Sports Medicine
Athletic Trainer
Zach Monette
monettez@northshoreschools.org
CONCUSSION MANAGEMENT
The Board of Education of the North Shore School District recognizes that concussions and head injuries are commonly reported injuries in children and adolescents who participate in sports and recreational activity and can have serious consequences if not managed carefully. Therefore, the District adopts the following policy to support the proper evaluation and management of head injuries.
Concussion is a mild traumatic brain injury. Concussion occurs when normal brain functioning is disrupted by a blow or jolt to the head. Recovery from concussion will vary. Avoiding re-injury and over-exertion until fully recovered are the cornerstones of proper concussion management.
While district staff will exercise reasonable care to protect students, head injuries may still occur. Physical education teachers, coaches, nurses and other appropriate staff receive training to recognize the signs, symptoms and behaviors consistent with a concussion. Any student exhibiting those signs, symptoms or behaviors while participating in a school sponsored class, extracurricular activity, or interscholastic athletic activity shall be removed from the game or activity and be evaluated as soon as possible by an appropriate health care professional. The School Nurse or Athletic Trainer will notify the student’s parents or guardians and recommend appropriate monitoring to parents or guardians.
If a student sustains a concussion at a time other than when engaged in school-sponsored activity, the district expects the parent/legal guardian to report the condition to the Coach, Teacher, Nurse or Athletic Trainer, so that the district can support the appropriate management of the condition.
The student shall not return to school or activity until authorized to do so by an appropriate health professional. The school’s chief medical officer will make the final decision on return to activity including physical education class and after-school sports. Any student who continues to have signs or symptoms upon return to activity must be removed from play and reevaluated by their health care provider.
The Superintendent, in consultation with appropriate district staff, including the chief school medical officer, will develop regulations and protocols to guide the return to activity.
CONCUSSION GUIDELINES AND PROCEDURES
Education
Concussion education is provided for all administrators, teachers, coaches, school nurses, athletic trainers and guidance counselors. Education of parents will be accomplished through preseason meetings for sports and/or information sheets provided to parents. Education will include, but not be limited to the definition of concussion, signs and symptoms of concussion, how concussions may occur, why concussions are not detected with CT Scans or MRI’s, management of the injury and the protocol for return to school and return to activity or interscholastic athletics. The protocols will cover all students returning to school after suffering a concussion regardless if the accident occurred outside of school or while participating in a school activity.
Concussion Management Team
The District has assembled a concussion management team (CMT). The CMT will consist of the School Doctor, Don Lang-- Athletic Director, Janice Nunziata-- School Nurse and Michael Gonzalez--Athletic Trainer. The District’s CMT will coordinate training for all administrators, teachers, coaches and parents. Training is mandatory for all coaches, assistant coaches and volunteer coaches that work with these student athletes regularly. In addition, information related to concussions will also be included at parent meetings or in information provided to parents at the beginning of sports seasons. Parents need to be aware of the school district’s policy and how these injuries will ultimately be managed by school officials.
Training includes: signs and symptoms of concussions, post-concussion and second impact syndromes, return to play and school protocols, and available area resources for concussion management and treatment. Particular emphasis should be placed on the fact that NO athlete will be allowed to return to play the day of injury and also that ALL athletes should obtain appropriate medical clearance prior to returning to play or school.
The CMT will act as a liaison for any student returning to school and/or play following a concussion. The CMT will review and/or design an appropriate plan for the student while the student is recovering.
Concussion Management Protocol
Return to Academic:
After an initial period of complete rest lasting approximately 24-48 hours, a healthcare provider may clear a student to begin a gradual return to academic (aka cognitive) activities. Even with classroom accommodations, a student with a concussion will need to gradually return to all academic activities. Students with concussions may become fatigued easily and may need time to rest in school.
Graduated return to school strategy:
Stage 1:
Aim- Daily activities at home that do not give the child symptoms.
Activity- Typical activities of the child during the day as long as they do not increase symptoms (e.g., reading, texting, screen time). Start with 5-15 minutes at a time and gradually build up.
Goal of each step- Gradual return to typical activities.
Stage 2:
Aim- School activities
Activity- Homework, reading, or other cognitive activities outside of the classroom.
Goal of each step- Increase tolerance to cognitive work
Stage 3:
Aim- Return to school part-time
Activity- Gradual introduction of school work. May need to start with a partial school day or with increased breaks during the day.
Goal of each step- Increase academic activities.
Stage 4
Aim- Return to school full-time.
Activity- Gradually progress school activities until a full day can be tolerated.
Goal of each step- Return to full academic and catch up on missed work.
Return to play:
A gradual return to physical activity typically is done by progressing a student through levels of activity that increase in duration and/or intensity. After a brief period of initial rest (24-48 hours), symptom-limited activity can be begun while staying below a cognitive and physical exacerbation threshold (stage 1). Generally, each step should take 24 hours, so that athletes would take a minimum of 1 week to proceed through the full rehabilitation protocol once they are asymptomatic at rest. However, the time frame for RTS may vary with player age, history, level of sport, etc., and management must be individualized.
Graduated return to sport strategy:
Stage 1
Aim- Symptom-limited activity
Activity- Daily activities that do not provoke symptoms.
Goal of each step- Gradual reintroduction of work/school activities.
Stage 2
Aim- Light aerobic exercise
Activity- Walking of stationary cycling at slow to medium pace. No resistance training.
Goal of each step- Increase heart rate.
Stage 3
Aim- Sport-specific exercise
Activity- Running or skating drills. No head impact activities.
Goal of each step- Add movement.
Stage 4
Aim- Non-contact training drills
Activity- Harder training drills, e.g., passing, drills. May start progressive resistance training.
Goal of each step- Exercise, coordination and increased thinking.
Stage 5
Aim- Full contact practice
Activity- Following medical clearance, participate in normal training activities.
Goal of each step- Restore confidence and assess functional skills by coaching staff.
Stage 6
Activity- Return to sport.
Goal of each step- Normal game play.
Student Parent Concussion Information