Laurier Athletics - Waterloo Campus

• Laurier’s concussion protocol
• Return to sport protocol
• Return to learn protocol
• Concussion – Home advice

Wilfrid Laurier Concussion Recognition and Management Protocol

Preseason:

• Athletes complete a baseline ImPACT neurocognitive computerized evaluation
• All athletes complete a detailed medical history form identifying previous head injuries, hospitalizations and any relevant diagnostic testing

At time of Injury:

• Use a Sport Concussion Assessment Tool on the sidelines to determine if an athlete has suffered a concussion (Certified Athletic Therapist / Student Therapist)
• Remove symptomatic athlete from practice / competition
• Complete a SCAT5 when appropriate
• Report injury to Certified Athletic Therapist (if not present) immediately
• Athlete sent home with a responsible adult who has been given the Concussion Injury Advice card and explained the protocol of monitoring the athlete for worsening signs or symptoms

Follow-up:

• Athlete has daily appointments with a Certified Athletic Therapist for symptom evaluation which is documented in the athlete’s chart
• Athlete does not engage in any physical activity and limits cognitive activities while experiencing symptoms
•  Notify and schedule an appointment with a Sports Medicine Physician if symptoms are not improving
• Referral to the Accessible Learning Centre on campus if necessary ? Athlete must remain asymptomatic for a period of time (will be based on the amount of time the athlete experienced symptoms)
• Arrange for step 2 of the graduated return-to-play protocol to occur when athlete is asymptomatic
• Progress through 6 stages as tolerated
• Prior to return-to-play, re-evaluate using the ImPACT test and compare to baseline
• Identify when the ImPACT scores return to baseline
• Obtain written medical clearance to return to competition from a Sports Medicine Physician or Certified Athletic Therapist

Laurier Concussion Management Protocol – Phase 2 (Return to Learn Plan)

The Laurier Athletics & Recreation Return to Learn Plan has been developed based on the most recent research and recommendations of the expert scientific community on concussion, that is the Canadian Guidelines on Concussion in Sport, July 2017 and the Berlin Consensus Statement on Concussion in Sport, October 2016.

The Laurier Concussion Management Protocol – Phase 2 is for student athletes and their support team which may include athletic therapists, sports medicine physicians, the Accessible Learning Centre staff, and Athletic & Recreation Department staff. This protocol guides the student athlete through an individualized plan of returning to learn and allows for communication to track a student athlete’s progress throughout the stages.

• Inform a student athlete of the importance to disclose any concussion / head injury symptoms with his / her athletic therapist
• Have a thorough concussion assessment completed by a healthcare professional
• If the student athlete is reporting difficulties with attending class, completing schoolwork etc., obtain a sports medicine physician’s note and referral to the Accessible Learning Centre (ALC) on campus
• The student athlete will schedule an appointment with the ALC in person or online at:

Waterloo Campus:

• P220 2nd floor Peters Building
• 519 884-0710 x3086
• https://students.wlu.ca/academics/support-and-advising/accessible-learning-centre/index.html

Brantford Campus:

• One Market (OM 207-20)
• 519 756-8228 x5871

• An Accessible Learning Centre (ALC) consultant will meet with a student athlete and discuss their respective needs and create a Return to Learn Plan with the necessary academic accommodations
• The Accessible Learning Centre (ALC) initiates a process to notify professors/respective faculties on behalf of the student athlete
• A student athlete is directed by the Athletic Therapist / Sports Medicine Physician as to concussion management guidelines, which include but are not limited to limitations of mental exertion and limiting screen time.  These guidelines will be explained verbally and also in written form (i.e. Email) to the student athlete and kept in the student athletes medical file within Athletics & Recreation.
• A student athlete moves forward to increasing the amount of schoolwork when activities at the current stage are tolerated and the student athlete has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms
• If symptoms return or new symptoms appear, the student athlete returns to the previous stage and only participates in tasks that can be tolerated
• Upon completion of the Return to Learn Plan a Sports Medicine Physician will reassess the student athlete and provide Medical Clearance to return to full school activities when appropriate.  The Athletic Therapist and/or Sport Medicine Physician will thoroughly explain verbally and follow in up in written form (ie. Email) all protocols and procedures the student athlete must follow.
• Until a student athlete has successfully completed their return to learn plan, they must not participate in any physical activity or sport unless prescribed by a therapist or physician.  This will be documented.
• Progression through the plan is individual, timelines and accommodations may vary

