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Intent of Webinar

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Title: Slide 1 Author: mslade Last modified by: mrounthwaite Created Date: 1/14/2011 7:16:40 PM Document presentation format: On-screen Show (4:3) Other titles – PowerPoint PPT presentation

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Title: Intent of Webinar


1
Intent of Webinar
  • The intent of the webinar is to provide training
    on the Ophea Concussion Protocol (reflects the
    minimum standards required by the Ministry of
    Education).
  • some Boards have localized the concussion
    procedures , tools or forms.
  • Localization changes will be addressed when
    possible.
  • Refer to your own Boards Concussion Protocol (if
    localized)

2
Before starting this webinar download/print the
following resources
  • Appendix C-1 Concussion Protocol Prevention,
    Identification and Management Procedures
  • - CHART 1 Steps and Responsibilities in
    Suspected and Diagnosed Concussions (colour copy)
  • Appendix C-2 Sample Tool to Identify a Suspected
    Concussion
  • Appendix C-3 Sample Documentation of Medical
    Examination
  • Appendix C-4 Sample Documentation for a
    Diagnosed Concussion Return to Learn/Return to
    Physical Activity Plan
  • Appendix C-5 Sample Concussion Prevention
    Strategies
  • Scenarios Questions

3
  • Concussion Identification Management and
    Prevention for
  • Schools

4
Purpose of Webinar
  • The following sample presentation has been
    developed for school staff as a training tool on
    the OPESGCP as
  • initial training or
  • ongoing training.
  • It is important for all school staff to be
    familiar with whole concussion protocol.

5
Learning Goals/Session Objectives
  • Participants will
  • increase awareness of concussions (definition,
    signs and symptoms) and the seriousness of
    concussions
  • become familiar with strategies for concussion
    prevention
  • learn about and apply the OPESGCP to identify a
    suspected concussion
  • learn about the management procedures for a
    diagnosed concussion
  • be introduced to sample tools for the
    identification and management processes.

6
What is a Concussion?
  • A concussion
  • is a brain injury that causes changes in how the
    brain functions, leading to symptoms that can be
    physical (e.g., headache, dizziness), cognitive
    (e.g., difficulty concentrating or remembering),
    emotional/behavioural (e.g., depression,
    irritability) and/or related to sleep (e.g.,
    drowsiness, difficulty falling asleep).

7
What is a Concussion? contd.
  • A concussion
  • may be caused either by a direct blow to the
    head, face or neck, or a blow to the body that
    transmits a force to the head that causes the
    brain to move rapidly within the skull
  • can occur even if there has been no loss of
    consciousness (in fact most concussions occur
    without a loss of consciousness) and,
  • cannot normally be seen on X-rays, standard CT
    scans or MRIs.

8
Dr. Mike Evans Youtube video
  • Dr. Mike Evans Concussion Management and Return
    to Learn
  • Question
  • Identify the four categories of concussion
    signs/symptoms that a student may experience.
  •  

http//www.health.gov.on.ca/en/public/programs/con
cussions
9
Dr. Mike Evans Youtube video
  • Answer
  • Physical Problems
  • Thinking Problems
  • Emotional Symptoms
  • Sleep Issues
  •  

10
Identification
  • Identification procedures are located in the
    Ontario Physical Education Safety Guidelines
    (OPESG), safety.ophea.net
  • Appendix C-1 - Concussion Protocol Prevention,
    Identification and Management Procedures
  • Chart 1 Steps and Responsibilities in Suspected
    and Diagnosed Concussion

11
Common Signs and Symptoms
  • Teachers/coaches/intramural supervisors must
    become familiar with the common signs and
    symptoms of a concussion.
  • Note Only a medical doctor/nurse practitioner
    can diagnose a concussion.
  • But Teachers/coaches/intramural supervisors can
    recognize signs and symptoms of suspected
    concussion and inform parents/guardians of the
    importance of evaluation by a medical
    doctor/nurse practitioner.

