Management of
Concussion
For Administrators
in
High School Athletics
MICHELE C. BENZ, ATC, LAT, CSCS, HFS
What Do I Need To Know?
1. What are the new guidelines on treatment and
management of concussion
2. how can we develop a second impact syndrome
prevention program?
Treatment, Management &
Prevention of SIS
Helmet Fitting Performed by ATC
Viewing of Concussion Video Prior to Play
Baseline Testing (ImPACT)
Use Concussion Evaluation Form
(SCAT/SAC)
Return To Play Guidelines, Zurich 2008
What Is A Concussion?
Complex pathophysiological process that affects the
brain, induced by traumatic biomechanical forces.
-Zurich Concussion Conference, 2008
Blow to the head resulting in
Concussion=BRAIN DAMAGE!!!
Facts About Concussion
1.2 Million Youth Concussions Per Year
50% FB Players Have Sustained A Concussion
35% Suffered Multiple Concussions
80% Symptoms Worsen Over Weeks
50% Return To Play Too Soon
70% Would RTP Concussed
41% Would Not Leave A Game
50 H.S. Football Players Have Died Since 97
“It’s not dangerous to play with a concussion,” said Kelby Jasmon,
a senior two-way player for his high school in Springfield, Ill., who has
had three concussions. “You’ve got to sacrifice for the sake of the team.
The only way I come out is on a stretcher.”
Recognizing A Concussion
1. Know the cognitive level of the student
2. Learn to recognize the signs and symptoms
Signs: Symptoms
•Athlete stumbles after play •Headache
•Shakes head in attempt to •Nausea
“shake it off” •Sensitivity to Light
•Goes to wrong huddle or in •Lethargic
wrong direction •Personality Changes
•Takes a knee/bent over
•Runs the wrong play
•Eyes don’t focus/follow
Baseline Testing and Videos
Testing
Online
20 minute test
Inexpensive
Printed test score
Tests
– Reaction time
– Working & Design memory
– Attention span
– Non-verbal problem solving
– Visual processing speed
– Impulse control Videos
– Response inhibition
Heads Up
CDC/NFHS Youth Concussion
ESPN’s
– E:60 (5.4.10)
– Outside The Lines (11.4.07)
Example Evaluation Form
Treatment
National Federation of State High Schools: February, 2010
– Removal from participation, even if symptoms clear within 15 minutes.
– In absence of medical staffing, officials now charged with removal from
participation without LOC.
1) SCAT evaluation
2) Parental/guardian contact
3) Dialogue with coach/athlete
4) Referral/Diagnostic testing*
5) Post-Injury ImPACT test
6) Graduated RTP
7) Head Injury Reporting Form
*Referral based upon results of evaluation.
Diagnostic testing diagnoses structural abnormality, not concussion.
Return To Play
New guidelines (Zurich Conference, 2008) recommend a graduated RTP
“Step-Wise Return to Play Protocol”
1) Complete physical and cognitive rest
2) Light aerobic activity
3) Sport specific exercise
4) Non-contact training drills
5) Full contact practice
6) Return to game play
Athletes should also be back to baseline and depending on grade of
concussion, be cleared by a neurologist and/or neuropsychologist.
The NFL changed their RTP guidelines on Dec. 3rd, 2009 stating:
“Any player suffering signs/symptoms of a concussion should not return to play the
same day and should be checked out by proper medical staff.”
Non-Athletic Injured Students
•Physical Education Classes
•Fighting or other accident
*Have a plan in place prior to the school year*
1. Do not move the student
2. Have an administrator decide whether or not EMS is needed
3. Contact the parent or guardian
4. If transport is not necessary-advise the parent to have the
student checked out by their doctor.
5. Fill out accident report
Second Impact Syndrome (SIS)
Second concussion before previous concussion
has completely resolved
Metabolic volcano within the brain
Athletes under 23 at greatest risk
Catastrophic brain injury or Death
Second Impact Syndrome is
PREVENTABLE
Before & After SIS
Prevention
Miami Palmetto SIS Prevention Program
1) Coaches are on board with program
2) Baseline testing-ImPACT
3) Concussion awareness videos
4) Parent/Athlete Information Sheet
5) Equipment fit by ATC
6) Use of Sideline Evaluation Test
7) Responsibility Clause –Physical form
8) Referral for diagnostic testing via
Sports Medicine team.
SIS is PREVENTABLE
ESPN’s E:60
Questions?