LEHIGH UNIVERSITY SPORTS MEDICINE CONCUSSION MANAGEMENT PLAN

Transcription

1 LEHIGH UNIVERSITY SPORTS MEDICINE CONCUSSION MANAGEMENT PLAN Table of Contents Definitions Education and Prevention Management o Concussion Education o Reducing Head Trauma Exposure o Football Helmet Facts Concussion Management o Baseline Concussion Assessment o Recognition and Diagnosis of Concussion o Post Concussion Management o Non-Sport Related Concussions Academic Management o Cognitive Rest o Academic Support o Post Concussion Management Athletic Management o Return to Participation Criteria o Graduated Exertional Return to Participation Protocol o Final Clearance for Athletic Participation o Disqualification from Athletic Participation Appendices LUSM Concussion Fact Sheet Student-Athlete Statement of Acknowledgement Head Coach Statement of Acknowledgement Athletic Trainer Statement of Acknowledgement Team Physician Statement of Acknowledgement Dean of Athletic Statement of Acknowledgement LUSM Concussion Instruction Form LUSM Best Practice Guidelines for Cognitive Management Lehigh University Athletics Football Head Protection and Helmet Policy Resources o Lehigh Sports Medicine YouTube Channel o LUSM Concussion Awareness Video o LUSM Concussion Awareness and Management Video

2 DEFINITIONS Concussion: LUSM: Athletic Trainer: Team Physician: Designee: Amnesia: Loss of Consciousness: GSC: CNA: SAC: BESS: KD: A complex pathophysiological process affecting the brain, induced by biomechanical forces. These guidelines further describe common features that incorporate clinical, pathological, and biomechanical constructs that may be utilized in defining the nature of a concussive head injury, including: Direct blow to the head, neck, or elsewhere on the body with an impulsive force transmitted to the head. Rapid onset of short-lived impairment of neurological function that resolves spontaneously. In some cases, symptoms and signs may evolve over a number of minutes to hours. Functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies. Graded set of clinical symptoms that may or may not involve loss of consciousness. Lehigh University Sports Medicine Athletic Trainers are health care professionals who collaborate with physicians. The services provided by Athletic Trainers comprise prevention, emergency care, clinical diagnosis, therapeutic intervention, and rehabilitation of injuries and medical conditions. Athletic Training is recognized by the American Medical Association (AMA) as a health care profession. Designated physician(s) responsible for the supervision of LUSM Athletic Trainers and the health care of Lehigh University intercollegiate student-athletes. A qualified health care professional designated to evaluate and assess concussions in the absence of a LUSM Athletic Trainer or Team Physician. This includes: Athletic Trainer assigned to event at which a Lehigh intercollegiate team is participating Team Physician assigned to event at which a Lehigh intercollegiate team is participating Neurologist to whom a student-athlete is referred by a LUSM Team Physician An impairment to or lack of memory. A state of impaired consciousness in which one shows no responsiveness to environmental stimuli but may respond to deep pain with involuntary movements. Graded Symptom Checklist Cranial Nerve Assessment Standardized Assessment of Concussion Balance Error Scoring System King-Devick Test

3 EDUCATION AND PREVENTION MANAGEMENT Concussion Education Student-Athletes All student-athletes will view the LUSM Concussion Awareness video each academic year. All student-athletes will read the LUSM Concussion Fact Sheet each academic year. All student-athletes will be required to sign a Statement of Acknowledgement confirming their understanding of the LUSM Concussion Management Plan. Head Coaches All head coaches will view the LUSM Concussion Awareness and Management video each academic year. All head coaches will read the LUSM Concussion Fact Sheet each academic year. All head coaches will sign a Statement of Acknowledgement form confirming their understanding of the LUSM Concussion Management Plan. All head coaches will be responsible for communicating the LUSM Concussion Management Plan with their full time, part time, graduate assistant, and volunteer assistant coaches. Athletic Trainers All staff Athletic Trainers will complete the annual LUSM Concussion Management training. This session will include a review of the LUSM Concussion Management Plan, the LUSM Concussion Awareness video, the LUSM Concussion Awareness and Management video, and the LUSM Concussion Fact Sheet. All staff Athletic Trainers will sign a Statement of Acknowledgement form confirming their understanding of the LUSM Concussion Management Plan. Team Physicians All Team Physicians will be required to sign a Statement of Acknowledgement confirming their understanding of the LUSM Concussion Management Plan. Dean of Athletics The Dean of Athletics will view the LUSM Concussion Awareness video each academic year. The Dean of Athletics will read the LUSM Concussion Fact Sheet each academic year. The Dean of Athletics will be required to sign a Statement of Acknowledgement confirming his/her understanding of the LUSM Concussion Management Plan. Parents/Guardians All parents/guardians of student-athletes participating in contact/collision sports will be sent a letter each academic year outlining the LUSM Concussion Management Plan. Reducing Head Trauma Exposure Safety First Approach Our goal is to reduce the number and cumulative effect of concussions sustained by student-athletes each season. Various preventative initiatives have been implemented to accomplish this objective.

