Lamar University Intercollegiate Athletics

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1 Lamar University Intercollegiate Athletics Institutional Concussion Return-to-Play Policy PHILOSOPHY The Department of Intercollegiate Athletics at Lamar University believes that the safety of student-athletes is of the utmost importance. Concussions, or mild traumatic brain injuries (MTBIs), are more widely recognized in sports for the short-term and long-term danger they can be to the student-athlete. The Athletic Trainer must be able to recognize signs and symptoms of brain injuries of varying severity, including signs of worsening symptoms during head injury assessment and follow-up care. There is a risk of serious traumatic brain injury (TBI) in athletes which, if not recognized and treated in a timely manner, could become life-threatening. Because of the possibility of serious brain injury, compliance with this policy is mandatory for the safety of Lamar University s student-athletes. Athletic heathcare providers shall have unchallengeable authority to determine management and return-to-play in student-athletes diagnosed with a concussion or MTBI. It is important for student-athletes, parents, coaches, and health-care personnel to understand the dangers of concussions, and to refer the student-athlete to a member of the sports medicine team for immediate evaluation in any case with suspected concussion or MTBI. Lamar University Athletic Training will follow this policy to maintain compliance with minimum requirements for concussion management in intercollegiate athletics as mandated by the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS). DEFINITIONS Concussion Often referred to as a mild traumatic brain injury (MTBI) Involves a blow to the head or the head striking an object Results in one or more of the following: headache, nausea, vomiting, dizziness, balance problems, feeling slowed down, fatigue, trouble sleeping, drowsiness, sensitivity to light or noise, loss of consciousness, blurred vision, difficulty remembering, or difficulty concentrating (Report of the Quality Standards Subcommittee of the American Academy of Neurology, 1997) Concussion Assessment Tools Measures used to evaluate a student-athlete for signs and symptoms of MTBI Symptom Checklist Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) ImPACT Applications Inc. NeuroCom Computerized Dynamic Posturography (CDP) Sensory Organization Test (SOT) NeuroCom, Inc Baseline Testing Concussion assessment measures administered to a student-athlete prior to athletics participation to determine a normal result, or baseline Post-concussion testing will be compared to the baseline to help determine when it is safe to progress the student-athlete to the graduated return-to-play progression Post-concussion ImPACT data will be reviewed and compared to baseline measures by personnel trained in evaluation of ImPACT data Post-concussion NeuroCom CDP data will be reviewed and compared to baseline measures by personnel trained in evaluation of NeuroCom CDP data

