Concussions in Youth Sports

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Concussions in Youth Sports Best Practice Recommendations Randall Wroble MD Chairman, OHSAA Joint Advisory Committee on Sports Medicine

Transcript of Concussions in Youth Sports

Page 1: Concussions in Youth Sports

Concussions in Youth Sports

Best Practice Recommendations

Randall Wroble MDChairman, OHSAA Joint

Advisory Committee on Sports Medicine

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•What are the 9 current best practice recommendations?

•Where do we stand in

Ohio?

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1) Schools should develop an Emergency Action Plan (EAP) for handling life-threatening emergencies and a referral

plan for concussions

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• General recommendations in place• No mandates• Athletic trainers in Ohio public high schools*–45% have full-time trainers–53% have part-time trainers

*Korey Stringer Institute, 2015

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2) Enforce the standard use of sport-specific, properly

fitting, and certified helmets/equipment

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• Guidelines adopted per NFHS Football Manual for Coaches and Officials– “4 Quarters of Football Helmet Safety”

• Proposals for minimizing head impact exposure are under consideration this summer– 2-3 full-contact days/week– Only 1 full-contact practice during “2-a-

days”

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3) The Pre-Participation Exam (PPE) should include concussion specific

questions• Many athletes do not recognize they have

had concussions due to lack of knowledge• A history of concussions identifies athletes

at risk• Includes:– Previous injuries– Previous symptoms– Length of recovery

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• Ohio was the first state to adopt an electronic pre-participation exam (ePPE) as the standard

• PRIVIT– Online documentation of existing health

conditions once. Updates only when necessary– E-signature– Information accessible from any  mobile

device– Secure/encrypted - Information only shared

with medical personnel and administration

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PRIVIT e-ppe research potential

Collecting, reviewing, & analyzing de-identified data can result in improved health & safety

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4) Preseason education for personnel, coaches, and athletes on

basics of concussion• Best way to prevent a catastrophic

injury is to educate those involved on how to recognize the signs and symptoms of concussion

• Education on assessment techniques and management

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• Coaches (since 2011) and officials (since 2013) have had a mandatory online concussion training requirement– NFHSA: Concussion in Sports – What you

need to know– CDC Heads Up Concussion in Youth

Sports • Yearly football pre-season

meeting – discussing health and safety

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5) Athletes suspected of sustaining a concussion are not permitted to

return to a practice, game, or activity involving exertional

activity on the same day

• An athlete who returns to activity is at significantly higher risk of additional injury

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• Rule in place since 2013

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6) Athletes are not permitted to return to

participation until written release from a licensed physician or trainer (in

consultation with or under supervision of a physician)

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• Athlete must have:1. Assessment2. Written authorization

• 2011 – written release form from physician

• 2013 – student/parent sign-off

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7) No child/adolescent should return to sports unless he or she has returned to school

• Schoolwork exacerbates signs and symptoms of a concussion in most circumstances

• All symptoms related to increased mental activity must be resolved before return

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• No current mandate– Recommendation to OHSAA Board is

under consideration

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“Return to learn” – 4 step approach– No school, no homework, no computer,

no texting, no video games, and no TV if it makes symptoms worse

– Light cognitive activity – School-specific activity should be

increased gradually– Able to do one to two hours of

homework at home for one to two days - try to return for half day. Three to four hours – try a full day.

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8) Implementation of a graduated return to participation protocol

• Rehabilitation stages progress stepwise– No activity– Light aerobic exercise– Sport specific exercise– Non-contact training– Full-contact practice– Return to play

• One to two steps/day• No progression unless symptom-free

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• Adopted in 2011 in OHSAA concussion regulations

• NFHS/Zurich protocol– Recommend no more than 1 step/day

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And, Finally

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9) Comprehensive medical management plan for acute care of a

potential head or cervical spine injury

• Immediate removal from play• Examination by qualified health care

provider• Sideline line assessment tools• Continued serial observation

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• Determined by the medical personnel on site

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Thanks!