Concussion Identification, Management and Prevention

1. 1Concussion Training Webinar – June 2015
How to use this Training Module
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2. 2Concussion Training Webinar – June 2015
Concussion
Identification
Management
and Prevention
for Schools

3. 3Concussion Training Webinar – June 2015
Purpose of Training Module
• The purpose of this training module is to review the WRDSB
Concussion Management Protocol, which reflects the Ophea
minimum standards required by the Ministry of Education.
• It is important for school staff to be familiar with the
Concussion Management Protocol.

4. 4Concussion Training Webinar – June 2015
Before starting this training module
download/print :
The “WRDSB CONCUSSION MANAGEMENT PROTOCOL - STAFF HANDBOOK”
Of particular importance are the following Appendices,
which appear on pages 15 to 22.
1. Appendix A: Tool to Identify a Suspected Concussion
2. Appendix B: Return to Learn Strategies and Approaches
3. Appendix C: Documentation of Medical Examination
4. Appendix D: Return to Learn/Return to Physical Activity Plan
5. Appendix E: Documentation/Permission to Return to
Learn/Return to Physical Activity
6. Appendix F: Return of Symptoms
7. Appendix G: Pocket Scat2
8. Appendix H: OSBIE Incident Report Form

5. 5Concussion Training Webinar – June 2015
Learning Goals
Participants will:
• increase awareness of concussions (definition, signs and
symptoms) and the seriousness of concussions;
• become familiar with strategies for concussion prevention;
• learn about and apply the WRDSB Tool to Identify a
suspected concussion;
• learn about the management procedures for a diagnosed
concussion

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What is a Concussion?
A concussion:
• is a brain injury that causes changes in how the brain
functions, leading to symptoms that can be physical
(e.g., headache, dizziness), cognitive (e.g., difficulty
concentrating or remembering), emotional/behavioural
(e.g., depression, irritability) and/or related to sleep
(e.g., drowsiness, difficulty falling asleep).

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What is a Concussion? cont’d.
A concussion:
• may be caused either by a direct blow to the head,
face or neck, or a blow to the body that transmits a
force to the head that causes the brain to move rapidly
within the skull;
• can occur even if there has been no loss of
consciousness (in fact most concussions occur without a
loss of consciousness); and,
• cannot normally be seen on X-rays, standard CT scans
or MRIs.

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• Teachers/coaches/intramural supervisors must
become familiar with the common signs and
symptoms of a concussion.
• Note… Only a Physician/Nurse Practitioner can
diagnose a concussion.
• But… Teachers/coaches/intramural supervisors can
recognize signs and symptoms of suspected concussion
and inform parents/guardians of the importance of
evaluation by a Physician/Nurse Practitioner.
Common Signs and Symptoms

9. 9Concussion Training Webinar – June 2015
Initial Response – Suspected
Concussion
Student:
Receives a blow to the head, face or neck, or a blow
to the body that transmits a force to the head,
and as a result may have suffered a concussion

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Identification: Initial Response
Teacher/Coach/Supervisor – If Student is Unconscious

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Identification: Initial Response
cont’d
Unconscious: Concussion Suspected
• EMS transports student to hospital for medical
examination
• Principal informs appropriate staff of suspected concussion
• Parent/Guardian is asked to complete and return
Appendix C –Documentation of a Medical Examination
Form (see next slide)

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Documentation of Medical Examination

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Identification: Initial Response
cont’d

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Identification: Initial Response
cont’d
A “Tool to Identify a Suspected Concussion” is used.
The teacher/coach/intramural supervisor
completes the form.
Teacher/coach/supervisor:
Conduct initial concussion assessment
using Appendix A – Tool to Identify
Suspected Concussion
Conscious: Initial
Concussion Assessment

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Teacher/Coach/Supervisor – If Concussion Suspected and Student is Conscious
Identification: Signs and Symptoms Present

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Teacher/Coach/Supervisor – If Student shows NO signs or symptoms of Concussion
Identification: No Signs and Symptoms Present

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Implementation Identification
Procedures
Check your knowledge
in the following scenarios.

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Implementation Identification Procedures
Scenario A:
In a ball hockey game during Physical Education class, two
students rush for the ball and collide.
As Kate lunges and reaches for the ball in an attempt to shoot
on goal, she slips and falls head first onto Satinder’s knee.
Kate collapses onto the floor, lying on her side with eyes
closed and motionless for approximately 30 seconds. She
does not respond when students call her name. As you
approach, her eyes open, she moans and starts to get up.
See next slide for questions.

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Implementation Identification Procedures
Determine if Kate should be suspected of having a
concussion.
1. Which concussion pathway should you follow?
a) Conscious
b) Unconscious
See next slide for answers.

