What Is a Concussion?

 

A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.

For more information:

https://www.p12.nysed.gov/sss/documents/FinalConcussionGuidelines7_6_2022PDF.pdf

https://www.cdc.gov/headsup/basics/concussion_symptoms.html

https://www.cdc.gov/headsup/basics/concussion_danger_signs.html

https://www.cdc.gov/headsup/highschoolsports/parents.html

 Symptoms of a concussion include, but are not necessarily limited to:

• Amnesia (e.g., decreased or absent memory of events prior to or immediately after the injury, or difficulty retaining new information)

• Confusion or appearing dazed

• Headache or head pressure

• Loss of consciousness

• Balance difficulty or dizziness, or clumsy movements

• Double or blurry vision • Sensitivity to light and/or sound

• Nausea, vomiting, and/or loss of appetite

• Irritability, sadness or other changes in personality

• Feeling sluggish, foggy, groggy, or lightheaded

• Concentration or focusing problems

• Slowed reaction times, drowsiness

• Fatigue and/or sleep issues (e.g., sleeping more or less than usual) Students who develop any of the following signs, or if the above listed symptoms worsen, must be seen and evaluated immediately at the nearest hospital emergency room:

• Headaches that worsen

• Seizures

• Looks drowsy and/or cannot be awakened

• Repeated vomiting

• Slurred speech

• Inability to recognize people or places

• Weakness or numbing in arms or legs, facial drooping

• Unsteady gait

• Dilated or pinpoint pupils, or change in pupil size of one eye

• Significant irritability

• Any loss of consciousness

• Suspicion of skull fracture: blood draining from ear, or clear fluid from nose

Post-Concussion Management

Students who have been diagnosed with a concussion require both physical and cognitive rest as determined by the treating healthcare provider. How long that rest period is, and what activities may or may not be permitted will be different for each student.

 Cognitive rest requires that the student avoid participation in, or exposure to, activities that require concentration or mental stimulation including, but not limited to:

• Computers and video games

• Television viewing

• Driving • Texting

• Reading or writing

• Studying or homework

• Taking a test or completing significant projects

• Participation in band, chorus, plays, etc.

• Employment • Loud music • Bright lights

I have a concussion and want to play? When can I get back?

Concussion Management

Return to Play Protocol

Return to Academic Activities

After an initial period of complete rest lasting approximately 24-48 hours, a healthcare provider may clear a student to begin a gradual return to academic or cognitive activities. This may or may not coincide with the student’s return to physical activities. The healthcare provider should give clear orders on the gradual return to activity protocol that the district must follow. If a district has concerns or questions about the private healthcare provider’s orders, the district medical director should contact that provider to discuss and clarify. Even with classroom accommodations, a student with a concussion will need to gradually return to all academic activities.

 

 

Return to Play Protocol and Clearance

A gradual return to physical activities typically is done by progressing a student through levels of physical activity that increase in duration and/or intensity. Gradual return to activity should occur with the introduction of new activity level every 24 hours. If any post-concussion symptoms return, the student should stop the activity and drop back to the previous level of activity. Current research suggests that some level of symptoms with activity is acceptable

Student-athletes who sustain, or are suspected to have sustained, a concussion during athletic activities will be immediately removed from such activities. No student-athlete should return to full athletics before going through a return-to-play protocol including a post-injury neurocognitive (ImPACT) test.  The return-to-play protocol is usually a 3-6 day supervised program. Return to play following a concussion involves a stepwise progression once the student-athlete is symptom free. No student should return to play while symptomatic. Student-athletes are prohibited from returning to play the day the concussion is suspected. If there is any doubt as to whether a student-athlete has sustained a concussion during activity, it should be treated as a concussion.

 

STEP 1:

Evaluation by a licensed New York State physician, nurse practitioner, physician’s assistant or a Credentialed ImPACT Consultant(CIC). Student-athletes must provide the Health Office with written authorization allowing the resumption of full physical activity by a licensed New York State physician, nurse practitioner, or physician’s assistant and:

1. the student-athlete shall undergo post-injury neurocognitive (ImPACT) testing.

 

STEP 2:

Initiate Return to Play Protocol administered by the Certified Athletic Trainer.

 

Day 1: Low impact, non-strenuous, light aerobic activity.

Day 2: Higher impact, higher exertion, moderate aerobic activity. No resistance training.

Day 3: Sport specific non-contact activity. Initiate low resistance weight training with a spotter.

Day 4: Sport specific activity, non-contact drills. Higher resistance weight training with a spotter.

Day 5: Full contact training drills and intense aerobic activity.

Day 6: Return to full activities with clearance by the Certified Athletic Trainer.

Each step should take 24 hours so that an athlete would take approximately one week to proceed through the full rehabilitation protocol once they are asymptomatic at rest and with provocative exercise. If any post-concussion symptoms occur while in the stepwise program, then the student should drop back to the previous asymptomatic level and try to progress again after a further 24-hour period of rest has passed. If a student -athlete is not progressing, or there is an indication of a more serious head injury, the Certified Athletic Trainer will notify the school nurse. The school nurse will consult with the school physician and the student-athlete may be required to see a neurologist prior to continuing the Return to Play Protocol.

Any return of symptoms during the return to play protocol, the student-athlete will return to the previous day’s activities until symptom free. The Certified Athletic Trainer and school nurse will oversee the return to play protocol with the school physician. Final return to play decisions will be made by the School District’s Chief Medical Officer/Physician by providing written authorization allowing the resumption of all activities.