HEADS UP! CONCUSSION PREVENTION AND AWARENESS INTRODUCTION WHERE - - PowerPoint PPT Presentation

HEADS UP! CONCUSSION PREVENTION AND AWARENESS

INTRODUCTION

WHERE WE WERE OVER A YEAR AGO

• July 2012, DSBN created Administrative Procedure 3-

27 entitled “CONCUSSIONS”

• The Concussion Administrative Procedure went to the

Policies and Procedures Committee for approval in October 2012

• The Administrative Procedure was vetted to all

Principals for input prior to being adopted by the Board

• Administrative Procedure 3-27 was approved in

January 2013

• The Administrative Procedure was communicated to all

Principals via Superintendent Area meetings in January 2013

WHERE WE WERE OVER A YEAR AGO

• DSBN revised our Administrative Procedure 1-14 entitled

“PERMISSION TO PARTICIPATE IN CURRICULAR (PHYSICAL EDUCATION) AND EXTRA-CURRICULAR ATHLETIC PROGRAMS”

• The revised AP requires parent/guardians to

acknowledge previous concussions and divulge them to the school board even if the injury occurred while in the care of the parent (weekend, summer break, etc.)

WHAT DSBN CREATED TO TRACK INJURIES AND CONCUSSIONS

• DSBN created a tracking system for all student injuries

including concussions

• DSBN staff fill in our own OSBIE form which requests a lot

more information then is required for OSBIE submissions

• Only the required OSBIE information is extracted and sent

to OSBIE

• DSBN can run reports with the word concussion within

the description if needed and further sub-divide by the type of sports injury

• Schools that use OSBIE can request a summary report

for injuries

WHAT DSBN CREATED TO TRACK INJURIES AND CONCUSSIONS

COMMUNICATING PREVENTION OF CONCUSSIONS

• School Boards need to consider distributing information to

students, parents, guardians, board employees and volunteers about the prevention of head injuries, the identification of symptoms of concussions and the management of concussions

• In Administrative Procedure 3-27, there are seven Appendices,

three of which are posters

• Appendix A - Signs and Symptoms of a Concussion Posters

were distributed to all schools for posting on walls within the schools for everyone within the school to read

• Appendix C - Concussions Guidelines for the Teacher Poster

was posted in the staff rooms of all schools

• Schools were encouraged to use the information in Appendix B
• Parent Fact Sheet to educate parents on concussions via the

school newsletter

COMMUNICATING PREVENTION OF CONCUSSIONS

Partnerships are Extremely Important

• DSBN and Regional Niagara Public Health (RNPH) have partnered to

develop online concussion resources to come in the fall of 2013

• Awaiting the launch of Parachute Canada’s free Online Concussion

Courses, coming in the Fall of 2013

• DSBN and RNPH partnered previously on an online Infection Control

training session mandatory to staff and available to all students and visitors to our DSBN website, www.DSBN.org, under the heading of Parents and the sub-heading of health and safety

• Your school health nurse should be able to assist with concussion

management of suspected concussed students

RECOGNITION OF CONCUSSIONS

Sports Medic

• DSBN uses Sports Medic for all high risk sport activities such

as football, rugby and track and field

• Paramedics are in attendance for the duration of the event
• If any injury occurs, the paramedic staff can attend to the

injured immediately after the event minimizing the risk of further injury

• Sports Medic has the ability to detect concussions and remove

suspected concussed individuals from play

CENTERS F CENTERS FOR DISEASE CONTR R DISEASE CONTROL & L & PREVENTION PREVENTION Def Definition nition

• A concussion is a type of traumatic brain injury (TBI) that

results from 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. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain.

• DSBN used this definition for our Administrative

Procedure

WHAT IS CONTAINED IN AP 3-27?

COMMUNICATING PREVENTION OF CONCUSSIONS

PREVENTION PREVENTION

• 1. Education for coaches, staff, parents and students to:
• a) Recognize the symptoms of concussion;
• b) Remove the athlete from play;
• c) Refer the athlete to a physician.
• 2. Wearing the protective equipment appropriate for the sport engaged

in:

• a) Equipment should fit properly;
• b) Equipment should be well maintained;
• c) Equipment should be worn consistently and correctly.
• 3. Students should follow their coaches' rules for safety and the rules of

the sport.

