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

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

3. 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

4. 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)

5. 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

6. 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.

7. 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

8. 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.

9. 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

10. 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.”

11. 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)

12. 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.

13. 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

14. 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

15. 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.

16. 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

17. 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.

18. 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 #:
SCORE Hotline Hours:
Mon-Fri 8am-9pm
Sat-Sun 10am-9pm

19. 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

20. 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!

21. 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.

22. 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.

23. 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.

24. 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!

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

26. 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

27. 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

28. 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

29. 0= Not a problem
2= Moderate problem
4= Severe problem

31. 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

32. 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.

34. 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

35. 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

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