Department f Athletics Sprts Medicine Texas Tech University Cncussin Management Plan 2015-2016 The fllwing plicy and prcedures n educatin, baseline testing, and subsequent assessment and management f cncussins, as well as return t learn and return t play guidelines, has been develped in accrdance with the Big 12 and NCAA t prvide quality healthcare services and assure the well-being f each student-athlete at Texas Tech. PURPOSE: Texas Tech University Athletics recgnizes sprt induced Mild Traumatic Brain Injuries (mtbi s) and/r cncussins pse a significant health risk fr thse student-athletes participating in athletics. With this in mind, Texas Tech University, alng with the Big 12 and the NCAA has implemented plicies and prcedures t assess, identify, and manage thse student-athletes wh have suffered a cncussin. It is als recgnized baseline neurpsychlgical and pstural stability testing can prvide imprtant cmparisn data when perfrming subsequent serial cmputerized neurpsychlgical testing as an ancillary assessment in making return t cmpetitin decisins fr student athletes participating at Texas Tech University. This baseline data alng with physical examinatin, and/r further diagnstic testing will be used in cnjunctin when determining timing fr a student athlete t return t the classrm and t cmpetitin. CONCUSSION DEFINITION: There are mre than 42 cnsensus-based definitins f cncussin. A recently published, evidence-based definitin f cncussin fllws. Cncussin is: a change in brain functin, fllwing a frce t the head, which may be accmpanied by temprary lss f cnsciusness, but is identified in awake individuals, with measures f neurlgic and cgnitive dysfunctin. REDUCING HEAD TRAUMA EXPOSURE MANAGEMENT PLAN Texas Tech recgnizes and fllws the Inter-Assciatin Cnsensus fr Independent Medical Care Guidelines as well as the Year-Rund Ftball Practice Cntact Guidelines. These guidelines will be reviewed annually with the ftball caching staff. Educatin will als be prvided n reducing gratuitus cntact during practice, taking the head ut f cntact and taking a safety first apprach t sprt. Annually, by signature acknwledgement f Texas Tech University Statement f Expectatins, all caches agree t prmte health and safety educatin, a safe and cnstructive envirnment fr practice/play, and that the sprts medicine staff in cnjunctin with the medical directr and team physicians have the unchallengeable authrity t make all medical decisins in regard t a student-athletes medical care and return t play decisins. PRE-SEASON EDUCATION: All student-athletes, caches, medical staff, and athletic directrs will have annual educatin and/r training apprpriate fr their psitin. Once cmpleted, all parties will sign an acknwledgement f understanding f cncussin facts and the cncussin management plan. This training will address signs and symptms f cncussin t increase recgnitin and will educate participants n methds fr reprting cncern fr cncussin t health care prviders.
PRE-PARTICIPATION ASSESSMENT Student-athletes will have a thrugh, dcumented, review f their cncussin and brain injury histry when they first arrive n campus as part f their pre-participatin physical exam. Student-athletes will sign a statement in which they accept the respnsibility fr reprting their injuries and illnesses t the institutinal medical staff, including signs and symptms f cncussins. Baseline metrics including symptm evaluatin, cgnitive assessment, and balance evaluatin will als be perfrmed. This prcess must be cmpleted befre participatin in any rganized athletic activity at Texas Tech University. The team physician will determine final clearance and/r the need fr additinal cnsultatin r testing. BASELINE TESTING AND POST-CONCUSSION TESTING: SCAT3 / Mdified BESS: Sprt Cncussin Assessment Tl and Mdified Balance Errr Scring System All incming freshman and transfer student-athletes will have a baseline SCAT3 and Mdified BESS test as part f their incming pre-participatin physical. SCAT3 and Mdified BESS Testing results will be interpreted by the team physician in the management f the cncussin and in cnjunctin with neurpsychlgical testing, and/r any further diagnstic testing t determine when it is safe fr a student athlete t return t physical activity. Neurpsychlgical Testing: All incming freshman and transfer student-athletes will have a baseline neurpsychlgical test as part f their incming preparticipatin physical. Baseline testing may be repeated peridically as needed r after a student athlete has recvered frm a cncussin. Currently, Texas Tech utilizes the ImPACT cncussin management system. SIGNS AND SYMPTOMS OF CONCUSSION: Certified athletic trainers and athletic training students all need t be aware f the signs and symptms f cncussin t prperly recgnize and intervene n behalf f the student-athlete. These include, but are nt limited t: Physical