Concussion Management Plan

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Purpose

Head injuries can pose a significant health risk for student-athletes competing in intercollegiate athletics. The University of Notre Dame is committed to promoting the safety of its student-athletes. In light of this commitment and developing research on the symptoms and effects of head injuries, Notre Dame has taken steps to prevent, identify, evaluate, and manage head injuries in a comprehensive and consistent manner.

The Notre Dame Athletic Department, in accordance with NCAA bylaw 3.2.4.17, has implemented this Concussion Management Plan (“the Plan”) to establish guidelines and procedures for assessing intercollegiate student-athletes who have or may have suffered a head injury. The Plan covers the education, recognition, emergency care, long-term care, and return-to-play of student-athletes who exhibit concussion-like symptoms. The Notre Dame Sports Medicine Department recognizes that each head injury and each student-athlete is unique. Therefore, in certain cases, modifications to this protocol may be deemed appropriate by Notre Dame team physicians and sports medicine staff.

Definitions

Concussions are the most common form of head injury suffered by student-athletes. A uniform definition of a concussion does not exist because of the complexity of concussions. A concussion can be caused by a direct or indirect blow to the head or elsewhere on the body resulting in an impulsive force being transmitted to the head. A concussion may cause impaired neurologic function, which may or may not involve loss of consciousness. The exact recovery periods from these types of head injuries are uncertain timeframes and will often vary from student-athlete to student-athlete.

Throughout this policy, team physician means a university physician with experience in the evaluation and management of concussions.

Signs/Symptoms:

A concussed student-athlete may exhibit a variety of symptoms or very few symptoms. Despite popular belief, most concussions do not involve student-athletes losing consciousness. One important factor to take into consideration is that, while some symptoms appear immediately, others may take time to appear. Additionally, symptoms and the severity of symptoms will vary among student-athletes. Signs and symptoms of concussions include, but are not limited to:

Symptoms:

  • Dizziness
  • Nausea/Vomiting
  • Confusion
  • Irritability
  • Headaches
  • Ringing in ears
  • Fatigue
  • Light headedness
  • Disorientation
  • Seeing bright lights/stars
  • Depression
  • Feeling of being stunned
  • Pressure in head
  • Neck pain

Signs:

  • Difficulty concentrating
  • Reduced attention
  • Decreased playing ability
  • Cognitive dysfunction
  • Vacant stare
  • Personality change
  • Loss of consciousness
  • Slurred/incoherent speech
  • Delayed verbal or motor responses
  • Sleep disturbances

Education/Responsibilities

  1. Student-Athletes: Notre Dame student-athletes must be truthful and forthcoming about symptoms of illness and injury, both at the time of an injury as well as upon the emergence of any reoccurring or new symptoms. In conjunction with the annual pre-participation physical, student-athletes will sign a questionnaire in which they acknowledge their responsibility to be truthful and forthcoming about symptoms of illness and injury.
    Each year, the sports medicine staff will educate Notre Dame student-athletes specifically about concussions. As part of that education, each student-athlete will receive the NCAA Concussion Fact Sheet (Appendix A) and will sign the Student-Athlete Concussion Responsibility Form (Appendix B). In signing the form, student-athletes will acknowledge that:
    1. they have received and reviewed the NCAA Concussion Fact Sheet for Student-Athletes and participated in education related thereto; and
    2. they accept the responsibility for truthfully and promptly reporting their illnesses and injuries to the sports medicine staff, including any signs or symptoms of a concussion, regardless of whether any such illnesses, injuries, signs, or symptoms are related to participation in intercollegiate athletics.
  2. Coaches All Notre Dame coaches (and appropriate athletics administrators) will receive the NCAA Concussion Fact Sheet for Coaches (Appendix C) and will sign the Coach’s Concussion Responsibility Form (Appendix D), acknowledging that:
    1. they have received and reviewed the NCAA Concussion Fact Sheet for Coaches and participated in education related thereto;
    2. they will encourage their student-athletes to report their illnesses and injuries to sports medicine staff, especially any signs or symptoms of a concussion;
    3. they will refer any student-athlete whom they suspect of sustaining a concussion to the proper medical authority; and
    4. they have read and understand the Notre Dame Concussion Management Plan, including the fact that team physicians (and, in their absence, athletic trainers) have unchallengeable authority to withhold a student-athlete from practice or competition, and that team physicians have unchallengeable authority to determine concussion management, return-to-play, and medical clearance.
  3. Sports Medicine Staff: The Notre Dame Sports Medicine staff will undergo at least annual training sessions on the diagnosis and treatment of head injuries and this Concussion Management Plan.

