Laurel School Sports Medicine Traumatic Brain Injury (TBI)/Concussion Management Document

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1 Laurel School Sports Medicine Traumatic Brain Injury (TBI)/Concussion Management Document Baseline Testing Laurel School Sports Medicine utilizes ImPACT neurocognitive testing as part of our concussion protocol. All students in the Upper School will complete a baseline ImPact test every two years (during their freshmen and junior years) with the following exceptions: 1. If a student sustains a concussion during the previous school year they will retake the baseline test for the current school year. 2. All transfer students will be tested upon acceptance to Laurel School. TBI Occurance If it is suspected that a student has sustained a head injury, she should be immediately removed from all activity and assessed by the Sports Medicine staff. Any student who is removed from activity for a suspected head injury is not permitted to return to play the same day. Assessment and Referral At the time of injury, the Sports Medicine staff will determine whether immediate evaluation in the emergency room is necessary. 1. For all students who lose consciousness for greater than one minute, have repeated vomiting, changes in mental status, or whose symptoms worsen, transport to the nearest medical facility will be required. 2. For all other students, evaluation by either the athletic trainer or team physician must occur within hours. Parent Notification If immediate referral to an emergency room IS necessary, parents will receive a phone call from the athletic trainer (AT). Information will be provided indicating where their daughter has been transported. Management The student may be managed by the athletic trainer, however the athlete must see a sports medicine physician or concussion specialist if any of the following occur: The symptoms extend past five days. The symptoms are not improving on a daily basis. The symptoms are worsening. The athlete visited the emergency room. The symptoms return twice during the Return to Play(RTP) protocol. The athlete has had more than one concussion.

2 There is any disagreement between parents or coaches and the athletic trainer (diagnosis or management). The student must check in with the athletic trainer on a daily basis until full return to learn/play is approved. Return to Learn (RTL) Protocol A student s best chance of full recovery from a concussion involves two critical components: cognitive and physical rest. Continued research has shown that cognitive rest is essential to the quick resolution of concussion symptoms. Cognitive stimulation includes: driving, video games, computers, text messaging, cell phone use, loud and/or bright environments, television, reading and studying. These must be limited, and in most cases, completely avoided in the early stages of recovery. Physical activity such as physical education, dance and drama classes, sports activities, and strength or cardiovascular conditioning must be regulated and monitored closely by a healthcare professional or avoided while recovering from a concussion. Reporting a Head Injury It is imperative that parents communicate all information regarding head injuries to the school via the athletic trainer (AT) or school nurse (RN). This will allow us to begin the Return to Learn (RTL) Protocol. 1. When a head injury occurs outside of school, parents should contact the school nurse (RN) who will inform the athletic trainer (AT). 2. When a head injury occurs during the school day, the school nurse (RN) will inform the athletic trainer (AT), and an assessment will be completed to determine if there is a concussion and what steps will be taken. 3. When a head injury occurs at a home Laurel athletic event, the athletic trainer(at) will complete an assessment and if there is a concussion, will notify the school nurse(rn) that the student has sustained a concussion. Intra-School Communications 1. The student must be evaluated by a health care professional (MD, DO or AT) and documentation must be provided to the athletic trainer (AT) or school nurse (RN). 2. The athletic trainer will inform the appropriate division directors and deans when a student sustains a concussion. 3. The deans will then inform the student s advisor, grade level leader, teachers and learning specialist that a student has sustained a concussion which will require academic accommodations.

3 Points of Emphasis It is important to note that the recovery from a concussion is a very individualized process. Caution must be taken not to compare students with concussions as they progress through the recovery process. The student will be granted adequate time to complete missed academic work based on the amount of time needed for complete recovery. It is important to note that some types of cognitive activity will be tolerated before others based on each individual s recovery. i.e. the athlete may be able to return to math before reading or vice versa. Once the student has returned to school, they report to the AT on a daily basis in order to monitor symptoms and determine progression to the next stage within the RTL guidelines. As the student s recovery progresses through Stages 1-3, teachers should be prepared to apply mastery learning criteria within their subject matter. Identifying only essential academic work will aid the student s recovery by reducing anxiety levels related to the perceived volume of work that will be required once medically cleared to resume a full academic load. Anxiety can increase and prolong post-concussive symptoms. Students and parents are encouraged to meet with their dean, advisor and teachers regularly to discuss progress and status of make-up work The student is encouraged to meet with their dean/athletic trainer to review any recurring symptoms, disrupted sleep habits, or emotional concerns. Progression to Full Academic Activity Stage 1: No school attendance, emphasize cognitive and physical rest Characteristics Severe symptoms at rest: Students may be sensitive to light and noise Students may complain of intense and continuous/frequent headaches Students may not be able to read for more than 10 minutes without an increase in symptoms o Symptoms may also include but are not limited to: dizziness, nausea, concentration difficulty, amnesia, and visual disturbances Abnormal ImPACT results (9-12 grades only) The ImPACT Test is a computerized neurocognitive test which, along with a variety of other tests, is used to help determine neurocognitive function.

