Concussions--Forms & Facts
REMINDER: ALL parents and athletes must sign off on the concussion information & signature sheet during on-line registration PRIOR TO PARTICIPATION in any sport.
New Guidelines - RTL/RTP Academic Procedures (2016)
Concussion Facts - Athletes
The Youth Sports Concussion Safety Act (eff. 8/3/2015) requires that all athletes must complete the school approved Return-to-Learn and Return-to-Play protocols, be cleared by a physician licensed to practice medicine in all its branches or a licensed athletic trainer working under such a physician (as the athletic trainers at LFHS are), and the parents have signed a Post-Concussion Consent Form. The IHSA has developed a form which LFHS will be requiring for all concussions occurring during the 2016-17 athletic seasons (and beyond), which can be accessed through this link.
Rule changes are what's needed to protect young athletes, expert says...read more here
- What is a concussion?
- How can you prevent a concussion?
- What about helmets?
- How should the players take care of their helmets?
- Does an athlete have to be unconscious or “knocked out” to have a concussion?
- How can you tell if someone has a concussion?
- Is it dangerous to continue playing with a concussion?
- What is the treatment for a concussion?
- How long will someone be out of sports after a concussion?
- When do you know it’s safe to start to return to play after a concussion?
- What is the return to play protocol?
- Who can clear an athlete to return to play after a concussion?
- How can I tell if my son/daughter needs to go to the doctor?
- What is this ImPACT test all about?
- Why do we need to baseline test?
- How do you decide which sports need baseline testing?
A concussion is an interruption of normal brain function caused by a force transmitted to the brain. It could occur from a blow directly to the head, or elsewhere which causes a jarring effect. It could also occur simply from rapid movement of the head, causing the brain to move inside the skull. It is primarily a functional injury, rather than a structural injury, so it usually does not show up on standard imaging studies (such as x-ray, CT scan, or MRI).
The simple answer is to not hit your head, by using proper playing technique. A phrase to remember is “Heads Up for Safety”. Rather than lowering your head and using it as your primary point of contact, keep your head up so you can see where you’re going, and take the contact with your torso, shoulder, or some other part of your body. Of course that isn’t foolproof, because the OTHER player may drop THEIR head and use THEIR helmet as a weapon, or you may be in a position or situation where you can’t avoid hitting your head.
In some sports, such as football or lacrosse, the players wear helmets that will help absorb or redirect some of the force from a blow, but relying on the helmet to protect you can give you a false sense of security. As mentioned above, a concussion can often be caused by the brain moving inside the skull. Nothing you put on the OUTSIDE of the head can stop this movement. It is logical to think that redirecting or absorbing some of the force will reduce the amount of force transmitted to the brain and therefore potentially reduce the likelihood or severity of a concussion, but ALL football helmets sold today have stickers attached to them by the manufacturer that say NO helmet can prevent a concussion. Helmets purchased by LFHS:
1. Meet or exceed all applicable industry standards for shock absorption.
2. Are issued to the athlete by coaches or athletic trainers trained and experienced in properly fitting helmets.
3. Are reconditioned according to industry standards at the end of the playing season. For example, all football helmets used during the season are picked up by a professional reconditioner. At their facility, all stickers, facemasks, hardware, and padding are removed and the shell is thoroughly examined for any cracks or defects. Similarly, all facemasks are examined for excessive bare metal, dents, etc. If any problems are found, that helmet or facemask is discarded. Then the helmets are thoroughly cleaned, painted, and new hardware and padding are installed. The final stage is to select a random assortment of our helmets and test them according to industry standards. If any of those helmets allow too much force to pass thru, they are rejected and discarded. And if too many of those tested helmets are rejected, the entire batch of helmets must be recertified.
4. Are removed from service after 5 years of use, regardless of their condition.
1. First, they should make sure it continues to fit properly. Over time, the helmet may lose some air and loosen up. Or the athlete might get a haircut, causing the helmet to loosen. And often the athlete ALLOWS it to loosen because they want it easy to take on and off, or they just prefer the feel of the loose fit. The helmet is designed to protect the head while it’s on; to do that, it needs to hold the head firmly. It shouldn’t be so tight as to squeeze the head, but it needs to hold it. If the helmet is easy to take off or put on, odds are it’s not holding the head firmly enough while it’s on.