Symptms Cgnitive Symptms Emtinal Symptms Sleep Symptms Headache Visin Difficulty Nausea/vmiting Dizziness Balance Difficulties Light sensitivity Sensitivity t nise Fatigue Lss f Cnsciusness Memry Lss Attentin Disrder Reasning difficulty Fgginess Irritability Sadness Feeling mre emtinal Nervusness Persnality Change Drwsiness Sleeping mre than usual Sleeping less than usual Truble falling asleep RECOGNITION AND DIAGNOSIS OF CONCUSSION: The recmmendatins in this prtcl fr the management f cncussins are based n review f the current medical Literature (see references) and the Big 12 and NCAA plicies fr cncussin management and are in full cperatin with Texas Tech University Athletics medical directr, team physicians, and athletic training staff. In any circumstance where a cncussin is suspected in a student-athlete, the first pririty after an initial assessment fr cervical spine r assciated head trauma, is t remve the student-athlete frm further participatin until a thrugh sideline assessment can be made. Initially, a SCAT-3 sideline evaluatin shuld take place invlving a certified athletic trainer and, if pssible, a team physician. A sideline pstural stability exam will be perfrmed, using the mdified BESS Test. Furthermre, if there is a questin abut the state f mental clearing it is best t err in the directin f cnservative management and withhld the athlete frm further participatin until a physician assessment can be arranged.
POST-CONCUSSION MANAGEMENT: Cnsideratin fr initiatin f an emergency actin plan and transprtatin fr further medical care shuld be cnsidered fr any student-athlete wh has a Glasgw Cma Scale (GCS) f less than 13, prlnged lss f cnsciusness, fcal neurlgical deficit suggesting intracranial trauma, repetitive vmiting, persistently diminished/wrsening mental status r ther neurlgical signs and symptms, r suspected spine injury. Emergency Actin Plans fr each venue are psted in visible areas at every lcatin. Crdinatin with the EMS is discussed and reviewed annually in crdinatin with the event management staff. EMS respnse times fr any venue n campus are within 5 minutes fr any emergencies that arise during a practice. Any student-athlete identified as having a cncussin, either by a team physician r a certified athletic trainer, shall be remved frm play fr the remainder f the day s participatin. It is necessary t schedule further evaluatin with a team physician and apprpriate fllw-up neurpsychlgical testing as sn as pssible upn return t campus fr the studentathlete wh sustains a cncussin while cmpeting in away events. When travelling, the athletic trainer may request evaluatin by the hst team s team physician befre travel hme. Initially, the student-athlete shuld nt be left alne. The student-athlete will receive serial mnitring f his/her mental/cgnitive status t detect signs f deteriratin. The student-athlete (and a cmpanin r guardian wh will be with them cnsistently) will be prvided with a clsed head injury symptm handut (see appendix) with written discharge instructins and prtcl fr emergency actin in case f symptm deteriratin. A symptm inventry shall be perfrmed n a regular basis until an athlete has been deemed t be asymptmatic frm his/her cncussin. Accmmdatins will be made t prmte physical and cgnitive rest fr student-athletes after a cncussin. Student-athletes wh have a prlnged recvery will be evaluated by the team physician fr additinal diagnses and apprpriate referral and management ptins. The Sprts Medicine Staff in cnjunctin with the Medical Directr will keep an updated list f utside cnsultants t be used when deemed apprpriate. Additinal diagnses may include pst-cncussin syndrme, sleep dysfunctin, migraine r ther headaches disrders, and cular r vestibular dysfunctin. Final return t play decisins will still be made by the team physician r his/her designee. RETURN TO LEARN GUIDELINES: Any student-athlete wh has been diagnsed with a cncussin r has cncussin-like symptms will be required t fllw a return t learn prtcl. Unnecessary cgnitive stressrs shuld be limited including watching TV, vide games, texting, and cmputer wrk. The Sprts Medicine staff and/r team Athletic Trainer will ntify the Directr f the Learning Assistance Prgram/Learning Specialist f a student-athlete's cncussin diagnsis r cncussin symptms. The learning specialist will crdinate the return t learn with the student-athlete. The return t learn prtcl includes the fllwing: Temprary Accmmdatins (up t tw weeks) 1. The Learning Specialist requests dcumentatin frm Sprts Medicine that includes: injury, date f injury, methd f treatment, estimated time fr treatment, estimated time frame fr recvery and recmmended medical accmmdatins (e.g., Staying at hme, medical absence, gradual return t the classrm). Student-athletes shuld nt attend class n the same day as his/her cncussin. ***Nte: Only a prfessr has the authrity t excuse a student frm class 2. The Learning Specialist prvides the dcumentatin frm Sprts Medicine t the Athletic Academic Advisr. 