Lake Shore Central School District

Definition of concussion:

A concussion is a traumatic brain injury induced by biomechanical forces. Essentially, a concussion results from the brain moving back and forth or twisting rapidly inside the skull. The symptoms of a concussion result from a temporary change in the brain’s function. In most cases, the symptoms of a concussion generally resolve over a short period of time; however in some cases symptoms can last for weeks or longer.  In a small number of cases, or in cases of re-injury during the recovery phase, permanent brain injury is possible.  Children and adolescents are more susceptible to concussions and take longer than adults to fully recover.  Therefore, it is imperative that any student who is suspected of having sustained a concussion be immediately removed from athletic activity (PE class, sports) and remain out of physical and athletic activities until evaluated and cleared to return to physical activity by a physician.  

Features utilized in defining concussive head injuries include:

1. Concussion may be caused by a direct blow to the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head.
2. Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, symptoms may evolve over a number of minutes or hours.
3. Concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury, and as such, no abnormality is seen on standard structural neuroimaging studies (ie MRI, CT scan).
4. Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. In some cases, symptoms may be prolonged.

CONCUSSION RECOGNITION

Signs and Symptoms:

Headache                                                    Dizziness

Nausea, vomiting                                        Confusion, disorientation

Balance problems                                        Visual disturbances

Sensitivity to light or sound                        Behavior or personality changes

Loss of consciousness                                 Amnesia

Feeling lethargic, foggy                              Concentration difficulties

At present, there is no perfect diagnostic test for health care providers to rely on for immediate diagnosis in the sporting environment.  If one or more sign/symptom is present, a concussion should be suspected and the appropriate management strategy implemented.  Therefore, if a player shows ANY signs or symptoms of a concussion the following steps will be taken:

1. The player will immediately be taken out of participation and not be allowed to return to play in the current game or practice.
2. The player will not be left alone and will be regularly monitored for deterioration. This is imperative over the initial 24 hours following injury. Instructions will be given to the athlete and parent/guardian.
3. The player will be referred for medical evaluation by a physician following the injury.

***A player should NEVER return to play while symptomatic***

“WHEN IN DOUBT, SIT THEM OUT!”

RETURN TO PLAY (RTP) PROTOCOL

The process of recovery and return to participation after a concussion should follow a graduated stepwise strategy.  An initial period of 24-48 hours of both relative physical and cognitive rest is recommended before beginning the RTP protocol.  Once an athlete has been cleared by a physician to begin physical/athletic activity and has been symptom-free for at least 24 hours, s/he may start the RTP protocol.  An additional consideration is that concussed athletes should be symptom-free without the use of pharmacological agents that may modify symptoms. The student-athlete will be monitored daily by District staff for return of signs/symptoms as well as supervised while completing each step of the RTP protocol.  A student-athlete should only move to the next step of activity if the remain symptom-free.  There should be at least 24 hours (or longer) for each step of the progression.  If symptoms return, the athlete will drop back to the previous step after 24 hours of rest.

Step 1 – Light aerobic activity, low impact, non-strenuous such as brisk walking or biking
Step 2 – Moderate aerobic activity with higher impact and exertion, such as jogging, sit-ups
Step 3 – Sport-specific exercise; no head impact activities
Step 4 – Non-contact sport-specific training drills

**After completing through step 4 of the RTP protocol, interscholastic athletes MUST be seen and cleared by the District Medical Provider before progressing to Step 5**

Step 5 – Full contact practice
Step 6 – Return to full activities and competition without restrictions

This concussion return to play protocol will be followed despite the athlete presenting a     note to return to play sooner from a licensed physician/medical provider.

ImPACT Concussion Management Tool

The Lake Shore CSD utilizes ImPACT, which is a computerized neurocognitive test.  A baseline test is given to each athlete every 2 years.  As part of the RTP protocol, a Post Injury test is given and a report is generated comparing scores to the athlete’s baseline scores, which is reviewed by the District Medical Provider.

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