2 POLICY It is the policy of the Lamar University Athletic Training Department to conduct pre-season baseline screening with those student-athletes deemed most at-risk for sport-related concussion. Student-athletes participating in the following sports are deemed at-risk for sport-related concussion: Football Women s Soccer Volleyball Men s & Women s Basketball Baseball & Softball Pole-vault Student-athletes participating in sports sponsored by Lamar University but not included in mandatory baseline testing under this policy may be subject to baseline testing at the discretion of the Head Team Physician, Head Athletic Trainer, and/or designee. Student-athletes with a history of concussion or headaches may be subject to baseline testing regardless of sport participation. It is the policy of the Lamar University Athletic Training Department that non-medical terms (such as ding, got his/her bell rung, etc.) are misleading in accurately describing the potential severity of sport-related concussion, and as such are not to be used in reference to a student-athlete injury. PROCEDURES Baseline Screening 1. Pre-participation baseline screenings will be conducted before the first athletic activity, including weight lifting or conditioning, with all NEW student-athletes deemed at-risk of sport-related concussion. 2. Any returning student-athletes deemed at-risk of sport-related concussion who have not completed a baseline assessment shall do so before the first athletic activity, including weight lifting or conditioning. 3. Baseline screening measures include the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) and the NeuroCom Computerized Dynamic Posturography (CDP) Sensory Organization Test (SOT). 4. Baseline screening with ImPACT will take place in a designated computer lab on the campus of Lamar University. All ImPACT testing will be supervised by an athletic trainer experienced with the ImPACT protocol. Lamar University reserves the right to have a student-athlete s baseline ImPACT reviewed and the test repeated if deemed necessary by the Head Athletic Trainer and/or his designee. 5. NeuroCom CDP SOT will take place in the Lamar University Audiology clinic under the supervision of Vickie Dionne, AuD, and/or her designee. The SOT will be performed on an individual appointment basis through the Audiology Clinic (409) Test results will be forwarded to the Head Athletic Trainer. 6. Baseline screening is only required once at the beginning of the student-athlete s tenure at Lamar University, unless deemed otherwise by the Team Physician, Head Athletic Trainer, and/or designee. Recognizing Concussion 1. The Athletic Trainer, coach, and student-athlete should be familiar with common mechanisms of injury which may cause a concussion. 2. The Athletic Trainer, coach, and student-athlete should be able to recognize signs and symptoms of concussions, especially in situations which the signs and/or symptoms may be deteriorating. a. Institutions should ensure healthcare professionals attain continuing education on concussion evaluation and management annually. 3. The Athletic Trainer should educate student-athletes, coaches, parents, and other athletics personnel about the signs and symptoms associated with concussions, as well as potential risks of playing while still symptomatic. a. Student-athletes must sign a statement in which they accept the responsibility for reporting their injuries and illnesses to the institutional medical staff, including signs and symptoms of concussions. b. During the review and signing process student-athletes should be presented with educational material on concussions.

3 c. Structured and documented education of student-athletes and coaches is required to improve the success of recognition and referral components of a consistent concussion management program. Concussion education should be done at least annually for all student-athletes and coaches. 4. The Athletic Trainer should document all information about the concussive episode, including but not limited to: a. Mechanism of injury and incident information b. Initial signs and symptoms c. State of consciousness d. Finding on serial testing of symptoms, neuropsychological function and postural stability testing e. Instructions given to athlete and/or a designated care-giver f. Continued management g. Recommendations provided by the physician h. Date and time of return to participation i. Any other relevant information Equipment Issues 1. In sports requiring helmet protection, the athletic trainer and/or designee should ensure that all helmets meet protection requirements of either the National Operating Committee on Standards of Athletic Equipment (NOCSAE) or the American Society for Testing and Materials (ASTM). 2. In sports requiring helmet protection, a qualified individual must ensure that all helmets are properly fit for individual student-athletes. Student-athletes should be instructed to examine his/her helmet daily before use for damage. Any damage should be reported to the individual responsible for distributing and fitting protective equipment. 3. Athletics staff, student-athletes and officials should continue to emphasize that purposeful or flagrant head or neck contact in any sport should not be permitted and current rules of play should be strictly enforced. 4. The athletic trainer and coaching staff should enforce the standard use of mouth guards as indicated. Mouth guards are not to be cut or altered in any way except by the athletic trainer or dentist for purposes of achieving a proper fit. 5. There is currently no scientific evidence supporting the use of soccer headgear for reducing concussive injury to the head. Lamar University will provide soccer headgear for those student-athletes wishing to wear it, but will neither endorse nor discourage its use for protecting against concussion. 6. Protective headgear for student-athletes in other sports will be addressed on a case-by-case basis with the Head Athletic Trainer, the athletic trainer in charge of that sport, the Head Coach, and the student-athlete. The parent(s)/guardian(s) will be involved if the student-athlete is under the age of 17, or by request of the studentathlete. Evaluating and Making Return-to-Participation Decision 1. The Athletic Trainer, Team Physician, coaching staff, and the student-athlete should work together to appropriately assess suspected sport-related concussion in a student-athlete. 2. Any student-athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be removed from practice or competition and evaluated by an athletics healthcare provider with experience in the evaluation and management of concussion. 3. The Lamar University Athletic Training Department does not use a grading scale in assessing severity of MTBI, but rather focuses on the student-athlete s signs and symptoms as well as results of concussion assessment tools in determining safe return-to-play guidelines for the student-athlete. 4. The Lamar University Head Injury Flow Sheet will be followed in all cases of MTBI. (Appendix A) 5. Any student-athlete experiencing loss of consciousness will be transported emergently to the nearest hospital with spine precautions. 6. In all cases, final authority for return-to-play shall reside with the team physician and/or the physician s designee. 7. Student-athletes diagnosed with a MTBI must follow-up daily with a licensed athletic trainer in the Lamar University Athletic Training Department.

