Concussions: The Invisible Injury
Student and Parent Information Sheet
Facts about concussions according to the
Center for Disease Control (CDC)
lAn estimated 4 million people under age 19 sustain a head
injury annually. Of these approximately 52,000 die and
275,000 are hospitalized.
lAn estimated 300,000 sports and recreation related
concussions occur each year.
lStudents who have had at least one concussion are at
increased risk for another concussion.
In New York State in 2009, approximately 50,500 children
under the age of 19 visited the emergency room for a traumatic
brain injury and of those approximately 3,000 were hospitalized.
Requirements of School Districts
lEach school coach, physical education teacher, nurse, and
athletic trainer will have to complete an approved course on
concussion management on a biennial basis, starting with the
2012-2013 school year.
jSchool coaches and physical education teachers must
complete the CDC course.
jSchool nurses and certified athletic trainers must complete
the concussion course. (http://preventingconcussions.org)
lProvide concussion management information and sign off
with any parental permission form.
lThe concussion management and awareness information or
the State Education Department’s web site must be made
available on the school web site, if one exists.
Removal from athletics:
lRequire the immediate removal from athletic activities of any
pupil that has or is believed to have sustained a mild
traumatic brain injury.
lNo pupils will be allowed to resume athletic activity until
they have been symptom free for 24 hours and have been
evaluated by and received written and signed authorization
from a licensed physician. For interscholastic athletics,
clearance must come from the school medical director.
jSuch authorization must be kept in the pupil’s permanent
jSchools shall follow directives issued by the pupil’s
Symptoms of a concussion are the result of a temporary
change in the brain’s function.In most cases, the symptoms of a
concussion generally resolve over a short period of time; however,
in some cases, symptoms will last for weeks or longer. Children
and adolescents are more susceptible to concussions and take
longer than adults to recover.
It is imperative that any student who is suspected of having
a concussion is removed from athletic activity (e.g. recess, PE
class, sports) and remains out of such activities until evaluated and
cleared to return to activity by a physician.
Symptoms include, but are not limited to:
lDecreased or absent memory of events prior to or immediately
after the injury, or difficulty retaining new information
lConfusion or appears dazed
lHeadache or head pressure
lLoss of consciousness
lBalance difficulties, dizziness, or clumsy movements
lDouble or blurry vision
lSensitivity to light and/or sound
lNausea, vomiting and/or loss of appetite
lIrritability, sadness or other changes in personality
lFeeling sluggish, foggy or light-headed
lConcentration or focusing problems
lFatigue and/or sleep issues – sleeping more or less than usual
Students who develop any of the following signs, or if signs
and symptoms worsen, should be seen and evaluated immediately
at the nearest hospital emergency room.
lHeadaches that worsen
lLooks drowsy and/or cannot be awakened
lUnable to recognize people or places
lWeakness or numbing in arms or legs, facial drooping
lChange in pupil size in one eye
lAny loss of consciousness
lSuspicion for skull fracture: blood draining from ear or
clear fluid from the nose
A concussion is a reaction by the brain to a jolt or force that canbe transmitted to the head by an impact or blow occurring anywhere
on the body. Essentially a concussion results from the brain moving back and forth or twisting rapidly inside the skull.
State Education Department’s Guidance for
Schools are advised to develop a written concussion management
policy. A sample policy is available on the NYSPHSAA web
site at www.nysphsaa.org. The policy should include:
lA commitment to reduce the risk of head injuries.
lA procedure and treatment plan developed by the district
lA procedure to ensure proper education for school nurses,
certified athletic trainers, physical education teachers,
lA procedure for a coordinated communication plan among
lA procedure for periodic review of the concussion
Return to Learn and Return to Play
Cognitive Rest: Activities students should avoid include, but are
not limited to, the following:
lComputers and video games
lReading or writing
lStudying or homework
lTaking a test or completing significant projects
Students may only be able to attend school for short periods of
time. Accommodations may have to be made for missed tests and
Physical Rest:Activities students should avoid include, but are
not limited to, the following:
lContact and collision
lHigh speed, intense exercise and/or sports
lHigh risk for re-injury or impacts
lAny activity that results in an increased heart rate or
increased head pressure
Return to Play Protocolonce symptom free for 24 hours and
cleared by School Medical Director:
Day 1: Low impact, non strenuous, light aerobic activity.
Day 2:Higher impact, higher exertion, moderate aerobic activity.
No resistance training.
Day 3: Sport specific non-contact activity. Low resistance weight
training with a spotter.
Day 4:Sport specific activity, non-contact drills. Higher resistance
weight training with a spotter.
Day 5:Full contact training drills and intense aerobic activity.
Day 6:Return to full activities with clearance from School Medical
Any return of symptoms during the return to play protocol, the
student will return to previous day’s activities until symptom free.
Concussion Management Team
Schools may, at their discretion, form a concussion management
team to implement and monitor the concussion management policy
and program. The team could include, but is not limited to, the
lPrivate Medical Provider
lDirector of Physical Education and/or Athletic Director
lCertified Athletic Trainer
lPhysical Education Teacher and/or Coaches
lNew York State Education Department
lNew York State Department of Health
lNew York State Public High School Athletic Association
lCenter for Disease Control and Prevention
lNational Federation of High Schools
www.nfhslearn.com – The FREE Concussion Management course
does not meet education requirement.
lChild Health Plus
lLocal Department of Social Services – New York State
Department of Health
lBrain Injury Association of New York State
lNationwide Children’s Hospital – Concussions in the
lUpstate University Hospital – Concussions in the Classroom
lESPN Video – Life Changed by Concussion
lAmerican Association of Neurological Surgeons
lConsensus Statement on Concussion in Sport – Zurich