Concussion Management Plan

Carmel Medical Education on Concussion Management

Medical management of concussions is evolving. In recent years there has been a significant amount of research into concussions. This document has two goals:

1. To educate students and parents of the signs and symptoms of a concussion
2. To inform parents of the possible consequences of unreported incidents.

Concussion: Also referred to as Traumatic Brain Injury (TBI). A brain injury that causes changes in how the brain cells function leading to symptoms that can be physical, cognitive or emotional. It is a complex pathophysiological process affecting the brain induced by traumatic biochemical forces. Here are some signs and symptoms to be aware of. All do not have to be experienced to suffer from a concussion.

Signs (observed by others):
Appears "dazed" or "stunned"
Confusion
Forgets plays
Moves clumsily/balance problems
Personality changes
Responds slowly to questions
Forgets events prior to the hit
Forgets events after the hit
Loss of consciousness

Symptoms (reported by athlete):
Headache
Fatigue
Nausea/vomiting
Sensitivity to light or noise
Feels sluggish/foggy
Problems concentrating
Problems remembering

Second Impact Syndrome (SIS): A condition in which the brain swells rapidly and catastrophically after a person suffers a second concussion or head injury before symptoms of a previous one has subsided. The second blow may occur days or weeks after an initial concussion. Even a mild grad concussion can lead to SIS. This condition is often fatal or can lead to permanent brain damage. If you have signs or symptoms of a concussion or recognize someone that does, it should be reported immediately to the athletic trainer or school nurse. If neither is available, you should visit a physician or the emergency room.

STAGE 1
   Activity: Rest until symptom-free (asymptomatic)
   Progression:  To begin stage one the athlete must be completely symptom-free for a 24-hour period

STAGE 2
   Activity: Light aerobic exercise
   Progression:
      Fast walk/stationary bike or elliptical for 15-20 minutes, supervised
      Stop activity if any signs or symptoms return
      If symptomatic post-exertion within 24 hours, rest until asymptomatic and restart stage 2
      When asymptomatic for 24 hours, successful completion of stage 2 may proceed to stage 3 the following day

STAGE 3
   Activity: Moderate aerobic exercise
   Progression:
      Jogging/running 20 minutes, supervised
      Stop activity if any signs or symptoms return
      If symptomatic post exertion within 24 hours, rest until asymptomatic and restart stage 3
      When asymptomatic for 24 hours, successful completion of stage 3 may proceed to stage 4 the following day

STAGE 4
   Activity: Non-contact sport-specific activity
   Progression:
      Sport-specific drills i.e. - dribbling, catching, throwing, agility up to 1 hour
      Stop activity if any signs or symptoms return
      If symptomatic post-exertion within 24 hours, rest until asymptomatic and restart stage 4
      When asymptomatic for 24 hours, successful completion of stage 4 may proceed to stage 5 the following day

STAGE 5
   Activity: Full participation in practice without contact
   Progression:
      No scrimmaging
      Stop activity if any signs or sympto9ms return
      If symptomatic post exertion within 24 hours, rest until asymptomatic and restart stage 5
      When asymptomatic for 24 hours, successful completion of stage 5 may proceed to stage 6 the following day

STAGE 6
   Activity: Full participation in practice no restriction
   Progression:
      Scrimmaging is allowed and athlete can participate in all drills
      Stop activity if any signs or symptoms return
      If symptomatic post exertion within 24 hours, rest until asymptomatic and restart stage 6
      When asymptomatic for 24 hours, successful completion of stage 6 may proceed to stage 7 the following day

STAGE 7
   Activity: Cleared for RTP to competition, no restrictions
   Progression: Final clearance by athletic trainer

NOTES

• No more than one stage can be performed on any given day. If the athlete experiences any symptoms during any phase or the following 24 hours the athlete will drop back down to the previous asymptomatic stage and resume the progress after 24 hours.
• If there are previous concussions the athlete will be handled on a case-by-case basis. Athletes with 2 or more concussions will require additional rest and may be held out for the season. Athletes with 3 or more concussions will not be allowed to participate in contact sports until cleared by a neurologist.