4 Same-day Return-to-Participation NCAA Ruling 8. Student-athletes with a possible MTBI, which is defined as having an impact injury and showing one or more identified signs and symptoms, are to be immediately removed from all activity, including non-contact practice, weight lifting, and conditioning, for the remainder of the day. a. Heathcare professionals should assume a concussion when unsure and waiting for a final diagnosis. When in doubt, sit the athlete out. 9. NCAA Guidelines do not allow for a student-athlete diagnosed with a concussion/mtbi to return to activity the same day of the injury. Home Care Instructions 10. Student-athletes with a concussion must be given proper oral and written home care instructions (Appendix B). In addition, home care instructions MUST be discussed with a parent, roommate, or friend of the concussed student-athlete who will be able to observe and care for the student-athlete for hours. 11. Student-athletes with a concussion are prohibited from driving until cleared by a physician. 12. Student-athletes with a concussion should be instructed to avoid all medications except acetaminophen (Tylenol) as directed by a physician. Other medications should be taken only under direction of a physician. 13. Rest is indicated for the concussed student-athlete. Activities of daily living are allowed as tolerated. A normal, well-balanced diet that is nutritious in both quality and quantity is recommended. 14. A student-athlete should be awakened during the night to check for deteriorating signs and symptoms only if he/she experienced LOC, prolonged amnesia, or was experiencing significant symptoms at bedtime. 15. Student-athletes with a concussion that have deteriorating signs and/or symptoms at any time should be immediately referred to the emergency room for a complete evaluation. Returning Disqualified Student-athlete to Participation 16. The Functional Protocol Guidelines (Appendix C) are to be followed in returning disqualified student-athletes to participation in a safe manner. 17. A more conservative treatment should be considered in student-athletes who have a history of concussion injury. In student-athletes with three (3) or more concussions and experiencing slowed recovery, temporary or permanent disqualification from contact sports may be indicated. This will be evaluated on a case-by-case basis. 18. A student-athlete who is experiencing prolonged signs and symptoms may be referred to a neurologist at the discretion of the team physician or designee.

5 Appendix A Lamar University Intercollegiate Athletics Institutional Concussion Return-to-Play Policy Head Injury Flow Sheet Baseline testing with ImPACT and NeuroCom SOT Protocol with Indicated Inter-collegiate Athletes (YES) Injury Prolonged loss of consciousness and/or Focal neurologic deficit and/or Significant alteration or deterioration in mental status (NO) Transport emergently to hospital with spine precautions Remove from athletic activity for the day. Monitor signs/symptoms for deterioration/improvement. Complete symptom checklist. Severe symptoms, or lack of reliable person to monitor athlete at home Mild to moderate symptoms and reliable person to monitor athlete at home Admit to hospital for appropriate testing and observation Discharge home with reliable observer and concussion sheet. NO DRIVING. Next day, re-evaluate ImPACT and NeuroCom SOT protocol. Complete symptom checklist. (Repeat testing every 2-3 days as necessary until resolved Repeat symptom checklist DAILY) (Symptoms and baselines resolve < 7 days) (Symptoms or baselines unresolved > 7 days) Wait 48 hours following symptom resolution and ImPACT/NeuroCom SOT normalization, then initiate functional return-to-play progression. Further work-up indicated. Return-to-play following successful completion of functional return-to-play progression.

