Athletic Training

A concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head that can change the way the brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even what seems to be mild bump or blow to the head can be serious (CDC, 2014). Although most concussions are mild and will resolve completely, all concussions are potentially serious and may result in complications including prolonged brain damage and death if not recognized and managed properly. Proper management of concussion can prevent further injury and help with recovery (CDC, 2014) Children and adolescents are among those at greatest risk of concussion. Most concussions do not result in loss of consciousness. Concussions aren’t visible in the same way that other injuries are visible. In fact, most concussions are not visible on CT scans or MRI. Signs and symptoms of concussion can occur right away, at time of impact, or hours or days later. It is important to know the signs and symptoms of concussion. If your child reports any symptoms of a concussion, or if you notice signs and symptoms of concussion, seek medical attention right away.

Symptoms may include, but are not limited to, one or more of the following:
* Headaches
* "Pressure in the head"
* Neck pain
* Balance problems or dizziness
* Blurred, double, or fuzzy vision
* Sensitivity to light or noise
* Feeling sluggish or slowed down
* Feeling foggy or groggy
* Drowsiness
* Changes in sleep patterns
* Nauseous
* Amnesia
* "Don’t feel right"
* Fatigue or low energy
* Sadness
* Nervous or anxious
* Irritability
* More emotional
* Confusion
* Concentration or memory problems
* Repeating the same question/comment

Signs observed by teammates, parents and coaches include:
* Appears dazed
* Vacant facial expression
* Confused about assignment
* Forgets plays
* Is unsure of game, score, or opponent
* Moves clumsily or displays lack of coordination
* Answers questions slowly
* Slurred speech
* Shows behavior or personality changes
* Can’t recall events prior to the hit
* Can’t recall events after the hit
* Seizures or convulsions
* Any change in typical behavior or personality
* Any changes in typical behavior or personality
* Loses consciousness
* Throwing up

Adapted from the CDC and the 3rd International Conference on Concussion in Sport

The ImPACT test provides computerized neurocognitive assessment tools used by physicians and athletic trainers to assist in determining a student’s baseline status (pre-season) and readiness to play after suffering a concussion. New student-athletes (first year or transfer) will be given a pre-season baseline screening through the ImPACT program. This test will be repeated prior to the athlete’s junior year. Pre-season baseline testing is used as a standard measure for comparison in the event a concussion should occur. Post-Concussion testing will be provided at the discretion of the athletic training staff and physician. Ideally post-concussion ImPACT testing will be completed when the athlete is symptoms free and used as one criterion for return to play. Post-concussion ImPACT testing will not be done more than once a week. If a baseline test does not exist, the post-concussion imPACT test will be used and compared with test normative values. ImPACT test results can be made available upon request to the Athletic Trainer.

Any athlete suspected of sustaining a concussion will be immediately removed from competition or practice for the remainder of that day's activities. The Certified Athletic Trainer will conduct an evaluation of the athlete through the use of established evaluation techniques. If concussion is suspected, the athlete’s parent/guardian will be notified by the athletic trainer or coach. Follow up assessment of the student after a suspected concussion must be done by a physician. The Athletic Trainer will notify the School Nurse of students who have sustained concussion to coordinate care in the academic environment.

In the event that an athlete sustains a loss of consciousness, the athlete will be transported to a hospital via 911 for emergency assessment and treatment.

Written medical clearance to return to practice/play following concussion will be determined by the treating physician in collaboration with the Athletic Trainer.

Please see Appendix A: Home Care for Concussed Athletes

All concussed athletes must be seen by an MD trained in the evaluation and management of concussions for written clearance to start the "return to play" progression. It is recommended that the athlete be under the care of a MD who is not the parent/guardian or immediate family member. Athletes who have signs or symptoms of concussion or abnormal cognitive testing may not return to play on the day of the injury. Athletes who have been diagnosed with concussion will need to advance through a stepwise return to play progression implemented by the Athletic Trainer and the physician before returning to full play. These 5 steps must be completed over a minimum of 7 days. Each step must be at least 24 hour apart. If at any time the symptoms return, the athlete must rest for at least 24 hours and repeat the step. The AT will contact the parent/guardian if the student athlete complains of symptoms.

