PA 10-62 An Act Concerning Student Athletes and Concussions

P.A. 14-66 An Act Concerning Youth Athletics and Concussions

“Concussion Education Plan and Guidelines for Connecticut Schools” adopted by the State Board of Education, January 7, 2015.

1.    A student athlete who has been removed from play may not participate in any supervised team activities involving physical exertion, including, but not limited to practices, games, or competitions, sooner than twenty-four hours* after such athlete was removed from play until the athlete is evaluated by a licensed health care provider trained in the evaluation and management of concussions and receives a written clearance to return to play from that health care provider. [or: Any athlete removed from play because of a concussion must have written medical clearance from an appropriate health care professional before he/she can resume practice or competition and not until the student athlete and his/her parent/guardian completes the State Board of Education concussion education plan.] (Refer to Appendix E: “The Proper Procedures for Allowing a Student Athlete Who Has Sustained a Concussion to Return to Athletic Activity.”)

2.    After medical clearance, the return to play by the athlete should follow a step-wise protocol with provisions for delayed return to play based on return of any signs or symptoms.
3.    The medical clearance return to play protocol is as follows:

a.    No exertional activity until asymptomatic.
b.    When the athlete appears clear, begin low-impact activity such as walking, stationary bike, etc.
c.    Initiate aerobic activity fundamental to the specific sport such as skating, or running and may also begin progressive strength training activities.
d.    Begin non-contact skill drills specific to sport such as dribbling, fielding, batting, etc.
e.    Full contact in practice setting.
f.    If athlete remains asymptomatic, he/she may return to game/play

4.    Once all academic requirements are made up and/or there is a plan in place to complete all academic assignments, the student/athlete may return to his or her athletic team. 

HEADS UP: CONCUSSION IN YOUTH SPORTS
A Fact Sheet for COACHES

 

To download the coaches fact sheet in Spanish, please visit:
http://www.cdc.gov/concussion/HeadsUp/youth.html 

THE FACTS

•    A concussion is a brain injury.
•    All concussions are serious.
•    Concussions can occur without loss of consciousness.
•    Concussions can occur in any sport.
•    Recognition and proper management of concussions when they first occur can help prevent further injury or even death.
 

A concussion is an injury that changes how the cells in the brain normally work.  A concussion is caused by a blow to the head or body that causes the brain to move rapidly inside the skull.  Even a ding, getting your bell rung, or what seems to be a mild bump or blow to the head can be serious.  Concussions can also result from a fall or from players colliding with each other or with obstacles, such as a goalpost.

The potential for concussions is greatest in athletic environments where collisions are common.1 Concussions can occur, however, in any organized or unorganized sport or recreational activity. As many as 3.8 million sports- and recreation-related concussions occur in the United States each year.2
 

To help recognize a concussion, you should watch for the following two things among your athletes:

1.    A forceful blow to the head or body that results in rapid movement of the head.
-and-
2.    Any change in the athlete’s behavior, thinking, or physical functioning. (See the signs and symptoms of concussion.) 
SIGNS AND SYMPTOMS

SIGNS OBSERVED BY COACHING STAFF

Appears dazed or stunned Is confused about assignment or position Forgets sports plays Is unsure of game, score, or opponent Moves clumsily Answers questions slowly Loses consciousness (even briefly) Shows behavior or personality changes Can't recall events prior to hit or fall Can't recall events after hit or fall

SYMPTOMS REPORTED BY ATHLETE

Headache or pressure in head Nausea or vomiting Balance problems or diziness Double or blurry vision Sensitivity to light Sensitivity to noise Feeling sluggish, hazy, foggy, or groggy Concentration or memory problems Confusion Does not feel right

Adapted from Lovell et al. 2004

Athletes who experience any of these signs or symptoms after a bump or blow to the head should be kept from play until given permission to return to play by a health care professional with experience in evaluating for concussion. Signs and symptoms of concussion can last from several minutes to days, weeks, months, or even longer in some cases.

