We acknowledge that when it comes to the well-being of student-athletes, there are a number of people who each play a significant role. No one person is any more important than another when dealing with the safety concerns of a student-athlete and if any one of the partners fails to fulfil their responsibilities that failure may have life-altering consequences on a student-athlete who suffers from a concussion.

THE SCHOOL LEADER

It is clear from the outset that the School Leaders will have the ultimate responsibility for bringing this program to life within their school. School Leaders will provide direction with respect to administration, record keeping and monitoring of the program at their school. They will not be required to perform all of the tasks, but they will be responsible for delegating authority and responsibilities to appropriate members of their staff.

The official School Leader of a secondary school should be the Principal, who is already the person ultimately responsible for everything that goes on at the school and is therefore the person who is legally responsible for student well-being and achievement. The School Leadership Committee at a secondary school should consist of the Principal, Vice-Principal and Physical Department Head of the school. Together they will be responsible for overseeing the implementation of the Student-Athlete Concussion Management Program at the school.

The official School Leader of a post-secondary institution should be the Athletic Director, who is already the person who is responsible for everything that goes on in the Athletic Department.  The School Leadership Committee at a post-secondary school will consist of the Athletic Director plus two or more persons who will be appointed by the Athletic Director to assist him/her in the administration of the Student-Athlete Concussion Management Program.

The official leader of a minor sport organization should be the Executive Director of the association. The Leadership Committee could be two other senior staff members or two members of the Board of Directors.

THE TEAM COACH

For secondary schools operated by the school board, all members of the coaching staff for each of the designated teams, including community volunteer coaches, should participate in a special inaugural training workshop facilitated by one of the School Leaders.

For post-secondary institutions, we recommend that all members of the coaching staff and any other person who may be involved with any of the designated teams be invited to attend a special inaugural training workshop which will be conducted by the Athletic Director and the other members of the School Leadership Committee.

For minor sport organizations, the issue of who will be authorized to do the training and administration of computerized testing is one that must be addressed. There should be some consistency in order to ensure that the standards are being met throughout the system.

THE STUDENT-ATHLETE

All student-athletes who wish to participate on a designated school team where there is an inherent risk of concussion (which includes just about all teams or activities) should be required to successfully complete the Training Course at least once. In addition, it is recommended that the student-athlete must have completed a valid ImPACT Baseline evaluation that will be no older than two years by the end of the up-coming sports season.

THE PARENTS/GUARDIANS

Once again, we acknowledge that the situation will be somewhat different when it comes to student-athletes attending post-secondary institutions, but nonetheless, parents/guardians will play a very important role when it comes to the concussion identification and post-injury rehabilitation protocol of the Student-Athlete Concussion Management Program. In fact, it is our position that the parent/guardian perhaps plays the most important of all roles in the program, especially at the secondary school level. After all, it is the parent/guardian who knows his/her child best and should be the first to notice signs and symptoms of brain injury.

While we do not recommend making it mandatory for the parents/guardians to physically attend a training session, we do suggest that parents/guardians be asked to sign a declaration form that indicates that they are aware of the elements of the Student-Athlete Concussion Management Program and encourage them to read the information that is found on the school board web site. The Steering Committee should develop a self-directed program plan that will provide Parents/Guardians with the full benefit of the concussion management curriculum. The only thing missing will be the facilitator who will be able to witness and verify the parent/guardian’s participation.

We also recommend that School Leaders hold at least one Parents/Guardians information session each school year where they will go over the elements of the Student-Athlete Concussion Management Program and raise the awareness level of the seriousness of concussions, especially among young people. This may be a special session that is sponsored by the Parent Council of the school.

Training of parents/guardians involved with a minor sport organization may be easier to accomplish since parents/guardians often accompany their children to the sporting events, games and practices.

CLASSROOM TEACHERS & PROFESSORS

The Student-Athlete Concussion Management Program recognizes that during the rehabilitation process a student-athlete will still be expected to meet certain responsibilities as a student. Because of this, we recommend preparing a comprehensive guide for classroom teachers and professors that will help them make necessary accommodations and adjustments for student-athletes with sport-related concussions. We also recommend that School Leaders at the secondary school level hold a workshop training session during a professional activity day once every year or two in order to help classroom teachers become better prepared to meet the challenges of working with student-athletes following a concussion.

SPORT MEDICINE SPECIALISTS

When it comes to post-secondary school varsity sports, we understand that most teams will have their own team sport medicine doctor and/or certified athletic therapist or trainer. Therefore, much of what follows will be more applicable to secondary schools being operated by school boards. However, it is possible that some post-secondary institutions do not have their own “team doctor” and may be relying on a trainer or therapist as their primary on-site medical professional.