Page 11
12
Identification Tool to Identify a Suspected
Concussion
13
Initial Response - Suspected Concussion
Student Receives a blow to the head, face or
neck, or a blow to the body that transmits a
force to the head, and as a result may have
suffered a concussion
14
Identification Initial Response
  • Unconscious

Student UNCONSCIOUS
Teacher/coach/supervisor Stop activity
initiate emergency action plan and call 911
Teacher/coach/supervisor contact parent/guardian
re the injury and of the need to pick up
student. Provide information on the injury and
form to document medical examination (e.g.,
Appendix C-2 and Appendix C-3 Sample
Documentation of Medical Examination inform
principal of suspected concussion).
15
Identification Initial Response contd
  • Unconscious Concussion Suspected
  • EMS transports student to hospital for medical
    examination
  • Principal informs staff of suspected concussion
  • Parent/Guardian returns document of medical
    examination to principal (e.g., Appendix C-3
    Sample Documentation of a Medical Examination)

16
Identification Initial Response contd
17
Identification Initial Response contd
  • Conscious

Student CONSCIOUS
Teacher/coach/supervisor Stop activity
initiate emergency action plan
Page 17
18
Identification Initial Response contd
  • Conscious Initial Concussion Assessment
  • A Tool to Identify a Suspected Concussion is
    used.
  • The teacher/coach/intramural supervisor
    completes the form.

Teacher/coach/supervisor Conduct initial
concussion assessment (e.g., Appendix C-2
Sample Tool to Identify Suspected Concussion)
Page 18
19
Identification Signs and Symptoms Present
  • Conscious

Student Concussion Suspected
Student does not return to play that day
Teacher/coach/supervisor contact parent/guardian
re the injury and of the need to pick up
student. Provide information on the injury and
form to document medical examination (e.g.,
Appendix C-2 and Appendix C-3 Sample
Documentation of Medical Examination inform
principal of suspected concussion
Parent/guardian informed that student is to be
examined by medical doctor or nurse practitioner
as soon as possible that day
20
Identification No Signs or Symptoms Present
  • Conscious

Student Concussion NOT Suspected
Student may resume full participation in
physical activity
Teacher/coach/supervisor contact parent/guardian
and provide information of the injury and
importance of continued monitoring (e.g.,
Appendix C-2)
Parent/guardian Continued monitoring for 24-48
hours
21
Implementation Identification Procedures
  • Check your knowledge in the following scenarios.

22
Implementation Identification Procedures
  • Scenario A
  • In a ball hockey game during Physical Education
    class, two students rush for the ball and
    collide.
  • As Kate lunges and reaches for the ball in an
    attempt to shoot on goal, she slips and falls
    head first onto Satinders knee.
  • Kate collapses onto the floor, lying on her side
    with eyes closed and motionless for approximately
    30 seconds. She does not respond when students
    call her name. As you approach, her eyes open,
    she moans and starts to get up.
  • See next slide for questions.

23
Implementation Identification Procedures
  • Determine if Kate should be suspected of having a
    concussion.
  • Which concussion pathway should you follow?
  • Conscious
  • Unconscious
  • See next slide for answers.

24
Implementation Identification Procedures
  • Answer
  • Unconscious Pathway
  • Key points to determine concussion pathway
  • Kate lies motionless and unresponsive for
    approximately 30 seconds
  • loss of consciousness (physical sign on Tool
    to Identify a Suspected Concussion)

25
Implementation Identification Procedures
  • Scenario B
  • During an intramural soccer game, Reilly pushes
    Sam in an attempt to get the ball. Sam trips on a
    small rock hidden by the grass in the field and
    falls forward, smashing his chin on the ground.
    As you approach, Sam sits up and blood streams
    from the split in his chin. He panics, gets up
    and staggers towards you, almost falling again
    complaining of dizziness.
  • During the Initial Response procedures, you learn
    that Sam is feeling dizzy and cant remember the
    sport he was playing.
  • See next slide for questions.

26
Implementation Identification Procedures
  • Determine if Sam should be suspected of having a
    concussion.
  • Which concussion pathway should you follow?
  • Conscious Concussion Not Suspected
  • Conscious Concussion Suspected
  • Unconscious
  • See next slide for answer.

27
Implementation Identification Procedures
  • Answer
  • Conscious Pathway Concussion Suspected
  • Key points to determine concussion pathway
  • one or more signs/symptoms observed/reported
    (i.e., he reported that he was dizzy) and
  • Sam responded incorrectly to one of the memory
    function questions (i.e., he didnt know what
    sport he was playing)

28
Implementation Identification Procedures
  • Scenario C
  • During a tag game at recess, Louis is one of the
    last people to be caught. Faking to one side and
    sprinting away, he turns to check that Addison is
    not following him and runs into the basketball
    net pole. You are supervising the playground and
    hear the sound of Louis head hitting the pole.
    He pauses, shakes his head and then continues
    playing. Worried that he might have a concussion
    after such a hard collision, you call him over to
    question him.
  • After using the Tool to Identify a Suspected
  • Concussion you cant find anything wrong with
    him.
  • See next slide for questions.

