Basketball Manitoba Youth Concussion Protocol Summary
The following is a summary of the BASKETBALL MANITOBA YOUTH CONCUSSION PROTOCOL.
The following is a summary of the BASKETBALL MANITOBA YOUTH CONCUSSION PROTOCOL.
- All youth athletes (<18 years of age), parents, coaches, trainers and officials participating in Basketball Manitoba activities are required to review the Canadian Guideline on Concussion in Sport Pre-season Concussion Education Sheet prior to the first practice of the season. In addition to reviewing information on concussion, it is also important that all sport stakeholders have a clear understanding of the BASKETBALL MANITOBA YOUTH CONCUSSION PROTOCOL.
- In the event that a Basketball Manitoba athlete is suspected to have sustained a head injury or concussion the following procedures must be followed:
- If any athlete is suspected of sustaining a severe head or spine injury during a basketball-related activity, an ambulance should be called immediately to transfer the patient to Children’s Hospital Emergency Department or the nearest hospital for Medical Assessment. If follow-up care is needed, the patient should follow-up with their primary care provider or a referral can be made to the Pan Am Concussion Program.
- If the athlete develops symptoms of a concussion during a basketball game or practice, they must be evaluated immediately at the Children’s Hospital Emergency Department or the nearest emergency room. If follow-up care is needed, the patient should follow-up with their primary care provider or a referral can be made to the Pan Am Concussion Program.
- If the athlete develops delayed concussion symptoms several hours later, the athlete should be evaluated by their primary care provider.
All athletes with a suspected concussion must provide their coach/teacher with a Canadian Guideline on Concussion in Sport Medical Assessment or Medical Clearance Letter before returning to any basketball-related activities.
For more information on the BASKETBALL MANITOBA YOUTH CONCUSSION PROTOCOL please see below for outline of the complete protocol.
For more information on concussion please visit http://www.parachutecanada.org/injury-topics/item/canadian-guideline-on-concussion-in-sport
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BASKETBALL MANITOBA YOUTH
CONCUSSION PROTOCOL
In collaboration with Sport Manitoba, BASKETBALL MANITOBA has developed the BASKETBALL MANITOBA YOUTH CONCUSSION PROTOCOL to help guide the
management of athletes who may have a suspected concussion as a result of
participation in basketball-related activities.
Purpose
This protocol covers
the recognition, medical diagnosis, and management of athletes who may sustain
a suspected concussion during a sport activity. It aims to ensure that athletes
with a suspected concussion receive timely and appropriate care and proper
management to allow them to return back to their sport safely. This protocol
may not address every possible clinical scenario that can occur during
basketball-related activities but includes critical elements based on the
latest evidence and current expert consensus.
This guideline has
been adapted from the Canadian Guideline on Concussion in Sport. However, the
management principles described in these guidelines should also be applied to
children and adolescents who sustain a concussion outside of a sporting
activity and are returning to sports.
Who should use this protocol?
This guideline is
intended for use by all individuals who interact with youth inside and outside
the context of school and non-school based organized sports activity, including
athletes, parents, coaches, officials, teachers, trainers, and licensed
healthcare professionals.
Recommendations
1. Pre-Season Education
Despite recent
increased attention focusing on concussion there is a continued need to improve
concussion education and awareness. Optimizing the prevention and management of
concussion depends highly on annual education of all sport stakeholders
(athletes, parents, coaches, officials, teachers, trainers, licensed healthcare
professionals) on current evidence-informed approaches that can prevent
concussion and more serious forms of head injury and help identify and manage
an athlete with a suspected concussion.
Concussion education
should include information on:
● the definition of concussion,
● possible mechanisms of injury,
● common signs and symptoms,
● steps that can be taken to prevent
concussions and other injuries from occurring in sport.
● what to do when an athlete has suffered a
suspected concussion or more serious head injury,
● what measures should be taken to ensure
proper medical assessment,
● Return-to-School
and Return-to-Sport Strategies, and
● Return-to-Sport medical clearance
requirements
Who: Athletes, parents, coaches, officials, teachers, and trainers, licensed
healthcare professionals
All athletes,
parents, coaches, trainers, and officials are required to review the Canadian Guideline on Concussion in Sport
Pre-season Concussion Education Sheet
prior to the first practice of each season. In addition to reviewing
information on concussion, it is also important that all sport stakeholders
have a clear understanding of the BASKETBALL
MANITOBA YOUTH CONCUSSION PROTOCOL.
