count number of times athlete moves out of that
position. If they stumble out of this position, have them open eyes and return to the start position and continue balancing.
Start time when they are set and eyes are closed.
19 Sadness
20. Nervous or anxious
SLEEP
Stance I: # of Errors (10 max.)
/10
Stance II: # of Errors (10 max.)
/10
Stance III: # of Errors (10 max.)
/10
Total # Balance Errors (30 max.)
/30
FINGER-TO-NOSE COORDINATION TASK With athlete seated and either arm outstretched and
index finger pointed out, have athlete touch finger to tip of nose and return to starting position. Perform five
successive repetitions as quickly and accurately as possible.
Total F-to-N Coordination Task (1 max.)
Score 1 pt. with 5 correct repetitions in < 4 seconds
/1
c DELAYED RECALL Repeat back as many words as can be remembered from the group of 5 words from the Immediate
Memory question above. Score one point for each word remembered (5 points possible).
Delayed Recall Score
/5
TOTAL
/30
Begin counting errors only after the athlete has assumed the proper start position.
Score each stance test individually by counting the number of accumulated errors
with a maximum of 10 errors per stance. If athlete commits multiple errors
simultaneously, only one error is recorded but they must quickly return to the
testing position, and counting resumes once they are set. If unable to maintain
the stance for a minimum of 5 seconds, assign 10 errors.
21. Drowsiness
22. Trouble falling asleep
Baseline Exam Score Totals
Total # of Symptoms
/22
Symptom Severity Score
/132
Total # of Balance Errors
/30
F-to-N Coordination Task
/1
Total Cognition Score
/30
c TOTAL COGNITION SCORE Add individual (c) scores. (30 pts. possible)
Adapted from SCAT3, McCrory P, et al. Br J Sports Med 2013;47:250–258
2/2016
Name ____________________________________________________ n M n F Birthdate ________ Date of Injury ________
Athlete’s Symptoms
SCORE Card 1
Sport/Team/School ______________________________________________________ Phone _________________________
n Parent/Guardian Contacted _____________________________________________ Phone _________________________
Initial Examiner _________________________________________________________ Phone _________________________
Concussion Management Team Leader _______________________________________ Phone _________________________
This SCORE Card must be filled out each time you see a physician for a concussion. Kansas law requires a physician’s authorization to get you “back in the game.”
1
Symptom Evaluation
How do you feel now? Score the symptoms:
none
mild
moderate severe
0
1
2
3
4
5
6
2
3
4
5
6
7
8
9
10
11
12
13
14
Exam
Date:
By:
1. Headache
2. Pressure in head
3. Neck pain
PHYSICAL
4. Nausea or vomiting
5. Dizziness
6. Blurred vision
7. Balance problems
8. Sensitivity (light)
9. Sensitivity (noise)
10. Fatigue or low energy
11. Don’t feel right
COGNITIVE
12. Feeling slowed down
13. Feeling like in a fog
14. Difficulty concentrating
15. Difficulty remembering
EMOTIONAL
17. More emotional
SLEEP
16. Confusion
21. Drowsiness
18. Irritability
19 Sadness
20. Nervous or anxious
22. Trouble falling asleep
SCORE Cards
1
FOR OFFICE USE ONLY
Total # of Symptoms (22 max.)
Symptom Severity Score (132 max.)
Total # of Balance Errors (30 max.)
2
F-to-N Coordination Task (1 max.)
Total Cognition Score (30 max.)
If accommodations in school are necessary, go to Classroom Rx Form 3 to direct their Return to Learn progression.
When the student athlete is symptom-free, with normal exams, and attending school without difficulty, consider clearing the athlete to
start the Warm-up to Play using Release Form 4 .
2/2016
Sport/Team/School_________________________________________ Initial Examiner _________________________________
Prior Concussions: How many? ________ Most Recent: Date ____________ Length of Recovery_________________________
Yes No
n
n
n
n
n
SCORE Card 2
Yes No
n
n
n
n
n
n n Has any family member had a history of
depression, migraines or psychiatric disorder?
n n Do you suffer from neck pain?
Range of Motion _____________________
Tenderness _________________________
Exam Date:
Upper & Lower Limb
sensation/strength ___________________
By:
Ever been hospitalized or had MRI for a head injury?
Ever been diagnosed with headaches or migraines?
Ever experience motion sickness?
Do you have a learning disability or dyslexia?
Ever been diagnosed with ADD/ADHD, depression,
anxiety or other psychiatric disorder?
n n Are you taking prescription medication for any of these?
Cognition/Balance Assessment
c ORIENTATION
Medical Assessment
1
2
3
4
5
Read these questions and check box if answered correctly: n What month is it? n What is today’s date?
n What day of the week is it? n What year is it? n What time is it now (within 1 hour)?
Orientation Score
Score 1 point for each correct response (checked box). 5 points possible.
c IMMEDIATE MEMORY
Read a list of five words and have athlete
repeat back as many words as can be
remembered, in any order. Repeat the
same list again for the second and third
trials. Have athlete repeat back as many
words as can be remembered in any
order, even if they said the word before.
Complete all 3 trials regardless of score
on trials 1 & 2. Read the words at a rate
of one per second.
Exam 1
Exam 2
Exam 3
Exam 4
Elbow
Candle
Baby
Finger
Basket
Apple
Paper
Monkey
Penny
Hammer
/5
/5
/5
/5
/5
Exam 5
Carpet
Sugar
Perfume
Blanket
Orange
Trial I
/5
/5
/5
/5
/5
Saddle
Sandwich
Sunset
Lemon
Stick
Trial II
/5
/5
/5
/5
/5
Bubble
Wagon
Iron
Insect
Plant
Trial III
/5
/5
/5
/5
/5
Immediate Memory Score
/15
/15
/15
/15
/15
/1
/1
/1
/1
/1
/1
/1
/1
/1
/1
/1
/1
/1
/1
/1
/1
/1
/1
/1
/1
/4
/4
/4
/4
/4
/1
/1
/1
/1
/1
/5
/5
/5
/5
/5
With athlete seated and either arm outstretched and index finger pointed out,
have athlete touch finger to tip of nose and return to starting position. Perform five successive repetitions as quickly and accurately
as possible. Score 1 pt. with 5 correct repetitions in < 4 seconds
Transfer total to athlete’s SCORE Card 1. Total F-to-N Coordination Task (1 max.)
/1
/1
/1
/1
/1
c DELAYED RECALL Repeat back as many words as can be remembered from the group of 5 words from the
Immediate Memory question above. Score one point for each word remembered (5 points possible).
Delayed Recall Score
/5
/5
/5
/5
/5
/30
/30
/30
/30
/30
c CONCENTRATION
Score 1 point for each correct response. 5 points possible for each trial.
