What must I do?

What do I do when my player or child has sustained a concussion?

It is important that coaches and parents follow the necessary steps to ensure that the concussion is managed effectively.

Action Plan for coaches

If you suspect that one of your players has suffered a concussion, REMOVE THEM FROM THE GAME OR PRACTICE IMMEDIATELY!
Alert the medical personnel available at the match fixture or the school first-aid team. The team should be trained to assess concussion and assist you in taking the appropriate steps.
In the event that medical personnel or a first aid team is unavailable, utilize an on-field concussion assessment card made available by ImPACT. This will help you to recognize the signs and symptoms of a concussion.
If you are sure that the player has sustained a concussion, refer them to a qualified medical practitioner at the emergency and trauma unit which is closest to the school. This should be done as soon as possible after the concussion has occurred. Utilize either an ambulance or a responsible adult driver (preferably a parent/guardian) to drive them to the trauma unit promptly. A list of trauma units, names of doctors and phone numbers available nationwide will be provided by the ImPACT psychologist managing the schools concussion program.
If the player does not report or show any signs or symptoms of concussion but you are still unsure about whether the player has been concussed, do not return them to play for the rest of the match. “When in doubt, sit them out!”
Inform the student-athletes parents or guardians of the situation as well as the steps you have taken.
Once the student-athlete has been evaluated by a medical practitioner at the trauma unit, refer them to the ImPACT accredited Clinical Psychologist who is managing your schools concussion program. Your player will normally undergo post-concussion neuropsychological testing with ImPACT to evaluate their cognitive abilities once any initial very severe symptoms have subsided. This is usually within a few days following the injury.
Await for feedback from both the Medical Practitioner and ImPACT psychologist to assist you in managing a return to play protocol.

Action Plan for parents

Should you be attending the game or practice in which your child sustains a concussion, assist the coach by driving your child to the emergency and trauma unit. If your child has sustained a severe concussion, utilize the services of an ambulance if one is available.
Once the medical practitioner has assessed your child, contact the ImPACT psychologist responsible for concussion management at your school. An appointment will be arranged to ensure post-concussion testing with ImPACT usually between three to seven days after sustaining the concussion. Should your child be on tour and out of the area, either the coach or another ImPACT accredited psychologist will conduct the testing.
Monitor your child by looking for worrying signs and symptoms mentioned above.
Seek medical advice for the treatment of pain with medication.
If your child’s headache worsens, take them to a hospital immediately.
Ensure that the return to play protocol provided by the Medical Practitioner, ImPACT psychologist and coach is adhered too.
Adhere to advice from the ImPACT psychologist about the extent to which it is appropriate for your child to participate in study activities. If necessary a letter will be provided for school authorities in this regard especially if there are important tests or examinations to be written since a concussed individual will not be capable of performing at their normal level. Physical AND mental exertion should be avoided to facilitate rapid recovery from a concussion.

When is it safe to return to play?

Most concussions which are straight-forward in nature will resolve with a few days. In these cases, players will proceed quickly through the steps necessary to return them to active competition. In all cases, it is important that the recommendations of the Medical Practitioner be adhered to. He or she has the knowledge and experience of how to manage concussion as well as the information provided by the ImPACT psychologist based on the player’s neuropsychological test results.

Before a further consultation is made with the Medical practitioner to give the go-ahead for return to play, the student-athlete should be referred to the ImPACT psychologist for further neuropsychological testing. The Medical Practitioner will subsequently have the results of the baseline test, post-concussion test within the first week, and a further test taken before play is to be resumed. Based on their clinical training, experience and information from the ImPACT test, they will advise whether it is safe to return to play to training and matches.

It is important that coaches ensure the student-athletes follow a strict return-to-play protocol in order to ensure their safety following a concussion. The following Return to Play Recommendations were endorsed at the recent international sports symposiums on concussion:

Athletes should complete the following step-wise process prior to return to play following concussion.

Removal from contest following and signs/symptoms of concussion.
No return to play in current game
Medical evaluation following injury
a. Rule out more serious intracranial pathology
b. Neuropsychological Testing considered “cornerstone” or proper post-injury assessment
Stepwise return to play
a. No activity and rest until asymptomatic
b. Light aerobic exercise
c. Sport-specific training
d. Non-contact drills
e. Full-contact drills
f. Game play

It was specifically recommended that each step would, in most circumstances, be separated by 24 hours. Furthermore, any recurrence of concussive symptoms should lead to the athlete dropping back to the previous level. In other words, if an athlete is asymptomatic at rest and develops a headache following light aerobic exercise, the athlete should return to complete rest.

