Athletics

Concussion Management

 
The recognition and treatment of athletes who have suffered a concussion has become a local, state, and national priority, as well as a priority for The Williams School Athletic Department. An increasing number of studies have revealed that concussions, if not properly treated, can result in permanent physical and cognitive deficits, including learning differences.

Recovery from a concussion requires limitation of physical activity, especially sports activity such as practice, drills, games, and physical education classes. In significantly symptomatic athletes, mental activity should also be limited cognitively to allow the brain time to heal.

To better manage instances of concussion in our athletic program, The Williams School requires the following:

1. All coaches must complete annual training in the area of current concussion management practices and provide proof of that training to the School’s Athletic Director. This training should include up-to-date information on the identification of concussion, the signs and symptoms associated with the injury, the risks involved with allowing athletes to continue to play while symptomatic, methods of concussion assessment, and the importance of gradual return to play practices.

2. Information about sports-related concussions will be provided to parents annually via the School’s website. Additionally, literature will be sent home, and parents will be asked to return signed acknowledgement prior to their child(ren) being allowed to participate in any school-sponsored sport activity. These acknowledgement forms will be updated annually and kept by the School’s Athletic Office for a period no shorter than seven (7) years.

3. Prior to the start of every sports season, parents will receive a copy of The Williams School’s Concussion Management Policy & Plan. This document details the risks of concussion in sports and helps educate on how to identify the signs and symptoms associated with the injury, along with the potential risks involved with playing while symptomatic.

4. Prior to the start of every sports season, the Athletic Trainer will work with coaches to re-educate about concussions, signs and symptoms, and potential long-term risks.

5. All student-athletes will take a baseline cognitive test (ImPACT) at the beginning of their sports season.

6.  If, during a practice or game, an athlete sustains a concussion or exhibits the signs, symptoms, or behaviors of the injury, that athlete must be removed from all athletic activity as expressed by Connecticut State Law. That athlete may not return to any practice or game activity until he/she is evaluated by a licensed health care professional trained in the evaluation and management of concussion (i.e., physician, physician assistant, nurse practitioner, or athletic trainer). The athlete must provide written clearance from that provider prior to the athlete being allowed to resume physical activity. The school’s athletic trainer will keep evidence of all written clearance forms on file for a period no shorter than seven years. Once the athlete receives written medical clearance to return to physical activity the Athletic Trainer, Emily McNally, will follow a gradual return to play progression.
What is a Concussion – Signs & Symptoms of a Concussion

A concussion is a type of traumatic brain injury that changes the way the brain normally works. A concussion can be caused by a fall, bump, blow, or jolt to the head or body that causes the head and brain to move quickly back and forth.
 
You can’t see a concussion. Signs and symptoms of concussions can show up right after the injury or may not appear or be noticed until days or weeks after the injury. If the student reports any symptoms of a concussion, or if you notice symptoms yourself, seek medical attention right away. A student who may have had a concussion should not return to play on the day of the injury and until a health care professional clears them to return to play.
 
Signs Observed By Parents, Coaches, Teammates (What The Athlete Looks Like):
  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets an instruction
  • Can’t recall events prior to or after a hit or fall
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows mood, behavior, or personality changes
Symptoms Of A Concussion (What The Athlete Reports):
  • Headache or dizziness
  • Nausea or vomiting
  • Ringing in ears
  • Oversensitivity to sound/light/touch
  • Feeling foggy or groggy
  • Blurred or double vision

If You Suspect A Concussion – Or An Athlete Sustains A Head Injury

1. Seek Medical Attention Right Away – Any athlete with signs or symptoms related to a concussion must be evaluated by a licensed health care professional trained in the evaluation and management of concussions. A health care professional will be able to decide how serious the concussion is and when it is safe for the student to return to regular activities, including sports. If loss of consciousness, vomiting, or seizures occur the athlete must be immediately transported to a hospital. Ignoring symptoms and trying to “tough it out” often makes it worse. Make sure you also report any previous concussions at this time.