Remember, you can’t see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. If you have any suspicion that your athlete has a concussion, you should keep the athlete out of the game or practice.
 
As a coach, you can play a key role in preventing concussions and responding to them properly when they occur. Here are some steps you can take to ensure the best outcome for your athletes and the team:
 
Check with your youth sports league or administrator about concussion policies. Concussion policy statements can be developed to include the leagues commitment to safety, a brief description of concussion, and information on when athletes can safely return to play following a concussion (i.e., an athlete with known or suspected concussion should be kept from play until evaluated and given permission to return by a health care professional). Parents and athletes should sign the concussion policy statement at the beginning of the sports season.

•    Teach athletes and parents that it’s not smart to play with a concussion. Sometimes players and parents wrongly believe that it shows strength and courage to play injured. Discourage others from pressuring injured athletes to play.  Don’t let athletes persuade you that they’re just fine after they have sustained any bump or blow to the head.  Ask if players have ever had a concussion.

•    Prevent long-term problems. A repeat concussion that occurs before the brain recovers from the first usually within a short period of time (hours, days, or weeks) can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in brain swelling, permanent brain damage, and even death. This more serious condition is called second impact syndrome.4, 5 Keep athletes with known or suspected concussion from play until they have been evaluated and given permission to return to play by a health care professional with experience in evaluating for concussion. Remind your athletes: It’s better to miss one game than the whole season.
 
WHAT SHOULD A COACH DO WHEN A CONCUSSION IS SUSPECTED?

1.    Remove the athlete from play. Look for the signs and symptoms of a concussion if your athlete has experienced a bump or blow to the head. Athletes who experience signs or symptoms of concussion should not be allowed to return to play. When in doubt, keep the athlete out of play.

2.    Ensure that the athlete is evaluated right away by an appropriate health care professional. Do not try to judge the severity of the injury yourself. Health care professionals have a number of methods that they can use to assess the severity of concussions. As a coach, recording the following information can help health care professionals in assessing the athlete after the injury:
3.    Inform the athlete’s parents or guardians about the possible concussion and give them the fact sheet on concussion.  Make sure they know that the athlete should be seen by a health care professional experienced in evaluating for concussion.

4.    Allow the athlete to return to play only with permission from a health care professional with experience in evaluating for concussion.  A repeat concussion that occurs before the brain recovers from the first can slow recovery or increase the likelihood of having long-term problems. Prevent common long-term problems and the rare second impact syndrome by delaying the athletes return to the activity until the player receives appropriate medical evaluation and approval for return to play.

If you think your athlete has sustained a concussion take him/her out of play, and seek the advice of a health care professional experienced in evaluating for concussion.

For more information and to order additional materials free-of-charge, visit: 
https://www.cdc.gov/headsup/youthsports/index.html

For more detailed information on concussion and traumatic brain injury, visit:
https://www.cdc.gov/TraumaticBrainInjury/index.html

REFERENCES

1.    Powell JW. Cerebral concussion: causes, effects, and risks in sports. Journal of Athletic Training 2001; 36(3):307-311. 
2.    Langlois JA, Rutland-Brown W, Wald M. The epidemiology and impact of traumatic brain injury: a brief overview. Journal of Head Trauma Rehabilitation 2006; 21(5):375-378. 
3.    Lovell MR, Collins MW, Iverson GL, Johnston KM, Bradley JP. Grade 1 or ding concussions in high school athletes. The American Journal of Sports Medicine 2004; 32(1):47-54. 
4.    Institute of Medicine (US). Is soccer bad for children’s heads? Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer. Washington (DC): National Academy Press; 2002. 
5.    Centers for Disease Control and Prevention (CDC). Sports-related recurrent brain injuries-United States. Morbidity and Mortality Weekly Report 1997; 46(10):224-227. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00046702.htm

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION

Content Source: National Center for Injury Prevention and Control, Division of Injury Response

Page Located on the Web at http://www.cdc.gov/concussion/index.html
Appendix B What is a concussion?

