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Skyview Concussion Management Protocol

Skyview High School

CONCUSSION MANAGEMENT PROTOCOL

The following guidelines will be used as part of a comprehensive concussion management program for Skyview High School student-athletes. The time frame between steps in this protocol may be extended depending on the ability of the student-athlete to perform the required actions satisfactorily and without a return of symptoms.

Pre-Participation Assessment / Physical Exam:

All student-athletes are required to go through a preparticipation physical exam with certified Athletic Trainers, family physicians, and or team orthopedic surgeons. Pre-participation physical exam shall include detailed medical history questionnaire consisting of general medical pathologies and orthopedic/musculoskeletal pathologies. Optional cardiac testing which is highly suggested for all athletes, will be offered once a year on the school grounds. Specific questions pertaining to concussion history are included in the general medical questionnaire. All student athletes should have a baseline concussion test performed consisting of an XLNTbrain.com computerized cognitive test as well as a XLNTbrain Balance test. This will be used as comparison for follow-up testing following a diagnosis of a concussion.

No student-athlete shall participate in any team activities until they are cleared by a physician.

Pre-Participation Education:

All student-athletes, parents, coaches, medical staff and athletic directors shall take part in a pre-season concussion education session that may include but is not limited to, a verbal, written or video presentation outlining the definition, recognition and treatment of concussions. This education session should take place prior to the beginning of each sport season and may be repeated as necessary throughout the competitive season. As part of the education session, all parties shall be provided with information related to minimizing head trauma exposure. Following the education session, each party shall be able to print a certificate acknowledging they have both read, understand passed the concussion education quiz following the material provide to them.

Initial Suspected Concussion Evaluation:

If a student-athlete displays any signs or symptoms of concussion or complains of symptoms consistent with a concussion, they are to be removed from all activity immediately and may not return to activity for the remainder of that day. An evaluation shall be performed by a certified Athletic Trainer or a team physician which will include, but is not limited to:

  1. Injury history
  2. Physical exam which may include a neurological exam a. Assess for emergent injuries such as cervical-spine pathology, skull fracture, or intracranial bleeding.
  3. Cognitive and balance exam
  4. Further testing such as diagnostic imaging as determined by the team physician or consultant
  5. Student-athlete may require emergency transportation to hospital or physician based on the results of a physical and cognitive exam for concussion as determined by certified Athletic Trainer or team physician. Specifically, Emergency Medical Services/Skyview High Sports Medicine Emergency Action Plan will be initiated for any of the following:
  1. Glasgow Coma Scale < 13;
  2. Prolonged loss of consciousness;
  3. Focal neurological deficit suggesting intracranial trauma;
  4. Repetitive emesis;
  5. Persistently diminished/worsening mental status or other neurological signs/symptoms;
  6. Spine injury.

Post-Concussion Management:

Following the diagnosis of a concussion, the following personnel must be notified by the certified Athletic Trainer responsible for that student-athlete’s sport:

  1. Head coach and/or position coach
  2. School Nurse
  3. Team Physician
  4. School Counselor  
  5. Teachers, Including Strength, Conditioning, and Fitness instructors

No medication shall be given to the student-athlete for the first 24 hours unless verbal or written permission is granted by the team physician. After 24 hours the student-athlete may receive oral pain management medication. No NSAIDS such as ibuprofen or naproxen shall be given unless verbal or written permission is granted by the team physician.

Please note that academic requirements such as classes, computer labs, workshops and study sessions as well as team lifts and workouts with the strength and conditioning coaches may be affected. Therefore, it is necessary to provide notification to the proper support personnel associated with the affected student athlete’s team regarding their condition.

All Skyview High emergency action plans shall be updated yearly and reflect steps that are to be taken in the event of any catastrophic injury or illness requiring evaluation, diagnosis, and/or transportation for further medical care. These emergency action plans should include guidelines for repeated evaluation and follow-up care post-injury, including oral or written instructions for student-athletes or other responsible parties.

Student-athletes with prolonged recovery following concussion will be re-evaluated by a physician to confirm the diagnosis of concussion, and to consider other diagnoses such as post-concussion syndrome, sleep dysfunction, migraine or other headache disorders, mood disorders such as anxiety and depression, and ocular or vestibular dysfunction.

