Athletic Training Concussion Policy Exam

For athletes with a history of concussions, it is important to clarify any pattern of:

- Concussions occurring as a result of lighter impact - Concussions occurring closer together in time - Lengthier recovery time with successive concussions - Less complete recovery with each subsequent concussive injury

List the characteristics of Sickle Cell Trait

- During intense exercise, red blood cells containing sick hemoglobin can change shape from round to quarter-moon, or "sickle" - Sickled red cells may accumulate in the bloodstream during intense exercise, blocking normal blood flow to the tissues and muscles. - during intense exercise, athletes with sickle cell trait have experienced significant physical distress, collapsed and even died. - Heat, dehydration, altitude and asthma can increase the risk for and worsen complications associated with sickle cell trait, even when exercise is not intense. - Athletes with sickle cell trait should not be excluded from participation as precautions can be put into place.

Recommend ____ be used sparingly in treatment of headache symptoms of concussion, and only when consent of ____

Acetaminophen (Tylenol), Team Physician

A MTBI involves what mechanism

An acceleration-deceleration mechanism in which a blow to the head or the head striking an object may result in one or more symptoms.

At Creighton, what do they do regarding Sickle Cell?

An athlete is asked if they know if they have it, and then they are asked if they want to be tested. Then they must sign a document saying they know the risks and what not. It is likely that most African American players will be tested anyways just by going off of statistics.

If the student-athlete has returned to baseline GSC, but the SAC and BESS scores have not yet returned,

Beginning the return to play progression should be delayed until these scores also return to baseline.

Clinical assessment for _____ will be a component of evaluation

Cervical spine injury, skull fracture, and intracranial bleeding

Who at Creighton is given a fact sheet regarding education?

Coaches, Athletes, and Strength & Conditioning Coaches

For athletes with a history of concussions, it is also important to clarify any pattern of:

Concussions occurring as a result of lighter impact. Concussions occurring closer together in time. Lengthier recovery time with successive concussions. Less complete recovery with each subsequent concussive injury.

Complex Concussion

Defined as, "Encompassing cases where athletes suffer persistent symptoms (including symptom recurrence with exertion) specific sequel or prolonged cognitive impairment following the injury. This group may also include athletes who suffer multiple concussions over time or where repeated concussions occur with progressively less force." These athletes may not be able to progress through a step-wise return to play in so simple a fashion and may require a more prolonged period of asymptomatic rest and more time at each step. They are to be managed by the management team and any specialists that may be required.

Simple Concussion

Described as, "An injury that progressively resolves without complication over seven to ten days." Simple Concussions are the most common and will generally progress through the step-wise return to play without symptom aggravation and return to play without difficulty.

During the educational process, students are provided with

Educational material on concussions through the "Concussion: A Fact Sheet for Student-Athletes" provided by the NCAA. Students are also required to watch the video: "Concussions: Don't Hide It, Report It, Take Time to Recover", also provided by the NCAA.

Once the athlete has been thoroughly evaluated and diagnosed with a concussion

Frequent medical evaluations and observations, continued monitoring of post-concussion signs and symptoms, and post-injury cognitive assessment and postural stability will be performed.

Baseline testing, 3 tests:

Graded symptoms checklist (GSC), cognitive assessment (SAC) and postural stability, or balance test (BESS) will be conducted for all athletes. We use these 3 things as a baseline test. Can be viewed in "Concussion Assessment Packet" located in files. Be able to identify and explain what these tests are and what they do.

A blow to the head or the head striking an object may result in the following symptoms

Headache, nausea, vomiting, dizziness, balance problems, feeling slowed down, fatigue, trouble sleeping, drowsiness, sensitivity to light or noise, LOC, blurred vision, difficulty remembering or concentrating

Documenting a ______ is also very important in interpreting baseline and post injury neuropsychological testing.

History of attentional disorders, learning disability, or any other cognitive developmental disorders

Symptoms of sick cell trait while active are

Muscle pain, abnormal weakness, undue fatigue or breathlessness.

Student-athletes diagnosed to have sustained a concussion shall

Not return to physical or classroom activity for the remainder of the day.

List the 3 components of Recognition, Referral, and Treatment Plan

Recognition, Emergency Action Plan, and Treatment Plan.

A student-athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be

Removed from practice or competition and be evaluated by an athletic trainer or team physician with concussion experience.

An athlete showing signs, symptoms, or behaviors consistent with a concussion shall be:

Removed from practice or competition and be evaluated by an athletic trainer or team physician with concussion experience.

A student athlete who sustains a concussion will be treated using an individualized treatment plan based on

Self reported signs and symptoms, cognitive function, and balance ability.

the NCAA mandates that student-athletes:

Sign a statement in which they accept the responsibility for reporting their injuries and illnesses to the Athletic Training Staff, including signs and symptoms of concussions.

What are the three things athletes must do regarding concussion education?

Sign the statement saying they will be honest with their symptoms/see teammates with symptoms. Read over the fact sheet given, and watch the NCAA mandated video "Don't Hide It, Report It, Take Time to Recover"

Following a concussion sustained by a student athlete while at Creighton, a:

Six month new baseline concussion assessment will be administered

The Creighton University Athletic Training Staff will educate:

Student Athletes, Sports Administrators, and Coaches

What is Creighton's policy on baseline testing?

Student athletes will receive a new baseline every two years while at Creighton University to reassess cognitive ability and postural stability.

The Athletic Department will ensure ____________ are provided with educational material regarding concussions and have signed and watched the video.

Students, Coaches, Team Physicians, Athletic Trainers, Sports Administrators, and Director of Athletics

3 baseline tests

Symptomology (GSC), Cognitive assessment (SAC), and postural stability (BESS) will be conducted for all student-athletes.

