Athletic Concussion Policy & Protocol

A concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. A concussion may be caused by a direct blow to the head, face, neck or elsewhere on the body with forces transmitted to the head. They typically result in a rapid onset of short lived impairment of neurological function that resolves spontaneously. These impairments include a headache or pressure in the head, dizziness or balance problems, nausea or vomiting, sensitivity to light and sounds, feeling slowed down or in a fog, visual problems, hearing problems, and irritability or emotional changes.  

Concussions can be broken down into two groups, a simple concussion and a complex concussion. A simple concussion can be categorized when an athlete suffers an injury that progressively resolves without complication over 7-10 days. This type of concussion is the most commonly represented kind of concussion seen in athletics today. A complex concussion is when an athlete suffers persistent symptoms, including persistent symptoms recurrence with exertion, concussive convulsions, prolonged loss of consciousness longer than one minute, or prolonged cognitive impairment after the injury. Complex concussions can also include athletes who have had multiple concussions over time or where repeated concussions occur with  progressively less impact force.  

Concussion Policy

  1. A medical Release of Information signed by parents, along with any physician recommended accommodations, will be given to the STA case manager.
  2. Before the student resumes classes, he will meet with his case manager who will review accommodations provided by the student’s physician.
  3. The Director of Academic Life or case manager will communicate the accommodations to parents and to the student’s teachers.
    a. Should academic accommodations keep students from taking semester exams, the Director of Academic Life, in consultation with the case manager, will determine if those exams will be waived or rescheduled for a later date.
  4. The case manager continues to meet with the student weekly until the student is symptom free.
  5. The school nurse is available as needed during the school day should concussion symptoms appear.
  6. The administration will consider academic modifications such as pass/fail grading or schedule changing if the student has had academic accommodations for three weeks.
  7. Academic modifications to curriculum and/or pass/fail grading may make the student ineligible for academic awards.
  8. In order to participate in Physical Education, STA co-curricular activities, practices, or competitions, the student and case manager must have an academic plan in place to complete make up work after the student’s physician has lifted academic accommodations.
  9. A student may not begin the Saint Thomas Academy Athletic Concussion Protocol until all academic accommodations have been lifted.

The Administration reserves the right to modify the concussion procedures for just cause.

Athletes with an Acute Injury

When a student athlete exhibits any signs and symptoms of a concussion, the following will be applied:

  1. The student athlete will not be allowed to return to play in the current game or practice.
  2. The student athlete will not be left alone, and regular monitoring for deterioration is essential over the initial few hours after injury
  3. The student athlete should be medically evaluated after the injury
  4. Return to play must follow a medically supervised stepwise process.

A student athlete should never return to play while symptomatic and need to remain symptom free during the Return to Play Protocol. The Saint Thomas Academy Sports Medicine team reserves the right to deny an athlete of participation in practice or a return to concussion protocol despite a clearance note, if the athlete is found to still be exhibiting symptoms.

Return to Play Protocol

During the first few days after an injury occurs, it’s important that student athletes have complete cognitive and physical rest. Activities requiring concentration and attention will likely exacerbate the symptoms and result in a delayed recovery. The typical stepwise progression back to exercise is as follows:

  1. No activity, complete rest until all symptoms have resolved.  Once asymptomatic, proceed to level 2.
  2. Light aerobic exercise such as walking or stationary cycling, no resistance training
  3. Sport specific exercise - skating in hockey, running in soccer, progressive addition of resistance training at steps 3 or 4
  4. Non-contact training drills
  5. Full contact training drills after medical clearance
  6. Game Play

In this stepwise progression, student athletes should only progress to the next level if they continue to remain asymptomatic for a full 24 hours. In more complex cases, the time period between levels could be delayed. In addition to being symptomatic, student athletes should also no longer be taking any prescription or over the counter medications that may affect or modify any symptoms of a concussion.

Neuropsychological Assessment After a Concussion

Neuropsychological testing, such as IMPact, after a concussion has been shown to be of value and continues to contribute significant information in a concussion evaluation. However, this should not be the sole basis of a return to play decision but rather seen as an aid to the clinical decision making. Neuropsychological testing should not be performed while an athletic is still symptomatic because it does not aid in the return to play decision making and it may contaminate the testing process by allowing practice effects to skew the results.  

In order to provide Saint Thomas Academy Student Athletes the best possible care and prevention of multiple concussions and second impact syndrome, team members of the following sports will perform baseline testing: Football, Soccer, Basketball, Lacrosse, Wrestling, Diving, Pole Vault, and Baseball. These baseline scores will be saved in an on-line database only accessible to the Saint Thomas Academy Sports Medicine Staff. If an athlete sustains a concussion we will administer a post-concussion follow-up test. These scores will be compared to their baseline scores and/or the national average for their respective sport.

When requesting test results, please allow 24 hour notice.

References

1. Gessel, BS, L. M., Fields, JD, PhD, S. K., Collins, MA, C. L., Dick, MS, FACSM, R. W., & Comstock, PhD, R. D. (2007). Concussion Among United States High School and Collegiate Athletes. Journal of Athletic Training, 42(4), 495-503.

2. McCory, P., Johnson, K., Meeuwisse, W., Aubry, M., Cantu, R., Dvorak, J., et al. (2005). Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. British Journal of Sports Medicine, 39, 196-204.