• 4. Parents need to teach their child that it is not smart to participate in

sports if they received a head injury.

COMMUNICATING PREVENTION OF CONCUSSIONS

PREVENTION PREVENTION

• 5. It is not a badge of honour to play injured.
• 6. Discourage others from pressuring injured students to play.
• 7. Parents/coaches must not convince the child/student that he/she is "just

fine".

• 8. Sharing of information with the school and the school coaches about any

concussions the student may have suffered in the past.

• 9. Provide reassurance, support and request/offer academic accommodations

as needed.

• 10. Outline the risks associated with the activity/sport for a concussion.
• 11. Demonstrate how the risks can be minimized e.g. teach proper sport

techniques - correct tackling in football, effective positioning in soccer, how to avoid over-crowding when using the creative playground. Take attendance in class and interschool sports and instruct absent student/athletes, on previously taught safety skills, prior to next activity session.

COMMUNICATING PREVENTION OF CONCUSSIONS

PREVENTION PREVENTION

• 12. Document safety lessons e.g. date, time, brief content, list of students

in attendance.

• 13. Teach skills in proper progression.
• 14. Enforce the rules of the sport.
• 15. Emphasize the principles of head-injury prevention e.g. keeping the

head up and avoiding collision.

• 16. Eliminate all checks to the head.
• 17. Eliminate all hits from behind.
• 18. Check that protective equipment is visually inspected prior to activity

and well maintained.

• 19. Enforce the principles of: respect for the rules of the game and practice

fair play.

COMMUNICATING PREVENTION OF CONCUSSIONS

• Appendix A – Signs and Symptoms of a

Concussion Poster

• Appendix B – Parent Fact Sheet – Concussion
• Appendix C - Concussion Guidelines for the

Teacher

• Appendix D – Concussion Signs and Symptoms

Checklist

• Appendix E – Coach Pocket Scat 2 Test
• Appendix F – Principal Responsibilities Poster
• Appendix G – Request to Resume Athletic

Participation: Concussion Related Injuries

• As soon as an injury occurs, first aid must be

administered.

• Do not leave the student alone;
• monitor signs and symptoms for deterioration.
• Do not administer medication.
• Staff must be alert for symptoms that worsen
• ver time.

WHEN A SUSPECTED CONCUSSION OCCURS

The student should be seen in an emergency department immediately if he/she has:

• One pupil (the black part in the middle of the eye) larger than

the other

• Drowsiness or cannot be awakened
• A headache that gets worse and does not go away
• Weakness, numbness, or decreased coordination
• Repeated vomiting or nausea
• Slurred speech
• Convulsions or seizures
• Difficulty recognizing people or places
• Increasing confusion, restlessness, or agitation
• Unusual behavior
• Loss of consciousness (even a brief loss of consciousness

should be taken seriously)

WHEN A SUSPECTED CONCUSSION OCCURS

RESPONSIBILITIES

• Responsibilities of the School Board and

School

• Responsibilities of the Principal (Appendix F)
• Responsibilities of Teaching Staff (academic,

coaching, psychologists, speech language pathologists etc.)

• Responsibilities of Parents/Guardians
• Responsibilities of Physician/Health Care

Provider

• Responsibilities of the Student

RESTRICTING PARTICIPATION IN ATHLETICS

The Think First Return to Play Guidelines can be used:

• A concussion is a serious event, but you can

recover fully from such an injury if the brain is given enough time to rest and recuperate. Returning to normal activities, including sport participation, is a step-wise process that requires patience, attention, and caution.

http://www http://www.thinkfir .thinkfirst.ca/pr t.ca/programs/do grams/documents/TF_Concussion_R cuments/TF_Concussion_RTP_E_20 TP_E_2012.pdf 12.pdf

RESTRICTING PARTICIPATION IN ATHLETICS

St Step 1: NO A ep 1: NO ACTIVIT TIVITY, ONL , ONLY COMPLETE RES COMPLETE REST Limit school, work and tasks requiring

• concentration. Refrain from physical activity until

symptoms are gone. Once symptoms are gone, a physician, preferably one with experience managing concussions, should be consulted before beginning a step wise return to play process.

