While this Guide for School Coaches is written primarily for coaches that are involved with student-athletes at the secondary school level, many of the concepts and principles will apply to the post-secondary varsity coaches as well. So when one is developed specifically for a post-secondary institution it will be somewhat different, but will still hold the same general principles.

BEFORE YOU BEGIN…

Before you begin reading through this chapter you should complete the following section: Preparation, Identification & Rehabilitation.

INTRODUCTION

The CMP Student-Athlete Concussion Management Program that we recommend includes four distinct positions of responsibility at any individual school.

1.      One School Leader (Principal) and his/her Assistant Leaders (Vice-Principal and Physical Education Department Head) who will form the School Leadership Committee. This committee will oversee the implementation of the program at the school.

2.      One School Head Coach for each designated team;

3.      One or more additional School Coaches for each designated team. These will be licensed teachers on staff at the school;

4.      Volunteer Community Coaches who may be involved with designated teams in any manner, such as coach, trainer, manager, etc.

All teachers, non-teaching staff and community volunteers who wish to be involved in any way with any of the school teams that are deemed to involve the risk of concussion injuries should be required to complete a Student-Athlete Concussion Management Training Course facilitated by a School Leader and be included on a school or school board Concussion Management Registry.

At the very least, there should be two trained members on any coaching staff, including the School Head Coach. It is recommended that over time all of the members of the coaching staff should be required to attend a mandatory training session.

SCHOOL LEADER

The Principal of the school should be designated as the School Leader. He/she should be the person who is ultimately responsible for overseeing the implementation of the Student-Athlete Concussion Management Program at the school.

The School Leader may delegate some of his/her responsibilities to the Vice-Principal and/or the Physical Education Department Head. These people must be qualified School Coaches and will be designated as School Assistant Leaders.

The School Leader should be responsible for facilitating the training and certification of all other School Coaches at the school. He/she may delegate this responsibility to one or more of the School Assistant Leaders following the inaugural training & certification session.

SCHOOL  COACH

Anyone taking the training who has a teaching certificate, whether they are active or not, may be designated as a Certified School Coach.
 

A Certified School Coach would be qualified to facilitate training courses for Student-Athletes.
 

A Certified School Coach would also be qualified to administer the baseline and/or post-injury ImPACT test to student-athletes.
 

COMMUNITY VOLUNTEER COACH

Anyone who does not have a teaching license or certificate and who participates in the training should be designated as a Certified Community Volunteer Coach.

A Certified Community Volunteer Coach should  be permitted to assume any of the responsibilities on the coaching staff such as coach, assistant coach, manager, trainer, etc.

With no disrespect to the quality and dedication of community volunteers, the Community Volunteer Coach should not be authorized to facilitate the Student-Athlete Concussion Management Training Courses or administer the ImPACT test to student-athletes. These responsibilities should be assigned to the School Head Coach and/or one of the other School Coaches at the school.
 

SCHOOL HEAD COACH

The School Leader should appoint one School Coach associated with the team to act as Head Coach for the team and that person will be called the School Head Coach.

Note that a Community Coach should not be qualified to be appointed as the School Head Coach since these are school-sanctioned activities and we feel that a staff member should be responsible for the concussion management program with the team.

This does not mean that the School Head Coach needs to be the main "coach" on the bench. It is simply referring to the Student-Athlete Concussion Management Program. In fact, it is quite possible that the School Head Coach may only be responsible for this function and may not even get involved in the general operations of the team. However, as you will see, there are a lot of responsibilities associated with the role of School Head Coach.

DETERMINING DESIGNATED TEAMS
 
The School Leader, in consultation with appropriate school and board personnel, should designate the sports and activities at the school that will fall under the Student-Athlete Concussion Management Program.

Those should be the sports and activities for which there is significant risk of head injury, including but not limited to: football, hockey, soccer, basketball and volleyball for both boys and girls.

TRAINING OF TEAM COACHING STAFF

The coaching staff for any of the designated teams will include head coaches, assistant coaches, trainers, managers, teacher supervisors and anyone else who will be assisting the team in any way.

The School Leader will ensure that "all" of the members of the coaching staff who are also teachers on staff at the school are trained and Certified School Coaches. It is recommended that while we only require two qualified school coaches per team, all of the professional licensed teachers should be trained in order to provide maximum effectiveness for the program.

