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1 UTEP Concussion Policy and C3 Logix Testing the University of Texas at El Paso Department of Athletics Will Follow the Guideli

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1 UTEP Concussion Policy and C3 Logix Testing the University of Texas at El Paso Department of Athletics Will Follow the Guideli UTEP Concussion Policy and C3 Logix Testing The University of Texas at El Paso Department of Athletics will follow the guidelines below regarding concussion diagnosis and management. As of August 1st, 2016, baseline testing will include C3 Logix integrated testing with concussion history, a baseline symptom score, digital SAC test, BESS testing on two surfaces, and a neurocognitive testing battery. These baselines will be completed prior to the student-athlete’s first competition, and all sports will complete new baseline testing by September 15th of that year In subsequent semesters, the concussion baseline will serve as a part of the pre- participation exam. The following sports at UTEP will complete the C3 Logix pre-participation assessment: Football Men’s Basketball Women’s Basketball Volleyball Women’s Soccer Softball Track and Field (Pole-vaulters only) Cheerleading NCAA Recommendations and UTEP Protocol: The components of the UTEP Sports Medicine Concussion Protocol are the following, and the entire document is available upon request or on our website: 1. Education: o UTEP athletic trainers present concussion NCAA/CDC concussion facts to student athletes prior to every competition season and get a signed acknowledgement that those student athletes have received and understand the information given to them. o These fact sheets are presented during team meetings prior to the season. Coaches are present at these meetings and also receive concussion fact sheets. o Team physicians review the UTEP Concussion Policy annually and are given copies of the policy. o All parties, including the athletic training staff and office of the athletic director sign an acknowledgment that they have received and understand the material 1 2. Pre-participation assessment: A one-time, pre-participation baseline concussion assessment for all varsity student-athletes should include, but not necessarily be limited to: o A brain injury/concussion history; o Symptom evaluation; o Cognitive assessment; and o Balance evaluation. The team physician will determine pre-participation clearance and/or the need for additional consultation or testing. Athletes that suffer a concussion will be re-baselined at least six-months after, or before their next competition season. Recognition and Diagnosis of Concussion: All student-athletes who are experiencing signs, symptoms or behaviors consistent with a sport-related concussion, at rest or with exertion, must be removed from practice or competition and referred to an athletic trainer or team physician with experience in concussion management. A student-athlete’s health care provider experienced in the diagnosis and management of concussion should conduct and document serial clinical evaluation inclusive of symptom inventory and evaluation of cognition and balance. A student- athlete diagnosed with sport-related concussion should not be allowed to return to play in the current game or practice and should be withheld from athletic activity for the remainder of the day. Disposition decisions for more serious injuries such as cervical spine trauma, skull fracture or intracranial bleed, should be made at the time of presentation. Initial Suspected Concussion Evaluation: The foundation of sport-related concussion management is initial physical and relative cognitive rest as part of an individualized treatment plan. Initial management of sport-related concussion is based on individual serial clinical assessments, taking a concussion history, modifying factors, and taking specific needs of the student-athlete into consideration. Such management includes, but is not limited to: Clinical evaluation is at the time of injury. When the rapid assessment of concussion is necessary (e.g., during competition), symptom assessment, physical and neurological exam, and balance exam should be performed. UTEP Sports Medicine utilizes the SCAT-5 and other acceptable sideline evaluation tools, which include the Standardized Assessment of Concussion (SAC). Evaluation will include at the minimum a symptom assessment, physical and neurological assessment, cognitive assessment, and balance exam. Assessment for head and cervical spine injury at time of injury and implementation of the emergency action plan, as warranted. Transportation to the nearest hospital if any of following signs and symptoms are present: Glasgow Coma score less than 13; prolonged period of loss of consciousness (longer than 1 minute); focal neurological deficit; 2 repetitive emesis; persistently diminished or worsening mental status or other neurological signs or symptoms; and potential