Concussions

Please note: No Student Athletes are to take the online ImPACT concussion test unless instructed by a BRRSD school athletic trainer

The Bridgewater-Raritan School District has been utilizing an innovative program for our student-athletes. The program is called ImPACT (Immediate Post Concussion Assessment and Cognitive Testing) and is an online computerized exam that the athlete takes prior to the season. We are asking our student-athletes to take the baseline test on their home computers. The system is utilized throughout professional sports, has been mandated in the NHL, and is fast becoming the “Gold Standard” in recognizing and better managing concussion type injuries. The University of Pittsburgh Medical Center’s Sports Concussion Program is the founding group of this software. The Bridgewater-Raritan School District performs ImPACT baseline testing in 7th, 9th, and 11th grade (unless the athlete’s first year of participation is in an even year).

The exam takes about 20-25 minutes and is non-invasive. The program is basically set-up as a “video-game” type format. What it is doing is giving the brain a preseason physical of its cognitive abilities. It tracks information such as memory, reaction time, processing speed, and concentration. For example, in one part of the exam, a dozen common words appear one at a time on the screen for about one second each. The athlete is then later asked what words were displayed. It is a simple exam and has gained recognition around the world.

If a concussion is suspected, the test is re-taken at school with one of our certified athletic trainers. The results of the test are used in conjunction with the physical and neuromuscular exam to help determine the extent of the injury and when it is safe to return to play. The information can be used to better determine recovery from a concussion. The information is shared with our team doctor and a sound decision can be made as to when return-to-play is appropriate and safe. If an injury of this nature occurs we will be in contact with you.

ImPACT online test instructions:

To ensure a valid test, please follow these instructions. It is very important that you are able to fully concentrate during the entire test. Poor performance will result in an invalid test and will require a re-take.

• Set aside 30 minutes in a quiet room with no distractions to take the test.

• No headphones or cell phone use during the test.

• Turn off any televisions, radio or anything else that can produce background noise. AVOID ALL INTERRUPTIONS

• Note the test will begin by asking you background questions called the “demographic” section.
• There are 6 test sections called “modules.” These include word memory, design memory, Xs and Os, symbol match, color word match and three letters.
• Take your time to read each section’s instructions very carefully. Each module is self explanatory.
• It is common to perform the color word match module incorrectly, PLEASE read that section’s instructions thoroughly.
• You must use a standard external mouse. You may not use a finger mouse pad (ie: laptop mouse), a Track Mouse, or anything other than a standard mouse.
• To take the baseline test, go to: www.impacttestonline.com/schools
• Select NJ and then click on “Launch Baseline Test.”
• Make certain to select Bridgewater-Raritan High School when asked for “school/organization” in the demographic section.
• Enter Bridgewater-Raritan’s customer ID code:  50DF27742A
• Your test results are not displayed once you are finished (all results are password protected). 
• Please do not allow others to take an additional test.

Thank you for participating in our Impact Concussion Management Program.

Feel free to contact us if there is any question or concern about your athlete’s ImPACT exam.

Sincerely,

Dave Kennedy, MS, ATC
Amanda Cheshire, ATC 
Katie Reynolds, MS, ATC, CSCS, CES

I. Definition

A concussion is a traumatic brain injury caused by a direct or indirect blow to the head or body.

II. Indicators of Concussions and Head Injuries

• A. Possible Signs of Concussions (Could be observed by teachers, coaches, athletic trainer, school/team physician, or school nurse):

• • Appears dazed, stunned, or disoriented

• • Is forgetful, or demonstrates short term memory difficulty

• • Exhibits difficulties with balance or coordination

• • Answers questions slowly or inaccurately

• • Loses consciousness

• B. Possible Symptoms of Concussions (Reported by the student)

• • Headache

• • Nausea/vomiting

• • Balance problems or dizziness

• • Double vision or changes in vision

• • Sensitivity to light or sound/noise

• • Feeling sluggish or foggy

• • Difficulty with concentration and short term memory

• • Sleep disturbance

• • Irritability

III. Staff Training

In accordance with N.J.S.A. 18A:40-41:3, the district shall adopt an interscholastic head injury training program to be completed by all coaches, school nurses, school/team physicians, certified athletic trainers and other district personnel, as determined by the Superintendent.

The interscholastic head injury training program must include:

1. The recognition of the symptoms of head and neck injuries, concussions, and injuries related to second impact syndrome; and
2. The protocol for a return to practice or competition, which may specify an appropriate amount of time to delay the return to sports competition or practice of a student-athlete who has sustained a concussion or other head injury

IV. Return to School

A student who has suffered a concussion or head injury is excused from school a minimum of the next two calendar days. A physician’s note is required for return to school. Members of the interscholastic head injury training program or the school nurse, as appropriate, will oversee the student’s return to school and extracurricular activity.

V. Temporary Accommodations for Students with Concussions or Head Injuries

(Requests for these accommodations shall be directed to the school nurse. In addition, student-athletes involved in the interscholastic sports program should consult with the interscholastic training team. See Section VI below.)

Mental exertion increases the symptoms from concussions and affects recovery. Therefore, for recovery, cognitive rest is just as important as physical rest. The student should be monitored for the reoccurrence of symptoms due to mental exertion, such as reading, working on a computer, or taking a test.

Students who return to school after a concussion may need to:

• Take rest breaks as needed

• Spend fewer hours at school

• Be given more time to take tests or complete assignments

• Receive help with school work

• Reduce time spent on the computer, reading, and writing

• Be granted early dismissal from classes to avoid crowded hallways

• Be excused from physical education classes.

