St. Rita of Cascia High School Concussion Management Plan

Transcription

1 St. Rita of Cascia High School Concussion Management Plan

2 PURPOSE: In accordance with the various state laws overseeing concussions throughout the country, St. Rita has proactively developed a Concussion Management Plan for its Certified Athletic Trainer(s). ROLE: Along with the team physician, the athletic trainer acts as a point person at the affiliate for dealing with athletic injuries. This includes the care and management of concussions. The Athletic Trainer (AT) will provide initial evaluation of the injury, and see to it that the athlete is properly managed and attended to during the extent of the injury. EVALUATION: Proper evaluation of a concussion entails monitoring symptoms, as well as basic sideline screenings. Examples of such screenings would be the SCAT 3 and Graded Symptom Checklist. CONCUSSION MANAGEMENT TEAM: Dr. Danielle Bass MD and Jason DePue ATC REFERRAL: All concussions should be referred on to a physician. It is the AT s discretion if the athlete should be sent to an Emergency Room for closer evaluation. Signs such as abnormal pupil response, abnormal cognition, decreasing vital signs, or a sudden increase in amount and/or severity of symptoms should warrant an immediate referral to the Emergency Department at a near hospital. RETURN TO PARTICIPATION: Once it has been determined that an athlete has sustained a concussion, they must be removed from athletic participation immediately. The athlete should remain removed from participation until they are symptom free at rest and have written clearance from a physician to begin the concussion protocol. Upon being symptom free at rest, the student-athlete may begin a progression back to sports participation. The B.R.A.I.N.-G return to participation model will be used for St. Rita ATs. Once student-athlete completes all RTP stages he will return to physician for written clearance back to sport. Athletic Trainer has final say in student-athletes return to play. ADDITIONAL RESOURCES USED FOR CONCUSSION MANAGEMENT: Protocol for Return to Play: Regarding concussions and return to participation can be sent to parents to educate about the return to participation process after a concussion. In addition, this form can be used as a parent sign-off for compliance measures. Protocol for Return to Learn: Regarding concussions and return to learn can be sent to parents to educate them about the return to learn process after a concussion. This protocol, along with examples of student accommodations will be sent out to the teacher s for students who sustain a concussion. Concussion Physician Note: Used to send to physicians after a student-athlete sustains a concussion. SCAT 3: Assessment tool to help evaluate concussions. This document can also be used a baseline test for affiliates that do not have computerized testing such as IMPACT. Impact: Each student-athlete will perform a baseline at the beginning of fall sports or before their perspective sport begins. Those student-athletes sustaining a concussion will perform post-injury test till they reach their baseline score. Concussion Progress Sheet: This allows your athletic trainer to track all of the phases of an athlete s recovery in one easy to follow form. Return to Play Verification Form: This document provides a means of communication from the athletic trainer to the physician that verifies where an athlete is within the Return to Play process. Graded Symptom Checklist: Management tool to grade the symptoms that the concussed athlete is experiencing. Concussion Information form for Parents: Used to give to parents after an athlete sustains a concussion.

