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Embry-Riddle Aeronautical University Concussion Policy and Management Protocol 2018-2019

1 updated 7/2018 MCS

Definition: Sports related concussion (SRC) is a traumatic brain injury induced by biomechanical forces. Several common features that may be utilized in clinically defining the nature of a concussive head injury include (Berlin 2016): 1. Sports related concussion may be caused either by a direct blow to the head, face or neck or a blow elsewhere on the body with an impulsive force transmitted to the head. 2. Sports related concussion typically results in the rapid onset of short-lived impairment of the neurologic function that resolves spontaneously. However, in some cases, symptoms and signs may evolve over a number of minutes to hour. 3. Sports related concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies. 4. Sports related concussion results in a range of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged. *The clinical signs and symptoms cannot be explained by drug, alcohol or medication use, other injuries (such as cervical injuries, peripheral vestibular dysfunction, etc) or other comorbidities (eg, psychological factors or coexisting medical conditions). Education Regarding Head Injuries: Annually, all Embry-Riddle Aeronautical University student-athletes will be presented the NCAA Concussion Fact Sheet (Appendix A), and watch the NCAA concussion awareness video. In addition to the NCAA Concussion Fact Sheet and video the student-athlete will sign the student-athlete statement acknowledging that:

They have read and understand the NCAA Concussion Fact Sheet.

They accept the responsibility for reporting their injuries and illnesses to the Embry-Riddle Aeronautical University Sports Medicine staff, including signs and symptoms of concussions.

Due to the severe nature of a concussion, Embry-Riddle Aeronautical University believes in conservative approach for treatment. This includes the student-athlete self-reporting their symptoms after suffering a concussion. Self-reporting symptoms plays an important part in tracking the severity and how each student-athlete recovers from a concussion. Therefore, the student-athlete is responsible for reporting his or her signs and symptoms completely and honestly to the athletic training staff as soon as they present and each day following the injury. Signs and Symptoms can include; but are not limited to the following: Following a concussion the athlete may experience a variety of symptoms. Most concussions occur without a loss of consciousness. It is important to remember that some symptoms may appear right away and some may be delayed. Symptoms, as well as symptom severity may differ between individuals however a combination of symptoms typically occurs:

Symptoms: Signs:

*Nausea/Vomiting *Difficulty Concentrating

*Dizziness *Inappropriate playing behavior

*Confusion *Decreased playing ability

*Fatigue *Inability to perform daily activities

*Light Headedness * Reduced attention

*Headaches *Cognitive and memory dysfunction

*Irritability *Sleep Disturbances

*Disorientation *Vacant Stare

*Seeing bright lights/stars * Loss of bowel and/or bladder control

*Feeling of being stunned *Personality Change

*Depression * Unsteadiness of gait

*Ringing in the ears *Slurred/incoherent speech

*Loss of consciousness



Notification of injury/symptoms: Due to the serious nature of a concussion and potential catastrophic results of returning to activity, suspected concussions need to be recognized and identified as soon as possible. It is required that student-athletes are truthful and forthcoming about their symptoms as soon as they present. If and when they are diagnosed with a concussion, the student-athlete must report symptoms each day until they are cleared for full activity by the athletic training staff. Failure to do so may increase the risk of further brain damage and post-traumatic concussion syndrome. Baseline Assessment: All incoming freshman and/or incoming transfer student-athletes who are participating in collision or contact sports and/or those that have a prior history as identified by their health history will undergo baseline testing as part of their Pre-Participation Physical. The following sports will be included in baseline testing: Men’s Soccer Women’s Soccer Volleyball Softball Men’s Basketball Wrestling Women’s Basketball Men’s and Women’s Cross Country Men’s and Women’s Golf Baseline testing may include but not limited to:

Post- Concussion Symptom Scale (Appendix B)

Sports Concussion Assessment Tool (SCAT 5) (Appendix C), which includes symptom evaluation, physical signs score, modified Maddocks, Standardized Assessment of Concussion (SAC), neurological screening, cognitive screening and delayed word recall.

