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ALEXANDRIA CITY PUBLIC SCHOOLS

COMPLIES WITH CODE OF VIRGINIA AND VIRGINIA BOARD OF EDUCATION REQUIREMENTS RELATED TO CONCUSSION, SUDDEN CARDIAC ARREST, AND HEAT-RELATED ILLNESS EDUCATIONAL PROGRAMS​

PARENT/GUARDIAN AND STUDENT-ATHLETE

HEALTH EDUCATION PROGRAM

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INTRODUCTION

PROGRAM

OVERVIEW

Virginia’s Student-Athlete Protection Act (Code of Virginia 22.1-271.5)requires completion of a concussion education program by parents/guardians and students before the student can participate in school-sponsored athletics​

• Concussion management
• Infectious disease prevention
• Sudden Cardiac Arrest
• Environmental conditions (lighting, heat and cold
• Mental health (depression, suicide)

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Communication is critical!

WHAT’S INVOLVED IN CONCUSSION MANAGEMENT?

Education

Recognition

Evaluation

Treatment

Return to

Learn

Return to

Play

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WHAT IS A

CONCUSSION?

• May be caused by a direct blow to the head, face, neck or elsewhere onthe body​
• Concussion is not usually associated with structural damage to the brain; Routine imaging (CT scans, MRIs, x-rays) likely normal​
• Typically features rapid onset of symptoms that may evolve over minutes, hours or days​
• Concussion may or may not involve a loss of consciousness (LOC)​
• Concussion results in a wide range of symptoms lasting a few minutes, days, weeks, months or longer in some cases​

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“A Sport related concussion is a traumatic brain injury​ induced by biomechanical forces.”

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(Berlin 5th Consensus Statement on Concussion in Sport, 2016)​

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RECOGNIZING A CONCUSSION

• Early recognition of symptoms is essential to safe, effective concussion management​
• If a concussion is suspected, the student should stop activity and report the injury to an athletic trainer or another adult immediately​
• Symptoms may occur immediately following the trauma to the head/body, develop hours or even days later, and change over time​
• Visits to the hospital are necessary when signs and symptoms worsen in the hours following the injury​
• A negative or “normal” CT scan or MRI does NOT mean you do not have a concussion​

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COMMON CONCUSSION SIGNS AND SYMPTOMS

PHYSICAL

BEHAVIORAL/

EMOTIONAL

SLEEP

COGNITIVE

• Headache​
• Nausea/vomiting​
• Dizziness​
• Balance problems​
• Vision/hearing problems​
• Fatigue​
• Sensitivity to light/noise​

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• More emotional​
• Irritability​
• Depression/Anxiety​
• Anger/easily frustrated​
• Nervousness​
• Apathetic​
• Impulsivity​

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• Confusion​
• Feeling “foggy”​
• Feeling slowed down​
• Difficulty concentrating​
• Difficulty with communication, reading/writing​
• Difficulty with problem solving and planning​
• Memory loss​

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• Drowsiness​
• Sleeps too much​
• Sleeping too little​
• Trouble falling asleep​

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WHEN TO RUSH TO THE HOSPITAL

These are signs of a MEDICAL EMERGENCY!

• Headaches that worsen​
• Repeated vomiting​
• Seizures​
• Neck pain​
• Very drowsy​

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• Significant irritability​
• Unusual behavior changes​
• Slurred speech​
• Weakness/numbness inarms/legs

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If symptoms get worse following the injury

CALL 911 or GO TO THE HOSPITAL​

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QUICK REVIEW

WHEN IN DOUBT, SIT IT OUT

Trauma

Signs/Symptoms or

“Feeling Different”

Remove from activity,

Rest, and Report

• Suspect a concussion if a student:
• BEHAVES DIFFERENTLY following trauma to the head or body​
• EXPERIENCES SYMPTOMS (headache, light sensitivity, etc.)​
• HAS TROUBLE CONCENTRATING OR SLEEPING​

• Remove from activity and seek further evaluation and care from a licensed medical professional

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FOLLOWING A CONCUSSION...

Keep the student home from school if they experience

• Trouble sleeping
• Persistent headache
• Sensitivity to light/noise
• Feeling foggy
• Dizziness or lightheadedness
• More irritable than usual

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-Do not use any medication unless directed by a medical professional

Is it ok to send your child to school if he or she

• Slept well
• Wakes up headache-free
• Wakes up feeling “normal”

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-Your child may experience a return of symptoms during class

• Please be prepared to pick your child up and take them home to rest

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Please provide any documentation related to the student’s concussion with the appropriate school staff member(s) and the MS Athletic Coordinator

• Notes, treatment recommendations, academic or athletic participation instructions

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KEYS TO CONCUSSION

TREATMENT

• Physical and Cognitive rest
• Minimizing physical and mental activities early on helps promote brain recovery
• Avoid further trauma/injury to the brain
• Sleep is helpful- no need to awaken during the night
• Limit stress and anxiety
• Progressive return to academic and athletic activities
• Effective communication
• Parents/guardians, medical professionals and school staff should share information on a regualr basis
• Don’t do anything that makes symptoms worse!

