Concussion Information

Santa Margarita Catholic High School understands the seriousness of concussion both in and out of sport. That is why we've created a comprehensive Concussion Management Program that begins the moment a concussion is suspected. Based on medical best practices set forth by professionals in the study of concussion management, this program is designed to transition your student back to the classroom and playing field in the safest way possible.

If you suspect your student has suffered a concussion, please review these tabs for additional information.

If you believe your student is having a medical emergency, please call 911.

First and foremost DO NOT PANIC!! A vast majority of individuals that suffer a concussion resolve back to normal function over time. Expressing panic may exacerbate the student's symptomology as they may feed off of a parent's emotions. Concussions are to be taken seriously, but are generally not cause for panic.

If you feel your student is having a medical emergency, call 911.

If your child has been diagnosed with a concussion or you feel they may have suffered a concussion, it is imperative the Concussion Management Program be implemented as soon as possible. The first step in this process is both physical AND cognitive rest. Please see the definitions page for more information.

If your child has not yet been diagnosed with a concussion and you feel they may have suffered one, please arrange a physician visit to one of our approved concussion management providers by contacting one of them directly.

The purpose of this program is to underscore the importance of specifically addressing the topic of head injuries sustained by SMCHS students and provide a consistent, comprehensive approach for the management and safe Return to Activity of the student. A student’s best chance of full recovery from a concussion involves two critical components: cognitive and physical rest followed by a stepwise Return to Learn (RTL) progression then a stepwise Return to Play (RTP) progression.

It is important to note that the recovery from a concussion is a very individualized process. Caution must be taken not to compare students with concussions as they progress through the recovery process.

In any circumstance where a concussion is suspected, the first priority is to remove the student/athlete from further participation for the remainder of the day. This initiates the Concussion Management Program. For the academic (RTL) protocol to be initiated the student must be evaluated by an approved health care professional within 2 days and documentation must be provided to the school’s concussion management team coordinator.

The recommendations in this document for the management of concussion are based on a review of the current best practices in concussion management from a wide variety of resources from across the country.

Points of Emphasis
It is important that once the student has returned to school that they report to the concussion management team coordinator on a daily basis in order to monitor symptoms as well as to determine progression to the next stage within the return to academics guidelines. In the event the concussion management team coordinator is unavailable, the student must report to the athletic trainer or school nurse.

If a student remains in stages 1-3 for more than 2 weeks, it MAY be necessary to schedule a conference with the assistant principal, counselor, concussion management team coordinator, and the student’s parents in order to discuss a medical withdrawal for the rest of the semester.

Special Considerations
Medications are usually not needed but in some cases may be needed when considering sleep and headaches. Please follow your physician’s orders when taking any medications during concussion recovery.

Any physician authorized or restricted medication use (especially Ibuprofen or Acetaminophen for pain management) must be reported to the concussion management team coordinator and the nursing staff.

NOTE: The student/athlete should not be using medication when assessing symptoms and RTP.

Successful recovery from a concussion is a multi-faceted process. Following a concussion, your student will work closely and be an integral part of the Concussion Management Team (CMT). The SMCHS CMT is a team of individuals within the school and in the community to assist the student through the recovery from concussion. Members of the concussion management team include physicians, administrators, counselors, teachers, school nurses, athletic trainers, coaches or club leaders, parents, and the student themselves. In more complex cases, it may be necessary to add more team members such as: neurologists, psychologists, neuropsychologist, additional physicians, etc.

Concussion Management Team Coordinator - The CMT Coordinator acts as the point person for all members of the CMT. The CMT Coordinator collects and disseminates information from and to all appropriate CMT members throughout the recovery process. Please submit all correspondence through the CMT Coordinator regarding your student's recovery process.

It is important that once the student has returned to school they report to the school psychologist as indicated in order to monitor symptoms as well as to determine progression to the next stage within the RTL guidelines. In the event the concussion management team coordinator is unavailable, the student must report to the athletic trainer or school nurse.

Much like the Return to Play (RTP) progression, SMCHS employs a RTL progression as well.

Stage 1: No School Attendance, Emphasize Cognitive and Physical Rest.

