Concussion Checklist

Concussion safety starts with smart policy. Our concussion experts have identified 10 critical items that academic and athletic organizations must address when implementing concussion safety protocols. Need a hand getting started? A Concussion Legacy Foundation program specialist can help you evaluate your program focusing on these 10 areas, and help make you a leader in concussion safety. Contact us to get started today.

1. Education
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Concussion prevention, diagnosis, and recovery requires a team effort—everyone needs to know their role. We recommend concussion education for athletes, parents, coaches, administrators, referees, and school staff. Click here for more information about Concussion Legacy Foundation educational programs. The CDC also offers several online programs.

2. Prevention
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Concussion prevention is too often overlooked. This area provides the most significant opportunity for improvement. Research at the high school and collegiate level using head impact sensors has shown us that changes to practice style can greatly reduce overall brain trauma. Use of age-appropriate rules and the strengthening of neck muscles can also reduce the number of concussions and overall brain trauma an athlete sustains. 

3. Remove from play
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When a concussion occurs, the first critical step is recognizing the injury and getting the athlete out of the game immediately. Research shows that we fail to identify the majority of concussions, and failing to identify injuries increases the risk of negative health outcomes including additional injury, post concussion syndrome, and second impact syndrome. Proper remove-from-play training and policies, which include objective sideline testing, can help keep athletes safer. We recommend building your remove-from-play protocol beginning with the King-Devick Test, which has been shown to identify 90% of sports concussions in under two minutes when used. Contact us to learn more about other protocols appropriate for your program.

4. Return to life
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Concussion recovery requires rest and support at home. Daily life is full of demands that can hinder progress, and emotional symptoms can cause temporary crises for which families need to be prepared.  We recommend training family members so they can identify warning signs and learn to support a loved one with an invisible brain injury. Designating a Concussion Caretaker can ensure someone is always responsible for the injured athlete. 

5. Return to school
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Concussion recovery requires cognitive rest, and back-to-school can mean back-to-symptoms if mismanaged. Balancing the needs of the patient with the pressure of keeping up with classwork requires education and coordination of care among doctors, parents, teachers, administrators, and school nurses. Effective communication strategies between stakeholders and a variety of academic accomodations are essential to ensuring that the transition goes smoothly.

6. Return to play
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Knowing when it’s safe to get back in the game helps prevent re-injury and a prolonged recovery. Baseline testing and graduated return to play under the supervision of a medical professional can help make sure athletes aren’t at risk of going back too soon. Rushing the return to play decision puts athletes at greater risk for prolonged recovery and potential catastrophic outcomes.

Sample graduated return to play protocol following concussion

Rehabilitation stage Functional Exercise Objective
1. No activity Complete physical and cognitive rest Recovery
2. Light Aerobic Activity Walking, swimming, stationary cycling. Mild intensity Increase heart rate
3. Sport Specific Activity Running or skating drills. No head impact activities Add movement
4. Non-contact training drills Progression to more complex training drills Exercise, coordination, cognitive load
5. Full contact practice Normal training activities following medical clearance Restore confidfencve, assesment of functional skills by coaching staff
6. Return to play Normal game play  

*Return to play plans should always be developed and supervised by trained medical professionals.

7. Medical Infrastructure
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In a perfect world, there would be a doctor present wherever there was a risk of injury. Professional sports teams have the resources to have a certified athletic trainer and concussion expert at every game, but the lack of resources and commitment at the youth level leaves children vulnerable. Investing in an athletic trainer and creating an Emergency Action Plan can pay enormous dividends in concussion prevention and care. 

8. Equipment
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No helmet can prevent every concussion, and it is critical for athletes to understand the limited safety they provide. In addition to following manufacturer guidelines on use and fit, the Concussion Legacy Foundation recommends monitoring overall brain trauma by including Hit Count certified impact sensors as an integral part of athletic equipment.

9. Rules and penalties
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Rules, rule enforcement, and penalties are a useful tool in preventing behaviors that may increase risk of concussion. Exploring how other leagues have introduced refereeing points of emphasis on safety can help your program protect athletes better.

10. Playing area and surfaces
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Research shows playing areas affect the risk of concussion, and yet most surfaces were created without concussion safety in mind. The Concussion Legacy Foundation recommends programs regularly audit playing surfaces, including annual G-max testing for turf fields and regular inspection of hockey boards for safety.

To read more about the role of synthetic turf in concussion, read the White Paper.

Leading to a Safer Future

Contact Us

Concussion Legacy Foundation
(Formerly Sports Legacy Institute)
230 2nd Avenue, Suite 200
Waltham, MA  02451

(T) 781.790.1921 | (F) 781.790.8922
info@concussionfoundation.org

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