Graduated Return to School Strategy

Concussion may affect the ability to learn at school. A student athlete may need to miss a few days or more of school after sustaining a concussion. When returning to school, some athletes may need to go back gradually and may need to have some changes made to their academic schedule so that concussion symptoms do not get worse. If an activity makes symptoms worse, then the student athlete should stop that activity and rest until symptoms improve. It is imperative that the student athlete is honest about how they are feeling to ensure the best possible care.To ensure that an athlete can return to school without problems, it is important that healthcare professionals, professors and support staff communicate so that everyone knows the plan for the student athlete’s return to learn.If at any time a student athlete believes they are not being provided proper care they should immediately connect with the Associate Director, Interuniversity Sport Programs or the Coordinator, Athlete Services.

Note:

 If mental activity does not cause any symptoms, the athlete may be able to skip step 2 and return to school part-time before doing school activities at home first.

 If a student athlete continues to report symptoms with mental activity, some accommodations that may help with return to school may include:

• Starting school later, only going for half days, or going only to certain classes
• Additional time to complete assignments / exams
• Quiet room to complete assignments / exams
• Avoiding noisy areas such as common areas, sporting events, fitness centre etc.
• Taking lots of breaks during class, homework, tests
• No more than one exam per day
• Shorter / modified assignments
• Repetition / memory cues / learning aids
• Use of a tutor

Concussion Injury Advice

This athlete has received an injury to the head. A careful medical examination has been carried out and no sign of any serious complications has been found. The athlete will need monitoring for a further period by a responsible adult. The athlete should not be left alone and must go to the hospital at once if any of the following occur.

Signs to watch for:                                                                                        Other Important Points:

· Have a headache that gets worse                                                               · Rest and avoid strenuous activity

· Are very drowsy or can’t be awakened (woken up)                                     · NO alcohol

· Can’t recognize people or places                                                                 · NO medication

· Have repeated vomiting                                                                               · Don’t drive until medically cleared

· Behave unusually or seem confused; are very irritable                              · Do not train or play sport until medically cleared

· Have seizures (arms & legs jerk uncontrollably)                                            

· Are unsteady on their feet; have slurred speech

Are you a varsity athlete and think you might have a concussion?

What is a concussion?

A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. – Brain Line 

Signs and symptoms of a concussion may include:

• Headache or a feeling of pressure in the head
• Temporary loss of consciousness
• Confusion or feeling as if in a fog
• Memory loss surrounding the traumatic event
• Dizziness or "seeing stars"
• Ringing in the ears
• Nausea / Vomiting
• Slurred speech
• Delayed response to questions
• Appearing dazed
• Fatigue

You may have some symptoms of a concussion immediately or symptoms may be delayed for hours or days after injury, such as:

• Concentration and memory complaints
• Irritability and other personality changes
• Sensitivity to light and noise
• Sleep disturbances
• Psychological adjustment problems and depression
• Disorders of taste and smell

If you’re experiencing any of these symptoms following a hit to the head or body, make an appointment with your Athletic Therapist as soon as possible. https://wlutherapy.setmore.com

WATCH : “Concussion Management & Return to Learn” video) - https://www.youtube.com/watch?v=_55YmblG9YM

Concussion Protocol 

Wilfrid Laurier Concussion Recognition and Management Protocol

Preseason: 

· Athletes complete a baseline ImPACT neurocognitive computerized evaluation (W Lacrosse, M & W soccer, M & W rugby, M & W basketball, M & W hockey, M football) 

· All athletes complete a detailed medical history form identifying previous head injuries, hospitalizations and any relevant diagnostic testing 

At time of Injury: 

