Concussions: The Invisible Injury

Student and Parent Information Sheet

Facts about concussions according to the

Center for Disease Control (CDC)

l An estimated 4 million people under age 19 sustain a head

injury annually. Of these approximately 52,000 die and

275,000 are hospitalized.

l An estimated 300,000 sports and recreation related

concussions occur each year.

l Students 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


l Each 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.

j School coaches and physical education teachers must

complete the CDC course.


j School nurses and certified athletic trainers must complete

the concussion course. (


l Provide concussion management information and sign off

with any parental permission form.

l The 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:

l Require the immediate removal from athletic activities of any

pupil that has or is believed to have sustained a mild

traumatic brain injury.

l No 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.

j Such authorization must be kept in the pupil’s permanent

heath record.

j Schools shall follow directives issued by the pupil’s

treating physician.


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:

l Decreased or absent memory of events prior to or immediately

after the injury, or difficulty retaining new information

l Confusion or appears dazed

l Headache or head pressure

l Loss of consciousness

l Balance difficulties, dizziness, or clumsy movements

l Double or blurry vision

l Sensitivity to light and/or sound

l Nausea, vomiting and/or loss of appetite

l Irritability, sadness or other changes in personality

l Feeling sluggish, foggy or light-headed

l Concentration or focusing problems

l Drowsiness

l Fatigue 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.

l Headaches that worsen

l Seizures

l Looks drowsy and/or cannot be awakened

l Repeated vomiting

l Slurred speech

l Unable to recognize people or places

l Weakness or numbing in arms or legs, facial drooping

l Unsteady gait

l Change in pupil size in one eye

l Significant irritability

l Any loss of consciousness

l Suspicion for skull fracture: blood draining from ear or

clear fluid from the nose

Concussion definition

A concussion is a reaction by the brain to a jolt or force that can be 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

Concussion Management

Schools are advised to develop a written concussion management

policy. A sample policy is available on the NYSPHSAA web

site at The policy should include:

l A commitment to reduce the risk of head injuries.

l A procedure and treatment plan developed by the district

medical director.

l A procedure to ensure proper education for school nurses,

certified athletic trainers, physical education teachers,

and coaches.

l A procedure for a coordinated communication plan among

appropriate staff.

l A procedure for periodic review of the concussion

management program.

Return to Learn and Return to Play


Cognitive Rest: Activities students should avoid include, but are

not limited to, the following:

l Computers and video games

l Television viewing

l Texting

l Reading or writing

l Studying or homework

l Taking a test or completing significant projects

l Loud music

l Bright lights

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:

l Contact and collision

l High speed, intense exercise and/or sports

l High risk for re-injury or impacts

l Any activity that results in an increased heart rate or

increased head pressure

Return to Play Protocol once 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


l Students

l Parents/Guardians

l School Administrators

l Medical Director

l Private Medical Provider

l School Nurse

l Director of Physical Education and/or Athletic Director

l Certified Athletic Trainer

l Physical Education Teacher and/or Coaches

l Classroom Teachers

Other Resources

l New York State Education Department

l New York State Department of Health


l New York State Public High School Athletic Association

l Center for Disease Control and Prevention

l National Federation of High Schools – The FREE Concussion Management course

does not meet education requirement.

l Child Health Plus


l Local Department of Social Services – New York State

Department of Health

l Brain Injury Association of New York State

l Nationwide Children’s Hospital – Concussions in the


l Upstate University Hospital – Concussions in the Classroom


l ESPN Video – Life Changed by Concussion


l American Association of Neurological Surgeons


l Consensus Statement on Concussion in Sport – Zurich