Prince William County Public Schools High School Concussion

Prince William County Public Schools High School Concussion Education For Grade 9 and New High School Students 2019 -20 HS Face-To-Face 1

Presentation Objectives This presentation will provide you: Definition of concussion and Second Impact Syndrome; Identify possible signs and symptoms of a concussion or Traumatic Brain Injury (TBI); Understand the process for reporting a concussion Learn Prince William County Public Schools concussion management process; Understand who to contact for proper medical treatment and referral guidelines • Understand the protocol for Return-to-Learn [Return-to. School]and Return-to-Play HS Face-To-Face 2

Virginia State Law On an annual basis, each school district shall provide student athletes with information on concussions and each student athlete and the student athlete's parent/guardian shall sign a statement acknowledging receipt of the information. The athlete must obtain written clearance to return to play from the health care provider. HS Face-To-Face 3

Virginia State Law Policies and regulations implemented by Prince William County Public Schools for handling studentathlete concussions, include the state mandated protocol and care for athletes suspected of sustaining a concussion or head injury. This includes the removal from play until evaluated by a licensed health care provider. HS Face-To-Face 4

Prince William County Regulation 759 -1: • All staff, coaches, school health nurses, certified athletic trainers, volunteer coaches, participating students, and parents/guardians of participating students will complete concussion training annually. • The training will include the Return-To-Play and Return -To-Learn protocols that will be implemented when a concussion injury occurs. HS Face-To-Face 5

Concussion Defined A concussion is a brain injury that results in the rapid onset of shortlived impairment of neurological function that resolve. Direct force- a blow to the head, face or neck Indirect force- elsewhere on the body with an impulsive forces that is transmitted to the head HS Face-To-Face 6

Effects of Concussive Forces on the Brain This invisible injury disrupts the way the brain normally works by affecting mental stamina, as the brain must work longer and harder even to complete simple tasks. 7

Effects of Concussive Forces on the Brain A concussion is a functional injury, not a structural injury. Typically, the “software” of the brain is affected, chemical changes. HS Face-To-Face Not the “hardware” or a physical injury. 8

Signs or Symptoms Observed by Coaches, Staff and Teammates üSlow reaction time üDizziness üLoss of consciousness üDazed or confused üBalance problems üMemory loss üHeadache üConfusion üBehavioral changes üSleep/wake disturbances HS Face-To-Face 9

Signs or Symptoms at Home Behavioral changes Difficulty completing tasks Reduced play/ activity Changes in sleep patterns Peronality changes Fatigue Irritability HS Face-To-Face 10

Signs or Symptoms in the Classroom Decreased attention span May not be able to finish homework assignments Difficulty concentrating May not be able to take tests in school Slowed reaction time May be slow to answer questions Driving can be impaired Visual Sensitivities Student may strggle with screen time (smartboard, computer) A+ student may become C- student HS Face-To-Face 11

Referral Guidelines An athlete will be immediately referred to an Emergency Department via ambulance in the event of… • • Witnessed or reported loss of consciousness Decreasing level of consciousness Difficulty breathing Suspected spine injuries or skull fractures Following an emergency department visit, all athletes must follow up with a primary care physician or specialist! Athlete’s parents will be given a copy of the Acute Concussion Evaluation to take their physician or ER for a follow up evaluation. HS Face-To-Face 12

How long does it take for symptoms to resolve? Just like Snowflakes… No Two Concussions Are Alike No one knows how long it will take for symptoms to resolve! HS Face-To-Face 13

Importance of Managing Concussion Risks • Timely evaluation by an appropriate medical provider, trained in concussion evaluation and management. • Return to play for 3 minutes after a concussion increases your risk for prolonged recovery • Clinical evaluation, vestibular testing and Im. PACT are tools used to diagnose a concussion. • NO imagining techniques used will detect concussions. HS Face-To-Face 14

What’s the worst thing that could happen? ? ? HS Face-To-Face 15

Second Impact Syndrome occurs when an athlete, who has already sustained a head injury, sustains a secondary head injury before symptoms have fully resolved. HS Face-To-Face 16

