Goal of the Concussion Management Plan is to fulfill the NCAA requirement in addition to improving the prevention, recognition, evaluation, and management of concussions in student-athletes. This will best be accomplished using a team approach, involving the athlete, coach, administrator, certified athletic trainers, neuropsychologist, and team physician. Communication between the members of all involved is crucial.
Concussion is defined as a complex patho-physiological process affecting the brain, induced by traumatic biomechanical forces.
- Concussion may be caused by a direct blow to the head, face, neck or elsewhere with force transmitted to the head.
- Short-lived impairment of neurologic function typically resolves spontaneously.
- Concussion may result in neuro-pathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
- Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution typically follows a sequential course; however a small percentage of cases, have prolonged post–concussive symptoms.
- Concussions show no abnormality on standard structural neuroimaging (CT Scan, MRI).
Standard Assessment of Concussion
Ideally, each athlete will have an established baseline for the concussion assessment tools. Included would be one or more of the following: computer based neuropsychologic testing, i.e.: ImPACT (Immediate Post-concussion Assessment and Cognitive Testing), SAC (Standardized Assessment of Concussion), BESS (Balance Error Scoring System), SCAT2 (Sport Concussion Assessment Tool 2). All contact and collision athletes are REQUIRED to complete a baseline test prior to the first practice.
- The baseline tests would then be used to help evaluate for concussion and aid in determining return to play after concussion.
- Documentation of concussion, including scores of Concussion Assessment Tools, would be maintained in athletic office and/or medical chart.
- Consideration for other injuries, including cervical spine, should be considered and excluded prior to a formal sideline concussion assessment.
- Emergent transport for appropriate assessment and imaging should be considered any time symptoms are worsening or a more severe brain/cervical spine injury is suspected.
- If a concussion is suspected, on-field assessment should be conducted by Certified Athletic Trainer and/or Physician to evaluate for symptoms and abnormal exam findings. SAC (Standardized Assessment of Concussion) Test with BESS (Modified Balance Error Scoring System) may be used on the sideline for potential concussed student athlete. If a Certified Athletic Trainer or Team Physician is not available, then any athlete suspected of possible concussion will be removed from play and appropriately referred for assessment.
- A complete SCAT2 will be used as the standard assessment when a concussion is suspected. Components of SCAT2 include:
- Symptom Evaluation Score (number/22)
- Physical Signs Score (Number/2)
- Glasgow Coma Score (Number/15)
- Sideline Assessment – Maddocks Score (Number /5)
- Cognitive Assessment – SAC (Number/30)
- Modified Balance Error Scoring System (BESS) (Number/30)
- Coordination Examination (Number/1)
- Follow Up Assessment
- Certified Athletic Trainer and/or Team Physician reassessment within 24-72 hours.
- Repeat Concussion Assessment tools, including the SCAT2 and Neuropsychological Testing (ImPACT) will be used when appropriate/ available. Generally, repeat ImPACT testing should occur when the student-athlete is asymptomatic, and further testing depending on symptoms and scores. Earlier neuropsychological testing may be considered, or at 7 days post injury if symptoms still present. (McCrory et al. 2009, page 187)
- Timing and frequency of follow up will be determined on a case to case basis.
- When a student-athlete is diagnosed with a concussion, the certified athletic trainer involved will either discussed the case with one of the team physicians by phone or have the patient seen by a physician prior to return to play.
Return to Play
- When a student-athlete shows any signs, symptoms or behaviors consistent with a concussion, the athlete shall be removed from practice or competition and evaluated by any athletic health-care provider with experience in the evaluation and management of concussion. (From NCAA Memorandum April 29,2010 5.d)
- A student-athlete suspected of, or diagnosed with concussion will be withheld from the competition or practice and not return to activity for the remainder of that day.
- Return to play decisions will be made on clinical judgment based on an individual case by case situation.
- Generally, any concussed student-athlete will have physical and cognitive rest until symptoms resolve, and then a graded program of exertion prior to medical clearance and return to play. Each level of exertion will be advanced approximately every 24 hours, as long as athlete is symptom free.
- Asymptomatic at rest
- Asymptomatic with light aerobic exercise (i.e. exercise bike)
- Asymptomatic with sport-specific exercise (i.e. agility drills, lifting weights)
- Asymptomatic with non-contact training drills
- Asymptomatic with full-contact practice
- Asymptomatic with normal game play
- Ultimate, final authority for return-to-play will reside with the team physician or the physician’s designee.
Student-Athlete’s Signature for Reporting of Symptoms - Each student-athlete will sign a form to assure timely reporting of any injury; specifically any symptoms that could possibly be a concussion for them or their teammates will be reported.
Every Athlete and Coach will be given a Concussion Informational Sheet providing basic information about concussions to help improve awareness, identification, appropriate assessment, and prevention of concussions.
(McCrory et al. 2009)