Total equals sum of all 3 trials. (15 pts. possible)
Exam 1
Exam 2
Exam 3
Exam 4
Exam 5
Trial I
A. Read a string of digits at a rate
4-9-3
6-2-9
5-2-6
4-1-5
1-7-3
of one per second. Have athlete
Trial II
3-8-1-4
3-2-7-9
1-7-9-5
4-9-6-8
6-2-9-5
repeat back the list of numbers
Trial III
6-2-9-7-1
1-5-2-8-6
3-8-5-2-7
6-1-8-4-3
4-7-2-6-1
in reverse order. If correct, score
one point and go to next trial with
7-1-8-4-6-2 5-3-9-1-4-8 8-3-1-9-6-4 7-2-4-8-5-6 6-1-3-7-2-9 Trial IV
one additional digit. If incorrect,
score zero for that trial and
Digits Backward Total
A. Score 1 pt. if entire sequence per trial is correct. (4 pts. possible)
subsequent trials.
Months
in Reverse Order
B. Score 1 pt. if entire sequence is correct. (1 pt. possible)
B. Have athlete recite months of
year in reverse order: Dec-Nov-Oct-Sept-Aug-Jul-Jun-May-April-Mar-Feb-Jan
Total Concentration Score
Dominant Foot: n Left n Right
Testing Surface: _______________
BALANCE ERRORS Remove shoes, roll up your pant legs above the ankle (removing
ankle taping). This test will consist of three, 20-second timed tests from different stances.
I. Double Leg Stance: Stand feet together, with hands on hips and eyes closed. Maintain
stability for 20 seconds. Count number of times that person moves out of that position.
Types of Balance Errors:
• Hands lifted off iliac crest
• Opening eyes
• Step, stumble, or fall
• Moving hip into > 30˚ abduction
• Lifting forefoot or heel
• Remaining out of test position
longer than 5 seconds
II. Single Leg Stance: Stand holding dominant leg off the floor a few inches and maintain
stability for 20 seconds with hands on hips and eyes closed. Count number of times athlete
moves out of that position. If they stumble, have them open eyes and return to the start
position and continue balancing. Start timing when they are set and have their eyes closed.
III. Tandem Stance: Stand heel-to-toe with non-dominant foot in back. Weight is evenly
distributed across both feet. Maintain stability for 20 seconds with hands on hip and eyes
closed. Count number of times athlete moves out of that position. If they stumble out of this
position, have them open eyes and return to the start position and continue balancing. Start time when they are set and eyes are closed.
Begin counting errors only after the athlete has assumed the proper start position. Score
each stance test individually by counting the number of accumulated errors with a maximum
of 10 errors per stance. If athlete commits multiple errors simultaneously, only one error is
recorded but they must quickly return to the testing position, and counting resumes once
they are set. If unable to maintain the stance for a minimum of 5 seconds, assign 10 errors.
Transfer total to athlete’s SCORE Card 1.
Stance I: # of Errors (10 max.)
Stance II: # of Errors (10 max.)
Stance III: # of Errors (10 max.)
Total # Balance Errors (30 max.)
FINGER-TO-NOSE COORDINATION TASK
c TOTAL COGNITION SCORE Add individual (c) scores and transfer total to SCORE Card 1. (30 pts. possible)
TOTAL
2/2016
Return to Learn
Classroom Rx 3
When can the student-athlete return to school? It will depend on the individual.
Every student’s injury and recovery is unique and requires careful observation from parents and doctors.
Promote recovery and prevent ongoing symptoms by following a Return to Learn plan like the one below.
The physician will customize a plan to allow recovery at student’s own pace.
Schools should identify a team leader to work with each student-athlete who sustained a concussion
to facilitate a safe return to learn. This identified team leader should establish a communication system
between the physician, athletic trainer, school administrators, teachers, coaches, school nurse, school
counselor, parent/guardian and any other members.
STUDENT MAY NOT ATTEND SCHOOL AT THIS TIME. Student may not attend class and should
not work on homework assignments, reading projects, etc. This includes no extracurricular activities, such as all athletic activity, weightlifting, gym class, band, music, debate, etc. Continue to limit
at-home activities that can worsen symptoms, such as loud music, television, computer screen
time, texting, etc.
PARTIAL SCHEDULE & ACCOMMODATIONS. Student may attend school with a partial class
schedule. Work with the student to help determine the most appropriate schedule. Classes should
be prioritized and not worsen symptoms. Special accommodations may be required to limit
symptoms (e.g. longer time period to take exams, postponing research papers, quiet studying in
the library, etc.) Homework should be limited during this time. Participation in all athletic activity,
weightlifting, gym class, and extracurricular activities is still fully restricted.
Do NOT allow student to
participate in the following:
n PE class
n Weightlifting
n Band or Music
n Wood shop or Metal shop
n Debate and Forensics
n Homework
n Exams or Quizzes
n Research Papers
n Computer Use
n Videos or Movies
n Other: ___________________
________________________
Please accommodate the
student in the classroom by:
n Extending test time
n Allowing quiet work time
(in library, for example)
n Creating a planner with
assignments, due dates, etc.
n Providing a tutor
n Creating an individualized
learning plan
n Other: __________________
________________________
FULL SCHEDULE & ACCOMMODATIONS. Student may participate in a normal classroom schedule, but will still require some accommodations, depending on their current symptoms. Continue to
work with the student to identify any specific classroom activities that could be worsening
symptoms. Student may be able to participate in band and music class if this does not worsen
concussions symptoms. All athletic activity, weightlifting and gym class is still not allowed, but the
student can start to participate in non-athletic extracurricular activities as tolerated.
Classroom options while student has not achieved 100% cognitive recovery could include:
• Offer a tutor, reader, or a note taker to assist with performance in the classroom.
• Give an extended period of time to complete quizzes, tests, papers, etc.
• Allow classroom attendance but postpone tests, quizzes, papers, etc. until cognitive function has improved.
• Offer accommodations to minimize noisy/stimulating environments or allow them preferential seating in the classroom
Gradually increase school participation and independence as tolerated by the student. Goal is to achieve full return to school
without accommodations.
NORMAL CLASSROOM. Student is NOT allowed to participate in any physical activity, such as weights, jogging, drills, practice or
games. The athlete is NOT cleared to start “Warm-up to Play” but may fully participate in normal classroom activities. Work with the
student to ensure a classroom “catch-up” plan is in place, if necessary.
Once participation in the classroom is normal and all concussion symptoms have resolved, physician should use the
Warm-up to Play Release Form 4 if authorization for Warm-up to Play can be safely started. Once the Warm-up to Play progression is
fully completed without return of symptoms, the student will be cleared for all athletic activity, weightlifting and gym class without restrictions.
Concussion symptoms may develop within days after a head injury. The patient should continue to be observed for any new symptoms.
Medical Professional Signature: ______________________________________________________________ Date ________________
Scheduled Follow-up Date ________________
Notes:________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
2/2016
Warm-up to Play
Release Form 4
An athlete’s return to his/her sport will be a step-by-step process. Once the athlete has no symptoms or
signs of concussion and is doing well in school and daily activities, a physician (MD/DO) will sign this form
allowing the athlete to start the progression back to play. This will be monitored by a coach, athletic trainer or designated school official.
Athlete should spend a minimum of 30 minutes on each step. Athlete must wait 24 hours before progressing to the next step and remain
completely symptom-free. STOP IMMEDIATELY if there is any return of signs/symptoms and report this right away. Go back to rest for the
day, refrain from activities including bike riding, skateboarding, playful wrestling, etc. The following day — only if symptom free— athlete
may repeat step that was previously symptom-free and resume progression. If symptoms persist or worsen for more than a day, please notify
the physician.
n Physician Release to Start Warm-up to Play. Proceed to Step 1.