The Creighton University Athletic Concussion Management Team shall consist of

Team Certified Athletic Trainer, a Team Physician, and a Consulting Neurologist/Neuropsychologist/Neurosurgeon

Who determines pre-participation clearance?

Team Physician

Sickle cell trait is

The inheritance of one gene for sickle hemoglobin and one for normal hemoglobin.

What is the team physicians role in baseline testing?

The team physician determines pre-participation clearance and along with the Sports Medicine Staff and Concussion Management Team determine the need for additional consultation or testing.

After the initial concussion evaluation, the ATC or Team Physician will determine

Whether the athlete requires more advanced medical intervention on an emergent or non-emergent basis.

During Pre-Screening, it is specifically important to establish:

Whether the player has any history of concussion, and if so how many. Injury characteristics of any previous concussions (LOC, amnesia, symptoms, recovery time, time lost from participating, and any medical treatment.)

In Pre-Screening, it is important to establish what?

Whether the player has any history of concussions, and if so how many. Who diagnosed your concussion? Injury characteristics of any previous concussions.

Sickle cell trait is not a

disease

The athlete should be awakened during the night to monitor potentially deteriorating signs and symptoms only if

he/she experienced LOC, had prolonged periods of amnesia, was still experiencing significant symptoms at bedtime, or the initial injury is less than four hours before the athlete goes to sleep.

Substances to avoid include those that adversely affect

the CNS function including alcohol and narcotics.

People at high risk for Sickle Cell trait are

those whose ancestors come from Africa, South or Central America, India, Saudi Arabia and caribbean and Mediterranean countries.

Sickle cell is a lifelong condition that

will not change over time

What follows a concussion sustained by a student athlete in terms of baseline testing?

A six month new baseline concussion assessment will be administered

How can you prevent a collapse?

- Know your sickle cell status - Engage in a slow and gradual preseason conditioning regimen. - build up your intensity slowly while training. - Set your own pace. Use adequate rest and recovery between reps, especially during gassers or sprints. - Avoid pushing with all-out exertion longer than two to three minutes without a rest interval or breather. - If you experience symptoms stop the activity immediately and notify your athletic trainer/coach. - Stay well hydrated at all times, especially if hot and human conditions. - Avoid using high caffeine energy drinks or supplements because they can cause dehydration. - Maintain proper asthma management - Refrain from exercising during acute illness, if feeling ill, or while experiencing a fever. - Beware when adjusting to a change in altitude. Request that supplemental oxygen will be provided for you. - Seek prompt medical care when experiencing unusual physical distress.

Name the statistics regarding Sickle Cell Trait

- Sickle cell trait overs in about 8 percent of the US African American population, and between one in 2,000 to 1 in 10,000 in the caucasian population. - Most US states test at birth, but most athletes with sickle cell trait don't know they have it. - The NCAA recommends that athletics departments confirm the sickle cell trait status in all student-athletes. - Knowledge of sickle cell trait can be a gateway to education and simple precautions that may prevent collapse among athletes with sickle cell trait.

Several feature that incorporate clinical, pathologic, and biomechanical injury constructs associated with MTBI are:

1. Concussion may be caused by a direct blow to the head or elsewhere in the body from an impulsive force transmitted to the head. 2. Concussion may cause immediate and short lived impairment of neurologic function. 3. Concussion may cause a gradient of clinical syndromes that may or may not cause loss of consciousness (LOC). Resolution of the clinical and cognitive symptoms typically follow a sequential course.

The management team shall recognize the following common understandings about concussion:

1. Every concussion is individualized 2. The long term effects of repeated concussions are cumulative. 3. All Concussions are enigmatic in their presentation, and should be treated with utmost caution. 4. The majority of concussions resolve in a short 7-10 day period. 5. The majority of repeat concussions during a sport season occur within 10 days of the initial incident. 6. The cornerstone of concussion management is physical and cognitive real until symptoms resolve, and then a graded program of exertion prior to medical clearance to return to play.

Transportation for further medical care will be obtained if the injured athlete has any of the following

1. Glasgow Coma Scale <13 2. Prolonged loss of consciousness 3. Focal neurological deficit suggesting intracranial trauma 4. Repetitive emesis 5. Persistently diminished or worsening mental status or other neurological signs/symptoms 6. Spine Injury

In the event of a prolonged recovery following a concussion the student-athlete will have further evaluation by a physician to consider any additional diagnosis. These additional diagnoses include:

1. Post Concussion Syndrome 2. Sleep dysfunction 3. Migraine or other headache disorders 4. Mood disorders such as anxiety and depression 5. Ocular or vestibular dysfunction

Examples of minimizing head trauma exposure include, but are not limited to:

1. Produced an educational form for all coaching staff. 2. Address concussion management in the rules of all sports 3. Address several points of contact that are included other than head to head such as: Contact and blows to the head with the shoulder, forearm and hand. 4. Taking a safety first approach to specific sports 5. An Emergency Action Plan (EAP) with clearly defined written and practice protocols has been developed and in place at every location. An Athletic Trainer should be present at all practices and games, the athletic trainer is the key component in any event to reduce the risk of injury and optimize safety for student athletes.

Students will receive a new baseline every ____ while at Creighton

2 years (At some colleges it's every year)

In addition to a thorough symptom assessment and physical evaluation, what other tests will be given?

A formal cognitive assessment (SAC) and a postural stability (BESS) testing will be performed to objectively determine the injury severity.

Cerebral concussion can best be classified as

A mild diffuse brain injury and is often referred to as a mild traumatic brain injury (MTBI)

Concussions have been categorized into what?

A simple concussion or a complex concussion (In Zurich)