Characteristics

Severe symptoms at rest

Symptoms may include but are not limited to:

Headache, dizziness, nausea, photosensitivity, phonosensitivity (see Graded Symptom Checklist)

Home Modifications

Parents to monitor smartphone, computer, and TV use in the home as use may exacerbate concussion symptoms

Curricular Modifications

Postponed tests, quizzes, or homework

Students may not be able to read longer than 10 minutes without an increase in symptoms

Provide students with copies of class notes (teacher or student generated)

Progress to Stage 2 when:

Decreased sensitivity to light or noise

Decreased intensity and frequency of headaches

Ability to do light reading for 10 minutes without increased symptoms

Stage 2: Option for Modified Daily Class Schedule

Characteristics

Mild symptoms at rest, increasing with physical and mental activity

Example: Start with morning classes, then work up to more periods daily

Home Modifications

Parents to monitor smartphone, computer, and TV use in the home as use may exacerbate concussion symptoms

Curricular Modifications

Optional: Reduce weight of backpack or temporarily provide second set of textbooks if available: arranged by counselor

Optional: Obtain a “five minute pass” from the school nurse in order to avoid noisy, crowded hallways between class periods: arranged by school nurse

Wear sunglasses when viewing Smart Boards, using tablets, or as needed

Postpone tests, quizzes, daily work or homework

Provide student with copies of class notes (teacher or student generated)

Excused from physical education classes and/or sports activities

If student does not complete school day, student must fill out Graded Symptom Checklist (GSC) with school nurse prior to leaving nurse’s office

Report Daily for Evaluation

Report daily to the concussion management team coordinator. In the event the concussion management team coordinator is unavailable, the student must report to the athletic trainer or school nurse

Progress to Stage 3 when:

Each of the student’s classes have been attended at least once

School activity does not increase symptoms

Overall symptoms continue to decrease

Stage 3: Full Day of School

Characteristics

Nearly Symptom free at rest

Little or no increase in symptoms with mental and physical activity

Curricular Modifications

Student may begin test, homework and quizzes as tolerated in accordance with academic modifications

Provide student with copies of class notes (teacher or student generated)

Optional: Reduce weight of backpack or temporarily provide second set of textbooks if available: arranged by counselor

Optional: Obtain a “five minute pass” from the school nurse in order to avoid noisy, crowded hallways between class periods: arranged by school nurse

Excused from physical education classes and/or sports activities

Report Daily for Evaluation

Report daily to the concussion management team coordinator. In the event the concussion management team coordinator is unavailable, the student must report to the athletic trainer or school nurse.

Progress to Stage 4 when:

Symptom free with mental and physical activity

Student should report any return of symptoms with mental or physical activity

GSC scores have normalized and/or symptoms have resolved completely

NOTE: If the student is in stage 3 more than one week, where it is unlikely the student will be able to make up required work, the school staff MAY discuss with the student and their parents a possible medical withdrawal for the rest of the semester.

Stage 4: Full Academic Load

Resumption of current academic responsibilities once GSC results have normalized and/or symptoms have resolved completely

In cooperation with guidance counselor and teachers, create plan for the gradual completion of missed tests, quizzes, and homework

Students are not required to makeup missed Physical Education classes due to a concussion

Gradual resumption of physical activity

NOTE: Students will return to Physical Education classes and will spend a minimum of 3 days with modified activity directed by the concussion management team coordinator.

The Return to Play (RTP) process following a concussion follows a step-wise progression. The student must be symptom free for a minimum of 24-48 hours before beginning this progression. The student will complete each level and progress to the next only if they remain asymptomatic both at rest and with provocative exercise. There will be roughly 24 hours between each step of the RTP progression and this process will take no less than 8 days. Should the student become symptomatic during the progression, they will drop back to the previous asymptomatic level and try to progress after a 24 hour period of rest has passed. Each phase of the RTP will be administered and assessed by an ATC (certified athletic trainer) at SMCHS. BOTH parents must, in writing, approve of their student to progress back to full contact activities. Final return to play clearance is at the sole discretion of the athletic training staff in accordance with state education codes.