This patient has had an injury to the head. Patient may “Return to Play” after normal classroom full participation is achieved and
successfully completing Steps 1 through 4 of the “Warm-up to Play” below. Symptoms of concussion may develop within days after
a head injury. Patient should continue to be observed for any new symptoms.
Physician Signature ______________________________________
Date ___________________
Step 1. Light aerobic exercise, including walking or riding an exercise bike. No weightlifting. (increase heart rate)
n Step 1 completed successfully.
Athlete reports no return of
Coach/Athletic Trainer ____________________________________ Date _______________
symptoms after 24 hours.
Notes: _____________________________________________________________________
Okay to proceed to Step 2.
Step 2. Running in a gym or on the field. No helmet or equipment should be used. (add movement)
Notes: _____________________________________________________________________
Step 3. Non-contact training drills and full equipment. Start light resistance training or light weight training. (add coordination and cognitive load)
Notes: _____________________________________________________________________
Step 4. Full contact training under the supervision of the coach/athletic trainer. (restore confidence and assess functional skills)
Notes: _____________________________________________________________________
Okay to “Return to Play.”
Return to Play
Student may fully Return to Play if all the above steps were successfully completed without return of any symptoms. This includes
full participation in live competition or practice. Symptoms of concussion may develop within days after a head injury. Patient should
continue to be observed for any new symptoms.
2/2016
ATHLETE’S
CONCUSSION GUIDE
Game plan for the education, recognition and management of sports related head injuries.
Quick Facts >
1. ALWAYS remove athletes immediately after
suspecting a concussion. Do NOT allow
return to play the same day with a concussion.
2. Athletes do NOT have to be knocked out to
have a concussion. 90% of concussions
occur without a loss of consciousness.
3. CT scans don’t diagnose concussions. Everyone with a concussion has a normal CT scan.
4. It is OK to let someone fall asleep after being
hit in the head. With careful monitoring, rest
and sleep will be helpful.
5. “Warm Up for Return” is a graded process
that requires a minimum of five days.
6. 9 out of 10 athletes will be back to normal
within two weeks. They may miss a few games.
7. Kansas law requires a physician’s signature
(MD/DO) to “Return to Play.”
8. Athletes who return to full contact too early
risk Second Impact Syndrome, a rare but
devastating brain injury that may result in
death.
9. Concussions can affect driving, school work,
sleep, emotions, relationships and self worth.
10. The “game plan” is not just about returning
an athlete to their sport; it is about returning
the person back to their life.
Recognition >
SIGNS OBSERVED BY OTHERS
• Forgets plays
• Shows behavior or personality changes
SYMPTOMS REPORTED BY YOU
• Headache
• Concentration or memory problems
• Confusion
Definition >
A concussion is the most common form of head injury suffered by athletes. It is a form
of traumatic brain injury that occurs when the brain is violently jarred back and forth or
rotated inside the skull as a result of a blow to the head or body. This can “stun” the
brain cells or even result in their death. You do not need to lose consciousness to suffer
a concussion.
Any athlete in motion is at risk for a concussion. This may occur in any sport, to boys
and girls alike. Symptoms may appear immediately or develop over several days. They
may last a few days to several months and interfere with schoolwork and social life.
Management >
How do I know if I have a concussion?
If you have any of the signs or symptoms listed under the “Recognition” section of this
guide, then you may have a concussion. Don’t ever play through a concussion because
it’s not worth the risk to your health and your life.
What do I do if I think I might have a concussion?
Stop playing right away! Don’t ignore a bump, blow or jolt to your head. Tell a referee,
coach or athletic trainer about your symptoms. You should be immediately removed
from practice or the game to avoid further injury. If symptoms develop at home or
school, immediately tell a parent/guardian, teacher or coach.
What happens when I report a possible concussion?
An athletic trainer, coach, EMT/paramedic or physician will evaluate you as soon as you
report your symptoms. If there are not qualified health care professionals available at
your practice or game, you need to call your doctor or go to the Emergency Department
as soon as possible. If you do have a concussion, you will not be able to play your sport
until cleared by a physician.
What do I need to do while I continue to have symptoms of a concussion?
• Rest as much as possible. You may need frequent naps during the first few days after
your injury.
• Avoid places with bright lights or loud noise and activities that stimulate your brain
because mental rest is vital to your recovery. Eliminate or reduce watching television
or movies, texting, reading, playing video games and browsing on a computer.
• Do not perform any physical activities, such as weightlifting, riding a bike, jogging,
practice drills or other types of exercise.
• Stay home or only attend partial days if schoolwork makes your symptoms worse.
Talk to your teachers. You may require more time to complete assignments and take
tests, need written instructions for homework or need information repeated. Visit the
school nurse if you have headaches.
• Do not drive because the symptoms from a concussion can slow your reaction times
and lead to an accident.
• The more aggressively you rest your brain, the sooner you should heal from a
concussion.
How often do I need to see the doctor?
This will vary depending on the situation. If your symptoms are severe, the physician
may want to see you on a daily basis for a few days. You may only have to go into the
physician’s office once a week. A physician must sign a written clearance form that you
will take to school that says you are allowed to participate in full contact practice again.
This is now a state law in Kansas.
Athlete’s CG • 7/2013 • Page 1
SCORE Card >
Concerns >
The first health care professional that evaluates you will fill out a
concussion evaluation tool called a SCORE Card. If this first person
is not your physician who you will visit during recovery, make
sure you get a copy of SCORE Card 1 to take to your physician
appointment. This will contain important information that your
physician will use to monitor your progression and return you to the
game as soon as possible.
What are possible complications from a concussion?
While 90% of athletes are back to their baseline within 7-10 days,
there are 10% of athletes who will experience prolonged symptoms
or other complications.
This is called Post-Concussive Syndrome and occurs when symptoms from a concussion are prolonged. Difficulty with concentration,
memory and persistent headaches are common symptoms.
Talk with the physician if symptoms last longer than a couple of
weeks. A referral to a specialist for further evaluation and treatment
may be required.
Return to Play >
When can I start playing my sport again?
Only consider starting the Warm-up to Play progression once you are
fully participating in school again without any symptoms. Returning
to your sport will be a step-by-step process. Once you have no
symptoms or signs of concussion and achieve normalized results
on SCORE Card 2 , a medical authorization will start your Warm-up
to Play 4 . This process should be monitored by an athletic trainer,
coach or designated school official.
Once you successfully complete the progression back to play, you
will be authorized to start the “Warm-up to Play.” At any time that
you do not feel quite right, tell your doctor, parent, coach or athletic
trainer immediately.
After I am symptom-free, what is the progression back to play?
Think of this progression as a warm up for return to your sport.
Taking at least 24 hours for each step before moving on to the next
step is recommended.
If any symptoms recur, report this right away and stop and rest for
the day. You must be completely symptom-free before starting the
progression again.
Step 1. Light aerobic exercise, including walking or riding an
exercise bike. No weightlifting.