If there is more than one School Coach working with the team, then one of them will be designated as the School Head Coach and will be the person responsible for overseeing the Student-Athlete Concussion Management Program with that team. Keep in mind that the School Head Coach does not have to be the person who is the "Head Coach" of the competitive side of the team. The School Head Coach is responsible for administering the Student-Athlete Concussion Management Program with the team, so this becomes somewhat of a managerial role.

If there is only one certified School Coach working with the team, then that person will be deemed the School Head Coach. The major responsibilities of the School Head Coach include receiving the permission forms from parent/guardians; the training and certification of the student-athletes; making sure that all of the student-athletes have valid ImPACT baseline test scores; and overseeing the identification and rehabilitation of injured student-athletes. This is a very important position on the team. The School Head Coach will report directly to the School Leader or a designated School Assistant Leader assigned to the team.

The School Leader or designate will be responsible for making sure that at least two (2) members of the Coaching staff for any of its designated teams or activities, including any of the current teachers on staff who are part of the team, have been certified through the CMP Training Program. This means, for example, that if the coaching staff consists of three teachers and two volunteers from the community, then all three teachers must be certified and this will meet the requirement. However, if only one teacher is part of the coaching staff and the rest are volunteers from the community, then that means the teacher must be certified and in this case take on the School Head Coach role, plus at least one of the other volunteers must attend a formal training session in order for the team to be qualified to begin practice and/or play.

COMMUNITY VOLUNTEER COACHES

We strongly recommend that all community volunteer coaches be required to take the training program at the earliest opportunity. The training will be of benefit to the volunteers while working with the school team and also with any of the minor sports organizations with which they may be involved. This is not a waste of time for them and will certainly give parents more confidence knowing that all members of the coaching staff are certified.

LOCAL SCHOOL BOARD REGISTRY

The qualifications of the members of the coaching staff should be confirmed from their listing on a school board registry. The School Leader must make sure to confirm that the coaching staff are members on the Registry. Therefore, anyone who wishes to confirm their training and qualification simply needs to provide the School Leader with a signed copy of their original  Certificate of Participation or the School Leader can verify that the person is on the school board Registry.

The School Leader should make sure that sufficient opportunities are provided during the year for members of the Coaching staff as well as any other teachers, non-teachers, volunteers who are not yet on the local Registry, to take part in a Student-Athlete Concussion Management Program Training Workshop. We recommend that the School Leader or designated School Assistant Leader organize one such session at the beginning of each semester. We would also suggest that this might be a good exercise to do during one of the Professional Activity Days during the school year. It would be a way of certifying all members of the teaching staff at once so that they are all qualified for future participation with school teams.

Keep in mind that a person needs only take the Student-Athlete Concussion Management Training Workshop once.

PRE-SEASON MEETINGS

The School Head Coach should organize meetings with his/her coaching staff well ahead of the beginning of the season in order to establish procedures and responsibilities with respect to the concussion management protocols. This team meeting will also help identify which of the coaches are certified and trained under the program.
 
At least four weeks prior to the beginning of training camp or try-outs, the School Head Coach should ask for all of the student-athletes who will be trying out for the team to indicate their desire by signing a registration sheet.

PARENT/GUARDIAN CLEARANCE TO PARTICIPATE

The School Head Coach should at that time provide each student-athlete who wishes to try-out for the team with a Parent/Guardian Declaration and Permission to Play form.

The Parent/Guardian form should not only contain a clearance for the child to participate on the team, it will also contain a section where the parent/guardian acknowledges that he/she is aware of the fundamental principles of the concussion management program and will accept the responsibilities outlined for parent/guardians.

This signed form should be in the School Head Coach's hands before the student-athlete is permitted to even try-out for the team. It will also be needed in order for the student-athlete to take the CMP Student-Athlete Concussion Management Training & Certification Course (if necessary) and the baseline ImPACT test if either or both of those are required.

NOTE: A student-athlete who is not a member of the School Board Registry should not be permitted to take the ImPACT test.

LOCAL SCHOOL BOARD REGISTRY

Student-Athletes who have already taken a Student-Athlete Concussion Management Course will be asked to provide the School Head Coach with a copy of the Certificate of Participation they received when they completed their training.

