CONCUSSION MANAGEMENT POLICY
A concussion is a brain injury that is caused by a blow to the head or body that may result in improper brain functioning. A concussion can range from mild to very severe and manifests itself differently in each individual.
Concussions are recognized as being a potentially very serious condition that if managed improperly, can lead to catastrophic consequences. At Wake Forest University, we take great pride in providing optimal health care to all student-athletes. The following policy has been adopted by the Sports Medicine Department in an effort to provide a consistent management approach to any student athlete that suffers a concussion, while also recognizing that each concussion, as well as each athlete, is unique and individualized in nature. By managing concussions individually, and considering the athlete's medical history, it allows the physicians and athletic trainers on staff to ensure the safety for each student athlete.
Wake Forest University recognizes that concussions may occur outside of participating in a sport. Therefore the acute management of the student-athlete with such a concussion may occur outside the scope of this document. However, return to play decisions for the student athlete that may have suffered a concussion outside of sport participation will be guided by this policy. This policy includes, but is not limited to the management principles mandated by the NCAA.
Prior to each preseason, student-athletes will be educated on how to recognize signs and symptoms of concussion, the Wake Forest University Sports Medicine Department Concussion Management Policy, as well as current trends in concussion management.
At the conclusion of the educational session, student-athletes will sign a statement acknowledging the receipt of the education, as well as their role in reporting any student-athlete exhibiting signs and symptoms of a concussion to the appropriate member of the Sports Medicine Staff.
SIGNS AND SYMPTOMS OF A CONCUSSION
Signs and symptoms of a concussion may include, but are not limited to the following:
Tinnitus (ringing in ears)
Sensitivity to light and/or noise
Loss of consciousness
Exercise or activities that require a lot of concentration may cause symptoms to re-appear or worsen, thus increasing the time one needs to recover from a concussion.
Each athlete (TBD on a sport by sport basis) on an active sport roster, as part of a comprehensive pre-participation physical exam, will be tested with a computerized neuro-psychological exam (ImPACT®). The reason for this is to have "baseline scores" for comparison should a student athlete sustain a concussion throughout their athletic career.
REPORTING A CONCUSSION
Anyone that suspects a student athlete has a concussion, or notices any athlete suffering from any symptoms of a concussion, must report the concerns to the appropriate member of the Wake Forest University Sports Medicine Staff.
ACUTE MANAGEMENT OF A CONCUSSION
Any athlete that suffers from symptoms of a concussion shall be removed from participation for evaluation by the Sports Medicine Staff. Following evaluation from the Sports Medicine Staff, decisions will be made whether the athlete should be transported to the local hospital for emergency care and/or further diagnostic testing. Any athlete that is diagnosed with a concussion by a Physician shall not return to participation for the remainder of that day. This is to ensure that the athlete does not negatively influence the nature of the injury by further exerting themselves.
POST-ACUTE CONCUSSION MANAGEMENT
Follow-up Physician care will be determined on an individual basis as directed by the Wake Forest University Sports Medicine Staff. ImPACT® testing will be performed as determined by the Sports Medicine Staff based on the individual, and their symptoms.
Testing will be performed on a schedule as determined by the sports medicine staff based on the scores of the student-athlete and their symptoms. A "symptom score" shall be taken each day up to, and including the day the student-athlete is completely asymptomatic. Once a student-athlete has been asymptomatic for at least 24 hours and the neuro-psychological test scores have returned to the baseline scores, a gradual return-to-play protocol shall be implemented, unless directed otherwise by a Physician.
Step 1. Light Aerobic Exercise
Step 2. Resistance Training
Step 3. Sport Specific Training
Step 4. Non-Contact Practice Participation
Step 5. Full-Contact Practice Participation
Step 6. Return to Full-Participation
With the aforementioned progression, an athlete should be allowed to progress, as long as symptoms do not arise at the current level. If symptoms do arise during the progression, the student-athlete will return to the previous asymptomatic level.
FACTORS IN CONCUSSION MANAGEMENT
Wake Forest University Sports Medicine Department recognizes that there are several factors that influence the concussion management policy. These factors include, but are not limited to:
If it is determined by the sports medicine staff that the athlete should follow an adapted concussion management protocol, it is in an effort to ensure the safety of the student-athlete during their recovery from a concussion. At any point throughout the recovery of the student athlete, a neurologist, or other specialist specifically trained in concussion management may be consulted as determined by the Physician.
The entire management process from initial evaluation, until eventual return to full participation, including any diagnostic testing, shall be documented in the student athletes medical file.
Coordination of Care for Concussions