· Use the pocket SCAT (Sport Concussion Assessment Tool) on the sidelines to determine if an athlete has suffered a concussion (Certified Athletic Therapist / Student Therapist) 

· Remove symptomatic athlete from practice / competition 

· Complete a SCAT5 as soon as possible if the athlete is able to do so 

· Report injury to Certified Athletic Therapist (if not present) immediately 

· Athlete sent home with a responsible adult who has been given the Concussion Injury Advice card and explained the protocol of monitoring the athlete for worsening signs or symptoms 33 

Follow-up: 

· Athlete has daily appointments with a Certified Athletic Therapist for symptom evaluation which is documented in the athlete’s chart 

· Athlete does not engage in any physical activity and limits cognitive activities while experiencing symptoms 

· Notify and schedule an appointment with a Sports Medicine Physician if symptoms are not improving 

· Referral to the Accessible Learning Centre on campus if necessary 

· Athlete must remain asymptomatic for a period of time (will be based on the amount of time the athlete experienced symptoms) 

· Arrange for step 2 of the graduated return-to-play protocol to occur when athlete is asymptomatic 

· Progress through 6 stages as tolerated 

· Prior to return-to-play, re-evaluate using the ImPACT test and compare to baseline values 

· Identify when the ImPACT scores return to baseline 

· Obtain written medical clearance to return to competition from a Sports Medicine Physician

Second Impact Syndrome

What is Second Impact Syndrome?

Second Impact Syndrome (SIS) is when an individual that is suffering from a concussion, receives another concussion. This can cause rapid and severe brain swelling and damage which can often lead to death. This can result from a minor blow to the head or the body that moves the brain inside the skull. 

In patients who sustains a second concussion when the first one has not fully healed, the brain loses its ability to auto regulate intracranial and cerebral perfusion pressure. This may lead to cerebral edema (severe swelling of the brain) and possible brain herniation. Loss of consciousness after the initial injury followed by secondary brain damage creates ionic fluxes, acute metabolic changes, and cerebral blood flow alterations.  All of these characteristics enhance the vulnerability of the brain and greatly increase the risk of death, even if the second injury was far less intense.

Symptoms of Second Impact Syndrome

Second Impact injuries can occur within days or week, or in the same game that the athlete received their initial concussion. The impact does not have to be extreme for SIS to occur. After the second impact, symptoms often arise rather quickly. 

Symptoms of Second Impact Syndrome include:

• Dilated pupils
• Loss of eye movement
• Unconsciousness
• Respiratory failure
• Death

Avoid activities that can result in second concussions

It is crucial for an individual that has sustained a concussion to avoid all activities which can lead to another potential concussion. 

If you or a fellow athlete is suffering from one or more concussion symptoms, immediately make an appointment with your athletic therapist. No athlete should return to play until they have been cleared by their athletic therapist or doctor.

Rowans Law

On March 7, 2018, Ontario passed Rowan's Law (Concussion Safety), 2018 and related amendments to the Education Act. This new legislation, which received all-party support, is intended to protect amateur athletes by improving concussion safety on the field and at school.

Rowan Stringer

Rowan Stringer was a 17-year old Ottawa varsity rugby player who died from sustaining multiple concussions resulting in a catastrophic swelling of the brain – second impact syndrome.

Rowan had three head injuries within 6 days while playing rugby. She was concussed and did not know it. Her parents, teachers and coaches did not know that she was concussed. No one knew, including Rowan that her brain needed time to heal. 

Rowan’s Law and Rowan’s Law Day were established to honour her memory and bring awareness to concussions and concussion safety.

