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VBCPS Concussion Management Nancy Como-Lesko, PhD

VBCPS Concussion Management Nancy Como-Lesko, PhD. VBCPS Current Process. Preseason Coaches are required to complete training Parents and student-athletes attend preseason meetings and hear concussion presentations Contact sport student-athletes undergo ImPACT baseline testing.

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VBCPS Concussion Management Nancy Como-Lesko, PhD

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  1. VBCPS Concussion ManagementNancy Como-Lesko, PhD

  2. VBCPS Current Process Preseason • Coaches are required to complete training • Parents and student-athletes attend preseason meetings and hear concussion presentations • Contact sport student-athletes undergo ImPACT baseline testing

  3. VBCPS Current Process In-season • Certified Athletic Trainers (ATC) are present at a majority of practices and competitions • If a concussion is suspected: • Student-athlete is removed from play • Student-athlete is evaluated by ATC • Student-athlete is referred to a physician as needed • ATC consults with physician for medical clearance and return to play • Consultation with nurses, teachers, Guidance

  4. Virginia Board of Education Proposed Guidelines for Policies on Concussions in Student-Athletes (11-18-10) A concussion policy team shall refine and review local concussion management policies on an annual basis

  5. VBCPS Protocol Response • Concussion Management Team (16 members): • Central office and school administrators, Certified Athletic Trainers, Coordinator of Health Services, coaches, Pediatric Clinical Neuropsychologist, a parent and a student

  6. Virginia Board of Education Proposed Guidelines for Policies on Concussions in Student-Athletes (11-18-10) Protocol for Removal from and Return to Play • No member of a school athletic team shall participate in any event or practice the same day he or she is injured and: • Exhibits signs, symptoms or behaviors attributable to a concussion; or • Has been diagnosed with a concussion

  7. Virginia Board of Education Proposed Guidelines for Policies on Concussions in Student-Athletes (11-18-10) • No member of a school athletic team shall return to participate in an athletic event or training on the days after he/she experiences a concussion unless all of the following conditions have been met: • The student-athlete is symptom-free • Continues to be symptom-free with increasing exertion • Receives medical clearance from an appropriate Licensed Health Care Provider

  8. Appropriate Health Care Provider • Physician • Physician Assistant • Osteopath • Athletic Trainer licensed by the Board of Medicine • Neuropsychologist licensed by the Board of Psychology • Nurse Practitioner licensed by the Board of Nursing

  9. VBCPS Protocol Response • A student-athlete suspected of sustaining a concussion will be immediately removed from play and not be allowed to return that day • Once medically cleared and symptom-free, the student athlete will begin the Concussion Graduated Return to Play

  10. Signs Observed • Answers questions slowly • Loses consciousness (even temporarily) • Shows behavior or personality change • Forgets events prior to hit (retrograde amnesia) • Forgets events after hit (anterograde amnesia) • Appears to be dazed or stunned • Is confused about assignment • Forgets plays • Is unsure of game, score, or opponent • Moves clumsily

  11. Signs Reported by Athlete • Feeling sluggish • Feeling "foggy” • Change in sleep pattern • Concentration or memory problems • Headache • Nausea • Balance problems or dizziness • Double or fuzzy vision • Sensitivity to light or noise

  12. ImPACT • Neurocognitive assessment system • Computerized • Group administered • Provides pre-injury baseline • Normed for 12+

  13. ImPACT Areas Assessed • 4 Composites • Verbal Memory • Visual Memory • Reaction Time • Visual-motor reaction time • Symptom Count • Cognitive Efficiency Index

  14. VBCPS and ImPACT • First piloted at Kempsville HS ‘07-’08 • In all regular High Schools ‘10-’11 • Contact sports athletes • Presently, 2841 baseline tests this year • 148 Invalid baseline tests

  15. Virginia Board of Education Proposed Guidelines for Policies on Concussions in Student-Athletes (11-18-10) • Each student-athlete and the student-athlete’s parent or guardian shall review, on an annual basis, information on concussions provided by the school division. • Each student-athlete and student-athlete’s parent shall sign a statement acknowledging receipt, review and understanding of such information

  16. VBCPS Protocol Response Annual education for parent and student-athletes will include: • Mandatory preseason meeting • Video presentations about concussions and VBCPS protocol • Information packets (HeadsUp fact sheets, ImPACT testing information and consent) • Parents and student-athletes will be required to sign Concussion Information Sheet and Statement of Understanding • Additional resources will be provided

  17. VBCPS Process • Athletes/families see presentation in pre-season meeting • Informed consent obtained • Groups of athletes are assessed in computer lab in preseason, before competition begins • Validity of baseline asessments reviewed

  18. Invalid Baselines • Check for special education eligibility • Ask athlete what happened during test • Re-Test • If profile similar to psych profile, consider it baseline

  19. Post-Injury • Athlete takes post-injury test once clear and able to tolerate • Compare to baseline • Examine change index • Review symptom count • Return to play protocol

  20. Return to Play • No signs or symptoms • Normal neurologic exam • Normal balance • Neurocognitive exam back to baseline • Then…Return to play progression

  21. Return to Play Progression • No activity • Light aerobic exercise • Sport-specific exercise • Non-contact training drills • Full-contact practice • Return to play

  22. VBCPS Protocol Response • Concussion Graduated Return to Play

  23. Treatment of the Student-Athlete in School • School will develop an individualized Health Care Plan as needed to address need for physical and cognitive rest • Information and training provided to teachers • Consultation with Neuropsychologist as needed

  24. Persistent Symptoms • Monitor symptoms • SST accommodations • 504 Plan • Full Neuropsychological if indicated • Possible IDEA, although rare

  25. Common Accommodations • No quizzes/tests initially, then extended time and shortened • Copies of notes/assignments • Possibility of oral testing • Reduced day/ partial homebound • Read Aloud • No PE or sports participation • Allowance for breaks as needed • Put head on desk or visit clinic • Extended time for homework and/or shortened assignments

  26. Less Common Accommodations • Drop course • Drop to a lower level of course • Take an Incomplete until able to participate • Forego exams until later in the year, summer, or able to participate • AP exams, SAT, and ACT accommodations through 504 • College Board and ACT have a process for temporary disability accommodations

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