VI. Student-Athletes Involved in Interscholastic Sports

A. Background

Students who participate in an interscholastic sports program and are suspected of sustaining a concussion or other head injury in practice or competition shall be immediately removed from the sports practice or competition. A student-athlete who is removed from competition or practice shall not participate in further sports activity until he or she is evaluated by a physician or licensed healthcare provider trained in the evaluation and management of concussions, and receives written clearance.

Implementation of the policy is the shared responsibility of a team consisting of coaches, the Athletic Director, the Athletic Trainer, the school nurse, and the school administration, with the district Medical Officer leading the team.
 

B. Prevention

• Pre-season baseline testing

• Review of educational information for student-athletes on prevention of concussions

• Reinforcement of the importance of early identification and treatment of concussions to improve recovery

• Student-athletes who are exhibiting the signs or symptoms of a sports-related concussion or other head injuries during practice or competition shall be immediately removed from play and may not return to play that day.

C. Protocol When a Concussion is Suspected

When a concussion or head injury is suspected, the following protocol must be followed:

1. Immediate removal from competition or practice.
2. When available, the student-athlete should be evaluated by the school’s licensed healthcare provider to determine the presence or absence of a sports related concussion or head injury. 911 should be called if there is a deterioration of symptoms, loss of consciousness, or direct neck pain associated with the injury.
3. School personnel shall contact the student-athlete’s parent/guardian with information about the suspected sports related concussion or head injury.
4. Student-athletes must be evaluated by a physician or licensed health care provider trained in the evaluation and management of concussions.
5. School personnel shall provide the parent/guardian with the approved information/medical checklist to provide to the physician or other licensed healthcare professional.
6. The student-athlete must receive written clearance from his or her physician or licensed healthcare provider that he or she is asymptomatic at rest and may begin the graduated return-to-play protocol. School personnel may consult with the school/team physician after medical clearance is given by the student-athlete’s physician, especially in cases where the medical clearance is inconsistent with district policy.

D. Graduated Return to Practice and Competition Protocol

After the student-athlete submits written medical clearance stating that he or she is asymptomatic, he or she may begin a graduated individualized return-to-play protocol, such as the following.

1. Complete physical, cognitive, emotional and social rest is advised while the student-athlete is experiencing symptoms and signs of a sports-related concussion or other head injury.
2. Following medical clearance stating that the student-athlete is asymptomatic, completion of a full day of normal physical and cognitive activities (school day, studying for tests, watching practice, interacting with peers) without re-emergence of any signs or symptoms. If there is no return of symptoms, next day advance to:
3. Light aerobic exercise, which includes walking, swimming, or stationary cycling, keeping the intensity to less than 70% maximum percentage heart rate (no resistance training.) The objective of this step is increased heart rate. If there is no return of symptoms, next day advance to:
4. Sport-specific exercise including skating, and/or running; no head impact activities. The objective of this step is to add movement and continue to increase heart rate. If there is no return of symptoms, next day advance to:
5. Non-contact training drills (e.g. passing drills.) The student athlete may initiate progressive resistance training. If there is no return of symptoms, next day advance to:
6. Following medical clearance (consultation between school health care personnel, i.e., licensed athletic trainer, school/team physician, school nurse and student-athlete’s physician) participation in normal training activities. The objective of this step is to restore confidence and to assess functional skills by the coaching staff. If there is no return of symptoms, next day advance to:
7. Return to play involving normal exertion or game activity.

Utilization of available tools such as symptom checklists, baseline, and balance testing is suggested.

If the student-athlete exhibits a re-emergence of any post concussion signs or symptoms once he or she returns to play, he or she will be removed from exertional activities and returned to the school/team physician or primary care physician for evaluation.

If concussion symptoms reoccur during the graduated return-to-play protocol, the student-athlete will return to the previous level of activity that caused no symptoms.

E. Documentation

The DOE Concussion and Head Injury Fact Sheet shall be distributed annually to the parents or guardians of student-athletes. A signed acknowledgement of the receipt of the fact sheet shall be obtained from the parent or guardian of the student-athlete and retained by the school for future reference.

Helpful Links/Health and Wellness Resources

Local Hospitals

Robert Wood Johnson University Hospital Somerset
10 Rehill Avenue, Somerville, NJ
(908) 685-2200

Robert Wood Johnson University Hospital
1 Robert Wood Johnson Place , New Brunswick, NJ
(732) 235-7816

Overlook Hospital
Summit, New Jersey
(908) 522-2000

Local physical therapy and sports performance training

RWJ Sports Physical Therapy and Performance Center
TD Bank Ballpark, Bridgewater, NJ 08807
(908) 203-5972

RWJ Barnabus Health

Online resources for athletes, parents, and coaches

Sports Medicine for the Masses - Information for coaches, parents, and athletes on a number of sports medicine and fitness topics

Athletic Trainers’ Society of New Jersey
Information for athletes, parents, and coaches

Let’s Move in School
Information on quality physical education as the foundation so that youth will develop the knowledge, skills, and confidence to be physically active for a lifetime

National Athletic Trainers’ Association
Public information pertaining to athletic training and healthcare

National Strength and Conditioning Association
Extensive exercise technique video library

New Jersey State Interscholastic Athletic Association

Stop Sports Injuries - Keeping Kids in the Game for Life
Information to help prevent athletic overuse and trauma injuries in kids.