WATCH Rowans Law Video: https://www.youtube.com/watch?v=pE-2rMk-yN0 

https://www.brainandspinalcord.org/second-impact-syndrome/ 

http://www.mtc.gov.on.ca/en/sport/rowans_law_day.shtml 

Fact or Myth: 

1. A concussion only occurs as a result of a direct blow to the head – MYTH
   • Concussions can be caused by a direct blow to the head, face, neck or elsewhere on the body where the force is of impact is transmitted to the head
2. A concussion only occurs when an athlete experiences a loss of consciousness – MYTH
   • Concussions can occur with or without a loss of consciousness. ~90% of concussions do not result in a loss of consciousness.
3. An athlete should not return to play while experiencing concussion symptoms – FACT
   • There are many different signs and symptoms of a concussion. Any athlete should not be allowed to return to play, even if symptoms clear quickly. Athletes should be cleared by their athletic therapist before they return to play.
4. You must be placed in a dark room without noise and distraction to recover from a concussion – MYTH
   • Reducing light, noise and screen time can help the brain recover as you are letting the brain rest, not eliminating everything all together.
5. Helmets do not prevent concussions – FACT
   • While helmets have been shown to protect against skull fractures and severe traumatic brain injury, there is very little evidence that helmets reduce concussions.
6. Having one concussion increases your risk of future concussions – MYTH
   • Proper clinical management is the best form of prevention. Recovery should not put an athlete at risk of another.

Reference: http://rethinkconcussions.upmc.com/2016/10/concussion-myths-facts/ 

Laurier Concussion Research

Laurier undergraduate student to take concussion research international https://www.wlu.ca/news/spotlights/2016/summer/laurier-undergraduate-student-to-take-concussion-research-international.html 

Laurier’s concussion expert Michael Cinelli stresses the importance of concussion treatment and patient care https://www.wlu.ca/news/spotlights/2015/fall/after-the-impact.html 

LAURIER EXPERT ALERT: Concussions 
https://www.wlu.ca/news/news-releases/2015/dec/laurier-expert-alert-concussions.html 

Laurier concussion research group teams up with local hockey academy to investigate safe return to sport protocol
http://victusacademy.com/2017/08/15/laurier-concussion-research-group-teams-local-hockey-academy-investigate-safe-return-sport-protocol/ 

Wilfrid Laurier University research team making concussions safer
https://www.570news.com/2015/10/04/wilfrid-laurier-university-research-team-making-concussions-safer/ 

Concussion research shows athletes return to action with slower reaction time
https://www.waterloochronicle.ca/community-story/7514874-concussion-research-shows-athletes-return-to-action-with-slower-reaction-time/ 

More information 

http://www.parachutecanada.org/downloads/injurytopics/Canadian_Guideline_on_Concussion_in_Sport-Parachute.pdf  – Parachute

http://concussionsontario.org  – Concussion Ontario
http://concussionsontario.org/standards/tools-resources/concussion-information-for-patients-and-families/ 

https://www.coach.ca/making-head-way-concussion-elearning-series-p153487 

http://obia.ca  – Ontario Brain Injury Association

https://sirc.ca/concussion  – SIRC Concussion

https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594  – Mayo Clinic

https://www.cdc.gov/headsup/basics/concussion_whatis.html – CDC

https://medlineplus.gov/concussion.html  – Medline Plus

https://www.webmd.com/brain/concussion-traumatic-brain-injury-symptoms-causes-treatments#1 – WebMD

What to do: Home Advice

General advice for managing a concussion includes the following:

• Get plenty of sleep at night and rest during the day. It is not necessary to be woken up every 2 hours.
• Avoid visual and sensory stimuli, including video games and loud music - Limit all screen time (smartphones, televisions)
• Eat well-balanced meals.
• Ease into normal daily activities slowly, not all at once.
• Make sure to let employers or teachers know that you had a concussion.
  • Talk to your athletic therapist for help reaching out to make academic accommodations
• Avoid strenuous physical or mental tasks.
• Avoid activities that could lead to another concussion, such as sports, certain amusement park rides, or (for children) playground activities.
• Get your doctor's / athletic therapists permission before driving, operating machinery, or riding a bike (since a concussion can slow one's reflexes).
• If necessary, ask your employer if it is possible to return to work gradually (for example, starting with half-days at first). Students may need to spend fewer hours at school, have frequent rest periods, or more time to complete tests.
• Take only those drugs approved by your doctor.
• Do not drink alcohol. Alcohol and other drugs may slow recovery and increase the chance for further injury.
• For some people, an airplane flight shortly after a concussion can make symptoms worse.
• Avoid tiring activities such as heavy cleaning, exercising, working on the computer, or playing video games.
• See your Athletic Therapist frequently for testing before you resume your routines, including driving, sports, and play.