3. The Athletic Academic Advisr prvides guidance t the Student-Athlete in cntacting Prfessrs/Instructrs regarding the student s injury, recmmended classrm absences, and any arrangements fr making up missed assignments. 4. If symptms wrsen with prgressin f academic challenges, the student-athlete will be re-evaluated by the team physician. 5. The Sprts Medicine staff will ntify the Directr f the Learning Assistance Prgram/Learning Specialist when the student-athlete has been cleared medically. Lng Term Accmmdatins If the student-athlete will nt be cleared medically after tw weeks, the Sprts Medicine Staff will ntify the Directr f the Learning Assistance Prgram/Learning Specialist that lng-term supprt is needed. A multi-disciplinary apprach will be cnsidered and the fllwing will als be prvided t the student-athlete:
a. Student-athlete will meet with the Learning Specialist t cmplete an applicatin fr Student Disability Services (SDS) i. A student must register with Student Disability Services and file apprpriate dcumentatin t be eligible fr academic accmmdatins. (Texas Tech Operating Plicy 34.22: Establishing Reasnable Accmmdatin fr Students with Disabilities) b. The Learning Specialist emails, scans, r faxes the student-athlete s applicatin and the medical dcumentatin t SDS. i. The Learning Specialist in cnjunctin with SDS will ensure cmpliance with Americans with Disabilities Act Amendments Act, ADAAA. c. The Learning Specialist schedules the private student-athlete intake meeting with Student Disability Services Assciate Directr i. Student Disability Services Intake Meeting - In additin t receiving the letter f accmmdatin, the assciate directr explains the students rights and respnsibilities, academic expectatins, and general guidelines abut utilizing temprary academic accmmdatins. ii. The Letter f Accmmdatin is saved in student-athlete s file in the Marsha Sharp Center (MSC). The university-apprved mechanism fr establishing reasnable accmmdatin is written ntificatin in the frm f a Letter f Accmmdatin frm Student Disability Services. The Letter f Accmmdatin indicates t faculty that the student has given prf f her/his disability and that the accmmdatin nted is cnsidered apprpriate and reasnable. N further prf f disability shuld be required f the student. Students presenting ther kinds f verificatin shuld be referred t Student Disability Services fr the apprpriate identificatin. N requirement exists that accmmdatin be made prir t cmpletin f the apprved university prcess. (Texas Tech Operating Plicy 34.22: Establishing Reasnable Accmmdatin fr Students with Disabilities) RETURN TO PLAY GUIDELINES: Any student-athlete wh has been diagnsed with a cncussin is required t fllw a return t play prtcl after receiving clearance frm the team physician. The team physician will decide if utside cnsultatin is necessary and will make the apprpriate referrals at that time. The team physician will utilize all available infrmatin (symptm evaluatin, cgnitive and physical evaluatin, balance assessment, neurcgnitive testing, and/r ther diagnstic testing) t determine clearance. The return t play prtcl will include the fllwing: Upn cgnitive and/r physical exertin, a student-athlete must remain asymptmatic and with n new symptms assciated with his/her cncussin. They will be supervised and prgressed as fllws: Light aerbic exertin (e.g. walking, swimming, exercise bike) Sprt specific activity Nn-cntact training drills Cntact drills/practice Return t game activity (per clearance by team physician r team physician s designee) If a student-athlete has a return f symptms r develps new symptms during any part f the prgressin, the student-athlete will drp back t the last asymptmatic level fr 24hrs and begin again. The student-athlete must be re-integrated academically befre final return t play clearance is granted. Clinical evaluatin f pst-cncussive symptms, prir cncussin histry, neurlgical examinatin, and any utside diagnstic testing deemed necessary will be utilized by the team physician in establishing a timeline fr a student-athlete t return t activity. It is imprtant t nte this timeline culd last frm a perid f days t weeks r even mnths, and culd pssibly result in eventual medical disqualificatin frm Texas Tech University Athletics. All cases will be handled n a caseby-case basis. The decisin by the Team Physician fr all cases f an athlete s return t activity is final. Medical clearance t return t cmpetitin is based n current best practices, existing evidence based infrmatin and cnsensus statements, clinical examinatin, and cmpletin f all required testing. Medical clearance des nt guarantee against future adverse utcmes r eventual cmplicatins.