2. Keep Your Student Out of Play – Concussions take time to heal. Do not let the student return to play on the day of the injury, and the student may only return to play after he/she has been cleared by a medical professional. A student who returns to play too soon, while the brain is still healing, risks a greater chance of having a second concussion. Repeat or second concussions increase the time it takes the brain to recover and can cause permanent brain damage.

3. Return to Play (RTP) & Return to Learn (RTL) – Currently, it is impossible to accurately predict how long concussions will last. There must be full recovery before someone is allowed to return to participation. Connecticut Law now requires that no athlete may resume participation until they have received written medical clearance from a licensed health care professional (Physician, Physician Assistant, APRN, Certified Athletic Trainer) trained in the evaluation and management of concussions. During recovery, rest is key. Exercising or activities that involve a lot of concentration (such as studying, working on the computer, or playing video games) may cause concussion symptoms to reappear or get worse. Students who return to school after a concussion may need to spend fewer hours at school, take rests breaks, be given extra help and time, spend less time reading, writing, or on a computer. After a concussion, returning to sports and school is a gradual process that should be monitored by a health care professional. After the RTP protocol has been successfully administered, final written medical clearance is required by one of the licensed health care professionals mentioned above for them to fully return to unrestricted participation in practices and competitions.

Note: Public Act No. 14-66 requires that a coach must immediately remove a student-athlete from participating in any intramural or interscholastic athletic activity who is (A) exhibiting signs, symptoms or behaviors consistent with a concussion following a suspected blow to the head, or (B) is diagnosed with a concussion. Upon removal of the athlete a qualified school employee must notify the parents/legal guardians within 24 hours.

Return to Play (RTP) Protocol pdf for printing
This progression from injury to returning to play will be managed by Emily McNally (Athletic Trainer, Assistant AD), Kevin Steuer (Athletic Director), and our coaching staff.

Stage
Activiy Level
Objective of the Stage
1. Total Rest
Complete physical and cognitive rest until asymptomtic
Recovery
2. Light Aerobic
Activity
Walking, swimming, stationary bike, 15-20 minutes
Increase heart rate
3. Sport Specific
Activity
Running, drills, skills with no contact, 60 minutes
Add sport movement
4. Sport Training Activity
Progression to more complex training drills, resistance training, 60-90 minutes
Exercise, coordination, & cognitive load
5. Full Contacet
Practice/Game
Return to full practice and play
Restore confidence & assess functional skills by coaches and trainer
 
*If at any time signs or symptoms should worsen during the RTP progression, the athlete should stop activity for that day. After 24 hours if the symptoms have stopped, athlete may return to Stage 2.

Return to Learn (RTL) Protocol pdf for printing
This Kevin Steuer (Athletic Director), Macy Kleinfelder (Dean of Student Affairs), and Megan LaCour (School Counselor).
Stage
Activiy Level
Objective of the Stage
1. Total Rest
No mental exertion (computer, TV, texting, homework)
Recovery
2. Light Mental Activity
Up to 30 minutes miminal mental exertion (TV, computer, reading)
Minimal mental stimulation
3. Part-time School
Shortened day, breaks, academic accommodations, no tests or quizzes, no extra curriculars
Increased mental stimulation
4. Full-time School
No tests, no quizzes, possible RTP, low impact social interactions, extensions on homework and assignments
Complete full day with no symptom return
5. Full release School
No academic restrictions during the day, might still need extensions, RTP
Return to full academic ability
 *If at any time signs or symptoms should worsen during the RTL progression, the athlete should stop mental activity for that day. After 24 hours if the symptoms have stopped, athlete may return to Stage 2.
References:
1. Centers for Disease Control and Prevention. Heads Up Program. http://www.cdc.gov/headsup/youthsports
2. NFHS. Concussions. 2008 NFHS Sports Medicine Handbook (Third Edition). 2008: 77-82. http://www.nfhs.org
3. CIAC Concussion Central – http://concussioncentral.ciacsports.com