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Answer:
b) Unconscious Pathway
• Key points to determine concussion pathway:
 Kate lies motionless and unresponsive for
approximately 30 seconds;
 = loss of consciousness (physical sign on
“Tool to Identify a Suspected Concussion”);
Implementation Identification Procedures

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Staff take the following steps:

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Scenario B:
During an intramural soccer game, Reilly pushes Sam in an
attempt to get the ball. Sam trips on a small rock hidden by the
grass in the field and falls forward, smashing his chin on the
ground. As you approach, Sam sits up and blood streams from
the split in his chin. He panics, gets up and staggers towards you,
almost falling again complaining of dizziness.
During the Initial Response procedures, you learn that Sam is
feeling dizzy and can’t remember the sport he was playing.
See next slide for questions.
Implementation Identification Procedures

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Determine if Sam should be suspected of having a
concussion.
1. Which concussion pathway should you follow?
a) Conscious – Concussion Not Suspected
b) Conscious – Concussion Suspected
c) Unconscious
See next slide for answer.
Implementation Identification Procedures

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Answer:
b) Conscious Pathway – Concussion Suspected
• Key points to determine concussion pathway:
 one or more signs/symptoms
observed/reported (i.e., he reported that he
was dizzy); and
 Sam responded incorrectly to one of the
memory function questions (i.e., he didn’t
know what sport he was playing)
Implementation Identification Procedures

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Staff take the following steps:

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Scenario C:
During a tag game at recess, Louis is one of the last people to be
caught. Faking to one side and sprinting away, he turns to check
that Addison is not following him and runs into the basketball net
pole. You are supervising the playground and hear the sound of
Louis’ head hitting the pole. He pauses, shakes his head and then
continues playing. Worried that he might have a concussion after
such a hard collision, you call him over to question him. After
using the Tool to Identify a Suspected Concussion you can’t find
anything wrong with him.
See next slide for questions.
Implementation Identification Procedures

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Determine if Louis should be suspected of having
a concussion.
1. Which concussion pathway should you follow?
a) Conscious – Concussion Not Suspected
b) Conscious – Concussion Suspected
c) Unconscious
See next slide for answer.
Implementation Identification Procedures

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Answers:
a) Conscious Pathway - Concussion Not Suspected
• Key points to determine concussion pathway:
 Louis is conscious and never lost consciousness;
 No signs were observed nor symptoms relayed
from Louis; and
 Louis correctly answered the memory function
questions.
Implementation Identification Procedures

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Staff take the following steps:

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Diagnosis
Concussion

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Management Procedures for a
Diagnosed Concussion
Principal informs school staff of concussion
and establishes collaborative team identifying
designated school staff lead
Parent/guardian: report back to school principal
(e.g., Appendix D – Return to Learn/Return to Physical
Activity Plan: Appendix E - Documentation for a Diagnosed
Concussion )
Return to Learn/Return to Physical
Activity – Step 1 (home)
Student: complete cognitive and physical
rest
Student:
Returns to School

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Collaborative Team
Manages Return to Learn and Return
to Physical Activity
Collaborative Team is led by the school
principal and includes:
• the concussed student;
• her/his parents/guardians;
• school staff and volunteers (e.g., coaches)
who work with student; and
• the Physician/Nurse Practitioner .

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Return to Learn/Return to Physical Activity
– Step 1: Rest
Cognitive and Physical Rest at Home
• Continues for a minimum of 24 hours until symptoms
improve or student is symptom free as determined by
parent and student
“Given that children and adolescents spend a
significant amount of their time in the classroom, and
that school attendance is vital for them to learn and
socialize, full return to school should be a priority
following a concussion”
Davis GA, Purcell LK. The evaluation and management of acute concussion differs in young children. Br J Sports Med.
Published Online First 23 April 2013 doi:10.1136/bjsports-2012-092132 (p. 3)

34. 34Concussion Training Webinar – June 2015
Symptoms are Improving
Symptom Free
+
Student:
Returns to School
Return to Learn – Step 2 (with symptoms)
Student: requires individualized classroom strategies and/or
approaches, see Appendix B: Return to Learn Strategies/Approaches
Parent/Guardian: report
progress to school principal
(Appendix E)
Return to Learn – Step 2
(symptom free)
Student: begins regular learning
activities
Return to Physical Activity –
Step 2 (home)
Student: individual light aerobic
physical activity only
Return to Learn/Return to Physical Activity

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Return to Learn – Step 2 with symptoms
Step 2: Symptoms are Improving
• Collaborative team lead identifies student’s
symptoms and responses to learning activities
• Develops appropriate strategies/approaches to
meet student’s needs
• School staff and volunteers need to be aware of
student’s cognitive and emotional/behavioural
difficulties
• GRADUAL return to school/learning

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Return to Learn Strategies
Return to Learn Strategies/Approaches
• Located in Appendix B, pgs. 16 and 17
• Lists Cognitive Difficulties and
Emotional/Behavioural Difficulties that may
be experienced by students

