Drs | Physio | Nurses | Trainers

Find out what role you can play to manage head injuries in sport using the Concussion FirstAid Kit

  • Medical Doctors
  • Physiotherapists
  • Registered nurses
  • Athletic trainers

The Concussion First Aid Kit

Compete the symptom assessment from before head injury to ensure that accurate symptom recording can be completed after concussion

Symptom Assessment Form

 Symptom Assessment – allow the athlete to complete the easy to use online interactive symptom assessment form. Identify if any symptoms occur “normally” on most days of the week.

 

 

 

Balance testing as a measure of postural stability / sway

Balance stability / sway testing

Balance assessment – perform a series of static and dynamic balance tests that should take about 10 minutes. The medical practitioner should use the easy to use data collection form to record times and errors in balance testing.

 

 

 

 

The black spades represent common playing cards used in the Axon Sports Test

Axon Sports Baseline Test

Axon Sports Baseline Test +- voucher code distribution to athletes that are familiar with the test.

 

 

 

 

Follow the GP’s Approach to Concussion Management Quick & Easy

* can be performed by nursing staff

Visit 1 – as soon after the head injury / potential concussion as possible.

Q1 Does the athlete have a structural head injury – thinks to check for skull fractures, haematomas (epidural, subdural, intracerebral)?
Q2 Does the athlete have an occult (underlying) neck injury?

  • Understand the mechanism of the injury – speeds and forces of the collision
  • Perform full cervical spine and neurological examination
    1. If a neck or structural head injury is confirmed or susp3ected – refer to Emergency Department + Head CT/MRI scan + Neurosurgery Consult
    2. If there are no signs of a neck or structural head injury – has the condition (symptoms) of the athlete deteriorated since the injury occurred / game took place? Ask the parents for their feedback aswell.
    3. Management: Ensure that the athlete has at least 72 hours of physical and cognitive rest at home. Instruct the parents to make sure the athlete rests, spends minimal time looking at computer + mobile device screens. Use Paracetamol to treat the early headache and not anti-inflammatory medication. Do not drive or use sedative medication and/or alcohol.

  If Yes – go to Step 1

  If No – go to Step 3

Visit 2

Q1 Has the athlete improved since the first visit?
Q2 What do the parents / guardian say?
Q3 Does the athlete have any concussion modifiers (factors) that can be associated with slower recovery times?

  • Assess the athlete’s symptoms*
  • Perform a balance assessment on the Athlete*
  • Complete the Athletes Axon After Injury Test*

If No – go to Step 3 above

If Yes – start the Back-To-School Programme + initial stages of Balance & Visual Training → communicate with School Nurse & Physiotherapist respectively

Visit 3

Q1 Does the athlete continue to improve since the last visit?
Q2 What do the parents / guardian say?

  • Repeat symptom assessment of the athlete*
  • Repeat the athletes balance assessment*
  • Repeat the athletes Axon After Injury Test*
  • Speak to the parents / guardian

If No – consider referring to a sports physician with expertise in concussion as they will have multidisciplinary resource member team (neuropsychologist, occupational therapist)

If Yes – progress the Back-To-School + Balance & Visual Training programme → communicate with School Nurse & Physiotherapist respectively

Visit 4

Q1 Have the symptoms settled?
Q2 Has the balance test returned to baseline measure (pre-injury)?
Q3 Is the Axon After Injury test similar / no different from the Axon Baseline Test?
Q4 Are the parents / guardian satisfied with progress?

  • Review all the results of the symptom assessment / balance assessment / computerised brain function tests (Axon) / Balance & Visual Training from the school, practice nurse & physiotherapist
  • Discuss results with the Athlete
  • Speak to the parents / guardian.

If No –  consider referring to a sports physician with expertise in concussion as they will have multidisciplinary resource member team (neuropsychologist, occupational therapist)
If Yes – progress to full school day + start the Back-To-Exercise Programme

Visit 5

Q1 Has the athlete successfully completed Stage 4 of the Back-To-Exercise Programme?
Q2 Can a Concussion Clearance Certificate be issued for the athlete to start contract training – Stage 5 of the Back-To-Exercise Programme

  • Discuss the results of the Back-To-Exercise Programme with the Athlete / Trainer / Physiotherapist / Coach.
    Explain to the Athlete / Parents / Guardian that all the correct processes and procedures for concussion treatment and rehabilitation have been followed. As far as medical science can predict, the Athlete has recovered satisfactorily to return to contact training.The coach / es will be the ones to assess the Athletes sports specific performance that can dictate when they play a game.

Concussion Modifiers / Factors should encourage the doctor to take a much more conservative recovery time frame:

  • Symptoms: large symptom cluster / lasting >10 days / high severity score.
  •  Prolonged loss of consciousness (>1 min).
  •  Amnesia: retrograde / anterograde.
  •  Concussions close together in time / less impact.
  •  Age <18 years old.
  •  Migraine, depression or other mental health disorders, attention deficit hyperactivity disorder, learning disabilities, sleep disorders.
  •  Medication psychoactive drugs, anticoagulants.
  •  Female gender.

THE SCHOOL NURSE

Back-To-School

The school nurse is an important coordinator for the student who returns to school after concussion. As the coo-coordinator, effective implementation of accommodations for the learner (athlete) to transition back to school is necessary. This process relies on effective communication between the parents, teachers and health care providers. The school nurse is ideally positioned for this role. The correct amount of thinking (cognitive) rest can be adjusted to suite the learner while the brain continues to recover.

Initially school activities will be limited. Time for rest during the school day can be implemented. Only part of the school day can be attended. Any exams, tests, homework, projects and physical exertion (sports days & after hour sport) can be removed from the programme.  The school nurse needs to monitor the symptoms of concussion – noting are the number and symptom severity becoming less or more – and adjust the programme accordingly. For learners who have ongoing / persistent symptoms a referral to a concussion specialist management team is required.

During the recovery phase, the school nurse should pay special attention to symptoms of emotional symptoms, depression and anxiety. Clear discussion with the class teacher should aim to detect any deficits in concentration and memory through reviewing class activities. Important to note that these deficits can be very subtle.    The Back-To-School programme is an online interactive form that makes communication and transfer of information very easy between the various care givers

Education & Support

The opinion of the author promotes the school nurse as needing to provide regular education sessions to parents, coaches and teachers about concussion. Reassurance, support

 Record Keeping

Working closely with the sports coaches to record the details of concussion injuries: date of injury / signs present at the time / memory problems / symptoms. Ensure that the athlete has a valid concussion clearance certificate from a medical doctor that is forwarded to the coach before the athlete takes part in contact training drills or the potential for collision or contact.

 Concussion Testing

Baseline symptom assessment

Baseline balance testing

Supervisor for the Axon Sports Baseline Test. All nurses have the opportunity to be effectively trained to administer this test correctly. Nurses are not expected to interpret the test. School nurses are able to ensure that the environment, the athlete is well prepared to return a good test score.

Last Updated 9 December 2013

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