Coaches Understanding Sports-Related Concussion Safe Concussion Outcome, Recovery & Education (SCORE) Program Children’s National Medical Center Washington, DC

USA Hockey Foundation Project Goal of Project: Maximize safety of youth hockey players, specifically as it relates to the prevention and management of concussion.

USA Hockey Foundation Project Completed with support from USA Hockey Foundation (Heads Up Hockey) In collaboration with Gardens Ice House and Montgomery Youth Hockey Association Modeled after NHL Concussion Program Education, Baseline Testing, Post-Concussion Evaluation & Gradual Return-To-Play

1997 NHL REQUIRES BASELINE TESTING FOR ALL ATHLETES Over 3800 athletes tested 800 concussion evaluations Player and league supported Post-Concussion Evaluation Gradual Return-To-Play Eric Lindros (8 reported concussions)

Four-Part Concussion Education & Management Program Education: Increase knowledge of signs, symptoms, and risks associated with concussion Baseline: Establish pre-season baseline levels of concussion symptoms Early ID of concussion: Promote effective, early identification of concussions Return to play: Implement safe return-to-play (RTP) protocol

Key Starting Points Concussions can occur in any sport Ice hockey is a safe sport Concussions are relatively infrequent Concussions vary with the level, skill & intensity of the play. Individual’s likely vary in their susceptibility to concussion. Proper management of a suspected concussion significantly reduces the chances of a bad outcome.

Four-Part Concussion Education & Management Program Education: Increase knowledge of signs, symptoms, and risks associated with concussion Baseline: Establish pre-season baseline levels of concussion symptoms Early ID of concussion: Promote effective, early identification of concussions Return to play: Implement safe return-to-play (RTP) protocol

What is a Concussion? A concussion is an injury to the brain that: Is caused by a bump, blow or jolt to the head. Can change the way the brain normally works. Can range from mild to severe. Can occur during practices or games in any sport.

What are the Symptoms of a Concussion? 3 symptom types Physical: Headache, nausea, balance problems, double/fuzzy vision, sensitivity to light or noise, feel sluggish, dizziness Thinking: Poor concentration, memory, trouble following conversation, fogginess, confusion Emotions: irritable, more emotional, sadness

Do you need to lose consciousness with a concussion? NO! You may or may not have a loss of consciousness Only a small % do (approx 10)! Can happen even if you haven’t been knocked out. Can be serious even if you’ve just been “dinged” or had your “bell rung.”

Incidence Traumatic brain injury (TBI) is among the most common injuries in children Annually, more than one million children sustain a TBI; 80-90% “ mild” Concussion = Mild TBI Estimated 300,000 sports-related concussions per year (likely an underestimate by 3-8x)

How do you know if a player has had a Concussion? After a blow, something seems different. You might notice some symptoms right away (confusion, loss of balance, fogginess, memory). Player is not following the game or the plays. BUT - Other symptoms may take hours, days, or weeks (headache, irritability, poor concentration). Later on, difficulties with schoolwork, completing everyday tasks, irritability.

What Parents/ Coaches/ Teammates See (Signs) Appears dazed, stunned, glassy Confused about tasks, game assignment Forgetful, repeating same questions Unsure of game, score, opponent Moves clumsily Answers questions slowly Shows behavior or personality changes Can’t recall events before hit or after hit Loses consciousness

Symptoms The Player May Report Headache Nausea Balance problems, dizziness Double or fuzzy vision Sensitivity to light or noise Feeling sluggish or slowed down Feeling foggy or groggy Concentration or memory problems Confusion

What to do if your player has a Concussion Initial Assessment - Do NOT ignore a blow or jolt to the head. Observe the player for signs and symptoms. If a Concussion is suspected, implement the ACTION PLAN. When in doubt, sit them out.

Basic Assessment Observe player for signs & symptoms Questions to Ask: Check Concussion Card or clipboard Questions to Ask: Score of game, Who playing, Last Play, Current Period What happened right before hit What happened right after hit Symptom list (card/ clipboard) Questions Not to Ask (not useful) Name of self or others Day, date, time, where they are (orientation) How many fingers

ACTION PLAN Do NOT allow the player to play with symptoms. Remove the player from the game/ practice. Inform the parents. Encourage a medical checkup. Obtain a proper evaluation by sports concussion expert. Allow return to play only with permission from an appropriate health care professional.

