DePaul University Sports Medicine Concussion Policy
Concussion is defined by The 3rd International Conference on Concussion in Sport as a complex process affecting the brain, induced by trauma. Concussions may be caused by a direct blow to the head, face, neck, or elsewhere on the body with an ''impulsive'' force transmitted to the head. Concussions typically result in the rapid change in neurologic function that resolves spontaneously. Concussion symptoms may be prolonged, but MRI and CT scans are generally normal. These scans, however, may be used to evaluate the presence and severity of other injuries that may be associated with a concussion. Concussions result in a graded set of symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course; however, it is important to note that in a small percentage of cases symptoms may linger.
Since concussions are a complex pathophysiological process; there are many signs and symptoms, and combinations thereof, which indicate the presence of a concussion. Common symptoms include the following:
The cornerstone of concussion management is physical and cognitive rest until symptoms resolve and then a graded program of exertion prior to medical clearance and return to play (RTP). The recovery and outcome of this injury may be modified by a number of factors that may require more sophisticated management strategies.
As described above, the majority of patients will recover spontaneously over several days. In these situations, it is expected that an athlete will proceed progressively through a stepwise RTP strategy. During this period of recovery while symptomatic following an injury, it is important to emphasize to the athlete that physical AND cognitive rest is required. Activities that require concentration and attention (e.g, scholastic work, video games, text messaging, etc) may exacerbate symptoms and possibly delay recovery. In such cases, apart from limiting relevant physical and cognitive activities (and other risk-taking opportunities for reinjury) while symptomatic, no further intervention is required during the period of recovery, and the athlete typically resumes sport without further problem.
As concussions manifest themselves as functional changes, it is necessary to document an initial point of reference for proper evaluation. High risk sports such as Men's and Women's Basketball, Men's and Women's Soccer and Softball will, as part of their pre-participation physical exam, undergo a baseline test using ImPACT concussion management software.
When a student-athlete exhibits or reports signs or symptoms of a concussion, he or she will be removed from participation for evaluation by a DePaul University athletics trainer. If the student-athlete is practicing or working out and there is no athletic trainer present, the coach or staff member supervising the activity shall remove the student-athlete from participation until he or she can be evaluated by a member of the DePaul University Sports Medicine team.
If the initial evaluation yields findings indicating the sign(s) or symptom(s) are not due to a concussion, but another condition, the student-athlete will be treated according to the appropriate guidelines for that particular assessment. If the initial evaluation yields an assessment of a concussion, the student-athlete will be withheld from the competition or practice and not return to activity for the remainder of that day. Following the initial evaluation, the student-athlete will be monitored to ensure that the injury is stable, ensuring the student-athlete is safely discharged from care for the day. On discharge, the student-athlete will receive written instructions detailing instructions on how to proceed in the event symptoms deteriorate while the student-athlete leaves the training room.
All cases of concussion will be reviewed by a team physician prior to establishing any case-specific, stepwise return to play (RTP) criteria. Prior to beginning the RTP protocol established by the team physician, the student-athlete must be symptom-free when at rest. When following the physician-established stepwise progression, the student-athlete will proceed to the next level only if asymptomatic at the current level. If any post-concussive symptoms occur while in the stepwise program, then the student-athlete shall drop back to the previous asymptomatic level and try to progress again after a 24-hour period of rest has passed.
Final RTP decisions shall be at the discretion of a team physician or a member of the DePaul University Sports medicine team as designated by the team physician.
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