Virginia Department for Aging and Rehabilitative Services Brain Injury Report Out Day Mitchell Callis, M.S.,Ed.,ATC,VATL Certified Athletic Trainer Childrens Hospital of the Kings Daughters Virginia Athletic Trainers Association Virginia High School League Sports Medicine Advisory Committee

Board of Education Guidelines Local school divisions MUST establish concussion management policies by July 1, 2011 Defines Appropriate Licensed Health Care Provider (ALHCP) ATC, MD, DO, NP, PA, Neuropsychologist Policies include: Annual concussion education for parents and students Removal from play if concussion suspected No same day RTP nor until cleared by ALHCP Must complete graduated RTP progression

What Have We Learned? Anecdotal evidence says its working… Increased awareness about concussion Students, parents, coaches, school staff, etc Increased utilization of concussion management best practices On the sideline, in the office and in the classroom

What Have We Learned? Education delivery mechanisms Paper forms requiring signatures Face-to-face meetings Online Most effective seems to be a combination of different methods Different learning styles, technological limitations, repeated exposure to content

What Have We Learned? Communication and collaboration are critical Effective management is truly a team effort Parents, medical professionals, teachers, school counselors Cannot afford to underestimate academic consequences Schools need to be ready and able to accommodate students with concussion

Summary and Agreement Statement of the International Conference on Concussion in Sport, Zurich (2012) and SCAT 3

Grading Scales of Concussions 1. 1.Colorado 2. 2.American Academy of Neurology 3. 3.Cantu 4. 4.Maroon 5. 5.Hugenholz 6. 6.Wilberger 7. 7.Roberts 8. 8.VNI 9. 9.AMSSM Ommaya & Gennarelli Ommaya Torg Gersoff Rugby Football league (UK) Federation Internationale de Ski Amateur Boxing Association Auto Cycle Union (UK) The Jockey Club Rugby Union Rugby League (Australia) Schneider Kulund Kolb Saal Nelson Parkinson NO MORE GRADES

Return to Play Criteria No signs or symptoms Normal neurological exam Normal balance Neuropsychological exam back to baseline And then… return to play progression

Return to Play Progression No activity Light aerobic exercise Sport specific exercise Non-contact training drills Full-contact practice Return to Play (Game) *24 hr minimum at each stage