University of Richmond Sports Medicine Department Head Injury Evaluation, Management, and Return to Play Guidelines The following policy and procedures on neurocognitive baseline testing, assessment, management, and return to play guidelines have been developed through evidence based medicine and in accordance with the University of Richmond Department of Sports Medicine’s mission to provide quality healthcare services and assure the well-being of each student-athlete. This policy is directly supervised by an independent Neurologist.

The University of Richmond Department of Sports Medicine recognizes that head injuries, particularly sport-induced concussions, pose a significant health risk for those student-athletes participating in intercollegiate athletics at the university. Consequently, the Department of Sports Medicine has implemented policies and procedures to assess and identify those student-athletes who have suffered a concussion. The Department also recognizes that baseline neurocognitive testing on student-athletes who participate in those sports which have been identified as collision or contact sports will provide significant data for return to competition decisions. This policy will also apply to those student-athletes who have a past medical history of concussions prior to their participation at the University of Richmond. This baseline data along with physical examination, and/or further diagnostic testing will be used collectively in determining when it is safe for a student-athlete to return to competition.

Definition: Concussions are the most common form of head injury suffered by athletes. Due to the complexity of the injury and ever-growing research, a unanimous definition of concussion does not exist. The National Athletic Trainers’ Association has released a consensus statement with universal agreement on several features that incorporate clinical, pathologic, and biomechanical injury constructs associated with a head injury.1 A concussion can be caused by a direct or indirect hit to the head or body (for example, a hard tackle or check that causes an impulsive force transmitted to the head). This may cause impairment in neurologic function which may result in a gradient of clinical symptoms that may or may not involve loss of consciousness.1-5 When an athlete suffers a concussion, the brain suddenly shifts or shakes inside the skull and can knock against the skull's bony surface. A hard hit to the body can result in an acceleration and/or deceleration injury when the brain brushes against bony protuberances inside the skull. Such forces can also result in a rotational injury in which the brain twists, potentially causing shearing of the brain nerve fibers.1-3 The exact recovery period from this trauma is unclear and will vary from individual to individual. It has been documented however, that during a concussion the brain temporarily does not function normally1-4 and additionally is more vulnerable to a second head injury. This second injury, known as Second Impact Syndrome, may result in far greater brain trauma and even Updated 7/14

death. Athletes who continue their participation in activity also increase their risk of post-traumatic concussion syndrome which causes prolonged and intensified concussion symptoms.1-3,5

Symptoms of a Concussion: Following a concussion the athlete may experience a variety of symptoms. Contrary to popular belief, most concussions occur without a loss of consciousness.1-5 It is not yet known exactly what happens to brain cells in a concussion, but the mechanism appears to involve a change in chemical function.4 It is important to remember that some symptoms may appear right away and some may be delayed. Symptoms, as well as symptom severity may differ between individuals however a combination of symptoms classically occurs.

Some Symptoms and Signs Include:1-5 Symptoms: - Nausea/vomiting - Dizziness - Confusion - Fatigue - Light headedness - Headaches - Irritability - Disorientation - Seeing bright lights/stars - Feeling of being stunned - Depression - Ringing in the ears

Signs: - Difficulty concentrating - Inappropriate playing behavior - Decreased playing ability - Inability to perform daily activities - Reduced attention - Cognitive and memory dysfunction - Sleep disturbances - Vacant stare - Loss of bowel and/or bladder control - Personality change - Unsteadiness of gait - Slurred/incoherent speech - Loss of consciousness

Notification of Injury/Symptoms: Due to the serious nature of this injury and potential catastrophic results of returning to activity, concussions need to be recognized and diagnosed as soon as possible. It is required that studentathletes are truthful and forthcoming about their symptoms as soon as they present. If/when they are diagnosed with a concussion, the student-athlete must report symptoms each day until they are cleared for full activity by the sports medicine staff. Failure to do so may increase the risk of further brain damage and post-traumatic concussion syndrome.