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Return to Learn –Step 2 (cont’d)
Symptom free
Step 2: Symptom Free
• Parents/Guardians communicate that student is
symptom free and ready to move on to Step 3 – Return
to Learn and Step 3 – Return to Physical Activity
Step 2: If student is symptom free after Step 1
• Parents/Guardians communicate student is symptom
free and is returning to school
• Student proceeds directly to Step 3 - Return to Learn
and Step 3 – Return to Physical Activity
• Progress monitored by the collaborative team

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Return of Concussion Signs/Symptoms
Concussion signs/symptoms can reoccur during cognitive and
physical activities
• Student must be closely monitored for:
― return of signs/symptoms;
― deterioration of work habits and performance.
If concussion signs/symptoms return:
• a medical examination is required (Physician/Nurse
Practitioner );
• the parents/guardians complete Appendix F: Return of
Symptoms form.
• Student returns to step as determined by Physician/Nurse
Practitioner

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Return to Physical Activity – Steps 2 and 3
Symptom Free
Return to Physical Activity – Step 4 (school)
Student: individual sport specific physical activity only
+
Return to Learn – Step 3
(symptom free)
Student: begins regular learning
activities
Return to Physical Activity –
Step 3 (home)
Student: individual light aerobic
physical activity only
Parent/Guardian: report progress to
school principal (Appendix E)

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Return to Physical Activity – Steps 5, 6 and 7
Return to Physical Activity – Step 5 (school)
Student: activity with no body contact
Parent/Guardian: report back to
school principal - include written
documentation from Physician or Nurse
Practitioner to indicate the student remains
symptom free and able to return to full
participation (Appendix E: Step 6)
Teacher: inform parent of
completion of Step 5
(Appendix E: Step 5)
Return to Physical Activity – Step 6 (school)
Student: full participation in non-contact sports – full practice for contact
sports
Return to Physical Activity – Step 7 (school)
Student: full participation in all physical activity
(including contact sports)

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Question A
Alex has a few concussion symptoms, but is
progressing well through the Return to Learn plan
developed by the school. She would love to be active.
When can she participate in DPA or intramural
activities?
See next slide for answers.

42. 42Concussion Training Webinar – June 2015
Answer to A
DPA
Alex can participate:
 when she is symptom free (has completed Step 2 of
Return to Learn Plan);
 After she has completed Step 2 of the Return to
Physical Activity Plan;
If the DPA activities meet the criteria of Step 3 of
Return to Physical Activity Plan.

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Answer to A cont’d
Intramural Sport/Activities
Alex can participate:
 when she is symptom free (has completed Step 2);
 After she has completed Steps 3-6 of the Return to
Physical Activity Plan;
 After examined and “cleared” for non-contact
physical activity by Physician/Nurse Practitioner .

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Question B
After Step 1 – physical and cognitive rest, Ryan has no
signs or symptoms. He desperately wants to play in the
tournament this weekend. At which step can Ryan fully
participate in the volleyball games (non-contact
interschool sport)?
See next slide for answers.

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Answer B
Play in volleyball tournament?
 successfully completed Step 6 of Return to Physical
Activity Plan;
 examined and “cleared to participate” by a Physician
or Nurse Practitioner

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Prevention
“…there is evidence that education about concussion leads to
a reduction in the incidence of concussion and improved
outcomes from concussion…”
(Delaney, Lacroix, Leclerc, & Johnston, 2000;
Goodman & Gaetz, 2002; McCrea, Hammeke,
Olsen, Leo, & Guskiewicz, 2004).
.

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Prevention
• Curriculum Connections
• Resources:
• Safety.ophea.net – Appendix C-5: Sample Concussion
Prevention Strategies
• Safety.ophea.net - The Generic Section and
sport/activity pages of all modules.
• WRDSB Administrative Procedure XXXX
• Off Campus Forms IS-04-F-1, IS-04-F-3 direct parents to
concussion awareness resources

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Prevention Cont’d
Culture of Safety Mindedness
When planning activities teacher/coach/intramural
supervisor must:
• be familiar with Board’s Concussion policy;
• review with students;
• background concussion information, and
• ways to minimize the risk of concussion around
the school and in physical activities
and sports.

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Culture of Safety Mindedness
It is important for staff to:
• Communicate the importance of disclosing all
injuries and symptoms
• Communicate the danger of not reporting symptoms
• Believe the student when they communicate their
symptoms
Prevention Cont’d

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Prevention – Pre-Activity
Prior to physical activity and/or prior to the sport
season teachers/coaches/intramural supervisors
should:
•be knowledgeable of safe practices in the
sport/activity, (e.g., rules and regulations and
specific sport/activity pages in the Ophea Safety
Guidelines);
•Be familiar with risks of concussion/potential
injuries associated with the activity/sport and
ways to minimize those risks.

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Prevention – During Activity
Strategies that should be used during a unit of physical
education and/or sport season or intramural activities:
•Teach skills and techniques in proper progression);
•Encourage students/athletes to follow rules of
play and to practice fair play.

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Questions?
• Website: safety.ophea.net
• Email: safety@ophea.net

53. 53Concussion Training Webinar – June 2015
This is the end of the Concussion
Training Module
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