What if I Have Questions about a possible Concussion? If Coach, Parent, or Player has any question: Call the SCORE Information Hotline to discuss with a Concussion consultant SCORE Hotline #: 240-426-8057 SCORE Hotline Hours: Mon-Fri 8am-9pm Sat-Sun 10am-9pm

Treatment of a Concussion Give yourself time to recover. REST! Your brain needs to heal. If not healed, your brain is more likely to be injured again - and worse. Recovery can take several days or weeks. Manage physicial (e.g., running, weightlifting) and cognitive (e.g., schoolwork, homework) exertion

What could happen if nothing is done? Player is more likely to be re-injured. Second/ third... injuries: are more likely to be more severe could cause permanent brain damage can take longer to recover from. The player is put in greater danger. The player is not helping their team or teammates. Teammates must help their fellow teammates!

After a Concussion, When Can the Player Return to Play? No longer have symptoms No longer need medicine to control symptoms. Cognitive/ thinking skills back to “normal.” Cleared by medical professional.

After a Concussion Gradual Return to Play Protocol After rest and gradual activity (exertion) Light aerobic exercise such as walking or stationary cycling. Sport specific training. Non-contact training drills. Full contact training. Game play.

How Can Concussions be Prevented? Follow the sport’s safety rules (especially checking, rough play). Good sportsmanship. Use proper equipment. Right equipment for the sport and position. Use equipment properly. Properly fitted. Use it every time you play. Do not ignore a blow or jolt to the head.

Play Hard! Play Safe! Play Smart! Key Ending Points Know what a concussion is and its symptoms. Dings and bell-ringers count! 3 types of symptoms: physical, thinking, emotional Don’t Ignore. Observe the players, tell parents. Encourage teammates to watch out for their friends. When in doubt, consult with SCORE. Give TIME to recover. REST! Follow the sports’ rules safely. Use the equipment properly. Play Hard! Play Safe! Play Smart!

It’s better to miss a game or two than the whole season or a career!

Four-Part Concussion Education and Management Program Education: Increase knowledge of signs, symptoms, and risks associated with concussion Baseline: Establish pre-season baseline levels of concussion symptoms Early ID of concussion: Promote effective, early identification of concussions Return to play: Implement safe return-to-play (RTP) protocol

Pre-Season Symptom Baseline Assess presence of any “symptoms” prior to any injury Allows for comparison following an injury Identify number and degree of symptoms After an injury, symptoms are monitored until return to pre-injury levels Assist in guiding a safe return to play

Pre-Season Symptom Baseline With parental permission, complete baseline assessment by both parent and athlete Copies of baseline assessments collected by SCORE staff; will be returned to parents for their records Letter to pediatrician indicating that baseline has been completed, should a concussion occur

0= Not a problem 2= Moderate problem 4= Severe problem

Four-Part Concussion Education and Management Program Education: Increase knowledge of signs, symptoms, and risks associated with concussion Baseline: Establish pre-season baseline levels of concussion symptoms Early ID of concussion: Promote effective, early identification of concussions Return to play: Implement safe return-to-play (RTP) protocol

Concussion Identification and Return to Play Implement the ACTION PLAN Should an injury occur, SCORE staff can provide consultation and evaluation, in collaboration with athlete’s physician Return to Play: Ideally, conducted by certified athletic trainer.

Safe Concussion Outcome, Recovery, and Education (SCORE) Program Staff includes neuropsychologists, sports medicine physician, and athletic trainer Symptom monitoring and concussion-specific neuropsychological testing Computerized testing (ImPACT) assessing attention, memory, and processing speed/ reaction time

Safe Concussion Outcome, Recovery, and Education (SCORE) Program Provide consultation to coaches and trainers regarding safe return to play Provide consultation to schools regarding academic issues

SCORE Hotline If Coach, Parent, or Player has any question: Call the SCORE Hotline to discuss with a Concussion consultant SCORE Hotline #: 240-426-8057 SCORE Hotline Hours: Mon-Fri 8am-9pm Sat-Sun 10am-9pm