4 Education Regarding Safe and Proper Technique The Lehigh University coaching and Sports Medicine staffs emphasize, educate, and reinforce the use of proper technique on and off the playing field in an effort to take the head out of contact and minimizing the head trauma exposure. This includes, but is not limited to, designated practice periods focused on: o Proper Tackling Technique (Football) o Proper Blocking Technique (Football) o Proper Take Down Technique (Wrestling) o Proper Heading Technique (Soccer) Reduction of Gratuitous Contact During Practice Lehigh University adheres to the Inter-Association Consensus:Year-Round Football Practice Contact Guidelines in an effort to reduce the potential exposure to head trauma. Lehigh University limits the volume of soccer drills with potential exposure to head trauma. Football Helmet Facts Overview of Football Helmet Industry The design, development, and testing of football helmets continues to evolve at an accelerated rate. Manufacturers conduct standardized National Operating Committee on Standards for Athletic Equipment (NOCSAE) testing as helmets are produced. This test is intended to ensure the quality of the helmet shell as it pertains to catastrophic head injuries, not concussions. Helmets are reconditioned and recertified by licensed professions annually to ensure NOCSAE standards. Since 2011, the scientifically peer-reviewed Summation of Test for the Analysis of Risk (STAR) helmet rating study published by Virginia Tech has been utilized to describe the perceived effectiveness at reducing the risk of concussions. Similar to rating systems used by the National Highway Traffic Safety Administration (NHTSA) and the Insurance Institute for Highway Safety (IIHS) to evaluate new automobiles, the STAR rating is intended to predict occurrence of injury. However, rating systems are not perfect. Just because a helmet receives 4 stars instead of 5, does not necessarily mean it provides less protection. Virginia Tech admits the limitations of their study, namely the lack of testing for rotational forces which are believed to be a contributing factor in concussions. Further data focusing on rotational forces is expected to be published in the near future. We will continue to monitor information as it is released. Manufacturers often market their helmets by promoting high STAR ratings. This has created a perception among the public, most notably concerned parents, that one helmet brand or model is more protective than another based upon its STAR number. The Virginia Tech team indicates their rating system is meant to be a research tool, not a buying guide, regardless of public interpretation. Helmet Facts Helmets are not designed to prevent concussions. According to the manufacturer, their purpose is to prevent skull fractures and catastrophic brain injuries. There is no such thing as a concussion proof helmet. Helmets which use air bladder linings, such as those found in traditional football helmets, are designed to sustain repetitive, moderate velocity impacts. Helmets which use linings made of expanded polystyrene (Styrofoam and any other composite materials), such as those found in motorcycle helmets, car racing helmets, and some newer football helmets, are designed to absorb a single, high velocity impact. Once an impact is sustained, the integrity of the helmet is compromised (Consumer Product Safety Commission Report, 1993). Helmets which use Kevlar fibers in the shell are light weight, but do not aid in concussion reduction. Helmets which use non-traditional sites for facemask fixation leave the face and jaw exposed.

5 CONCUSSION MANAGEMENT Baseline Concussion Assessment Brain Injury and Concussion History All student-athletes will complete a Brain Injury and Concussion History as part of their annual Pre Participation Questionnaire. Baseline Testing Baseline testing is completed annually for all student-athletes participating in contact/collision sports. o Graded Symptom Checklist (GSC) o Standardized Assessment of Concussion (SAC) o Balance Error Scoring System (BESS) o King-Devick (KD) Pre Participation Clearance The LUSM Team Physician will determine the pre participation clearance for student-athletes and/or the need for additional consultation or testing. New baseline testing should be considered after six months for student-athletes with a documented concussion, especially those with complicated or multiple concussion history. Recognition and Diagnosis of Concussion Recognition Student-athletes exhibiting signs, symptoms, or behaviors consistent with a concussion will be removed from practice or competition and evaluated by a LUSM Athletic Trainer, Team Physician, or designee. Initial Evaluation Student-athletes will be evaluated by a LUSM Athletic Trainer, Team Physician, or designee (in consultation with a LUSM Athletic Trainer) for an initial diagnosis. o Clinical Assessment for Cervical Spine, Skull Fracture, and Intercranial Bleed o Graded Symptom Checklist (GSC) o Cranial Nerve Assessment (CNA) o Standardized Assessment of Concussion (SAC) o Balance Error Scoring System (BESS) Student-athletes initially diagnosed with a possible concussion during a practice or event will not return to activity for the remainder of the day. Post Concussion Management Emergency Post Concussion Management Student-athletes exhibiting any of the following signs/symptoms will be transported to the emergency room per the LUSM, host institution, or event venue Emergency Action Plan: o Glasgow Coma Scale >13 o Focal Neurological Deficit o Repetitive Emesis