A concussion is a brain injury that:
How can I prevent a concussion?

It’s different for every sport. But there are steps you can take to protect yourself from concussion.
How do I know if I’ve had a concussion?

You can’t see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up days or weeks after the injury. It’s best to see a health care professional if you think you might have a concussion. An undiagnosed concussion can affect your ability to do schoolwork and other everyday activities. It also raises your risk for additional serious injury.

What are the symptoms of a concussion?
What should I do if I think I have a concussion?
Common symptoms in concussions are generally divided into physical/somatic, cognitive/thinking/remembering, sleep and emotional/mood disruption categories.

1.    Physical
2.    Sleep
3.    Cognitive (Thinking/Remembering)
4.    Mood Disruption
Source: Adapted from Pardini et al 2004.

Athletes who experience any of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating concussions, provides written clearance that they are symptom-free and can to return to play. It is important to note that some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. For some people, however, signs and symptoms of concussion can last for days, weeks, or longer. 

Potential Signs Observed by Coaches, Athletic Trainers, Parents or Others: 
Potential Symptoms Reported by Athlete: 
Athletes who experience any of the signs and symptoms listed above after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating concussions, provides written clearance that they are symptom-free and can to return to play. It is important to note that some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. For some people, however, signs and symptoms of concussion can last for days, weeks, or longer. 
 
When managing an athlete with a concussion, the management plan should cover both returning to school and to play, and should:
An athlete should be referred for follow-up care from a health care professional who can help him or her gradually return to school and to play when fully recovered. An athlete who has been diagnosed with a concussion should not return to practice or play the same day. In addition, Public Act No. 14-66, An Act Concerning Youth Athletics and Concussions requires that:
There are five gradual steps to help safely return an athlete to play, adapted from the International Concussion Consensus Guidelines located at:
http://www.cdc.gov/concussion/headsup/return_to_play.html

Suggested Return-to-Play Progression

Baseline (Step 0): As the baseline step of the Return-to-Play Progression, the athlete needs to have completed physical and cognitive rest and not be experiencing concussion symptoms for a minimum of 24 hours. Keep in mind, the younger the athlete, the more conservative the treatment. There should be a minimum of 24 hours before progressing to the next step.

Step 1: Light Aerobic Exercise 
Goal: only to increase an athlete’s heart rate 
Time: 5 to 10 minutes 
Activities: exercise bike, walking, or light jogging 
No weight lifting or resistance training, jumping, or hard running 

Step 2: Moderate Exercise 
Goal: limited body and head movement 
Time: reduced from typical routine 
Activities: moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting and resistance training 
No head impact activities 

Step 3: Non-contact Exercise 
Goal: more intense, but non-contact movement 
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 in Steps 1 and 2. 

Step 4: Practice 
Goal: reintegrate in full contact practice with vigilant observation by the coach and/or athletic trainer 

Step 5: Return to Play 
Goal: return to competition 

It is important to monitor symptoms and cognitive function carefully during each increase of exertion. Athletes should only progress to the next level of exertion if they are not experiencing symptoms at the current level. If symptoms return at any step an athlete should stop these activities as this may be a sign that the athlete is pushing too hard. Only after additional rest, when the athlete is once again not experiencing symptoms for a minimum of 24 hours, should he or she start again at the step during which symptoms were experienced. 

The Return-to-Play Progression process is best conducted through a team approach and by a health care professional who knows the athlete’s physical abilities and endurance, such as the school’s athletic trainer in collaboration with the school nurse. By gauging the athlete’s performance on each individual step, a health care professional will be able to determine how far to progress the athlete on a given day. In some cases, the athlete may be able to work through one step in a single day, while in other cases it may take several days to work through an individual step. It may take several weeks to months to work through the entire 5-step progression. 