What is Second-Impact Syndrome?

Whilst the first concussion a player sustains may not cause permanent damage, a repeat injury to the head soon after the prior unresolved concussion, can have serious consequences. This is referred to as second impact syndrome which results from increases in intracranial pressure, massive swelling, herniation and even death. The second injury does not have to be severe to have permanently disabling or deadly effects.

Prevention of second-impact syndrome may be assisted by neuropsychological testing in which brain functions such as visual motor speed, reaction time, impulse control and memory are measured. The results of the neuropsychological testing conducted by an accredited ImPACT Clinical Psychologist are compared to the results of the player’s “baseline” test, completed before the start of the season. If the player has not received baseline testing, the post-concussion test results can be compared to South African normative data.

The most important consideration to prevent Second-Impact Syndrome is to never go back to play before all symptoms of concussion have resolved resolved!

General facts about concussion

Concussion manifestations vary from individual to individual.
Minor blows can cause more symptoms, whereas harder blows may cause fewer symptoms.
Younger athletes (in high school or in lower grades) have been shown to exhibit longer recovery times when compared to college and professional athletes (Field et al., 2003).
There may be a significant risk if they return to play too quickly.
Concussions seem to have more symptoms and last longer in females (Bazarian and Atabaki, 2001).
A gene may exist that causes some individuals to be more susceptible to concussions (Friedman et al., 1999).
Each concussion should be treated individually depending on the symptoms and the neuro-cognitive test results. This may be the reason why standardized management guidelines are unsuccessful.

What must I do?

What do I do when my player or child has sustained a concussion?

It is important that coaches and parents follow the necessary steps to ensure that the concussion is managed effectively.

Action Plan for coaches

If you suspect that one of your players has suffered a concussion, REMOVE THEM FROM THE GAME OR PRACTICE IMMEDIATELY!

Alert the medical personnel available at the match fixture or the school first-aid team. The team should be trained to assess concussion and assist you in taking the appropriate steps.

In the event that medical personnel or a first aid team is unavailable, utilize an on-field concussion assessment card made available by ImPACT. This will help you to recognize the signs and symptoms of a concussion.

If the player does not report or show any signs or symptoms of concussion but you are still unsure about whether the player has been concussed, do not return them to play for the rest of the match. “When in doubt, sit them out!”

Inform the student-athletes parents or guardians of the situation as well as the steps you have taken.

Await for feedback from both the Medical Practitioner and ImPACT psychologist to assist you in managing a return to play protocol.

Action Plan for parents

Should you be attending the game or practice in which your child sustains a concussion, assist the coach by driving your child to the emergency and trauma unit. If your child has sustained a severe concussion, utilize the services of an ambulance if one is available.

Monitor your child by looking for worrying signs and symptoms mentioned above.

Seek medical advice for the treatment of pain with medication.

If your child’s headache worsens, take them to a hospital immediately.

Ensure that the return to play protocol provided by the Medical Practitioner, ImPACT psychologist and coach is adhered too.

When is it safe to return to play?

It is important that coaches ensure the student-athletes follow a strict return-to-play protocol in order to ensure their safety following a concussion. The following Return to Play Recommendations were endorsed at the recent international sports symposiums on concussion:

Athletes should complete the following step-wise process prior to return to play following concussion.

What is Second-Impact Syndrome?

The most important consideration to prevent Second-Impact Syndrome is to never go back to play before all symptoms of concussion have resolved resolved!

General facts about concussion

Concussion manifestations vary from individual to individual.

Minor blows can cause more symptoms, whereas harder blows may cause fewer symptoms.

Younger athletes (in high school or in lower grades) have been shown to exhibit longer recovery times when compared to college and professional athletes (Field et al., 2003).

There may be a significant risk if they return to play too quickly.

Concussions seem to have more symptoms and last longer in females (Bazarian and Atabaki, 2001).

A gene may exist that causes some individuals to be more susceptible to concussions (Friedman et al., 1999).

Each concussion should be treated individually depending on the symptoms and the neuro-cognitive test results. This may be the reason why standardized management guidelines are unsuccessful.