Concussion Management Plan
Definition of a Concussion
Although many definitions of concussion exist, MYL finds the one referenced below from the 4th International Concussion in Sport Conference (2013), to be the most useful:
"Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include:
Signs and Symptoms of a Concussion
A concussion should be suspected if any one or more of the following signs or symptoms are present, OR if the coach/evaluator is unsure.
2. Symptoms of a concussion may include (i.e., what the athlete reports):
Preseason Education
Parents, participants, and coaches will receive preseason concussion education and information from AFA. The education program will include information regarding the signs and symptoms, possible prevention, mechanisms of injury, treatment, return to activity guidelines, and limitations of protective equipment. Coaches are strongly encouraged to register and complete the free NFHS/CDC Concussion in Sports online program, which can be found on the Centers for Disease Control' s website at: https://www.cdc.gov/headsup/youthsports/training/
In addition, US Lacrosse/CDC Heads Up Lacrosse materials will be used by AFA to support this effort, which can be found on the Centers for Disease Control's website at: https://www.uslacrosse.org/blog/heads-up-on-concussions
Evaluation
A participant exhibiting signs and symptoms of a concussion will be removed by the coach, referee or league official from play immediately and must be evaluated by a Qualified Healthcare Provider before being allowed to resume AFA activities.
Return to Physical Activity
Participants diagnosed with a concussion should rest both physically and cognitively until they are back to their baseline level of symptoms. The graduated return to activity program described below will be used when the participant has been cleared to do so by a Qualified Healthcare Professional. Written documentation from the Qualified Healthcare Provider will be maintained by AFA.
The return to play progression is an individualized one that should incorporate the individual's past medical history related to the specific injury (e.g. the nature, burden and duration of symptoms, prior concussion history, history of migraines, learning disabilities, depression/anxiety), as well as how the participant responds to each step of the progression.
Medical Clearance Return to Participation protocol (recommended one full day between steps)
Rehabilitation stage
Functional exercise at each stage of rehabilitation
Objective of each stage
1. No activity
Complete physical and cognitive rest until asymptomatic
Recovery
2. Light aerobic activity
Walking, swimming or stationary cycling keeping intensity <70% of maximal exertion; no resistance training
Increase heart rate
3. Sport specific exercise
Skating drills in ice hockey, running drills in soccer; no head impact activities
Add movement
4. Non-contact training drills
Progression to more complex training drills, i.e., passing and line drills; may start progressive resistance training
Exercise, coordination and cognitive load
5. Full contact practice
Following final medical clearance, participate in normal training activities
Restore confidence and assess functional skills
- Participants, parents, coaches, and league administrators will be provided with educational information about concussions, including: the signs and symptoms; possible prevention; mechanisms of injury; treatment; return to activity guidelines; and limitations of protective equipment.
- Participants' parents, players, coaches, and league administrators will be required to acknowledge that they have received information about the signs and symptoms of concussions and understand the importance of promptly reporting all signs and symptoms of concussion, as well as all injuries and illnesses, to a participant' s coach, parent(s), and Qualified Healthcare Provider.
- Participants who exhibit signs, symptoms or behaviors suggestive of a concussion will be removed from AFA activities (e.g., competition, practice, conditioning sessions) and will not be allowed to return to AFA activities until the participant is evaluated and cleared (in writing) by a Qualified Healthcare Professional.
- Participants diagnosed with a concussion are prohibited from returning to AFA activity (e.g., competition, practice, conditioning sessions) for at least the remainder of that calendar day; and
- Participants will be required to follow a multi-step return-to-play protocol that outlines what participants, coaches, and parents should expect if there is a concussion diagnosis.
Definition of a Concussion
Although many definitions of concussion exist, MYL finds the one referenced below from the 4th International Concussion in Sport Conference (2013), to be the most useful:
"Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include:
- Concussion may be caused either by a direct blow to the head, face, neck, or elsewhere on the body with an 'impulsive' force transmitted to the head.
- Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, ill some cases, symptoms and signs may evolve over a number of minutes to hours.
- Concussion may result in neuropathalogical changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.
- Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. However, it is important to note that in some cases symptoms may be prolonged."
Signs and Symptoms of a Concussion
A concussion should be suspected if any one or more of the following signs or symptoms are present, OR if the coach/evaluator is unsure.
- Signs of a concussion may include (i.e., what the athlete looks like):
- Confusion/disorientation/irritability
- Trouble resting/getting comfortable
- Lack of concentration
- Slow response /drowsiness
- Incoherent/slurred speech
- Slow/clumsy movements
- Loss of consciousness
- Amnesia/memory problems
- Act silly/combative/aggressive
- Repeatedly ask same questions
- Dazed appearance
- Restless/irritable
- Constant attempts to return to play
- Constant motion
- Disproportionate/inappropriate reactions
- Balance problems
2. Symptoms of a concussion may include (i.e., what the athlete reports):
- Headache or dizziness
- Nausea or vomiting
- Blurred or double vision
- Oversensitivity to sound/light/touch
- Ringing in ears
- Feeling foggy or groggy
Preseason Education
Parents, participants, and coaches will receive preseason concussion education and information from AFA. The education program will include information regarding the signs and symptoms, possible prevention, mechanisms of injury, treatment, return to activity guidelines, and limitations of protective equipment. Coaches are strongly encouraged to register and complete the free NFHS/CDC Concussion in Sports online program, which can be found on the Centers for Disease Control' s website at: https://www.cdc.gov/headsup/youthsports/training/
In addition, US Lacrosse/CDC Heads Up Lacrosse materials will be used by AFA to support this effort, which can be found on the Centers for Disease Control's website at: https://www.uslacrosse.org/blog/heads-up-on-concussions
Evaluation
A participant exhibiting signs and symptoms of a concussion will be removed by the coach, referee or league official from play immediately and must be evaluated by a Qualified Healthcare Provider before being allowed to resume AFA activities.
Return to Physical Activity
Participants diagnosed with a concussion should rest both physically and cognitively until they are back to their baseline level of symptoms. The graduated return to activity program described below will be used when the participant has been cleared to do so by a Qualified Healthcare Professional. Written documentation from the Qualified Healthcare Provider will be maintained by AFA.
The return to play progression is an individualized one that should incorporate the individual's past medical history related to the specific injury (e.g. the nature, burden and duration of symptoms, prior concussion history, history of migraines, learning disabilities, depression/anxiety), as well as how the participant responds to each step of the progression.
Medical Clearance Return to Participation protocol (recommended one full day between steps)
Rehabilitation stage
Functional exercise at each stage of rehabilitation
Objective of each stage
1. No activity
Complete physical and cognitive rest until asymptomatic
Recovery
2. Light aerobic activity
Walking, swimming or stationary cycling keeping intensity <70% of maximal exertion; no resistance training
Increase heart rate
3. Sport specific exercise
Skating drills in ice hockey, running drills in soccer; no head impact activities
Add movement
4. Non-contact training drills
Progression to more complex training drills, i.e., passing and line drills; may start progressive resistance training
Exercise, coordination and cognitive load
5. Full contact practice
Following final medical clearance, participate in normal training activities
Restore confidence and assess functional skills