Alternatively, the School Head Coach may just check to see if they are listed on the school or school board Registry. Student-Athletes who obtained their training from another school board will obviously need to be able to produce their signed Certificate, if this is acceptable to the School Leader. It is quite understandable if a school or school board wishes to have all student-athletes trained by their own staff.

Student-Athletes who are not listed on the school or school board Registry will be required to take part in a Student-Athlete Concussion Management Training Session before they are permitted to take part in any try-outs or do the ImPACT Baseline test.

The School Head Coach for the team or for any one of the other teams at the school will make arrangements to provide the course on one or more occasions in order to allow student-athletes to become qualified by taking their certification course. The course shouild take approximately 90 minutes to complete.

It must be noted that student-athletes should be permitted to sit in on the courses that are being presented to other designated teams in order to become qualified. All of the sessions should contain the same basic content and information.

BASELINE NEUROPSYCHOLOGICAL TEST

The School Head Coach should then take the names of all student-athletes who have registered to try-out for the team and verify that each of them has a valid baseline ImPACT test on file that will be no more than two years old by the end of the upcoming season. Information on how to access this information will be provided by the School Leader or designate who will have a password to obtain this data.

Student-Athletes who do not have a valid baseline ImPACT test should then be given an opportunity to take a test that will be administered by one or more of the School Coaches. The School Head Coach will make arrangements to reserve one of the computer labs for as often as is needed in order to allow all of the student-athletes an opportunity to take the baseline test. It should be noted that the School Coach who is administering the test need not be directly involved with the student-athlete's school team. It could be another School Coach from another team or one of the School Leadership committee who offers to supervise the test.

PREPARATION AND SAFETY

The risk of sport-related concussion will always be present in certain activities. It doesn’t matter how good your equipment is, or whether you have the most advanced helmets to protect your head, it is going to be impossible to prevent your brain from moving inside your skull in reaction to significant impact to your body.  However, we feel it is possible to reduce the risk of concussion with education, appropriate equipment and qualified coaches.

We strongly encourage coaches to show their players how to “play safe” and how to avoid putting themselves in vulnerable situations where injury may occur. If players are more aware of what is going on around them and develop playing styles that enable them to be prepared for contact, they may be able to brace themselves and reduce the impact on the brain. Often it is the unexpected hit, or reckless play with complete disregard for personal safety that results in incidents which lead to concussions. We do not recommend “playing scared”, but just “playing safe”. There are numerous sources of information on sport-specific safe play strategies, so we encourage coaches to read up on the most appropriate ones.

We also encourage coaches to make sure that their players are “physically fit”, especially in the upper back and neck areas. This training should continue all season long. It is important that players be in “game shape” before exhibition games are played.

Finally, we urge school boards to place more emphasis on the training and development of coaches. Improving the qualifications of the coaching staff is an investment in the safety of student-athletes.

ESTABLISHING A BASELINE WITH STUDENT-ATHLETES

Much has been said about the importance of establishing a baseline evaluation of a student-athlete which can be compared to a post-injury assessment in order to have some idea of the extent of deficiency that may exist. Most of the discussion about baseline assessment is focussed on the computerized tests that are conducted through ImPACT.

However, we would like to recommend that each School Coach also create a baseline with respect to sport-specific skills that can also serve as a very important comparison. For example you can develop a simple test that will produce some objective measurements which involve reaction time, skill level, light sensitivity, balance, coordination, etc. These observations and results should be recorded in a way which will allow the coach to compare the progress of any rehabilitation program as the student-athlete begins the return-to-play progression. If the post-injury levels differ significantly from the baseline, then the coach can assume that the effects of the concussion are still present, even if symptoms have subsided. This will simply give another measurement upon which to determine any return-to-play status.

INITIATING THE PROCESS

If a student-athlete receives a serious blow to the body or head during practice or competition that in the opinion of any one or more of the School Coaches, a Community Coach, the Parent/Guardian, or a School Leader, may have been sufficient enough to have caused a concussion, then the player “must” be observed very closely in the ensuing minutes following the incident. It may not be necessary to initiate the concussion management protocol yet, so we don't want to overreact, but once a significant force has been experienced by the body, all CMP trained partners must direct their attention to the student-athlete to look for signs, symptoms or behaviours that are consistent with a concussion.

