Concussion Protocol

Baseline

At baseline, student-athletes will undergo ImPACT® testing and undergo a pre-participation exam where they will be assessed for concussion vulnerability (history of migraines, learning disabilities, attention deficit, family history of Alzheimer's, previous concussions, etc.). Additionally, athletes will receive educational information on concussions.

Sideline

The athlete must be removed for the duration of the game if concussion is suspected based on the signs and symptoms including, but not limited to:

  • Headache
  • Confusion
  • Dizziness
  • Abnormal behavior

Furthermore, emergency medical assistance should be obtained in the following circumstances:

  • Loss of consciousness for more than 2 minutes
  • Neurological deficits (loss of sensation or motor function)
  • Deteriorating mental status
  • Glasgow coma scale less than 15
  • Potential spinal injury
  • Repetitive emesis (vomiting)

If the above criteria are not met, the athlete should:

  • Be monitored for the duration of the game.
  • Be assessed by a clinician within 24 hours.
  • Have their emergency contact informed.
  • Receive concussion education.
  • Be instructed to have arrangements made for overnight monitoring.
  • Be provided with documentation of oral and/or written care (documentation should be given to both the student-athlete and another responsible adult—may be parent or roommate).

If there is a question about the presence of concussion, the following should be done:

Symptom checklist

  1. Do you have a headache? (If so, scale 1–10)
  2. Do you have a feeling of fogginess?
  3. Do you have dizziness? (Lightheaded versus room spinning)
  4. Do you have trouble seeing? (Spots, double-vision, blurry vision)
  5. Do you feel numbness in your arms or legs?
  6. Do you feel weakness in your arms or legs?

Mental Status

  1. Is the athlete alert or lethargic?
  2. Is their speech slurred?
  3. Ask the day of the week, month, year, or date, what team they are playing against, home or away, etc.
  4. Ask athlete to repeat the following sentence, "The cat always hid under the couch when dogs were in the room."
  5. Ask athlete to repeat the following number sequence, "1, 7, 4, 9"
  6. Ask athlete to repeat the previous number sequence backwards, "9, 4, 7, 1"

Neurologic Exam

  1. Check pupils with provided pen light (Check for differences in size)
  2. Have athlete follow a pen using eyes only (not moving head) up, down, left, and right (Check for bouncing of the eyes)
  3. Have athlete hold arms in front of them as if they were holding a pizza with eyes closed for 10 seconds (Check for a lot of swaying or a fall)
  4. Have athlete walk in a straight line touching heel to toe for 5 paces (Check to see if they cannot walk in straight line)

If any of the above are abnormal, the athlete should be treated as if they have a concussion.

Clinical Consultation

During the initial visit after suffering a concussion, the student will be evaluated by a qualified physician.

  • Athlete to fill out the symptom checklist
  • History
    1. What are symptoms since injury?
    2. Experience any fogginess?
    3. History of migraines in the past?
    4. Family history of migraines?
      If so, has anyone developed paralysis during a headache? (Screen for familial hemiplegic migraine—may be associated with 2nd impact syndrome)
    5. History of attentional problems? Did you ever take medication for attention?
    6. Have you ever had a concussion before? If so, how many have you had?
    7. History of depression?
    8. History of anxiety?
    9. Were medications taken for any of the above conditions?
  • Physical Exam
    1. Cranial Nerves
    2. Mental Status
    3. UE and LE strength and sensory
    4. Cervical spine exam
    5. Visual testing (Extraocular motion, Accommodation, Convergence, King Devick cards)
    6. Balance testing (Balance Master machine)
  • OMT Intervention
  • Retesting on Balance Machine

If indicated, further consultation by a neurologist and/or diagnostic imaging will be provided.

Return to Play/Learn

Day 0: Home—Total Rest

No mental exertion—no computer, texting, video games, or homework. Stay at home. No driving.

Athletic trainer to notify NYIT Counseling and Wellness Services.

Day 1: Home—Light Mental Activity

Up to 30 minutes mental exertion. No prolonged concentration. Stay at home. No driving.

At this point if tolerated they may begin light aerobic activity. Physician to notify NYIT Counseling and Wellness Services if accommodations are required. Patient to follow up with Counseling and Wellness Services for the remainder of Return to Learn.

May begin light aerobic activity:

  • Goal: Only to increase an athlete's heart rate
  • Time: 5 to 10 minutes
  • Activities: Exercise bike, walking, or light jogging
  • Restrictions: Absolutely no weight lifting, jumping, or hard running

Progress to the next level when able to handle up to 30 minutes mental exertion without worsening of symptoms.

Day 2: School—Part Time

Maximum accommodations with shortened days/schedule and plenty of built-in breaks.

Provide quiet place for scheduled mental rest. No significant classroom or standardized testing. Modify rather than postpone academics. Provide extra time, extra help, modified assignments. Progress to the next level when able to handle 30–40 minutes mental exertion without worsening of symptoms.

At this stage include the athletic staff in planning.

May begin sport-specific activity:

  • Goal: Limited body and head movement
  • Time: Reduced from typical routine
  • Activities: Moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting

Once a student-athlete is symptom free at rest for 24 hours, able to handle 40 minutes of mental exertion, and cleared by a physician, s/he may begin the return to initial practices, as per the International Conference on Concussion in Sport.

  • McCrory, P., Meeuwisse, W., Johnston, K., Dvorak, J., Aubry, M., Molloy, M., & Cantu, R. (2009). Consensus statement on Concussion in Sport, 3rd International Conference on Concussion in Sport. Zurich, November 2008. South African Journal of Sports Medicine, 21(2).

Day 3: School—Part Time

Moderate accommodations.

No standardized testing. Modified classroom testing. Moderate decrease of extra time, help, and modification of assignments. Progress to the next level when able to handle 60 minutes mental exertion without worsening of symptoms.

May begin heavy non-contact training drills:

  • Goal: More intense but non-contact
  • Time: Close to typical routine
  • Activities: Running, high-intensity stationary biking, the player's regular weightlifting routine, and non-contact sport-specific drills. This stage may add some cognitive component to practice in addition to the aerobic and movement components introduced on Days 1 and 2.

Day 4: School—Full Time

Minimal accommodations.

No standardized testing, Routine tests are okay. Continue decrease of extra time, help, and modification of assignments. May require more supports in academically challenging subjects.

May begin full-contact practice:

  • Goal: Reintegrate into full-contact practice

Day 5: School—Full Time

No accommodations.

Full academics. Attend all classes. Full homework.

May begin full return to play:

  • Goal: Return to competition. Cannot occur without full-time academics.

Note: If the student-athlete is able to, they may progress faster on the Return to Learn Protocol than the Return to Play Progression, NOT vice versa.

Each step should take 24 hours, so that an athlete would take approximately 5 days to proceed through the full rehabilitation protocol once they are asymptomatic at rest and with provocative exercise. If any post-concussion symptoms occur while in the stepwise program, then the student should drop back to the previous asymptomatic level and try to progress again after a further 24-hour period of rest has passed.