3 St. Rita of Cascia High School Recommendations for Concussion Management This document represents the best practices and recommendations for athletic trainers at St. Rita in regards to concussion management. It is intended that this document is used as a guide to help support athletic trainers in the management of concussions. Prevention/Education It is important for athletic trainers to recognize that there is no equipment or activity that can completely prevent concussion. Mouth guards are proven to successfully prevent dental and maxillofacial injuries, however there is no evidence to support that they prevent concussions. Athletic trainers should work with school administration to ensure proper education for athletes, parents, coaches, and school faculty surrounding concussions. This should include basic concussion information and academic considerations after injury. Successful programs that schools have used in the past are: o Center for Disease Control - o National Federation of State High School Associations - o ACTive concussion - Athletic trainers should work with the affiliate and team physician to ensure they are within accordance with the Illinois concussion Law. o Parental education of concussion IHSA provides athletic departments with forms that outline concussion education. This form is signed by parents/guardians and acts as proof of education and understanding of concussions. o Approved concussion protocol All concussion protocols must be reviewed and approved by the school. Protocols should be updated annually, with the school being notified of the changes. It is important that athletic trainers utilize proper terminology when discussing concussions by avoiding the terms ding and bell ringer. Athletic trainers should encourage educators and administrators to understand the effect that concussions have on students in the classroom. It is recommended that the athletic trainer have a proactive conversation with the team physician and athletic director/affiliate contact regarding proper procedures when working with parents who want to have their child return to participation before receiving the proper clearances. Each school, organization, and otherwise affiliate of Athletico, and Athletico athletic trainers should be aware of their current state concussions laws as it relates to: o Education of parents, coaches, athletes, etc o Removal and return to play of concussed athlete All St. Rita coaches and licensed officials will need to complete a training program of at least two hours on concussions. Coaches, nurses, and game officials must provide the school or district with proof of successful completion of the training. Training must be completed every two years. Head coaches and assistant coaches must complete the required training as well as members of a school/district s COT.

4 Baseline Testing St. Rita uses Impact (Immediate Postconcussion Assessment and Cognitive Testing, Pittsburg, PA) to baseline its student athletes at the beginning of their sport every two years. Evaluation Upon initial evaluation, athletic trainers should rule out all serious head and spinal injury through clearing sensation, motor movement, and evaluating ABC s. Vital signs should be generally monitored to evaluate for more serious head injury. The athletic trainer should have a sideline assessment card for quick evaluations during game situations that determine if a full evaluation is needed. It is recommended that athletic trainers make a best effort to evaluate a concussion away from busy sidelines. Evaluation Procedures Below is an example on how a St. Rita Athletic trainer should handle a concussion evaluation: o Athlete suspected of concussion is removed from play for evaluation. o Initial evaluation should rule our all serious head and spinal injuries. o Athlete is examined using SCAT3, and/or other appropriate evaluation tool. o If the athletic trainer does not suspect a concussion, the athlete should be functionally tested before RTP. o If a concussion is suspected, the athlete is removed from play until being evaluated by a physician. o Coach is notified of player status due to injury. o Parents/guardians are contacted to inform of injury, review concussion information sheet, Physician Concussion Note, RTP protocol, and next actions. o Concussion information sheet, RTP (BRAIN-G) program, and Physician Concussion Note are reviewed and sent home with the student-athlete/parent. Injury Communication ATHLETE: The athletic trainer should explain the injury, review the concussion information sheet and physician letter to be sent home, review RTP protocol, advise on academic considerations that may need to be made, and inform that the school nurse will be aware of their injury. Use metaphors when possible while explaining the injury to an athlete. PARENT/GUARDIAN: The parents/guardian should be contacted the day of the injury. The athletic trainer should explain the injury, review the concussion information sheet and physician letter that were sent home, explain proper care instructions, review RTP protocol based on state law, inform that the school nurse will be notified, and advise on academic considerations that may need to be made. Physician: St. Rita provides physician concussion letter that should be filled out by the athletic trainer, sent with the athlete, and returned to confirm treatment plan. School Counselor: Ideal communication to the school counselor should be specific, to the point, and happen the day of the injury. An example to the school counselor is as follows: ATHLETE sustained a suspected concussion during practice/game today. The parents and athlete were given educational material regarding concussions, and will need to see a physician. I am writing to inform you that they may come to your office with concussion-like symptoms, and that this athlete is currently seeking care. Athlete should be held out of all Physical Education classes until further notice. ATHLETE may need accommodations in the classroom and I have attached a guide for that. Please inform the faculty of ATHLETES injury and ask that academic accommodations be made if needed. Counselors: Brian Hagen- bhagen@stritahs.com, Jill Nagel- jnagel@stritahs.com, Terry Landstrom- tlandstrom@stritahs.com, Wes Benak wbenak@stritahs.com Communication with the physician should take place regarding cognitive rest for the athlete. This could look like temporarily excusing the athlete from class, tests, quizzes, homework, etc. It

