Concussion Management and Awareness Act Dave Boyland, PT, DPT, SCS, ATC Maggie Reinhard, PT, DPT, ATC Goldwyn & Boyland Physical Therapy

The Law A student diagnosed with a concussion is not to be returned to athletic activities until at least 24 hours have passed without symptoms and the student has been assessed and cleared by a medical provider to begin a graduated return to activities.

The 3 rd International Conference on Concussion in Sport Panel of Sports Medicine Physicians, Neurologists, Psychologists, Athletic Trainers, Researchers, Athletes, Coaches, etc. Endorsed by FIFA, IOC, IRB, IIHF

The 3 rd International Conference on Concussion in Sport Concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. ▫ Eliminated the terms “complex” and “simple” concussion Established Return to Play (RTP) Guidelines

Direct/Indirect Observation Any student suspected of having a concussion either based on the disclosure of a head injury, observed or reported symptoms, or by sustaining a significant blow to the head or body must be removed from athletic/physical activity and observed until an evaluation can be completed by a medical provider.

The Team Medical Director School Nurse Certified Athletic Trainer Director of Physical Education/Athletics School Administrator Teacher Coach Student Parent/Guardian

Training Course NYSED approved training course ▫ Heads up to Clinicians (CDC) Every 2 years

Who Must Take the Course? School Nurse Certified Athletic Trainer Physical Education Teacher Coach

Neurocognitive Computerized Testing Impact CogSport Headminders ANAM (Automated Neuropsychological Assessment Metrics)

Identification Amnesia Confusion Headache LOC Balance Difficulty/Dizziness Double or Blurred Vision Sensitivity to Light and/or Sound Nausea/Vomiting/Loss of Appetite

Identification Irritability/Sadness/Changes in Personality Feeling Sluggish or Light-headed Concentration or focusing problems Slowed Reaction Times Fatigue/Sleep Issues

Immediate Referral Headache that Worsens Seizures Looks drowsy or cannot be awakened Repeated Vomiting Slurred Speech Unable to recognize people or places Weakness or Numbness Unsteady Gait Dilated or Pinpoint Pupils

Sideline Assessment Tools SCAT 2 SAC BESS

SAC

Diagnosis Licensed Physician Nurse Practitioner Physician Assistant

Post-concussion Management Cognitive Rest ▫ Avoidance of participation or exposure to:  Computer and Video Games  Television Viewing  Texting  Reading or Writing  Studying or Homework  Taking a Test or Completing a Significant Project  Loud Music  Bright Lights

School Responsibility Providing Accommodations ▫ Shorter School Day ▫ Rest Periods ▫ Peer Note Takers ▫ Extended Time for Tests and Assignments

Post-concussion Management Physical Rest ▫ Adequate Sleep ▫ Taking Frequent Rest Periods and Naps ▫ Avoiding Exertion

Post-concussion Management 24 Hours SYMPTOM FREE Clearance for Return to Activity ▫ Private Medical Provider ▫ Medical Director

Return to Activity Phase 1 ▫ Low impact, non-strenuous light aerobic activity Phase 2 ▫ Higher impact, higher exertion, moderate aerobic activity Phase 3 ▫ Sport specific, non-contact activity, low resistance weight training Phase 4 ▫ Sport specific, non-contact activity, higher resistance weight training Phase 5 ▫ Full contact training drills, intense aerobic activity

Return to Activity Phase 6 ▫ Return to full activity without restrictions ▫ Determined by Medical Director

Second Impact Syndrome (SIS) A Severe, Life Threatening Condition That Causes Irreversible Brain Damage, Hemorrhage, And Cerebral Edema ▫ Almost Exclusively In Individuals Under Age 25

References esforConcussionManagement.pdf esforConcussionManagement.pdf McCrory P, Meeuwisse W, Johnston K etal. Consensus Statement on Concussion in Sport: The 3 rd International Conference on Concussion in Sport Held in Zurich, November J Ath Training. 2009;44: Wojtys EM, Hovda D, Landry G et al. Concussion in Sports. Am J Sports Med. 1999;27:

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