Education Regarding Concussions: Annually, the student-athletes will be presented with educational materials that provide information about the mechanisms of head injury, as well as the signs and symptoms of a concussion. Subsequently, it will be required that all student athletes sign The University of Richmond Concussion Education and Notification Form (Appendix A), a statement accepting the responsibility for truthfully reporting of his or her injuries and illnesses, including signs and symptoms of a concussion. Due to the severe nature of a concussion, the University of Richmond Department of Sports Medicine believes in a conservative Updated 7/14

approach for treatment. This includes the student-athlete self-reporting his or her symptoms after suffering a concussion. Self-reporting of symptoms plays an integral role in tracking the severity and subsequent recovery of a concussion. Therefore, the student-athlete is responsible for reporting his or her signs and symptoms completely and honestly to the medical staff as soon as they present and each day following the injury. Additional educational opportunities will be provided to the student-athletes and members of the athletic department with an annual review of The University of Richmond Head Injury Policies and Procedures.

Baseline Testing: Baseline neurocognitive testing will be performed on student-athletes who participate in those sports which have been identified as collision or contact sports and/or who have had a past medical history of concussions as identified in the Pre-participatory Examination or the Health History Questionnaire prior to the first practice. Collision/contact sports tested: -

Baseball Basketball (M/W) Diving Field Hockey

- Football - Lacrosse (M/W) - Soccer (W) - Pole vaulting

The baseline assessment will consist of both subjective and objective tests, including the use of symptoms checklist, standardized cognitive and balance assessments, physical evaluation, and neuropsycholgical tests. The baseline assessment includes: -

ImPACT™ , a computerized neurophsychological concussion assessment. Sport Concussion Assessment Tool (SCAT2) (Appendix B) which includes; o Symptom Evaluation, Physical Signs Score, Glasgow Coma Scale (GCS), Sideline Assessment (Maddocks Score), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), Coordination Examination, and Delayed Word Response.

Recognition and Evaluation: Circumstances involving any signs, symptoms, or behaviors consistent with a concussion warrant a student-athlete’s immediate removal from athletic participation until a thorough sideline head injury assessment can be performed by a member of the University of Richmond Sports Medicine Staff. The sideline head injury assessment to determine the presence of a concussion will include: -

Head Injury Initial Evaluation Form (Appendix C) SCAT2

Continued neuropsychological testing will be performed through the administration of the ImPACT™ test post-injury.

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Same Day Return to Play: A student-athlete diagnosed with a concussion shall be withheld from the competition or practice and not return to ANY athletic activity for the remainder of that day.

Referrals: On the field IMMEDIATE referral Upon initial evaluation, activation of the Emergency Action Plan and subsequent IMMEDIATE referral to the Emergency Room is warranted with any of the following findings: -

Documented loss of consciousness Deteriorating level of consciousness High index of suspicion of spine or skull injury Seizure activity Evidence of hemodynamic instability/deterioration of vital signs

Off the field emergent referral In the event that the student-athlete shows signs of deterioration from the status originally assessed on the field, an EMERGENT off the field assessment is warranted. An emergency referral is necessitated by any of the following findings: -

Deterioration of neurological signs such as motor, sensory, and cranial nerve deficits subsequent to initial on-field assessment. Documented loss of consciousness Deteriorating level of consciousness Persistent vomiting Post-concussion symptoms that worsen

Non-immediate referral All student-athletes who have been diagnosed with a concussion will be evaluated by a University of Richmond team physician prior to return to unrestricted activity.

Follow Up Care: In the event of a concussion, follow-up care and proper education is paramount. Due to the necessity of serial monitoring for deterioration of symptoms, the student-athlete will be released under the care of an on-campus emergency contact when discharged from the care of the Department of Sports Medicine. The Concussion Take-Home Instructions (Appendix D) will be explained and given to both the concussed student-athlete as well as the on-campus emergency contact. Pertinent contact information will be provided in addition to scheduled follow up appointments. A member of the Sports Medicine Updated 7/14

Department will contact the concussed student-athlete 3-4 hours after discharge to ensure appropriate arousal and cognitive function. In the circumstance that the Sports Medicine department is unable to contact neither the concussed student-athlete nor the on-campus emergency contact, the situation will be deemed emergent and the University of Richmond campus police will be alerted.