5 is not the athletic trainers responsibility to excuse athletes from there items mentioned above, but they should advise that these considerations made need to be used. Return to Learn Recommendations Athletes suffering from concussion-like symptoms may need work/academic accommodations to ensure proper recovery. Continuing work tasks/schoolwork that result in a trigger or increase in symptoms may delay the length of recovery for the athlete Faculty will be notified by Guidance Counselor via along with Return to learn protocol and a list of accommodations. Referral to Physician It is strongly recommended that any athlete who sustains a concussion be evaluated by a licensed physician (not a chiropractor) who has experience in concussion management. Athletic Trainer will not start any progression to sport unless ATHLETE is seen by a physician and signed off on treatment plan. The 2014 National Athletic Trainers Association (NATA) Position Statement on Management of Sport Concussion states situations where athletes should be sent to the physician immediately after a mild traumatic brain injury. To access this list, please go to: Post Injury Testing Each athlete will have a baseline neurocognitive test completed using Impact. Athletic Trainer will do Post Injury Testing once the athlete has been symptom free for 24 hours or when instructed by treating physician. When utilizing ImPACT, athletes should not be tested more than two times per week, and there should be a minimum of 48 hours between testing sessions. Return to Play In all state platforms, it is recommended that athletic trainers work under the direction of a physician for the return to play for concussed athletes. No athlete should return to participation the same day as a concussive event. Athletes shall return to participation utilizing a step-wise symptom-limited program. St. Rita uses the return to participation protocol called the B.R.A.I.N.-G. principle. Athlete cannot RTP or begin BRAIN-G until a signed physician concussion letter is returned stating the treatment plan. Return to play procedures- Below is a recommended guideline on how an Athletico athletic trainer should handle concussion return to play: o Proper communication should have been made to the parents, school, and coaches on the treatment plan and academic considerations. o The athlete should report after school to have symptoms documented on the daily symptoms checklist provide by AT. o Once symptom free, the athlete should begin BRAIN-G. The physician letter must be filled out and returned before the athlete can begin BRAING-G, even if symptom free. o Once the athlete has successfully completed BRAIN-G, full unrestricted activity status should be reported to the physician, coach, and parent. Any return of symptoms during RTP protocol re-starts the protocol at the previous step. It is recommended that the athlete have a full academic workload before being released back to full athletic participation. Progress throughout the concussion should be documented on the Athletico Concussion Progress Sheet. Athletic trainer has final say in student-athletes Return to Play. Event Coverage- Non St. Rita sponsored events

6 All athletes suspected of a concussion at event coverage outside of St. Rita High School athletics should follow the same procedures as St. Rita High School. It is recommended that athletic trainers follow up with any concussed athlete, parent, and athlete s athletic trainer that they assess at event coverage via phone in order to monitor the athlete s condition and assist with proper referral. Physical Therapy When an athlete has consistent symptoms for an extended period of time (approximately 7-10 days for adults and 2-3 weeks for adolescents), the athletic trainer should consider vestibular physical therapy as a possible treatment option. Athletes suffering from neck discomfort in addition to their concussion symptoms should consider physical therapy as a possible treatment option. This option should be reviewed with the physician during any appointments.

