What is a Concussion?
A concussion is a complex patho-physiologic process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the head. A concussion is caused by a blow or jolt to the head that disrupts the function of the brain. A concussion results in a wide range of physical, cognitive, emotional and/or sleep related symptoms. Symptoms include but are not limited to: headache, nausea, sensitivity to light/noise, fatigue, drowsiness, irritability, and feeling slowed down and/or foggy. Duration of symptoms is highly variable and may last from several minutes to days, weeks, months, or even longer in some cases. Concussions are not graded based on symptoms or loss of consciousness at the time of injury.
What is Second Impact Syndrome?
Second Impact Syndrome (SIS) occurs when an athlete, who has already sustained a head injury, sustains a second head injury prior to complete resolution of symptoms. This often occurs because a person has returned to participation too soon. Most persons do not realize that it may take days and weeks for concussion symptoms to resolve. Second Impact Syndrome most likely affects young athletes (jr/sr high school), however, any athlete who returns to play too soon is a possible candidate. Second Impact Syndrome is a very serious condition that has been linked to permanent brain damage or even death.
What is Neurocognitive Testing?
Given these outlined concerns and inherent difficulties in managing concussion, individualized and comprehensive management of concussion is optimal. This plan can help to objectively evaluate the concussed athlete’s post-injury condition and track recovery for safe return to play, thus preventing the cumulative effects of concussions. ImPACT is a user-friendly computer based testing program specifically designed for the management of sports-related concussion. The instrument has been designed after approximately 10-years of university-based, grant-supported research. ImPACT is currently the most widely utilized computerized program in the world and is implemented effectively across high school, collegiate, and professional levels of sport participation.
What is Balance Error Scoring System (BESS) Testing?
The Balance Error Scoring System (BESS) provides a portable, cost effective, and objective method of assessing static posture stability. In the absence of expensive, sophisticated postural stability assessment tools, the BESS can be used to assess the effects of mild head injury on static postural stability. Information obtained from this clinical balance tool can be used to assist clinicians in making return to play decisions following mild head injury. The BESS can be performed in nearly any environment and takes approximately 10 minutes to conduct.
State of Ohio House Bill 143
In April of 2013 the General Assembly of the State of Ohio enacted Ohio House Bill 143 - aimed at making youth sports safer. The bill requires all coaches and referees involved in youth sports to receive training in how to recognize the symptoms and signs of a concussion or head injury or hold a current Pupil Activity Permit (PAP) obtained through the Ohio Department of Education. Training in the recognition of a concussion or head injury is offered online by the Ohio Department of Health. In order to obtain a PAP, applicants are required to complete concussion and head injury recognition training.
How will a suspected concussion be managed at Ohio Wesleyan University?
OWU Department of Athletics Education
At the Athletic Department yearly physical examination each athlete will be required to sign an NCAA mandated waiver that states their responsibility to report all injuries to a sports medicine staff member, including head injuries. Each Student-Athlete will be provided the NCAA created, Concussion: A Fact Sheet for Student-Athletes (Appendix B) for their education and/or review. There will also be posters in each of the athletic training rooms outlining the signs and symptoms of head injuries and concussions.
OWU Baseline Testing
In order to provide Ohio Wesleyan University Student Athletes the best possible care and prevention of multiple concussions and second impact syndrome, team members of all sports will perform baseline ImPACT testing. Incoming participants in the following sports will begin baseline testing in the 2015-16 academic year, with each additional class until the full roster has completed this test: Golf, Swimming, Tennis, and Track and Field. This testing will be completed at on-campus computer labs. These baseline scores will be saved in an on-line database.
If an athlete is diagnosed with their second concussion or the injury causes long term symptoms, a post-concussion follow-up test will be administered. These scores will be compared to their baseline scores. A return to play plan protocol will then be determined by a Board Certified Sports Medicine trained Team Physician in conjunction with the athletic training staff at OWU.
In addition, each student-athlete will perform Baseline BESS (Balanced Error Scoring System) testing to be used during the evaluation process of any diagnosed concussion. Baseline results will be recorded on the BESS scorecard and a copy will be placed in their medical chart kept in the athletic training room. This baseline assessment will begin with the incoming participants in the 2015-16 academic year.