In any case, we recommend that each school, at either level implementing the Student-Athlete Concussion Management Program should make arrangements with one or more local sports medicine specialists in the community who have experience in dealing with sport-related concussions. The arrangement should allow for any student-athlete who is suspected of suffering a concussion to receive priority appointments upon request for a thorough examination to determine if there are any structural damages caused by the brain trauma.

CONSULTING NEUROPSYCHOLOGIST

We believe that the inclusion of a neuropsychological baseline and post-injury assessment is critical to helping in the identification of a concussion and then to monitor the recovery progress during the rehabilitation period, and we also believe that these assessments should be done under the supervision of a licensed neuropsychologist. If a school board or post-secondary institution is going to include neuropsychological assessment, then we recommend that the school board find a local neuropsychologist who is familiar with that particular form of testing. This is the type of injury that requires the attention of a specialist who is familiar with the workings of the brain.

CONCLUSION

The Partner Approach which is a fundamental element of the Student-Athlete Concussion Management Program Development Guide is an example of creative innovation which simply requires a willingness to think differently about the things we already know. There is nothing new in what we have presented in this Program Development Guide, but we feel we have designed a model which will facilitate healthy discussion and collaboration among steering committee members in arriving at a student-athlete concussion management program which will meet the needs of all school boards, post-secondary institutions and minor sport organizations in Canada and the United States and will provide a standard of care which will ensure the well-being of all student-athletes.

Most concussion management programs require a medical practitioner’s clearance before a student-athlete is permitted to return to competition following a concussion. Further, most programs indicate that it is only a health-care provider who can identify a concussion, which is why a health-care provider must provide a signed statement declaring that a person has recovered from the concussion before returning to play.

Unfortunately, more and more doctors are choosing to refer patients who come to them with concussion-like symptoms, to sport medical specialists who have experience dealing with concussions. Some doctors now realize that the nature of concussions makes it difficult for them to know exactly when it is safe for a student-athlete to return to play. If this trend continues, it is going to become extremely difficult for a student-athlete to find an available medical practitioner to provide him/her with the clearance needed in order to return to play. There just are not enough sports medicine specialists available. If student-athletes have trouble getting in to see a doctor, we will soon find coaches and parents/guardians choosing to avoid even attempting to see a doctor except for the most severe of cases. In most instances, the student-athlete does not even feel symptoms by the time he/she gets home from the game or practice and in other cases, the brain damage continues to grow over the days and weeks following the injury, often well after a doctor has provided the clearance to return to play.

The Partnership Approach to concussion management recognizes the fact that a medical practitioner is very limited in what he/she can identify when it comes to a possible concussion. A doctor can diagnose the physical and structural damages such as a fractured skull, swelling of the brain tissue, internal bleeding in the brain from broken blood vessels, and damage to the neck muscles, to name a few, by using MRI and CT scans or by physical examination of the patient. But a doctor is unable to observe the sleep patterns of the patient, or the cognitive deficiencies in the classroom, or the emotional difficulties that have arisen since the injury. When examined by a doctor, a student-athlete may answer a series of questions about how he/she is feeling, but relying upon self admission of symptoms has been found to be very unreliable when it comes to concussions because up to 80% of all concussion victims are not even fully aware of their symptoms.

Therefore, in order to properly identify a concussion we feel it is incumbent upon everyone around a student-athlete to be constantly on the look out for signs, symptoms and behaviours consistent with concussion if there is any reason to believe that the student-athlete suffered a blow to the body or head that may have transferred enough force to the brain to cause a concussion. If we really want to protect our youth against potential life-altering consequences from concussion, we must spread the responsibility among all of the partners who have an interest in the student-athlete.

That includes the parent/guardian, the coach, the classroom teacher, the school principal, the health care professional, the medical doctor, the neuropsychologist, and most importantly, the student-athlete him/herself. Each has a role to play in both the identification and rehabilitation process. We can no longer ignore our individual responsibilities and simply place the onus on the medical doctor. A doctor can only do so much because he/she is not able to observe the patient on a continuous basis. A parent/guardian is in a much better position to notice changes in their child. A classroom teacher is in a much better position to notice emotional and cognitive deficiencies in the student-athlete. A coach is in a much better position to notice sport specific symptoms during a progressive return to play training procedure.

And since the school principal is ultimately responsible for the well-being of the students enrolled at the school, the school principal should reserve permission to return to play until he/she has evidence from the doctor, the parent/guardian, the classroom teachers, the coaches, the neuropsychologist, and the student-athlete that symptoms have subsided and are no longer being generated by physical or cognitive exertion. Only then should the School Leadership Committee (Principal, Vice-Principals and Phys. Ed. Department Head) be prepared to make a decision about giving a student-athlete permission to return to play.

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