William Jewell College Athletics

William Jewell College is committed to providing optimal medical care to its student-athletes in regard to all injuries and illnesses, especially the potentially catastrophic brain injury known as the sport concussion. This policy is written in accordance with all guidelines set by the National Collegiate Athletic Association and National Athletic Trainer’s Association and is derived from the most current research available on sport related concussions. 
 
The Sports Medicine Team, consisting of certified Athletic Trainer’s, orthopedic surgeons, general medical physicians, nurses, and dentists will strive to utilize prevention, recognition, evaluation, treatment, referral, and rehabilitative techniques in all efforts to return student-athletes to his/her respective sport in the most expedited and safest manners possible. Sports Medicine team members will remain cognizant of the “total” athlete, including mental, emotional, and physical needs.
 
Clinical research has shown that an athlete’s balance and/or cognitive functioning are often decreased following a concussion even in the absence of self-reported symptoms. It has been demonstrated that it typically takes anywhere from 3 to 10 days for an athlete to return to their normal state following a concussion. However, in some cases (<10%) athletes="" can="" experience="" post-concussion="" syndrome="" in="" which="" the="" symptoms="" last="" beyond="" 3="">
 
The Jewell Sports Medicine staff utilizes a three-fold approach when determining an athlete’s readiness to return to play following a concussion. In the event of a suspected concussion, the concussion management protocol requires the evaluation of the athlete’s symptoms, neurocognitive function, and balance which provide the sports medicine staff with the objective information necessary to return the athlete to play safely. The findings of these post-injury assessments are then compared to pre-season baseline assessments. All student-athletes from Jewell teams are preseason baseline tested.
 
The following concussion policy and concussion management protocol has been adopted by Jewell Sports Medicine and is to be followed by all teams for managing athletes suspected of sustaining a concussion.
 
William Jewell Concussion Policy

• All Jewell student-athletes must read the NCAA Concussion Fact Sheet and sign the attached student athlete statement acknowledging that:
  • they have read and understand the NCAA Concussion Fact Sheet
  • they accept the responsibility for reporting their injuries and illness to the institutional        
  • medical staff, including signs and symptoms of concussions.
• All Jewell coaches (head coaches and assistant coaches) must read and sign the attached coaches statement acknowledging that they:
  • have read and understand the NCAA Concussion Fact Sheet
  • will encourage their athletes to report any suspected injuries and illness to the institutional medical staff, including signs and symptoms of concussions; and that they accept the responsibility for referring and athlete to the medical staff suspected of sustaining a concussion.
  • have read and understand the Jewell Concussion Management Protocol
• All Jewell team physicians (primary care), athletic trainers, graduate assistant athletic trainers, and athletic training students, must read and sign the attached medical provider statement acknowledge that they:
  • will provide athletes with a NCAA Concussion Fact Sheet and require their athletes to report any suspected injuries and illness to the institutional medical staff, including signs and symptoms of concussion.
  • have read, understand, and will follow the Jewell Concussion Management protocol
• The head athletic trainer will coordinate the distribution, educational session, signing, and collection of the necessary documents. These documents will be kept in their student-athlete’s medical file.
• The Compliance Officer and Head Athletic Trainer will coordinate the signing of the aforementioned documents on an annual basis for the medical personnel and coaches. The Compliance Office will keep the signed documents, along with the established Jewell concussion policy, on file. A copy of the Jewell Concussion Policy will also be distributed through the Policies and Procedures manuals for the athletic training facility and coaches’ staff manual.
• The Jewell staff will conduct an annual meeting each May to review and update the Concussion Policy. Any changes to the policy will be effective August 1 of that year.

Jewell Concussion Management Protocol
Concussions and other brain injuries can be serious and potentially life threatening injuries in sports. Research indicates that these injuries can also have serious consequences later in life if not managed properly.  In an effort to combat this injury the following concussion management protocol will be used for Jewell student-athletes suspected of sustaining a concussion.
 