Modified Balance Error Scoring System (Modified BESS) (Appendix D): The modified BESS consists of 3 tests lasting 20 seconds each, performed on two different surfaces, firm and foam:

o The athlete first stands with the feet narrowly together, the hands on the hips, and the eyes closed (double leg stance). The athlete holds this stance for 20 seconds while the number of balance errors (opening the eyes, hands coming off hips, a step, stumble or fall, moving the hips more than 30 degrees, lifting the forefoot or heel, or remaining out of testing position for more than 5 seconds) are recorded. The test is then repeated with a single-leg stance using the non-dominant foot, and a third time using a heel-toe stance with the non-dominant foot in the rear (tandem stance).

ImPACT Testing o A computerized neuropsychological concussion assessment.

Other testing deemed necessary at the discretion of the treating healthcare provider

Concussion Management: UNDER NO CIRCUMSTANCES WILL A STUDENT-ATHLETE SUSPECTED OF HAVING A CONCUSSION BE PERMITTED TO RETURN TO PLAY THE SAME DAY, AND NO STUDENT–ATHLETE IS PERMITTED TO RETURN TO PLAY WHILE SYMPTOMATIC FOLLOWING A CONCUSSION Sideline Evaluation: *It is important to note that SRC is an evolving injury in the acute phase, with rapidly changing clinical signs and symptoms, which may reflect on the underlying physiological injury to the brain. SRC is considered to be among the most complex injuries in sports medicine to diagnosis, assess, and manage (Berlin 2016). Circumstances involving any signs, symptoms or behaviors consistent with a concussion warrant a student-athlete’s IMMEDIATE removal from athletic participation until a thorough sideline head injury evaluation can be performed by a member of the Embry-Riddle Aeronautical University Sports Medicine Staff. The sideline head injury evaluation to determine the presence of a concussion will include:

Airway, breathing and Circulation (ABC’s)

Concussion Evaluation Form

SCAT 5

Other sideline assessment tools as deemed necessary by the treating healthcare provider



Referrals: ON FIELD IMMEDIATE REFERRAL: Upon initial evaluation, activation of the Emergency Action Plan and IMMEDIATE referral to the Emergency Room is warranted with any of the following findings:

Documented loss of consciousness

Deteriorating level of consciousness

High index of suspicion of spine or skull injury

Seizure activity

Deterioration of vitals

Deterioration of neurologic function

Unequal, dilated, or unreactive pupils Off the field Emergent Referral: In the event that the student-athlete shows signs of deterioration from the status originally assessed on the field, an EMERGENT off the field assessment is warranted. An emergency referral is necessitated by any of the following findings:

Deterioration of neurological signs such as motor, sensory, and cranial nerve deficits following the initial on field assessment

Documented loss of consciousness

Deteriorating level of consciousness

Persistent vomiting

Post-concussion symptoms worsen Non-Immediate Referral: All student-athletes who have been diagnosed with a concussion will be evaluated by Embry-Riddle Aeronautical University team physician or other healthcare provider who has been identified by and referred to by the team physician prior to return to unrestricted activity. A student -athlete with signs and symptoms of a concussion lasting longer than 48 hours should be seen by the team physician or other health care provider who has been identified by and referred to by the team physician. Team Physician will:

Determine if additional testing is needed

Educate student- athlete regarding the importance of reporting all signs and symptoms

Determine if any modification to academic program/classes are necessary. o Upon notification the Athletic Director or Assistant Athletic Director will email the student- athletes’ academic

advisor along with the Dean of Students. The Dean of Students will then email the athletes professors. o The Athletic Trainer can, in the absence of the Athletic Directors’, email the Dean of Students who will then email

the athletes’ professors.



Follow- Up Care: A student-athlete that is sent home the day of with a documented concussion will be given Concussion Take Home Instructions. A copy will be given to the student-athlete and a roommate or other person who will be able to closely observe the injured athlete.

Follow-Up Management: Daily Follow-up: Cognitive testing, symptom monitoring, along with physical examination performed by the sports medicine staff and team physician or other health care provider who has been identified by and referred to by the team physician, will determine the appropriate time frame for progression back to activity for the student-athlete. Daily monitoring of the student-athlete’s status will be performed through the physical and symptomatic evaluation of the individual.

Daily completion of symptom checklist (See Concussion Evaluation and follow-up) o The post-concussion symptom scale must return to pre-season baseline before the Graduated Return to Play

Protocol is started

Balance testing when self-reported symptom free (Modified BESS testing) o The modified BESS score must be equal to or less to the pre-season baseline before the Graduated Return to Play

Protocol is started

ImPACT testing will be performed within 24 to 48 hours post concussive episode. ImPACT testing will be reassessed when athlete is self-reported as asymptomatic.

