Greenwave United – Concussion Policy

Concussion Policy

Preamble

This Policy is based on the 5th Consensus Statement on Concussion in Sport, released in April 2017. It interprets the information contained in the report prepared by the 2017 Concussion in Sport Group (CISG), a group of sport-concussion medical practitioners and experts, and adapts the concussion assessment and management tools outlined in that report.

The CISG suggested 11 “R’s” of Sport-Related Concussion (SRC) management to provide a logical flow for concussion management. This Policy follows the same structure.

The 11 “R’s” in this Policy are:

Recognize, Remove, Re-Evaluate, Rest, Rehabilitation, Refer, Recover, Return to Sport, Reconsider, Residual Effects, and Risk Reduction.

A concussion is a clinical diagnosis that can only be made by a physician. Greenwave United accepts no liability for participants or other individuals in their use or interpretation of this Policy.

Definitions

The following terms have these meanings in this Policy:

“Participant” – Coaches, athletes, volunteers, officials, and other registered individuals.

“Registered Individuals” – All individuals employed by or engaged in activities with the club, including, but not limited to, employees, volunteers, administrators, committee members, directors, and officers.

“Suspected Concussion” – The recognition that an individual appears to have experienced an injury or impact that may result in a concussion, or is exhibiting unusual behaviour that may be the result of a concussion.

“Sport-Related Concussion (SRC)” – A sport-related concussion is a traumatic brain injury induced by biomechanical forces. Common features that may be used to define the nature of an SRC include:

• Caused by either a direct blow to the head, face, or neck, or by a blow elsewhere on the body with an impulsive force transmitted to the head.

• Typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms may evolve over a period of minutes to hours.

• May result in neuropathological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury. As such, no abnormality may be visibly apparent.

• Results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of clinical and cognitive features typically follows a sequential course; however, symptoms may be prolonged in some cases.

Purpose

The club is committed to ensuring the safety of those participating in the sport of basketball. Greenwave United recognizes the increased awareness of concussions and their potential long-term effects and believes that concussion prevention is paramount to protecting the health and safety of Participants.

This Policy provides guidance on:

• Identifying common signs and symptoms of a concussion;

• The protocol to be followed in the event of a possible concussion; and

• Return-to-participation guidelines if a concussion is diagnosed.

Awareness of the signs and symptoms of concussion, as well as knowledge of how to properly manage a concussion, is critical to recovery and helps ensure that an individual does not return to physical activity too soon, which could increase the risk of further complications.

Recognize

If any of the following red flags are present, an ambulance should be called and/or an on-site licensed healthcare professional should be summoned:

• Neck pain or tenderness

• Double vision

• Weakness or tingling/burning in the arms or legs

• Severe or increasing headache

• Seizure or convulsion

• Loss of consciousness

• Deteriorating conscious state

• Vomiting

• Increasingly restless, agitated, or combative behaviour

Observable Signs

The following observable signs may indicate a possible concussion:

• Lying motionless on the playing surface

• Slow to get up after a direct or indirect hit to the head

• Disorientation or confusion, or inability to respond appropriately to questions

• Blank or vacant look

• Balance or gait difficulties, motor incoordination, stumbling, or slow, laboured movements

• Facial injury following head trauma

Symptoms

A concussion may result in the following symptoms:

• Headache or a feeling of “pressure in the head”

• Balance problems or dizziness

• Nausea or vomiting

• Drowsiness, fatigue, or low energy

• Blurred vision

• Sensitivity to light or noise

• Increased emotionality or irritability

• Feeling that something is “not right”

• Sadness, nervousness, or anxiety

• Neck pain

• Difficulty remembering or concentrating

• Feeling slowed down or “in a fog”

Memory Questions

Failure to correctly answer any of the following memory questions may suggest a concussion:

• What venue are we at today?

• Which team is winning?

• Which quarter is it?

• What team are you playing against?

Remove

In the event of a Suspected Concussion, where there are observable signs of a concussion, symptoms of a concussion, or a failure to correctly answer the memory questions, the Participant should be immediately removed from participation.

Participants who have a Suspected Concussion and are removed from participation should:

• Not be left alone, particularly during the first 1–2 hours;

• Not consume alcohol;

• Not use recreational or prescription drugs unless directed by a medical professional;

• Not be sent home alone; and

• Not drive a motor vehicle until cleared to do so by a medical professional.