If during this observation period any of the universally accepted signs, symptoms or behaviours that are consistent with concussion are evident, then the player must be removed from further play and the Identification & Rehabilitation Protocols will be initiated immediately.

We will always acknowledge that individuals have different thresholds when it comes to brain trauma. Some forces that would injure one person may not have an affect on another. However, we must all pay particular attention to a person who seems to have suffered a significant blow. There may not be a need to keep the player out of the game, but if there is "any" indication that an injury may have been suffered, the player should be immediately removed from action.

NO HESITATION OR DEBATE

There can be no hesitation in making this decision. There can be no debating the merits of the decision. In other words, if a parent/guardian of a student-athlete approaches the coach during the game and informs that coach that his/her son/daughter appears to have been injured and that the parent/guardian would like to initiate the Concussion Management Identification & Rehabilitation Protocol, there should be no hesitation on the part of the coach. The student-athlete should be removed from action immediately and the process will begin.

The fact that we have so many pairs of eyes observing student-athletes in competition should help us to spot the accepted signs that will give us cause for concern.

We expect the School Head Coach to step in at that moment and make sure that the proper procedures are followed. That is why, when the School Head Coach is absent from the game or practice, there should be a clearly designated person who will assume the role. It must also be pointed out at this time that there should always be two (2) certified trained coaches present for all team activities. At least one of them must assume the role of School Head Coach if the official Head Coach is absent.
  

SIGNS TO LOOK FOR

Keep in mind that while every one of the partners must be on the look out for the signs listed below, when a student-athlete suffers a serious blow to the head or body, a great deal of responsibility falls upon the shoulders of the School Head Coach to take charge of this part of the process.

Once again, we are not suggesting that every time forceful contact is made with a student-athlete we should be pulling the player from the game. However, knowing what we know about concussions, and especially when we are now aware of the fact that upwards of 80% of all concussions go unreported when they first occur, it is critical that the School Coaches be on the lookout for tell-tale signs of concussion after a significant blow to the body or head has occurred.

If any of the following are observed, we “must” assume that a concussion has occurred until we have evidence to the contrary. We should never ignore any of these signs in a student-athlete who:

·        appears to be dazed or stunned immediately after the incident, even if only for a few seconds;
 

·        seems to be confused about his position or assignment during the game or on the bench;
 

·        is not sure of the score, the period, the opponent, the time, etc. when questioned;
 

·        seems to move clumsily on the field/ice or around the bench/dressing room, displaying balance issues;
  

·        responds to questions with a bit of hesitation or not at all, demonstrating a delay in processing information;
 

·        seems irritable or displays uncharacteristic mood/personality changes which are out of the ordinary;
 

·        can’t recall the play where he got injured, even if he says he is fine;
 

·        can’t recall what happened after he got injured;
 

·        seems easily distracted with poor concentration;
  

·        has a vacant stare or seems to have glassy eyes;
  

·        is slurring his speech;
  

·        seems to be having minor convulsions or seizures;
 

SYMPTOMS TO LOOK FOR
 

Besides the “signs” that may be evident, if the student-athlete reports any of the following symptoms, the School Coach or the Community Coach must remove the player from further play. Symptoms will usually be identified by the student-athlete but he/she may not articulate the symptom clearly. We must be able to "read' the student-athlete.
 

The following self-admitted symptoms are absolutely serious enough to assume a concussion has occurred so the Student-Athlete Concussion Management Program procedures will immediately be put into action when the student-athlete:
 

·                     complains of headache or pressure inside the head, even if it is only a slight pain;
 

·                     complains of dizziness or trouble keeping his balance;
 

·                     is feeling nauseous or feels like vomiting, even if it is well after the incident;
 

·                     complains of vision problems;
 

·                     states that he is sensitive to light or noise;
 

·                     complains about feeling sluggish, foggy or groggy;
 

·                     says he/she is feeling confused;
 

·                     says he/she is just not feeling right;
 

·                     says he/she is seeing stars;
 

·                     complains about a ringing in his/her ears

DON’T BE FOOLED BY A NECK INJURY

There has been some indication that soft tissue neck injuries can produce concussion-like symptoms. We want to make it clear that in order to rule out brain injury, if a student-athlete complains of a neck injury while self-admitting concussion symptoms or displaying concussion-like signs, DO NOT disregard the possibility of brain trauma. DO NOT simply pass the symptoms off as a neck injury that will go away with rest.