Stepwise Return to Play:

The following steps are to be performed when returning a student-athlete to competition following a diagnosis of concussion. The protocol shall not begin until the student-athlete reports and/or presents as symptom free for a minimum of 24 hours following their diagnosis. Post-concussion symptom checklists will be recorded daily on the XLNTbrain.com computerized system. The student-athlete may progress step by step on a daily basis as long as there are no symptoms displayed or reported from the previous stage. The timeline for the return to play protocol may only be condensed if directed to do so by the team physician.

  1. Step 0
  2. Step 3
  3. Step 4
  1. Incident leading to concussion diagnosis is documented. Balance test is administered day of incident as part of diagnosis.
  2. Implement return-to-learn management plan.
  3. Symptom checklist recorded daily until athlete is cleared to play.
  4. XLNTbrain Post Concussion Cognitive Test administered
  5. Student-athletes with prolonged symptoms shall follow-up with team physicians and/or neuropsychologist consultant as appropriate.
    1. Step 1
  6. Student-athlete completes symptom checklist to confirm asymptomatic after activity
  7. SWAY balance and reaction time testing system administered
  8. Low intensity activity (approx. 0-40% maxHR) a. i.e. 15-20 minutes of stationary bike, UBE, elliptical, or equivalent
    1. Step 2
  9. Student-athlete completes symptom checklist to confirm asymptomatic after activity
  10. Moderate intensity activity (approx. 40-60% maxHR)
    1. 20-30 minutes of stationary bike interval sprints (i.e. 15 second spring: 45 second active rest) with 3-5 minute warm up and 3-5 min cool down
    2. 3-5 sets of functional, sport specific, movement exercises i. i.e. push-ups, sit-ups, squats, burpies, etc.
    3. 8-10, 30-60 yard striders (depending on the sport and surface of competition)

      Following successful completion of “Step 2” student-athlete may return to team lifts performing light resistance training  

  11. Student-athlete completes symptom checklist to confirm asymptomatic after activity
  12. Heavy intensity activity (approx. 60-80% maxHR)
    1. 10, 30-60 yard sprints
    2. 15-20 minutes of sport specific agility drills
  13. Student-athlete completes symptom checklist to confirm asymptomatic after activity
  14. Aggressive Sport Specific Drills (approx. 80-90% maxHR)
  15. Return to non-contact team practice sessions
  16. Progress into some contact drills
    1. Step 5
  17. Student-athlete completes final symptom checklist to confirm asymptomatic after activity
  18. Return to regular/contact team practice sessions
  19. Post stepwise RTP XLNTbrain Cognitive test and Balance test administered  
    1. Step 6
  20. Full return to team activities without limitations, including competition
    1. Student-athlete’s final return to play decision is determined by team physician or designee (i.e. certified Athletic Trainer).
  21. Student-athlete may be put through a follow-up XLNTbrain Cognitive test and or Balance test assessment after full return to team activities.

 

 

CONCUSSION RETURN-TO-LEARN MANAGEMENT PLAN

Skyview High return-to-learn management plan shall be used to help student-athletes diagnosed with a concussion return to normal cognitive functioning both inside and outside of the academic classroom.

Each concussion will be handled on an individual basis, with the student-athlete’s primary certified Athletic Trainer serving as the point person for their return-to-learn process.

After a concussion has been diagnosed, a student-athlete shall be instructed to not attend class, study sessions, or any other form of classroom activities on that day. The student-athlete may remain at home if he/she is unable to tolerate light cognitive activity. The student-athlete’s return-to-learn point person (i.e. certified Athletic Trainer) is responsible for notifying the school’s nurse and counselor about their concussion and any immediate academic restrictions as necessary. A gradual return to classroom and studying plan shall be implemented by the student-athlete, certified Athletic Trainer, team physician, school nurse and school counselor. If symptoms worsen while returning to academic work, the student-athlete shall follow-up with the team physician. Additionally, the team physician or members of the multi-disciplinary team noted below will re-evaluate student-athletes with symptoms that last more than 2 weeks.

In the event of prolonged symptoms and difficulty returning to academic work, a multi-disciplinary team shall be formed to assist with the process. The multi-disciplinary team may consist of, but is not limited to:

  • Team physician
  • Certified Athletic Trainer
  • Family physician
  • School Psychologist
  • School nurse
  • School counselor
  • Student instructors
  • School administrators 
  • Coaches

Academic accommodations and schedule modification will be made as appropriate. All accommodations and modifications should be in compliance with the Americans with Disabilities Act Amendments Act (ADAAA; http://www.eeoc.gov/laws/statutes/adaaa.cfm).

Date Revised: 10/19/2016