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PARENT’S ROLE

• Recognize and report any signs and symptoms or changes in behavior to the student’s medical provider
• Parents are urged to support the recommended modifications for progressive return to academics and physical activity
• Continue to provide feedback, share observations with school staff (counselors, teachers, etc.)

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STUDENT-ATHLETE’S ROLE

• Be aware of signs and symptoms​
• Understand importance of recognition​
• Don’t hide it, report it!​
• Be AWARE of teammates on and off the field, specifically any behavior that is out of the ordinary for them​
• REPORT problems​
• Friends don’t let friends play with signs of a concussion​

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WHAT IS RETURN TO LEARN?

• Systematic/progressive reintroduction of cognitice and academic activites
• Usually includes a series of distinct stages lasting days or weeks, occasionally longer and may include the following:
• Rest at home, limited school attendance
• Changes in the amount/type of schoolwork and tests
• Increased levels of academic and instrucitonal support

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HOW DOES RETURN TO LEARN WORK?

• Collaborative effort involving the student, his or her parents/guardians, medical professionals and school staff​
• Effective communication is critical!​
• As the student recovers, academic demands are increased in a gradual, progressive fashion​
• Progression is determined by the resolution of symptoms​
• Students are expected to be participating normally in the classroom before returning to sports​

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• The student no longer shows any signs or symptoms consistent with a concussion.
• The student has obtained written medical clearance from an appropriate licensed healthcare provider, such as:

An athletic trainer, physician (MD or DO), nurse practitioner, physician assistant, or neuropsychologist.

• The student has completed the return-to-play progression, which includes:

* A period of supervised, gradually increasing physical activity.

* A minimum progression period of 5–7 days.

• Typically, there is a 24-hour interval between each stage.
• Progression to the next stage depends on the absence of symptoms.

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WHEN IS IT SAFE TO RETURN TO PLAY?

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RETURN TO PHYSICAL ACTIVITY

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LONG-TERM CONCUSSION CONCERNS

• The long-term effects of concussion are not yet fully understood.
• Key areas of concern include:

-Ongoing concussion-related symptoms

-Increased risk of developing mental health conditions

-Potential for chronic, concussion-related brain changes

• There are still many unanswered questions about who may experience long-term complications and under what conditions.

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• Although many questions about concussions remain, medical experts agree on the following key points:

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• Early identification and proper management are critical to minimizing both short and long-term consequences
• Returning to activity (physical and cognitive) too soon can negatively impact recovery
• Physical activity and sport participation minimize the risk of certain diseases and are essential to promoting a healthy lifestyle

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LONG-TERM CONCUSSION CONCERNS

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Is the Student Ready to Return to Normal Activities?

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Teacher Feedback

• No classroom modifications needed
• Student is participating at normal levels
• Describe the student’s behavior and performance before the injury:
• Describe the student’s behavior and performance now:

Parent Feedback

• Is the parent comfortable with the student returning to normal activities?
• Is the student is ready to return?

Medical Professional Feedback

Has the student completed the Return to Learn and Return to Play progressions

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SUMMARY

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•The nature of sports leads to an increased risk of communicable infections, particularly skin infections

•Skin infections include, but are not limited to, ringworm (fungal infection), staph, impetigo (bacterial infections), herpes (viral infections), MRSA and conjunctivitis (pink eye)

•Transmission of disease and skin infection can be minimized when athletes practice proper hygiene, including showering daily after practice

PREVENTING SPREAD OF INFECTIOUS DISEASE

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•Carefully and thoroughly inspect your body for lesions or signs of skin infection regularly

•Lesions identified during self-inspections or observed on a teammate should be brought to the immediate attention of the coach

•Follow the direction of the medical provider regarding participation in practices and competition if diagnosed with a communicable infection

PREVENTING THE SPREAD OF

INFECTIOUS DISEASE

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TIPS FOR PREVENTING THE SPREAD OF INFECTIOUS DISEASE

•Shower with soap and water immediately following practices or competitions

•Do not share clothes, towels, soap, razors, deodorant or other personal care items

•All clothes/towels worn or used during practice and competition should be washed daily

•Drink from team water bottles by squirting, not sucking or slurping

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SUDDEN CARDIAC ARREST

•Sudden Cardiac Arrest (SCA) occurs when the heart stops beating

•Pre-participation screening should include any family history of sudden cardiac arrest as well as any personal episodes of exertional syncope (fainting), chest pain, or shortness of breath