Treatment of a Suspected Head Injury/Concussion
A student athlete with a suspected head injury will be evaluated by an Athletic Trainer at the time of incident. The Athletic Trainer will decide, using an evaluation consisting of current symptoms, cranial nerve assessment, and a cognitive and physical examination (as outlined in a SCAT3 Sport Concussion Assessment Tool) if the student athlete is able to return to participation, needs to be removed from participation or requires an immediate referral to the ER. If no immediate referral is necessary the student athlete will be sent home with care instructions (NCAA created, “Concussion, A Fact Sheet for Student-Athlete”, Appendix B). The athlete will follow up with a team physician in the athletic training room or at the student health center, where a complete SCAT 3 evaluation will be performed.
Home care instructions will include the following list of signs and symptoms. An athlete should be taken to the emergency room if any of the following signs or symptoms are severe or worsening:
The student athlete will check in with the athletic training staff daily to fill out a symptom score checklist (Appendix A). When an athlete is reporting a zero on the symptom score checklist, the student-athlete will begin the return to play protocol outlined below.
What is the return to play protocol after a student athlete has been diagnosed with a concussion?
The return to play progression is a multi-step process. It will begin once the athlete is symptom free for 24 hours. Completing one step and moving on to the next is contingent upon finishing the prior day’s activity with no return of symptoms. The “Concussion Return to Play – Progression Notes” (Appendix C or Appendix D) form will be completed on a daily basis by the student-athlete as administered by a member of the athletic training staff during this time.
- Day 1: Light aerobic exercise without resistance training, For example, a 20 minute bike
- Day 2: 25 minute running workout along with sport specific movements without head impact.
- Day 3: Non-contact sports drills and allowed to resume weight training.
- Day 4: Full contact practice
- Day 5: Clearance for full participation, aka. Competitions
The return to play protocol will differ from non-contact to contact sport student athletes. For example, if a cross country runner were to be diagnosed with a concussion, they would never have a non-contact vs. contact practice, therefore, their day 3 return to play progression would result in a modified workout. A modified workout would be agreed upon by the Team Physician, Athletic Trainer, and Head Coach. Therefore, Day 4 would result in Full Practice with Day 5 being clearance for competitions.
Return to Academics
As with physical stress, cognitive stress will also have adverse effects on the healing process of a concussion. A student-athlete who is diagnosed with a concussion will be advised to reduce the amount of cognitive stress they perform for the initial time after incident. This includes school work, reading, spend playing video games, watching television, and using their phones or tablets. If the student-athlete complains of continued symptoms while following these instructions, per the Team Physician’s discretion, they may be provided an excuse letter to give to faculty members for a short term. If they experience long term symptoms, they will be referred to the Office of Student Disability Services for additional help and assistance with school work.
Youth Sports Organizations
Ohio Wesleyan University offers and sponsors many sports camps or workshops for youth participants throughout the school year. To remain in compliance with Ohio House Bill 143, the director of each youth sports organization will be responsible to ensure the following practices are being met:
- Every Coach (paid or volunteer) and Official (if applicable) involved with the program submits a copy of either a Pupil Activity Permit (PAP) from the State of Ohio Department of Education OR a copy of completion an online concussion training program.
- Provide a copy of an informational handout (Appendix E) on concussions and head injuries developed by the Ohio Department of Health to every parent/legal guardian of any athlete who is participating in the programs being offered by the organization.
- Ensure that any participant that is exhibiting the signs and symptoms of a concussion be removed from participation for that day. A letter of clearance from a physician MUST be received in order for the participant to return to activity.
A more detailed handout of information concerning House Bill 143 is listed as Appendix F.
- Appendix A – Concussion Symptom Score Checklist
- Appendix B – Concussion Fact Sheet for Athletes
- Appendix C – Concussion Progression Notes (Contact)
- Appendix D – Concussion Progression Notes (Non-Contact)
- Appendix E – Ohio Department of Health Concussion Fact Sheet
- Appendix F – OhioHealth House Bill 143
- Cantu, R.C. (1996). Head injuries in sport. British Journal of Sports Medicine, 30, 289-296.
- Guskiewicz, K.M. et.al. (2004). National athletic trainers’ association position statement: management of sports related concussion. Journal of Athletic Training, 39, (3): 280-297
- ImPACT: The best approach to concussion management. (2009). Retrieved November 12, 2009, from http://www.impacttest.com/impactbackground.php.
- National Collegiate Athletic Association (2014). 2014-15 NCAA Sports Medicine Handbook. 25th ed. pg 56-64.
- Information on Concussion Management. (2013). Retrieved May 5, 2015, from http://www.ohsaa.org/medicine/Concussions/ConcussionRegulations.pdf