Reference: https://my.clevelandclinic.org/health/diseases/15038-concussions/management-and-treatment

Athlete & Coach Orientation:

à Intro what a concussion is / how serious they are

à Brief info about what actions are taken at Laurier if an athlete gets hit:

Preseason: 

· Athletes complete a baseline ImPACT neurocognitive computerized evaluation (M & W soccer, M & W rugby, M & W basketball, M & W hockey, M football) 

· All athletes complete a detailed medical history form identifying previous head injuries, hospitalizations and any relevant diagnostic testing 

At time of Injury: 

· Use the pocket SCAT (Sport Concussion Assessment Tool) on the sidelines to determine if an athlete has suffered a concussion (Certified Athletic Therapist / Student Therapist) 

· Remove symptomatic athlete from practice / competition 

· Complete a SCAT5 as soon as possible if the athlete is able to do so 

· Report injury to Certified Athletic Therapist (if not present) immediately 

· Athlete sent home with a responsible adult who has been given the Concussion Injury Advice card and explained the protocol of monitoring the athlete for worsening signs or symptoms 33 

Follow-up: 

· Athlete has daily appointments with a Certified Athletic Therapist for symptom evaluation which is documented in the athlete’s chart 

· Athlete does not engage in any physical activity and limits cognitive activities while experiencing symptoms 

· Notify and schedule an appointment with a Sports Medicine Physician if symptoms are not improving 

· Referral to the Accessible Learning Centre on campus if necessary 

· Athlete must remain asymptomatic for a period of time (will be based on the amount of time the athlete experienced symptoms) 

· Arrange for step 2 of the graduated return-to-play protocol to occur when athlete is asymptomatic 

· Progress through 6 stages as tolerated 

· Prior to return-to-play, re-evaluate using the ImPACT test and compare to baseline values 

· Identify when the ImPACT scores return to baseline 

· Obtain written medical clearance to return to competition from a Sports Medicine

A concussion is a brain injury resulting from a hit to the head, neck or body that causes the brain to hit against the skull. A concussion alters the way you think and feel due to damage to the brain. 

Can I get a concussion from not getting hit in the head?

• Yes, A concussion can occur from direct trauma to the head or neck as well as indirect trauma. You can get a concussion from;
  •  Falling on your tailbone, 
  • Taking a hit to the body and your head getting whipped back
  •  Whiplash from a car accident
  • Direct trauma to the head or neck

What are the symptoms of a concussion?

• Dizziness
• Ringing in the ears
• Headache 
• Nauseous
• Pressure in head
• Difficulty with balance/ feeling drunk
• Sensitivity to light
• Sensitivity to noise
• Blurred vision 
• Confused 
• Feel like you’re in a fog
• Sleepy/ tired low energy
• Can’t remember
• Irritable
• Nervous/ anxious
• Emotional
• Sad 
• Don’t feel right/ don’t feel yourself
• Difficulty concentration 

How do I know if I should go to the hospital?

• neck pain along the spine
• double vision
• loss of consciousness 
• seizure or convulsion
• vomiting
• headache gets worse 
• arms or legs feel weak, tingling or burning 

*Do NOT drive yourself to the hospital*

I only have one symptom does that still mean I have a concussion?

• Having 1 or more sign or symptom could mean you have a concussion.
• If you have ANY symptoms of a concussion, talk to your Athletic Therapist or Doctor. 

What are the consequences of going back into the game with a concussion?

• If you get hit again you could suffer from second impact syndrome
• Second impact syndrome can result in rapid brain swelling from receiving a second blow to the head while still recovering from the 1st concussion. 
• Death can result from second impact syndrome 

Can I drive myself home?

