Concussion Guide. for Teachers. The Human Motion Institute at Randolph Hospital

Transcription

1 Concussion Guide for Teachers Revised 5/2014

2 Concussion Guide for Teachers GFELLER-WALLER CONCUSSION AWARENESS ACT The Gfeller-Waller Concussion Awareness Act was created to help educate and prepare for concussion in high school and middle school athletics. The law is named for two North Carolina football players who died as a result of concussion related injury and whose deaths could have been prevented with proper preparation. Matthew Gfeller suffered a severe helmet to helmet collision during his fi rst varsity football game at RJ Reynolds high school. Matthew never regained consciousness and died two days later. The accident caused a fatal traumatic brain injury. Jaquan Waller suffered a concussion at a practice at JH Rose high school. He played in a game two days later, without being medically cleared, and collapsed on the sideline. He died the following day as a result of Second Impact Syndrome. The Gfeller-Waller Concussion Awareness Act has three main sections: 1. Education: Each school shall develop a concussion safety training program. In order to be in compliance with the portion of the law, Concussion Information for Coaches/School Nurses/School Volunteers and Concussion information for Student Athlete/Parent forms are given as education materials. Each person who receives those materials is required to complete and sign the Concussion Statement form. Copies of these documents can be found at unc.edu 2. Emergency Action Plan and Post-Concussion Protocol: Each school is required to have an Emergency Action Plan in case of any serious athletic injury or illness. Included in the Emergency Action Plan is a post-concussion protocol which states the actions that will be taken in the case of suspected concussion. By law, an athlete who has a suspected concussion shall be removed from the activity and WILL NOT be allowed to play or practice on the same day. 3. Clearance/Return to Play following a Concussion: An athlete with a suspected concussion must be evaluated and receive written clearance by a medical professional trained in concussion management before he or she returns to practice or play. The Gfeller-Waller Clearance/NCHSAA Return to Play Form must be completed by a physician and returned to the Athletic Trainer, First Responder, or Coach. In order to be in compliance with the law, these forms must be kept on fi le. A copy of this form can also be found at

3 Concussion Guide for Teachers Teacher Education During the upcoming school year, you may have a student with a suspected concussion. Please read the following information as it will help you understand how to manage some of the functional academic defi cits this student may experience and answer some of your questions. If you have additional questions, please contact your school nurse, athletic trainer, or the Concussion Hotline (336) Concussion Basics: Signs and Symptoms As a result of a concussion, a student may experience any of the following symptoms: Headache Seeing Stars Disorientation Loss of Consciousness Sensitivity to Light Poor Balance Pressure in head Unequal Pupil Size Poor Coordination Dizziness Vacant Stare/Glassy eyed Ringing in the ears Drowsiness Feel in a fog Sleep disturbance Fatigue Feel slowed down Excess Sleep Memory Loss Inappropriate emotions Nausea/Vomiting Poor Concentration Change in personality Neck Pain Easily Distracted Irritability Irregular Breathing Blurred Vision Nervousness Irregular Pulse Please be aware that these symptoms may increase or change several days after injury and may result in negative effects on academic performance.

4 Concussion Guide for Teachers How is a concussion treated? After sustaining a concussion, the best rehabilitation is physical and cognitive (mental) rest. This means moving and thinking as little as possible. The following are recommendations for someone who has sustained a concussion: Use an ice pack on the head or neck for comfort. If symptoms include nausea or vomiting, eat a light diet and avoid spicy foods. Drink plenty of fl uids. NO alcohol. It is recommended that NO medications should be taken for the fi rst 10 days after injury. DO NOT use anti-infl ammatory medicines such as ibuprofen/advil, aspirin, naproxen/aleve, as they may mask symptoms or make them worse. The student may take acetaminophen/ Tylenol. Consult your physician regarding medication questions. The student SHOULD NOT drive while symptomatic. The student SHOULD NOT exercise or lift weights while symptomatic. This includes PE class and participation in sports. Limit use of electronics while symptomatic. This includes cell phones, television, computers, projector screens/smart boards, and video games.! "

5 Concussion Guide for Teachers What is Exertion Level Zero? In order to return to physical activity (Level 6), the student must progress through levels 0 to 5 of exertion. Level 0 means that the student is suspected to have a concussion and that he or she is displaying one or more of the signs or symptoms of a concussion. The student should remain on Level 0 until he or she is evaluated by a physician and that physician permits progression to Level 1. Level 0 may also be called a period of rest. A concussion, like any other injury needs time to heal properly. Because a concussion is an injury to the brain, the healing process includes both physical and mental rest. Lack of rest will cause a longer period of healing time and may cause a longer time until full recovery. The student at exertion Level 0 should practice the following recommendations: Physical Rest It is important to limit any activity that may increase blood fl ow or heart rate. Most of the following activities increase the heart rate, which increases blood fl ow to the brain and may cause symptoms to increase. Avoid positions that put the head lower than the rest of the body. This increases blood fl ow to the head. Limit excessive motion. If he or she has to move, move in slow, controlled motions as to not increase the heart rate. Avoid lifting or moving heavy objects. Mental Rest The only time a person can achieve complete mental rest is during sleep. Each person has a different mental tolerance. If a mental activity increases symptoms, those are the activities the student should limit. Limit the following mentally stimulating activities: Using a computer Watching television or overhead projectors/smart boards Using a cell phone or texting Reading or writing Playing video games Listening to loud music

