Listed below, I will include information that may be helpful when dealing with a concussion. Please scroll down to find the following documents.
Concussion State Laws, Definition and Possible Complications: An overview of what a concussion is, how it can occur, potential complications, and the CHSAA AND YOUTH SPORTS MANDATED LAWS concerning this injury.
Parent Informational Handout: This is what I give the student/athlete and their parent, when a concussion is suspected.
Concussion Management Guidance: A basic outline of what to expect for the initial management and return to play protocols.
SSHS Concussion Management Team: The role of those who may be involved in the management of this injury including the coach, certified athletic trainer, school nurse, teachers and administrators, primary care physician, ImPact test facilitators and specialists.
Student Academic/Activity Accommodation Form: This form is filled out BY THE HEALTHCARE PROFESSIONAL evaluating your child. They will fax this to the school nurse, so that the appropriate accommodations can be set in place. As symptoms resolve and the injury is healing, this form will be updated by the physician as necessary.
BACKGROUND INFORMATION (LAW, DEFINITION AND COMPLICATIONS)
Colorado High School Athletics Association (CHSAA) State Law
Due to Colorado Concussion state law SB 11-040, if an athlete is removed from practice or competition due to concussion-like symptoms, they are required to obtain written clearance from an approved medical provider (Doctor of Medicine, Doctor of Osteopathic Medicine, Licensed Nurse Practitioner, Licensed Physician Assistant, Licensed Doctor of Psychology) before returning to activity.
Go to https://chsaanow.com/sports-medicine to view all policies.
Youth Sport Leagues
On March 29, 2011 Colorado Governor Hickenlooper signed in to law ‘Jake Snakenberg Youth Sports Concussion Act’ making Colorado one of the dozen or so states to enact legislation. The bill requires that coaches receive education about concussion, that a student athlete is removed from the field of play if a concussion is suspected and that the student be signed off by a healthcare professional before returning to play. The Act went into effect January 1, 2012.
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.
Complications: If concussions are mismanaged, consequences can be moderate to severe. In mild cases, healing and recovery are prolonged or even worsened. In severe cases, there is a potential for second impact syndrome or chronic traumatic encephalopathy.
Second Impact Syndrome
Second impact syndrome occurs when the athlete receives a second blow (which can be less severe than the first impact), before the symptoms of the first concussion have healed. Within two to five minutes of this second impact, the brain rapidly swells, leading to respiratory failure, decreased ocular movement, and potentially death. This is our biggest fear as a medical community when dealing with concussions.
Chronic Traumatic Encephalopathy (CTE)
CTE is a brain disease that results from changes in the brain. These changes can affect how a person thinks, feels, acts, and moves. Traumatic brain injuries, including concussions, and repeated hits to the head, called subconcussive head impacts, may lead to CTE. www.cdc.gov/HEADSUP.com
Your child may have sustained a head injury. In some instances the signs of a concussion do not become obvious until several hours or even days after the injury. If your child has any of the following symptoms, please notify their physician as soon as possible. Please be observant of the following signs and symptoms and note any symptoms that worsen.
Headache (especially one that increases in intensity)*
Nausea and vomiting*
Blurry or double vision*
Difference in pupil size from right to left eye, dilated pupils*
Noticeable changes in the level of consciousness (difficulty awakening, or losing consciousness suddenly)*
Decreased or irregular pulse OR respiration*
Mental confusion/behavioral changes
Ringing in the ears
Change in gait or balance
***Seek medical attention immediately ***
If you have any questions or concerns about the symptoms you are observing, contact your family physician for instructions, or seek medical attention at the closest emergency department. Otherwise you can follow the instructions outlined below.
It is ok to:
eat a light diet
go to sleep
use ice pack on head and neck as needed
take tylenol or Ibuprofen (motrin/advil) for pain
have light exercise if symptom free (walk to dog, walk to school, short hike)
take long hot showers with a locked door
drive while symptomatic
Participate in any physical activity that may involve hitting the head again
sit in a dark room
wake up them up at night
SSHS concussion management protocol:
Every concussion injury is different, and the plan of care is unique to that individual. Ultimately, you will be following your medical provider’s guidance, but this is a basic outline of what to expect for the initial management and return to play protocols.
Do not go to school the first couple of days if symptomatic. If you become symptomatic during school, go to the nurse’s office...DO NOT JUST GO HOME!
Avoid activities that increase your symptoms which may include screen-time, concentration, driving, exercise, busy or bright environments, or other specific triggers.
Make an appointment with one of the approved providers as soon as possible. Most people choose their family physician/pediatrician. The ImPact certified physicians in our area are Dr. Dana Fitzgerald at Pediatrics of Steamboat, and Dr. Brian Harrington at Yampa Valley Medical Associates.
At the close of your doctor appointment, be sure that you were provided with the standard ACE form that outlines any necessary athletic or academic modifications. This form will also be faxed to the school nurse so that the information reaches the appropriate staff.
If you cannot get into your physician right away, an ImPact trained physical therapist at SportsMed, or the school athletic trainer can temporarily evaluate and fill out the ACE form.
Your doctor will guide you on when the post-injury ImPact test should be scheduled.
Return to doctor if symptoms are not improving, getting worse or last longer than 1-2 weeks.
Relax accommodations as symptoms resolve.
Take the post-injury ImPact test (if not done already). The provider will compare this test to your baseline, as a part of the clearance assessment.
