REAP the Benefits of Good Concussion Management Karen McAvoy, PsyD, Center for Concussion, Rocky Mountatin Youth Sports Medicine Institute Page 1 of 2

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  "Don't even try to fool me because I'm watching you!" So says Jay Driscoll, ATC / CSCS, athletic director at Washington, DC’s St. Albans School, to his student athletes, alluding to the fact that some athletes cover up a mild brain injury so as to stay in the game. With a no-nonsense attitude and a keen sense of humor, Jay talks to BrainLine about his program on injury prevention, care, and rehabilitation services as well as how he helps his athletes meet and exceed demands by enhancing their physical fitness, performance, and health.
  
  Transcript of this video.
• Working the Sidelines
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  Skier Lesley LeMasurier was going 80 mph down the slopes when she fell. "I don't want to imagine what would have happened if I hadn't been wearing a helmet." This is an excerpt from BrainLine's webcast Concussion: Understanding Mild Traumatic Brain Injury. See full webcast here.
• Olympic Hopeful Lesley LaMasurier on the Importance of Wearing a Helmet
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  Lesley LeMasurier started downhill skiing when she was a little kid. When her concussions started to affect her on and off the slopes, she knew something was significantly wrong. This is an excerpt from BrainLine's webcast Concussion: Understanding Mild Traumatic Brain Injury. See full webcast here.
• From Olympic Hopeful to TBI: Lesley LeMasurier's Story
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  Hear hockey great Pat LaFontaine recount his story and the steps he took during his recovery after several brain injuries. Produced by BrainLine. Transcript of this video.
• NHL Hall of Famer Pat LaFontaine Shares His Story
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  “Brown Is Bad, Brown Is Cell Death.”  The “brown” is tau, a protein that accumulates in the brains of people, like professional football players and boxers, who have sustained repeat blows to the head. Learn about the research and education going on at the Center for the Study of Traumatic Encephalopathy, a collaboration between Boston University School of Medicine and the Sports Legacy Institute. See all videos interviews with Dr. Ann McKee.
• Game Changers
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  Retired NFL player Jason Belser talks about what strategies the NFL Players Association is using to educate young players about concussion and safety.
• Young Football Players and the NFL's New Safety Tactics
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  Jason Belser played 11 seasons in the NFL and is now an executive with the National Football League Players Association. Here he discusses why athletes might resist leaving the game after a possible concussion. Produced by Brian King and Noel Gunther. Transcript of this video.
  
• Jason Belser Discusses Concussion and the NFL
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  Retired NFL player Jason Belser  talks about how the National Football League Players Association is working to protect athletes of all ages. "When you have symptoms, tell someone!" Produced by Brian King and Noel Gunther. Transcript of this video.
  
• NFL Players Association: Report Concussion Symptoms
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  Neurologist Dr. James Kelly, one of America’s top experts on treating concussions, talks about the data on heading the ball in soccer and brain injury. This is an excerpt from BrainLine's webcast Concussion: Understanding Mild Traumatic Brain Injury. See full webcast here.
• Does Heading a Soccer Ball Cause TBI?
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  Blatant hits and fouls are not necessary in kids' sports; rule changes could make sports safer.
• Making Kids' Sports Safer
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  The hormonal and morphological structures in girls make them more vulnerable to TBIs than boys.
• Why Are Girls More Likely to Sustain a TBI in Sports?
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  Increased knowledge about the long-term effects from contact sports may catalyze rule changes.

  See all videos interviews with Dr. Ann McKee.

• Are Contact Sports Dangerous?
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  A jarred brain needs sufficient time to rest and recover. It's simple, but makes all the difference in the long term.

  See all videos interviews with Dr. Ann McKee.