YOU MUST adhere to the Student-Athlete Concussion Management Protocols that follow without exception. The last thing we want is to pass off an injury as a soft tissue neck injury and put the student-athlete at risk for a serious repeat concussion by returning him/her to play without proper clearances. Therefore, regardless of what you may hear about soft tissue neck injuries, when the concussion-like symptoms occur or you see signs that may indicate a concussion, you should never pass it off as a neck injury without going through all of the procedures in this program. A medical practitioner is needed to diagnose a neck injury.

HIDDEN SYMPTOMS

Even if there are no apparent signs and the student-athlete reports no symptoms, if a School Coach, the parent/guardian and/or the School Leader has a strong suspicion that a particularly hard blow to the body or head area may be cause for concern, then it is at the discretion of any one or more of them to initiate the protocol and request that the School Coach remove the player from further action.

The School Head Coach must make sure that everyone associated with the team understands that we will always err on the side of caution. When it comes to head injuries, we must demonstrate that it is well worth the inconvenience of going through the process and finding out that the student-athlete did not suffer a concussion. It is much better for us to be safe than sorry, because the consequences of making a mistake are serious. There is a growing body of evidence that concussions during teen years, especially repeat concussions, tend to change the course of a person's life.

SIGNIFICANT CHALLENGES WITH STUDENT-ATHLETES

When it comes to identifying concussion in student-athletes, we run into several significant challenges:

1.                  Student-athletes may have sustained a concussion and may actually not be aware of it at the time. Many symptoms may not appear for hours or days after the incident. This is why it is so difficult to identify a concussion, but the School Head Coach and his/her coaching staff must do everything they can to spot the tell-tale signs. We have a lot of eyes on our student-athletes, at the game, at home and in the classroom. It should be pretty hard for signs to go undetected. 

2.                  Student-athletes may think there is something wrong but haven’t told anyone about how they feel in order to remain playing. Teenagers are natural risk-takers and they get a "chemical rush" in their brains from playing sports. They may even try to hide symptoms for a while, but a careful observer should be able to spot some signs that would indicate trouble. The student-athlete has also agreed to abide by the Student-Athlete Concussion Management Protocols in order to be on the team, so just remind him/her of this commitment if there is any arguing about being pulled from the game.

3.                  Student-athletes may think there is something wrong but haven't told anyone about how they feel because they are unable to articulate their symptoms. Once again, careful observations by all partners involved after a significant blow to the head or body should be able to identify subtle signs, symptoms and behaviours consistent with concussion. It is also why we ask School Coaches to "talk" to the student-athlete when he/she comes to the sidelines. All the person needs to tell you is that he/she doesn't feel right and that is enough to initiate the protocol. Again, please make sure that student-athletes must let their coach or parent know when something just doesn't feel right.

SIDELINE CONCUSSION EVALUATION

Once it is suspected that the student-athlete may have suffered a concussion and he/she is removed from play, the School Head Coach or one of the other School Coaches who can leave the playing area should take the student-athlete to a quiet area or dressing room to rest and get changed. There is no way the player should be going back into the game. At that time the School Coach should fill out an Injury Assessment Form that has been developed and approved by the school board to provide as many details of the incident as possible. You can also include observations and symptoms that are being admitted by the student-athlete.

Some school boards may wish to administer the SCAT2 Sport Concussion Assessment Tool sideline concussion evaluation test at that time, but we recommend that this only be done if the School Coach is trained and experienced in using this assessment tool.

Once the Injury Assessment Form is completed a copy should be made for the School Head Coach and the original given to the Parent/Guardian to bring along with him/her when the student-athlete is brought to a physician for an examination. The Parent/Guardian will be encouraged to bring their child to a physician at the earliest opportunity.

STUDENT-ATHLETE MUST GO HOME WITH A RESPONSIBLE ADULT

It is very important to remember that a Student-Athlete who is injured and has a suspected concussion must always be taken home by a responsible adult. If the parent/guardian is not at the game or practice, then you must try to contact them and see if they can come and pick up their child. If not, then it is important that another adult take responsibility for bringing the child home and making sure that he/she is not left alone.