A concussion occurs when there is a direct or indirect insult to the brain. As a result, transient impairment of mental functions such as memory, balance/equilibrium, vision may occur.  It is important to recognze that many sport-related concussions do not result in loss of consciousness and, therefore, all suspected head injuries should be taken seriously. Coaches and fellow teammates can be helpful in identifying those who may potentially have a concussion, because a concussed athlete may not be aware of their condition or potentially be trying to hide the injury to stay in the game or practice.
 

• Concussion management begins with pre-season baseline testing. Every new (first year or transfer) student-athlete must receive a pre-season baseline assessment for concussion involving a graded symptoms checklist (GSC), Standard Assessment of Concussion (SAC), Sway balance testing and computerized neuropsychological test (ImPACT). This baseline testing will be kept in the student-athlete’s medical file. 
  • The Athletic Training staff will conduct the following assessments for all new athletes: 
    • GSC, SAC, Sway, and ImPACT
• In the event of a suspected concussion, the student-athlete will be re-assessed and compared to preseason baseline measures according to the outlined protocol below.
• The respective team’s athletic trainer will keep a file of baseline scores on file so they can have easy access to the information for away contests.
• An athlete suspected of sustaining a concussion will be evaluated by the team’s athletic trainer using the Standardized Assessment of Concussion (SAC), and Graded Symptom Checklist (GSC). Should the team physician not be present, the athletic trainer will notify the team physician ASAP to develop an evaluation and treatment plan. Ideally, an assessment of symptoms will be performed at the time of injury and then serially thereafter (i.e. 2-3 hours post-injury, 24 hours, 48 hours, etc). The presence or absence of symptoms will dictate the inclusion of additional neurocognitive testing.
• Any student-athlete that presents with signs of concussion shall not return to activity for the remainder of the day. Medical clearance will be determined by the team physician or combination of team physician and athletic trainers involved with the management of the concussion.  Student-athletes that sustain a concussion outside of their sport will be managed in the same manner as those sustained during sport activity.
• Student-athletes that have sustained a concussion will be provided with written home instructions upon discharge; preferably with a roommate, teammate, parent, guardian or someone that can follow the instructions.
• The student-athlete will be monitored for recurrence of symptoms both from physical exertion (ie. practice, conditioning, and weight training) as well as mental exertion such as reading, phone texting, computer games, watching film, athletic meetings, working on a computer, classroom work, or taking a test. Academic advisors and professors will be notified of student-athlete’s concussion, with permission for release of information from the student-athlete.
• After the athlete is self- reported symptom free, as determined by the GSC, neurocognitive testing will be conducted to determine return to normal function as compared to the baseline test results. Testing usually takes about an hour to complete, and athlete’s should expect to be there the entire time. 
• If requested by the team physician or athletic trainer (typically for the purpose of evaluating whether and athlete should return to class, reschedule exams, etc), testing may be conducted while the athlete is still symptomatic.
• If the athlete has not returned to normal functioning compared to baseline scores upon laboratory testing, another appointment will be scheduled at a time deemed appropriate by the team physician and athletic trainer.  In the rare event that an athlete does not have baseline scores, age-matched normative percentile scores will be used in comparison to post-injury scores.
• The following assessment and return to play protocol will be used for all concussions:

Concussion Assessment
NO ATHLETE SUSPECTED OF HAVING A CONCUSSION IS PERMITTED TO RETURN TO PLAY THE SAME DAY, AND NO ATHLETE IS PERMITTED TO RETURN TO PLAY WHILE SYMPTOMATIC FOLLOWING A CONCUSSION.
 

