Concussion Management Protocol
Step 1: Immediate Evaluation
Step 2: PA STATE LAW: Proper Medical Clearance
Step 3: Neurocognitive Testing (ImPACT)
Step 4:School/Activities Modified As Needed
Step 5: Monitor Symptoms and Repeat ImPACT Testing
Step 6: Progressive Return to Participation in Sport
Step 1
 Recognition of concussion signs and symptoms by the athlete, coach,
parent, or Athletic Trainer.
 Removal from the event if a concussion is suspected.
 Immediate evaluation of the athlete by a trained medical professional
(Physician or Athletic Trainer) should occur as soon as possible.
 Athletes with concussions should be referred to a physician on the day of
injury if he or she lost consciousness or experienced amnesia lasting
longer than 15 minutes.
 CT or MRI scans of the head are not necessary; unless the person is
experiencing increasing symptoms that raise the concern of an intracranial
bleed. These symptoms are stated on the Recognition of Concussion form
provided by the Aspire Sports Medicine Staff.
Step 2
AS STATED IN THE PENNSYLVANIA STATE LAW EFFECTIVE JULY 1, 2012;

NO RETURN TO PLAY WITHOUT WRITTEN MEDICAL
CLEARANCE: Athletes who have been removed may not return to play
until evaluated and received written clearance from either a:
 Licensed physician who is trained in the evaluation and
management of concussions or a licensed health care
professional with such training designated by such
physician; or
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
Licensed neuropsychologist trained in the evaluation and
management of concussions or who has postdoctoral
training in neuropsychology and specific training in the
evaluation and management of concussions. [Note: unlike
some other states, and an earlier version of the bill,
certified athletic trainers, while they may remove a player
from play, may not give the medical clearance required for
return to play.]
Step 3
 Post-concussion Neurocognitive testing with the ImPACT program
should take place within 24-72 hours.
 If the athlete is a participant in a contact sport, they will have a baseline
ImPACT test performed prior to the beginning of season.
Step 4
 School attendance and other activities (gym class) may need to be
modified according to the individual’s symptoms.
 Use of cell phones, loud music, television, computer and exposure to
bright lights may need to be limited.
 Students who are unable to attend school for an entire day without
symptoms may need special accommodations.
 Workload and homework may also need to be reduced.
Step 5
 The individual’s symptoms should be closely monitored until they feel
symptom free.
 ImPACT testing will be performed again 24 hours after the symptoms
have cleared, or 7-10 days after the first post-concussion test.
 ImPACT testing will continue to be performed as recommended by the
ImPACT Neuropsychologist (concussion specialist) that reviews the test
data.

Step 6
 Once the athlete is symptom free, they have a note from a Neurologist,
and they have been cleared through ImPACT, they may begin a
progressive return to their sport.
 A progressive return involves gradually increasing the level and intensity
of the activity, while closely monitoring the athlete for any return of
symptoms.
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


Example:
 Day 1: Impact Test
 Day 2: Walking or easy biking for 20-30 min.
 Day 3: Jogging or moderate biking for 20-30 min.
 Day 4: Running, lifting or heavy biking for 20-30 min.
 Day 5: Sport specific drills/practice (non-contact)
 Day 6: Return to contact sports
If symptoms return at any point during the progression the activity
should be stopped. The athlete should return to rest and must be
symptom free for at least 24 hrs before starting the progression again.
Further Information:
 Second Impact Syndrome: Occurs when an adolescent receives a
second blow to the head after they have already sustained a
concussion, which results in rapid swelling of the brain and is often
fatal. Even a very minor blow can cause Second Impact Syndrome.
 Post-Concussion Syndrome: Is characterized by prolonged
concussion symptoms (headache, nausea, dizziness, difficulty
concentrating, poor memory, etc.) that may continue for months or
longer.
 Guidelines: These are the guidelines stated by the National Athletic
Trainers Association (NATA) and by law are to be followed and
enforced by the Licensed Athletic Trainer. More information can be
found at www.nata.org
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RECOGNITION OF A CONCUSSION
→ Headache or pressure in the head
→ Temporary loss of consciousness
→ Confusion or feeling as if in a fog
→ Amnesia surrounding the traumatic event
→ Dizziness or "seeing stars"
→ Ringing in the ears
→ Nausea or vomiting
→ Slurred speech
→ Fatigue
→ Difficulty concentrating at school or work
→ Irritability
→ Sensitivity to light and noise
→ Sleep disturbances
→ Psychological adjustment problems and depression
Some symptoms of concussions may be immediate or delayed in
onset by hours or days after injury
PLEASE SIGN AND DATE THIS FORM ACKNOWLEDGING THAT YOU HAVE
READ AND UNDERSTAND THE GUIDELINES WE WILL FOLLOW THIS
UPCOMING ATHLETIC SEASON.
THANK YOU,
ASPIRE SPORTS MEDICINE STAFF
SIGN:__________________________________________________________
PRINT:__________________________________________________________
DATE:__________________
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