Assessing & Managing Concussion If a brain or head injury is suspected, our evaluation process is on the leading edge Annemarie Francis, MS, ATC, VATL JP Athletic Trainer

What is a concussion? A concussion is a brain injury resulting from a bump, blow or jolt to the head or body. Loss of consciousness may or may not happen. The brain is suspended in fluid inside the skull, so when a force is delivered … the brain can move & result in injury. The forces needed to create the injury do not have to be great. Signs and symptoms may develop immediately or over a period of several days. They may exist for days, weeks or longer. Early recognition, proper rest and medical evaluation are necessary.

Thinking long term- Each case is unique. Different dangers can arise if another blow is sustained before complete recovery occurs, and with a history of repeat concussions. The results could be life-threatening, or lead to life- altering disabilities. The medical community is looking at this injury differently than it did 10 years ago. It evaluates and manages such an injury in varying ways, often depending on where you start looking for answers and with whom. Research and evidence-based efforts are on-going.

What’s the fuss? The athletic community is often unaware of the significance of such injuries, so educational awareness needs to be raised. Cases are historically under-reported. Current state law and standards of practice require educational efforts get made in public schools. Many private schools, athletic associations and leagues are following the same reasoned approach. Brain injuries including concussion are difficult to assess, define, and manage. Diagnostic scans like CT, MRI and x-rays do not identify a concussion. Such tests may be done to rule out other potentially dangerous injuries. Concussions are diagnosed by clinical examinations (sometimes computerized tools like ImPact) and commonly involve repeated visits, exams and communications. Please do not expect only one interaction with healthcare or school personnel when this kind of injury occurs.

Students have unique demands academically. Student-athletes will need assistance to rest appropriately and recover. Athletes are known for downplaying symptoms/ signs, often because they want to keep playing regardless of consequences.

What sort of things would a parent or athlete see that should raise concern? In short, you know “something isn’t right” about what you’re child is feeling and/or you are observing after a blow to the head or body. The list of concussion signs/ symptoms is long, but they tend to cluster in and among 4 categories: ▫Physical ▫Emotional ▫Cognitive ▫Sleep disturbances If a child does not report the situation during a practice or game event, a parent, teacher or coach may be among the first to observe concerns. An athletic trainer may be on-site and be alerted by someone, or notice something as well.

“If in doubt, sit them out.” Then seek a medical evaluation. A parent or coach may contact the athletic trainer in person or by phone/ to identify the initial concern or relay actions that have already been taken. If the student remains monitored at home during the next school day, it may be best for a parent to call or . The student-athlete can visit the athletic trainer that day or the next school/ athletic day to identify the concern. If concerns are serious in an acute situation, a visit to the Emergency Department may be an option. Follow-up contact with the JP athletic trainer is expected by the next day. ▫Additional follow-up visits will likely be needed, and may include a family’s physician or JP team physician Dr. Scott Ross. Be sure to contact the JP nurse and guidance within 48 hours. Concussion recovery will involve multiple communications, and often multiple healthcare and school professionals. They will help manage school related things.

What is the coach’s role? Our coaches are being educated on a variety of sports medicine topics to aid their athletes, especially including the issue of concussion. JP coaches maintain current CPR certification. In medical situations, coaches are expected to make relevant first aid decisions only. Removal from play is a first aid sort of decision that may be made. The athletic trainer guides a progressive process for return to play decisions after a diagnosed concussion. A coach does not make this decision. ▫Written statements from another healthcare provider may also be needed.

Using ImPACT to help assess Clinical evaluations and a computerized test called ImPACT may be used to assess a head/ brain injury Computerized baseline reports are done, and re-tests happen when concussion is suspected ▫It is best to compare against your child’s ‘normal’ precisely because the adolescent brain is growing ▫When feasible, baselines are done at least once during the high school athletic career and before contact sport competitions begin

So what is “ImPACT”? Immediate Post concussion Assessment and Cognitive Testing Essentially, it’s “preseason physical of the brain” A non-invasive computer test set up in a “video-game” type format developed by researchers & clinicians at the University of Pittsburgh Medical Center. It’s being used within the NFL, NHL, MLB and various colleges/ high schools around the country. Takes about 30 minutes to complete, including medical & academic history details It examines neurocognitive brain functions, such as verbal & visual memory, reaction time, brain processing speed, and concentration/ attention span This data is securely maintained by the JP Athletic Trainer, and case by case consultations are arranged with the team physician and family

Things a parent needs to know… It’s possible that multiple medical professionals will be involved in treating a concussion case ▫perhaps emergency department personnel, our Team Physician or a neuropsychologist ▫your family doctor may be included, but ImPACT data interpretation requires specific expertise that many primary care physicians don’t have Cognitive effort in school & life may strain a student trying to recover ▫A parent’s discussion with the school guidance counselor can be well-advised ▫Use of a computer, phone texting, video game play require mental efforts too ▫If the student says something is harder than usual, it may be hard to describe... so help raise the concern with the athletic trainer and guidance counselor

Returning to sports participation A staged and progressive return-to-play process will begin when appropriate, and guided by the athletic trainer ▫Physical and cognitive rest are part of the recovery ▫Symptom resolution is vital ▫ImPACT tests may be done several times in monitoring recovery Return to sport decisions are made by the athletic trainer  in consultation with the treating physician(s), parents, athlete and coach  returning to early can lead to dangerous, even life- threatening consequences  All involved need to be in agreement

If/ when you have questions… Contact the Athletic Trainer, Annemarie Francis at or by Our team physician, Dr. Scott Ross of Bull Run Family Practice, is also an available resource. He is a credentialed consultant with Impact.

Consent Form Please complete and return this page to the athletic trainer, Miss Francis. I have read and reviewed the informational details about concussion and the ImPACT program. I understand and acknowledge its contents. I have been given an opportunity to ask questions and get answers. I agree to comply with the Pope John Paul the Great Catholic High School’s concussion management policy and procedures. A one time fee of $30 is also required for the school to meet the software license needs. Printed name of athlete: _________________________________ Student ID # _______________________ Sport (s): ___________________________________ ______________________________________ Signature of athleteDate ______________________________________ Signature of parentDate