Stage 1: Light Aerobic Activity

• 20-25 minutes of walking or stationary biking under direct supervision of an ATC

Stage 2: Moderate Aerobic Activity/Light Resistance Training

• 20-30 minutes of jogging or stationary biking
• 10 minutes body weight exercises (planks, sit ups, pushups, squats)

Stage 3: Non-Contact Training and Sport Specific Drills

• Non-contact drills, sport specific activities (cutting, jumping, sprinting)
• No contact with people, padding, or floor/mat

Stage 4: Contact Practice

• Return to normal training
• Full weightlifting routine

Stage 5: Return to Competition

• Normal game play

Your student will complete a number of forms during their recovery process. Some of these forms will need to be picked up in person from the CMT Coordinator. Other forms the student my need are listed below.

Suspected Head Injury Home Information - This form alerts you to the fact that your student may have suffered a concussion while at a school related event. It also outlines certain instances when a trip to the Emergency Department is warranted and how to initiate the Concussion Management Program for your student.

Graded Symptom Checklist (GSC) - This checklist helps the Concussion Management Team document the recovery process following a concussion. It is vital accurate information is documented on the GSC to ensure the safety of the injured student-athlete and to make return-to-play decisions. Directions for filling out the GSC are located near the bottom of the form.

In an effort to provide your student with the best possible care, SMCHS encourages students to use licensed health care providers we know are trained in the management of concussions. This is backed up by an Assembly Bill passed in 2011. If you choose to use another provider for any reason and the Sports Medicine department does not feel your child has received the standard of care they deserve, we may ask that you get a second opinion with one of our approved providers.

APPROVED PROVIDERS

Dr. Suzy McNulty 26161 La Paz Road, #115 Mission Viejo, CA 92691 (949) 206-0001	Dr. Chris Koutures 500 S. Anaheim Hills Road, #140 Anaheim Hills, CA 92807 (714) 974-2220
Dr. David Kruse 280 S Main Street, #200 Orange, CA 92868 (714) 634-4567	Dr. Sam Sunshine 26700 Towne Centre Dr. Foothill Ranch, CA 92610 (949) 460-9111

Concussion - A complex pathophysiological process affecting the brain, induced by traumatic 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 neurologic function that resolves spontaneously.

Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.

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 a small percentage of cases, post-concussive symptoms may be prolonged.

No abnormality on standard structural neuroimaging studies (i.e. x-ray, ct-scan) is seen in concussion.

Mild Traumatic Brain Injury (mTBI) – All concussions are a form of mTBI, however not all mTBI's are concussions. The terms mTBI and concussion should NOT be used interchangeably.

Post-Concussion Syndrome – A set of symptoms which may last for weeks, months, or years following a concussion.

Second Impact Syndrome – Rare condition when an athlete sustains a second head injury before symptoms from the first have resolved, often fatal.

Cognitive Rest – Avoiding such behaviors and activities as: driving, video games, computers, text messaging, cell phone use, loud and/or bright environments, television, and reading and studying; these must be limited, and in most cases, completely avoided.

Physical Rest – Avoiding such activities and behaviors as: physical education, sports activities, and strength or cardiovascular conditioning must be regulated or avoided while recovering from a concussion.

Return to Activity – A two part process involving BOTH Return to Learn (RTL) and Return to Play (RTP) components to assist SMCHS students in returning to both full academic and extra-curricular activities in a safe manner.

Return to Learn (RTL) – A stepwise process re-integrating the student back into the classroom and a full academic load.

Return to Play (RTP) – A stepwise process re-integrating the student back into their extracurricular activities.

Concussion Management Team (CMT) – A team of individuals within the school and in the community to assist the student through the recovery from concussion. Members of the concussion management team include physicians, administrators, counselors, teachers, school nurses, athletic trainers, coaches or club leaders, parents, and the student themselves. In more complex cases, it may be necessary to add more team members such as: neurologists, psychologists, neuropsychologist, additional physicians, etc.

Concussion Management Team Coordinator – An individual within the school appointed to coordinate the return to activity of the student. The CMT Coordinator acts as the go to team member for ALL members of the CMT and the point person for the student.