6 Concussion Guide for Teachers Concussion Return to Play Guide for Student-Athletes The following information may help answer some of your questions and provide directions for follow-up care. ImPACT Testing Be advised that your school may participate in the ImPACT Concussion Management System. ImPACT is a computer based testing program that takes about minutes to complete. It records demographic information, graded signs and symptoms, and measures attention, verbal and visual memory, processing speed, and reaction time. The student athlete may have a baseline score of these measurements on record. In the event of a concussion, a post-injury test is performed to compare baseline results to the student athlete s current state. The ImPACT system does not diagnose concussion. The student athlete s results will be sent to his or her designated physician and will aid in the return to play decision. Physician Clearance The Gfeller-Waller Law requires an athlete with a suspected concussion to be cleared by a physician before returning to play. The student athlete should see a physician after completing the ImPACT test unless instructed otherwise, and a signed Gfeller-Waller form should be returned to the Athletic Trainer, First Responder, or Coach. The Gfeller-Waller form contains physician s recommendations for sports, physical education, and academics. Return to Play Please be aware that the student athlete should be progressed appropriately into participation. For their safety, they will be physically exerted over AT LEAST a six day period. Progression into participation will only occur when the child no longer has ANY symptoms. A detailed description of the levels of exertion will be provided upon request. Return to School Please be aware that the student may not be performing at his or her typical level while recovering from a concussion. For most students, only temporary academic adjustments are needed during recovery. Check your school s policy for concussion management. The student may be eligible for a 504 plan, IEP, or Transitory Impairment Plan. The type of support will differ depending on the specifi c needs of each student. Second Impact Syndrome Second Impact Syndrome is a dangerous condition which can occur if a student athlete returns to sports before full recovery of an initial concussion. If a student athlete sustains a second concussive injury, even a relatively minor one, before the symptoms of the initial concussion have cleared, the consequences can be deadly.

7 Concussion Guide for Teachers Concussions and the Classroom Every concussion is slightly different and each student experience and recovery is unique. In most cases, a concussion will not cause signifi cant limitations in the classroom, but it can affect the student s ability to participate, learn, and perform well in school. Academic activities requiring concentration may actually cause concussion symptoms to reappear or increase. Students may display the following: Problems paying attention or concentrating. Diffi culty remembering or learning new information. Need increased time to complete tasks or assignments. Diffi culty organizing tasks or multi-tasking. Inappropriate or impulsive behavior during class. Increased irritability. Decreased ability to cope with stress. Diffi culties with visual or audio stimulation from increased sensitivity. Fatigue and physical symptoms such as headache, dizziness, or nausea. Based on the identifi cation of symptoms and how the student responds to academic activity, interventions can be implemented on the student s behalf. Identify the symptoms the student is experiencing and the factors that increase the student s symptoms. Take into account the student s normal level of performance and consider the following: Does the student seem to struggle with specifi c subjects or tasks compared to normal? Does the student appear unfocused or fatigued after a specifi c amount of time in the class? Does the student perform better or worse related to the time of day? Do specifi c things in the classroom distract the student? Are any behavioral problems linked to specifi c settings, tasks, or activities?

8 Concussion Guide for Teachers It is normal for the student to feel frustrated, sad, or embarrassed because they are having disruptions in their normal level of performance and participation in the classroom, sports, driving, or daily activities. Talk with the student about these issues and offer support and encouragement. The following chart outlines fi ve common neuropsychological defi cits and offers strategies in managing each defi cit. Neuropsychological Deficit Attention/Concentration Working Memory Memory Consolidation/ Retrieval Processing Speed Fatigue Functional School Problem Management Strategy Short focus on lecture, class work, or homework Holding instructions in mind, reading comprehension, math calculations, writing Retaining new information, accessing learned information when needed Keep pace with work demand, process verbal information effectively Decreased arousal/activation to engage basic attention, working memory Shorter assignments, break down tasks into sections, lighter work load Repetition, written instructions, use of a calculator, short reading passages Smaller amounts to learn, recognition cues Extended time, slow down verbal information, comprehension checking Provide rest breaks

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10 Concussion Hotline (336) To help ensure that all of Randolph County has immediate access to proper concussion education and care.