6 o Persistently Diminishing Mental Status or Other Neurological Signs/Symptoms o Loss of Consciousness (Spineboard Protocol) o Spine Injury (Spineboard Protocol) The LUSM Team Physician will be notified about the student-athletes concussions immediately following the concussion. Non-Emergency Post Concussion Management Student-athletes initially diagnosed with a possible concussion during a practice or event and another responsible adult (i.e. parent or roommate) will be provided a copy of the LUSM Concussion Instructions form by the LUSM Athletic Trainer performing the initial evaluation. The LUSM Team Physician will be notified about the student-athletes concussions within hours following the concussion. Re-Evaluation and Monitoring Student-athletes will be re-evaluated within hours by a LUSM Athletic Trainer, Team Physician, or designee (in consultation with a LUSM Athletic Trainer) for a working diagnosis. o Graded Symptom Checklist (GSC) o Standardized Assessment of Concussion (SAC) o Balance Error Scoring System (BESS) o King-Devick (KD) GSC is recorded daily until student-athletes are cleared for full participation. SAC, BESS, and KD tests are performed according to the following schedule: o 3 days post-injury o 7 days post-injury o Every 7 days post-injury until asymptomatic Referral and Diagnostic Testing Student-athletes will be referred to the LUSM Team Physician based on the following criteria: o Loss of Consciousness o Amnesia o Post-concussive symptoms worsen or do not improve o Increase in the number of symptoms reported o Post-concussive symptoms begin to interfere with the student-athlete s daily activities The LUSM Team Physician will determine if further diagnostic testing (i.e. CT Scan, MRI) and/or follow-up with a neurologist is warranted. Prolonged Recovery Student-athletes with symptoms lasting greater than 14 days will be evaluated by a LUSM Team Physician in order to consider additional diagnosis and best management options. Additional diagnoses include, but are not limited to: o Post-concussion syndrome o Sleep dysfunction o Migraine or other headache disorders o Mood disorders such as anxiety and depression o Ocular or vestibular dysfunction Non-Sport Related Concussions Student-athletes will be evaluated and referred by a LUSM Athletic Trainer. The LUSM Concussion Instructions form will be completed and reviewed with student-athletes.

7 The LUSM Team Physician will be notified about student-athlete concussions within hours. o All student-athletes diagnosed with a non-sport related concussion will be instructed to schedule an office visit with the LUSM Team Physician for clinical evaluation. o The LUSM Team Physician will determine if further diagnostic testing (i.e. CT Scan, MRI) and/or follow-up with a neurologist is warranted. Once the LUSM Team Physician has cleared the student-athlete, they will follow-up with a LUSM Athletic Trainer for re-evaluation prior to beginning the Athletic Management procedures.