A Participant who has been removed from participation due to a suspected concussion should not return to participation until the Participant has been medically assessed, preferably by a physician who is familiar with the Sport Concussion Assessment Tool – 5th Edition (SCAT5) for Participants over 12 years of age or the Child SCAT5 for Participants between 5 and 12 years of age, even if concussion symptoms have resolved.

For Participants who have been removed from participation:

• The Participant’s parent/guardian should be contacted immediately.

• The Participant should be isolated in a quiet, low-stimulation area.

• The Participant should not be left alone.

• The Participant should be monitored.

• Any cognitive, emotional, or physical changes should be documented.

Re-Evaluate

A Participant with a Suspected Concussion should be evaluated by a licensed physician. The physician should conduct a comprehensive neurological assessment and determine the Participant’s clinical status and whether neuroimaging may be required.

Rest and Rehabilitation

Participants with a diagnosed SRC should rest during the acute phase, generally for 24–48 hours, and may then gradually and progressively become more active as long as activity does not worsen their symptoms.

Participants should avoid vigorous exertion during the recovery process.

Participants and medical professionals should consider the diverse symptoms and problems associated with SRCs. Rehabilitation programs involving controlled activity below the threshold at which symptoms worsen should be considered.

Refer

Participants who experience persistent post-concussion symptoms, meaning symptoms that continue beyond the expected recovery timeline, should be referred to physicians with experience managing SRCs.

The expected recovery timeline identified in this Policy is:

• Adults: approximately 10–14 days

• Children: up to 4 weeks

Recovery and Return to Sport

SRCs can have significant adverse effects on cognitive functioning and balance during the first 24–72 hours following an injury. For most Participants, cognitive deficits, balance problems, and other symptoms improve rapidly during the first two weeks after injury.

One important predictor of slower recovery from an SRC is the severity of the Participant’s initial symptoms during the first few days following the injury.

The table below represents a graduated Return-to-Sport strategy for most Participants, particularly those who did not experience high-severity initial symptoms during the first few days following the injury.

Table 1 – Return-to-Sport Strategy

Return-to-Sport Guidelines

• An initial period of 24–48 hours of both physical and cognitive rest is recommended before beginning the Return-to-Sport strategy.

• There should be at least 24 hours, or longer if necessary, between each step.

• If symptoms recur or worsen, the Participant should return to the previous step.

• Resistance training should only be added during the later stages, such as Stage 3 or Stage 4.

• If symptoms persist, the Participant should return to see a physician.

• The Participant’s Return-to-Sport strategy should be guided and approved by a physician, with regular consultations throughout the process.

• The Participant must provide the club with a medical clearance form signed by a physician following Stage 5 and before proceeding to Stage 6.

Reconsider

The 2017 Concussion in Sport Group (CISG) considered whether certain populations, including children, adolescents, and elite athletes, should have SRCs managed differently.

It was determined that all Participants, regardless of competition level, should be managed according to the same fundamental SRC management principles.

However, children and adolescents require additional considerations.

Adolescents (13–18 years old) and children (5–12 years old) should be managed differently. SRC symptoms in children may persist for up to four weeks.

The CISG recommended that children and adolescents should first follow a Return-to-School strategy before proceeding with a Return-to-Sport strategy.

Table 2 – Return-to-School Strategy

Residual Effects

Participants should remain alert for potential long-term problems, including cognitive impairment and depression.

The potential for developing chronic traumatic encephalopathy (CTE) should also be considered. However, the CISG stated that a cause-and-effect relationship between CTE and SRCs, or exposure to contact sports, has not yet been demonstrated. Therefore, the relationship between repeated concussion or subconcussive impacts and CTE remains uncertain.

Risk Reduction and Prevention

The club recognizes that knowledge of a Participant’s SRC history can assist in developing an appropriate concussion-management and Return-to-Sport strategy.

The clinical history should also include information about previous injuries involving the head, face, or cervical spine.

The club encourages Participants to make coaches and other relevant stakeholders aware of their individual injury histories.

Non-Compliance

Failure to comply with any of the guidelines and/or protocols contained within this Policy may result in disciplinary action in accordance with the club’s internal policies.