UCHealth-YVMC SportsMed, ForeverFit, Center for Sports Medicine, Steamboat Spine and Sport, and Pediatrics of Steamboat can administer the test.
SportsMed also performs an evaluation and exertional workout before administering the post-test. They then communicate the results and their recommendations with your physician, ensuring a comprehensive approach.
Return to doctor for clearance to begin return to play process
Once you are symptom free at rest and with a full academic workload, and your ImPact test is normal, your provider can clear you for a supervised gradual return to play progression.
Return to Sport:
5 Exertional stages: can be guided by the doctor themselves, the school athletic trainer, or a member of the UCHealth-SportsMed concussion management team.
Stage 1: Very light aerobic conditioning, stretching, balance and strengthening exercises in a controlled environment. Stage 2: Increase stage 1 exercises to a moderate level, with positional changes in a busy environment. Stage 3: (Exit Test) Aggressively test strength, cardio, plyometrics, and proprioception in a busy environment.
*At this point, communicate with physician to verify that exercise has not triggered any symptoms, and that they are clear to complete the rest of the program.*
Stage 4: Return to a non-contact practice and sport-specific drills.
Stage 5: Return to one full contact practice and then released to play in a competition.
If symptoms are experienced at any stage, the athlete should cease activity for the day and contact the supervising professional for further advice. The general recommendation is that you wait 24 hours, drop back a step, and try to progress again.
SSSD Concussion Management Team and Their Roles:
Coach - Communication begins with you!
If you suspect an injury, remove the athlete and report it to the certified athletic trainer. If an ATC is unavailable at the time of injury, you will need to notify the parents or a responsible adult. In the case of an emergency situation, a coach should accompany the athlete and remain with the athlete until the parents arrive. Make sure the ATC and school nurse are immediately notified, so they can begin the management process. Remind the athlete and their parents to report directly to the school nurse on the day they return.
Colorado State Law requires coaches to complete concussion training courses every 2 years.
School Nurse - Cathy LaPointe
It is crucial to make the school nurse aware of the injury as soon as possible. They are responsible for communicating with the healthcare team, the parents,and the school staff concerning academic accommodations and progression.
If symptoms develop throughout the school day, or rest break are needed, the nurse will supervise these in their office.
Certified Athletic Trainer - Stephanie Stefanelli
Often times, the athletic trainer is the first to be aware of a potential concussion. They cannot “diagnose” a concussion, but are well trained on the recognition of one. The athletic trainer plays a strong role in the immediate communication with parents and staff, the appropriate referral process, the follow-up evaluations and communications, and the return to play progression.
Primary Care Physician
The doctor is who will officially diagnose and oversee the care of the student/athlete until they are fully returned to academics and athletics. The doctors will fax the accommodations and clearances to the school nurse.
If the parent is unsure of what doctor to see for this specific injury, the ATC and school nurse can provide guidance.
Post-ImPact Test Facilitators - UCHealth-SportsMed, Kinetic Energy, ForeverFit, Center for Sports Medicine, Pediatrics of Steamboat Springs, Steamboat Spine and Sport
At this time, these are the groups in town that post-impact test. The doctor will recommend the appropriate time to take this test, depending on if they want to use it as a diagnostic or clearance tool.
School accommodations may temporarily come from these groups until a physician evaluation.
These physical therapy groups can also supervise and communicate a gradual return to play program, that assures the student is safely returned to their sport.
Staff and Administrators
When the school nurse has communicated that accommodations are necessary, it is important for the teachers to cooperate and be flexible. Extended test dates, alternate modes of learning, no PE, and rest breaks are examples of some of the changes they may be asked of.
A guidance counselor or tutor may be necessary during this time.
In severe or prolonged recovery cases, there may be support coming from different specialties. These may include speech therapists, occupational therapists, neuropsychologists, counselors, tutors, etc
Student Academic/Activity Accommodation Form
Today’s Date:_____________________ Date of Concussion: ____________________
Student Name: _____________________________________ DOB:_______________________
Symptoms: ? Symptomatic ? Not symptomatic Comments:___________________________________________________________________________
Attendance: ? Full Days ? Half Days ? No school until ____________________.
Testing: ? Extra time ? Test in a quiet environment ? No standardized tests
? Allow testing across multiple sessions ? Reduce length ? No tests/quizzes for _______________
? Open note/open book/take home tests
Workload Reduction: ? Reduce overall amount of make-up work, class work, homework (50-75%)
? Limit computer time as much as possible ? Audiobooks only ? Trial reading (STOP if symptomatic) ? Note Taking: Allow student to obtain class notes or outlines ahead of time
? Breaks: If symptoms worsen during class, the student should put his/her head down or go to nurse’s office. ? Extra Time: Allow students extra time to complete and turn in assignments.
Other Accommodations: ? Change computer setting (brightness/contract) ? No videos
? Allow student to wear hat and/or sunglasses ? Rest time__________________________________
? Avoid busy environments (leave class early to avoid hallways, cafeteria, assemblies, school dances)
Activity/Sports: ? No physical education class ? No sports participation ? No Recess
? Light/Modified activity Comment:________________________________________________
____ Follow up with this office on: Date: ____________________
____ Refer to physician: _____________________________
____ Student is cleared for return to school without accommodations and full RTP (MD,DO, LNP, PA signature required)
____ Full RTP: RTP stg 1__ Stg 2__ Stg 3__ Stg 4__ Stg 5 __ (See above)
____ OK to relax accommodations as symptoms improve
Completed by: __________________________________________________________
Medical Facility: ________________________________________________________