Sports Concussion Program

A concussion is a brain injury that can be caused by a blow to the head or body that disrupts normal functioning of the brain. Concussions are a type of Traumatic Brain Injury (TBI), which can range from mild to severe and can disrupt the way the brain normally functions. Concussions can cause significant and sustained neuropsychological impairment affecting problem solving, planning, memory, attention, concentration, and behavior.

The Centers for Disease Control and Prevention estimates that 300,000 concussions are sustained during sports related activities nationwide, and more than 62,000 concussions are sustained each year in high school contact sports.

Second-impact syndrome occurs when a person sustains a second concussion before being fully healed from a previous concussion. It can lead to severe impairment and even death of the victim.

Most people recover quickly and fully from a concussion. However, symptoms can last for days, weeks, or longer. Recovery tends to be longer with older adults, teens and young children.  Symptoms typically fall into four categories: Thinking/Remembering, Physical, Emotional / Mood, and sleep. While some of these symptoms may appear right away, others may not be noticed for days or months after the injury.

Learn all you can about concussions. What causes them and what are the signs and symptoms of one?

Get Baseline Testing on your children prior to sport participation.

Find out if your child’s school has a concussion prevention program and if the coaches, administrators, guidance counselors, and health care professionals are getting the required education.

Partner with your schools to set up a strong concussion education and response program.

Don’t Play with concussions. If you think you have a problem, talk to someone.

Don’t let your friends play with concussions. If you think they have symptoms, tell a coach.

Make sure to get enough rest—between games and between seasons.

1. Know your state law regarding concussion. What is your role and responsibility?

Pennsylvania

Coaches must take training courses—Once each school year, coaches must complete a concussion management certification training course offered by the Centers for Disease Control and Prevention, the National Federation of State High School Associations, or another provider approved by the Pennsylvania Department of Health. A coach can not coach an athletic activity until he or she has completed the required training course - See more here. 

All school districts, charter, and non-public schools that participate in interscholastic sports will distribute annually this educational fact to all student athletes and obtain a signed acknowledgement from each parent/guardian and student-athlete.

Each school district, charter, and non-public school shall develop a written policy describing the prevention and treatment of sports-related concussion and other head injuries sustained by interscholastic student or athletes.

New Jersey

Legislation (P.L. 2010, Chapter 94) signed on December 7, 2010, mandated measures to be taken in order to ensure the safety of K-12 student-athletes involved in interscholastic sports in New Jersey. It is imperative that athletes, coaches, and parent/guardians are educated about the nature and treatment of sports related concussions and other head injuries. The legislation states that:

All Coaches, Athletic Trainers, School Nurses, and School/Team Physicians shall complete an Interscholastic Head Injury Safety Training Program by the 2011-2012 school year.

All school districts, charter, and non-public schools that participate in interscholastic sports will distribute annually this educational fact to all student athletes and obtain a signed acknowledgement from each parent/guardian and student-athlete.

Each school district, charter, and non-public school shall develop a written policy describing the prevention and treatment of sports-related concussion and other head injuries sustained by interscholastic student or athletes.

Any student or athlete who participates in an interscholastic sports program and is suspected of sustaining a concussion will be immediately removed from competition or practice. The student-athlete will not be allowed to return to competition or practice until he/she has written clearance from a physician trained in concussion treatment and has completed his/her district’s graduated return-to-play protocol.

2. Learn all you can about the signs and symptoms of a concussion.

3. If an athlete is suspected of having a concussion, that player should be pulled out of play immediately and evaluated by a trained health professional. Athlete should not be permitted to return to play on the same day. When in doubt, sit them out. No game is worth a child’s future

4. Assume the role of field decision maker; don't let others, even parents, persuade you to keep an injured athlete in the game. 

1. All parents, players, coaches and community members can receive education from the following:

• Safe Sports International’s Concussion Wise program at www.concussionwise.com
• Centers for Disease Control and Prevention’s Heads Up program, at www.cdc.gov/concussion/HeadsUp/youth.html

2. If an athlete is suspected of having a concussion, that player should be pulled out of play immediately and evaluated by a trained health professional. Athlete should not be permitted to return to play on the same day. When in doubt, sit them out. No game is worth a child’s future.

When can a concussed patient return to the classroom?

In general, students are returned to school on a limited schedule. This may include limiting coursework, an abbreviated schedule, or arranging their return-to-classroom plan around classes where neurocognitive improvement is shown. Classroom work is reintroduced gradually. Sometimes it is necessary to drop a student to a less rigorous level while they ease back into coursework. Accommodations are recommended based on the individual patient’s symptoms, for example, seating away from bright lights and noise or supplementing presentations with printouts to reduce eye strain. Students are typically held from participation in recess and physical education classes. Those who participate in organized sports will follow a separate return-to-play protocol.

When is a concussed athlete cleared to return to play?

Once the patient has become symptom free for 24–48 hours, is taking no medications to control symptoms, and has a computerized neurocognitive test such as ImPACT that has approached baseline scores, the patient may begin a return-to-play protocol. This protocol was first proposed by the Concussion in Sport Group and has been approved by many sports medicine bodies over the last several years.