Step 2. Running in a gym or on the field. No helmet or equipment
should be used.
Step 3. Non-contact training drills and full equipment. Start light
resistance training or light weight training.
What might happen if the athlete returns to his/her sport too soon?
If an athlete receives another blow while still recovering from a first
concussion, he/she could develop Second Impact Syndrome. This
syndrome can cause serious life-long health difficulties or, in rare
situations, even result in death.
This possibility is a major reason why health care professionals are
concerned about carefully treating any concussion. While the brain is
still healing, it may not be able to compensate and protect itself from
a new injury.
Better to miss a game or two than
the whole season or your whole life!
Step 4. Full contact training under supervision of coach/athletic
trainer.
Step 5. Return to competition or game play.
You must be seen by a physician (MD/DO) during the
warm up progression to be legally released for return to
competition or practice.
Other Resources >
Kansas Law: www.kslegislature.org/li/b2011_12/year1/measures/hb2182/
KSHSAA Guidelines: www.kshsaa.org/Public/General/ConcussionGuidelines.cfm
Centers for Disease Control and Prevention: www.cdc.gov/concussion/HeadsUp/youth.html
Kansas Sports Concussion Partnership: www.kansasconcussion.org
Athlete’s CG • 7/2013 • Page 2
PARENT’S
CONCUSSION GUIDE
Quick Facts >
death.
Recognition >
• Forgets plays
SYMPTOMS REPORTED BY ATHLETE
• Headache
• Confusion
Definition >
a concussion.
Management >
What do I do if I suspect my child has a concussion?
Pull your child out of practice or the game immediately to avoid further aggravating the
injury. Look for signs or symptoms listed under the “Recognition” section of this guide
and report them to an athletic trainer, coach, EMT/paramedic or physician who will
evaluate your child. If your child has a concussion, he/she will not be able to participate
in practice or a game until cleared by a physician (MD/DO) as required by Kansas law.
When does my child need to visit the Emergency Room?
Take your child to an Emergency Department if instructed to by the athletic trainer,
coach, EMT/paramedic or physician who evaluated your child. If no qualified health professional is available to conduct an evaluation or if you have concerns about monitoring
your child at home, proceed to an Emergency Department as soon as possible.
If the athlete is at home when severe symptoms appear, such as vomiting, severe
headache, difficulty answering simple questions, loss of consciousness or seizures,
proceed immediately to an Emergency Department for evaluation.
What should I watch for at home?
• If your child is at home when you first recognize any symptoms listed under the
“Recognition” section of this guide, immediately consult a physician so your child can
be evaluated.
• After your child has been evaluated and returned home, pay attention to see if
symptoms worsen and report them to a physician or proceed to the closest
Emergency Department.
How should I care for my child who still has symptoms of a concussion?
• Encourage your child to rest as much as possible. He/she may need frequent naps
during the first few days after the injury. The more aggressive your child rests the
brain, the sooner healing will occur.
• Your child should avoid places with bright lights or loud noise and activities that
stimulate the brain because mental rest is vital to recovery. Eliminate or reduce
watching television or movies, texting, reading, playing video games and browsing on
a computer.
• Do not allow your child to perform any physical activities, such as weightlifting, riding
a bike, jogging, practice drills or other types of exercise.
• Do not allow your child to drive because the symptoms from a concussion can slow
his/her reaction times and lead to an accident.
• After your child has been evaluated, make sure a medical follow-up plan is in place.
Does my child need to stay home from school?
If schoolwork makes your child’s symptoms worse, he/she should stay home or only
attend partial days. While at school, your child may require more time to complete
assignments and take tests, need written instructions for homework or need new
Parent’s CG • 7/2013 • Page 1
information repeated. Written assignments and/or tests may need to
be delayed. Discuss these issues with your physician, teachers and
school officials and develop a plan to help your child fully recover
physically, mentally and academically. Encourage your child to
visit the school nurse if he/she has headaches at school. Finally,
communicate often with your school’s concussion management
team during your child’s recovery. For more information, consult
KSCP’s Return to Learn Safe Progression guide.
How often do we need to see the doctor?
This will vary depending on the situation. Your child may only have
to visit the physician once a week. If symptoms are severe, the
physician may want to see your child on a daily basis for a few days.
A physician (MD/DO) must sign a written clearance form for the
school that says he/she is allowed to participate in full contact
practice again. This is now a state law in Kansas.
When should my child be referred to a specialist?
If symptoms persist beyond 2 weeks or are unusually severe, consider
discussing with your physician the need for a referral to a concussion
specialist, such as a sports medicine physician, neurologist,
neuropsychologist or physical medicine and rehabilitation physician.
Concerns >
may be required.
a new injury.
SCORE Card >
The first health care professional that evaluates your child will fill out
a concussion evaluation tool called a SCORE Card. If this first person
is not the physician who will oversee your child’s recovery, make
sure to get a copy of SCORE Card 1 for the physician. This will
contain important information that the physician will use to determine
how to care for your child’s concussion and monitor his/her
progression from the injury.
Return to Play >
When can my child start playing his/her sport again?
Only consider starting the Warm Up to Play progression once your
child is fully participating in school again without any symptoms.
Your child’s return to sports will be a step-by-step process. Once
your child has no symptoms or signs of concussion and achieves
normalized results on SCORE Card 2 , a medical authorization will
start a Warm-up for Return 4 . This process should be monitored by
an athletic trainer, coach or designated school official.
Encourage your child to tell you, the coach, athletic trainer or physician immediately if he/she does not feel quite right at any time.
After my child is symptom-free, what is the progression back to
play?
Think of this progression as a warm up for return to his/her sport.
Each step takes at least 24 hours before moving on to the next step.
If any symptoms recur, your child should report this right away so
he/she can stop and rest for the day. Before starting the progression
again, your child must be completely symptom-free.
should be used.
trainer.
The athlete must be seen by a physician (MD/DO) during
the warm up progression to be legally released for return
to competition or practice.
the whole season or a whole life!
Other Resources >
Parent’s CG • 7/2013 • Page 2
Plan de juego para la educación, reconocimiento y administración de lesiones en la cabeza relacionadas con el juego www.KansasConsussion.org Hechos Rápidos > 1.
