1. Sport NI Concussion Care Pathway.
Impact.
Sport NI Concussion Care Pathway.

2. NI Sports Concussion Care Pathway

3. Impact. Sport NI Concussion Care Pathway.
Please find here information and resources to help manage Sports Concussion in Northern Ireland.
Successfully treating Sports Concussion requires moving through the following three pillars of management
Early Recognition
Management
Return to Sport Protocols

4. NI Sports Concussion Guidelines.
Caution
Age Group
Minimum period of rest
Period between progression in Graduated Return to Play Protocol.
Minimum period between Concussion and return to full impact sport
Athletes should only commence return to play protocol when medically cleared to do so.
NB. Some sports recommend longer return to play time frames than are recommended here.
Under 20’s
2 weeks
2 days
21 days
Adults
1 week
1 day
14 day

5. 1 )What is1) What is Concussion it? 2)Recognising concussion.
Early Recognition
1 )What is1) What is Concussion it?
2)Recognising concussion.
3) Assessing concussion.
Medical Discharge Advice.

6. 1) What is Concussion
Concussion is a traumatic injury that causes alterations in brain function occurring either by receiving a direct hit to the head, or an indirect impulse to the head via the body.
Concussed athletes are at high risk of sustaining a more severe brain injury if they receive a second impact.
Most athletes are unaware they have sustained a concussion and don`t lose consciousness. It is important therefore that we recognise concussion and remove athletes from play. Athletes who have been concussed should not return to play until they have been medically cleared to do so.
Thankfully the majority of concussions resolve with several days of rest.

7. 2) Recognising Concussion.
If an athlete sustains a concussion they may exhibit signs and symptoms immediately, or they can develop over a number of hours through to the following 1-2 days.
Some signs of a serious head injury are obvious with the athlete requiring urgent medical assessment – examples include an athlete who is knocked out, an athlete lying motionless, having seizures or losing their balance and falling over.
However, on most occasions the signs of concussion are more subtle causing changes only to an athletes behaviour or how they look. The following clues may alert you to concussion:
Visible signs: dazed/blank facial expression, vomiting, lack of co-ordination/balance.
Behavioural changes: confusion or repeatedly asking the same questions, lack of awareness in where they are at, or of recent events, agitation.
Athlete may complain of: headache, a pressure in their head, dizziness, blurred vision.

8. 3) Assessing concussion.
If you suspect someone is concussed remove them from play and get them medically assessed.
Concussed athletes sometimes have difficulty remembering recent events. It is useful to assess for this as it may help confirm a concussion. Appropriate questions can be found on the “Pocket Scat” tool attached below.
Please record anything you have observed on a “Pocket Scat Document” so that this information can be transferred with the athlete for any subsequent medical assessments. Concussed athletes will often forget events which occur around the time of their concussion and are therefore unable to describe this to someone managing their condition.
Pocket scat

9. Medical Discharge Advice.
Document to be created.

10. Acute Episode
Management
Returning to Sport

11. Fundamentals of treatment Physical Rest Cognitive Rest
Management
Fundamentals of treatment
Physical Rest
Cognitive Rest
Concussion assessment tools
Unresolving sysmptoms

12. Fundamentals of Treatment: “Rest the Body-Rest the Brain”.
The mainstay of concussion treatment is simply Rest! Both Physical and Mental Rest.
80-90% of Concussions resolve spontaneously within 7-10 days.
Symptoms should be clear before you return to Sport.
It is recommended you seek medical clearance to ensure your symptoms are clear and that it is appropriate to begin return to play protocols.
Returning to sport when the brain hasn’t completely recovered is dangerous and an athlete can be exposed to “second impact syndrome” if they receive another trauma. Young athletes are at greater risk of second impact syndrome and this can be fatal.

13. Physical Rest
Thankfully most concussions resolve with rest. It is important that the athlete avoids exercise until symptoms settle. Why? Raising blood pressure and heart rate can aggravate symptoms and slow down recovery.
When we recommend avoiding exercise we don’t expect athletes to become completely bedbound…it is OK to stand, walk, and move around.
Once symptoms have settled and you have been medically cleared to recommence exercise then you should follow a return to play protocol specific for your sport. A generic return to sport protocol is provided in this resource.

14. Assessment tools
As there are currently no absolute diagnostic tests for Concussion the current best practice guidelines suggest we use the following tools to aid decision making:
Adults SCAT3
Children SCAT3 ages 5-12.
Videos and demos available at World Rugby Concussion Resource:
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15. Un-resolving Symptoms- advice for Medical Providers.
Unfortunately a small number of athletes have ongoing problems following concussion. Athletes may present with any of a wide array of ongoing symptoms that long term may be classed as Post Concussion Syndrome.
Common problems are ongoing sleep disturbance, headaches, dizziness, sensitivity to light or noise, mood disorders to include irritability.
If an athlete is symptomatic beyond 2 weeks consider onward referral to Secondary care. Providers of this specialism would be Sports Medicine Departments /Neurology /Neurosurgery Departments.
Sometimes Concussions have associated vestibular or cervicogenic components that influence ongoing symptoms of dizziness, headache and balance disturbance. Where this has been identified then appropriate treatment should be delivered by other disciples such as Physiotherapy.

16. Cognitive Rest
As concussion is a mild brain injury – it is recommended that athletes avoid working their brain “too” hard until their symptoms settle.
Concussion often affects our cognitive ability such that it is hard to concentrate and process information. This can affect our ability to work or study.
Cognitive activity is defined as anything that taxes the brain. This would include anything from reading, to doing homework, to watching TV or going to a movie, and it also includes texting, being on the phone, or being on the computer.
Current research suggests that concussed individuals who engage in high levels of cognitive activity take longer to recover than individuals who modify their cognitive activity. Naomi Brown : Pediatrics.
It is therefore advised upon sustaining a concussion that the athlete to take 1-2 days off work/school to recover.
Prolonged absence from school/work is generally not felt to be constructive. Upon return to school or the workplace some temporary adjustments may need to be made to ensure that the injured brain isn’t overexerted too early, provoking symptoms and delaying full recovery.

17. NI Sports Concussion Return To Learn Protocol
Stage
Immediate Post Concussion
Initial Cognitive activity.
Moderate Cognitive Activity.
Full Cognitive Activity.
Advice
48 hours complete cognitive rest.
Engage in short periods of activity requiring attention.
Recommence activities requiring sustained attention/concentration.
Engage in all activities that involve full concentration and retention of information.
Practical implication.
Rest at home in a quiet environment- avoiding reading, homework, texting, computers, gaming etc.
Return to environments which involve conversation. Try short periods of watching TV. Take a walk outside. Continue to avoid activities that require processing or retention of information.
Return to lessons, recommence reading, homework. Short periods of gaming.
Recommence study, attend all lectures/exams. Use computers/gaming

18. Standardised letter for educational institutions/ employers.

19. Resources/Links
Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms:
01/01/peds full.pdf

20. Return to Play Protocol