Under no circumstances should the student-athlete drive him/herself home or be left home alone.
 
GO TO HOSPITAL IF CONDITIONS WORSEN OR CHANGE

It is not always necessary to go to the hospital the night of the injury. However, if the student-athlete lost consciousness for even a brief period of time, you must get the student to the hospital to be checked for structural damages.

Also, once the athlete is brought home, if symptoms worsen during the evening, then it is strongly advised that the child be brought immediately to the hospital. We never want to take chances when symptoms begin to get worse. And, once at home, the child should never be left alone during that first night. Somebody should always be checking on him/her. There is nothing wrong with allowing the student-athlete to rest and sleep. But someone should be around in case symptoms worsen.

INJURY PACKAGE FOR PARENT/GUARDIAN

The School Coach completing the Injury Assessment Form should provide the parent/guardian with an Injury Package that contains a number of clearance forms that will be needed in the coming days and weeks as the student-athlete goes through the process.

This package should include (copies on the pages that follow):
 
             An injury assessment note that describes the nature of the injury and informs the parent/guardian that the Concussion Management protocol has been initiated for their son or daughter.
 

             A medical clearance form for the doctor;

            A parent/guardian clearance form;
 

            A student-athlete declaration form

RECORD KEEPING IS CRITICAL

At the earliest opportunity, the School Head Coach should provide the School Leader or designate with a copy of the Injury Assessment Form along with a detailed account of the incident. The School Leader or one of his/her assistants will begin a special file for the student-athlete in order to gather all of the relevant documents, clearance forms and reports that may be forthcoming as a result of the initiating of the concussion management protocol.

It is important that you document all steps in the process and keep accurate and complete records. You have a responsibility for the well-being of students enrolled at the school and  must always be certain that everything possible has been done to fulfill your responsibilities. The student-athlete file is something that you can turn to in the future when making decisions that are in the best interests of the student. For example, it may be noted that a particular student has suffered several concussions in the previous year or two. That may have a tremendous influence in the School Leader's final decision on whether or not to give the student-athlete clearance to play for the school team.

POST-INJURY ImPACT TEST
 

The Parent/Guardian will also be advised to contact the School Head Coach within 24 to 72 hours to arrange for a post-injury ImPACT test to be given to the student-athlete at the school. It is important that the School Head Coach make sure that the parent/guardian calls to make this arrangement. If the parent/guardian does not call, then the School Head Coach must call the parent/guardian. It would be a nice gesture on the part of the School Head Coach to make the phone call the following morning in any event just to check up on the condition of his/her player.
 

When the parent/guardian brings in his/her child for the post-injury ImPACT test, it critical that that this test be done in a quiet place without distractions. The student-athlete will already be feeling pressure to perform well on the test or face a lengthy rehabilitation process which may keep him out of action for the rest of the season. Conditions must be perfect so that the student-athlete can do the test in as relaxed a state as possible.
 

If possible, the School Head Coach should try to have the School Leader or designate supervise the test. Otherwise, it can be administered by any other certified School Coach. At this point it might be recommended that the School Head Coach for the student-athlete remains out of the testing room so that there can be no perceived conflict of interest with respect to the results of the test. Some people may claim that the School Head Coach will try to influence the student-athlete to perform well in order to be able to return to play faster. Having a 3rd party, especially if that is the School Leader, will alleviate any of this concern.
 

If CMP Concussion Management Partners Inc. have been given the responsibility for managing the concussion management program, the School Leader or designate will notify CMP (Dr. Czarnota will give the School Leader a contact email and/or phone number) that a post-injury ImPACT test has been submitted and will provide all of the necessary details about the incident and the student-athlete involved. This information will normally be sent by email and the School Leader or designate must make sure that he/she receives confirmation that the message has been received. Follow up again if confirmation does not come within a reasonable amount of time.
 

If the results of the post-injury ImPACT test show evidence of diminished functioning as compared to the student-athlete’s baseline score, CMP will advise the School Leader or designate that clearance to return to physical training should be delayed until another test can be performed at a date that will be recommended by CMP.
 

