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VBCPS Concussion Management Nancy Como-Lesko, PhD. VBCPS Current Process. Preseason Coaches are required to complete training Parents and student-athletes attend preseason meetings and hear concussion presentations Contact sport student-athletes undergo ImPACT baseline testing.

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vbcps current process
VBCPS Current Process

Preseason

  • Coaches are required to complete training
  • Parents and student-athletes attend preseason meetings and hear concussion presentations
  • Contact sport student-athletes undergo ImPACT baseline testing
vbcps current process1
VBCPS Current Process

In-season

  • Certified Athletic Trainers (ATC) are present at a majority of practices and competitions
  • If a concussion is suspected:
    • Student-athlete is removed from play
    • Student-athlete is evaluated by ATC
    • Student-athlete is referred to a physician as needed
    • ATC consults with physician for medical clearance and return to play
    • Consultation with nurses, teachers, Guidance
slide4
Virginia Board of Education Proposed Guidelines for Policies on Concussions in Student-Athletes (11-18-10)

A concussion policy team shall refine and review local concussion management policies on an annual basis

vbcps protocol response
VBCPS Protocol Response
  • Concussion Management Team (16 members):
  • Central office and school administrators, Certified Athletic Trainers, Coordinator of Health Services, coaches, Pediatric Clinical Neuropsychologist, a parent and a student
slide6
Virginia Board of Education Proposed Guidelines for Policies on Concussions in Student-Athletes (11-18-10)

Protocol for Removal from and Return to Play

  • No member of a school athletic team shall participate in any event or practice the same day he or she is injured and:
    • Exhibits signs, symptoms or behaviors attributable to a concussion; or
    • Has been diagnosed with a concussion
slide7
Virginia Board of Education Proposed Guidelines for Policies on Concussions in Student-Athletes (11-18-10)
  • No member of a school athletic team shall return to participate in an athletic event or training on the days after he/she experiences a concussion unless all of the following conditions have been met:
  • The student-athlete is symptom-free
  • Continues to be symptom-free with increasing exertion
  • Receives medical clearance from an appropriate Licensed Health Care Provider
appropriate health care provider
Appropriate Health Care Provider
  • Physician
  • Physician Assistant
  • Osteopath
  • Athletic Trainer licensed by the Board of Medicine
  • Neuropsychologist licensed by the Board of Psychology
  • Nurse Practitioner licensed by the Board of Nursing
vbcps protocol response1
VBCPS Protocol Response
  • A student-athlete suspected of sustaining a concussion will be immediately removed from play and not be allowed to return that day
  • Once medically cleared and symptom-free, the student athlete will begin the Concussion Graduated Return to Play
signs observed
Signs Observed
  • Answers questions slowly
  • Loses consciousness (even temporarily)
  • Shows behavior or personality change
  • Forgets events prior to hit (retrograde amnesia)
  • Forgets events after hit (anterograde amnesia)
  • Appears to be dazed or stunned
  • Is confused about assignment
  • Forgets plays
  • Is unsure of game, score, or opponent
  • Moves clumsily
signs reported by athlete
Signs Reported by Athlete
  • Feeling sluggish
  • Feeling "foggy”
  • Change in sleep pattern
  • Concentration or memory problems
  • Headache
  • Nausea
  • Balance problems or dizziness
  • Double or fuzzy vision
  • Sensitivity to light or noise
impact
ImPACT
  • Neurocognitive assessment system
  • Computerized
  • Group administered
  • Provides pre-injury baseline
  • Normed for 12+
impact areas assessed
ImPACT Areas Assessed
  • 4 Composites
    • Verbal Memory
    • Visual Memory
    • Reaction Time
    • Visual-motor reaction time
  • Symptom Count
  • Cognitive Efficiency Index
vbcps and impact
VBCPS and ImPACT
  • First piloted at Kempsville HS ‘07-’08
  • In all regular High Schools ‘10-’11
  • Contact sports athletes
  • Presently, 2841 baseline tests this year
  • 148 Invalid baseline tests
slide15
Virginia Board of Education Proposed Guidelines for Policies on Concussions in Student-Athletes (11-18-10)
  • Each student-athlete and the student-athlete’s parent or guardian shall review, on an annual basis, information on concussions provided by the school division.
  • Each student-athlete and student-athlete’s parent shall sign a statement acknowledging receipt, review and understanding of such information
vbcps protocol response2
VBCPS Protocol Response

Annual education for parent and student-athletes will include:

  • Mandatory preseason meeting
  • Video presentations about concussions and VBCPS protocol
  • Information packets (HeadsUp fact sheets, ImPACT testing information and consent)
  • Parents and student-athletes will be required to sign Concussion Information Sheet and Statement of Understanding
  • Additional resources will be provided
vbcps process
VBCPS Process
  • Athletes/families see presentation in pre-season meeting
  • Informed consent obtained
  • Groups of athletes are assessed in computer lab in preseason, before competition begins
  • Validity of baseline asessments reviewed
invalid baselines
Invalid Baselines
  • Check for special education eligibility
  • Ask athlete what happened during test
  • Re-Test
  • If profile similar to psych profile, consider it baseline
post injury
Post-Injury
  • Athlete takes post-injury test once clear and able to tolerate
  • Compare to baseline
  • Examine change index
  • Review symptom count
  • Return to play protocol
return to play
Return to Play
  • No signs or symptoms
  • Normal neurologic exam
  • Normal balance
  • Neurocognitive exam back to baseline
  • Then…Return to play progression
return to play progression
Return to Play Progression
  • No activity
  • Light aerobic exercise
  • Sport-specific exercise
  • Non-contact training drills
  • Full-contact practice
  • Return to play
vbcps protocol response3
VBCPS Protocol Response
  • Concussion Graduated Return to Play
treatment of the student athlete in school
Treatment of the Student-Athlete in School
  • School will develop an individualized Health Care Plan as needed to address need for physical and cognitive rest
  • Information and training provided to teachers
  • Consultation with Neuropsychologist as needed
persistent symptoms
Persistent Symptoms
  • Monitor symptoms
  • SST accommodations
  • 504 Plan
  • Full Neuropsychological if indicated
  • Possible IDEA, although rare
common accommodations
Common Accommodations
  • No quizzes/tests initially, then extended time and shortened
  • Copies of notes/assignments
  • Possibility of oral testing
  • Reduced day/ partial homebound
  • Read Aloud
  • No PE or sports participation
  • Allowance for breaks as needed
  • Put head on desk or visit clinic
  • Extended time for homework and/or shortened assignments
less common accommodations
Less Common Accommodations
  • Drop course
  • Drop to a lower level of course
  • Take an Incomplete until able to participate
  • Forego exams until later in the year, summer, or able to participate
  • AP exams, SAT, and ACT accommodations through 504
  • College Board and ACT have a process for temporary disability accommodations