8 ACADEMIC MANAGEMENT Cognitive Rest Cognitive rest is an often-neglected component of concussion recovery. Students recovering from a concussion are faced with predictable challenges in the academic realm. Mental/physical fatigue and sleep disruption may leave students without the mental capacity to participate in a full day of classes and subsequent efforts necessary for assignments or scheduled exams. The therapeutic goal during recovery involves eliminating athletic activity, limiting physical activity, and increasing cognitive rest by reducing demands pertaining to learning, concentration, and memory as these are directly affected by a concussion. The therapeutic goal requires a synchronization of academic support initiated by a LUSM Athletic Trainer to the Dean of Students office resulting in communication with professors and possibly the Office of Disabilities. Academic Support Our goal is to assist recovering students in fulfilling academic requirements being cautious not to overload cognitive functions resulting in a worsening of symptoms. Developing a plan between the Dean of Students office and medical staff prioritizes academic efforts through utilization of appropriate, temporary, and necessary accommodations. These modifications will promote cognitive rest, and ensure student-athletes continued educational success as symptoms resolve. Post Concussive Management Initial Recovery Sport-Related Concussions o The LUSM Athletic Trainer will a letter to the Dean of Students for student-athletes with symptoms lasting greater than 72 hours. o The Lehigh Team Physician(s), the Director of Student-Athlete Academic Services, and the Office of Disabilities will be copied on any to the Dean of Students office regarding a student-athlete s concussion. o Student-athletes will be instructed to schedule an appointment with the Dean of Students office to discuss their academic management as it relates to their concussion. Non-Sport Related Concussions o Student-athletes will be instructed to schedule an appointment with the Dean of Students office to discuss their academic management as it relates to their concussion. Prolonged Recovery Sport-Related Concussions o The LUSM Athletic Trainer will a follow-up letter to the Dean of Students for student-athletes with symptoms lasting greater than 14 days. o The Lehigh Team Physician(s), the Director of Student-Athlete Academic Services, and the Office of Disabilities will be copied on any to the Dean of Students office regarding a student-athlete s concussion. o Student-athletes will be instructed to schedule a follow-up appointment with the Dean of Students office to discuss their academic management as it relates to their prolonged recovery. Non-Sport Related Concussions o Student-athletes will be instructed to schedule a follow-up appointment with the Dean of Students office to discuss their academic management as it relates to their prolonged recovery.

9 ATHLETIC MANAGEMENT Return to Participation Criteria Return to participation is an objective decision. No single test (GSC, SAC, BESS, KD) will be utilized solely to determine recovery or return to participation. After the student-athlete is symptom free and SAC, BESS, and KD test scores have returned to baseline, the Graduated Exertional Return to Participation Protocol will begin based on the severity of concussion. o o o Mild Concussion No Amnesia or Loss of Consciousness - When the student-athlete is completely symptom free, they will be re-assessed for the SAC and BESS test scores. Once the student-athlete s SAC, BESS, and KD test scores have returned to baseline and they remain completely symptom free for an additional 24 hours, the Graduated Exertional Return to Participation Protocol will begin. Moderate Concussion Amnesia With No Loss of Consciousness - When the student-athlete is completely symptom free, they will be re-assessed for the SAC and BESS test scores. Once the studentathlete s SAC, BESS, and KD test scores have returned to baseline and they remain completely symptom free for an additional 7 days, the Graduated Exertional Return to Participation Protocol will begin. Severe Concussion Loss of Consciousness With or Without Amnesia - When the student-athlete is completely symptom free, they will be re-assessed for the SAC and BESS test scores. Once the studentathlete s SAC, BESS, and KD test scores have returned to baseline and they remain completely symptom free for an additional 2 to 4 weeks, the Graduated Exertional Return to Participation Protocol will begin. Graduated Exertional Return to Play Protocol Exertion Step 1 - Exertional Bike Test (20 Minutes, Manual Program, Level 5, MPH) If there are no return of symptoms during the Exertional Bike Test, there is no change in the SAC, BESS, KD scores following the Exertional Bike Test, and they remain completely symptom free for an additional 24 hours following the Exertional Bike Test, the student-athlete is cleared to progress to Exertion Step 2. If there is a return of symptoms during the Exertional Bike Test, there is a change in the SAC, BESS, KD scores following the Exertional Bike Test, or they do not remain completely symptom free for an additional 24 hours following the Exertional Bike Test, continue to re-evaluate daily. Repeat all procedures from the beginning of Return to Participation Criteria. Exertion Step 2 - Cardiovascular Activities (Functional Agilities Protocol Workout or Interval Bike Workout and Body Weight Circuit) If there are no return of symptoms during the Cardiovascular Activities, and they remain completely symptom free for an additional 24 hours following the Cardiovascular Activities, the student-athlete is cleared to progress to Exertion Step 3. If there is a return of symptoms during the Cardiovascular Activities, or they do not remain completely symptom free for an additional 24 hours following the Cardiovascular Activities, continue to re-evaluate daily. Repeat all procedures from the beginning of Return to Participation Criteria. Exertion Step 3 - Non Contact Practice (Non-Contact Skill Drills, No Live Activity) If there are no return of symptoms during the Non Contact Practice, and they remain completely symptom free for an additional 24 hours following the Non-Contact Practice, the student-athlete is cleared to progress to Exertion Step 4.

