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Concussion Management: Pro-Active Parents Needed

  • Because athletes often feel significant pressure to play through injuries and "tough it out," emphasize to your child the dangers of failing to immediately report or underreporting of concussion symptoms, and that doing so places them at risk for a catastrophic injury.

  • Insist that all coaches and certified athletic trainers (ATCs) involved in your child's sports program are trained to recognize and manage concussions, and that they, in turn, educate athletes about the signs and symptoms of concussion and the dangers of SIS, which can result from not reporting symptoms to the coach, ATC or team physician.

  • Make sure that team physicians and ATCs agree on definitions, procedures and referral guidelines for concussions. Clear communication among sports medicine personnel is necessary to provide consistent and proper care to the athlete.

  • Find out what concussion grading system and return-to-play guidelines if any, are being used at your child's school or by the sports program in which he or she participates. In a 2001 study reported in The Journal of Athletic Training, a surprising majority (63%) of the ATCs surveyed reported that they did not use any scale for evaluating concussions, and nearly a quarter (22%) allowed athletes to return to play in the same game or practice even after LOC, a practice contrary to all of the most frequently followed return-to-play guidelines.

  • If no set of guidelines is being used, demand that the school pick one and use them carefully for several years while the sports medicine team develops its own on-field decision-making skills.

  • Request that all athletes in contact or collision sports be tested before the start of every season to provide a baseline and individualized normal to be used for comparison purposes should an athlete sustain a concussion.

    • In an article in the July-September 2001 issue of the Journal Of Athletic Training entirely devoted to concussions in sports, three college ATCs advocated in favor of a more comprehensive approach to evaluating and managing concussions and presented a model for making return-to-play decisions based not solely on a guideline, but also on the athlete's symptoms and performance on objective tests such as the Balance Error Scoring System (BESS)Standardized Assessment of Concussion (SAC)

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    • Under their proposal, athletes would be administered the BESS and SAC during pre-participation physical examinations, so that, in the event of a head injury, the tests can then be easily re-administered on the sideline (at the end of the bench area, away from teammates and other distractions) or in the locker room. In another article in the same Journal Of Athletic Training, the author proposes a model for management of concussions at the high school level that also relies on the SAC.
  • Call for the testing of student-athletes after any concussion to compare against the baseline tests to detect any changes over time.

  • Insist that NO athlete ever be allowed to return to the same contest or practice if either he or she has suffered a loss of consciousness (however short in duration), is still experiencing any post-concussion signs or symptoms or less than 20 or 30 minutes have elapsed since such symptoms cleared. To be on the safe side, an athlete suffering even a Grade 1 concussion with no loss of consciousness, should wait one week before returning to practice or play.
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