– It is essential that the coach and Athletic Trainer be aware of any athlete with a family history of SCA

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SUDDEN CARDIAC ARREST

•Common signs and symptoms for SCA include:

–Unexplained collapse/fainting

–Unexplained shaking, convulsions, or tremors (seizure-like movements)

–Unexplained shortness of breath

–Feeling like the heart is racing or “beating out of the chest”

–Chest pain

–Unexplained dizziness

–Extreme fatigue

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SUDDEN CARDIAC ARREST

•Individuals experiencing any signs or symptoms indicating increased risk for SCA are encouraged to report these signs or symptoms to a trusted adult immediately

•A failure to do so may delay medical evaluation and medical intervention, increasing the risk of sudden death or disability

•Student-athletes who continue to play while experiencing these signs or symptoms may experience SCA

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• A student removed from play after experiencing signs or symptoms of SCA shall not return to play that day nor until evaluated by and in possession of written clearance to return to play from an appropriate licensed health care provider

• Starting CPR and using an AED as soon as possible are the best treatments for SCA

–AEDs are available in every ACPS middle school

–Coaches have established Emergency Action Plans in case of an emergency

–ACPS has over 650 AEDs in schools and offices??

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SUDDEN CARDIAC ARREST

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•The most effective way to prevent lightning injury is to remain or move indoors during lightning activity

•Each team has an established Emergency Action Plan identifying the safe shelter closest to outdoor athletic venues in case of lightning

•With few exceptions, the nearest safe shelter is the school building

•If the building is not accessible, a school bus or private vehicle is the next best option

ENVIRONMENTAL CONDITIONS: LIGHTNING

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•Student-athletes should be properly dressed when participating outdoors during cold weather

•Proper attire includes:

–Long sleeves and pants

–Hats and gloves

–Sweatshirts and jackets

•Students not properly dressed for the weather may not be allowed to participate that day

ENVIRONMENTAL CONDITIONS:

COLD

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• Heat cramps- cramping associated with dehydration and sodium/electrolyte loss during exercise in hot/humid environments

• Heat syncope (fainting)- temporary decrease in blood flow resulting in fainting; associated with dehydration

• Heat exhaustion- the cardiovascular system is temporarily unable to meet the body’s demand for oxygenated blood

• Heat stroke- a medical emergency occurring when the body is unable to adequately cool itself during exercise; characterized by elevated core body temperature

ENVIRONMENTAL CONDITIONS:

HEAT-RELATED ILLNESS

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•Risk factors for heat-related illness include:

–Inadequate fluid intake before and during exercise, leading to dehydration

–Inadequate rest and recovery time

–Inadequate acclimatization to exercise in hot/humid environments

–Being overweight or obese

–Wearing dark colored or heavy-weight clothing

–Low overall fitness level

ENVIRONMENTAL CONDITIONS: HEAT-RELATED ILLNESS

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•Signs and symptoms of heat-related illness include:

–Irrational behavior, irritability, or emotional instability

–Altered consciousness

–Excessive fatigue

–Disorientation

–Dizziness

–Headache

–Confusion

–Nausea or vomiting

–Diarrhea

–Collapse

–Staggering or sluggish feeling

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• Individuals experiencing or reporting any of these signs or symptoms should be removed from the activity immediately

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ENVIRONMENTAL CONDITIONS: HEAT-RELATED ILLNESS

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ENVIRONMENTAL CONDITIONS: HEAT-RELATED ILLNESS

•Individuals who continue to exercise while experiencing any of these signs or symptoms are at risk of experiencing a medical emergency

•If heat exhaustion or heat stroke are suspected, immediately cool the individual through whole-body, cold- water immersion, cold water dousing (cold shower), and/or ice towels or ice bags placed over their body and rotated frequently

•A student-athlete suspected of experiencing heat stroke shall not return to play that day nor until evaluated by and in possession of written clearance to do so from an appropriate licensed health care provider

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CAUSES OF ANXIETY AND DEPRESSION

• Some have atypical activity in areas of the brain that deal with fear and emotional regulation

•Females are generally more at risk for developing anxiety disorders

•Genetics and temperament play a role

•Environmental factors (stressful environment, witnessed traumatic event)

• Experiences play a part (observe others, overly protective/controlling adults, learning to avoid situations)

•Styles of thinking – negative, unrealistic

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• Have headaches, stomachaches, or other pain
• Trouble falling or staying asleep
• Difficulty concentrating and remembering information
• Worry excessively
• Feel tired

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SIGNS OF ANXIETY

• Be irritable or angry, may become aggressive or yell.
• Cry easily
• Sweat a lot or have shortness of breath
• Tremble/shake
• Easily upset by mistakes
• Avoidance/withdrawal

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SIGNS OF DEPRESSION

Every person has experienced some of these feelings; however, when many of these occur at once for a period of several weeks, it is time to seek professional help.