10 If there is a return of symptoms during the Non Contact Practice, or they do not remain completely symptom free for an additional 24 hours following the Non Contact Practice, continue to re-evaluate daily. Repeat all procedures from the beginning of Return to Participation Criteria. Exertion Step 4 - Return to Controlled Full Contact in a Practice (Controlled Situation Live Activity, Limited Repetition Live Activity) If there are no return of symptoms during the Controlled Full Contact Practice, and they remain completely symptom free for an additional 24 hours following the Controlled Full Contact Practice, the student-athlete is cleared to progress to Exertion Step 5. If there is a return of symptoms during the Controlled Full Contact Practice, or they do not remain completely symptom free for an additional 24 hours following the Controlled Full Contact Practice, continue to re-evaluate daily. Repeat all procedures from the beginning of Return to Participation Criteria. Exertion Step 5 - Return to Unrestricted Full Contact in a Practice (Live Activity, Full Repetition Live Activity) If there are no return of symptoms during the Unrestricted Full Contact Practice, and they remain completely symptom free for an additional 24 hours following the Unrestricted Contact Practice, the student-athlete is cleared to progress to Exertion Step 6. If there is a return of symptoms during the Unrestricted Full Contact Practice, or they do not remain completely symptom free for an additional 24 hours following the Unrestricted Full Contact Practice, continue to re-evaluate daily. Repeat all procedures from the beginning of Return to Participation Criteria. Exertion Step 6 - Return to Participation in a Game/Event Final Clearance for Athletic Participation Final return to play decisions will be made solely by a LUSM Athletic Trainer, Team Physician, or designee based upon the LUSM Concussion Management Plan. Disqualification from Athletic Participation Termination of participation in intercollegiate athletics at Lehigh University will be determined by the LUSM Team Physician based upon frequency and severity of concussions over time leading to cumulative effects. Medical disqualification will be reviewed on a case by case basis. 7/2003 * Revised 7/2015

11 CONCUSSION FACT SHEET CONCUSSION FACTS Concussions are a brain injury that alters the way your brain functions. CONCUSSION SYMPTOMS Different symptoms can occur and may not show up for several hours. Common symptoms include: Concussions can occur from a blow to the head/body including helmet to helmet contact and/or contact with the ground, object, or another player. Most concussions occur without being knocked unconscious. Severity of injury depends on many factors and is not known until symptoms resolve and brain function is normal. - Confusion - Headache - Amnesia/difficulty remembering - Balance problems - Irritability - Dizziness - Difficulty concentrating - Nausea - Feeling sluggish, foggy or groggy - Sensitivity to noise - Sensitivity to light - Double/fuzzy vision - Slowed reaction time - Feeling more emotional - Sleep disturbance - Loss of consciousness All concussions are not created equally. Each player is different and each injury is different. All student- athletes exhibiting signs/symptoms of concussion should be evaluated by a LUSM Athletic Trainer. Symptoms may worsen with physical or mental exertion (i.e. cardiovascular exercise, weight lifting, use of electronic devices, reading, etc.) Why Should I Report My Symptoms? Practicing or playing while still experiencing symptoms can prolong the time to recover and return to play. Unlike other injuries, there may be significant consequences of playing through a concussion. Repetitive brain injury, when not treated promptly and properly may cause permanent damage to your brain. What Should I Do If I Think I Have A Concussion? REPORT IT: Never ignore symptoms even if they appear mild. Look out for your teammates. Tell your Athletic Trainer or coach it if you think you or a teammate may have had a concussion. GET CHECKED OUT: Your team medical staff has your health and well being as its first priority. They will manage your concussions according to Lehigh University Concussion Management Plan which include being fully asymptomatic, both at rest and after exercise, normal Graded Symptom Checklist, having a normal neurological examination, and clearance to play by both the team medical staff and team neurologist. TAKE CARE OF YOUR BRAIN: According to the CDC, traumatic brain injury can cause a wide range of short or long term changes affecting thinking, sensation, language, or emotions. These changes may lead to problems with memory and communication, personality changes, as well as depression and the early onset of dementia. Concussions and conditions resulting from repeated brain injury can change your life and your family s life forever. 7/2010 * Revised 7/2015