• Baseline Testing:  conducted on each athlete upon entering as first-year student-athlete, transfer, or for those athletes sustaining a concussion the previous season (re-baseline). This will include Impact, Sway, and symptom checklist.
• Time of Injury: clinical evaluation, (including Standardized Assessment of Concussion) symptom checklist, and balance assessment
• 1-3 hours post-injury: symptom checklist; referral if necessary
• Next day:  follow-up clinical evaluation and symptom checklist
• Follow-up evaluations daily to track symptom recovery
• Once athlete becomes asymptomatic:
  • Determine where the athlete is relative to baseline on following measures.
    • Symptom Assessment – Graded Symptom Checklist
    • Mental Status Assessment – Standardized Assessment of Concussion
    • Neurological Assessment- VOMS Screening
    • Neuropsychological Assessment – ImPACT
    • Balance Assessment – Sway
  • If the measures (a-e) listed above are at least 95% of baseline scores and the athlete remains asymptomatic for 1 additional day following the tests, the physician can instruct the athletic trainer to begin the 5-step graduated exertional return to play protocol with the athlete to assess for increasing signs and symptoms. Symptoms should be reassessed immediately following exertional activities.
  • If the athlete remains asymptomatic on the day following the first step(s) of the graduated extertional RTP protocol, the athlete will be reassessed using the A-E measures of Step 1 and continue with the next steps on the graduated exertional RTP protocol.
  • All scores on the aforementioned assessments or exertional activities below will be recorded in the athlete’s medical file.

 
IF AT ANY POINT DURING THE PROCESS THE ATHLETE BECOMES SYMPTOMATIC THE ATHLETE SHOULD BE RE-ASSESSED DAILY UNTIL ASYMPTOMATIC.  ONCE ASYMPTOMATIC , THE ATHLETE SHOULD THEN FOLLOW STEPS 1-4 ABOVE.
 
5-Step Graduated Exertional Return to Play Protocol
This exertional protocol allows a gradual increase in volume and intensity during the return to play process.  The athlete is monitored for any concussion-like signs/symptoms during and after each exertional activity.
 
The following steps are not ALL to be performed on the same day.  Athlete must remain symptom free for 24 hours before advancing from one phase to the next. Athlete must complete all 5 phases to before returning to competition.                 
Phase 1 – Active Rest

• Cognitive – no concentration level, no film/meetings, no class
• Cardio – THR 30-40% (Ex: 24 y/o RHR 60 BPM – 79 BPM is 40%) , no impact, stationary bike
• Stretching – light stretching, no head movement
• Resistance – light, no exertion (SLR, SAQ, Shld Tband)
• Balance – Romberg, SL balance, solid surfaces, steamboats

Phase 2 – Light Exertion

• Cognitive – partial meetings, video games, mild concentration activities
• Cardio – THR 40-60% (78-117 BPM), minimal impact, interval bike ride, treadmill walking, pool
• Stretching – light dynamic stretches, no constant head position changes
• Resistance – light, machine work, body weight
• Balance – cup drill pick up, SL balance on foam/dynadisc
• Vestibular Rehab – oculomotor rehab (notes with abc’s/numbers), convergence (eye tracking, zipper)

Phase 3 – Moderate Exertion

• Cognitive – more concentration, attend meetings/film, attend practice
• Cardio – THR 60-80% (117-156 BPM), team warm up, modified FIFA11+, run with head movement, 60 yd shuttle, plyometrics
• Stretching – any is ok
• Resistance – return to wt room with coaches and AT supervision
• Balance – high levels with multi-tasking – kick balls for player to catch on bosu
• Vestibular Rehab – head movements with ball catches in sport environment, challenging

Phase 4 – Sports Specific Drills – non contact practice – skill work (in helmets for fb)

• Cognitive – Full 
• Cardio – THR 80%, hills, hurdles, band running
• Resistance – aggressive strength program
• Balance – medicine ball quadraped push ups

Phase 5 – Sports Performance Training – initiate and return to full contact practice

• Cardio – THR full exertion
• Resistance – full activity

No athlete can return to full activity or competitions until they are asymptomatic in limited, controlled, and full-contact activities, and cleared by the team physician.