2. Head Injury Recognition
Although the formal
diagnosis of concussion should be made following a medical assessment, all
sport stakeholders including athletes, parents, teachers, coaches, teachers,
officials, and licensed healthcare professionals are responsible for the
recognition and reporting of athletes who may demonstrate visual signs of a
head injury or who report concussion-related symptoms. This is particularly
important because many sport and recreation venues will not have access to on-site
licensed healthcare professionals.
A concussion should
be suspected:
● in any athlete who sustains a significant
impact to the head, face, neck, or body and demonstrates ANY of the visual signs of a suspected concussion or reports ANY symptoms of a suspected concussion
as detailed in the Concussion Recognition
Tool 5.
● if an athlete reports ANY concussion
symptoms to one of their peers, parents, teachers, or coaches or if anyone
witnesses a student exhibiting any of the visual signs of concussion.
In some cases, an
athlete may demonstrate signs or symptoms of a more severe head or spine injury
including convulsions, worsening headaches, vomiting or neck pain. If an
athlete demonstrates any of the ‘Red Flags’ indicated by the Concussion Recognition Tool 5, a more
severe head or spine injury should be suspected.
Who: Athletes, parents, coaches, officials, teachers, trainers, and
licensed healthcare professionals
3. Onsite Medical Assessment
Depending on the
suspected severity of the injury, an initial assessment may be completed by
emergency medical professionals or by an on-site licensed health professional
where available.
3a. Emergency Medical Assessment
If an athlete is
suspected of sustaining a more severe head or spine injury during a game or
practice, an ambulance should be called immediately to transfer the athlete to
the nearest emergency department for further Medical Assessment. Coaches, parents, teachers, trainers and
officials should not make any effort to remove equipment or move the athlete
until an ambulance has arrived and the athlete should not be left alone until
the ambulance arrives. After the emergency medical services staff has completed
the Emergency Medical Assessment, the
athlete should be transferred to the nearest hospital for Medical Assessment. In addition, the athlete’s parents should be
contacted immediately to inform them of the athlete’s injury.
Who: Emergency medical professionals
3b. Sideline Medical Assessment
If an athlete is
suspected of sustaining a concussion and there is no concern for a more serious
head or spine injury, the athlete should be immediately removed from the field of play. If a licensed
healthcare professional is present, the athlete should be taken to a quiet area
and undergo Sideline Medical Assessment
using the Sport Concussion Assessment Tool-5 (SCAT5) or the Child SCAT5. The
SCAT5 and Child SCAT5 are clinical tools that should only be used by a licensed
medical professional that has experience using these tools. It is important to
note that the results of SCAT5 and Child SCAT5 testing can be normal in the
setting of acute concussion. As such, these tools can be used by licensed
healthcare professionals to document initial neurological status but should not
be used to make sideline return-to-sport decisions in youth athletes. Any
athlete who is suspected of having sustained a concussion must not return to
the game or practice and must be referred to a medical doctor, nurse
practitioner or physician assistant for Medical
Assessment.
If an athlete is
removed from play following a significant impact but there are NO visual signs
of a concussion and the athlete reports NO concussion symptoms then the athlete
can be returned to play but should be monitored for delayed symptoms.
Who: Athletic therapists, physiotherapists, medical doctor
How: Sport
Concussion Assessment Tool 5 (SCAT5), Child Sport
Concussion Assessment Tool 5 (Child SCAT5)
4. Medical Assessment
In order to provide
comprehensive evaluation of athletes with a suspected concussion, the Medical Assessment must rule out more
serious forms of traumatic brain and spine injuries, must rule out medical and
neurological conditions that can present with concussion-like symptoms, and
must make the diagnosis of concussion based on findings of the clinical history
and physical examination and the evidence-based use of adjunctive tests as
indicated (i.e CT scan). In addition to nurse practitioners and physician assistants,
medical doctors[1] that
are qualified to evaluate patients with a suspected concussion include
pediatricians, family medicine, sports medicine, emergency department and
rehabilitation (physiatrists) physicians as well as neurologists and neurosurgeons.
In geographic regions of Manitoba or Canada with limited access to medical
doctors (i.e. rural or northern communities), a licensed healthcare
professional (i.e. nurse) with pre-arranged access to a medical doctor or nurse
practitioner can facilitate this role. The Medical
Assessment is responsible for determining whether the athlete has been
diagnosed with a concussion or not. All athletes with a diagnosed concussion
should be provided with a Canadian
Guideline on Concussion in Sport Medical
Assessment Letter indicating a concussion has been diagnosed. Athletes that
are determined to have not sustained a concussion must be provided with a Medical Assessment Letter indicating a
concussion has not been diagnosed and the athlete can return to school, work
and sports activities without restriction.
