Concussion – Definition

A complex pathophysiological process affecting the brain induced by traumatic biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury.

Concussion – Causes

Concussions may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an “impulsive” force transmitted to the head.  Concussions typically result in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously. Concussions may result in neurologic changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.  Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. It is important to note that, in a small percentage of cases, post concussion symptoms may be prolonged. No abnormality on standard structural neuroimaging studies have been seen in concussion.

Concussion – Signs and Symptoms

A diagnosis of a concussion can include one or more of the following symptoms:

• Headache
• Difficulty falling asleep
• Temporary loss of memory
• Blurred vision
• Loss of appetite
• Difficulty focusing
• Difficulty concentrating
• Sensitivity to light
• Sensitivity to sound
• Nausea
• Ringing in the ears
• Feeling like they are in a ‘Fog’
• Irritable
• Emotional

Concussion Oversight Team:

Each school shall construct a Concussion Oversight Team to ensure compliance with Illinois State Law. 

Responsibilities include but not limited to:

• Review current research and update school policies.
• Review and establish Emergency Action Plans for each venue and discuss with local EMS providers.
  • Athletic areas
  • Performing Arts areas
  • Cafeteria
• Ensure EAP’s are posted in appropriate areas with easy access by all.
• Ensure EAP’s are distributed to appropriate personnel for each area.
• To confirm EAP’s are practiced by appropriate personnel.

Note: All EAP’s must be approved by a designated district superintendent

Each team will consist of:

• Licensed Athletic Trainer
• Licensed Nurse
• Administrator
• A medical physician, if available
• Each school may add additional members (social worker, psychologist, counselor, etc.) at their discretion.

The nurse and athletic trainer must complete a continuing education course on concussions that is approved by the administrator on the Concussion Oversight Team once every two years to maintain their seat on the committee. The medical physician should, to their greatest extent, complete continuing education course in concussions. 

Any school personnel who may have exposure to concussions or the treatment of a concussion must also complete an educational course on concussions once every two years. This can be provided via the IHSA.  

Proof of completion of all education must be submitted to the administrator on the Concussion Oversight Team.

At the beginning of each school year, the Concussion Oversight Team will communicate with all parents (via the student Handbook) of District 207 an informational sheet regarding concussions.

Removal From Activity for Students

Any student that may have symptoms of a concussion will be removed from physical (and cognitive) activity by any of the following: Medical Physician, Teacher, School Staff, Nurse, Athletic Trainer, Coach, Game Official, Student’s parent/guardian, or Student.

Students will be tested and evaluated by an athletic trainer and/or a medical physician. Neurocognitive testing will consist of researched and vetted formats approved by the medical community. If a student shows no symptoms and testing proves normal they will be allowed to return to activity.  If a student shows symptoms of a concussion, physical activity will stop immediately and contact will be made with the student’s parent/guardian. The student will be placed on Concussion Protocol(procedure) and instructed to see medical physician for an evaluation and diagnosis.  

Students and parents should be aware that while a student is going through the Concussion Procedures and completing the Return to Learn and Return to Play steps, the school reserves the right  to limit(excuse from) extra curricular activities, such as but not limited to: participation in school clubs, music and fine arts performances, attending school dances, attending school sporting events as a spectator and other events held in District 207.  

Communication of Injury for Athletes during practice or contest:

• If the emergency medical system (EMS) was activated and the athletes contest is away, the coach should contact an ATC and the parent/guardian. 
• If the (EMS) was activated and the injury is at school, the teacher or coach must contact an administrator and nurse or ATC on duty.
• The professional in charge (ATC, nurse, coach, administrator) at the time of the injury must contact the athlete’s parent/guardian and inform them of the condition/status of the athlete and of the Concussion Procedures. The athletic trainer, nurse or coach will only release the student/athlete to the parent/guardian or representative appointed by the parent/guardian, on site.
• All suspected concussed athletes MUST be evaluated by a medical physician, who will be informed of the Concussion Protocol(procedures) used by Maine Township High Schools. Maine Township staff will be available to answer any questions of the treating medical physician and to share the ImPACT testing results, if any.
• All concussions occurring away from district facilities and supervision MUST be seen by a medical doctor and a diagnosis/treatment note MUST be received by the nurse before the injured student/athlete will begin on the Concussion Protocol(Procedures).