12 Lehigh University Sports Medicine Concussion Management Plan Student-Athlete Statement of Acknowledgement I acknowledge that I have a responsibility to report all injuries and illnesses to the Lehigh University Sports Medicine (LUSM) staff, including concussions. As a Lehigh student-athlete, I agree to the following statements by initialing on the line provided: I have read and understand the LUSM Concussion Management Plan, which is available online at lehighsports.com/sportsmed I have watched and understand the LUSM Concussion Awareness video, which is available online at youtube.com/lehighsportsmedicine I have read and understand the LUSM Concussion Fact Sheet, which is available online at lehighsports.com/sportsmed I understand there is an inherent risk of injury associated with participating in intercollegiate athletics. This includes the possibility of sustaining a concussion. If I observe a teammate with signs/symptoms of a concussion, I understand it is my responsibility to inform a LUSM Athletic Trainer, Team Physician, or coach if an Athletic Trainer is not present. If I am experiencing any signs/symptoms of a concussion, I understand it is my responsibility to report them immediately to a LUSM Athletic Trainer, Team Physician, or coach if an Athletic Trainer is not present. I understand I will be removed from participation and evaluated by a LUSM Athletic Trainer, Team Physician, or designee. If I am initially diagnosed with a possible concussion by a LUSM Athletic Trainer, Team Physician, or designee, I understand I will not return to activity for the remainder of the day. I will be re-evaluated within hours by a LUSM Athletic Trainer or designee (in consultation with a LUSM Athletic Trainer) for a working diagnosis. If I am diagnosed with a concussion by a LUSM Athletic Trainer, Team Physician, or designee, I understand I will not return to activity until I have successfully completed all Return to Participation steps as specified in the LUSM Concussion Management Plan. I understand a concussion is not a visible injury, and I might notice some of the symptoms right away. Other symptoms may not present for hours or days following the injury. No two concussions are alike. I understand the brain needs time to heal following a concussion. I recognize that I am much more likely to have a repeat concussion if I return to play before symptoms resolved. In rare cases, repeat concussions can cause permanent brain damage, and even death. I understand a concussion can affect my everyday activities, reaction time, balance, sleep, and academic performance. I understand that only a LUSM Athletic Trainer, Team Physician, or designee can give final clearance for me to return to participation following a concussion. Student-Athlete Signature Printed Name of Student-Athlete Parent/Guardian Signature (Only for Student-Athletes Under 18 years) 7/2015 Date Sport(s) Date

13 Lehigh University Sports Medicine Concussion Management Plan Head Coach Statement of Acknowledgement I acknowledge that I have a responsibility to report all injuries and illnesses to a Lehigh University Sports Medicine (LUSM) Athletic Trainer, including concussions. As a head coach at Lehigh University, I agree to the following statements by initialing on the line provided: I have read and understand the LUSM Concussion Management Plan, which is available online at lehighsports.com/sportsmed I have watched and understand the LUSM Concussion Awareness and Management video, which is available online at youtube.com/lehighsportsmedicine I have read and understand the LUSM Concussion Fact Sheet, which is available online at lehighsports.com/sportsmed. I understand there is an inherent risk of injury associated with participating in intercollegiate athletics. This includes the possibility of sustaining a concussion. I will instruct my student-athletes to report any signs/symptoms of a concussion to me, a LUSM Athletic Trainer, or designee. If a student-athlete reports any signs/symptoms, a teammate reports a student-athlete with signs/symptoms, or if anyone on my coaching staff observe a student-athlete with signs/symptoms of a concussion, I understand it is my responsibility to immediately inform a LUSM Athletic Trainer, Team Physician, or designee. I understand the student-athlete will be removed from participation and evaluated by a LUSM Athletic Trainer, Team Physician, or designee. If a student-athlete reports any signs/symptoms, a teammate reports a student-athlete with signs/symptoms, or if anyone on my coaching staff observe a student-athlete with signs/symptoms of a concussion, I will not knowingly allow that student-athlete to return to play in a practice/game. I understand that a student-athlete initially diagnosed with a possible concussion by a LUSM Athletic Trainer, Team Physician, or designee will not return to activity for the remainder of the day. The studentathlete will be re-evaluated within hours by a LUSM Athletic Trainer or designee (in consultation with a LUSM Athletic Trainer) for a working diagnosis. I understand that a student-athlete diagnosed with a concussion by a LUSM Athletic Trainer, Team Physician, or designee will not return to activity until they successfully completed all Return to Participation steps as specified in the LUSM Concussion Management Plan. I understand a concussion is not a visible injury, and the student-athlete might notice some of the symptoms right away. Other symptoms may not present for hours or days following the injury. I understand the brain needs time to heal following a concussion. I recognize student-athletes are much more likely to have a repeat concussion if they return to play before symptoms are resolved. In rare cases, repeat concussions can cause permanent brain damage, and even death. I am aware that only a LUSM Athletic Trainer, Team Physician, or designee can give final clearance for a student-athlete to return to participation following a concussion. _ Head Coach Signature _ Printed Name of Head Coach Date Sport 7/2015

