Help & F.A.Q

GUIDE TO USING THE CBS SIDELINE Pro

Any athlete with suspected concussion should be removed from play, medically assessed at the sports venue or online through a secure telemedicine portal and monitored. No athlete diagnosed with suspected concussion should be returned to play on the day of injury. Returning a player with a concussion (mTBI) could result in a second impact syndrome (SIS) which has significant additional effects on the player.  An athlete should be referred to a medical facility for urgent assessment if there is a negative result to the CBS concussion Pro tests or it is decided by the qualified medical professional that this course of action is required.

Athletes with suspected concussion should not drink alcohol, use recreational drugs and should not drive a motor vehicle until cleared to do so by a medical professional. The use of electronic devices should be discouraged until a clear diagnosis is obtained. Concussion signs and symptoms evolve over time and it is important to consider repeat evaluation or more in-depth testing in the assessment of concussion. The diagnosis of a concussion is a clinical judgment, made by a medical professional.

CBS Sideline Pro should not be used by itself to make a diagnosis of concussion. An athlete may have a concussion even if their CBS Sideline Pro assessment is “normal”. Preferably a baseline is available for the player being tested as this will allow more accurate comparison of his/her current health status. If their baseline or previous tests for this player is not available, a comparison with their peer group may be used for additional informative purposes.

The basic principles of first aid (immediate danger, player response, clear airway, observable breathing, normal circulation – no cynosis) should be followed. Do not attempt to move the athlete (other than that required for airway management) unless trained to do so or in          co-operation with other medical personnel. Assessment for a spinal cord injury is a critical part of the initial on-field assessment. Do not remove a helmet or any other equipment attached to the player unless trained to do so safely.

RED FLAGS

Neck pain or tenderness – Double vision – Weakness or tingling/ burning in arms or legs  Severe or increasing headache – Seizure or convulsion – Loss of consciousness

Deteriorating conscious state – Vomiting – Increasingly restless, agitated or combative

Any of these red flags indicate that this player should not return to the field of play

“IF IN DOUBT SIT THEM OUT” and refer the player to a medical doctor or qualified health professional as soon as possible. Second Impact Syndrome (SIS) is to be avoided at all cost.

An athlete suspected of a concussion and showing any red flags or observable signs should not be returned to play in the same game or participate in the on-going athletic event. Recent studies have clearly shown that a second concussion within a short period of time can have significant effects on the player’s recovery from concussion and exacerbate the initial injury. “Second Impact Syndrome.” Todd May; Lisa A. Foris; Chester J. Donnally III. https://www.ncbi.nlm.nih.gov/books/NBK448119/

NCAA

• “Institutions shall have a concussion management plan on file such that a student-athlete who exhibits signs, symptoms or behaviours consistent with a concussion shall be removed from practice or competition and evaluated by an athletics healthcare provider with experience in the evaluation and management of concussion. Student-athletes diagnosed

with a concussion shall not return to activity for the remainder of that day. Medical clearance shall be determined by the team physician or their designee according to the concussion management plan. In addition, student-athletes must sign a statement in which they accept the

responsibility for reporting their injuries and illnesses to the institutional medical staff, including signs and symptoms of concussions. During the review and signing process student-athletes should be presented with educational material on concussions.”

— NCAA Memorandum. April, 2010. www.ncaa.org/health-safety

Consult your physician or licensed healthcare professional within 48 hours after a suspected concussion. Remember, it is better to be safe so immediate care if possible within

12-24 hours of the concussive event is important

Rest & Rehabilitation.

After a concussion, the athlete should have physical rest and relatively few cognitive challenges for a few days to allow their symptoms to improve. In most cases, after no more than a few days (3-5 days) of rest, the athlete should gradually increase their daily activity level as long as their symptoms do not worsen. Once the athlete is able to complete their usual daily activities without concussion-related symptoms, the second step of the return to play/sport progression can be started.

The athlete should not return to play/sport until their concussion-related symptoms have completely resolved, and the athlete has successfully returned to full school/learning/work activities. When returning to play/sport, the athlete should follow a stepwise, medically managed exercise progression, with gradually increasing amounts of exercise.

Graduated Return to Sport Strategy Exercise

1. Symptom limited activity- Daily activities that do not provoke symptoms. Gradual reintroduction of work/school activities.
2. Light aerobic exercise Walking or stationary cycling at slow to medium pace. No resistance training. Gradually increase the player’s heart rate.
3. Sport-specific exercise. Running or Training drills. No head impact activities.
4. Non-contact training. Increased training e.g., passing/kicking drills. May start progressive resistance training. Exercise, coordination, and increased movement co-ordination.
5. Full contact practice. Following medical clearance with an objective rehabilitation evaluation, the player can participate in normal training activities. Restores player confidence with an assessment of the player’s functional skills by coaching staff.
6. Return to play/sport. Normal game play. If any symptoms worsen while exercising, the athlete should go back to the previous graduated step. Resistance training should be added only in the later stages (Stage 3 or 4 at the earliest). Written clearance should be provided by a healthcare professional before return to play/sport as directed by relevant local law and regulations. Graduated Return to School Strategy Concussion may affect the ability to learn at school. The athlete may need to miss a few days of school after a concussion.

When going back to school, some athletes may need to go back gradually and may need to have some changes made to their schedule so that concussion symptoms do not get worse.    

If a particular activity makes symptoms worse, then the athlete should stop that activity and rest until symptoms completely cease. Make sure that the athlete can get back to school without problems. It is important that the healthcare provider, parents, caregivers and teachers talk to each other so that everyone knows what the plan is for the athlete to go back to school.

Mental Activity – Goal of each step

1. Daily activities that do not give the athlete symptoms Typical activities that the athlete does during the day as long as they do not increase symptoms (light physical activity, reading. Texting, screen time or electronic use should be minimal. Start with 5-10 minutes at a time and gradually build up. Gradual return to typical previous activities.
2. School activities Homework, reading or other cognitive activities outside of the classroom. Increase tolerance to cognitive work.
3. Return to school part-time. Gradual introduction of schoolwork. The student may need to start with a partial school day or with increased breaks during the day. Gradually increase academic activities.
4. Return to school full-time. Gradually progress school activities until a full day can be tolerated. Return to full academic activities and catch up on missed work. If the athlete continues to have symptoms with mental activity, some other accommodations that can help with return to school may include:

•  Starting school later
•  Only going for half days or going only to certain classes
•  More time to finish assignments/tests
•  Quiet room to finish assignments/tests
•  Not going to noisy areas like the cafeteria, assembly halls, sporting events, music class, shop class, etc.
•  Taking lots of breaks during class, homework, tests
•  No more than one exam/day
•  Shorter assignments
•  Repetition/memory cues
•  Use of a student helper/tutor
•  Reassurance from teachers and parents that the child will be supported while recovering.

The athlete should not go back to their sporting activities until they have been thoroughly tested with an objective rehabilitation program. They should be back to school/ learning without symptoms getting significantly worse and no longer needing any changes to their school schedule

.

1. Maddocks, DL; Dicker, GD; Saling, MM. The assessment of orientation following concussion in athletes. Clinical Journal of Sport Medicine 1995; 5: 32-33
2. Jennett, B., Bond, M. Assessment of outcome after severe brain damage: a practical scale. Lancet 1975; i: 480-484
3. McCrea M. Standardized mental status testing of acute concussion. Clinical Journal of Sport Medicine. 2001; 11: 176-181
4. Guskiewicz KM. Assessment of postural stability following sport-related concussion. Current Sports Medicine Reports. 2003; 2: 24-30