Baseline Assessment

At the beginning of each new season, Notre Dame sports medicine staff shall administer a baseline assessment for all student-athletes The baseline assessment includes an evaluation of brain injury and concussion history, symptom evaluation, and balance evaluation. The team physician will then determine pre-participation clearance.

Recognition and Evaluation

  1. If a student-athlete reports or displays signs, symptoms, or behaviors that a Notre Dame athletics staff member believes are consistent with a concussion, the Notre Dame athletics staff member shall inform the student-athlete’s coach, as well as the student-athlete’s team physician and/or athletic trainer. The student-athlete shall be removed from any practice or competition then underway, and will be evaluated by a team physician or athletic trainer, who will make a determination of whether there is a basis for a suspected concussion.
  2. A student-athlete with a suspected concussion shall be withheld from practice or competition and shall not return to athletic activity for the remainder of that day. The team physician or athletic trainer making such decision should notify the coaching staff that the student-athlete will not return to athletic activity for the remainder of the day.
  3. A treating athletic trainer or team physician shall have the authority to require that a student-athlete be continuously monitored during a period that the student-athlete, in the judgment of the athletic trainer or team physician, is acutely symptomatic.
  4. A student-athlete with a suspected concussion will be evaluated by a team physician for a diagnosis as soon as possible in accordance with the severity of the symptoms. Such evaluation will generally include follow-up testing (which may include but is not limited to SCAT III testing); the timing and nature of any follow-up testing are in the discretion of the treating team physician.
  5. Student-athletes and/or sports medicine staff may not be able to recognize the possibility of a concussion until hours or days after the precipitating event. Under these circumstances, once a student-athlete reports or displays signs, symptoms, or behaviors that a Notre Dame athletics staff member believes are consistent with a concussion, the athletics staff member shall inform the student-athlete’s coach, as well as the student athlete’s team physician and/or athletic trainer, and the team physician or athletic trainer shall initiate normal evaluation and return-to-play procedures.
  6. If a student-athlete sustains a potential concussion outside of participation in intercollegiate athletics, the student-athlete is responsible for truthfully and promptly reporting the injury to the sports medicine staff, including any signs or symptoms of a concussion, at which point the potential concussion will be managed in the same manner as potential concussions sustained during participation in intercollegiate athletics.
  7. Visiting team student-athletes evaluated by Notre Dame sports medicine staff will be managed under the same guidelines as Notre Dame student-athletes while under the evaluation of Notre Dame sports medicine staff.
  8. If a Notre Dame student-athlete reports or displays signs, symptoms, or behaviors that a Notre Dame athletics staff member believes are consistent with a concussion while away from campus in connection with team activities and a team physician is not present, the athletics staff member shall inform the student-athlete’s coach and the student athlete’s athletic trainer. The Notre Dame athletic trainer shall manage the student-athlete under the guidelines set forth in this Plan, and should consult with a local physician experienced in the evaluation and management of concussions, if deemed necessary by the athletic trainer. Regardless, the student-athlete will be evaluated by a team physician as soon as possible upon return to campus.

Emergency Referrals

In the event that a student-athlete displays one or more of the following symptoms during an initial evaluation, a team physician and/or athletic trainer should consider activation of the applicable Medical Emergency Response Procedures and/or immediate referral to the Emergency Room:

  • Prolonged loss of consciousness
  • Deteriorating level of consciousness
  • Suspicion of spine or skull injury
  • Seizure activity
  • Evidence of hemodynamic instability/deteriorating of vital signs
  • Repetitive vomiting