• Poor performance in school
• Withdrawal from friends and activities
• Sadness and hopelessness
• Lack of enthusiasm, energy, or motivation
• Anger or rage
• Difficulty dealing with criticism
• Feelings of being unable to reach goals

• Low self-esteem or guilt
• Indecision, lack of concentration, forgetfulness
• Restlessness or agitation
• Changes in eating or sleeping patterns
• Substance abuse
• Problems with authority
• Suicidal thoughts or actions

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RISK FACTORS FOR SUICIDE

•Teens who attempt suicide often have long-standing problems, and the attempt is triggered by a specific event that sends them “over the top.”

– No one factor or event causes suicide.

•However, there are several risk factors that have been identified, such as:

*History of substance abuse

*Conduct disorder

*Depression

*Access to firearms/weapons

*Hopelessness

*Impulsivity

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CONTRIBUTING FACTORS

• Abuse or trauma exposure
• Academic difficulties or school failure
• Anniversary of the death of a loved one
• Breakup with a significant other
• Bullying
• Disappointment or rejection

• Extended separation from friends or family
• Family conflict/dysfunction
• Getting into legal trouble
• Knowing someone who died by suicide
• Loss or death of a loved one
• Serious illness or injury

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WARNING SIGNS OF SUICIDE

• Making suicide threats
• Giving away valued possessions
• Overwhelming sense of guilt and/or shame
• Suddenly seeming “fine” when they have been feeling very depressed
• Being obsessed with death

• Severe drop in school performance
• Changed eating or sleeping patterns
• Creating poems, essays, or drawings that refer to death
• Making dramatic changes in personality or appearance
• Engaging in irrational, bizarre behavior

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TIPS TO INCREASE MENTAL WELLNESS

• Exercise
• Eat a healthy diet
• Have a support network
• Get enough sleep
• Engage in relaxation activities
• Be well-prepared
• Set realistic, attainable goals
• Be optimistic – look at the bright side of things

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BENEFITS OF REGULAR

EXERCISE

• Research has proven many benefits from exercise in addition to overall fitness:

-Increased alertness

-Increased amount of “feel-good: chemicals in the brain.

-Improved mood

-Improved self-confidence and esteem

-Improved sense of independence and control

-Improved social support from others

-Decreased anxiety/depression

-Decreased probability of developing mental health disorders

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WHAT CAN FAMILY AND

FRIENDS DO?

•Be available to listen and talk with your child

– Validate their feelings and let them know you care, even if you do not agree or think that the situation is not a big deal.

• Know where your children are and with whom they are hanging out

•Praise them and recognize when they do a good job

• Know warning signs and remove weapons and pills from your home

• If you think your child might be anxious or depressed, ask them if they’ve thought about suicide

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WHAT CAN FAMILY AND FRIENDS DO?

•Set clear and consistent boundaries

•Teach “life skills” (respect, responsibility, adaptive/coping skills)

•Seek professional help from a doctor, mental health professional, or community mental health resources

– People with clinical depression can be treated successfully with medication and/or talk therapy.

• Keep teachers, psychologists, doctors, and coaches informed, so we can work together to support your child

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WHAT CAN FAMILY AND FRIENDS DO?

• Provide caring and support

• Set and communicate high expectations, but avoid applying excessive pressure or stress on the student

• Provide opportunities for meaningful participation

– Volunteer, mentor, extracurricular activities

• Increase pro-social bonding

• Build resilience

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RESILIENCE

An ability to recover from or adjust easily to misfortune or change

<emotional resilience>

www.Merriam-Webster.com/dictionary/resilience, , April 29, 2014

A Safety Net

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BUILD YOUR ESILIENCE

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Vanderbilt University Faculty and Staff http://healthandwellness.vanderbilt.edu/ql/resilience-toolkit.php

Attitudes

•Be optimistic

•Build connections

•Welcome change

•Have a sense of humor

•Express gratitude

•Accept help

Skills

•Problem solver

•Communicator

•Emotionally Intelligent

•Practice Mindfulness

Lifestyle

• Stay active, eat well, and get plenty

of sleep

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RESOURCES

•Additional information about the ACPS Middle School Athletics Program is available here: ACPS MS Athletics

•Additional information on concussions is available from:

–American Academy of Family Physicians:

http://familydoctor.org/

–Centers for Disease Control and Prevention: http://www.cdc.gov/headsup/index.html

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ACPS ATHLETIC HEALTH EDUCATION PROGRAM

• Thank you for reviewing the ACPS Athletic Health Education Program for Parents and Student-Athletes

• If you have any questions, please contact the Athletic Coordinator at your student’s middle school.