Concussion Information for Parents/Guardians

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1 Concussion Information for Parents/Guardians What is a concussion and what causes a concussion? A concussion is a brain injury that causes changes in how the brain cells function, leading to symptoms that can be physical (e.g. headache, dizziness), cognitive (e.g. memory problems, decreased concentration), or emotional (e.g. feeling depressed). The brain injury cannot be seen on X-rays or CT scans. Concussions can occur without a loss of consciousness. In fact, most concussions occur without a loss of consciousness. A concussion can occur from a direct blow to the head, but may also occur from a major physical trauma to other parts of the body (e.g. a sideways check to the body) that causes a whiplash effect on the head and neck). What are the symptoms and signs of concussion? Concussion should be suspected in the presence of any one or more of the following symptoms and signs: Thinking Problems Does not know time, date, place, class, type of activity in which he/she was participating General confusion Cannot remember things that happened before and after the injury Knocked out Student s Complaints Headache Dizziness Feels dazed Feels dinged or stunned Having my bell rung Sees stars, flashing lights Ringing in the ears Sleepiness Loss of vision Sees double or blurry Other Problems Poor coordination or balance Blank stare/glassy-eyed Vomiting Slurred speech Slow to answer questions or follow directions Easily distracted Poor concentration Strange or inappropriate emotions, (e.g., laughing, crying, getting mad easily) Stomach ache/pain/nausea Not playing as well 1

2 What should you do if you child gets a concussion? Your child should immediately stop playing his/her sport. Your child should not be left alone and should be seen by a doctor as soon as possible. If your child is unconscious, call 911 to take your child to a hospital. Do not move your child until the paramedics arrive. How long does it take for my child to get better? The signs and symptoms of a concussion often last for 7 10 days, but may last much longer. The exact length of this period is unclear, but the brain temporarily does not function normally, and during this time, it is more vulnerable to a second head injury. In some cases, students may take many weeks or months to heal. Significant cognitive symptoms may result from concussion including; poor attention and concentration, reduced speed of information-processing and impaired memory and learning. There may also be a significant negative effect on educational and social attainment, as these functions are critical for learning new skills and attending to schoolwork. How is a concussion treated? Exertion, both physical and mental, worsens concussion symptoms and may delay recovery. Thus, the most important treatment for concussion is rest. Many students find that attending school aggravates their symptoms, and they may have to stay home and rest. It is not possible to know when symptoms will improve, as each concussion is unique. Therefore, a specific return date to school may not initially be possible for anyone, including the doctor, to provide. Once your child feels better, he or she can try going back to school, initially part-time (e.g. half-days at first) and, if there symptoms do not return, and he or she can go back full time. Mental exertion can make symptoms worse so your child s workload may need to be adjusted accordingly. When can my child return to learn and play? It is very important that your child not go back to physical activities if he or she has any concussion symptoms or signs. Upon the first visit to a medical doctor, he/she should complete Appendix: Documentation of Medical Examination. Following that, Return to learn and play must follow the step-by-step approach detailed in Appendix: Document for a Diagnosed Concussion Return to Learn/Return to Physical Activity Plan. Step 1 Return to Learn/Return to Physical Activity The student does not attend school during Step 1. Step 2a Return to Learn Student returns to school. Requires individualized classroom strategies and/or approaches which gradually increase cognitive activity. Physical rest includes restricting recreational/leisure and competitive physical activities. Step 2b Return to Learn Student returns to regular learning activities at school. Step 2 Return to Physical Activity Student can participate in individual light aerobic physical activity only. Student continues with regular learning activities. 2

3 Step 3 Return to Physical Activity Student may begin individual sport-specific physical activity only. Step 4 Return to Physical Activity Student may begin activities where there is no body contact (e.g., dance, badminton); light resistance/weight training; non-contact practice; and non-contact sport-specific drills. Step 5 Return to Physical Activity Student may resume regular physical education/intramural activities/interschool activities in non-contact sports and full training/practices for contact sports. Step 6 Return to Physical Activity Student may resume full participation in contact sports with no restrictions. Note: Each step must take a minimum of one day. If symptoms or signs of the concussion return (e.g. headache, feeling nauseated) either with activity or later that day, your child needs to rest for 24 hours, and return to the previous step. Your child should never return to play if symptoms persist. Your child may not participate in any physical education activities until Step 1 and Step 2a and 2b have been completed. Prior to beginning Step 3, the parent/guardian signature is required. It is important that your child not play any sports, including intramural or inter-school athletics or any part of the health and physical education curriculum, if he or she has any signs or symptoms of concussion. Your child must rest until he or she is completely back to normal. When he or she is back to normal and has been seen by a doctor, he or she can then go through the steps of increasing activity described above. When your child has progressed through these steps with no symptoms or problems, and has received clearance from a doctor, he or she may return to play. If you are unsure if your child should participate, remember, when in doubt, sit your child out. When should I take my child to the doctor? Every child who gets a head injury should be seen by a doctor as soon as possible. You should take him or her back to the doctor immediately or call 911, if, after being told your child has a concussion, he or she has worsening of symptoms such as: 1. Being more confused; 2. Worsening headache; 3. Vomiting more than once 4. Not awakening; 5. Trouble walking; 6. Having a seizure; and/or 7. Demonstrating strange behaviour. Problems caused by a head injury can get worse later that day or night. Your child should not be left alone and should be checked throughout the night. If you have concerns about your child s breathing or sleeping, wake your child up. If it appears that the signs or symptoms are getting worse, you should see your doctor immediately or call