Second Impact Syndrome Can result in loss of brain function, decreased blood supply, and increased intracranial pressure. Only occurs in persons under the age of 23 50% of occurrences are fatal 100% result in some form of physiological, cognitive, and/or emotional disability HS Face-To-Face 17

Concussion Recovery: Everyone has a responsibility to: - Know Concussion Signs and Symptoms - Understand importance of communication - Work collaboratively to implement Return-To. Learn progression when required - Understand the protocol for Return-To-Play HS Face-To-Face 18

Coaches Responsibility: Four Step Action Plan Step 1: Remove the athlete from play. DO NOT try to judge the severity of the injury yourself. . Step 2: Ensure that the athlete is evaluated by a health care professional experienced in evaluating concussions. Step 3: Inform the athlete’s parents or guardians about the possible concussion. Step 4: Keep the athlete out of play until they receive clearance from the health care professional. HS Face-To-Face 19

Parents Responsibilities Support the decision to remove from further play in high school and recreational sport leagues Contact ATC, coach, and/or administration if your child reports symptoms to you following practice/game Encourage rest both cognitive and physical Understand the Return-To-Play and Return-To-Learn protocols WHEN IN DOUBT, SIT THEM OUT! HS Face-To-Face 20

Student-Athlete Responsibilities Report symptoms to coaches and athletic trainers 50% to 70% of concussions go unreported Advocating for themselves in the classroom Communicate consistantly with all memers of the concussion management team and parents. HS Face-To-Face 21

Role of a Licensed Athletic Trainer (AT) As a licensed health care provider through certification by the Virginia Board of Education, Virginia Board of Medicine and Virginia Concussion Law, the AT is able to provide: Evaluation of the student-athletes for potential concussion after head injuries; Collaborate with a physician to determine concussion management; Direction for the use of the PWCS concussion policy and protocol; Return-To. Learn & Return-To. Play HS Face-To-Face 22

Responsibilities of the PWCS Athletic Trainer Provide Im. PACT testing to all athletes prior to the season and after injury Assess student injuries to determine next steps using approved sideline assessment tools When symptoms are apparent, recommendations are provided to begin recovery; Monitor Return-To-Learn & Monitor Return-To-Play HS Face-To-Face 23

Concussion Testing & Monitoring Tools Im. PACT testing • Annual baseline testing prior to sport season for all athletes per county reg 759 -1 • Post-concussion testing and retesting completed at appropriate intervals Sideline Assessment (ie SACVNI, SCAT 5, etc) • Exam consists of short-term memory, delayed recall, orientation, exertional maneuvers, concentration, and neurological function • ACE (Acute Concussion Evaluation) complete after assessment for communication between health care providers. HS Face-To-Face 24

Who is an appropriate medical professional? APPROVED State Licensed Athletic Trainer Primary Care Physician Neuropsychologist Physician’s Assistant Nurse Practitioner Doctor of Osteopath HS Face-To-Face NON APPROVED ER Doctor (no followup care) Urgent Care Physician Chiropractor Physical Therapists 25

Communication as a Team Development of Concussion Management Teams (CMTs) and a working chain of communication is imperative. This initiative will allow for smooth transitioning of students suffering from concussion back to the classrooms. Concussion teams within the school share common roles and responsibilities to assist other team members and the concussed student. HS Face-To-Face 26

Communication is a MUST! School Administrator Nurse Counselor Primary Care Physician Academic Team Concussed Student Parents HS Face-To-Face Athletic Staff 27

As of July 1, 2016 The State of Virginia passed legislation for Return-To-Learn protocol that provided six specific phases that provide guidance for schools and staff to follow that support student recovery from concussion. All staff shall use the protocol outlined in the Concussion Management Regulation 759 – 1. Utilizing the information in this presentation to implement a RTL process will enable a student to sustain progress in school and achieve recovery. HS Face-To-Face 28

Return-To-Learn Framework Which phase a student starts is dependent on the severity of the concussion? No School – Cognitive and Physical Rest Phase 1 Phase 2 Phase 3 No School Rest with Light Cognitive Mental Activity and Limited Physical Activity. Half Day Attendance with Moderate Instructional Modifications HS Face-To-Face 29

