Texas A&M University Concussion Management Plan

1. Texas A&M UniversityConcussion Management Plan David Weir, LAT,ATC Head Athletic Trainer for Football Texas A&M University

2. Basis • Consensus Statement on Concussion in Sport: • 3rd International Conference on Concussion in Sport • Zurich • November 2008

3. Basis • Health Care Providers • Team Physician • Athletic Trainers • Have unchallengeable authority to determine and manage the treatment and the return to play of any ill or injured athlete. • Return to play following a concussion will be made by the team physician or his/her designate.

4. Education • Coaches must acknowledge that have been educated and they understand the concussion management plan. • They are presented education and they answer basic questions. • Athletes must receive documentation and sign an acknowledgement form. • Athletes must agree to report if they feel they have an injury or suspect someone else.

5. Baseline Testing • Neurocognitive Testing • IMPACT Testing- a computer program in which symptoms checklist, concussion history and neuropsychological testing • Sports Tested for Baseline • baseball, basketball, diving, equestrian, football, pole vaulting, soccer, and softball

6. Mild Traumatic Brain Injury (MTBI) • Event occurs • Athletic Trainer Evaluates • Symptom Checklist • (+) Symptoms, Refer if Physician is present • Headache • Nausea • Vomiting • Balance Problems • Dizziness • Fatigue • Drowsiness • Visual Problems • Sensitivity to light • Sensitivity to noise • Irritable • Sadness • Nervousness • Numbness or Tingling • Feeling “foggy” • Difficulty in concentration

7. Evaluations • Short Term Memory Evaluation • How injury occurred • 3 word memory • Long Term Memory Evaluation • Day of Week • What did you eat for lunch • Processing Functions • Subtract from 100 by 7’s • Months of Year Backwards

8. Evaluations • Balance Testing • Double Leg Stance • Single Leg Stance • Tandem or Heel to Toe

9. Decisions • If Team Physician NOT present • Remove from all activities • If a concussion is suspected, do not return them that day!!! • Observe for minimum of 15 minutes • Athletic Trainer reevaluates • If athlete is: • COMPLETELY asymptomatic • Normal neurological exam including balance testing • Perform Functional Testing (Explained on next slide) • Still symptomatic • Athlete does not return that day and remains in observation • Arrange for physician evaluation

10. Functional Testing • Progressive • Walk • Jog • Sprint • Running Up/Downs • Bear Crawls • Observe for Symptoms • “Do you feel like normal _________ (name)?” • If Yes, allow return • If No, hold them

11. Diagnosed Concussion • Physician Evaluation ASAP • Sport Concussion Assessment Tool 2 (SCAT2) • Appropriate for persons Age 10 and above • Admitted or Released • Transportation Arranged • Athlete given Head injury Handout • Athlete instructed to follow-up with their staff athletic trainer daily

12. Immediate Concussion Treatment • Tylenol only for pain • Refrain from: • Physical Activity • Texting and Emailing • Playing video games • Watching TV, Video • Consider excusing from all academics

13. Daily Follow-up • Symptom Score • Determine athletes best interest depending on symptoms and academic demands • Refer to nutritionist to be placed on DHA Omega 3 • Has been shown to aid the brain tissue • If symptom score is less than 10 • Setup IMPACT testing

14. When do they become active? • At or near NO Symptoms • At or near Return to Baseline on IMPACT

15. Graduated Return-to-Play • Light Aerobic Exercise – Goal= Increase Heart Rate • Walking, Stationary Bike, Swimming -70% max • Sport Specific Exercise- Goal= Add Movement • Running Drills, jogging to sprinting • Training Drills- Goal= Add Coordination and Cognitive Function • Up/Downs, Bear Crawls, Pass Catching,

16. Final Clearance • Athlete is Completely Asymptomatic • Athlete Returns to Baseline on IMPACT • Athlete can accomplish all Return-to-Play activities with NO ONSET of SYMPTOMS • Athlete is referred by to physician for final clearance.

17. Ultimate Return-to-Play • Upon Medical Clearance: • Athlete is released to coaches for normal training exercises including contact drills if appropriate to restore athletes confidence and to determine if athletes is ready to participate.

18. Norms • Typical recovery is 5-7 days (Simple) • Complex much longer Weeks to Years

19. What symptoms are worse than others?

20. What symptoms are worse than others? • Fogginess

21. What symptoms are worse than others? • Fogginess • Dizziness