SIEMPRE retirar al deportista inmediatamente después que se sospecha de una concusión. NO dejar que regrese a jugar el mismo día de la concusión. 2. Los deportistas NO tienen que estar completamente noqueado para que sea una concusión. 90% de las concusiones ocurren sin que se pierda el conocimiento. 3. Las tomografías no diagnostican una concusión. Todos con una concusión salen normal en la tomografía. 4. ESTA BIEN dejar que se duerman después de haberse golpeado en la cabeza. Con cuidadoso control, descanso y dormir será beneficioso. 5. “Calentamiento para regresar” es un proceso gradual que requiere un mínimo de cinco días. 6. 9 de 10 deportistas regresaran a lo normal dentro de dos semanas. Ellos pueden no jugar unos juegos. 7. La ley de Kansas requiere la firma de un doctor (MD/DO) para “Regresar a Jugar”. 8. Los jugadores que regresan muy pronto de lleno a jugar pueden sufrir el Síndrome del Segundo Impacto, una rara pero devastadora lesión cerebral que puede resultar en la muerte. 9. Las concusiones pueden afectar el manejar, tareas escolares, dormir, emociones, relaciones y auto estima. 10. El “Plan de Juego” no es solo acerca de que el jugador regrese a su juego; es acerca de que regresen a su vida diaria. Reconocimiento > SIGNOS OBSERVADO POR OTROS •
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Se ven aturdidos o confundidos Se olvida de las jugadas No esta seguro del juego, resultados u oponentes. Se mueve con torpeza o tiene dificultad para hablar Contesta preguntas despacio Pierde el conocimiento Muestra cambios de comportamiento y de personalidad No recuerda eventos que fueron antes del golpe No recuerda eventos después del golpe SINTOMAS REPORTADOS POR EL JUGADOR •
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Dolor de cabeza Nausea o vomito Problemas de balance o mareos Doble visión o borrosa Sensibilidad a la luz o al ruido Sentirse débil o somnoliento Sentirse confuso o mareado Problemas de concentración o memoria Confusión GUIA PARA PADRES ACERCA DE LAS CONCUSIONES Definición > Una concusión es la forma más común de una lesión en la cabeza sufrida por un deportista. Es una forma de lesión traumática en el cerebro que ocurre cuando el cerebro es sacudido violentamente de atrás hacia adelante o gira adentro del cráneo como el resultado de un golpe a la cabeza o al cuerpo. Esto puede “aturdir” las células del cerebro o hasta puede causar la muerte. No necesariamente tiene que perder el conocimiento para sufrir una concusión. Cualquier deportista en movimiento esta en riesgo de una concusión. Esto puede ocurrir en cualquier deporte, a hombres y mujeres por igual. Los síntomas pueden aparecer inmediatamente o desarrollarse en varios días. Pueden durar varios días o meses y puede interferir con trabajos escolares y la vida social. Manejo > ¿Qué debo de hacer si sospecho que mi hijo/a tiene una concusión? Retírelo de la práctica o del juego inmediatamente para evitar mas danos a la lesión. Busque por signos o síntomas mencionados bajo la sección de esta guía “Reconocimiento” y reportarlo al director técnico, entrenador, paramédico o doctor quien evaluara a su hijo/a. Si el/ella tiene una concusión no podrán participar en las practicas o en los juegos hasta que este dado de alta por un doctor (MD/DO) como lo requiere la ley de Kansas. ¿Cuándo es necesario llevar a mi hijo/a a emergencias? Lleve a su hijo a Emergencias si se lo pide el director técnico, entrenador, paramédico o doctor quien evaluara a su hijo/a. Si no hay un profesional de salud calificado para que haga una evaluación o si tiene preocupación de cómo cuidarlo en casa llévelo a Emergencias lo más pronto posible. Si el deportista esta en casa cuando aparecen síntomas severos, como vomito, fuerte dolor de cabeza, dificultad para contestar preguntas simples, perdida de conciencia o convulsiones, llévelo inmediatamente al Servicio de Emergencias para una evaluación. ¿Qué es lo que debo de cuidar en casa? Si su esta en casa cuando usted nota cualquiera de los síntomas mencionados bajo la sección de esta guía “Reconocimiento”, inmediatamente consulte a su medico para que sea evaluado. Después de que su hijo ha sido evaluado y esta de regreso en casa, preste atención para ver si los síntomas empeoran e informe a un médico o llévelo al servicio de urgencias más cercano. ¿Cómo debo de cuidar a mi hijo/a que aun tiene síntomas de una concusión? Anime a su hijo a que descanse lo más posible. El/ella puede que necesiten tomar siestas frecuentemente durante los primeros días después de la lesión. Lo mas posible que su hijo descanse su cerebro, será lo mas rápido que se recupere. Su hijo/a debe evitar lugares con mucha luz o con mucho ruido y actividades que estimulen su cerebro porque el descanso mental es vital para la recuperación. Elimine o reduzca que vea televisión o películas, mandar textos, leer, jugar videojuegos o navegar el internet. No deje que su hijo/a ejecute ninguna actividad física, como levantamiento de pesas, andar en bicicleta, trotar, practicar ejercicios u otros tipos de ejercicio. No deje que su hijo/a maneje porque los síntomas de su concusión pueden disminuir su reacción y causar un accidente. Después que su hijo ha sido evaluado, asegúrese que regrese a una revisión médica. ¿Debe quedarse mi hijo/a en casa y no ir a la escuela? Si el trabajo escolar hace que los síntomas empeoren, el/ella deben quedarse en casa o solo asistir parte del día. Mientras este en la escuela, su hijo/a puede requerir más tiempo para completar sus asignaciones y tomar exámenes, si necesitan instrucciones escritas para su tarea o necesitan que la nueva información sea repetida. Asignaciones escritas y/o exámenes pueden posponerse. Hable de estos asuntos con su medico, maestros y personal de la escuela para desarrollar un plan que ayude a su hijo/a a recuperarse completamente físicamente, mentalmente, y académicamente. Anime a su hijo/a que valla con la enfermera de la escuela si tiene dolor de cabeza durante la escuela. Finalmente, comuníquese seguido con el equipo de manejo de concusiones de la escuela durante la recuperación de su hijo. Para mas información, consulte la guía de Aprenda la Segura Progresión para Regresar de KSCP. ¿Cada cuanto necesita ver al doctor? Esto varia depende la situación. Tal vez su hijo/a solo debe visitar al doctor una vez por semana. Si los síntomas son severos, el doctor puede que quiera ver a su hijo/a todos los días durante unos días. Un doctor (MD/DO) debe de firmar una forma dando de alta al estudiante que diga a la escuela que el puede participar de lleno en practicas de nuevo. Esto es ahora una ley en Kansas. ¿Cuándo debería mi hijo/a ser referido a un especialista? Si los síntomas persisten por mas de 2 semanas o están inusualmente severos, considere discutirlo con su discutirlo con su doctor para que lo refiera con un especialista en concusiones, como con un doctor de medicina de deportes, neurólogo, neuro psicólogo, o medicina física o de rehabilitación. PRECAUCIONES > ¿Cuáles son las posibles complicaciones de una concusión? Mientras 90% de los deportistas están de regreso dentro de 7-‐
10 días, hay un 10% de ellos que tendrán síntomas prolongados u otras preocupaciones. Esto se llama Síndrome Postconcusion y ocurre cuando los síntomas de una concusión son prolongados. Dificultad para concentrarse, memoria y dolores de cabeza persistentes son síntomas comunes. Hable con su medico si los síntomas duran mas que unas pocas semanas. Puede que se requiera que lo refieran a un especialista para una evaluación y tratamiento. ¿Qué pasa si el jugador regresa antes de tiempo a jugar? TARJETA de Puntuación > El primer profesional de salud medico que evalúa su hijo/a llenara una forma que evalúa la concusión llamada TARJETA de Puntuación. Si esta persona no es el medico que vera a su hijo/a hasta que se recupere, asegúrese de que le den una copia de su TARJETA de Puntuación 1 para su medico. Esto contiene información importante que el medico usara para determinar el tipo de cuidado que su hijo/a necesita por su concusión y para monitorear su progreso después de la concusión. Regreso a Jugar > ¿Cuándo puede mi hijo empezar a jugar otra vez? Solo considere que haga Calentamiento para Jugar una vez que su hijo este participando de lleno en la escuela sin ningún síntoma. Su regreso a jugar será un progreso paso a paso. Una vez que su hijo no tiene síntomas o señales de la concusión alcanza los resultados normales en la TARJETA de Puntuación 2, una autorización empezara un Regreso a Calentamiento 4. Este proceso debe ser monitoreado preparador físico, entrenador, o el personal asignado en la escuela. Anime a su hijo a que le diga a usted, al entrenador o medico inmediatamente si el no se siente bien en cualquier momento. Después que mi hijo no tiene ningún síntoma, ¿Cuál debe de ser su progreso para regresar a jugar? Piense en este progreso como un calentamiento para regresar a jugar. Cada paso dura al menos 24 horas antes de pasar al siguiente paso. Si cualquiera de los síntomas regresan, su hijo/a debe reportarlo al inmediatamente, y pare lo que esta haciendo y descanse por el resto del día. Antes de empezar su progreso de nuevo, su hijo/a no debe de tener ningún síntoma. Paso 1. Ejercicio aeróbico ligero, incluyendo caminar o montar en una bicicleta estática. No levantar pesas. Paso 2. Correr en el gimnasio o en el campo. No debe usar casco o equipo. Paso 3. No ejercicios de contacto o uso de todo su equipo. Empezar entrenamiento de resistencia ligero o levantamiento de pesas ligero. Paso 4. Entrenamiento de contacto completo bajo la supervisión de su entrenado/director técnico. Paso 5. Regresar a la competencia o juego.