Each student/athlete with a suspected concussion must be evaluated by a licensed medical physician. The medical physician will:

• Provide the school district with a written diagnosis and official signature.
• Provide a return to cognitive and physical activity release date or terms.
• Provide their contact information to enhance communication and treatment of the student/athlete.

Return to Learn Protocols for All Students*

Each student/athlete diagnosed with a concussion will be assigned cognitive activity by either/or the treating medical physician, school nurse or athletic trainer. Please see below.

Any changes or progressions to the above chart will be made by the nurse, athletic trainer or treating medical physician. The student parent/guardian will be notified as the student progresses through the Return To Learn steps. Once the student/athlete attains Return To Learn step 4 they will proceed to the Return To Play steps (see below)

Release To Full Cognitive(Non-Athletic) Activity

For a student or non in-season athlete to be released to full cognitive activity, they need to complete the following:

• A diagnoses and release from a medical physician
• Be asymptomatic for greater than 24 hours
• Complete the Return To Play for Physical Education Procedures
• Completion of the Return To Learn Protocol

Return to Play (Physical Activity) for Non-Athletes

*Students and parents should be aware that while a student is going through the Concussion Procedures and completing the Return to Learn and Return to Play steps, the school reserves the right  to limit extra curricular activities, such as but not limited to: participation in school clubs, music and fine arts performances, attending school dances, attending school sporting events as a spectator and other events held in District 207.  

Return to Play for Athletes

The ImPACT Test for Athletes

Neurocognitive testing is used as part of the evaluation and treatment of concussions. Maine Township has chosen to use ImPACT as their neurocognitive test. All athletes will complete a baseline ImPACT neurocognitive test. The results are subjective to each athlete and will be shared only with the athlete, parent/guardian, athletic trainer, medical physician or other persons receiving prior approval from parent/guardian.  There is no universal baseline score. Athletes who have prescribed medications should have all daily dosages finished before taking the ImPACT Baseline Test.  The ImPACT Test will be given to all athletes in their freshmen and junior years.

Post ImPACT Testing for athletes on Concussion Protocol

The Post ImPACT Test will be administered after the following terms are met:

• Completed or have progressed to step #4 of the Return To Learn
• Be 100% symptom free for 24 hours
• Have a medical physician note on file releasing them for physical activity

If the Post ImPACT Test indicates the baseline results have not been achieved, further Post ImPACT Tests will be administered every 72 hours for a total of two times. If the Post ImPACT Test indicates the baseline results have not been achieved on the second attempt we will request more specific medical evaluation and treatment. Once the student/athlete passes the Post ImPACT test (returns to or a few percentage points of his/her baseline score) they must complete the five-step Return-to-Play Program to resume full physical activity, practices, and games.

The following procedures will be completed after each Post ImPACT Test:

Post-Concussion Return-to-Play Program (McCrory, 2009)

• Once cleared to initiate the following steps by an approved provider (medical physician, athletic trainer), the athlete must complete each assigned activity without becoming symptomatic for a period of 24 hours.
• The athlete will report any symptoms immediately after the assigned activity to the athletic trainer.
• The athlete will again report any symptoms 24 hours after assigned activity has been completed.
• The athlete must be asymptomatic for the entire 24 hour period to be allowed to progress to the next step. 
• If symptomatic at any time the step will be discontinued wait for 24 hours and begin at step #1. If symptoms are experienced on the second attempt the process will stop and the athletic trainer will consult with the treating medical physician.

Release To Full Cognitive and Physical Activity for Athletes

For an athlete to be released from the Concussion Policy the following must be met:

1. A diagnosis and release from a medical physician
2. Completion of the Return To Learn Protocol
3. Be asymptomatic
4. Return to their ImPACT baseline score. If they cannot, an approval from their treating medical physician to proceed.
5. Completion of the Return To Play Protocol
6. Signed Parent Release Letter