APPENDICES: NCAA/CDC Cncussin Fact Sheet fr Athletes NCAA/CDC Cncussin Fact Sheet fr Caches Texas Tech University Cncussin Educatin Acknwledgement SCAT3 Sideline Evaluatin Sheet Texas Tech University Pst Cncussin Take Hme Sheet Texas Tech University Symptm Inventry Sheet REFERENCES: 1. NCAA Sprts Medicine Handbk, 25 th Ed. Guideline 2I. Sprts-related Cncussin. Indianaplis, IN; August 2014. Pp 54-64. Available at: www.ncaapublicatins.cm/prductdwnlads/md15.pdf. 2. NCAA Independent Medical Care Guidelines. Accessed at http://www.ncaa.rg/health-and-safety/independentmedical-care-guidelines. 3. NCAA Ftball Practice Guidelines. Accessed at http://www.ncaa.rg/health-and-safety/ftball-practice-guidelines. 4. McCrry P, et al. Cnsensus statement n cncussin in sprt: the 4 th Internatinal Cnference n Cncussin in Sprt held in Zurich, Nvember 2012. Br J Sprts Med 2013;47:250-258. 5. McCrry P, et al. SCAT3. Br J Sprts Med 2013;47:259-262. 6. Guskiewicz KM. Assessment f pstural stability fllwing sprt-related cncussin. Curr Sprts Med Rep 2003;2: 24 30. 7. Riemann BL, Guskiewicz KM. Effects f mild head injury n pstural stability as measured thrugh clinical balance testing. J Athl Train 2000;35(1):19-25. 8. Guskiewicz K, Bruce S, Cantu R, et al. Pstural stability assessment fllwing cncussin: ne piece f the puzzle. J Athl Train 2004; 39(3): 280-297. 9. Harmn, KG, Drezner, JA, Gammns, M, et al. AMSSM psitin statement: cncussin in sprt. Br J Sprts Med 2013;47:15-26. 10. Kissick J, Jhnstne K. Return t play after cncussin.. Clin J Sprt Med Nv 2005;12(6):426-431. 11. Brgli SP et al. Natinal Athletic Trainers Assciatin psitin statement: management f sprt cncussin. J Athl Train 2014; 49:245-265. 12. Guskiewicz K, Putukian M. Standardized assessment and return t play. Safety in Cllege Ftball Summit. Presented January 23, 2014, Atlanta, GA. 13. NCAA Sprts Medicine Handbk, 25 th Ed. Guideline 2I. Sprts-related Cncussin. Indianaplis, IN; August 2014. Pp 54-64. Available at: www.ncaapublicatins.cm/prductdwnlads/md15.pdf. 14. Carney N, Ghajar J, Jagda A et al. Cncussin guidelines step 1: systematic review f prevalent indicatrs. Neursurgery, September 2014;75(3):S3-S15. 15. NCAA/CDC Cncussin Fact Sheets fr Athletes and Caches. Available at: http://www.ncaa.rg/health-andsafety/medical-cnditins/printable-resurces.