Concussion Management Protocol for G-Force Program

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1 Concussion Management Protocol for G-Force Program Baseline ImPACT testing Recommended but not mandatory - Can be done anytime but ideally recommended before season begins - Ideally this should be done annually especially for young athletes under age 13 - If no individual Baseline test completed, should injury occur, athlete WILL BE required to be cleared with medical/clinical evaluation and impact testing utilizing age/gender normative data ANY Suspected Head Injury No Return to Sport that Day Action Plan Activated ACUTE ACTION PLAN 1. REMOVE athlete from sport, observe for signs/symptoms 2. Immediate Medical Triage EMS and Referral to Medical Facility if indicated 3. Record time of initial incident and Mechanism of injury communicate to medical personnel if being transported or to parents these details and the following if observed: a. Any Loss of Consciousness b. Memory Loss before or after the incident c. Any seizures 4. If not transported, athlete should observed by coach or responsible party until parents arrive 5. NOTIFY PARENTS 6. Parents given home care instructions (CDC ACE Form/thinkheadfirst.com) and advised to contact Think Head First for any questions regarding post injury follow up 7. Coach informs Club Administration of incident Further Action: 1. Athlete monitored over hrs by responsible individual for worsening symptoms or delayed responses. Any worsening of symptoms or if any of the 3 details listed above were observed, then transport à Medical facility to be evaluated clinically with any additional testing as deemed necessary. 2. If no problems and symptoms improving or resolved, schedule follow up evaluation within hours to include: Medical evaluation, symptom survey, balance assessment ImPACT post injury evaluation if symptom appropriate Post Injury ImPACT Assessment: 1. If the Medical Personnel clears athlete medically and athlete essentially symptom free, then the post injury ImPACT screen can be completed. 2. Think Head First CIC notified to arrange ImPACT post injury evaluation. This testing is possible to accomplish online from anywhere with an internet connection. Instructions will be given on how to access the post injury testing if out of Park City. 3. Once test completed, Think Head First CIC will review ImPACT result and will subsequently advise athlete, parent, coach and trainer regarding status for Return to Sport Progression.

2 Return to Sport Progression Basic Requirements Necessary to BEGIN Return to Sport Progression: 1. Asymptomatic at Rest Athlete symptoms have resolved at rest 2. Normal medical exam Normal medical/clinics screen and balance evaluation 3. ImPACT Normal post injury ImPACT return to baseline levels or acceptable compared to normative data General Return to Sport Guidelines: - The following represents a generalized progression in activities that can be scheduled once the athlete is symptom free at rest. Generally, 1 or more levels can be completed daily before progressing to the next level. Ideally, the initial RTS Conditioning Steps will be monitored by a Therapist or Athletic Trainer. - If ANY signs/symptoms return with any level of activity, stop and rest until symptoms clear and then begin at level where symptoms occurred. Initial Recovery Conditioning Progression: In addition to Initial Recovery Conditioning progression all athletes must complete the Think Head First POST CONCUSSION RETURN TO SPORT GRADUATED PROGRESSION listed below 1. Activities of Daily Living rest with light walking around home, short bouts of cognitive challenges (homework, reading, computer) etc. Possibly light manual massage, vestibular therapy if indicated 2. Supervised: Light Cognitive activity reading, limited school work or computer work (short duration/- mins with plenty of recovery between work intervals. Low levels of physical activity such as hike/walk, stationary bike, etc for - mins with no return of symptoms progress to jogging if hike/walk ok. Stretching/light yoga, balance drills, light strength exercises. 3. Supervised: Increasing cognitive stressors (more in school and increased homework loads). Increased cardio stressors to moderate, increased volume and some interval type. Increased strength challenges, balance challenges and sport specific drills. 4. Supervised: School full time. Resume full aggressive training without contact and management of risks. Cardio interval training, Strength full training loads, Impact/Agility at full sport loads, Balance training with no deficits. 5. Supervised by coach in program Sport Specific return to sport training progressions. Post Concussion Return to Sport Graduated Progression The following represents recommended initial progression for return to sport physical conditioning stress consistent with requirements defined in the Utah High School Athletic Association Concussion Return to Play Clearance. Physical Therapists and Athletic Trainers who have had experience with increasingly stressing athletes physically and dynamically to assure full recovery from concussive injury have created this program. General Recommended Process: Ø Starting level determined by injury extent and recovery. An athlete may progress through more than one level per day depending on symptoms/energy level. Assess symptom and energy level prior to and after each session. (scales attached) Ø Typically there will be 3 sessions of exercise progression (Level 2-4) under supervision of physical therapist, coach, or parent. Coaches supervise the final sport specific sessions. Ø Athlete must progress through each stage with no return of symptoms to advance to the next level. If excessive symptoms occur with current level, recommend rest for 24 hours and restart exercise stress at the level that created the symptoms Ø All stages must be signed off prior to full clearance into sport Ø Modify time and intensity of any/all exercises depending on age and fitness level