RESTRICTING PARTICIPATION IN ATHLETICS

St Step 2: LIGHT AER ep 2: LIGHT AEROBIC EXER BIC EXERCISE CISE Activities such as walking or stationary cycling. The player should be supervised by someone who can help monitor for symptoms and signs. No resistance training

• r weight lifting. The duration and intensity of the

aerobic exercise can be gradually increased over time if no symptoms or signs return during the exercise or the next day. Sym Symptoms? ms? Return to rest until symptoms have resolved. If symptoms persist, consult a physician. No sym No symptoms? ms? Proceed to St Step 3 ep 3 the next day.

RESTRICTING PARTICIPATION IN ATHLETICS

St Step 3: SPOR ep 3: SPORT SPECIFIC A T SPECIFIC ACTIVITIES TIVITIES Activities such as skating or throwing can begin at step

• 3. There should be no body contact or other jarring

motions such as high speed stops or hitting a baseball with a bat. Sym Symptoms? ms? Return to rest until symptoms have resolved. If symptoms persist, consult a physician. No sym No symptoms? ms? Proceed to St Step 4 ep 4 the next day.

RESTRICTING PARTICIPATION IN ATHLETICS

St Step 4: BEGIN DRILLS WITHOUT BOD ep 4: BEGIN DRILLS WITHOUT BODY CONT CONTACT. Sym Symptoms? ms? Return to rest until symptoms have resolved. If symptoms persist, consult a physician. No sym No symptoms? ms? The time needed to progress from non- contact exercise will vary with the severity of the concussion and with the player. Pr Proceed t

• ceed to St

Step 5 only ep 5 only af after medical clearance. r medical clearance.

RESTRICTING PARTICIPATION IN ATHLETICS

St Step 5: BEGIN DRILLS WITH BOD ep 5: BEGIN DRILLS WITH BODY CONT CONTACT. Sym Symptoms? ms? Return to rest until symptoms have resolved. If symptoms persist, consult a physician. No sym No symptoms? ms? Proceed to St Step 6 ep 6 the next day St Step 6: GAME PLA ep 6: GAME PLAY.

RESTRICTING PARTICIPATION IN ATHLETICS

Ho How Long Does this pr w Long Does this process tak

• cess take?

These steps do not correspond to days! It may take many days to progress through one step, especially if the concussion is severe. As soon as symptoms appear, the player should return to rest until symptoms have resolved and wait at least one more day before attempting any

• activity. The only way to heal a brain is to rest it.

NEVER RETURN T NEVER RETURN TO PLA PLAY IF THERE ARE S IF THERE ARE STILL S ILL SYMPT MPTOMS! MS! A player who returns to active play before full recovery from the first concussion is at high risk of sustaining another concussion, with symptoms that may be increased and prolonged.

RESTRICTING PARTICIPATION IN ATHLETICS

THERE ARE CHALLENGES THERE ARE CHALLENGES

Ho How does a w does a parent/guar parent/guardian f ian find a doct nd a doctor

• r

kno knowledgeable in ledgeable in concussions ? concussions ? When dealing with concussions, it is important to see a doctor who is knowledgeable in concussion

• management. This might include a General Practitioner
• r someone such as a sports medicine specialist. The

General Practitioner may be required to submit a referral to see a specialist.

• Contact the Canadian Academy of Sport and Exercise

Medicine (CASEM) to find a sports medical physician in your area. Toll F ll Free: 1-8 ee: 1-877-585-239 7-585-2394

CHALLENGES

• The biggest challenge is getting parents and doctors to abide by our

Administrative Procedure

• Doctor may refuse to use our Request to Resume Athletic

Participation: Concussion Related Injuries Form

• Parent says that they cannot afford the two physician visits to the

doctor to be diagnosed with a concussion and the second visit to resume athletic participation after following the step-wise return to play progression

• Parent refuses to acknowledge that the student is concussed or

refuses to take the student to a physician

• OHIP does not cover the Physician’s filling of the form and a $20 +

per visit fee is charged to the parent

• Our AP states: A school may choose to pay for the physician fees

associated with the filling in and signing of the Request to Resume Athletic Participation: Concussion Related Injuries form

POST-CONCUSSION RETURN TO LEARNING

• To start, identify the types of symptoms the

student is experiencing. Next, try to identify specific factors that may worsen the student’s symptoms so steps can be taken to modify those

• factors. For example:
• Do some classes, subjects, or tasks appear to

pose greater difficulty than others? (compared to pre-concussion performance)

• For each class, is there a specific time frame

after which the student begins to appear unfocused or fatigued? (e.g., headaches worsen after 20 minutes)

POST-CONCUSSION RETURN TO LEARNING

• Is the student’s ability to concentrate, read or

work at normal speed related to the time of day? (e.g., the student has increasing difficulty concentrating as the day progresses)

• Are there specific things in the school or

classroom environment that seem to distract the student?