El jugador debe ver a un doctor (MD/DO) durante el calentamiento progresivo para que legalmente sea dado de alta y pueda regresar a la competencia o juego. Si el jugador recibe otro golpe mientras se esta recuperando de la primera concusión, el/ella puede desarrollar el Síndrome de Segundo Impacto. Este síntoma puede causar dificultades serias de salud a lo largo de su vida, o en raros casos, puede causar hasta la muerte. Esta posibilidad es la principal razón de el porque un profesional de cuidado de la salud se preocupan demasiado cuando se trata de una concusión. Cuando el cerebro todavía se esta recuperando, puede ser que no se pueda reparar y proteger el mismo de una nueva lesión. Es mejor perderse un juego o dos que toda la temporada o toda su vida!
Otros Recursos > Kansas Law: www.kslegislature.org/li/b2011)12/year1/measures/hb2182/ KSHSSA Guidelines: www.kshsaa.org/Public/General/ConcussionGuidelines.cfm Centers for Disease Control and Prevention: www.cdc.gov/concussion/HeadsUp/youth.html Kansas Sports Concussion Partnership: www.kansasconcussion.org ¡
proyecto patrocinado por Un Kansas Sports Concussion Partnership
PHYSICIAN’S
CONCUSSION GUIDE
Quick Facts >
death.
Recognition >
• Forgets plays
• Headache
• Confusion
Definition >
a concussion.
Management >
What do I do if I suspect an athlete has a concussion?
If you are on the sideline, immediately pull the athlete out of practice or the game to
avoid further aggravating the injury. If necessary, check airway, breathing and circulation
and pay special attention to a possible cervical spine injury. Look for signs or symptoms
listed under the “Recognition” section of this guide when conducting an evaluation and
consider the need for emergency medical services. Notify parents/guardians of the
athlete’s injury.
If not on the sideline, see the athlete within 48-72 hours after the initial injury. While the
athlete is symptomatic and if the physical exam is abnormal, do not allow him/her to
participate in any physical activity and limit mental activities.
If the athlete has a concussion, he/she will not be able to participate in practice or a
game until a written authorization form is signed by a physician (MD/DO) as required by
Kansas law.
When does the athlete need to visit the Emergency Department?
If a focal neurological deficit is noted or severe symptoms appear, such as vomiting,
severe headache, difficulty answering simple questions, declining mental status, loss of
consciousness or seizures, call 911 or refer immediately to an Emergency Department
for further evaluation.
How should I conduct the sideline evaluation?
Once stabilized, and if no severe symptoms appear, the athlete can be examined by
using KSCP’s sideline concussion assessment SCORE Cards or SCAT3. A history and
full neurological exam should be performed. If a concussion is suspected, do not allow
the athlete to return to play. Serious complications may occur if the athlete returns to
play following a concussion.
When should I order a CT scan or MRI?
Concussions occur at a cellular level beyond our ability to clearly see during a physical
exam or with CT or MRI scans. If the injury is truly a concussion, these scans will be
completely within normal limits. However, if symptoms are severe, prolonged or if focal
neurological deficits are present, advanced imaging should be considered.
How should the athlete be treated during the concussion recovery?
• The athlete should not be left unmonitored for the initial 12-24 hours in case of clinical worsening. While it is not necessary to keep the athlete awake, he/she should be
observed periodically to ensure he/she is resting comfortably and breathing easily.
• Establish a medical follow-up plan after the athlete is evaluated. Closely monitor the
athlete until he/she returns to a baseline in terms of pain, emotions, sleep habits and
ability to concentrate. Seek assistance from the coach, athletic trainer, designated
school official or parents for daily evaluation of the athlete’s symptoms.
• Encourage the athlete to rest as much as possible. He/she may need frequent naps
during the first few days after the injury. The more aggressive your patient rests the
brain, the sooner healing will occur.
• The athlete should avoid places with bright lights or loud noise and activities that
Physician’s CG • 7/2013 • Page 1
•
•
•
•
•
stimulate the brain because mental rest is vital to recovery. Recommend eliminating or reducing watching television or movies,
texting, reading, playing video games and browsing on a computer.
Do not allow the athlete to perform any physical activities, such as
weightlifting, riding a bike, jogging, practice drills or other types of
exercise.
Do not allow the athlete to drive because the symptoms from a
concussion can slow his/her reaction times and lead to an accident.
It may be necessary to keep the athlete out of school or reduce
attendance to partial days. Upon return to school, it may be
necessary to recommend that the athlete delay tests and major
assignments. The athlete may benefit from written instructions
for homework and repeated presentation of new information.
For more information, consult KSCP’s Return-To-Learn Safe
Progression guide.
Use KSCP’s Return to Learn Classroom Rx 3 in coordination with
the school concussion team.
When should I refer the athlete to a specialist?
If symptoms persist beyond 2 weeks or are unusually severe,
consider referring your patient to a concussion specialist, such as a
sports medicine physician, neurologist, neuropsychologist or
physical medicine and rehabilitation physician.
memory and persistent headaches are common symptoms. A referral
to a specialist for further evaluation and treatment may be required.
situations, even result in death. This possibility is a major reason why
health care professionals are concerned about carefully treating any
concussion. While the brain is still healing, it may not be able to
compensate and protect itself from a new injury.
How can I help prevent concussions?
• Encourage a culture of safety within the local sports environment.
