Vernon Hills High School - Concussion Care Overview

 

Concussion Protocol

 

General Information

 

A student’s best chance of full recovery from a concussion involves a proper balance of two critical components: mental and physical rest, and participation in daily activities. Evolving research has shown cognitive rest still plays an essential part in the resolution of concussion symptoms. However full or complete rest for adolescents should be limited to approximately 24-48 hours immediately following the injury.  Gradual reintroduction of typical daily activities, including cognitive activities, should follow a sub symptom threshold approach (McCrory, et al. 2017).  

 

An illustration of this concept is drawing an imaginary line where the symptom threshold is located = level of symptoms at rest.  The student can participate in activities of daily living, including cognitive activities, as long as symptoms remain below the symptom threshold level at rest = “sub-symptom threshold.”  Symptoms should not increase above this level when performing an activity. When symptoms increase above that threshold or imaginary line, the student should stop the activity and rest. Once symptoms lessen below that “line”/threshold, the student may resume the activity.  This newer approach to concussion recovery includes light physical activity during recovery and stresses the importance of the social-emotional development and well-being in adolescence and its impact on concussion recovery.

 

Cognitive stimulation includes:  driving, screen time (playing video games, computer use, text messaging, cell phone use, watching television), loud and/or bright environments, reading, and studying.  In the school setting, physical activity such as physical education, athletics, strength or cardiovascular conditioning, and fine art practices/performances, must be completely avoided or strictly regulated (as in the return-to-play protocol), while recovering from a concussion. 

 

It is recommended that the school-specific concussion protocol is shared with the student’s primary care provider -  physician (licensed to practice medicine in all its branches, i.e. pediatrician), concussion specialist, advanced practice registered nurse (APRN), or physician’s assistant (PA). 

 

 

Phases of Concussion Recovery and Academic/Athletic Participation:

  1. Home, Rest & Limited Return to Daily Activities 

  2. School, Partial Attendance

  3. School, Full Attendance

  4. Return to Full Participation (Learning & Play)

 

Return to Learning:  Process to return to full cognitive/academic activities

Return to Play:  Process to return to full physical/athletic activities


 

Points of Emphasis

 

  • Recovery from a concussion is a very individualized process. Caution must be taken not to compare students with concussions as they progress through the recovery process. 

  • For the concussion care protocol to be fully implemented, the student must be initially evaluated by a primary care provider: a physician (licensed to practice medicine in all of its branches) or advanced practice registered nurse (APRN), or concussion specialist, and documentation must be provided to the school nurse or athletic trainer.  An emergency room/acute care note is effective only temporarily until seen by the student’s primary care provider or concussion specialist within one week.  A student may be referred to a specialist in concussion care for further recommendations and eventual clearance for full return to learning (academics) and return to play (PE/athletics).

  • The student’s missed academic work will be reviewed and granted extra time to complete, in conjunction with recommendations from the student’s primary care provider and/or specialist, and the school team.

  • As the student’s recovery progresses through all phases, teachers should identify essential academic work in each subject and collaborate with the student’s LST and department supervisors, as needed, to determine potential reduction in course workload. This will promote healing, and help reduce the student’s anxiety level related to the perceived volume of work that will be required once the student is medically cleared to resume a full academic load. 

  • The teacher has the option of assigning the student a grade of incomplete for the progress mark, final exam, and/or semester grade. 

  • Upon return to school, the student should report to the school nurse (and athletic trainer for student athletes) daily to monitor symptoms and determine progression to the next phase within the concussion care protocol.  

 

Phase 1: Home, Rest & Limited Return To Daily Activities 

  • Characteristics:  symptoms initially severe at rest; sub-symptom threshold is very low

  •  Initial evaluation by primary care provider: physician or advanced practice registered nurse (APRN) (not ER staff)

  • Student is at home with restricted cognitive and physical activity.

  • School nurse contacts parents and notifies teachers and appropriate staff.


 

 

Phase  2: School, Partial Attendance

  • Characteristics: able to tolerate light daily activities at home without increasing symptoms, or without any symptoms; symptoms typically increase with additional physical and cognitive activity 

  • Able to tolerate light academics/cognitive activities.  

