Nurses' Corner

Rosary Academy understands the seriousness of concussion both in and out of sport. That is why we've created a comprehensive Concussion Management Program that begins the moment a concussion is suspected. Based on medical best practices set forth by professionals in the study of concussion management, this program is designed to transition your daughter back to the classroom and playing field in the safest way possible.

If you suspect your daughter has suffered a concussion, please contact Rosary’s nurses at nurse@rosaryacademy.org and review these tabs for additional information. 

If you believe your daughter is having a medical emergency, please call 911.

First and foremost, Do Not Panic. A vast majority of individuals that suffer a concussion resolve back to normal function over time. Expressing panic may exacerbate the student's symptomology as they may feed off of a parent's emotions. Concussions are to be taken seriously but are generally not cause for panic.

If you feel your student is having a medical emergency, call 911.

If your child has been diagnosed with a concussion or you feel she may have suffered a concussion, it is imperative the Concussion Management Program be implemented as soon as possible. The first step in this process is both physical AND cognitive rest. Please see the definitions page for more information.

If your child has not yet been diagnosed with a concussion and you feel she may have suffered one, please contact Rosary’s nurses and arrange a physician visit to one of our approved concussion management providers by contacting one of them directly.

The purpose of this program is to underscore the importance of specifically addressing the topic of head injuries sustained by Rosary students and provide a consistent, comprehensive approach for the management and safe Return to Activity of the student. A student’s best chance of full recovery from a concussion involves two critical components: cognitive and physical rest followed by a stepwise Return to Learn (RTL) progression then a stepwise Return to Play (RTP) progression.

It is important to note that the recovery from a concussion is a very individualized process. Caution must be taken not to compare students with concussions as they progress through the recovery process.

In any circumstance where a concussion is suspected, the first priority is to remove the student/athlete from further participation for the remainder of the day. This initiates the Concussion Management Program. For the academic (RTL) protocol to be initiated the student must be evaluated by an approved health care professional within 2 days and documentation must be provided to the school’s nursing office.

The recommendations in this document for the management of concussion are based on a review of the current best practices in concussion management from a wide variety of resources from across the country.

It is important that once the student has returned to school that they report to the nurse on a daily basis in order to monitor symptoms as well as to determine progression to the next stage within the return to academics guidelines. In the event the nurse is unavailable, the student must report to the athletic trainer at lunch.

If a student remains in stages 1-3 for more than 2 weeks, it MAY be necessary to schedule a conference with the assistant principal of academics, counselor, and the student’s parents in order to discuss a plan of action for the rest of the semester.

Medications are usually not needed but in some cases may be needed when considering sleep and headaches. Please follow your physician’s orders when taking any medications during concussion recovery.

Any physician authorized or restricted medication use (especially Ibuprofen or Acetaminophen for pain management) must be reported to the nursing staff.

NOTE: The student/athlete should not be using medication when assessing symptoms and RTP.

Successful recovery from a concussion is a multi-faceted process. Following a concussion, your student will work closely and be an integral part of the Concussion Management Team (CMT). The Rosary CMT is a team of individuals within the school and in the community to assist the student through the recovery from concussion. Members of the concussion management team include physicians, administrators, counselors, teachers, school nurses, athletic trainers, coaches or club leaders, parents, and the student themselves. In more complex cases, it may be necessary to add more team members such as: neurologists, psychologists, neuropsychologist, additional physicians, etc.

The nurse acts as the point person for all members of the CMT. The nurse collects and disseminates information from and to all appropriate CMT members throughout the recovery process. Please submit all correspondence through the nurse regarding your student's recovery process.

It is important that once the student has returned to school they report to the nurse as indicated in order to monitor symptoms as well as to determine progression to the next stage within the RTL guidelines. In the event the nurse is unavailable, the student must report to the athletic trainer.

Much like the Return to Play (RTP) progression, Rosary employs a RTL progression as well.