Return to Learn Guidelines and Return to Activities of Daily Living: It is important to understand that concussion is not just a sport related injury, it is a disruption of daily life for many student athletes. Simple tasks that require attention focus such as reading, operating a computer, riding a bicycle, or driving a car may be impaired after a concussive event. Additionally, academic routines may be temporarily compromised until the treatment plan has been established and recovery has begun. As a result, those providing care for the injured student-athlete may impose specific limitations to these activities. It is a goal of the medical staff to develop a specific plan that meets the needs of each individual student-athlete. With regard to academic considerations, a multi-disciplinary team of Sports Medicine staff (consisting of team physicians, neurologists, athletic trainers and/or physical therapists as appropriate), the Athletic Director or Assistant Athletic Director will email the student- athletes’ academic advisor along with the Dean of Students. The Dean of Students will then email the student-athletes’ professors and will communicate the recommendations for accommodations given by the Sports Medicine staff and/or the team physician to the University faculty. In the event that the Athletic Directors’ are absent the Athletic Trainer can email the Dean of Students who will then email the athletes’ professors. This academic care team will rely on the recommendations of the Sports Medicine staff, on a case-by-case basis. Student-athletes who have an inability to focus after a concussion are at risk for poor academic performance and will need individualized academic advice to make the transition to full recovery. In compliance with the Americans with Disabilities Amendments Act (ADAAA), and in order to limit cognitive stressors and support recovery during this period, reasonable accommodations will be made to ensure continued academic progress.

Stepwise Progression for Return to Learn Guidelines and Return to Activities of Daily Living: In cases of suspected concussion, student-athletes will be withheld from classroom activity on the same day of injury, in accordance with NCAA guidelines. If objective measures demonstrate clear variance from prior baseline tests, indicating a concussion, student-athletes will be withheld from daily activities that require attention, focus, and concentration until it is objectively clear that recovery has occurred. A sample progression of daily and physical activities may involve the following:



Return to Play Guidelines: Return to play is the process in deciding when an injured or ill athlete may safely return to practice or competition. It is the goal of Embry-Riddle Aeronautical University, the sports medicine staff, and team physician to return an injured or ill student-athlete to practice or competition without putting the individual or others at undue risk for injury or illness. As recovery continues, modifications and/or additional steps may be required to complete the progression, depending on the academic and sport demands of the student-athlete. It is the responsibility of the Sports Medicine staff to appreciate these nuances and adjust progressions accordingly for each student-athlete. Before the Graduated Return to Play Protocol is started, the student-athlete to must remain asymptomatic for 24 hours. The Graduated Return to Play Protocol is a stepwise progression that will be utilized for return to play. The progression is a step-by-step procedure where an asymptomatic level is maintained as functional exercise is slowly added to the activity level. Progression to each stage occurs roughly every 24 hours, based on each individual’s status. If any post-concussion symptoms occur while in the Graduated Return to Play Protocol, then the student-athlete should return to previous asymptomatic level and try to progress again after 24 hours of rest. Progression is individualized on a case by case basis, where the ultimate return to play is determined at the discretion of the athletic training staff and team physician.

Ultimate return to normal academic routines, as well as return to play will only occur after completion of progression(s), and the team physician has granted final clearance

The team physician will need to clear the student-athlete for participation in full practice.

Student-athletes must sign off that they are symptom free and that they have informed the athletic training staff and team physician of all signs/symptoms or concerns of the injury prior to full release to activity.