Subsequent Testing: Neurocognitive testing, symptom monitoring, along with the physical examination performed by the Sports Medicine staff and team physicians, will determine the appropriate timeframe for progression back to activity for the student-athlete. Daily monitoring of the student-athlete’s status will be performed through the physical and symptomatic evaluation of the individual. The student-athlete will report to the Athletic Training Room around the same time period daily, where both a physical evaluation and the Concussion Assessment and Symptoms Scoring Evaluation (Appendix E) will be verbally administered to determine self-reported asymptomatic status. When the athlete has selfreported asymptomatic status for a time period greater than 24 hours, neurocognitive testing will be administered in a stepwise approach.

Return to Play Guidelines: “Return to play” is the process of deciding when an injured or ill student-athlete may safely return to practice or competition. It is the goal of the University of Richmond Sports Medicine Department to return an injured or ill student-athlete to practice or competition without putting the individual or others at undue risk for injury or illness. When an asymptomatic status has been established, and neurocognitive scoring has returned to the baseline level, a stepwise progression will be utilized for return to play. The progression is a step-bystep procedure where an asymptomatic level is maintained as functional exercise is slowly added to the activity level. Progression to each subsequent stage occurs roughly every 24 hours, based on each individual’s status. Return of symptoms necessitates further physical and cognitive recovery, and the return to Stage 1. Progressions are individualized on a case by case basis, where the ultimate return to play is left at the discretion of the sports medicine staff and team physicians. It is important to note that this timeline could last over a period of days, weeks, months, or ultimately result in a potential medical disqualification from participation in the University of Richmond athletics.

Updated 7/14

Functional Stage Progression Stage

1 2

Requirement

Rehabilitation Stage

Functional Exercise at Each Stage of Rehabilitation

Objective of Each Stage

No activity

Complete physical and cognitive rest Walking, swimming, or stationary cycling keeping intensity 24 hrs, return to baseline levels for SCAT2 and ImPACT™, completion of stage 1 Completion of stage 2

Light aerobic activity

4

Completion of stage 3

Non-contact training drills

5

Completion of stage 4

Full contact practice

6

Completion of stage 5

Return to play

3

Updated 7/14

Sport-specific exercise

Normal game play

Increase HR

Exercise, coordination, and cognitive load Restore confidence and assess functional skills by coaching staff

Return to Academics Guidelines: Return to academics (return-to-learn) is a parallel concept to return-to-play, but has received less scientific evaluation8. Return-to-learn guidelines assume that both physical and cognitive activities require brain energy utilization, and that after a sport-related concussion, brain energy may not be available for physical and cognitive exertion because of the brain energy crisis. Return-to-learn should be managed in a stepwise program that fits the needs of the individual, within the context of a multidisciplinary team that includes team physicians, athletic trainers, clinical psychologists/counselors, neuropsychologists, administrators as well as academic (e.g. professors, deans, academic advisors) and office of disability services representatives. The return-to-learn recommendations outlined below are based on expert consensus. Like return-to-play, it is difficult to provide prescriptive recommendations for return-to-learn. The student-athlete may appear physically normal but may be unable to perform as expected due to concussive symptomatology. When a University of Richmond student-athlete suffers a concussion, the Assistant Athletic Director for Sports Medicine or his / her designee will send a Concussion Awareness Letter (Appendix E) to the Assistant Athletic Director for Academics or his / her designee. The Assistant Athletic Director for Academics will send the Concussion Awareness Letter to the Westhampton or Richmond College Dean’s office for distribution to student-athlete’s professors. The Concussion Awareness Letter will describe the Return to Academic progression. As with return-to-play, the first step of return-to-learn is relative physical and cognitive rest. Relative cognitive rest involves minimizing potential cognitive stressors, such as school work, video games, reading, texting and watching television. Data from small studies suggest a beneficial effect of cognitive rest on concussion recovery. For the college student-athlete, consideration should be given to avoiding the classroom for at least the same day as the sport-related concussion. The period of time needed to avoid class or homework should be individualized. The gradual return to academics should be based on the student-athlete’s progression through their concussion recovery. The extent of academic adjustments needed will be decided by a multi-disciplinary team that may include team physicians, athletic trainer, athletic academic support staff, deans, individual teachers, and clinical psychologists/counselors. The level of multi-disciplinary involvement will vary on a case-by-case basis. The majority of student-athletes who are concussed will not need a detailed return-to-learn program because full recovery typically occurs within two weeks. For the student-athlete whose academic schedule requires some minor modification in the first one to two weeks following a sportrelated concussion, adjustments can often be made without requiring meaningful curriculum or testing alterations. For those student-athletes whose symptoms persist for longer than two weeks, there are differing ways to access academic adjustment or accommodations. The student-athlete may need to obtain short term disability accommodations through the office of disability services. In severe cases, medical withdrawal will need to be considered. A more difficult scenario occurs when the student-athlete experiences prolonged cognitive difficulties. In this case, considerations should include neuropsychological evaluation to: (a) determine the nature and severity of cognitive impairment, and (b) identify the extent to which psychological issues may be present and may be interacting with the cognitive processes. The information from such testing will allow a detailed academic plan to be devised that specifies the support services available for that Updated 7/14