spine injury. Serial evaluation and monitoring for deterioration following injury. Upon discharge from medical care, both oral and written instructions for home care should be given to the student-athlete and to a responsible adult (e.g., parent or roommate) who should continue to monitor and supervise the student-athlete during the acute phase of sport-related concussion. Concussion Diagnosis and Management Diagnosis and management of sport-related concussion is a clinical diagnosis based on the judgment of the athletic trainer and other UTEP health care providers. The diagnosis and management of sport-related concussion is challenging for many reasons: The physical and cognitive examinations are often normal, and additional tests such as brain computerized tomography (CT), brain MRI, electroencephalogram and blood tests are also commonly normal. Although comprehensive neuropsychological tests may be a useful adjunctive tool supporting the diagnosis of sport-related concussion, there remains controversy regarding interpretation and utility as a clinical tool. The clinical effects of sport-related concussion are often subtle and difficult to detect with existing sport-related concussion assessment tools. The symptoms of sport-related concussion are not specific to concussion and it is challenging to evaluate a student-athlete who presents non-specific symptoms that may be related to other conditions. Sport-related concussion may manifest with immediate or delayed-onset symptoms. Symptom manifestation can vary between individuals and in the same individual who has suffered a repeat concussion. Modifying factors and co-morbidities -- such as attention deficit hyperactivity disorder, migraine and other headache disorders, learning disabilities and mood disorders -- should be considered in making the diagnosis, in providing a management plan, and in making both return-to-play and return-to-learn recommendations. “Signal detection” on clinical measures (e.g., cognitive and balance testing) often quickly diminishes in the acute setting of early recovery. Although cognitive function and balance assessed within 24 hours with various sideline tests (Standardized Assessment of Concussion [SAC] and Balance Error Scoring System, respectively) have been shown to be useful in diagnosing concussion, these tests often normalize within a few days and cannot be used to make a definitive diagnosis. Student-athletes may underreport symptoms and inflate their level of recovery in hopes of being rapidly cleared for return to competition. 3 Clinical assessment of sport-related concussion is a surrogate index of recovery and not a direct measure of brain structure and functional integrity after concussion. Further Medical evaluation may be necessary in the event of a prolonged recovery to rule out or consider any differential diagnosis. *Additional diagnoses include, but are not limited to: Post-concussion syndrome. Sleep dysfunction. Migraine or other headache disorders. Mood disorders such as anxiety and depression. Ocular or vestibular dysfunction. UTEP athletic trainers who are trained in the diagnosis, treatment and initial management of acute concussion will be “present” at all NCAA varsity competitions in the following contact/collision sports: basketball; football; pole vault; soccer, softball, and volleyball. Furthermore, UTEP athletic trainers who are trained in the diagnosis, treatment and initial management of acute concussion will be “available” at all NCAA varsity practices in the following sports: tennis, golf, rifle, cross country and track and field. NCAA Guidelines and UTEP Treatment Protocol: A. When any student-athlete shows signs, symptoms, or behaviors consistent with a concussion, they will be removed from participation and evaluated by a certified athletic trainer, licensed athletic trainer, physician assistant, or team physician with experience in evaluation and management of concussion. The student-athlete will then have a follow up visit with a team physician at the next Larry K. Durham clinic time, or at that physician’s clinic. B. Student-athletes suspected of having a concussion will be evaluated with the following: a. Symptom assessment b. Physical and neurological exam c. Cognitive assessment d. Balance e. Assessment for cervical spine trauma, skull fracture, and intracranial bleed C. A student-athlete who has been diagnosed with a concussion shall be held out of participation for a minimum of 24-hours a. Diagnosis is to be made based on the individual provider’s expertise D. Student-athletes will be provided with written instructions upon discharge. Written instructions should preferably be given to a roommate or guardian. E. The student-athlete will undergo a “Graded Symptom Checklist” every 24- hours following the diagnosis of a concussion F. Once asymptomatic, the student-athlete will take the full test battery of the C3 Logix system. 4 G.
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