The School Head Coach will then notify all of the student-athlete's classroom teachers about the incident and remind teachers about the Guide for Teachers which is an important part of this document.
 

The School Leader or designate will administer subsequent post-injury ImPACT tests as directed by CMP. Once the test results have returned to baseline levels, CMP will so advise the School Leader of the return to baseline.
 

CMP Concussion Management Partners Inc. will not be giving an official “clearance to return to physical training” because there is so much that we do not know about the student-athlete. The responsibility that will have been taken on by our Consulting Neuropsychologist, Dr. Michael Czarnota, is to examine the post-injury test results and let the school know when the student-athlete’s scores have returned to baseline levels. This would be a sign that the cognitive functioning in the areas covered by the ImPACT test have been restored to pre-injury levels according to the test results.

This is an important thing to keep in mind. Just because the ImPACT test results have returned to baseline levels, one must not automatically assume that the student-athlete has recovered sufficiently to resume physical exertion. It is a good sign, but it is not an absolute sign. At CMP we feel that the parents/guardians will be in a better position to know when their child is "back to normal". Even the classroom teacher will be in a good position to know if there is still "something going on".

Nevertheless, the return of the ImPACT results to baseline levels is a significant sign that cognitive functioning has been restored. Until then, it must be assumed that there are still problems going on in the brain.

CLEARANCE FORMS MUST BE RECEIVED
 

As well as the notice that the ImPACT test results have returned to baseline levels, the School Leader should have received all of the clearance forms before allowing the student-athlete to resume physical training. It is expected that the School Head Coach will make sure that these forms are collected and brought to the School Leader. It will be the responsibility of the Student-Athlete's parent/guardian to bring the forms he/she received in the Injury Package back to the school. The School Leader will then issue the clearance form that is found on the following page:

RESUMPTION OF PHYSICAL TRAINING
 

If after receiving all of the above forms, and after talking to the student-athlete him/herself, the School Leader or designate is completely satisfied him/herself that the student-athlete has recovered sufficiently from the concussion; the School Leader may then issue a School Clearance to Resume Physical Training and give this clearance form to the School CMP Head Coach
 

Once the School Head Coach receives the School Clearance to Resume Physical Training from the School Leader, the Coaching staff will start the student-athlete on a physical training program that will include a gradual step by step progression designed to eventually prepare the student-athlete for a return to full contact practice and competition.

STEP-BY-STEP GRADUAL PHYSICAL TRAINING PROGRAM
 
The supervised training will consist of light aerobic exercises such as walking or stationary cycling that gradually increases in length and resistance.
 
If there is no recurrence of symptoms, then this will progress into sport-specific training, such as skating in hockey; running in soccer, etc. At this stage you should be working on the specific skills that will be needed in your sport.
 
If no symptoms return while performing the sport-specific skills, you can progress into non-contact training drills. This can be done with teammates who understand that under no circumstances are you to be involved in contact, whether that contact be accidental or deliberate. This is extremely important for your team to know and accept. Some players wear a special coloured sweater to remind team mates not to hit.
 
The Parent/Guardian will play a role in this physical training program and will monitor their child for any signs that symptoms are returning. Home observation is critical at this point because the child may actually be reluctant to report any symptoms to the coach.
 
If the Student-Athlete experiences any symptoms while going through the step-by-step progression, he/she will be required to return at least one step until the symptoms disappear. At no time should the student-athlete be engaging in any activity that brings on symptoms.
 
Each of the preceding steps should take at least one day to complete. This is not a time to rush into things since a return of symptoms could easily occur and seriously delay recovery.
 

If the School Head Coach, the Parent/Guardian and the student-athlete are satisfied that the step-by-step progression has been successful and there has been no return of concussion-like symptoms during the training, then the School CMP Head Coach will meet with the School Leader and may then recommend that the student-athlete is ready to return to full contact practice and competition. If the School Leader accepts the recommendation, he/she will issue a School Clearance to Resume Athletic Competition and the student-athlete will be permitted to return to full contact practice and competition.

CMP CONCUSSION MANAGEMENT PARTNERS INC.
Serving Canada & the United States
Offices in the Province of Ontario and the State of Michigan
email: rkirwan@infocomcanada.com   Phone: (705) 969-7215