The Return to Play (RTP) process following a concussion follows a step-wise progression. The student must be symptom free for a minimum of 24-48 hours and completed the entirety of the Return to Learn (RTL) protocol before beginning this progression. The student will complete each level and progress to the next only if they remain asymptomatic both at rest and with provocative exercise. There will be roughly 24 hours between each step of the RTP progression and this process will take no less than 8 days. Should the student become symptomatic during the progression, they will drop back to the previous asymptomatic level and try to progress after a 24-hour period of rest has passed. Each phase of the RTP will be administered and assessed by an ATC (certified athletic trainer) at Rosary. BOTH parents must, in writing, approve of their student to progress back to full contact activities. Final return to play clearance is at the sole discretion of the athletic training staff in accordance with state education codes.

Your student will complete a number of forms during their recovery process. Some of these forms will need to be picked up in person from the school nurse. Other forms the student may need are listed below.

When visiting your physician, please have the MD or DO complete the Physician Recommended School Accommodations Following Concussion form below. Return this form to your daughter's academic counselor.

The following "return-to-learn" documents are to assist the concussed student to “return to the classroom and learning environment” in a scientific manner regarding brain activity.

CIF Return to Learn Protocol

Physician Recommended School Accomodations Following Concussion

Medical science and concussion care experts have found that a concussed athlete must take a gradual and progressive, stage by stage, step by step return to practice under medical supervision to minimize risks and allow the brain to properly recover. 

A.B. 2127 and CIF Bylaws mandated a MINIMUM timeline, but medical experts recognize that many adolescent concussion patients may take much longer to recover.  Always be cautious as returning to practice and play too quickly may have catastrophic consequences. 

Concussion Return to Play Protocol

Forms that are filled out by the Concussion Management Team

Suspected Head Injury Home Information - This form alerts you to the fact that your student may have suffered a concussion while at a school related event. It also outlines certain instances when a trip to the Emergency Department is warranted and how to initiate the Concussion Management Program for your student.

Graded Symptom Checklist (GSC) - This checklist helps the Concussion Management Team document the recovery process following a concussion. It is vital accurate information is documented on the GSC to ensure the safety of the injured student-athlete and to make return-to-play decisions. Directions for filling out the GSC are located near the bottom of the form.

In an effort to provide your student with the best possible care, Rosary encourages students to use licensed health care providers we know are trained in the management of concussions. This is backed up by an Assembly Bill passed in 2011. If you choose to use another provider for any reason and the Sports Medicine department does not feel your child has received the standard of care they deserve, we may ask that you get a second opinion with one of our approved providers.

APPROVED PROVIDERS

Concussion - A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include:

Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with a great enough force which can be transmitted to the head.

Concussion typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously.

Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.

Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course; however, it is important to note that in a small percentage of cases, post-concussive symptoms may be prolonged.

No abnormality on standard structural neuroimaging studies (i.e. x-ray, ct-scan) is seen in concussion.

Mild Traumatic Brain Injury (mTBI) – All concussions are a form of mTBI, however not all mTBI's are concussions. The terms mTBI and concussion should NOT be used interchangeably.

Post-Concussion Syndrome – A set of symptoms which may last for weeks, months, or years following a concussion.

Second Impact Syndrome – Rare condition when an athlete sustains a second head injury before symptoms from the first have resolved, often fatal.

Cognitive Rest – Avoiding such behaviors and activities as: driving, video games, computers, text messaging, cell phone use, loud and/or bright environments, television, and reading and studying; these must be limited, and in most cases, completely avoided.

Physical Rest – Avoiding such activities and behaviors as: physical education, sports activities, and strength or cardiovascular conditioning must be regulated or avoided while recovering from a concussion.

Return to Activity – A two part process involving BOTH Return to Learn (RTL) and Return to Play (RTP) components to assist Rosary students in returning to both full academic and extra-curricular activities in a safe manner.

Return to Learn (RTL) – A stepwise process re-integrating the student back into the classroom and a full academic load.

Return to Play (RTP) – A stepwise process re-integrating the student back into their extracurricular activities.

Concussion Management Team (CMT) – A team of individuals within the school and in the community to assist the student through the recovery from concussion. Members of the concussion management team include physicians, administrators, counselors, teachers, school nurses, athletic trainers, coaches or club leaders, parents, and the student themselves. In more complex cases, it may be necessary to add more team members such as: neurologists, psychologists, neuropsychologist, additional physicians, etc.