Concussions in Youth Sports
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Transcript of Concussions in Youth Sports
Concussions in Youth Sports
Best Practice Recommendations
Randall Wroble MDChairman, OHSAA Joint
Advisory Committee on Sports Medicine
•What are the 9 current best practice recommendations?
•Where do we stand in
Ohio?
1) Schools should develop an Emergency Action Plan (EAP) for handling life-threatening emergencies and a referral
plan for concussions
• 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
2) Enforce the standard use of sport-specific, properly
fitting, and certified helmets/equipment
• 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”
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
• 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
PRIVIT e-ppe research potential
Collecting, reviewing, & analyzing de-identified data can result in improved health & safety
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
• 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
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
• Rule in place since 2013
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)
• Athlete must have:1. Assessment2. Written authorization
• 2011 – written release form from physician
• 2013 – student/parent sign-off
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
• No current mandate– Recommendation to OHSAA Board is
under consideration
“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.
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
• Adopted in 2011 in OHSAA concussion regulations
• NFHS/Zurich protocol– Recommend no more than 1 step/day
And, Finally
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
• Determined by the medical personnel on site
Thanks!