4 No tests, quizzes or homework Provide students with copies of class notes (teacher or student generated) No physical activity will be allowed at this time ImPACT testing will be used to help monitor the recovery process for students when appropriate. Progress to Stage 2 when: Decreased sensitivity to light and noise Decreased intensity and frequency of headaches Ability to do light reading for 10 minutes without increased symptoms Stage 2: Option for modified daily class schedule Upon returning to school, it is important that the student report to the AT on a daily basis in order to monitor symptoms and determine progression to the next stage within the RTL guidelines. Characteristics Mild symptoms at rest, increasing with physical and mental activity Abnormal ImPACT scores (if testing is needed) Gradual return to normal schedule o i.e.: Half days, alternating morning and afternoon classes as symptoms warrant. May wear sunglasses in bright classrooms or when viewing Smart Boards, as needed No tests, quizzes or homework Provide student with copies of class notes (teacher or student generated) With the deans and teachers, create a plan for possible modification and the gradual completion of missed tests, quizzes and homework. i.e.: Google Doc Excused from physical education classes, performing arts, and/or sports activities Report on a regular basis to the athletic trainer Progress to Stage 3 when: Each of the student s classes have been attended at least once School activity does not increase symptoms Overall symptoms continue to decrease Stage 3: Full day of school Characteristics Symptom free at rest Mild to moderate symptoms with mental and physical activity Abnormal ImPACT results (if tested)

5 No tests, homework, or quizzes Provide student with copies of class notes (teacher or student generated) With the deans and teachers, create a plan for possible modification and the gradual completion of missed tests, quizzes, and homework. i.e.: Google Doc Excused from physical education classes, performing arts and/or sports activities Report on a regular basis to the athletic trainer Progress to Stage 4 when: Symptom free with mental and physical activity *Student should report return of any symptoms ImPACT scores have normalized and/or symptoms have resolved completely Completion of clinical exam conducted by the appropriate health care professional (MD, DO, ATC) If the student is not able to progress past stage three at the end of a semester, a discussion should occur with the student, their parents and deans to determine next steps. Stage 4: Full academic load and Return to Play (RTP) protocol Resumption of current academic responsibilities once ImPACT scores have normalized and/or symptoms have resolved completely as determined by the appropriate health care professional With the deans and teachers, create a plan for possible modification and the gradual completion of missed tests, quizzes and homework Teacher has the discretion to apply mastery learning criteria for their subject matter Students are not required to makeup missed Physical Education classes due to a concussion Gradual resumption of physical activity Students will return to PE and Performing Arts classes and will spend a minimum of two days with modified activity directed by the athletic trainer Athletes will follow the Return to Play (RTP) protocol found below under the direction of the AT o Student will report on a regular basis to the AT Return to Play (RTP) Protocol An athlete may not return to any sports activity until: She is symptom free for at least 24 hours. ImPACT neurocognitive testing is within normal limits as determined by the AT and/or team physician. Written clearance is provided by the AT, team physician or a sports medicine physician.

6 The following progression will be used to return an athlete to full participation. The shortest time period between steps is 24 hours, but each step may take longer based on the length of symptoms and complexity of recovery. If any symptoms develop during the progression, the athlete should stop activity and report to the AT. Step 1 low level of non-contact physical activity for minutes (such as stationary bike). Step 2 non-contact, sport-specific exercise; no head impact activities Step 3 non-contact training drills; resistance training Step 4 full contact, normal training activities Step 5 normal game play It is important to note: Coaches are not permitted to allow an athlete to practice or compete until he/she verifies the athlete s clearance directly with the AT. According to Ohio High School Athletic Association Guidelines, and consistent with Ohio State Law, only a MD, DO, or other school-designated health care professional (the AT) licensed in Ohio can return an athlete to play following a concussion. If clearance is given by a doctor other than the team physician, it will be reviewed by the AT and/or team physician to verify clearance and return to play. The AT may refer to a concussion specialist for further evaluation before allowing an athlete s clearance. The school AT and team physician have final determination on when return to play occurs. Education All coaches and paid volunteers must complete an approved online concussion education course prior to their start date. The athletic director or AT will provide the coaches with information on how to complete the required education. All students and their parent/legal guardian shall review and sign the Concussion Information Sheet developed by the Ohio Department of Health. This form is required to be on file before the athlete is allowed to participate in any team activities.

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