7 St. Rita High School Protocol for Return to Play After a Head Injury After an athlete has been evaluated by an athletic trainer or physician and it has been determined that the athlete has sustained a concussion, the following protocol will be used to safely progress their return to play. Under no circumstances will this protocol be accelerated. There should be approximately 24 hours (or longer) for each stage, and the athlete should return to previous stages if symptoms recur. Resistance training should only be added in later stages. Rehabilitation Stage Functional Exercise at Each Stage of Rehabilitation 1. No activity Complete physical and mental rest 2. Biking 3. Running 4. Agility Exercises 5. Non-contact practice 6. Full contact practice Stationary cycling keeping intensity <70% maximum predicted heart rate (30 min. max) Running while keeping intensity <70% maximum predicted heart rate (30 min. max) Sport-specific exercises. No headimpact activities. Full practice without contact May start progressive resistance training Following medical clearance participate in normal training activities Success Goal of Each Stage Recovery (symptom free at rest) Increase heart rate without symptoms Add movement without symptoms Add coordination and cognition without symptoms Increase exercise, coordination, and cognitive load without symptoms Restore confidence and assess functional skills by coaching staff without symptoms 7. Return to play Normal game play Protocol established from: "Consensus statement on concussion in sport The 3rd International Conference on concussion in sport, held in Zurich, November 2008." Journal of Clinical Neuroscience. (2009) 16: Return to Participation: It is determined that an athlete is able to return to play when they are symptom free at rest and at exertion, and have returned to a baseline state of any of the tests they were administered. An athlete will not return to participation the same day as a concussive event. When returning athletes to play, they will follow the stepwise symptom-limited program outlined above. Once the athlete has received clearance from a physician licensed in all branches, and/or the athletic trainer, they may return to play. If an athlete receives clearance from a physician, the athletic trainer still reserves the right to hold the athlete out of participation. A parent s consent is not a sufficient means for an athlete to return to participation. Athletes who have not been cleared to participate cannot be in uniform for any games. This protocol is implemented to promote compliance with: IHSA Return to Play Policy, IHSA Protocol for Implementation of NFHS Sports Playing Rule for Concussions, Illinois HB 0200, and City of Chicago Ordinance Concussion Injuries in Student Athletes in Chicago Schools (Ch Municipal Code of Chicago) which outline that athletes exhibiting symptoms of a concussion cannot return to play until cleared by an appropriate health care professional. By signing this, I as a parent understand and will comply with St. Rita High School s Head Injury Protocol and Policy. Athlete s Name Parent s Signature Date

8 Below is the B.R.A.I.N.- G. Graduated Return to Play (RTP) protocol that you must successfully accomplish before returning from a concussion. You must successfully complete this program before returning to any competitions. The first stage (B) will not start until you have been asymptomatic for 24 hours continuously, and not taking any pain medications. Each step should be separated by a minimum of 24 hours. Return to game play must be consistent and in line with school/organization protocol, respective state law, and physician s order. Functional Exercise at each stage of RTP No Activity Relative physical and cognitive rest B Light Aerobic Exercise Stationary cycling keeping heart rate <70% maximum predicted heart rate. No resistance training R Heavier Aerobic Running >70% maximum exercise predicted heart rate. Still no resistance training A Sport specific exercise Resistance training may commence. Agility drills. Sports specific drills. (No heading) Drills with a rotation component I Non- contact training drills Progression to more complex training drills in a non- contact environment. Plyometrics, aggressive strengthening N Full contact practice Following medical clearance, participate in normal training and practice activities G Return to game play Normal Game Play Success goal of each stage Recovery (Symptom free at rest for 24 continuous hours) Increase heart rate without the onset of symptoms. Increase heart rate without the onset of symptoms. Add more advanced movements without the onset of symptoms Exercise, coordination, and cognitive load without symptoms Restore confidence and assess functional skills by coaching staff. Complete without symptoms For more information on concussion, please visit Athletico s concussion website at