Embry-Riddle Aeronautical University Sports Medicine

Reporting Concussion Symptoms Policy

__________ I understand that it is my responsibility to report all injuries and illnesses to my Initial athletic trainer and team physician. __________ I have read and understand the NCAA Concussion Fact Sheet. Initial After reading the NCAA Concussion Fact Sheet, I am aware of the following information: __________ A concussion is a brain injury, which I am responsible for reporting to my athletic Initial trainer and team physician. __________ A concussion can affect my ability to perform everyday activities, and affect Initial reaction time, balance, sleep, and classroom performance. __________ You cannot see a concussion, but you might notice some of the symptoms right Initial away. Other symptoms can show up hours or days after the injury. __________ I will not return to play in a game or practice if I have received a blow to the head Initial or body that results in concussion-related symptoms. __________ If I suspect a teammate has a concussion, I am responsible for reporting the injury to my Initial athletic trainer or team physician. __________ Following a concussion, the brain needs time to heal. You are much more likely Initial to have a repeat concussion if you return to play before your symptoms resolve. __________ In rare cases, repeat concussions can cause permanent brain damage, and even Initial death. __________________________________________ ____________ Signature of Student-Athlete Date __________________________________________ Printed Name of Student-Athlete



Appendix A



Graduated Return to Play Protocol

Date Step Activity Example of Exercises Asymptomatic Date of Repeat Asymptomatic

1. Light general conditioning (Goal: Increase HR 30%-40% of max)

-light aerobic activity (15-20 min) -sub max isometric strengthening and gentle isotonic -ROM/ Stretching

-stationary bike , UBE, treadmill , or walking -quad/ham sets, UE –light hand weights band rows, LE-SLR, ankle bands

Y N Y N

2. Moderate General conditioning and sports specific skill work; individually (Goal: Add movement, individual skill work)

-light mod. Aerobic activity (20-30 min) -sport specific warm-up -light wt exercises

-treadmill, stationary bike, elliptical, UBE -light wt. strength exercise, band exercise wall squats, lunges steps. -dynamic warm-up/stretching

Y N Y N

3. Heavy General conditioning skill work, individually and with teammate. NO CONTACT (Goal add movement. Teammate skill work)

-moderate-aggressive aerobic exercises -all strength exercise at 80% max -active stretching -agilities, plyometrics -propriceptive/ dynamic balance -non-contact sport specific training

-treadmill (jogging), stationary bike, elliptical, UBE -free weights, squats dynamic strengthen exercises -dynamic stretching -zig-zag runs, side shuttle

Y N Y N

4. Heavy General Conditioning, skill work, and team drills. NO LIVE scrimmages. VERY LIGHT CONTACT. (Goal: Team skill work, light static contact)

-limited contact training -aggressive strength exercises -impact activities/plyometrics -sport specific activities with LIGHT contact

-sport specific drills monitored by an ATC to appropriate limited contact activities

Y N Y N

5. Full Team Practice Body Contact Must have physician clearance before beginning this stage. -Participate in a full practice

-full practice Y N Y N

6. Full Return to Sport Full clearance to return to sport

Y N Y N



Embry-Riddle Aeronautical University Sports Medicine Concussion Take-Home Instructions

A concussion is a brain injury that may be caused by a blow to the head, a car accident, a fall, or any other trauma that severely jolts the head can cause a concussion; There may or may not be a loss of consciousness. When a concussion occurs, your brain hits against the bones of the skull and becomes injured. The brain is a very complex organ, and every brain injury is different. Some symptoms may appear right away, while other symptoms may not show up for days or weeks after the concussion. Most people with mild injuries recover fully, but it can take time. Some symptoms can last for days, weeks, or longer. I believe that_________________________________ sustained a concussion on_________. To make sure he/she recovers, please follow the following important recommendations:

1. Please remind him/her to report to the athletic training room tomorrow at _______________ for a follow-up evaluation. 2. Please review the items outlined below. If any of these problems develop prior to his/her visit, please contact the local emergency

medical system (911) IMMEDIATEDLY. Additionally, be sure to contact the treating Certified Athletic Trainer

*Headaches that become worse *Blurred Vision

*Mental status changes: lethargy, difficulty maintaining arousal, confusion, or agitation

*Post-concussion symptoms that worsen

*Seizure activity *Additional post-concussion symptoms are compared to those originally reported

*Weakness, numbness, or decreased coordination *Have one pupil-the black part in the middle of the eye-larger than the other

*Slurred Speech *Having any other new symptoms that worry you

3. Otherwise, please follow the instructions outlined below:

It is OK to: Do NOT:

*Use acetaminophen (Tylenol) for headaches *Drink Alcohol

*Use ice pack on head and neck as needed for comfort

*Perform any physical activity NOT specifically cleared by the ERAY Sports Medicine Staff

*Get plenty sleep at night, and rest during the day *Drive a vehicle without direct clearance by the ERAU Sports Medicine Staff