• Step 1: complete rest for 24 hours.
• Step 2: light aerobic exercise such as cycling or walking to increase heart rate to 70 % of maximum predicted heart rate
• Step 3: sport specific training which adds movement to the treatment paradigm
• Step 4: non-contact training drills that add exercise, coordination and cognitive load to the treatment paradigm
• Step 5: When the patient is symptom free, he or she may begin full contact training to restore confidence and assess functional skills. If the patient becomes symptomatic at any time, he or she is dropped to the step previous and progression is again attempted after 24 hours.

If there’s more change to make for safety, make it.

Don’t wait for legislation. Your school board can go beyond what the law calls for, e.g. cognitive testing, hiring athletic trainers.

Treatment TAB at the Rothman Orthopaedic Institute for your sports concussion injury will begin with a complete history and physical examination.

History:

• Number of concussions
• Symptoms
• Loss of consciousness and/or amnesia
• Duration of missed activity
• Number of missed practices and/or games
• Previous concussions
• Recovery time

Physical Exam:

• Vital signs
• Speech and gait analysis
• Full musculoskeletal and neurological examination
• Cranial nerve evaluation
• Romberg and Pronator Drift Tests
• Point to Point Discrimination Testing, and Vestibular and Balance Testing, with special consideration given to performing a BESS (Balance Error Scoring System) test
• Neuropsychological testing– ideally comparing to baseline – to check the cognitive function of the athlete’s brain.

What are the goals of treatment?

Concussion is treated symptomatically. Only when the athlete is symptom free, not taking any medication for symptom control, and has normal cognitive levels evidenced by computer neurocognitive testing can the athlete be placed on a return-to-activity protocol. The goals of treatment are to control symptoms, prevent the cumulative effects of concussion, prevent Second Impact Syndrome, and prevent Post-Concussion Syndrome. First line treatment is mental and physical rest that includes refraining from things that can challenge the vestibular and cognitive system such as texting, video games or long periods of reading. Each patient will have a treatment plan tailored to their needs.

What other treatments may a concussed patient receive?

Vestibular and physical rehabilitation can be used for patients with vestibular components of concussion such as those with balance and coordination issues. Ophthalmologic retraining either via formal programs or computer can be used for those patients with visual dysfunctions. Cognitive rehabilitation is a treatment option for those patients with severe cognitive dysfunction discovered during formal neuropsychological testing. Finally, patients who admit to beginning symptoms of a co-morbid mood disorder, such as depression, benefit from immediate psychological intervention.

Get your Team tested

If you or your group would like more information on Baseline testing or would like to schedule a test, please email Linda Mazzoli at Linda.Mazzoli@rothmanortho.com.

Neurocognitive

ImPACT (Immediate Post Concussion Assessment and Cognitive Testing) is a non-invasive cognitive screening made up of computerized tasks for the purpose of measuring skills commonly affected by concussion—skills such as memory, reaction time and processing speed. If a concussion is suspected, a clinician will re-administer ImPACT and compare the athlete’s healthy pre-injury scores to their post-injury scores, enabling them to make a more informed decision about the athlete’s recovery plan and ultimately about his or her ability to return to play and return to learn. An ImPACT baseline exam is not a measure of intelligence OR a diagnostic tool, it is simply a measure of your current cognitive state.

Response / Reaction Time

The King-Devick screening test is an objective measure used in concussion recognition geared toward the coach, athletic trainer, or sideline healthcare professional in concussion response and removal from play. This measure requires the athlete to quickly track numbers across a page or screen, providing information about visual processing speed. By obtaining an athlete’s baseline scores prior to concussion, healthcare and sideline professionals are better able to gauge changes in cognition and behavior.

Postural Screening

Recent findings indicate possible correlations between muscle imbalances and increased risk for concussive injury. In an effort to understand each individual’s potential for muscle imbalances, biomechanical postural screens will provide a view of muscle weaknesses, indications of scoliosis, and other potential deficiencies in core stability prior to the athletic season.

Balance / Vestibular

By using various postural stances and accompanying clinical scores, individual balance measurements prior to the athletic season provide physicians, athletic trainers, and other concussion management specialists the ability to better assess the effects of concussion on balance and coordination.

Research

The concussion specialists at the Rothman Sports Concussion Institute are leaders in research, education, treatment and management of the concussed athlete. Together with the community we can create an educated youth prepared to play sports at all levels—using our heads before the game.

Frequently Asked Questions about Baseline Testing Who should have a baseline screening?

Student athletes over the age of 10 should have a current baseline measure on file.

How often should my athlete have a baseline screening?

It is recommended that athletes receive an ImPACT baseline screening every two years from 6th grade to senior year of high school. In college and at the professional level, athletes should only be tested once.

How long does the baseline screening take to complete?

Depending on the screening package you choose, time from start to completion will range from approximately 45 minutes to 2 hours.

How should I prepare my athlete for his/her baseline screening?

Your athlete should be 100% cleared of all prior concussions, well rested, feeling healthy, and have refrained from physical exertion three hours prior to testing.

Is the baseline measure a test of my athlete’s abilities?

The baseline screening is not a test like those given in school and it cannot be used to make any diagnosis of a learning disorder or other illness or disability. It is strictly a healthy baseline marker used for post-concussion comparison.

What do I do if I suspect my athlete has sustained a concussion?

Have your athlete evaluated by a Rothman physician trained in sports concussion treatment and manage¬ment or schedule an appointment with one of our concussion experts.