Education and Protocols for Safer Sport Concussion: Education and Protocols for Safer Sport Stephanie Cowle, Parachute 

Would you skydive without a parachute? Canada’s national charity dedicated to preventing serious and fatal injuries Evidence-based solutions, advocacy and education

About Me 10 years in Injury Prevention Knowledge Translation = Evidence to practice Collaborate with more than 40 sports, including Skate Canada’s Safe Sport staff Am *this close* to learning how to skate backwards

The Plan In this session you will learn: the basics of concussion key components of a concussion protocol resources available to help you build safe sport

Concussion: The Basics

A concussion is a brain injury. It can affect the way a person thinks, feels, and acts. It can’t be seen on X-ray, CT or MRI.

A concussion can happen without a direct hit to the head. A concussion can be caused by: a blow to the head, face or neck a blow to the body

force of the blow causes the brain to move around inside the skull

Skate examples: colliding with another skater hitting your head on the ice sliding hard into the boards falling during off-ice training

Most concussions are not sport-related. Concussions can happen in sport and non-sport activities. Youth (10-19) are most likely to have a sport-related concussion. Falls and car crashes are common causes.

Females are at risk, too. Higher number of concussions in males. Higher risk among females. Longer recovery among females.

You don’t need to be knocked out. Only about 10% lose consciousness. Losing consciousness could be a sign of a more severe injury. (Red Flag) Most common symptom: Headache

Rest, but not TOO much rest. Rest and sleep are important for brain healing. Don’t wake the person through the night. 24-48 hours initial rest. No more “bedroom jail”.

Most people get better in 1 to 4 weeks. Youth: up to 4 weeks Adults: up to 2 weeks Longer than this? “Persistent symptoms” Most people don’t need specialty care.

Safe Sport: Concussion Protocol

A Canadian Approach to Concussion F/P/T efforts since 2016 Public Health Agency of Canada Sport Canada 45 NSOs including Skate Canada Coaching Association of Canada SIRC

Canadian Guideline on Concussion in Sport parachutecanada.org/guideline parachutecanada.org/lignes-directrices

Concussion Best Practice Pre-season education Head injury recognition Medical Assessment Concussion management Return to school, work and sport ⇣

1. Pre-Season Education Everyone should be aware of: what a concussion is potential causes and symptoms prevention their organization’s protocol + agree to follow it how to safely return to regular activities and sport

Education: How? Provide education resources Post information at rinks and training facilities Hold pre-season team meetings Include concussion at meetings/events (just like this!) Provide access to free training resources

2. Head Injury Recognition Recognition is not diagnosis. Everyone has a role to recognize It only takes one sign or symptom Recognition is not diagnosis.

Recognition: How? If a skater sustains a significant impact to and reports any symptoms or demonstrates any signs of a concussion. If a skater reports any concussion symptoms to one of their peers, coaches, trainers, parents, teachers. If anyone witnesses a skater exhibiting any signs of a concussion.

Recognition: How? Common signs and symptoms: Headache or pressure in the head Dizziness Nausea Trouble concentrating or remembering Unusual emotions (e.g., irritability) Drowsiness or fatigue

Red Flags: Signs of a more serious injury Loss of consciousness Seizure or convulsion Neck pain Vomiting more than once Getting more and more confused Headache is severe and getting worse Double vision Weakness/tingling in arms or legs ! Call 911

3. Medical Assessment Emergency? (Red flags) Emergency medical services will assess and transport to hospital

3. Medical Assessment Not an emergency? (No red flags) Safely remove the skater to a quiet area. An experienced, licensed healthcare professional (e.g., AT, PT, MD) can do an initial assessment. The skater should be checked as soon as possible by a medical doctor or nurse practitioner.

Medical Assessment: How? Remove anyone with suspected concussion from training or competition immediately. Contact the skater’s parent/guardian or emergency contact to pick them up. Don’t leave the skater alone. Let the skater/parent/guardian know they need to get checked out.

4. Management No concussion? Return to activities

4. Management Diagnosed concussion? Follow a step-wise return to school, work and sport-related activities Medical clearance before full return to sport

Return-to-Sport Strategy Principles: At least 24 hours per stage No new or worse symptoms 1 Symptom-limiting activity 2 Light aerobic activity 3 Sport-specific exercise 4 Non-contact training drills 5 Full contact practice 6 Return to sport

Return-to-Sport Strategy 24-48 hours initial rest. Stage 1: Symptom-limiting activities Daily activities that don’t provoke symptoms Moving around home, reading, etc.

Return-to-Sport Strategy Stage 2: Light aerobic activity Light intensity stationary cycling or jogging No resistance training. Start increasing heart rate

Return-to-Sport Strategy Stage 3: Individual sport-specific exercise with no contact or head impact activity Skating drills (e.g., stroking, then turns) Core, stabilization, flexibility exercises No twizzles, jumps, spins, lifts, throws Add movement

Return-to-Sport Strategy Stage 4: Non-contact training drills Run through skating program, starting with singles and progressing to doubles May progress to off-ice triple jumps May start progressive resistance training Coordination and increased thinking

Return-to-Sport Strategy Stage 5: Full contact practice following medical clearance by a doctor Full skating program with jumps Try adding spins outside program Full training, conditioning (limit jumps) Restore confidence and assess skills

Return-to-Sport Strategy Stage 6: Return to sport Normal on-ice and off-ice activity with no restrictions

Management: How? Use the strategy as a guide, but individual recovery will differ Communication among coach, skater, trainer, parent/guardian – possibly others Return to school and work before full return to sport

Gradual return to sport and activity. Education Recognize & remove Get assessed Gradual return to sport and activity. Communication

Safe Sport: Concussion Resources

Education & Awareness Skate Canada Safe Sport poster, brochure Concussion Ed mobile app

Education & Awareness Parachute concussion guides for coaches/trainers, parents, and athletes Pre-season concussion education sheet

Education & Awareness: Free Training www.cattonline.com Making Head Way www.coach.ca/concussion

Education & Awareness Campaign materials at sirc.ca/concussion

Concussion Recognition Skate Canada Safe Sport concussion recognition tool Concussion Ed mobile app

Medical assessment and clearance Medical assessment letter template Medical clearance letter template

Access these resources and more: skatecanada.ca/safe-sport parachutecanada.org/concussion

Thank You! @parachutecanada www.parachutecanada.org