29
Implementation Identification Procedures
  • Determine if Louis should be suspected of having
    a concussion.
  • Which concussion pathway should you follow?
  • Conscious Concussion Not Suspected
  • Conscious Concussion Suspected
  • Unconscious
  • See next slide for answers.

30
Implementation Identification Procedures
  • Answers
  • Conscious Pathway - Concussion Not Suspected
  • Key points to determine concussion pathway
  • Louis is conscious and never lost consciousness
  • No signs were observed nor symptoms relayed from
    Louis and
  • Louis correctly answered the memory function
    questions.

31
Diagnosis
  • Concussion

Page 31
32
Management Procedures for a Diagnosed Concussion
Return to Learn/Return to Physical Activity
Step 1 (home) Student complete cognitive and
physical rest
Principal informs school staff of
concussion and establishes collaborative team
identifying designated school staff lead
Parent/guardian report back to school
principal (e.g., Appendix C-4
Sample Documentation for a Diagnosed Concussion
Return to Learn/Return to Physical Activity
Plan Step 1)
Student Returns to School
Page 32
33
Collaborative Team
  • Manages Return to Learn and Return to Physical
    Activity
  • Collaborative Team is led by the school principal
    and includes
  • the concussed student
  • her/his parents/guardians
  • school staff and volunteers (e.g., coaches) who
    work with student and
  • the medical doctor/nurse practitioner.

Page 33
34
Return to Learn/Return to Physical Activity
Step 1- Rest
  • Cognitive and Physical Rest at Home
  • Continues for a minimum of 24 hours until
    symptoms improve or student is symptom free as
    determined by parent and student
  • Given that children and adolescents spend a
    significant amount of their time in the
    classroom, and that school attendance is vital
    for them to learn and socialize, full return to
    school should be a priority following a
    concussion
  • Davis GA, Purcell LK. The evaluation and
    management of acute concussion differs in young
    children. Br J Sports Med. Published Online First
    23 April 2013 doi10.1136/bjsports-2012-092132
    (p. 3)

Page 34
35
Return to Learn/Return to Physical Activity
Student Returns to School
Symptoms are Improving
Return to Learn Step 2a (with
symptoms) Student requires individualized
classroom strategies and/or approaches, see
Appendix C-1, TABLE 2 Return to Learn
Strategies/Approaches
Symptom Free
Parent/Guardian report progress to school
principal (e.g., Appendix C-4 Step 2a)
Return to Learn Step 2b (symptom free)
Student begins regular learning activities
Return to Physical Activity Step 2
(home) Student individual light aerobic physical
activity only

Page 35
36
Return to Learn Step 2a (with symptoms)
  • Step 2a Symptoms are Improving
  • Collaborative team lead identifies students
    symptoms and responses to learning activities
  • Develops appropriate strategies/approaches to
    meet students needs
  • School staff and volunteers need to be aware of
    students cognitive and emotional/behavioural
    difficulties

37
Return to Learn Strategies
  • Return to Learn Strategies/Approaches
  • Located in Appendix C-1, pgs. 14 and 15
  • Lists Cognitive Difficulties and
    Emotional/Behavioural Difficulties that may be
    experienced by students

Page 37
38
Return to Learn Step 2b (symptom free)
  • Step 2b Symptom Free after Step 2a
  • Parents/Guardians communicate that student is
    symptom free and ready to move on to Step 2b
    Return to Learn and Step 2 Return to Physical
    Activity
  • Step 2b Symptom Free after Step 1
  • Parents/Guardians communicate student is symptom
    free and is returning to school
  • Student proceeds directly to Step 2b - Return to
    Learn and Step 2 Return to Physical Activity
  • Progress monitored by the collaborative team

