Border Land School Division

Border Land School Division is committed to fostering inspiring educational opportunities, meaningful relationships, and engaged citizens.

Background:

Border Land School Division understands the seriousness and long-term effects of concussions and has developed this procedure to create standards to protect the children under our care to mitigate the risks associated with concussions. 

Definition of a Concussion:  Temporary change in a person’s mental state, because of a trauma to the head, face, jaw, or neck area (whiplash) not necessarily with loss of consciousness.

A student (adult) who may have experienced a concussion can display a wide variety of symptoms: Visible Clues, Signs and Symptoms include but not limited to:

Although the classic symptoms of loss of consciousness, confusion, memory loss, and/or balance problems may be present in some athletes with mild concussion, there may or may not be obvious signs that a concussion has occurred.

If a student is suspected of having a concussion or has informed the teacher/coach that they have a concussion, the student is to be immediately removed from all activities and play and are not allowed to return to activity/play until assessed by a doctor.  Direct supervision is required of all students suspected of having a concussion.  Parents/Guardians are to be called to transport their child to the doctor upon discovery of a suspected concussion.

Post-concussion symptoms can be quite subtle and may go unnoticed by the athlete, team medical staff, or coaches.

Many coaches and other team personnel may have limited training in recognizing signs of concussion and therefore may not accurately diagnose the injury when it has occurred.

Players may be reluctant to report concussive symptoms for fear that they will be removed from the game, and this may jeopardize their status on the team, or their athletic careers.

Traditional neurological and radiological procedures, such as CT, MRI, and BEG, although invaluable in discerning more serious head injuries, are not consistently useful in evaluating the effects of mild head injuries.

All physical education teachers and school coaches are responsible for familiarizing themselves with the signs and symptoms of a concussion, concussion management protocols, Return to School and Return to Play Strategies. 

Procedures:

1.      All schools are responsible for having a clear concussion reporting protocol for the school.  Students who may have a concussion must follow division concussion management protocols and identified as either a student who is returning to play, or returning to learn. This student information is to be shared with all staff.

2.      When a student athlete shows any signs or symptoms of concussion, they are not allowed to participate in any sporting activity (practice or game) or any physical activities such as recess, regular class, gym class or an outdoor education class.   The student is to seek medical attention.

3.      In the event of a trauma to the head, the following questions may be asked to check cognitive status (mental status testing):

a.       What venue are we at today? (Which gym / stadium / rink is this)?

b.      Which half (quarter, period)?

c.       Who scored last in this match (game)?

d.      What team did you play last week / game (Who was your opponent in the last match)?

e.       Did you / your team win the last match / game?

4.      After checking the mental / cognitive status of the student, ask the student to perform the following balance tests:

a.       Tandem Stance: (requires a stop-watch)

                                                  i.      Stand heel-to-toe with non-dominant foot in back (weight evenly distributed).

                                                ii.      Repeat position putting both hands-on hips with eyes closed.  Balance for 20 seconds.  NOTE: If more than 5 errors occur treat the situation as a concussion (lift hands off hips, opens eyes, lift forefoot or heel, step / stumble / fall, remain out of a start position for more than 5 seconds.

5.      If a concussion is suspected, remove the student from play (or practice) immediately and follow the steps are to be followed:

a.       Immediately remove the student from the game / practice.

b.      A student who has a concussion is not allowed to return to play until after a specially trained doctor or a professional sport health practitioner such as a sports physician, a certified athletic therapist, and/or a neuropsychologist, has cleared the student to return to activity/school.

c.       A return-to-activity/play- must follow a medically supervised, stepwise process (No training until medically cleared).

6.      When to seek medical assistance? If you suspect someone has a concussion they are to seek medical attention (a doctor) immediately. Parents / emergency contact are to be contacted and asked to take their child to the hospital for treatment. If the person exhibits any of the following symptoms, immediately call 911 to ensure that they are taken to the nearest hospital for treatment:

a.       Nausea or vomiting 2 or more times

b.      Tremors or convulsions (uncontrollable shaking or writhing movements)

c.       Slurred speech

d.      Increased confusion, restlessness or agitation

e.       Fluid leaking from the nose or ear

f.        Weakness, numbness or decreased coordination

g.      If a student has been unconscious for more than a minute

Return to School and Learning

1.      No two concussions are the same, students can experience different levels of symptom severity and progression. It is important to remember to never rush the process, students should only participate in activities that they can tolerate without worsening symptoms.

2.      Returning to school and learning must always happen before a return to sport and be approved by a licensed medical professional.

3.      Below, the 4 stage Return to School Strategy outlines the gradual increases in cognitive and physical activity.  This strategy should be followed by anyone involved in the care of a concussed student.

Source: Parachute Canada, 2018

Return to Play

1.      It is crucial to allow enough healing and recovery time following a concussion to prevent further damage. Research suggests that the effects of repeated concussion are cumulative over time.