student-athlete. The student-athlete can also choose to disclose the documentation to the disability office in order to seek long-term accommodations or academic adjustments. The disability office will verify if the impairment is limiting a major life activity per the Americans with Disabilities Act. Accommodations or academic adjustments are often provided in order to ‘level the playing field’ for the student-athlete with prolonged cognitive difficulties resulting from a concussion. A detailed academic plan coupled with accommodations can provide the needed support for a student-athlete as he or she returns to learning after a concussion. The successful implementation of return-to-learn depends on several variables:  Recognition that concussion symptoms vary widely among student-athletes, and even within the same individual who may be suffering a repeat concussion.  Identification of a point person or case manager for the student-athlete who can navigate the dual obligations of academics and athletics.  Identification of co-morbid conditions that may impair recovery, such as migraine or other headache conditions, attention-deficit hyperactivity disorder, anxiety and depression, or other mood disorders.  Identification of campus resources that can help assure that student-athletes are provided their full rights during this transition period.

Updated 7/14

Reference Documents 1. Guskiewicz, K. M., Bruce, S. L., Cantu, R. C., Ferrara, M. S., Kelly, J. P., McCrea, M., et. al. (2004). National Athletic Trainers’ Association position statement: management of sport-related concussion. Journal of Athletic Training, 39(3), 280-297. 2. McCrory, P., Meeuwisse, W., Johnston, K., Dvorak, J., Aubry, M., Molloy, M., et. al. (2009). Consensus statement on concussion in sport 3rd international conference on concussion in sport held in Zurich, November 2008. Clinical Journal of Sports Medicine, 19, 185-200. 3. McCrory, P., Johnston, K., Meeuwisse, W., Aubry, M., Cantu, R., Dvorak, J., et. al. (2004). Summary and agreement statement of the 2nd international conference on concussion in sport, Prague 2004. Clinical Journal of Sports Medicine, 15 (2), 48-54. 4. Concussion (mild traumatic brain injury) and the team physician: a consensus statement. Medicine & Science in Sports & Exercise (2006). 395-399. 5. Practice Parameter: The management of concussion in sports (summary statement). Neurology (1997), 48, 581-585. 6. The team physician and return-to-play issues consensus statement. Medicine & Science in Sports & Exercise (2002). 7. Memorandum: Concussion Management Plan. NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS). (2010). 1-5. 8. Inter-Association Consensus: Diagnosis and Management of Sport Related Concussion Guidelines. Safety in College Football Summit. (2014). 1-9.

