Concussion Education
A concussion is: a traumatic brain injury (TBI) that occurs when the head hits an object, a moving object hits the head, or the head is jarred during a whiplash related injury. Effects of a concussion are bad headaches, altered levels of consciousness, or unconsciousness. Affects from a concussion can influence memory, judgment, reflexes, speech, balance, coordination, and sleep patterns.
Concussion symptoms
-Fuzzy or blurry vision
-Nausea and vomiting
-Sensitivity to light or noise
-Balance problems
-Feeling tired or having no energy

-Not thinking clearly
-Feeling slowed down
-Not being able to concentrate
-Not being able to remember new information

-Easily upset or angered
-Nervous or anxious
-More emotional than usual

-Sleeping more than usual
-Sleeping less than usual
-Having trouble falling asleep
Who to talk to if you are experiencing any of these symptoms:
an Athletic Trainer, your coach, your counselor, anyone at the Health Center
Culver Academies' Learning and Activity protocols
Return to Learn Protocol:
Student will see psychologist
Student will be put on academic accommodations ranging from complete and total rest, to partial class time, to full class time with limited homework and anywhere in between.

Return to Play Protocol:
Student will start Concussion Rehabilitation with Athletic Training Staff
Once student is released from Physician the student will partake in 3 day protocol
Day 1: a strenuous, exertional test that focuses on cardio, upper body,
lower body, and core strengthening.
Day 2: practice with no contact
Day 3: practice full, no games
Day 4: full release, no restrictions
What is your name (Last, First)?
Your answer
What is your current grade level here at Culver Academies?
After contact (a hit or blow to the head), have you ever felt “slow” while participating in activity?
After contact (a hit or blow to the head) have you ever had ringing in the ears or blurred vision during activity?
Has contact (a hit or blow to the head) during an activity ever disrupted your sleep?
Have you ever been diagnosed with a concussion?
If you have been diagnosed with a concussion/s, what was the date of the most recent diagnosis? (month, year)
Your answer
Are you currently being treated for a concussion? (Taking medications, seeing a doctor, on restrictions, etc.)
Do you have ADD/ADHD? (Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder)
Has Culver Academies explained the concussion program with you thoroughly enough for you to understand its purpose?
Do you understand that if you experience any concussion like symptoms, YOU need to report what you’re experiencing to an Athletic Trainer, Coach, Nurse and/or trained medical personnel?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service