• Are any behavioral problems linked to a specific

event, setting (bright lights in the cafeteria or loud noises in the hallway), task, or other activity?

POST-CONCUSSION RETURN TO LEARNING

Talk with the student about these issues and

• ffer support and encouragement. In

consultation with the student’s heath care professional, and as the student’s symptoms decrease, extra help or support can be removed gradually.

POST-CONCUSSION RETURN TO LEARNING

Cognitiv Cognitive e

• Concentrate first on general cognitive skills, such as flexible

thinking and organization, rather than academic content.

• Focus on what the student does well and expand the

curriculum to more challenging content as concussion symptoms subside.

• Adjust the student’s schedule as needed to avoid fatigue:

shorten day, time most challenging classes with time when student is most alert, allow for rest breaks, reduced course load.

• Adjust the learning environment to reduce identified

distractions or protect the student from irritations such as too- bright light or loud noises.

• Use self-paced, computer-assisted, or audio learning systems

for the student having reading comprehension problems.

POST-CONCUSSION RETURN TO LEARNING

Cognitiv Cognitive e

• Allow extra time for test/in-class assignment completion.
• Help the student create a list of tasks and/or daily organizer.
• Assign a peer to take notes for the student.
• Allow the student to record classes.
• Increase repetition in assignments to reinforce learning.
• Break assignments down into smaller chunks and offer

recognition cues.

• Provide alternate methods for the student to demonstrate

mastery, such as multiple-choice or allowing for spoken responses to questions rather than long essay responses.

POST-CONCUSSION RETURN TO LEARNING

Beha Behaviour/Social/Emo viour/Social/Emotional tional

• If the student is frustrated with failure in one area,

redirect him/her to other elements of the curriculum associated with success.

• Provide reinforcement for positive behavior as well as

for academic achievements.

• Acknowledge and empathize with the student’s sense
• f frustration, anger or emotional outburst: “I know it

must be hard dealing with some things right now.”

• Provide structure and consistency; make sure all

teachers are using the same strategies.

POST-CONCUSSION RETURN TO LEARNING

Beha Behaviour/Social/Emo viour/Social/Emotional tional

• Remove a student from a problem situation, but avoid

characterizing it as a punishment and keep it as brief as possible.

• Establish a cooperative relationship with the student,

engaging him/her in any decisions regarding schedule changes or task priority setting.

• Involve the family in any Positive Behavior Support Plan.
• Set reasonable expectations.
• Arrange preferential seating, such as moving the student

away from the window (e.g. bright light), away from talkative peers, or closer to the teacher.

POST-CONCUSSION RETURN TO LEARNING

Ph Physical ysical

• Allow the student to go to the health room to rest (if

available) if headache returns

• Allow to go home if headaches persist
• Use the elevator in the school (if available)
• If photophobic, use of sunglasses or hat as needed
• May allow student to leave early from class to avoid

crowded or noisy hallways

• No Physical Education class
• Eat somewhere other than a noisy cafeteria

RESOURCES http://www.thinkfirst.ca/programs/concussion.a spx http://www.parachutecanada.org/injury- topics/topic/C9 http://www.cdc.gov/CONCUSSION/

CONCLUSION

Children and adolescents are among those at greatest risk for concussions. The potential for a concussion is greatest during activities where collisions can occur, such as during physical education (PE) class, playground time, or school- based sports activities. However, concussions can happen any time a student’s head comes into contact with a hard object, such as a floor, desk, or another student’s head or body. Proper recognition and response to concussion can prevent further injury and help with recovery. Prevention is the only cure for Brain and Spinal Cord Injuries.

MICHAEL LANGLOIS, CES, CRSP HEALTH AND SAFETY OFFICER DISTRICT SCHOOL BOARD OF NIAGARA

Thank-you