While most athletes will recover quickly and fully following a concussion, some will have symptoms for weeks or longer. Athletes should be referred to a concussion specialist if: 
School concussion management teams may be formed to create and implement a concussion management plan with sound procedures that support a concussed student. Suggestions for team members are as follows:

Student Athlete
Empowering students to self-assess symptoms and report may be a challenge. Consider inviting an influential student-athlete to the team. Help create an atmosphere of acceptance for reporting suspected and diagnosed concussions, and encourage athletes to report a fellow athlete’s symptoms. 

Parent(s)/Guardian(s) 
Invite a parent leader to the team who could be influential with parent organizations that support athletics and gaining parental and community support for district policies. 

School Administrator 
Administrator support is needed to change the culture surrounding sports concussions, put systems in place to manage concussions effectively, and provide the programs necessary to return students to full activity (athletics and academics) safely. 

School Medical Advisor 
It is important that the school medical advisor is appropriately trained in the current knowledge about concussion. 

Licensed Health Care Professional 
Student athletes who are suspected of or have a concussion must receive written clearance from a licensed health care professional trained in the evaluation and management of concussions in order to participate in supervised team activities. 

School Nurse 
The school nurse is the lead health and medical school staff who works in conjunction with the athletic trainer (when available), athletic director, coaches, school faculty, counselors, and administrators, as well as the student-athlete’s health care provider and family, in order to provide the best healing environment possible. In the case of a concussion, school nurses need to be able to recognize signs and symptoms, be aware of risks associated with recurrent injury, and make recommendations to student-athletes, parents, and school officials on proper care and recovery. 

Physical Education Director/Athletic Director (AD)
The physical education or athletic director’s leadership is a crucial component of good concussion management. They can support coach/athlete/parent training, promote a culture of awareness, ensure the teaching of safe techniques and sportsmanship, ensure proper and well maintained equipment, monitor appropriate incident protocols, promote good officiating, and encourage effective tracking of injuries. 

Certified Athletic Trainer (ATC) 
Certified athletic trainers (ATCs) are medical experts in preventing, recognizing, managing and rehabilitating injuries that result from physical activity. The ATC in a school environment works under the direction of a licensed physician, in collaboration with the school nurse and in cooperation with other health care professionals, athletic or physical education directors, coaches and parents. 

Coach 
Coaches play a key role in concussion management. They are responsible for pulling an athlete from competition or practice immediately after suspecting a concussion, Securing buy-in from the coaching staff is crucial to the safety of the athlete and to the success of the return to play protocol. Having a coach serve as the liaison between the school concussion management team and the other coaching staff can help ensure effective communication and understanding. 

Teachers 
Teachers are critical to student success post-concussion. Teachers need to have a strong understanding of the potential cognitive, behavioral, emotional, and physical symptoms of a concussion. A school concussion management team representative from the teaching staff can work with the student’s teachers to ensure appropriate classroom accommodations. 

School Counselor 
The school counselor is the ideal lead staff person to inform teachers of needed learning accommodations while the student is symptomatic. They can provide information needed for making decisions about return to activity, can work with the student’s teachers to ensure appropriate classroom accommodations, and can refer the student to more formalized supports such as 504 plans or Individualized Education Programs (IEP). 

School Psychologist 
School psychologists can help with assessment and test results interpretation. 
 

1. Seek medical attention right away. A health care professional will be able to decide how serious the concussion is and when it is safe for your child to return to sports. Notify your child’s coach if you think your child has a concussion.
2. Keep your child out of play. Concussions take time to heal. Don’t let your child return to play until a health care professional says it’s OK. Children who return to play too soon while the brain is still healing risk a greater chance of having a second concussion. Second or later concussions can be very serious. They can cause permanent brain damage, affecting your child for a lifetime.
3. Tell your child’s coach about any recent concussion in ANY sport or activity. Your child’s coach may not know about a concussion your child received in another sport or activity unless you tell the coach.