*Eat a normal diet *Ingest caffeine, chocolate, or spicy foods

*Be awakened during the night to assess arousal *Take ibuprofen or any other anti-inflammatories

Specific recommendation:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Recommendation provided to: ____________________Cell: _________________Relationship:_________________

Recommendation provided by: _______________________ Date: _____________________Time:________________________

Please feel free to contact me if you have any questions. I can be reached at: Office: ___________________________________________ Cell: _______________________________________ ATC Signature: __________________________________________________________________________



History of Current Injury: MOI: Head-Head Head- Ground Head-Body Part Other: __________ Region of Head: R/L Front R/L Temporal R/L Parietal R/L Occipital Facial MouthGuard: Y/N Injury Description:

____________________________________________________________________________________________________________________________________________________________________________________________________ Risk Factors (check all that apply):

Concussion History? Y N √ Headache History? Y N √ Developmental History Y N √ Psychiatric History Y N √ # 1 2 3 4 5 6+ Prior treatment for headache Learning disabilities Anxiety Longest Sx duration Days__Weeks__Months__Years_

History of migraine headache

Personal

Family___________________

Attention-Deficit/ Hyperactivity Disorder

Depression

If multiple concussions, less force

caused re-injury? Yes No

Other developmental disorder____________________

Other Psychiatric disorder_______________

AT Initial Evaluation: Memory: What happened? ______________ What day of the week is it? _____________ What month is it? __________ Who is the current president? ______________ Cognitive Assessment: 5 word recall (Immediate/Delayed):Rat___/____ Paper____/____ Boot____/____Note____/____ Truck____/____ Months in reverse order: Apr-Mar-Feb-Jan-Dec-Nov-Oct-Sept-Aug-Jul-Jun-May(circle incorrect) Digits Backwards: (check correct, X incorrect) 5-2-8____3-9-1____6-2-9-4____4-3-7-1____8-3-2-7-9____1-4-9-3-6____7-3-9-1-4-2____5-1-8-4-6-8_____ ASK FOR DELAYED 5 WORD RECALL NOW! Balance (BESS stable surface): Double Leg____ Single Leg (non-dominate)____ Tandem(non-dom in back)____ Neurological Screening (Pass/Fail): Speech____ Eye Motion and Pupils____ Pronator Drift____ Gait Assessment____

Initial Concussion Symptom Scale Date/Time: ____________ Symptom None Mild Moderate Severe

Headache “Pressure in the head” Neck Pain Nausea or Vomiting Dizziness Blurred Vision Balance Problems Sensitivity to Light Sensitivity to Noise Feeling slowed down Feeling like “in a fog” “Don’t Feel Right Difficulty Concentrating Difficulty Remembering Fatigue or Low Energy Confusion Drowsiness Trouble Falling asleep More emotional Irritability Sadness Nervous or Anxious

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

Notes:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Name: ______________________________ Sport/Position: ____________________ Date of Concussion: ___________________ Athlete’s Cell Number: ______________ Date of Evaluation: ____________________ Non-Athletic Injury: ________________ ATC: ________________________________



FIRST DAY AYSMTOMATIC: DATE: ________________________ Modified BESS Testing: Date: _____WNL_____/Date: _____WNL_____/Date: ____WNL_____/Date: _____WNL_____ Graduated Return to Play Protocol: Date initially started: _____________Final Return to Play Date: ______________

Date Step Activity Example of Exercises Asymptomatic Date of Repeat Asymptomatic 1. Light general conditioning

(Goal: Increase HR 30%-40% of max)

-light aerobic activity (15-20 min) -sub max isometric strengthening and gentle isotonic -ROM/ Stretching

-stationary bike , UBE, treadmill , or walking -quad/ham sets, UE –light hand weights band rows, LE-SLR, ankle bands

Y N Y N

2. Moderate General conditioning and sports specific skill work; individually (Goal: Add movement, individual skill work)

-light mod. Aerobic activity (20-30 min) -sport specific warm-up -light wt exercises

-treadmill, stationary bike, elliptical, UBE -light wt. strength exercise, band exercise wall squats, lunges steps. -dynamic warm-up/stretching

Y N Y N

3. Heavy General conditioning skill work, individually and with teammate. NO CONTACT (Goal add movement. Teammate skill work)