6 Appendix B Lamar University Intercollegiate Athletics Institutional Concussion Return-to-Play Policy Home Care Instructions The person you have agreed to monitor has sustained a head injury, commonly called a concussion. He/She will need to be checked for the following symptoms every 2 hours for the next 12 hours: Change in behavior / irritability Increasing or severe persistent headache Vomiting Inability to concentrate Confusion Severe dizziness Double vision Slurred Speech Clear or bloody drainage from the ears or nose Loss of consciousness Excessive drowsiness or inability to be awakened Difficulty breathing Seizures Incontinence (inability to control going to the bathroom) If any of these occur, call _(Athletic (Phone #). If he/she is unavailable, call 911 immediately. If you have any questions, call the athletic trainer above OR call the main athletic training room at (409) OR Joshua Yonker, Head Athletic Trainer at (409) (after hours). Patient cannot drink any alcohol or take medications that may alter their awareness such as pain killers or tranquilizers. Tylenol may be taken under direction of a physician. Dosing instructions provided with pain medications should be followed. Patient cannot drive a car until cleared by team physician. Patient needs to be examined by an athletic trainer on at AM / PM in the athletic training room. (date) (time) Patient MUST follow-up with the athletic trainer DAILY until further notice. NO ATHLETIC ACTIVITY (including running, weight-lifting, practice, etc.) IS ALLOWED UNTIL FURTHER NOTICE.

7 Appendix C Lamar University Intercollegiate Athletics Institutional Concussion Return-to-Play Policy Functional Return-to-Play Progression In student-athletes sustaining a 1 st concussion, this protocol may not be initiated until 48 hours (2 days) after: ALL post-concussive signs and symptoms have completely resolved (student-athlete must be asymptomatic for the ENTIRE day for symptoms to be considered resolved i.e. if wakes with headache but it goes away throughout the morning, that is a SYMPTOMATIC DAY) ImPACT scoring is normalized with respect to baseline as determined by a designee of the Head Team Physician NeuroCom SOT is normalized with respect to baseline as determined by a designee of the Head Team Physician If symptoms appear during any of the functional protocol: The test should be immediately stopped and the student-athlete monitored until symptoms resolve The functional protocol is not re-assessed on the same day If symptoms do not resolve, appropriate medical attention should be provided Functional testing may be resumed the following day if the student-athlete remains asymptomatic After each phase of functional testing, the presence of post-concussive symptoms should be assessed, and progression to the next phase of functional testing will require the absence of post-concussive symptoms. The student-athlete may not return to full contact sports until 5 days after normalization of the ImPACT and NeuroCom SOT scores, resolution of post-concussive symptoms and completion of the return-to-play progression. 10 minutes on a stationary bicycle. Target heart rate > 160bpm. 10 minutes of continuous jogging on a treadmill. 5 sprints of 30 yards. Sport Specific Agility drills. Non-contact practice 24 hours following completion of functional protocol. May return to full contact sports 24 hours following completion of non-contact practice. (Minimum 5 days after normalization of baseline test scores and resolution of post-concussive symptoms, following the first concussion.) See additional guidelines for 2 nd or 3 rd concussions. Continued, next page

8 Any student-athlete sustaining more than one (1) concussion within the same season/academic year, or having a concussion history, may be referred for further work-up at the discretion of the head athletic trainer, and/or his designee. Student-athletes sustaining a 2 nd concussion during the same season/academic year: Functional protocol may be initiated 9 days following resolution of all signs and symptoms and normalization of ImPACT and NeuroCom SOT baseline scores The student-athlete may return to full contact sports no earlier than 12 days after resolution of all signs and symptoms and normalization of ImPACT and NeuroCom SOT baseline scores Student-athletes sustaining a 3 rd concussion during the same season/academic year: Will be excluded from further participation for the remainder of the season/academic year