Return-To-Learn Framework cont. Phase 4 Full Day Attendance with Minimal Instructional Modifications Phase 5 Phase 6 Half Day Attendance with Maximum Instructional Modifications Full School and Extra. Curricular Involvement HS Face-To-Face 30

How Can Everyone Help? • Every concussion is different, and each student may need different assistance • Type and severity of symptoms should be used as a guide to identify the course of action to be taken. • Understand common symptom triggers • Reading • Computer use • Prolonged concentration • Triggers are variable and will differ from student to student. HS Face-To-Face 31

Activities Beyond Classroom Learning May Impact Recovery • Driving or loud bus rides • Band/choir • Dances, pep rallies and • Movies in school assemblies • Classes with excessive noise, such as woodworking, auto mechanics, etc. • After school sponsored events HS Face-To-Face • Computer use in classes like keyboarding, drafting, animation and film • Cafeteria, dining halls and busy hallways 32

Return to Play (RTP) “It is not appropriate for a child or adolescent student-athlete with concussion to RTP on the same day as the injury. ” Zurich consensus statement on concussion in sport (2012) In PWCS there is NO SAME DAY RETURN TO PLAY!! HS Face-To-Face 33

When Does Return-To-Play Process Start? • Must have minimal symptoms at rest and with exertion to start RTP. Post Injury • Im. PACT postinjury assessment must be within normal range Symptom • Clearance from a licensed health care professional trained in evaluating concussions. RTL • Completed the Return-to-Learn Process Clearance HS Face-To-Face 34

Return-To-Play Only when an athlete is cleared by a licensed health care professional, is the athlete released to begin the Return-To-Play progression. The Athletic Trainer will monitor the progress at the middle school and high school level. HS Face-To-Face 35

Return-To-Play Progression HS Face-To-Face 36

Return-To-Play Progression (RTP) Factors that may affect the rate of progression include: previous history of concussion duration and type of symptoms HS Face-To-Face age and sex of the athlete sport/activity in which the athlete participates Student’s individual traits : learning disorders, ADHD, Mood disorders, history of migraines 37

PWCS Commitment to Recovery: “Our main goal is to ensure that PWCS students and student-athletes who sustain concussions are properly diagnosed, given adequate time to heal, and are comprehensively supported at home and school throughout the recovery of their injury. ” HS Face-To-Face 38

Take Home Message • Be familiar with concussion signs/symptoms • Consult with an appropriate health care specialist • Each concussion will be dealt with on an individual basis. • Academic support is key to recovery and available for all students in the form of the Return to Learn framework. • All athletes are required to complete Return-To-Play progression once they have received written clearance HS Face-To-Face 39

Remember Athletes!. . Don’t hide it, report it and take time to recover. If you suspect that a teammate has sustained a concussion report it immediately to your coach and athletic trainer. It could save his/her life. IT’S BETTER TO MISS ONE GAME THAN TO MISS THE WHOLE SEASON! HS Face-To-Face 40

Where Can I Find More Information about Concussions? PWCS website Individual school website Athletic web pages for each school Athletic training web pages The(NFHS) offers a FREE Concussion course. http: //www. nfhslearn. com/ HS Face-To-Face 41

References • Im. PACT Applications, Inc. | 2000 Technology Drive | Suite 150 | Pittsburgh, PA 15219 • Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA 30333, USA 800 -CDC-INFO (800 -232 -4636) TTY: (888) 232 -6348, 24 Hours/Every Day cdcinfo@cdc. gov • Mc. Crory. P, et al. Summary and Agreement Statement of the 5 th International Conference on Concussion in Sport, Berlin, 2016. ERJ Sports Med. 2017; 1 -10. . • Guskiewicz KM, et al. National Athletic Trainers’ Association Position Statement: Management of Sport-Related Concussion. J Athl Train. 2004; 39(3): 280 -297. • The National Federation of State High School Associations www. nfhslearn. com • Sports Concussion Institute http: //concussiontreatment. com/ HS Face-To-Face 42