A concussion is the disruption of normal brain function due to either a direct blow to the head, face and neck, or an indirect blow or jolt to another part of the body that transmits an “impulsive” force to the brain. Some concussions may result in a loss of consciousness. However, loss of consciousness is not the defining characteristic of a concussion.

It is imperative that the brain have enough time to heal in order to prevent any further trauma or permanent damage. Rest must always come in the form of ceasing all physical activity, but may also involve a break from challenging cognitive activity as well.

Information in this definition was obtained from the Concussion in Sports Consensus Statement, provided by the Concussion in Sports Committee, as an extension of the Brain Injury Association of New Jersey, Inc.

Signs (observable behaviors) that may be present with concussions:

• Appears to be dazed or stunned
• Is confused about time, date, location
• Is unable to remember what he/she did prior to or after the injury
• Has altered balance
• Is slow to answer questions
• Displays a personality change
• Has altered sleep patterns
• Is vomiting
• Experiences loss of consciousness (not present in all concussions)

Symptoms (experienced and reported by the athlete) that may be present with concussions:

• Headache
• Nausea
• Dizziness
• Double or fuzzy vision or any other visual alteration
• Sensitivity to light and/or noise
• Feeling sluggish or slow
• Feeling “foggy” or in a “funk”
• Difficulty in concentrating when reading, listening or speaking
• Extreme fatigue

Taken from the University of Pittsburgh Medical Center, UPMC Sports Medicine, Sports Concussion Program.

Proper management of concussion is the best form of prevention of serious injury. Most important is prevention of Second Impact Syndrome – a catastrophic increase in intracranial pressure leading to massive brain swelling, herniation and death. This syndrome occurs in athletes up to 14 days post-concussion and when an athlete returns to competition prior to the complete resolution of symptoms. Therefore the following concussion protocols are utilized at Hunterdon Central:

1) Any student/athlete diagnosed with concussion are removed from competition.

2) No students with concussion are allowed to return to play in the current game.

3) All concussions are referred for medical evaluation following the injury.

4) Stepwise return to play:
a. No physical activity; rest until asymptomatic
b. Light aerobic exercise is supervised by the athletic trainer
c. Non-contact drills until 1 week post-injury
d. Return to contact sports after minimum of 1 week post-injury and completely asymptomatic (neurocognitive testing will now be used to assess return-to-play).
e. Any recurrence of concussive symptoms should lead to the athlete dropping back to the previous level.

5) An athlete with 2 concussions per season will be removed from contact sports for the remainder of that season. Return to play will require neurocognitive testing and approval by the school medical inspector.

6) An athlete with a history of 3 or more concussions is highly recommended to avoid contact sports. Participation will require neurocognitive testing and be at the discretion of the school medical inspector.

• Mild concussions (“bell ringers”) do not require loss of consciousness. Presenting symptoms may include headache, nausea, balance problems, photosensitivity, fatigue, foggy or sluggish feeling, change in sleep patterns and cognitive changes.

• Cutting edge research suggests that a concussion produces metabolic, rather than anatomic, injury to the brain, making CT scanning and MRI insensitive to the physiological changes in the concussed brain.

• An athlete who sustains a concussion is 4-6 times more likely to sustain a second concussion.

• Effects of a concussion are cumulative in athletes who return to play prior to complete recovery.

• High school athletes with a history of 3 or more concussions are up to 9 times more likely to have more severe symptoms following subsequent concussions.

• Post-concussion syndrome can involve decreased processing speed, short term memory impairment, concentration deficit, depression/irritability, fatigue/sleep disturbance, and academic difficulties.

More information on concussions can be obtained from the following website: www.sportsconcussion.com

ImPACT (Immediate Post Concussion Assessment and Cognitive Testing), is a software tool which was developed by the University of Pittsburgh Medical Center (UPMC). ImPACT is used in many professional, collegiate and high school sports programs across the country, to successfully diagnose and manage concussions. If an athlete is believed to have suffered a head injury, ImPACT is used to help determine its severity and help monitor the healing process.

During pre-season, before any physical contact is sustained, an athlete takes a 30-minute computerized test that measures brain processing, speed, memory and visual motor skills. The ImPACT testing procedures are non-invasive and pose no risks to your son/daughter. The results are collected and stored by our athletic trainers and physician. If an athlete experiences a head injury or concussion during the season, he/she is re-tested and the result is compared to the preseason baseline data. Doing this allows physicians to determine the athlete’s neurocognitive status and determine when it is safe for the player to return to active sports.

If an injury of this nature occurs to your son or daughter, you will be promptly contacted with all the details. The pre-season and post-injury test data may be sent to a neuropsychologist or neurosurgeon at the University of Pittsburgh Medical Center (UPMC) to help evaluate the injury. The information can also be shared with an athlete’s physician. The test data will enable these health professionals to determine when return-to-play is appropriate and safe for an injured athlete.

In order to ensure your child’s anonymity, we have set up and use an anonymous data submission system. The anonymous information gathered from the ImPACT program may also be used in studies currently being conducted by both Hunterdon Central and the University of Pittsburgh Medical Center.

Athletes who plan to participate in any of the following sports must complete the ImPACT baseline evaluation on-line, prior to the start of pre-season:

Fall:
Cheerleading
Cross Country
Football
Field Hockey
Gymnastics
Soccer
Volleyball (girls)

Winter:
Basketball
Ice Hockey
Pole Vaulting
Wrestling

Spring:
Baseball
Lacrosse
Pole Vaulting
Softball
Volleyball (boys)

Your son/daughter will only need to complete ONE baseline evaluation for the 2010-2011 school year, regardless of how many sports they plan to play during the year.

ImPACT must be completed by an athlete online at prior to the start of pre-season training. To take the ImPACT Test, please go to this website - copy and paste the link into your browser: www.impacttestonline.com/schools

PLEASE NOTE: ANY ATHLETE COMPLETING THE BASELINE TEST ONLINE MUST ENTER THIS CODE IN ORDER TO GAIN ACCESS TO THE SITE: 5260169296

A student athlete will not be allowed to participate in any activity with an increased chance of head injury until the baseline evaluation has been completed and One Form has been signed and submitted, indicating compliance with this regulation.

Student athletes and their parents/guardians must review the Concussion Information on the Sports Medicine & Athletic Training Webpage before signing and submitted One Form. Student athletes required to take the ImPACT test are also required to complete the ConcussionWise course for students and return the certificate of completion to the athletic trainer or head coach on the first day of pre-season. Student athletes may access the ConcussionWise course here: http://concussionwise.com

If you have questions about the ImPACT program, please contact our Athletic Trainers, Karen Manfre at 908-284-7131 or Anthony Riccardella at 908-284-7214, or our school physician, Dr. James Barr, at (908) 788-9468.