Locust Valley Central School DistrictLocust Valley Central School District

Concussion Management ProceduresConcussion Management Procedures

Mark J. DantuonoMark J. DantuonoDistrict Director of Health, Physical Education & AthleticsDistrict Director of Health, Physical Education & Athletics

Tony Marra- M.S., ATC, P/ETony Marra- M.S., ATC, P/EAssistant Athletic TrainerAssistant Athletic TrainerSchool District TBI ConsultantSchool District TBI Consultant

Concussion Management Concussion Management Awareness ActAwareness Act

NYS created and implemented this new law NYS created and implemented this new law effective July 1, 2012.effective July 1, 2012.

As a result, all school coaches, physical As a result, all school coaches, physical education teachers, nurses and athletic trainers education teachers, nurses and athletic trainers must on a biennial basis complete the training must on a biennial basis complete the training certification program.certification program.

This program will include recognizing the This program will include recognizing the symptoms pertaining to traumatic brain injuries symptoms pertaining to traumatic brain injuries and the monitoring and seeking the proper and the monitoring and seeking the proper treatment for students who experience mild treatment for students who experience mild traumatic brain injuries. traumatic brain injuries.

Definition of a Concussion Definition of a Concussion

What is a concussion?- What is a concussion?- Is a brain injury that Is a brain injury that is caused by a bump or blow to the head. is caused by a bump or blow to the head.

How can it occur?- How can it occur?- May occur from a fall or May occur from a fall or blow to the body that causes the head to blow to the body that causes the head to move rapidly back and forth.move rapidly back and forth.

Definition of Second Impact Definition of Second Impact SyndromeSyndrome

A potential catastrophic medical emergency A potential catastrophic medical emergency where a 2where a 2ndnd concussion is sustained while concussion is sustained while symptomatic from the initial concussion.symptomatic from the initial concussion.

Both injuries can occur within a same event, Both injuries can occur within a same event, very common to people under 20 years of very common to people under 20 years of

age. age. As a result may create massive pressure to As a result may create massive pressure to the brain which can lead to brain damage and the brain which can lead to brain damage and

or death. or death.

Post -Traumatic Concussion Post -Traumatic Concussion Syndrome Syndrome

Persistent post-concussion symptoms Persistent post-concussion symptoms lasting weeks, months or even years after a lasting weeks, months or even years after a concussion. concussion.

How Concussions May Occur in How Concussions May Occur in a School Settinga School Setting

Classroom- Classroom- Desk(top or bottom), door, Desk(top or bottom), door, trip/fall and or collision with another person trip/fall and or collision with another person or object.or object.

PE Class- PE Class- Collision with another student Collision with another student or non-moving object (wall), moving or non-moving object (wall), moving objects such as basketball or soccer balls.objects such as basketball or soccer balls.

Recess- Recess- Outdoor equipment which will Outdoor equipment which will include swings, slides, monkey bars, rings include swings, slides, monkey bars, rings and climbing ropes. and climbing ropes.

Signs and SymptomsSigns and SymptomsSigns observed by school professionals:

Appears dazed or stunnedIs confused about eventsAnswers questions slowlyRepeats questionsCan’t recall events after hit, bump or fallLoses consciousness (even briefly)

Signs and Symptoms (cont.)Signs and Symptoms (cont.)Symptoms reported by students

Thinking/Remembering Difficulty thinking clearlyDifficulty concentrating or rememberingFeeling sluggish, foggy or groggy

PhysicalHeadache or “pressure” in headNausea or vomitingBalance problems or dizzinessFatigue or feeling tiredBlurry or double visionSensitivity to light or noise

Emergency ProceduresEmergency Procedures

1. Observe body position of the child:1. Observe body position of the child:

face up/down, sitting, or face up/down, sitting, or standing standing unbalancedunbalanced

2. Radio or contact school nurse 2. Radio or contact school nurse immediately.immediately.

3. Do not move or have anyone else move 3. Do not move or have anyone else move student.student.

(If student is unconscious call 911)(If student is unconscious call 911)

Responsibilities of Parent and School Responsibilities of Parent and School Staff dealing with a concussed Staff dealing with a concussed

child/studentchild/studentParents- Parents- Observe daily child behavior Observe daily child behavior

Observe sleeping/eating behaviors and physical Observe sleeping/eating behaviors and physical symptoms (dizziness and headaches)symptoms (dizziness and headaches)

Eliminate the use of all electronic devices (TV, Eliminate the use of all electronic devices (TV, computer, IPAD/gaming devices and cell phone computer, IPAD/gaming devices and cell phone usage)usage)

Observe emotional behavior (irritability, Observe emotional behavior (irritability, sadness/crying and nervousness)sadness/crying and nervousness)

Responsibilities of Parent and School Staff Responsibilities of Parent and School Staff dealing with a concussed child/student-cont.dealing with a concussed child/student-cont.

School Staff-School Staff-

Observe academic performance (difficulty Observe academic performance (difficulty concentrating, remembering or thinking concentrating, remembering or thinking clearly)clearly)

Observe light and noise sensitivity, Observe light and noise sensitivity, headaches and dizziness. headaches and dizziness.

Observe emotional behavior (irritability, Observe emotional behavior (irritability, sadness/crying and nervousness)sadness/crying and nervousness)

NYS Return to Play ProtocolNYS Return to Play Protocol

In the event a child is concussed, he or she may In the event a child is concussed, he or she may not return to physical activities and physical not return to physical activities and physical education class until the 6-stage return to play education class until the 6-stage return to play protocol is administered and completed by the protocol is administered and completed by the school nurse and physical education teacher. school nurse and physical education teacher.

Elementary Return to Play ProtocolElementary Return to Play Protocol

Locust Valley School District

T.B.I. Primary/Intermediate Level Return To Play Protocol

Name:_____________________D.O.I.: , Dx. Date: AGE: , Max HR:____

STAGE 1: Very Light Aerobic Activities (30-40% max effort)

10-15 minutes of cardio exercise in a low stimulus environment; limiting

head movement and concentration activities. Example: walking stationary bike.

STAGE 2: Moderate Aerobic Activities (40-60% max effort)

20-30 minutes of cardio exercise and light strengthening in a gym environment,

allowing some positional changes and head movement: low level concentration activities. Example: light jogging or stationary bike, light weight training, and

balance training with limited hand/eye coordination.

Elementary Return to Play Elementary Return to Play Protocol (cont.)Protocol (cont.)

STAGE 3: Moderately Aggressive Aerobic Activities (60-80% max effort)

Balance and strength training at 80% effort.

Proprioceptive activities to incorporate concentration activities. Example: running/sprinting, stationary bike, and plyometrics,

STAGE 4: Sports Performance Training (80-90% max effort)

Training in sports specific activities, increasing hand/eye coordination. Example: student may increase training with multiple head, hand, and eye coordination skills.

STAGE 5: Full Unrestricted Performance Training

Student may return to ALL school related activities. Example: full unrestricted participation in P.E. classes ONLY. NO outside activities

Elementary Return to Play Elementary Return to Play Protocol (cont.)Protocol (cont.)

STAGE 6: Full Unrestricted Activities

Return to full activities, BOTH in and out of school environment.

Approved and authorized by LVCSD Physicians, the above stages must be implemented by School Nurse and Physical Education Teacher.