-moderate-aggressive aerobic exercises -all strength exercise at 80% max -active stretching -agilities, plyometrics -propriceptive/ dynamic balance -non-contact sport specific training

-treadmill (jogging), stationary bike, elliptical, UBE -free weights, squats dynamic strengthen exercises -dynamic stretching -zig-zag runs, side shuttle

Y N Y N

4. Heavy General Conditioning, skill work, and team drills. NO LIVE scrimmages. VERY LIGHT CONTACT. (Goal: Team skill work, light static contact)

-limited contact training -aggressive strength exercises -impact activities/plyometrics -sport specific activities with LIGHT contact

-sport specific drills monitored by an ATC to appropriate limited contact activities

Y N Y N

5. Full Team Practice Body Contact Must have physician clearance before beginning this stage. -Participate in a full practice

-full practice Y N Y N

6. Full Return to Sport Full clearance to return to sport

Y N Y N

Notes:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I, the athlete, acknowledge that I have been truthful in all of my statements and that I am asymptomatic both at rest and under exertion. Athlete Signature: _________________________________Date: _________________________



15 Minutes -1Hour Post Concussion Symptom Scale Date/Time: ____________

Symptom None Mild Moderate Severe


0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

Notes:__________________________________________________________________________________________________________________________________________________________________________________________________________________ Home instructions given to athlete: Yes/No

Next Day/ 24 hours Post Concussion Symptom Scale Date/Time: ____________



0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

Notes:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



Day 2/ 48 hours Post Concussion Symptom Scale Date/Time: ____________



0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

*If asymptomatic, Athlete may start Graduated Return to Play Protocol

Notes:__________________________________________________________________________________________________________________________________________________________________________________________________________________

Repeat Post Concussion Scales Day 3 Date/Time: _________________



0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6



Day 4 Date/Time: __________________



0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

Day 5 Date/Time: _____________________



0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6



Day 6 Date/Time:__________________



0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

NOTES: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



Embry-Riddle Aeronautical University Sports Medicine

Concussion Take-Home Instructions A concussion is a brain injury that may be caused by a blow to the head, a car accident, a fall, or any other trauma that severely jolts the head can cause a concussion; There may or may not be a loss of consciousness. When a concussion occurs, your brain hits against the bones of the skull and becomes injured. The brain is a very complex organ, and every brain injury is different. Some symptoms may appear right away, while other symptoms may not show up for days or weeks after the concussion. Most people with mild injuries recover fully, but it can take time. Some symptoms can last for days, weeks, or longer. I believe that_________________________________ sustained a concussion on_________. To make sure he/she recovers, please follow the following important recommendations:

1. Please remind him/her to report to the athletic training room tomorrow at _______________ for a follow-up evaluation. 2. Please review the items outlined below. If any of these problems develop prior to his/her visit, please contact the local emergency

medical system (911) IMMEDIATEDLY. Additionally, be sure to contact the treating Certified Athletic Trainer

*Headaches that become worse *Blurred Vision

*Mental status changes: lethargy, difficulty maintaining arousal, confusion, or agitation

*Post-concussion symptoms that worsen

*Seizure activity *Additional post-concussion symptoms are compared to those originally reported

*Weakness, numbness, or decreased coordination *Have one pupil-the black part in the middle of the eye-larger than the other

*Slurred Speech *Having any other new symptoms that worry you

3. Otherwise, please follow the instructions outlined below:

It is OK to: Do NOT:

*Use acetaminophen (Tylenol) for headaches *Drink Alcohol

*Use ice pack on head and neck as needed for comfort

*Perform any physical activity NOT specifically cleared by the ERAU Sports Medicine Staff

*Get plenty sleep at night, and rest during the day *Drive a vehicle without direct clearance by the ERAU Sports Medicine Staff

*Eat a normal diet *Ingest caffeine, chocolate, or spicy foods

*Be awakened during the night to assess arousal *Take ibuprofen or any other anti-inflammatories

Specific recommendation:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Recommendation provided to: ____________________Cell: _________________Relationship:_________________

Recommendation provided by: _______________________ Date: _____________________Time:________________________

Please feel free to contact me if you have any questions. I can be reached at: Office: ___________________________________________ Cell: ________________________________________ ATC Signature: ________________________________________________________________________________

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