Step 1: Light Aerobic Activity-increase heart rate <70%, 10-20 min. biking or walking

Step 2: Moderate Aerobic Activity-target HR <140-170 BPM, 10-30 min. jogging, bike at moderate intensity, agility drills, throwing and catching

Step 3: Moderate Anaerobic Activity-sprints, interval bike and weight training, non-contract Sport Specific Exercises: Close to typical routine without any contact.
*Physician clearance to advance to Steps 4 and 5 is required. This clearance is in addition to any immediate care provided immediately post-concussion in the Emergency Room or physician’s office.

Step 4: Full contact practice while monitoring symptoms

Step 5: Full uninhibited return to play

If an athlete is cleared by a physician to return to play on a practice or game day and has not met the Return to Play Progression or other health and safety criteria as deemed necessary by the Athletic Trainer, the athlete will not be permitted to participate. The health and safety of our student athletes is of utmost importance to us.

Remember: It is better to miss one game than the whole season.

In addition to a gradual return to play plan for athletics, athletes may also require a plan for return to the academic environment. Healing after concussion may require complete brain rest (no reading, writing, video games, computer etc.) for a period of time. Brain rest may be indicated for concussed athletes who are very symptomatic (headaches, extreme fatigue, feeling "out of it" etc.). Students often recover from concussion more quickly when they allow for complete brain rest in the period immediately following concussion. Please contact the School Nurse or School Counselor if your child has had a concussion. This is important information that should be shared with your child’s school team. If your physician has recommended a period of absence or partial day attendance during concussion recovery, we will require additional written information from the health care provider. When information is provided by the parent/guardian form the health care provider, the School based team can address any necessary classroom based accommodations. For more information on return to school please see Appendix B for school specific resources.

The Pennsylvania Concussion Law effective July 1, 2012 for interscholastic athletics, school-sponsored cheerleading and school based club sports requires the following: 1) Educational materials for students and their parents/guardians and coaches around the risk and nature of traumatic brain injury (TBI). 2) Removal from Play for students who exhibit signs or symptoms of a concussion 3) Return to Play after concussion only upon clearance in writing by an appropriate medical professional. Appropriate Medical Professionals are defined as a) MD trained in the management and evaluation of concussions b) a licensed or certified health care professional trained in the evaluation and management of concussions and designated by the appropriate licensed physician c) a licensed psychologist who is neuropsychologically trained in the evaluation or management of concussions or has post-doctoral training in neuropsychology and specific training in the evaluation and management of concussion 4) annual training for coaches in concussion through specific PA approved providers 5) penalties for coaches who violate Remove from Play or Return to Play provisions.

Athletic trainers are health care professionals who collaborate with physicians to provide preventative services, emergency care, clinical diagnoses, therapeutic intervention and rehabilitation of injures and medical conditions. AT’s are experts at recognizing, treating and preventing musculoskeletal injuries. ATs meet qualifications set by their Board of Certification and adhere to the requirements of a state licensing board. Once certified, they must meet ongoing continuing education requirements. They practice under the direction of a physician. In the LMSD, the high school ATs cover all PIAA games, events and practices. They are ImPACT Trained Athletic Trainers (ITAT). ATs in the LMSD provide physical medicine and rehabilitation services as well as prevent, assess and treat injuries of athletes. They coordinate with physicians to ensure that student-athletes are receiving the best care possible.

In compliance with the PA Safety in Youth Sports Act, all athletic coaches are required to complete an annual training around concussion that is approved by the Pennsylvania Department of Health. The Athletic Trainer is a resource to the coaches for concussion education.