• No. It is best to get a parent, roommate or teammate to drive you home. 
• Your vision and reaction time can be affected with a concussion so it isn’t safe to drive home
•  

I didn’t have symptoms right away but after the game I started to, does that mean I could have a concussion? 

• Yes, you could be concussed. Most of the time symptoms show up soon after the injury but can show up hours or days after. It is important to let your therapist know if you get new or worsening symptoms. 

What questions would I ask if I was diagnosed with a concussion

How long will I be out for?

• It depends. Most individuals take 8 days to 4 weeks to recover.

Why can’t I take Tylenol, Advil or Ibuprofen for my headaches?

• Medication can increase the risk of bleeding in the brain as well as mask the symptoms or the severity of the symptoms. 
• You should ask a doctor before taking medication following a concussion

Why can’t I drink alcohol after a concussion?

• Ultimately it could increase the amount of time it takes to recover 
• Unable to recognize your symptoms are getting worse because you’re under the influence of alcohol
• Alcohol magnifies some of the symptoms caused by a concussion 

Why can’t I be on my phone or have to limit my screen time?

• The light admitted from your phone may increase your symptoms. It is recommended that immediately following a concussion you physically and mentally rest for 24-48 hours. 
• If you need to use your phone, take frequent screen breaks, utilize dark mode, reduce brightness and increase the font size. 

Do I need to be woken up every few hours while I sleep?

• No, increased sleep and rest is needed for the brain to heal.

Why do I have to go through every step of the return to play protocol when I feel fine?

• Symptoms can be delayed after completing a task that is why there is 24 hours between each return to play step.
• It is important to gradually increase exercise. 
• Going too fast through the recovery process can inhibit recovery

Can I listen to music or podcasts while concussed?

• It depends if it makes your symptoms worse. If it makes the symptoms worse stop
• If you do decide to listen to music or podcast decrease the volume that you listen to it at and stop if your symptoms increase or you get new symptoms.

Why can’t I work out the first few days after a concussion?

• Your balance and coordination can be effected after a concussion therefore it isn’t safe to work out before being cleared by a doctor. 

Can anything speed up my recovery?

• You can’t speed up the time of recovery but you can do things to create a better environment for healing
• Getting enough sleep 
• Staying hydrated 
• Eating a healthy diet
• Things that can slow down your recovery
• Pushing yourself and returning to quickly 
• Drinking alcohol 
• Not get proper rest

Will I have any long term side effects?

• Possibly but following the concussion protocol and falling the doctor’s advice could limit the chances of long term effects
• If symptoms don’t go away after several weeks or months you could have post concussive syndrome
  • Post concussive syndrome is when symptoms last longer than the expected recovery time. 
  • Trouble sleeping could be a problem that last months or years after your concussion if this occurs talk to your doctor. 
  • Balance and coordination could be effected
  • Vision problems 

Who do I need to contact if I can't get my assignments done for class because I can't focus for a long period of time?

• You should contact the Coordinator, Athlete Services (Link to department directory) and they will work with you on connecting with your professors and potentially the ALC if needed.

Can I take any medication if I can't sleep?

• No, any medication you take while concussed needs to be approved by a doctor before taking it. 

Can I still attend practice if I can't participate in practice?

• It depends you should discuss this with your athletic therapist. If it doesn’t make your symptoms worse and if there isn’t an increase chance of you getting hit while watching you may be allowed to attend practice. 

Concussion Resources

https://www.canada.ca/en/public-health/services/diseases/concussion-sign-symptoms.html

https://www.cdc.gov/headsup/basics/concussion_symptoms.html

https://www.cdc.gov/headsup/basics/concussion_recovery.html

https://braininjuryguidelines.org/concussion/fileadmin/patient-version/02-Initial-Management-of-Concussion.pdf

https://www.mayoclinic.org/diseases-conditions/concussion/diagnosis-treatment/drc-20355600#:~:text=Headaches%20may%20occur%20in%20the,increase%20the%20risk%20of%20bleeding.

https://msktc.org/tbi/factsheets/Alcohol-Use-After-Traumatic-Brain-Injury