Page 38
39
Return of Concussion Signs/Symptoms
  • Concussion signs/symptoms can reoccur during
    cognitive and physical activities
  • Student must be closely monitored for
  • return of signs/symptoms
  • deterioration of work habits and performance.
  • If concussion signs/symptoms return
  • a medical examination is required (medical
    doctor/nurse practitioner)
  • the parents/guardians complete Return of Symptoms
    form.
  • Student returns to step as determined by medical
    doctor/nurse practitioner

Page 39
40
Return to Physical Activity Steps 2 and 3
Symptom Free
Return to Learn Step 2b (symptom free)
Student begins regular learning activities
Return to Physical Activity Step 2
(home) Student individual light aerobic physical
activity only

Parent/Guardian report progress to school
principal (e.g., Appendix C-4 Step 2b/Step 2)
Return to Physical Activity Step 3
(school) Student individual sport specific
physical activity only
Page 40
41
Return to Physical Activity Steps 4, 5 and 6
Return to Physical Activity Step 4
(school) Student activity with no body contact
Parent/Guardian report back to school principal
- include written documentation from medical
doctor or nurse practitioner to indicate the
student remains symptom free and able to return
to full participation (e.g., Appendix C-4 Step
4)
Teacher inform parent of completion of Step 4
(e.g., Appendix C-4 Step 4)
Return to Physical Activity Step 5
(school) Student full participation in
non-contact sports full practice for contact
sports
Return to Physical Activity Step 6
(school) Student full participation in all
physical activity (including contact sports)
42
Question A
  • Alex has a few concussion symptoms, but is
    progressing well through the Return to Learn plan
    developed by the school. She/he would love to be
    active. When can she/he participate in DPA or
    intramural activities?
  • See next slide for answers.

43
Answer to A
  • DPA
  • Alex can participate
  • when he/she is symptom free (has completed Step
    2a of Return to Learn Plan)
  • After he/she has completed Step 2 of the Return
    to Physical Activity Plan
  • If the DPA activities meet the criteria of Step 3
    of Return to Physical Activity Plan.

44
Answer to A contd
  • Intramural Sport/Activities
  • Alex can participate
  • when he/she is symptom free (has completed Step
    2a)
  • After he/she has completed Steps 2-4 of the
    Return to Physical Activity Plan
  • After examined and cleared for non-contact
    physical activity by medical doctor/nurse
    practitioner.

45
Question B
  • After Step 1 physical and cognitive rest,
    Ryan has no signs or symptoms. He/she desperately
    wants to play in the tournament this weekend. At
    which step can Ryan fully participate in the
    volleyball games (non-contact interschool sport)?
  • See next slide for answers.
  • .

46
Answer B
  • Play in volleyball tournament?
  • successfully completed Step 4 of Return to
    Physical Activity Plan
  • examined and cleared to participate by a
    medical doctor or nurse practitioner

47
Prevention
  • there is evidence that education about
    concussion leads to a reduction in the incidence
    of concussion and improved outcomes from
    concussion
  • (Delaney, Lacroix, Leclerc, Johnston, 2000
    Goodman Gaetz, 2002 McCrea, Hammeke, Olsen,
    Leo, Guskiewicz, 2004).
  • .

48
Prevention
  • Curriculum Connections
  • Resources
  • Safety.ophea.net Appendix C-5 Sample
    Concussion Prevention Strategies
  • Safety.ophea.net - The Generic Section and
    sport/activity pages of all modules.
  • Localized board prevention strategies

49
Prevention Contd
  • Culture of Safety Mindedness
  • When planning activities teacher/coach/intramural
    supervisor must
  • be familiar with Boards Concussion policy
  • review with students
  • background concussion information, and
  • ways to minimize the risk of concussion around
    the school and in physical activities and sports.

50
Prevention Pre-Activity
  • Prior to physical activity and/or prior to the
    sport season teachers/coaches/intramural
    supervisors should
  • be knowledgeable of safe practices in the
    sport/activity, (e.g., rules and regulations and
    specific sport/activity pages in the OPESG)
  • Be familiar with risks of concussion/potential
    injuries associated with the activity/sport and
    ways to minimize those risks.

51
Prevention During Activity
  • Strategies that should be used during a unit of
    physical education and/or sport season or
    intramural activities
  • Teach skills and techniques in proper
    progression)
  • Encourage students/athletes to follow rules of
    play and to practice fair play.

52
Questions?
  • Website safety.ophea.net
  • Email safety_at_ophea.net
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