  • Part-time attendance at school, with no extracurricular participation. 

  • Refer to list of recommended interventions specific to each school.

  • School nurse and athletic trainer will coordinate recovery progress with members of school team.

 

Phase  3: School, Full Day Of School Attendance

  • Characteristics:  symptom-free at rest, mild to no symptoms with cognitive and school day activity

  • If symptom-free during the school day, may attend practices or events, but no participation.

  • Refer to list of recommended interventions specific to each school.

  • School nurse and athletic trainer will coordinate recovery progress with members of school team.

 

Phase  4: Return To Full Participation (Learning & Play)

  • Characteristics:  symptom-free with academic/cognitive and physical activities

  • School nurse and athletic trainer will coordinate recovery progress with members of school team.

  • Refer to list of recommended interventions specific to each school for resumption of full activities.

  • Athletic trainer will follow IHSA Return to Play Protocol for student athletes.

 

ImPACT baseline testing for students is offered at Condell.

 

Resources

 

Centers for Disease Control and Prevention (CDC). (2016a). Heads up to schools. Atlanta, GA: National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. 

Retrieved from: http://www.cdc.gov/headsup/schools/index.html

 

Centers for Disease Control and Prevention. (2016b). HEADS UP to brain injury.  Atlanta, GA. : National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention.

Retrieved from:   https://www.cdc.gov/headsup/

 

Centers for Disease Control and Prevention. (2016c). HEADS UP to brain injury:  Acute concussion evaluation care plan. Atlanta, GA. :National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. 

Retrieved from: http://www.cdc.gov/headsup/pdfs/providers/ace_care_plan_school_version_a.pdf

 

Glenbrook South High School (n.d.)  Glenbrook South High School post-concussion return to academics and athletics [revised]. Glenview, IL.

Retrieved from: https://www.glenbrook225.org/gbs/Athletics/Training-Program/Documents/Academic-Policy-  Concussionpdf.aspx

      

Halstead, M.E., McAvoy, K., Devore, C.D., Carl, R., Lee, M., Logan, K.  (2013). Returning to learning following a concussion. Pediatrics, 132, 948-957. Illinois High School Association (2016).  Concussion management. Bloomington, IL. 

Retrieved from: http://www.ihsa.org/Resources/SportsMedicine/ConcussionManagement.aspx 

 

Lumba-Brown, A., Owen Yeats, K., Sarmiento, K., Breiding, M.J……..Timmons, S.D. (2018).  CDC Guideline on the diagnosis and management of mild traumatic brain injury among children. JAMA Pediatrics. doi:10.1001/jamapediatrics.2018.2853

    

Lurie Children’s Hospital, Institute of Sports Medicine (2015).  Return to learn after a concussion: A guide for teachers and school professionals.  Chicago, IL.  

Retrieved from: http://luriechildrens.peachnewmedia.com/store/seminar/seminar.php?seminar=45893

 

McCrory, P., Meeuwisse, W.H., Dvorak, J., Aubry, M., . . .Vos, P.E. (2017). Consensus statement on concussion in sport: The 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine, 0, 1-10. doi: 10.1136/bjsports-2017-097699 National Federation of High Schools (2015).  Sports medicine. Indianapolis, IN.  

Retrieved from: https://www.nfhs.org/resources/sports-medicine/

 

Nationwide Children’s Hospital (2016).  Concussion toolkit. Columbus, OH.  

Retrieved from: http://www.nationwidechildrens.org/concussion-toolkit


 

District 128 Concussion Oversight Team

Briant Kelly, Associate Superintendent

Greg Stilling, VHHS Assistant Principal

Ole Stevens, LHS Director of Student Services

Kajal Patel-Thakkar, VHHS School Nurse

Cameron Traut, LHS School Nurse

Brian McDonald, VHHS Athletic Director

John Woods, LHS Athletic Director

Kirsten Rous, VHHS Athletic Trainer

Sam Vandehaar, LHS Athletic Trainer

 

Updated: November 4, 2019