3 Progressive Exercise Stress Levels: Level 1: Activities of Daily Living: includes regular rest periods Work School Easy Aerobic Stationary Bike or Walk x - mins Light Meditative Yoga or Stretching x mins (nothing with head down) Level 2: Cardio: Stationary Bike: 5 minute warm up easy comfortable spin WORKOUT*: 2 min at Level 2 HR (65-75% max HR) 2 min at Level 1 HR (< 60% max HR) Perform above WORKLOAD cycle x 6 Strength: 1 x body wt squat 1 x body wt. squat on Dyna disc (1 under each foot) Wall push up or inclined push up x 10 Plank (prone): -s for younger athlete, -60s for high level athlete Balance: SLS reaching for cones placed in semi-circle in front of pt (4-5 cones) x 3 (Firm surface for younger athlete, Dyna Disc for high level athlete) Agility: Tandem gait Backward Walking High Knees Grapevine (walk) Side Shuffling Level 3: Cardio: Elliptical: 5 minute Warm Up WORKOUT*: 2 min Level 2 HR (65-75% max HR) 2 min Level 1 HR (<60% max HR) 2 min Level 2.5 HR (70% max HR) 2 min Level 1 HR (<60% max HR) 2 min Level 3 HR (75-80% max HR) 2 min Level 1 HR (<60% max HR) Perform above WORKLOAD cycle x 2 Strength: Double leg squat for younger athlete 2 x SL squat for high-level athlete 2 x (Can use dumbbells if needed) Shoulder Press (can do seated) 2 x Push Ups x 10 (knees for younger athlete) Side Planks- Knees for younger athlete - sec each side Ankles for high level athlete - 60 sec each side Balance: Hop and Stick on Foam 2 x sec younger athlete 2 x sec high level athlete

4 Agility: Level 4: Cardio: Strength: Ladder Drills- 5 different foot patterns up and back Side to side cross over box (up and over box laterally) sec younger athlete 60 sec high level athlete Treadmill: 5 minute easy warm up WORKOUT*: 1.5 min Level 2 (65-75% max HR) 1.5 min Level 2.5 (70% max HR) 1.5 min Level 3 (75-80% max HR) 5 min easy (HR<110) Perform above WORKOUT cycle x 2 with very last work interval at Level 4 (80-90% max HR) SL squat on Bosu (flat side up) (foam for younger athlete) 2 x10 Single arm Row 2 x Bilateral Squat Jump- controlled landing 5 reps Single leg step up w/ shoulder press and contra lateral LE hip flex 2 x Balance/Agility: Hex Obstacle: see attached sheet Box jump x younger athlete x high athlete Level 5: See sport specific Return to Sport Guidelines Level 6: Back to Competition

5 Workload Intensity Level Description It is most ideal to have some form of stress testing to obtain work load intensity levels that are specific for each individual s cardiovascular capacity and efficiency. However, if this is not an option, relative workload intensity levels can be estimated based on the following descriptions with typical associated % of maximal heart rate (MHR). If HR is measured utilizing the descriptors, individual HR work zones may be determined. Level Description Relative %MHR Example HR level Age Level 1 Level 2 Level 3 Level 4 Level 5 Easy Aerobic Ø Can maintain conversation easily while exercising Ø Comfortable, relaxed breathing Ø Can maintain this for extended time Aerobic Moderate Ø More difficult to maintain continuous conversation, can talk intermittently Ø Breathing is harder but not overwhelming Ø Think of power walking for mins continuous Aerobic Energy System Threshold Level Ø More difficult cannot maintain conversation Ø Breathing is heavier Ø Using Anaerobic energy systems primarily Ø Able to maintain work for 3-4 mins Anaerobic/Interval Ø Quite difficult No talking Ø Breathing is focus Ø Predominantly Anaerobic energy systems Ø Able to maintain work for secs Maximal Effort Ø All out effort Ø Breathing very hard Ø Fully anaerobic Ø Only able to maintain maybe for secs maximum <60% Maximal HR Generally 65-75% of maximal heart rate Individual based on Cardiovascular system Generally 75-80% of Maximal HR Generally 80-90% of maximum effort Greater than 90% of maximal effort HR <125 <1 <1 <110 < >185 >180 >170 >160 >1

6 Comment on estimated HR levels: Example HR levels were calculated based on generic estimate of maximal HR; 2-your age. Realize that this is GENERIC and your individual level could be higher or lower. Without stress testing to determine your exact Heart Rates for the various workloads, it is best to use the description and a HR monitor to see where your HR averages for the description provided. Sport Specific - Return to Sport Guidelines: Dry-land Conditioning à Progression Into On Ice Training à Competition: SKELETON ATHLETES & BOBSLED DRIVERS 1. Supervised light warm-up at moderate speeds with emphasis on stretching, flexibility, light plyometrics and limited core work. 2. Supervised full warm-up, -1/2 load of physical training activities including sprinting, weight training & plyometrics. 3. Supervised full warm-up, -3/4 load of physical training activities including sprinting, weight training & plyometrics. 4. Return to full load physical training. 5. One run as passenger or brakeman in a bobsled from Bobsled Start with qualified driver. No push start. 6. One run as a driver from Junior Start. 7. Two runs as a driver from Junior Start 8. Two runs starting between curve 2 & curve Two runs from Bobsled/Skeleton start with no push start. 10. Two runs from Bobsled/Skeleton start with full push start 11. Return to full training load. 12. Return to full competition. Athlete must be approved by head coach to enter into competition based on return to full training evaluation. Sport Specific - Return to Sport Guidelines: BOBSLED PUSH ATHLETES 1. Supervised light warm-up at moderate speeds with emphasis on stretching, flexibility, light plyometrics and limited core work. 2. Supervised full warm-up, -1/2 load of physical training activities including sprinting, weight training & plyometrics. 3. Supervised full warm-up, -3/4 load of physical training activities including sprinting, weight training & plyometrics. 4. Return to full load physical training. 5. One run as passenger or brakeman in a bobsled from Bobsled Start with qualified driver. No push start. 6. One run with push from Bobsled Start. 7. Two runs with push from Bobsled Start. 8. Return to full training load. 9. Return to full competition. Athlete must be approved by head coach to enter into competition based on return to full training evaluation.

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