• How Can We Improve the Way Sports Handle Brain Injuries?
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  A doctor/parent talks about trying to find a balance between the benefits and dangers of letting his children play contact sports.
• Should You Let Your Child Play Contact Sports?
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  People need to know that a concussion can be a serious event, repetitive concussions even more so. Proper recovery is essential to outcome.
• Concussions and Contact Sports

The REAP Project: Reduce, Educate, Accommodate, Pace

The REAP Project which stands for Reduce • Educate •Accommodate • Pace is a community-based model for Concussion Management that was developed in Colorado. The early origins of REAP stem from the dedication of one typical high school and it's surrounding community. After the devastating loss of a student to “Second Impact Syndrome,” the Administrators, Teachers, Certified Athletic Trainer, School Nurse, School Psychologist and Counselors all banded together to create a wider safety net for all students in that school. The net net became stronger when parents and community medical professionals also worked together to coordinate care and recovery from concussion. The lessons learned from this tragic event are that a “Multi-Disciplinary Team” approach is the foundation of good Concussion Management.

The Multi-Disciplinary Teams:

• Family Team
• School Physical Team
• School Academic Team
• Medical Team

These teams work closely to watch and care for the student/athlete during his or her entire recovery from concussion.

Table of Contents

• Intro and message to parents
• How to use this manual
• Reduce
• Educate
• R.E.A.P. timeframe
• Accommodate
• Pace
• Special Considerations
• Resources
• Appendix
• Teacher Template
• Symptom Checklist

TRUE OR FALSE:

A concussion is just a “bump on the head.”

FALSE: Actually, a concussion is a traumatic brain injury (TBI). The symptoms following a concussion can range from mild to severe and usually involve: confusion, disorientation, memory loss, slowed reaction times and extreme emotional reactions. The severity of the symptoms cannot be predicted at the time of the injury.

TRUE OR FALSE:

A parent should awaken a child who falls asleep after a head injury.

FALSE: Current medical advice is that it is not dangerous to allow a child to sleep after a head injury, once they have been medically evaluated. The best treatment for a concussion is sleep and rest.

TRUE OR FALSE:

A concussion is usually diagnosed by neuroimaging tests (i.e., CT scan or MRI).

FALSE: Concussions cannot be detected by neuroimaging tests; a concussion is a “functional” not structural injury. Concussions are typically diagnosed by careful examination of the signs/symptoms of concussion at the time of injury. The cause of symptoms during a concussion are thought to be due to an ENERGY CRISIS in the brain cells. At the time of a concussion, the brain cells (neurons) stop working normally. The “fuel” (sugar) that is needed to generate activity – for playing and for thinking- is simply not being delivered efficiently to the cells. As a result, a symptom will “flare.” It is the brain’s way of telling the body that it is not working properly. While a CT scan or an MRI is often used to rule out more serious bleeding in the brain, it is not a diagnostic test for concussion. A negative scan does not mean that a concussion did not occur.

TRUE OR FALSE:

Loss of consciousness (LOC) is necessary for a concussion to be diagnosed.

FALSE: According to the American Academy of Neurology (AAN), a concussion is any “traumatically induced alteration in mental status that may or may not involve a loss of consciousness.” CDC reports that an estimated 1.6 to 3.8 million sports- and recreation-related concussions occur in the United States each year.3 Ninety percent of concussions do not involve a loss of consciousness. While many students receive a concussion from sports-related activities, numerous other concussions occur from non-sports related activities — from falls, from motor vehicle, bicycle and playground accidents.

DID YOU KNOW …

More than 80% of concussions resolve very successfully if managed well within the first three weeks post-injury.¹ REAP sees the first three weeks post- injury as a “window of opportunity.” Research shows that the average recovery time for a child/adolescent is about three weeks, slightly longer than the average recovery time for an adult.²

The REAP project works on the premise that concussion is best managed by a Multi- Disciplinary Team that includes: the Student/Athlete, the Family, various members ofthe School Team and the Medical Team. The unique perspective from each of these variousteams is essential!

The first day of the concussion is considered Day 1.Thee first day of recovery also starts on Day 1. The REAP Project can help the Family, School and Medical Teams mobilize immediately to maximize recovery during the entire three week “window of opportunity.”

From the Center for Concussion, Rocky Mountain Youth Sports Medicine Institute. Used with permission. www.youthsportsmed.com.

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