14 Lehigh University Sports Medicine Concussion Management Plan Athletic Trainer Statement of Acknowledgement I acknowledge that I will adhere to the Lehigh University Sports Medicine (LUSM) Concussion Management Plan when treating and managing concussions sustained by Lehigh student-athletes. As a Lehigh University Athletic Trainer, I agree to the following statements by initialing on the line provided: I have completed the annual LUSM Concussion Management training. This session included a review of the LUSM Management Plan, the LUSM Concussion Awareness and Management video, the LUSM Concussion Management video, and the LUSM Concussion Fact Sheet. I will not knowingly allow a student-athlete to return to play in a game or practice if he/she has received a blow to the head or body that results in concussion-related symptoms. If I suspect a student-athlete has a concussion, it is my responsibility to have that student-athlete removed from participation and to evaluate him/her for a possible concussion. Following a concussion, the brain needs time to heal. Concussed athletes are much more likely to have a repeat concussion if they return to play before symptoms are resolved. In rare cases, repeat concussions can cause permanent brain damage, and even death. I am aware that student-athletes diagnosed with a concussion will be assessed by the medical staff and referred to a Lehigh University Team Physician as needed per the LUSM Concussion Management Plan. Once symptoms have resolved, the student-athlete will begin a graduated return to play guideline per the LUSM Concussion Management Plan. I am aware that only a Lehigh University Team Physician, Athletic Trainer, or designee can clear a studentathlete to return to activity following a concussion. Signature of Athletic Trainer _ Date Printed Name of Athletic Trainer 7/2015

15 Lehigh University Sports Medicine Concussion Management Plan Team Physician Statement of Acknowledgement I acknowledge that I will adhere to the Lehigh University Sports Medicine (LUSM) Concussion Management Plan when treating and managing concussions experienced by Lehigh student-athletes. As a Lehigh University Team Physician, I agree to the following statements by initialing on the line provided: I have read and am aware of the LUSM Concussion Management Plan, which is available online at lehighsports.com/sportsmed. I will not provide medical clearance to a student-athlete diagnosed with a concussion prior to successfully completing all criteria for return to activity per the LUSM Concussion Management Plan. Following a concussion, the brain needs time to heal. Concussed athletes are much more likely to have a repeat concussion if they return to play before symptoms are resolved. In rare cases, repeat concussions can cause permanent brain damage, and even death. I am aware that student-athletes diagnosed with a concussion will be assessed by the medical staff and referred to a Lehigh University Team Physician as needed per the LUSM Concussion Management Plan. Once symptoms have resolved, the student-athlete will begin a graduated return to play guideline per the LUSM Concussion Management Plan. I am aware that only a Lehigh University Team Physician, Athletic Trainer, or designee can clear a studentathlete to return to activity following a concussion. Signature of Team Physician _ Date Printed Name of Team Physician 7/2015

16 Lehigh University Sports Medicine Concussion Management Plan Dean of Athletics Statement of Acknowledgement I acknowledge that Lehigh University Athletic Trainers, Team Physicians, coaches, and student-athletes will abide by the Lehigh University Sports Medicine (LUSM) Concussion Management Plan. As the Dean of Athletics at Lehigh University, I agree to the following statements by initialing on the line provided: I have read and am aware of the LUSM Concussion Management Plan, which is available online at lehighsports.com/sportsmed. I have watched the LUSM Concussion Awareness video, which is available online at youtube.com/lehighsportsmedicine. I have read and understand the LUSM Concussion Fact Sheet, which is available online at lehighsports.com/sportsmed. If a student-athlete informs me he/she may be experiencing concussion-like symptoms following a blow to the head, I will instruct he/she to inform a LUSM Athletic Trainer if they have not done so already. Following a concussion, the brain needs time to heal. Concussed athletes are much more likely to have a repeat concussion if they return to play before symptoms are resolved. In rare cases, repeat concussions can cause permanent brain damage, and even death. I am aware that student-athletes diagnosed with a concussion will be assessed by the medical staff and referred to a Lehigh University Team Physician as needed per the LUSM Concussion Management Plan. Once symptoms have resolved, the student-athlete will begin a graduated return to play guideline per the LUSM Concussion Management Plan. I am aware that only a Lehigh University Team Physician, Athletic Trainer, or designee can clear a studentathlete to return to activity following a concussion. Signature of Dean of Athletics _ Date Printed Name of Dean of Athletics 7/2015