Who: Medical doctor, nurse practitioner, physician assistant, nurse
5. Concussion Management
When an athlete has
been diagnosed with a concussion, it is important that the athlete’s
parent/legal guardian is informed. All athletes diagnosed with a concussion must
be provided with a standardized Canadian
Guideline on Concussion in Sport Medical Assessment Letter that notifies
the athlete and their parents/legal guardians/spouse that they have been
diagnosed with a concussion and may not return to any activities with a risk of
concussion until medically cleared to do so by a medical doctor, nurse
practitioner, or physician assistant. Because the Medical Assessment Letter contains personal health information, it
is the responsibility of the athlete or their parent/legal guardian to provide
this documentation to the athlete’s coaches, trainers, teachers, or employers.
It is also important for the athlete to provide this information to sport or
school organization officials that are responsible for injury reporting and
concussion surveillance where applicable.
All athletes
diagnosed with a concussion should be provided with education about the signs
and symptoms of concussion, strategies about how to manage their symptoms, the
risks of returning to sport without medical clearance and recommendations
regarding a gradual return to school and sport activities. Athletes diagnosed
with a concussion are to be managed according to their Return-to-School and Sport-Specific Return-to-Sport Strategy under
the supervision of a medical doctor, nurse practitioner, or physician assistant. When available, athletes should be
encouraged to work with the team athletic therapist or physiotherapist to
optimize progression through their Sport-Specific
Return-to-Sport Strategy. Once the athlete has completed their Return-to-School and Sport-Specific
Return-to-Sport Strategy and are deemed to be clinically recovered from
their concussion, the medical doctor, nurse practitioner, or physician
assistant can consider the athlete for a return to full sports activities.
Return-to-School Strategy
The following is an
outline of the Return-to-School Strategy
that should be used to help athletes, parents, and teachers to collaborate in
allowing the athlete to make a gradual return to school activities. Depending
on the severity and type of the symptoms present athletes will progress through
the following stages at different rates. If the athlete experiences new
symptoms or worsening symptoms at any stage, they should go back to the
previous stage.
Stage
|
Aim
|
Activity
|
Goal of each step
|
1
|
Daily
activities at home that do not give the student-athlete symptoms
|
Typical
activities of the child during the day as long as they do not increase
symptoms (i.e. reading, texting, screen time)
Start
at 5-15 minutes at a time and gradually build up
|
Gradual
return to typical activities
|
2
|
School
activities
|
Homework,
reading or other cognitive activities outside of the classroom
|
Increase
tolerance to cognitive work
|
3
|
Return
to school part-time
|
Gradual
introduction of schoolwork. May need to start with a partial school day or
with increased breaks during the day
|
Increase
academic activities
|
4
|
Return
to school full-time
|
Gradually
progress
|
Return
to full academic activities and catch up on missed school work
|
Return-to-Sport Strategy (Basketball)
The following is an outline of the Return-to-Sport Strategy that should
be used to help athletes, coaches, trainers, teachers and medical professionals
to partner in allowing the athlete to make a gradual return to sport
activities. An initial period of 24-48 hours of rest is recommended before
starting the Sport-Specific
Return-to-Sport Strategy. If the athlete experiences new symptoms or
worsening symptoms at any stage, they should go back to the previous stage. It
is important that athletes return to full-time school activities before
progressing to stage 5 and 6 of the Sport-Specific Return-to-Sport Strategy. It
is also important that all athletes provide their coach with a Canadian Guideline on Concussion in Sport
Medical Clearance Letter prior to
returning to full contact sport activities.
Stage
|
Aim
|
Activity
|
Goal of each step
|
1
|
Symptom-limiting
activity
|
Daily activities that do not provoke
symptoms (free throw shooting, form shooting, basic ball handling /
dribbling)
|
Gradual reintroduction of
work/school activities
|
2
|
Light
aerobic activity
|
Walking or stationary cycling at slow to
medium pace. No resistance training (on the move shooting with walking or
slow run to shooting spots, medium pace layups, on the move ball handling
drill that involve cutting and acceleration and deceleration.