Updated 7/14

Appendix A

University of Richmond Sports Medicine Department Concussion Education and Notification Acknowledgement Definition: Concussions are the most common form of head injury suffered by athletes. Due to the complexity of the injury and ever-growing research, a unanimous definition of concussion does not exist. The National Athletic Trainers’ Association has released a consensus statement with universal agreement on several features that incorporate clinical, pathologic, and biomechanical injury constructs associated with a head injury. A concussion can be caused by a direct or indirect hit to the head or body (for example, a hard tackle or check that causes an impulsive force transmitted to the head). This may cause impairment in neurologic function which may result in a gradient of clinical symptoms that may or may not involve loss of consciousness. When an athlete suffers a concussion, the brain suddenly shifts or shakes inside the skull and can knock against the skull's bony surface. A hard hit to the body can result in an acceleration and/or deceleration injury when the brain brushes against bony protuberances inside the skull. Such forces can also result in a rotational injury in which the brain twists, potentially causing shearing of the brain nerve fibers. The exact recovery period from this trauma is unclear and will vary from individual to individual. It has been documented however, that during a concussion the brain temporarily does not function normally and additionally is more vulnerable to a second head injury. This second injury, known as Second Impact Syndrome, may result in far greater brain trauma and even death. Athletes who continue their participation in activity also increase their risk of post-traumatic concussion syndrome which causes prolonged and intensified concussion symptoms. Symptoms of a concussion: Following a concussion the athlete may experience a variety of symptoms. Contrary to popular belief, most concussions occur without a loss of consciousness. It is not yet known exactly what happens to brain cells in a concussion, but the mechanism appears to involve a change in chemical function. It is important to remember that some symptoms may appear right away and some may be delayed. Symptoms, as well as symptom severity may differ between individuals however a combination of symptoms classically occurs. Some symptoms and signs include: Symptoms: -

Nausea/vomiting Dizziness Confusion Fatigue Light headedness Headaches Irritability Disorientation Seeing bright lights/stars Feeling of being stunned Depression Ringing in the ears

Signs: -

Difficulty concentrating Inappropriate playing behavior Decreased playing ability Inability to perform daily activities Reduced attention Cognitive and memory dysfunction Sleep disturbances Vacant stare Loss of bowel and/or bladder control Personality change Unsteadiness of gait Slurred/incoherent speech Loss of consciousness

Notification of Injury/Symptoms: Due to the serious nature of this injury and potential catastrophic results of returning to activity, concussions need to be recognized and diagnosed as soon as possible. It is required that student-athletes are truthful and forthcoming about their symptoms as soon as they present. If/when they are diagnosed with a concussion, the student-athlete must report symptoms each day until they are cleared for full activity by the sports medicine staff. Failure to do so may increase the risk of further brain damage and posttraumatic concussion syndrome. I, ____________________________________________, understand and acknowledge the above statements and will notify my Staff Athletic Trainer of any and all symptoms associated with a head injury (diagnosed or potential). I also assume any risk associated with continuing my activity while experiencing post-concussion symptoms. __________________________________________________________ Student-Athlete Name Printed

____________________________________ Sport

__________________________________________________________ Student-Athlete Signature

____________________________________ Date

University of Richmond Sports Medicine Department Sport Concussion Assessment Tool (SCAT2) Name _____________________________________ Baseline / Injury

Appendix B

Sport _______________________________________________

Date/Time ____________________ Date/Time of Evaluation_______________________________

Place of Evaluation______________________________ Examiner ___________________________________________

Headache Headache Nausea Nausea Vomiting Vomiting Balance Problems Balance Problems Dizziness Dizziness Fatigue Fatigue Trouble Falling Asleep Trouble Falling Asleep Sleeping More Than Sleeping More ThanUsual Usual Sleeping Less Than Usual

Sleeping Less Than Usual

Drowsiness

Drowsiness

Sensitivity to Light

Sensitivity to Light

Sensitivity to Noise

Sensitivity to Noise

Irritability

Irritability

Sadness

Sadness

Nervousness

Nervousness

Feeling More Emotional

Feeling More Emotional

Numbness and Tingling

Numbness and Tingling

Feeling Slowed Down Feeling Slowed Down

Feeling Mentally “Foggy” Feeling Mentally “Foggy”

Difficulty Concentrating Difficulty Concentrating

Difficulty Remembering Difficulty Remembering

Visual Problems

Visual Problems

Appendix C

University of Richmond Sports Medicine Department Head Injury Evaluation Name _____________________________________

