Eagle C.A.R.E. — A Sport Club Concussion Management Program: Part 1

March 27, 2012

Bob Liebau
Associate Director of Campus Recreation
University of Mary Washington

Editor’s Note: In this two part series, the Eagle C.A.R.E Concussion Management Program is divided into two parts (a) Education and Baseline Testing and (b) Concussion Management & Assessment and Post Concussion Treatment Plan.

Concussions awareness has increased astronomically in recent years; professional ice hockey players and football players have become highly visible icons for the need for better understanding of the injury, management of the injury, and guideline for return-to-play decisions. The National Collegiate Athletic Association, the Centers for Disease Control, the National Athletic Trainers Association and other professional and medical organizations have established guidelines for concussion management. Concussions can be serious and potentially life threatening injuries. Research agrees that these injuries can have serious consequences later in life if not managed properly at the time of the initial injury. However, before going any further, it is important to understand what a concussion is.

A concussion is also referred to as a mild traumatic brain injury (mTBI). The injury is caused by when there is a direct or indirect physical insult to the brain. As a result, impairment of mental functions such as memory, balance and equilibrium, and vision may occur. It is important to understand that many sport-related concussions do not result in a loss of consciousness. This predicates that all suspected head injuries must be taken seriously.

The Department of Campus Recreation at the University of Mary Washington realized a record number of reported concussions and one death (not a UMW student-athlete) during the 2010-11 academic years. This emphasized the importance of having an appropriate concussion management program to safeguard the well-being of all student-athletes participating in Sport Club Programs. The result is the Department of Campus Recreation’s Eagle CARE Concussion Management Program. The program was developed in collaboration with Mary Washington Healthcare/Mary Washington Hospital and its Neuroscience Center for Excellence.

The groundwork and outline for the program comes from the acronym CARE.
C — Collaborate. The Department of Campus Recreation collaborated with Mary Washington Healthcare to develop the concussion management program for the 26 sport club student-athlete participants.

A — Acknowledge and Assess. The Department of Campus Recreation acknowledged the importance of accurate assessment and management of all head injuries and the potential long-term effect on brain function. Preseason baseline brain function assessment is provided by the ImPACT program (www.impacttest.com). Post-injury assessment and monitoring of all head injuries is performed by appropriately trained medical personnel of the Mary Washington healthcare system.

R — Recognize and Respond. The Eagle CARE model allows for the timely recognition and response to any head injury sustained by a Campus Recreation student-athlete during a sponsored practice or event whether it is a home or away event. The model also recognizes that medical information is private and cannot be freely shared with third parties without the expressed written approval of an individual; due to FERPA (http://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html) and HIPAA (http://www.hhs.gov/ocr/privacy/) guidelines, the Department of Campus Recreation professional staff does not have the consent to view a medical diagnosis without the expressed written consent of the student-athlete. The physician consulting with the Department of Campus Recreation is required to limit any return-to-play notes with this understanding.

E — Educate. The professional staff of the Department of Campus Recreation recognizes that compliance to any initiative requires knowledge and understanding of “what’s in it for me” for the student-athletes. A thorough educational component has been developed and used to educate student-athletes, coaches, parents, and UMW faculty and staff to the etiology of concussions and the appropriate follow-up management to guarantee the safe return of the student athlete to sports and academic endeavors.
The Eagle CARE program was developed over the course of 2010 and 2011 with program implementation starting August 2011.

Description of the components of the Eagle CARE program:

Education and Baseline Testing
Summary:

1. Concussion education session for all sport club officers and coaches presented by the Department of Campus Recreation and Mary Washington Healthcare
2. Student-athlete signs participation agreement to include baseline testing (ImPACT)
3. Baseline testing (ImPACT) for high risk sports: boxing, cheerleading, field hockey, lacrosse (men and women), polo, rugby (men and women), soccer, and women’s volleyball.

Detailed points for education and baseline testing include the following:

• Concussions and other brain injuries can be serious and potentially life threatening injuries. Research indicates that these injuries can also have serious consequences later in life if not managed properly at the time of the initial incident.
• A concussion occurs when there is a direct or indirect insult to the brain. As a result, impairment of mental functions such as memory, balance/equilibrium and vision may occur. It is important to recognize that many sport-related concussions do not result in a loss of consciousness. As a result, all suspected head injuries must be taken seriously.
• Coaches and teammates are critical in identifying those student-athletes who may have a concussion because a concussed athlete may not be aware of their condition or may be trying to hide their injury to remain in practice or competition.
• All Eagle Sport Club officers, first responders, and coaches will be required to attend the concussion education session presented by the Department of Campus Recreation and Mary Washington Healthcare during the first week of fall classes.
• All Eagle Sport Club student-athletes and coaches must read the NCAA Concussion Fact Sheet provided by the Department of Campus Recreation and sign the statement acknowledgement regarding sport club concussion management protocol.
• Every first-year or transfer student-athlete in the sports of boxing, cheerleading, field hockey, lacrosse (men and women), polo, rugby (men and women), soccer, and women’s volleyball will be required to take a supervised pre-season baseline assessment for concussion using the ImPACT system. Student-athletes who have already had ImPACT testing must provide a copy of the test results to the Director of Campus Recreation.
• ImPACT is a software tool utilized to evaluate recovery after concussion. ImPACT evaluates multiple aspects of neurocognitive function, including memory, attention, brain processing speed, reaction time, and post concussion symptoms. This data will help physicians evaluate recovery following concussions and assist in making recommendations for return to play.
• ImPACT testing will be conducted by the professional staff of the Department of Campus Recreation. Each Eagle Sport Club president will be contacted with the date and time(s) of their club’s testing sessions. The test administrator will confirm that all tests are certified as valid.
• The student-athlete will maintain a copy of the baseline test and the data will be stored in the ImPACT data base. This information will be available to Mary Washington Healthcare staff in the event the student-athlete presents to the hospital with a concussion or other head trauma.

Part 2 of this article (April Newsletter) describes the ‘Concussion Management and Assessment’ and ‘Post Concussion Treatment Plan’ components of the Eagle C.A.R.E. program.

Bob Liebau has been part of the University of since 1986. He began his tenure as the Head Athletic Trainer for Intercollegiate Sports and was the first athletic trainer hired by the institution. He is a Board of Certification Nationally Certified Athletic Trainer and is credentialed by the National Athletic Trainers’ Association, the Mid-Atlantic Athletic Trainers’ Association and Virginia Athletic Trainers’ Association, and is a Commonwealth of Virginia licensed Athletic Trainer.

During his time as the Head Athletic Trainer, the intercollegiate sports program grew from 11 sports to 23 sports. Bob became the Associate Director of Campus Recreation and Director of the Fitness Center May 2003. He can be contacted at rliebau@umw.edu