|
Increase heart rate
|
3
|
Sport-specific
exercise
|
Low to moderate intensity individual
running, agility, shooting and passing drills. No team drills or head impact
activities ; 1 on 0 moves with the ball, (imaginary 1v1 but 1 on 0), decision
making drill work (shooting, attacking and moves 1v0) - these moves in
addition to the actions in level 2)
|
Add movement
|
4
|
Non-contact
training drills
|
High intensity running, agility,
shooting, and passing drills. Non-contact individual and team drills. May
start progressive resistance training. No head impact activities ; same as
level 3 but at a higher rate of speed and intensity as well as duration. Add in multiple player skill and decision
making drills.
|
Exercise, coordination and
increased thinking
|
5
|
Full
contact practice
|
Following medical clearance
High intensity full contact practice and
drills including head impact activities; full practice with competitive drill
work inclusive of 1v1 to 5v5 mimicking a game like environment.
|
Restore confidence and assess
functional skills by coaching staff
|
6
|
Return
to sport
|
Normal game play
|
Who: Medical doctor, nurse practitioner, physician assistant and team
athletic therapist or physiotherapist (where available)
How: Return-to-Learn Strategy,
Sport-Specific Return-to Sport Strategy, Canadian
Guideline on Concussion in Sport Medical
Assessment Letter, Canadian
Guideline on Concussion in Sport Medical Clearance Letter
6. Multidisciplinary Concussion Care
Most athletes who
sustain a concussion while participating in sport will make a complete recovery
and be able to return to full school and sport activities within 1-4 weeks of
injury. However, approximately 15-30% of individuals will experience symptoms
that persist beyond this time frame. Youth athletes who experience persistent
post-concussion symptoms (>4 weeks) may benefit from their primary care provider
making a referral to the Pan Am Concussion Program, a medically-supervised
multi-disciplinary pediatric concussion clinic that has access to professionals
with licensed training in traumatic brain injury that include experts in
neurosurgery, sport medicine, neuropsychology, physiotherapy, and neurology.
Referral to a
multidisciplinary clinic for assessment should be made on an individualized
basis at the discretion of the athlete’s medical doctor, nurse practitioner, or
physician assistant.
Who: Multidisciplinary medical team, medical doctor with clinical training
and experience in concussion (e.g. a sports medicine physician, neurosurgeon,
or rehabilitation medicine physician), licensed healthcare professionals
7. Return to Sport
Athletes who have
been determined to have not sustained a concussion and those that have been
diagnosed with a concussion and have successfully completed their Return-to-School and Sport-Specific
Return-to-Sport Strategy can be considered for return to full sports activities.
The final decision to medically clear an athlete to return to full game
activity should be based on the clinical judgment of the medical doctor, nurse
practitioner, or physician assistant taking into account the athlete’s past
medical history, clinical history, physical examination findings and the
results of other tests and clinical consultations where indicated (i.e
neuropsychological testing, diagnostic imaging). Prior to returning to full
contact practice and game play, each athlete that has been diagnosed with a
concussion must provide their coach/teacher with a standardized Canadian Guideline on Concussion in Sport
Medical Clearance Letter that specifies that a medical doctor, nurse
practitioner, or physician assistant has personally evaluated the athlete and
has cleared the athlete to return to sports. In geographic regions of Manitoba
and Canada with limited access to medical doctors (i.e. rural or northern
communities), a licensed healthcare professional (such as a nurse) with
pre-arranged access to a medical doctor or nurse practitioner can provide this
documentation. A copy of the Canadian
Guideline on Concussion in Sport Medical Clearance Letter should also be
submitted to sports organization officials that have injury reporting and
surveillance programs where applicable.
Athletes who have
been provided with a Medical Clearance
Letter may return to full sport activities as tolerated. If the athlete
experiences any new concussion-like symptoms while returning to play, they
should be instructed to stop playing immediately, notify their parents,
coaches, trainer or teachers, and undergo follow-up Medical Assessment. In the event that the athlete sustains a new
suspected concussion, the BASKETBALL
MANITOBA YOUTH CONCUSSION PROTOCOL should be followed as outlined here.
Who: Medical doctor, nurse practitioner, physician assistant
For more information on concussion and how to download the Concussion
Recognition Tool 5, SCAT5 & Child SCAT5 please visit http://www.parachutecanada.org/injury-topics/item/canadian-guideline-on-concussion-in-sport
BASKETBALL MANITOBA YOUTH
CONCUSSION PATHWAY
[1] Medical
doctors and nurse practitioners are the only healthcare professionals in Canada
with licensed training and expertise to meet these needs; therefore all
athletes with a suspected concussion should undergo evaluation by one of these
professionals.