Catholic Youth Ministry, which administers athletics for students in grades three through 12, and the Delaware Interscholastic Athletic Association (DIAA) use similar protocols when it comes to handling concussions. Any player suspected of suffering a head injury must be removed from play immediately, and his or her return is subject to clearance by a doctor or other qualified health care professional.
DIAA follows a six-stage “return-to-play” plan, with advancement from one stage to another subject to clearance by a doctor, athletic trainer or other qualified professional. Before returning to full contact in practice, an athlete must be cleared by a physician. The plan is adapted from the acute concussion evaluation care plan developed by the Centers for Disease Control, which adapted the work of the University of Pittsburgh Medical Center.
ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) or other concussion testing has helped doctors and trainers when they need to keep an athlete from the field or a student from the classroom. Baseline scores give health care professionals an objective metric that measures brain activity: verbal and visual memory, which are measured in the front of the brain, and visual motors and reaction time, from the back of the brain.
The back “is more the athletic part of the brain. So, when you see a kid with low back-of-the-brain scores, if you don’t have this resolved and you send them back into the sport because they don’t have a headache, you’re taking a big risk without this data,” said Dr. Vince Schaller of Premier Urgent Care Center and the Mid-Atlantic Concussion Alliance.
Allowing athletes back to action too early puts them at an increased risk for a second concussion or other injuries, he said.
The return-to-action plan slows down the recovery and makes sure students can weather the physical activity Schaller said.
No matter what states, schools or athletic organizations do, there always will be parents and athletes who try to get around the system, he said.
“There’s no law that says you have to see a concussion doctor. There’s no law that says you have to follow the data on the impact testing. However, the doctor that signs off on that five-stage recovery is taking a major liability on their license because the state could come after that doctor.
“We just have to make it so that not every Tom, Dick and Harriet can clear somebody as a doctor. We have to make sure that the doctor is seeing that the five stages are being completed and that the athletic trainer or physical therapist is putting their name and license on this so that it’s been done,” Schaller said.
• No physical or cognitive activity. This includes no video games, computers or schoolwork. If the athlete has no signs of symptoms consistent with a concussion they may progress, after 24 hours, to stage 2.
• Low levels of activity. This includes walking, light jogging, light stationary bike, light weightlifting.
• Moderate levels of activity with body/head movement. Includes moderate jogging, brief running, moderate-intensity stationary biking, moderate-intensity weightlifting.
• Heavy non-contact activity. This includes sprinting/running, high-intensity stationary bike, regular weightlifting routine, non-contact sport-specific drills.
• Must have physician clearance before beginning this stage: Full contact in controlled practice.
• Full contact in game play. If signs or symptoms return after Stage 5, must see physician.