1. Concussion Management of the Student-Athlete
Jason Rodriguez, MS, LAT, ATC
Athletic Training Coordinator
Imperial Health

2. Disclosures
None

3. Concussions

4. Definition of Concussion
A concussion is the result of a physical, traumatic force to the head, neck, or body which produces altered neurological function that may last for a variable amount of time.

5. National Federation of High Schools
2002 Recommendations
If an athlete experiences a concussion, the NFHS return to play guidelines would allow an athlete to return to play once symptom free for 15 minutes
2011 Recommendations
No athlete should be allowed to return to activity on the same day of a concussion
NFHS free on-line course

6. Causes of Concussion
Caused by a bump, blow, or jolt to the head or body that results in rapid movement of the head
Does not require head contact

7. Occurrence of Concussion
Symptoms are unique for each athlete
million concussions occur each year
Not exclusive to football
Soccer, wrestling, basketball, and cheerleading also have a high rate of concussions

8. Signs of a Concussion Most do not lead to loss of consciousness
Symptoms may show up hours or days after the injury

9. Signs of a Concussion Appear to be dazed or confused
Forgets plays or assignments
Unsure of game, score, or opponent
Answers questions slowly
Behavior or personality change
Seizure/Convulsion
Moves Clumsily
Forgets events before/after the hit

10. Symptoms of a Concussion
Amnesia
Confusion
Headache
Sensitivity to light or noise
Nausea
Feeling Sluggish

11. Symptoms of a Concussion
Loss of Consciousness
Balance Problems
Double or Blurry vision
Concentration/Memory problems
Slow reaction time
Feeling unusually irritable

12. Diagnosis of a Concussion
“A blow, jolt, or bump to the head or body that results in any of the signs or symptoms of a concussion”

13. Prevention Cannot be eliminated
Precautions can reduce the risk of injury and help student athletes recover
Football helmets (well fitted), soccer head gear, and mouth piece

14. Memory Function “Orientation”
Failure to answer all questions correctly may suggest a concussion
“Where are we at today?”
“Which half is it now?”
“Who is the President?”

15. Memory Function Anterograde Amnesia Retrograde Amnesia
Elbow, Apple, Carpet, Saddle, Bubble
Retrograde Amnesia
“Who scored last in this game?”
“What play was called prior to your hit?”
“Do you remember the hit?”

16. Memory Function
Concentration
493
3814
62791
718462

17. Balance Testing
Series of three (3) – 20 second tests with different stances
Double Leg Stance
Single Leg Stance
Tandem Stance

18. Balance Testing Observe the athlete for 20 seconds.
Count the number of errors, such as lift their hands off their hips, open their eyes, lift their forefoot or heel, stumble or fall, or remain out of the start position for more than 5 seconds.

19. Memory Function Word List Memory
Ask the athlete to repeat the 5 words from earlier

20. On-Field Recommendations
Any athlete with a suspected concussion should be:
IMMEDIATELY REMOVED FROM PLAY
Urgently assessed medically
Should not be left alone
Should not drive a motor vehicle

21. Complications
If any of the following are present, EMS should be activated and the patient should be transported to hospital immediately:
Loss of consciousness
Irregular breathing
Persistent vomiting
Seizures

22. Return to Play Protocol
Athlete must be re-evaluated within 24 hours
If athlete is no better or gets worse, it may require a CT scan
If exam is normal and athlete has been asymptomatic for hours, proceed with step-wise return-to-play protocol

23. Return to Play Protocol
Once asymptomatic, athlete should be gradually re-inserted into the classroom setting

24. Return to Play Protocol
Step 1 – Light Aerobic Exercise
Walking, stationary bike, swimming, light jog
No weight lifting or resistance training
Step 2 – Sport Specific Exercise
Running, cutting, jumping, and shooting in the gym or on the field without helmet or other equipment

25. Return to Play Protocol
Step 3 – Non-Contact Training Drills
Progression to more complex drills in full uniform
May begin weight lifting, resistance training, and other exercises
Step 4 – Full Contact Practice
Following medical clearance, return to normal activities
Step 5 – Return to Play

26. Return to Play Protocol
If symptoms recur during any of the 5 steps, athlete must repeat the last attempted step once asymptomatic for at least 24 hours.

27. Return to Play Protocol
Subsequent concussions may warrant a longer rest period depending on the athlete’s longevity of signs/symptoms present.

28. Summary
When in doubt, sit them out!