Sport _______________________________________________

Date/Time of Injury _________________________

Date/Time of Evaluation________________________________

Place of Evaluation__________________________

Examiner ____________________________________________

Symptom Assessment General: NONE Headaches Nausea/Vomiting Neck/Back Pain Syncopal Episodes (fainting) Dizziness Tinnitus (ringing in ears) Vertigo (unsteadiness of gait) Blurred or double vision Photophobia

Irritability/Belligerent Anxiety Fatigue/Malaise/Subdued Apathy/Depression Personality Changes Sleep Disturbances Decreased Appetite Facial Expression(s) Other

Neurologic Exam Vital Signs: BP:_______/_______mm Hg HR:_______ RR:_______ Cranial Nerves (Check if ABNORMAL, cross out if NOT TESTED) I II III,IV,VI V VII VIII

Olfactory {smell} Optic {pupillary light reflex, ?symmetry} Oculomotor {pupil reaction/eye movements} Trigeminal (facial sensation) Facial {facial expressions/taste} Vestibulocochlear {hearing/balance}

Motor Exam (Check if PRESENT): NORMAL Hemiparesis (Circle: Rt Lt ) Monoparesis (Which limb:__________) Paraparesis/Paraplegia Quadraparesis/Quadraplegia)

IX X XI XII

Glossopharyngeal {swallowing/taste} Vagus {swallowing/gag reflex} Spinal accessory {trapezius/sternocleidomastoid} Hypoglossal {tongue movements}

Sensory Exam (Check if PRESENT): Numbness, tingling, pain (location________________)

Cerebellar (Check if ABNORMAL) Finger-Nose-Finger Gait

Additional Comments:

EXAMINER

Date

On Campus Emergency Contact

Telephone #

Relationship

Appendix D

University of Richmond Sports Medicine Department Concussion Take-Home Instructions A concussion is an injury to your brain from trauma to your head. A blow to the head, a car accident, a fall, or any other trauma that severely jolts the head can cause a concussion. When a concussion occurs, your brain which is soft, hits against the bones of the skulls and becomes injured. There may or may not be a loss of consciousness (passing out). Because the brain is very complex, every brain injury is different. Some symptoms may appear right away, while others may not show up for days or weeks after the concussion. Most people with mild injuries recover fully, but it can take time. Some symptoms can last for days, weeks, or longer.

I believe that ________________________________________sustained a concussion on ________________. To make sure he/she recovers, please follow the following important recommendations: 1.

Please remind him/her to report to the athletic training room tomorrow at________________ for a follow-up evaluation. 2. Please review the items outlined below. If any of these problems develop prior to his/her visit, please contact the local emergency medical system IMMEDIATELY. Additionally, be sure to contact the treating Certified Athletic Trainer.

On campus Emergency (804) 289-8911 • • • • • •

Off campus Emergency Dial 911

Headaches that become worse Mental status changes: lethargy, difficulty maintaining arousal, confusion, or agitation Seizure activity Repeated vomiting Weakness, numbness, or decreased coordination Slurred speech

• • • • •

Blurred vision Post-concussion symptoms that worsen Additional post-concussion symptoms as compared to those originally reported Have one pupil- the black part in the middle of the eye- larger than the other Have any other new symptoms that worry you

3. Otherwise, please follow the instructions outlined below. It is OK to: • Use acetaminophen (Tylenol) for headaches as directed by the UR Sports Medicine Department • Use ice pack on head and neck as needed for comfort • Get plenty of sleep at night, and rest during the day • Eat a normal diet • Be awakened during the night to assess arousal

Do NOT: • Drink alcohol • Perform any physical activity NOT specifically cleared by the UR Sports Medicine Department • Drive a vehicle without direct clearance by the UR Sports Medicine Department • Ingest caffeine, chocolate, or spicy foods • Take ibuprofen or any other anti-inflammatories

Specific recommendations:

Recommendations provided to:________________________________Cell #:_________________Relationship:__________________ Recommendations provided by:________________________________ Date:_________________ Time:_______________________