2.      Following a concussion, there is a period of change in brain function that may last anywhere from 24 hours to 10 days. During this time, the brain may be vulnerable to more severe or permanent injury. If the athlete sustains a second concussion during this time period, the risk of permanent brain injury increases.

Source: Bobbi Schram BScPT - Dynamic Physiotherapy & Sports Injury Clinic

3.      Care and patience are required when a student is returning to everyday activities in school and at home, as well as, sport participation. The following six-step procedure is to be followed with any student returning to participating in regular school physical activities (gym class, intramurals, recess, etc.) and/or a school team. Each step in the process must take a minimum of one day but could take longer, depending on the severity of the concussion and the health and fitness level of the student.

4.      Students should never return to active play before fully recovering from a concussion.  Returning to play before being fully recovered and cleared medically will reduce the risk of sustaining another concussion.

5.      The following six steps will take a minimum of six days, depending on the severity of the concussion.  Rest is the key to the healing process and as soon as any signs or symptoms re-appear the student is not allowed to move to the next step, required to rest, and must be re-evaluated by their doctor. Any return to activity/play timeline can be adjusted at the discretion of the student’s doctor or a professional sport health practitioner such as a sports physician, a certified athletic therapist, and/or a neuropsychologist.

Step 1: Activity in all school and sport related activities are not allowed until the concussion symptoms are gone. The procedures for a student to return-to-Activity/Play after a concussion begins only after a specially trained doctor or a professional sport health practitioner such as a sports physician, a certified athletic therapist, and/or a neuropsychologist, has cleared the student to return to activity/school.

Step 2: Restricted – Light Aerobic Exercise is allowed.  Student is to be directly supervised by a teacher who will monitor for signs of concussion symptoms returning.  A progress workload increases over time (duration and intensity) is followed if there are no concussion signs or symptoms.  If symptoms re-appear then all activity is stopped and the student must consult with a doctor.  If there are no symptoms, then the student can continue to the next step.

Step 3: Sport specific activities such as skating or throwing can begin.  No body contact or participating in drills or activities that could cause a jarring motion.  Hitting a baseball with a bat, spiking or blocking a volleyball, etc. are not allowed.  If symptoms re-appear then all activity is stopped and the student must consult with a doctor.  If there are no symptoms, then the student can continue to the next step.

Step 4: Sport specific drills without body contact can be introduced. Students may only move on to the next step without medical clearance from a doctor.  If symptoms re-appear then all activity is stopped and the student must consult with a doctor.  If there are no symptoms, then the student can continue to the next step.

Step 5: After day 5, medical clearance, and no re-appearance of concussion signs or symptoms, students may participate in body contact activities/drills. If symptoms re-appear then all activity is stopped and the student must consult with a specially trained doctor or a professional sport health practitioner such as a sports physician, a certified athletic therapist, and/or a neuropsychologist.  If there are no symptoms, then the student can continue to the next step.

Step 6: Return to game play. Students who are suspected of having or have been diagnosed with a concussion that occurred during non-school hours are required to follow the same guidelines.  Standard practice – if the school is made aware of, or suspects that a student has or has had a concussion, they are to be removed from all activities. Parents are to be contacted and a full assessment done by a qualified medial professional such as a specially trained doctor or a professional sport health practitioner such as a sports physician, a certified athletic therapist, and/or a neuropsychologist.

6.      Student can move forward to the next stage only when they are symptom free for 24 hours.

7.      If symptoms re-appear, student must regress to previous stages and only participate in activities that they can tolerate and contact their doctor, a professional sport health practitioner such as a sports physician, a certified athletic therapist, and/or a neuropsychologist, or seek medical help immediately at the nearest hospital, if symptoms worsen.

Resources/References

·         Concussion Management Guidelines published by Sport Medicine & Science Council of Manitoba

·         Support Document: SCAT2 Sport Concussion Assessment Tool 2

·         Concussions 101, A Primer for Kids and Parents by Dr. Mike Evans / YouTube Resource

https://www.youtube.com/watch?v=zCCD52Pty4A&feature=youtu.be

·         Concussion management and return to learn by Dr. Mike Evans / YouTube Resource

https://www.youtube.com/watch?v=_55YmblG9YM

·         www.coach.ca website / Concussion Awareness. Concussions can occur while participating in any sport or recreational activity. Since the circumstances under which a concussion can be sustained are so varied, it’s important for all coaches, parents, and athletes to be aware of the signs, symptoms, and what to do if a concussion occurs.

·         Coaches Training Video – www.SchoolCoach.ca / Concussion in Sports - What You Need To Know / https://www.schoolcoach.ca/courses.aspx

·         “Making Headway”  /  Concussion On-Line Course / www.coach.ca

·         Parachute Canada. 2018. Return-to-School Strategy. Retrieved from

http://horizon.parachutecanada.org/en/article/parachutes-return-to-learn-protocol/