This should include coaches, athletic trainers, school officials,
parents and athletes – all who are concerned with an athlete’s health
and want to create a safe playing environment for each athlete.
• Establish yearly educational activities on concussions with
coaches, athletic trainers, parents and student athletes.
• Help develop an emergency action plan for concussions with other
local health professionals, school nurses, coaches, athletic trainers
and school officials. This will ensure a prompt, coordinated
response when a concussion is suspected.
• When an injury does occur, encourage athletes and parents to take
the necessary time to heal.
SCORE Card >
The first health care professional that evaluates the athlete should
complete KSCP’s SCORE Card 1 , a useful tool for monitoring and
evaluating concussion symptoms. If you are not the first person to
evaluate the athlete, make sure you receive a copy of SCORE Card 1 .
This will contain important information that will help you determine how
to care for the athlete’s concussion and monitor his/her progression
from the injury.
At the initial visit, a complete neurological exam should accompany
SCORE Card 1 and 2 evaluations. Collect a history of previous
concussions or head injuries.
Depending on the situation, the athlete may need to visit your office once
a week or on a daily basis for a few days. Each time you see the patient,
use the SCORE Card 1 as a tool for serial monitoring.
Return to Play >
When can the student athlete start playing his/her sport again?
Only consider approving the Warm Up to Play progression once the
student athlete is fully participating in school again without any
symptoms. The athlete’s return to sports will be a step-by-step
process. Once he/she has no symptoms or signs of concussion and
achieves normalized results on SCORE Card 2 , a medical authorization will start a Warm-up for Return 4 . This process should be
monitored by an athletic trainer, coach or designated school official.
Encourage the student to tell you, their parents, the athletic staff or
teachers immediately if he/she does not feel quite right at any time.
After the athlete is symptom-free, what is the progression back to
play?
Think of this progression as a warm up for the athlete to return to
his/her sport. Each step takes at least 24 hours before moving on to
the next step.
During this progression, the coach or athletic trainer should ask the
athlete if any symptoms are starting to return. If symptoms recur,
the athlete must stop for the day and rest. Before starting the
progression again, the athlete must be completely symptom-free.
should be used.
trainer.
Other Resources >
Physician’s CG • 7/2013 • Page 2
Coach/Athletic Trainer’s
CONCUSSION GUIDE
Quick Facts >
death.
Recognition >
• Forgets plays
• Headache
• Confusion
Definition >
a concussion.
Management >
What key role do I play in concussion management?
As the coach/athletic trainer you play a critical role in preventing concussions and ensuring they are properly managed when it does occur. Ultimately it is all about the health and
welfare of our student athletes. Insist that safety comes first. Encourage good sportsmanship at all times. Insist your athletes wear the right protective equipment for their
sport. Ensure that equipment fits properly, is worn consistently and is well-maintained.
Talk with athletes and their parents about the dangers and potential long term
consequences of a concussion. Review the signs and symptoms of concussion with
your athletes. The “hit” may not be recognized but the symptoms should be. Your
concern will be heard by your athletes and they will follow your lead.
Some players and parents wrongly believe that it shows strength and courage to play
injured. Discourage anyone from pressuring an injured athlete to return too quickly, and
guard against being persuaded that the athlete is “just fine.” Educate yourself and your
staff on this important topic.
Every concussion is potentially serious. When in doubt, sit them out!
What should I do when a concussion is suspected?
• Immediately remove the athlete from play.
• If the athlete is stable and no severe symptoms appear, the athlete can be examined by
using KSCP’s sideline concussion assessment SCORE Cards or SCAT3.
• If a concussion is suspected, do not allow the athlete to return to play. Ensure the
athlete is evaluated right away by an appropriate health care professional. Details on
the injury, force of the impact, loss of consciousness, recognized symptoms and
history of previous concussions will be helpful to the health care provider.
• Inform the athlete’s parents or guardian about the possible concussion and give them
the fact sheet on concussion. Ensure that the athlete has a responsible party to
monitor him/her for several hours after the injury.
• Encourage rest until the athlete is symptom free.
• Assist in the education of the athlete, parents and other students as needed.
• Help monitor his/her warm-up for return to play.
When should I send the athlete to the Emergency Room?
If severe symptoms appear, such as vomiting, severe headache, difficulty answering
simple questions, declining mental status, focal neurologic deficits, loss of consciousness or seizures, call 911 or proceed to an Emergency Room immediately.
How can I help my athlete after a concussion?
• Implement an emergency action plan at your school in conjunction with local
physicians and health professionals, school nurses, athletic training staff and school
officials. This will help insure a prompt coordinated effort when a concussion is
suspected.
Coach/Athletic Trainer’s CG • 7/2013 • Page 1
• Encourage the athlete to rest as much as possible. He/she may
need frequent naps the first few days after the injury. The more
aggressively the brain is rested, the sooner it will heal.
• Recommend the athlete avoid bright lights, loud noises and
activities that stimulate the brain because mental rest is vital to
recovery. He/she should eliminate or reduce watching television or
movies, texting, reading, playing video games and browsing on the
computer.
• Do not allow the athlete to perform any physical activities such as
weight lifting, riding a bike, jogging, practice drills or other types of
exercise or sports activities at home.
• Encourage the athlete not to drive because the symptoms from a
concussion can slow his/her reaction times and possibly lead to an
accident.
• Inform school officials, training staff, teachers and other athletes
about the injury.
• Discuss any concerns about the athlete’s recovery with his/her
physician when necessary. You may be asked to regularly report
on the athlete’s symptoms. Notify the physician immediately if the
athlete worsens. Report to the physician when the athlete’s
symptoms return to zero.
• Communicate regularly with your school’s concussion
management team during your athlete’s recovery.
• For more information, consult KSCP’s Return to Learn Safe
Progression guide.
Concerns >
may be required.
a new injury.
SCORE Card >
The first health care professional that evaluates the athlete will fill out
KSCP’s concussion evaluation tool called SCORE Card 1 . If this first
person is not the physician who will oversee the recovery, make sure
the physician receives a copy of SCORE Card 1 . This will contain
important information that the physician will use to determine how to
care for the athlete’s concussion and monitor his/her progression
from the injury.
Discuss with the local physician the protocol for best coordinating
and monitoring the athlete’s recovery. You may fill out the symptom
score page with the athlete on a daily basis and copy or fax to the
physician.
Return to Play >
Only consider starting the Warm Up to Play progression once your
symptoms. The student’s return to sports will be a step-by-step
achieves normalized results on SCORE Card 2 , a medical authorization will start a Warm-up for Return 4 . This process should be
monitored by an athletic trainer, coach or designated school official.
physician immediately if he/she does not feel quite right at any time.
play?
Think of this progression as a warm up for return to his/her sport.
Each step takes at least 24 hours before moving on to the next step.
If any symptoms recur, the student should report this right away and
stop for the day and rest. Before starting the progression again, the
athlete must be completely symptom-free.
exercise bike. No weightlifting. (increase heart rate)
should be used. (add movement)
resistance training or light weight training. (add coordination and cognitive load)
trainer. (restore confidence and assess functional skills)
Other Resources >
National Federation of State High Schools: www.nfhslearn.com/electiveDetail.aspx?courseID=15000
Coach/Athletic Trainer’s CG • 7/2013 • Page 2
SCHOOL’S
CONCUSSION GUIDE
Quick Facts >
death.