Please feel free to contact me if you have any questions. I can be reached at: Office:_____________________________________________ ________Cell:______________________________________________ ATC Signature: _______________________________________________________________________________________________

Appendix E

University of Richmond Sports Medicine Department Concussion Assessment Evaluation Name _____________________________________

Sport _______________________________________________

Date/Time of Injury _________________________

Date/Time of Evaluation_______________________________

Place of Evaluation__________________________

Examiner ___________________________________________

Baseline

Symptom

Initial

Day

Day

Day

Day

Day

Day

Day

Day

Day

Day

Rest/Post Exertion

Rest/Post Exertion

Rest/Post Exertion

Rest/Post Exertion

Rest/Post Exertion

Rest/Post Exertion

Rest/Post Exertion

Rest/Post Exertion

Rest/Post Exertion

Rest/Post Exertion

Date Time

Headache Nausea Vomiting Balance Problems Dizziness Fatigue Trouble Falling Asleep Sleeping More Than Usual Sleeping Less Than Usual Drowsiness Sensitivity to Light Sensitivity to Noise Irritability Sadness Nervousness Feeling More Emotional Numbness and Tingling Feeling Slowed Down Feeling Mentally “Foggy” Difficulty Concentrating Difficulty Remembering Visual Problems

Total Score ATC Initial 0 = None

1-2 = Mild

3-4 = Moderate

5-6 = Severe

Appendix F Concussion Awareness Letter The University of Richmond Sports Medicine and Student-Athlete Support Departments would like to inform you that ______________ sustained a concussion during athletic participation on __________, 20_____. The student-athlete was evaluated by the Sports Medicine Staff and referred to our Team Neurologist, Dr. Robert White, for testing. The student-athlete will continue with follow-up testing until scores return to preconcussion baseline levels. Our policy states that no student-athlete will return to full activity until symptom free, has completed our return-to-play protocol, and is cleared by Dr. White. A concussion or mild traumatic brain injury can cause a variety of physical, cognitive, and emotional symptoms. Concussions range in significance from minor to major, but all temporarily interfere with the way the brain functions. As a result, this student-athlete may experience one or more of these signs and symptoms. Headache Memory Problems Diplopia - Double Vision Photophobia – Light Sensitivity

Nausea Dizziness Confusion Misophonia – Noise Sensitivity

Feeling Sluggish/Groggy Difficulty Concentrating Balance Problems Difficulty Sleeping

Be aware that side effects of the concussion may adversely impact academic performance. Recent research demonstrates that reduction in cognitive activity (including, but not limited to, homework, testing, and computer work) allows for faster recovery. Therefore, any academic modifications you may provide during this recovery would be greatly appreciated. We will monitor this student-athlete, anticipating a full recovery, but cannot predetermine how long the concussion will impede academic performance. Overall, you should be aware that: 1. Each situation is unique; thus, no standardized faculty protocol exists to accommodate all situations. 2. Faculty are encouraged to contact Bruce Matthews with questions about handling specific situations. 3. Faculty should recognize that concussion symptoms may exist without visible evidence of injury. 4. Student-athletes with a concussion diagnosis should attend class (if not hospitalized). 5. Although cognitive rest is beneficial, student-athletes should attempt to study/read as required and appropriate for their specific phase of recovery. 6. If a student-athlete can compete, then he/she is expected to complete academic assignments. The Coordinate College Dean’s Office (Richmond College and Westhampton College) will notify you when the student-athlete has completed the return to play progression and returned to competition. Should you continue to notice symptoms of concussion after he or she has been medically cleared, we ask that you inform us as this may indicate a presence of the injury that went undetected. If you have any questions or require further information, including but not limited to our full head injury protocol and academic research on the effects and treatment of concussions, please do not hesitate to contact us. Again, thank you in advance for your time and understanding. Chris Jones, MS, ATC, CSCS Assistant Athletic Director / Sports Medicine Ph: (804) 289-8928 Email: [email protected]

Bruce Matthews Assistant Athletic Director / Academics Ph: (804) 287-6415 [email protected]