By: Maria “Maggie” Florez-Cook MS, ATC, LAT WHAT YOU NEED TO KNOW! EpT894xNqqc

 Concussion Management Team  Removal from Play  Waiver and Graded Protocol to Return to Play  Specific Education/Training for all HCP’s  State Wide Tracking/Logging of Concussions

 A concussion is a brain injury that is caused by a sudden blow to the head or to the body. The blow shakes the brain inside the skull, which temporarily prevents the brain from working normally.

 Passing out.  Not being able to remember what happened after the injury.  Acting confused, asking the same question over and over, slurring words, or not being able to concentrate.  Feeling lightheaded, seeing "stars," having blurry vision, or experiencing ringing in the ears.  Not being able to stand or walk; or having coordination and balance problems.  Feeling nauseous or throwing up.  Irritability/Depression  Personality changes

“Old School” TermBELL RUNG/DING  Headache after impact is an indication of Concussion both mild & severe

Developing brain is most at risk! Long term testing is available now!  SECOND IMPACT SYNDROME ◦ Is condition in which the brain swells rapidly and catastrophically after a person suffers a second concussion before symptoms from an earlier one have subsided. This deadly second blow may occur days, weeks or minutes after an initial concussion, and even the mildest grade of concussion can lead to SIS. ◦ The condition is often fatal, and almost everyone who is not killed is severely disabled. The cause of SIS is uncertain, but it is thought that the brain's blood vessels lose their ability to regulate their size, and therefore lose control over cerebral blood flow, causing massive swelling of the brain.  LONG TERM BRAIN INJURY ◦ Confusion ◦ Light sensitivity ◦ Concentration ◦ Short term memory loss ◦ Early onset of dementia, Alzheimer's, Chronic Traumatic Encephalopathy (CTE)

 Currently ◦ Concussion Oversight Team ◦ Any suspect of concussion out for the remainder of the game/practice ◦ May not return to activity until evaluated by Oversight team and has completed all return-to-play protocol  Only a medical professional has the ability to allow an athlete to return to play following a concussion!

 Severe… seek emergency medical assistance  Danger Signs ◦ Drowsiness or can’t be awakened ◦ One pupil larger than the other ◦ Headache that gets worse or doesn’t go away ◦ Weakness, numbness, or decreased coordination ◦ Repeated vomiting or nausea ◦ Slurred speech ◦ Convulsions or seizures ◦ Difficulty recognizing people or places ◦ Increased confusion, restlessness, or agitation ◦ Unusual behavior ◦ Loss of consciousness (even briefly) ◦ Moderate-Mild: remove from activity  The first 24 hours ◦ No medications (except for acetaminophen) ◦ Constant questioning regarding memory ◦ Awaken every 2 hours to monitor alertness (some disagree) ◦ Decrease use of loud music, bright lights, reading, watching tv, playing on the computer/ipod/video games TAKE AWAY THE CELL PHONE!!!

Concussion Management  1. Recommended school modifications ◦ a. Notify Assistant Principal, School Nurse and Counselor of the student that he/she has MTBI ◦ b. Notify Counselor and Assistant Principal of post-concussion symptoms ◦ c. Student may need special accommodations such as limited computer work, reading activities, testing, assistance to class, etc. until symptoms subside ◦ d. Student may only be able to attend school for half days or may need daily rest periods until symptoms subside with physician authorization  2. Student must show no signs of post- concussion symptoms before return to play protocol begins.  3. Student will not return to full practice or competition for minimum of 7 days, unless cleared by physician.  4. The treating physician must provide a written statement to the parent and athletic trainer indicating that, in the physician’s professional judgment, it is safe for the student to return to play.  5. Student athlete and the parent/guardian have signed the form acknowledging the completion of the return to play guidelines which includes the understanding the risks associated with the student athlete’s return to play.

Be ideal to have baseline measures.  Released based on return to play protocol  Tests to be administered ◦ CT scan/MRI ◦ Cognitive test ◦ Motor test ◦ Agility testing

 Return to Play Guidelines  Athlete must show no signs of post-concussion symptoms before return to play protocol begins.  1. Athlete activity progressions (Athlete may participate in following protocol and/or one similar based on school’s athletic Trainer’s preferred program) ◦ a. Light aerobic exercise with no resistance training ◦ b. Moderate aerobic activity with resistance training ◦ c. Sport specific activity and Non-contact training drills ◦ d. Full contact training drills can begin after minimum 7 days, (unless otherwise released to do so by physician) ◦ e. Return to full participation (pending physician clearance) ◦ f. Note – Athlete activity progression continues as long as athlete is asymptomatic at current level. If the athlete experiences any post concussion symptoms, stop physical activity until symptom free for hours. Resume with phase or level in which they were previously asymptomatic.  2. Physician clearance  3. Athletic Trainer clearance PROPER DOCUMENTS HAVE BEEN SIGNED & TURNED INTO THE ATHLETIC TRAINER (ms/hs)/SCHOOL NURSE (elementary)

Observed signs Zero minutes15 Minutes30 minutes/comments Appears dazed or stunned Is confused about events Repeats questions Answers questions slowly Can’t recall events prior to hit or jolt Can’t recall events after hit or jolt Loses consciousness (even briefly) Shows behavior or personality changes Forgets class assignments or schedule Physical symptoms Headache or pressure in head Nausea or vomiting Balance problems or dizziness Fatigue of feeling tired Blurry or double vision Sensitivity to light Sensitivity to noise Numbness or tingling Pupils not responding properly Cognitive symptoms Difficulty thinking clearly Difficulty concentrating Difficulty remembering Feeling slow Feeling sluggish, hazy, foggy, or groggy Emotional symptoms Irritable Sad More emotional than normal Nervous