9 St. Rita of Cascia High Scool Protocol for Return to Learn After a Head Injury After an athlete has been evaluated by an athletic trainer or physician and it has been determined that the athlete has sustained a concussion, the following protocol will be used to safely progress their return to learn. Under no circumstances will this protocol be accelerated. Should the athlete not be fully symptom free, they may progress through the RTL Protocol under Physician s direction. However, the athlete MUST be fully symptom free to progress through the RTP Protocol. There should be approximately 24 hours (or longer) for each stage, and the athlete should return to previous stages if symptoms recur. Resistance training should only be added in later stages. Rehabilitation Stage 1. Limited Cognitive activities 2. Begin educational sessions in school with permission of parent and physician. 3. Full class day workload without breaks 4. Begin RTP protocol Functional Exercise at Each Stage of Rehabilitation The student athlete should be exposed to normalcy until symptoms increase. At that point, the athlete can be accommodated to keep those symptoms limited. The student athlete should attempt to carry out a normal school day until symptoms increase. Accommodations may include: having a reader, prepared notes from a teacher, delaying tests/quizzes, 15 minute breaks. The student may decide to report to school later or leave school earlier per parent or guardian s decision. The student athlete can complete all and any school work given to him/her without symptoms of a concussion. The RTP 6 day protocol begins. (B.R.A.I.N.G) Success Goal of Each Stage Symptoms are either manageable or absent after 1-3 days Increase the amount of classes each day until one full day of class can be completed without symptoms. Completed RTL protocol Complete the RTP protocol without symptoms of a concussion. Return to Participation: It is determined that an athlete is able to return to play when they are symptom free at rest and at exertion, and have returned to a baseline state of any of the tests they were administered. An athlete will not return to participation the same day as a concussive event. When returning athletes to play, they will follow the step by step symptom-limited program outlined above. Once the athlete has received clearance from a physician, a certified Athletic Trainer, and the concussion oversight team assigned by the school, they may return to play. If an athlete receives clearance from a physician, the athletic trainer and remaining oversight team still reserves the right to hold the athlete out of participation. A parent s consent is not a sufficient means for an athlete to return to participation. By signing this, I as a parent understand and will comply with St. Rita s Head Injury Protocol and Policy for returning to learn. Athlete s Name Parent s Signature Date

10 Athletico Mount Greenwood 3644 W. 111 th St. Chicago, IL P: F: St. Rita High School 7740 S. Western Avenue Chicago, IL T: (773) F: (773) Dear, I would like to introduce you to, a St. Rita student- athlete that has recently sustained a head injury. He/She reports with the following: Concussion like symptoms. See attached sheets. Assessment: The student- athlete has signs and symptoms consistent with a concussion. Plan 1 : AthletiCo has developed the following return to participation protocol in regards to concussion management per the 3 rd international Consensus Statement on Concussions. Based on your feedback, we would like to implement this protocol as a gradual means to return this student- athlete to full participation. (If asymptomatic, the athlete proceeds to the next step in 24 hours. If any post concussive symptoms return, the athlete will drop back to the previous level and try to progress again after 24 hours.) Step 1 B. Bike The athlete will bike for approximately 30 minutes. Step 2 R. Run The athlete with run for approximately 30 minutes Step 3 A. Agility The athlete will conduct various sprinting and agility drills. Step 4 I. In Red The athlete is considered In Red, thus may take place in non- contact drills Step 5 N. No Restrictions The athlete may resume practice with no restrictions Step 6 G. The athlete may participate in game play. Vestibular Rehabilitation: AthletiCo provides vestibular rehabilitation for student- athletes with ongoing symptoms, including balance deficits, for athletes who have persistent/prolonged concussion symptoms. We have defined student- athletes that exhibit symptoms of greater than seven (7) days of being possible candidates for vestibular rehabilitation. If you would like more information on our vestibular rehabilitation concussion management service line, please do not hesitate to give me a call. Thank you for your cooperation and help to safely return this athlete to competitions. Sincerely, Jason DePue ATC (773) Jason.depue@athletico.com Physician Response (Please check one) Agree with treatment plan stated above Modify treatment plan with suggestions below Physician Signature: Date: 1. Consensus Statement on Concussions in Sports: The 3 rd International Conference on Concussion in Sport Held in Zurich, November 2008, Clinical Journal of Sports Medicine, May :