2. Next, they should check the tightness of all the screws and hardware on a regular basis so they don’t miss playing time getting an emergency repair in the middle of the game.
3. Third, they should be careful what products they use to clean the helmet. Harsh cleaners, including citrus-based cleaners, can actually weaken the shell so it could crack and not protect the head. Water is good, and isopropyl alcohol can be used to remove adhesive residue.
4. Finally, they need to SPEAK UP. If their helmet needs air, or parts need to be replaced, or they find any other problem with their equipment, they should get it taken care of right away.
Concussions can present themselves in many different ways. The basic guideline is if they had the mechanism of injury that would produce a concussion (i.e. they hit their head), and if they have any combination of the common signs and symptoms of a concussion, you assume it’s a concussion and treat it that way. Common signs (things seen by others) include: Appears dazed or stunned; Is confused about what to do; Forgets plays; Is unsure of game, score, or opponent; Moves clumsily; Answers questions slowly; Loses consciousness; Shows behavior or personality changes; Can’t recall events prior to hit; Can’t recall events after hit. Common symptoms (things the athlete feels/reports) include: headache; nausea; balance problems or dizziness; double or fuzzy vision; sensitivity to light or noise; feeling sluggish; feeling foggy or groggy; concentration or memory problems; confusion. These signs and symptoms can change; for example, they may start off a little dizzy and have a headache, and then develop personality changes later.
It’s potentially VERY dangerous. The best-case scenario is that you will make the effects of the concussion last longer. The worst-case scenario is what’s called Second Impact Syndrome. When the brain gets a concussion, a number of chemical and physiological changes occur which make it vulnerable to another blow. That second blow can be lighter than the first blow, but cause much more severe damage. Most concussions will resolve on their own IF YOU LET THEM. If you try to play when you’re still having any symptoms, that means your brain is vulnerable and at risk. WHEN IN DOUBT, SIT THEM OUT!
The main treatment for a concussion is boredom. The brain will usually heal itself IF YOU LET IT. You need to give the brain and body lots of rest as long as you have symptoms. That means no strenuous physical OR mental activity. No video games, no television, stay off the computer and phone (including texting!), avoid bright lights and loud noises, limited studying for tests, limited homework, etc. If recommended by a Certified Athletic Trainer or other Medical Professional, staying home from school for the first day or so, and then starting back at a reduced level, may be an option. Anything that you have to concentrate on is going to prolong your symptoms. As the symptoms decrease, you can gradually start resuming these activities.
The current standard of care for sports concussions is to not put set timelines for return to play. The problem with saying “out for X days” is that the truth is no one really knows how long it will take for any specific injury. There really isn’t anything we can do to speed up the process (while some have promoted various types of treatments, medications, etc. none of them have been scientifically shown to make any significant difference), but we can very easily slow down the process. The key is to give the brain the time IT feels it needs to recover.
The decision to start back to play needs to be a joint decision between an appropriate healthcare professional (see below), the athlete, the parents, and the coach. But there are certain pieces of information that go into that decision. First and foremost, the athlete needs to be completely symptom free. If they’re still having headaches, dizziness, difficulty concentrating in school, or any of the other symptoms mentioned above, they don’t belong on the field. Once they say they’re symptom free, the next piece of information comes from testing their brain function. There are various types of tests we can do, including ImPACT, that will help us determine if their brain is really doing as well as they think it is. If they’re symptom free, their ImPACT scores are back at baseline level, and the decision team mentioned above thinks they’re ready to start, then we can begin the return to play progression.
The hallmark of the current standard of care of sports concussions is a GRADUATED return to play. The old days of sitting out X days, then going out that first day back at full speed are over. Everyone might think the athlete is completely healed, but the first time they go for a run, or the first time they take a hit, they may be right back where they started. So the athlete returns to play in stages, with 24 hours between each to make sure it isn’t bringing any symptoms back. Think of it as climbing a ladder; the safest way is one rung at a time, not skipping any steps. We start off with cardio activities, light at first and then at a higher intensity. If those don’t produce any symptoms, next we go with non-contact, sports specific drills. If they’re still feeling good the next day, then we can go with contact in practice. The first few hits should be against a tackling dummy or blocking sled, where the athlete can control the contact, then they can go live. Only after they’ve had a full contact practice with no return of symptoms are they considered safe to resume game play. If symptoms return after any of these stages, the athlete goes back to the bottom of the ladder.