Monitoring/Follow-Up Care

  1. Due to the need for ongoing monitoring for deterioration of symptoms, when an athletic trainer or team physician determines that a student-athlete who displays signs, symptoms, or behaviors consistent with a concussion or who is diagnosed with a concussion may be released from immediate care, the student-athlete should be accompanied by an individual who can provide reliable supervision (such as a roommate, parent/guardian, coach, member of residence hall staff or a teammate). In the alternative, such student-athletes should be liberally referred to University Health Services at Saint Liam’s for observation.
  2. Upon release from immediate care, the student-athlete and the individual who accompanies him/her will be provided with verbal or written instructions, which may include monitoring, limitation of certain activity, and additional assessments (see Concussion Take-Home Instructions in Appendix E for an example of information typically provided upon discharge).
  3. As appropriate, the sports medicine staff should communicate with Academic Services for Student-Athletes to assist in managing the return-to-learn protocol; Residence Hall or other Student Affairs staff to assist in managing supervision and other issues; and coaches and other Notre Dame athletics staff to assist in managing athletics-related issues.
  4. Student-athletes with a prolonged recovery shall be evaluated by a physician to consider additional diagnoses (e.g., post-concussion syndrome, sleep dysfunction, migraine or other headache disorders, mood disorders, or ocular or vestibular dysfunction) and proper management options.

Return to Play Guidelines

  1. When the treating University physician determines that it is appropriate for the student-athlete to be evaluated for return to play, the evaluation will follow the sports medicine staff supervised process set forth below.
  2. The following steps will typically take place over several days. In select settings in which student athletes have minimal concussive symptomology and no other modifiers that may prolong recovery, the return-to-play protocol may be modified. In contrast, in student-athletes with increased symptom burden and duration, the progression for return-to-play may be more conservative and each stage may take more than a day.
  3. If symptoms do arise during the stage-to-stage progression, the student-athlete will return to the previous asymptomatic level.
Stage Requirement Rehabilitation Stage Functional Excursive at each Stage Stage Objective
1 No activity Complete physical and cognitive rest Recovery
2 Light aerobic exercise Increase heart rate
3 Completion of Stage 2 Sport-specific exercise (non- contact) Non-contact simple movement patterns specific to sport Add movement
4 Completion of Stage 3 Non-contact training drills Progression to more complex training drills Exercise, coordination, and cognitive load
5 Completion of Stage 4 Full-contact practice Following medical clearance, participate in normal activities Restore student-athlete’s confidence and coaching staff assess functional skills
6 Completion of Stage 5 Return to play Normal game play
  1. No student-athlete can return to full activity, practice or competition until they are medically cleared to do so by a team physician.
  2. Team physicians shall have unchallengeable authority to determine concussion management, return-to-play and medical clearance. In the absence of a team physician, athletic trainers have unchallengeable authority to withhold a student-athlete from practice or competition.
  3. Any member of the Notre Dame Sports Medicine staff must report any attempt to interfere with proper concussion protocol to a member of the Executive Committee in the Department of Athletics.

Return-to-Learn Guidelines

  1. The athletic trainer and team physician will serve as the primary contacts to assist a student-athlete who is diagnosed with a concussion on return-to-learn issues. The athletic trainer and team physician will work with campus partners as appropriate, including but not limited to counselors from Academic Services for Student-Athletes, other academic advisors, the Faculty Athletics Representative, the student-athlete’s course instructors, the Office for Students with Disabilities, the University Counseling Center, coaches and athletics administrators. Implementation of the return-to-learn protocol must be in compliance with the Americans with Disabilities Act (ADA).
  2. Each student-athlete who is diagnosed with a concussion shall have an individualized plan that generally includes:
    1. No classroom activity on the day the concussion is sustained;
    2. Relative cognitive rest that minimizes potential cognitive stressors such as school work, video games, reading, texting and watching television;
    3. Remaining at home if the student-athlete cannot tolerate light cognitive activity;
    4. A gradual return to classroom and academic activities that may include modification of schedule or other academic accommodations for up to two weeks.
  3. At any point during the return-to-learn protocol, a physician shall re-evaluate the student-athlete if he or she becomes symptomatic. For any student-athlete who is symptomatic for more than two weeks, the athletic trainer and/or team physician shall work with the Office for Students with Disabilities and other campus partners to create a plan consistent with the ADA.

Reducing Exposure to Head Trauma

The University of Notre Dame will take steps to reduce student-athlete exposure to head trauma and otherwise act in the best interest of student-athlete health and safety, including adherence to the Inter-Association Consensus: Diagnosis and Management of Sport-Related Concussion Guidelines.

The above policy was adopted by the University of Notre Dame Department of Athletics effective July 1, 2014, revised July 31, 2015, and is adapted in part from The University of North Carolina at Chapel Hill Sport Concussion Policy.