SHREWSBURY PUBLIC SCHOOLS
CONCUSSION PROTOCOL

All coaches; athletic staff, parents, student-athletes, marching band members, volunteers, and any other persons involved with extracurricular activities must take the online concussion information course and provide certificate of completion prior to the start of the season as mandated by the MIAA and the State of Massachusetts.  

Coaches: are prohibited from encouraging or permitting a student-athlete to return to play after suffering from a possible head injury. The coach must provide documentation of injury occurrence to the Athletic Department within 24 hrs. of suspected injury. 

Parents/Student-Athletes: are responsible under the new Massachusetts state law to provide the school district with information regarding any past medical history of head injury/concussion. The Athletic Department must receive this information prior to that start of the student's sports season.

RETURN-TO-PARTICIPATION PROTOCOL

This protocol allows a gradual increase in volume and Intensity during the return-to-play process. The athlete is monitored for any concussion-like signs/symptoms during and after each activity period by the Certified Athletic Trainer. If symptoms return at any point during the re-exertion activity the athlete is expected to stop his/her activity for the day. The following day, if asymptomatic he/she may continue activities at the next step.  

Once you are symptom-free, for 48 hours you may begin the steps for return to play. 

Day 1: Light Aerobic Exercise: walking or stationary cycling, light jogging. No resistance training. No heavy exertion. Limit to 30 minutes. 

Day 2: Sport Specific Training: stretching routine, agility drills, change of direction, sprinting. No extended exertion. No contact. No helmet or equipment. 

Day 3: Light Contact Training: resume body contact drills, limit direct head contact (tackle drills in football, heading in soccer, checking in hockey), light resistance training (weight lifting). 

Day 4: Full Contact PRACTICE: participation in all areas of practice, contact is allowed (tackle drills, heading, checking), resistance training is full. Take Post-Injury ImPACT test online if necessary. 

Day 5: Game Play

• If any post-concussion symptoms develop at any stage, drop back to the previous level and try to progress again after 48 symptom-free hours.
• No medications may be taken at any step of the progression. This is to prevent masking a more serious underlying condition!
• You must check in daily with your athletic trainer every day PRIOR to practice to review these steps as well as for a minimum of 1 week after being cleared for full participation.

The most recent consensus of experts is that athletes who have suffered multiple concussions should be held out of play for an extended period of time 1-2 weeks after symptoms have cleared, especially during the same sports season. For athletes who have suffered three mild/simple concussions or two moderate-severe/complex concussions in the same season, experts advise that they not be permitted to return to play again that season.

Head Injury Information

• A blow to the head can disrupt the normal function of the brain. Doctors often call this type of brain injury a "concussion" or a "closed head injury." They may describe these injuries as "mild" because concussions are usually not life threatening. However, the effects of a concussion can be serious.
• After a concussion, some people lose consciousness or are "knocked out" for a short time, but not always - you can have a brain injury without losing consciousness. Some people are simply dazed or confused.
• Because the brain is very complex, every brain injury is different. Some symptoms may appear right away, while others may not show up for days or weeks after the concussion. Sometimes the injury makes it hard for people to recognize or admit that they are having problems.
• The signs of concussion are subtle. Early on, problems may be missed. People may look fine even though they are acting or feeling differently.
• Because all brain injuries are different, so is recovery. Most people with mild injuries recover fully, but it can take time. Some symptoms can last for days, weeks, or longer.
• People with a concussion need to be seen by a doctor.

Signs and Symptoms 

Some of the symptoms observed by MEDICAL STAFF:  

• Appears dazed or stunned 
• Is confused about assignment 
• Forgets sports plays 
• Is unsure of game, score, opponent 
• Moves clumsily 
• Slowness in thinking, acting, speaking, or reading. 
• Loses consciousness (even briefly) 
• Memory loss 
• Difficulty paying attention or concentrating 
• Lack of energy 
• Severe mood changes

Some of the symptoms reported by ATHLETE:  

• Headache or pressure in head
• Nausea 
• Balance problems or dizziness  
• Double vision or blurred vision 
• Sensitivity to light 
• Sensitivity to noise 
• Feeling sluggish or slowed down 
• Feeling in a fog or groggy 
• Increased fatigue  

Danger Signs 

In very rare cases, along with a concussion, a dangerous blood clot may form on the brain. Contact your doctor or Emergency Department right away if you have any of the following symptoms:  

• Headaches that get much worse than at initial evaluation 
• Weakness, numbness, or decreased coordination 
• Repeated vomiting  

The people checking on you should take you to an Emergency Department right away if you:  

• Cannot be awakened 
• Have one pupil (the black dot of your eye) larger than the other. 
• Have convulsions or seizures 
• Have slurred speech 
• Are getting more confused, restless, or agitated 

Recovery

• How fast people recover from a concussion varies from person to person.
• Although most people have a good recovery, how quickly depends on many factors.
• These factors include how severe the concussion was, what part of the brain was injured, their age, and how healthy they were before the concussion.
• Rest is very important after a concussion because it helps the brain to heal. You will need to be extremely patient because healing takes time. As the days go by, you can expect to gradually feel better.
• While you are healing, you should be very careful to avoid doing anything that could cause a blow to your head. On rare occasions, receiving another blow before a concussion has healed can be fatal. Here are some tips for healing:
  • Get plenty of sleep at night and rest during the day
  • Avoid use of electronics/media i.e. iPods, video games, computer, cell phone/texting, television that may over stimulate the brain 
  • Return to activities gradually, not all at once 
  • Avoid activities that could lead to a 2nd brain injury until cleared by the Doctor 
  • Take only those drugs that your doctor has approved