The Illinois High School Association (IHSA) defines appropriate licensed health care providers as physicians licensed to practice medicine in all its branches in Illinois (Medical Doctors [MD] & Doctors of Osteopathic Medicine [DO]) and certified athletic trainers working in conjunction with physicians licensed to practice medicine in all its branches in Illinois. All 3 of our Athletic Trainers at LFHS are licensed and Certified Athletic Trainers, who work under the direction of our team physicians, who are all MDs. Under the rules for all sports from the National Federation of High Schools, “any player who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the game and shall not return to play until cleared by an appropriate health care professional.” The Illinois High School Association has further extended this policy to state “In cases when an athlete is not cleared to return to play the same day as he/she is removed from a contest following a possible head injury (i.e., concussion), the athlete shall not return to play or practice until the athlete is evaluated by and receives written clearance from a licensed health care provider [as defined above] to return to play.”
The Certified Athletic Trainers at LFHS can help you make this determination. They have over 50 years of combined experience, and have dealt with hundreds of concussions. The “red flags” to look for that mean the athlete should be seen immediately in the emergency room include: unconsciousness, decreasing level of consciousness, difficulty or inability to get their attention, increasing headaches (especially if severe), any breathing irregularity, any type of seizure, or persistent vomiting. The vast majority of concussions will not involve these symptoms and can be monitored by the athletic trainers at the school under the direction of our team physicians. In cases where the athlete’s symptoms are taking longer than usual to resolve, or the athlete has a history of repeat concussions or other conditions of concern, the athletic trainers will advise you to have the athlete seen, preferably by a physician experienced in dealing with sports concussions. If you do take the athlete to a physician, be sure to let them know that we have the ImPACT testing available at the school (especially if we have baseline data on the athlete), and can easily provide them a PDF report of the data. Also, be sure to let them know about the graduated return-to-play protocol we follow.
ImPACT falls in the category of neurocognitive testing, which looks at the thinking, knowing, remembering, judging and problem-solving abilities of the patient. A number of neuropsychologists around the country have developed computerized versions of these tests; the most widely used of these is ImPACT, developed in the early 1990s by Mark Lovell, PhD and Joseph Maroon, MD, at the University of Pennsylvania. The big advantage of ImPACT is the high availability, especially to baseline data. We can do all the testing right here at the school, so there’s no need for making appointments, travel time, or inconvenience to the student or parent. The athlete sits at a computer and completes 6 different modules, which test various forms of memory and reaction time. These results can be compared to a large bank of normative data that have been accumulated, or to the athlete’s own baseline data. We should emphasize that ImPACT doesn’t make the decision about whether or not the athlete can return to play; it’s just one more tool to provide information to the decision-making team. As per federal law, all information obtained from ImPACT is confidential and released only to personnel with a true “need to know."
While we can compare an athlete’s results with the large bank of normative data available, having a baseline makes the information more useful and accurate. Instead of comparing the athlete’s brain function to the average of thousands of other brains, we can compare their post-injury brain function to their OWN normal function established by THEIR baseline. Sometimes results look low when comparing to the norms, but their baseline shows that’s THEIR normal. On the other hand, you might have someone who comes out at the 80th percentile on a test, which you’d think is pretty good based on the norms. But their baseline was at the 98th percentile. So that shows a deficit that would have been missed without the baseline.
The key consideration is the relative potential of an athlete in the sport or activity suffering a concussion. While it would be nice to have a baseline on every athlete in the school, our priority is to baseline test as many athletes involved in contact sports (tier 1) or limited contact sports (tier 2) in a group testing format, using the Classification of Sports According to Contact developed by the American Academy of Pediatrics.
Tier 1: Boys' Football, Soccer, Basketball, Wrestling, Diving, Lacrosse, Ice Hockey and Water Polo; Girls' Field Hockey, Soccer, Diving, Basketball, Lacrosse, Ice Hockey and Water Polo
Tier 2: Boys' Baseball, Volleyball, Pole Vault, and High Jump; Girls' Cheerleading, Volleyball, Gymnastics, Softball, Pole Vault, and High Jump
Tier 3: Boys' Cross Country, Golf, Swimming, Track, and Tennis; Girls' Cross Country, Poms, Golf, Swimming, Tennis, Badminton, and Track
If you wish your athlete to have a baseline test and they did not attend a group testing, please contact the athletic trainers and arrangements will be made.