4 Appendix A: Documentation of Medical Examination This form to be provided to all students suspected of having a concussion. This form should be taken to the first medical doctor s visit, if possible. (athlete name) sustained a suspected concussion on (date). As a result, this athlete must be seen by a medical doctor or nurse practitioner. Prior to returning to school, the parent/guardian must inform the school principal of the results of the medical examination by completing the following: Results of Medical Examination [ ] My child/ward has been examined and no concussion has been diagnosed and therefore may resume full participation in learning and physical activity with no restrictions. [ ] My child/ward has been examined and a concussion has been diagnosed and therefore must begin a medically supervised, individualized and gradual Return to Learn/Return to Physical Activity Plan. Medical Doctor s Signature: Parent/Guardian Signature: Date: Comments: Please follow the steps indicated in Appendix: Documentation for a Diagnosed Concussion Return to Learn/Return to Physical Activity Plan. 4

5 Appendix B: Documentation for a Diagnosed Concussion Return to Learn/Return to Physical Activity Plan To be used after the diagnosis of a concussion and submission of Appendix: Documentation of Medical Examination The Return to Learn/Return to Physical Activity Plan is a combined approach. Step 2a - Return to Learn must be completed prior to the student returning to physical activity. Each step must take a minimum of 24 hours (Note: Step 2b Return to Learn and Step 2 Return to Physical Activity occur concurrently). Step 1 Return to Learn/Return to Physical Activity Completed at home after a visit to a medical doctor, and diagnosis of a concussion on Appendix: Documentation of Medical Examination Cognitive Rest includes limiting activities that require concentration and attention (e.g., reading, texting, television, computer, video/electronic games). Physical Rest includes restricting recreational/leisure and competitive physical activities. [ ] My child/ward has completed Step 1 of the Return to Learn/Return to Physical Activity Plan (cognitive and physical rest at home) and his/her symptoms have shown improvement. My child/ward will proceed to Step 2a Return to Learn. [ ] My child/ward has completed Step 1 of the Return to Learn/Return to Physical Activity Plan (cognitive and physical rest at home) and is symptom free. My child/ward will proceed directly to Step 2b Return to Learn and Step 2 Return to Physical Activity. If at any time during the following steps symptoms return, please refer to the Return of Symptoms section on page 7 of this form. 5

6 Step 2a Return to Learn Student returns to school. Requires individualized classroom strategies and/or approaches which gradually increase cognitive activity. Physical rest includes restricting recreational/leisure and competitive physical activities. My child/ward has been receiving individualized classroom strategies and/or approaches and is symptom free. My child/ward will proceed to Step 2b Return to Learn and Step 2 Return to Physical Activity. Step 2b Return to Learn Student returns to regular learning activities at school. Step 2 Return to Physical Activity Student can participate in individual light aerobic physical activity only. Student continues with regular learning activities. My child/ward is symptom free after participating in light aerobic physical activity. My child/ward will proceed to Step 3 Return to Physical Activity. Step 3 Return to Physical Activity Student may begin individual sport-specific physical activity only. Step 4 Return to Physical Activity Student may begin activities where there is no body contact (e.g., dance, badminton); light resistance/weight training; non-contact practice; and non-contact sport-specific drills. 6

7 Student has successfully completed Steps 3 and 4 and is symptom free. Appendix: Documentation of Medical Examination will be returned to parent/guardian to obtain medical doctor/nurse practitioner diagnosis and signature. Teacher signature: Second Medical Examination I, (medical doctor/nurse practitioner name) have examined (student name) and confirm he/she continues to be symptom free and is able to return to regular physical education class/intramural activities/interschool activities in non-contact sports and full training/practices for contact sports. Medical Doctor/Nurse Practitioner Signature: Step 5 Return to Physical Activity Student may resume regular physical education/intramural activities/interschool activities in non-contact sports and full training/practices for contact sports. Step 6 Return to Physical Activity Student may resume full participation in contact sports with no restrictions. Return of Symptoms My child/ward has experienced a return of concussion signs and/or symptoms and has been examined by a medical doctor/nurse practitioner, who has advised a return to: Step of the Return to Learn/Return to Physical Activity Plan 7

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