17 CONCUSSION INSTRUCTIONS Name _ Date Following a head injury, symptoms may show up immediately, or in some cases, several hours after the injury. The following were signs and symptoms observed during the evaluation: HEADACHE VOMITING FATIGUE SADNESS NUMBNESS/TINGLING FEELING IN A FOG DIFFICULTY REMEMBERING DELAYED VERBAL / MOTOR SKILLS SLOWING OF PULSE BLURRED VISION OTHER: NAUSEA BALANCE PROBLEMS / DIZZINESS SENSITIVITY TO LIGHT / NOISE NERVOUSNESS FEELING SLOWED DOWN DIFFICULTY CONCENTRATING CONFUSION / DISORIENTATION SLURRED / INCOHERENT SPEECH CONVULSIONS / TREMORS CLEAR FLUID DRAINAGE FROM EARS / NOSE Please remember to report to Taylor Gym Sports Medicine tomorrow at for a follow-up evaluation. Please review the symptoms marked on the above checklist. If any of these symptoms worsen prior to your visit, or if any of the following symptoms appear, contact an athletic trainer and report to the emergency room immediately. BLOOD/FLUID FROM THE EARS OR NOSE VOMITING MORE THAN ONCE OR TWICE BREATHING DIFFICULTY CONTINUED DOUBLE VISION WEAKNESS IN EITHER ARM OR LEG UNCONTROLLABLE EYE MOVEMENTS Otherwise, you can follow the instructions outlined below. It is OK to: There is NO need to: Do NOT: *Use Acetaminophen (Tylenol) *Check eyes with flashlight *Use Aspirin or Ibuprofen for headaches *Wake up every hour (Mild Only) (Advil / Motrin) for headaches *Use ice pack on head and neck *Test reflexes *Drink alcohol as needed for comfort *Stay in bed *Drink caffeinated beverages *Eat a light diet *Eat spicy foods *Return to school *Play video games *Go to sleep *Watch television *Rest (No strenuous activity or sports) *Listen to music Emergency Telephone Numbers: Jack Foley: (610) Tim Doane: (610) Emily Dunn: (610) Rachel Kennedy: (484) Greg Scullin: (610) Patrick Yoder: (610) Catharine Rudio: (484)

18 BEST PRACTICE GUIDELINES FOR COGNITIVE MANAGEMENT Recommendations for the Students Recovering from a Concussion RECOMMENDATIONS Excused absence from class Rest period during the day Reduction of light or noise sensitivity Monitor computer use, TV use, video games, music Reduced course load/credits Preferential classroom seating Temporary assistance of a tutor or academic coach Extension of assignment deadlines Information processing speed and ability to handle full workload may be impeded Excuse from team sport practice or athletic activities RATIONALE Complete rest, progressing to limited attendance, may be needed When symptoms flare, brief rest may allow student to return to class Fluorescent light and high- stimulation environments may cause symptoms Avoidance of cognitive stresses Full course load may worsen symptoms Lessens distractions Assists in organizing and prioritizing assignments Postponement or staggering of exams in accordance with the professor s make up privileges Mental efforts to prepare and then take tests may worsen symptoms No physical activity progresses to limited physical activity Cognitive Management = Academic Management 7/2010 * Revised 4/2015

19 Lehigh University Athletics Football Head Protection and Helmet Policy Lehigh University Football Head Protection Lehigh University utilizes the Riddell Speed, considered to be an elite helmet provider used by the NFL and many NCAA institutions. Our helmet selection is based upon the following criteria: Provides the greatest safety. Provides the best fit. Fast and easy accessibility to replacement parts through an authorized manufacturing plant. Proven on-the-field success. New models require one to two years to produce these results. We continue to evaluate helmet brands and models annually as the marketplace makes advances with respect to player safety. Similar to a performance sports car, a highly rated helmet will not work properly without routine maintenance. Therefore, our football helmets are professionally fit prior to the fall preseason and spring practices. Mandatory helmet checks are conducted on a monthly basis throughout the competitive season. Student-athletes are ultimately responsible for daily inspection and maintenance of their equipment to ensure proper fit and function. Any helmet-related issue should be brought to the attention of the Equipment staff immediately. Lehigh University Football Helmet Policy Helmets purchased by any person or entity other than Lehigh University will not be permitted for use by football studentathletes. This is to ensure quality control of our equipment which includes, but is not limited to, high standard of safety, replacement of defective helmets, daily maintenance of helmets, annual reconditioning/recertification of helmets, and purchase of replacement parts for helmets. If a student-athlete or family has a justifiable reason for using a different helmet, Lehigh University will review the circumstances. Approval of alternative helmet brands/models and purchasing decisions will be the prerogative of the University. In the event a student-athlete utilizes a football helmet that has not been authorized, the University bears no responsibility for subsequent injuries. 7/2013 * Revised 7/2015