5141.7R

Adoption Date: 1/1/1900, Revised: 02/24/2014, 01/08/21

Concussion Management Policy
Regulation # 5141.7R
5141

 CONCUSSION MANAGEMENT PROTOCOL REGULATION

Definition

A “concussion” is a traumatic brain injury, caused by a blow to the head, face or neck, or a blow to the body that cause a sudden jarring of the head, that alters the way the brain functions.  

A concussion may be “simple” meaning that the concussion resolves without complication over 7-10 days.  It is estimated that 80% to 90% of concussion are of this severity.  Simple concussions can be managed appropriately by primary care physicians or by certified athletic trainers working under medical supervision.  Management of a simple concussion includes rest until all symptoms resolve, followed by a step-by-step program of exertion before return to sport.  All concussions require evaluation by a licensed physician and medical clearance by the District’s Chief Medical Officer for return-to-play/physical activity.

A “complex” concussion involves cases when the student suffers persistent symptoms, including persistent symptoms that recur with exertion.  A complex concussion may have characteristics such as concussion convulsions, prolonged loss of consciousness (longer than one minute) or prolonged cognitive impairment.  Students who suffer complex concussions should be referred to and managed by physicians with specific expertise in the management of concussive injury, such as sports physicians, sports neurologists or neurosurgeons.

A concussion cannot be graded until all symptoms have resolved and the student returns to practice/competition/physical activity.

Evaluation and Management of Concussions

When a student shows ANY features of a concussion, proper protocol is:

  1.  To remove the student from practice or play, medically evaluate onsite using standard emergency principles, and call 911 if indicated.
  2.  The parent will be contacted immediately, but after 911 is contacted in an emergency.
  3.  A student should not be left alone following the injury and should be monitored over the initial few hours following injury.
  4.  A student with a diagnosed concussion requires mental and physical rest until complete resolution of symptoms. This means a quiet environment and avoiding exposure to stimulation such as television, electronic devices, video games, computers or heavy reading.
  5.  A student with a diagnosed concussion will not be allowed to return to play or physical activity on the day of injury. The student will not be permitted to return to play or physical activity at all until he or she has been symptom free for at least seven (7) days, has been evaluated and received written and signed clearance from a licensed health care provider, and has completed the return physical activity protocol symptom free.
  6.  The School Nurse will consult with the District Chief Medical Officer for confirmation of the clearance.
  7.  The School Nurse will notify school personnel, as appropriate, including but not limited to:
    • Guidance/Team
    • Teacher (elementary level)
    • Principal and/or Assistant Principal
    • Physical Education teacher and Coaches will be notified that the student is excluded from Physical Education classes and any athletic activity until further notice.

These individuals will receive a symptoms checklist and recommendations for student accommodations (such as limited computer work, reading activities, assistance to class, etc.) until symptoms subside.  A student who demonstrates signs and symptoms during class should be attended to promptly and, if necessary, should be directed to the School Nurse.  If the student is symptomatic, the Parents should be contacted. 

  1.  Parents will be advised to:
  • Access the CDC Parent Fact Sheet available on the District website (http://www.lakelandschools.org/files/filesystem/concussion_factsheets_PARENTS.pdf
  • Notify the School Nurse and Guidance/Teacher if there are any changes in symptoms
  • Obtain a note from the student’s health care provider stating that the student has been symptom free for at least seven (7) days and may return to physical activity/sports. This note must be given to the School Nurse and confirmed by the District Chief Medical Officer.

ImPACT Program

The implementation of baseline and/or post-injury neurocognitive testing, such as ImPACT (Immediate Post Concussion Assessment and Cognitive Test), can help to objectively evaluate the individual’s post-injury condition and track recovery for safe return to cognitive and physical activities.

Return-to-Play/Physical Activity

The return-to-play/physical activity protocol is a progressive program designed to incrementally increase the student’s level of exertion.  The protocol may be administered by the coach, physical education teacher, athletic director, school nurse or athletic trainer.  If the student experiences any signs or symptoms of a concussion during the progression, all activities will be stopped and will not resume until authorized to do so, in writing, by a licensed health care provider.

  1.  For the first concussion, when ImPACT testing is available, after 48 hours symptom free and review of the ImPACT by the District’s Chief Medical Officer and a determination that the child is stable, he/she can proceed to return to Play/Physical Activity protocol.
  2.  When ImPACT testing is available, for a child with a history of a recent concussion or after a second concussion, the Chief Medical Officer shall evaluate the injury, the child’s condition and review follow-up ImPACT test results prior to determining whether the child can proceed to return to play/physical activity protocol prior to the eighth day.
  3.  A student who sustains three or more concussions in any school year must be reviewed by the Chief Medical Officer in conjunction with the recommendations of the student’s physician before being allowed to resume physical activity (e.g., physical education) and athletics participation.
  4.  When ImPACT testing is unavailable (e.g., middle school and elementary school levels), a minimum of seven (7) days out of sports/physical activity shall be required before consideration of return to play/physical activity protocol. In such cases, the School Nurse must receive a written and signed health care provider’s statement that the student has been asymptomatic (of symptoms consistent with concussion) for seven (7) or more days, and is cleared to return to play/physical activity.
  5.  The School Nurse will consult with the District’s Chief Medical Officer regarding confirmation of the clearance. The District’s Chief Medical Officer will make the final determination regarding return to play/physical activity.
  6.  The School Nurse will notify the Teacher (elementary level), Physical Education teacher, Guidance, Coaches and Athletic Trainer (as applicable) when the student has been cleared to return to progressive activity.
  7.  Any return of symptoms of concussion (as outlined in the CDC Parent Fact Sheet – see link above) such as difficulty thinking or remembering, physical, emotional or sleep alterations, should be reported to the School Nurse and the Teacher (elementary) and Guidance (secondary).
  8.  Failure of a student athlete or his/her family to report a concussion or other injury may result in the student’s disqualification from that sports season.

Return-to-Play/Physical Activity Protocol

This protocol will be started once the student is symptom free for 24 hours, and cleared by the District’s Chief Medical Officer.  If there are any signs/symptoms, the activity must stop.  When the student is asymptomatic after successful completion of each day of the protocol, the student may proceed to the next day.

Day 1:   Low impact, non-strenuous, light aerobic activity to be done at 50-60% maximal effort for 20-30 minutes (e.g., fast walking, stationary bike - under supervision).

Day 2:   Higher impact, higher exertion, moderate aerobic activity to be done at 60-70% maximal effort for 30-40 minutes (e.g., jogging/running).  No resistance training.

Day 3:   Sport specific non-contact activity.  Low resistance weight training with a spotter to be done at 70-80% of maximal effort for at least 10-15 minutes and activity should last 45-60 minutes in total.

Day 4:   Sport specific activity, non-contact drills.  Higher resistance weight training with a spotter to be done at 80-90% of maximal effort for at least 10-15 minutes and activity should last 60-90 minutes.

Day 5:   Full contact training drills and intense aerobic activity to be done at 90-100% of maximal effort for at least 10-
15 minutes and activity should last 90-120 minutes.

Day 6:   Return to full activity with clearance from the District’s Chief Medical Officer.

 


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