Recognition >
• Forgets plays
• Headache
• Confusion
Definition >
a concussion.
Management >
Who is involved in monitoring the student athlete’s recovery after a concussion?
Any student athlete suspected of sustaining a concussion should be immediately pulled
out of practice or the game to avoid further aggravating the injury. The student should
be closely monitored by the coach, athletic trainer and/or a physician (MD/DO) until
his/her symptoms return to baseline.
Parents are asked to monitor the student for increasing symptoms. They also are
asked to alter the student’s environment to allow as much rest as possible and to
decrease exposure to loud noises or bright lights and external stimuli, such as
television, texting, reading and computer use, while the brain is healing.
Symptoms can affect the student’s emotions, sleep and ability to concentrate. Therefore,
adequate healing time is imperative. Once the student returns to classes, school
personnel play an important role in monitoring the student’s recovery.
Which school personnel should be involved?
The student’s teachers along with the school nurse, school counselor, school psychologist and administrators as needed should be informed about the student’s concussion.
In addition, they should be aware of the types of symptoms related to a concussion (see
“Recognition” section) and look for any cognitive deficits the student may experience.
What symptoms may impact school performance?
Headaches, fatigue, irritability and decreased tolerance of stress are potential
symptoms. Cognitive deficits, including difficulty paying attention without distraction,
slowed speed of cognitive processing and difficulty learning and remembering
information, could impact an injured student’s schoolwork.
What accommodations may help the student return to school?
Initially, the student may require accommodations to allow for healing and to facilitate
learning and adequate performance in the classroom. A plan aimed at the student’s
particular symptoms and rate of recovery should be developed in consultation with
school personnel, coach, trainer, parents and the student.
• The student may need to stay home for a few days to rest and to allow for maximal
healing.
• Upon returning to school, the student may need to initially attend partial days if
he/she fatigues easily and develops headaches that require physical and cognitive
rest. This can be done with partial days or shortened classes with rest breaks between
classes.
• If the student has difficulty focusing and maintaining attention and/or slowed speed of
processing, he/she may benefit from extended time to complete coursework and
tests.
• If the student struggles to complete coursework with extra time allowed, the amount
of coursework and homework may need to be reduced.
School’s CG • 7/2013 • Page 1
• The student also may benefit from information repeated and/or
supplied in a written form to compensate for a slowed ability to
follow along in class.
• The student should not participate in any strenuous activity such
as physical education class. Return to PE should coincide with the
medical authorization for the progression back to play.
• The student should not complete any standardized testing or
significant examinations during recovery as results may be skewed
and not reflect the student’s true abilities.
• For more information, consult KSCP’s Return to Learn Safe
Progression guide.
• Use KSCP’s Return to Learn Classroom Rx 3 in coordination with
the athlete’s physician.
• Develop a school concussion Emergency Action Plan or a
School Concussion Management Plan so you are prepared
before a concussion occurs. An excellent guide to developing a
School Concussion Management Plan can be found at:
www.nationwidechildrens.org/academic-concussion-management
What should school personnel look for that could require
additional medical evaluation?
The student’s symptoms should gradually improve, though each
individual improves at a different rate. School personnel should look
for any increase in symptoms and any new symptoms that occur
when the student returns to classroom participation, as these may
represent complications in recovery. If these occur, the student’s
parents should be alerted along with the treating physician.
Concerns >
may be required.
a new injury.
SCORE Card >
The first health care professional that evaluates the student athlete
will fill out a concussion evaluation tool called SCORE Card 1 .
This contains important information that the treating physician will
use to determine how to care for the student’s concussion and
monitor his/her progression from the injury.
Return to Play >
Only consider starting the Warm-up to Play progression once your
symptoms. The student’s return to sports will be a step-by-step
is doing well in school and daily activities, a medical authorization
will start a Warm-up for Return 4 . This process should be monitored by an athletic trainer, coach or designated school official.
physician immediately if he/she does not feel quite right at any time.
play?
Think of this progression as a warm up for the athlete to return to
his/her sport. Each step takes at least 24 hours before moving on to
the next step.
If any symptoms recur, the student should report this right away and
stop for the day and rest. Before starting the progression again, the
athlete must be completely symptom-free.
should be used.
trainer.
the whole season or your whole life!
Other Resources >
School’s CG • 7/2013 • Page 2
Concussion
MYTHS
MYTH Concussions only happen in contact sports like football.
TRUTH
When someone is in motion, including any organized
sport and physical activity there is a risk of concussion.
Learn more about the education, recognition and
management of sports related head injuries at:
MYTH You need to be hit in the head to suffer a concussion.
TRUTH
A blow to the body can be just as dangerous,
transmitting force to the head.
MYTH You need to be knocked out to suffer a concussion.
TRUTH
90% of those injured do not lose consciousness.
MYTH A player can tell when he or she has sustained a concussion.
TRUTH
The player is the wrong one to ask, especially in the first 24 hours.
MYTH
The severity of a concussion is based on loss of consciousness and memory loss.
TRUTH
Concussion severity is based on the nature of the trauma, burden, duration of
symptoms, the frequency and any past history of sustaining concussions.
MYTH If a CT or MRI scan is normal, then an injured athlete does not have a concussion.
TRUTH
These scans can identify skull fractures and bleeding, but not concussions. Concussion requires a clinical diagnosis.
MYTH Frequently awaken concussed athletes at night “to make sure they are okay.”
TRUTH
This practice is no longer recommended. Rest is more beneficial.
MYTH Mouth guards can prevent concussions.
TRUTH
There is no evidence they prevent concussions. They are good at preventing dental injuries.
MYTH Soccer (soft) headgear protects athletes from sustaining a concussion.
TRUTH
No evidence this equipment prevents concussions.
MYTH Football helmets prevent concussions.
TRUTH
Helmets may actually increase concussion risk.
MYTH In football, receivers have the most concussions.
TRUTH
Linebackers, offensive lineman and defensive backs sustain the most concussions.
MYTH Most concussions in soccer occur from heading the ball.
TRUTH
Most occur from player contact.
MYTH Cheerleading has the highest concussion rates for female athletes.
TRUTH
It is soccer.
MYTH A new combination of concussion tests can predict when recovery from concussion will be prolonged.
TRUTH
Despite advancements, tests are unable to accurately predict a recovery timeframe.
MYTH With neuropsychological testing, there is now tools to detect all concussions.
TRUTH
A significant number of concussions cannot be identified with these tests.
MYTH Neuropsychological testing detects a concussion best within the first 24 hours.
TRUTH
The ideal timing, frequency and type of neuropsychological testing has not been determined.
MYTH Pre-season baseline neuropsychological testing is always useful in making the diagnosis of concussion when
compared to post-injury testing weeks or months later.
TRUTH
Even in the best environments, this form of testing and interpretation can be difficult and requires an honest effort on
the part of the athlete.

Complete Packet - Kansas Sports Concussion Partnership

Transcription

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