Sport/Season: ______

INFORMATION FOR MARLBORO STUDENT-ATHLETE’S AND PARENTS

What is a concussion?A concussion is an injury to the brain that is caused by a direct blow, violent shake or rotation to the head. It results in a functional injury to the brain, where there may be cognitive, physical, or behavioral issues (see table below). It may or may not result in a loss of consciousness.

How do I know if I have a concussion?There are many signs and symptoms of concussions that you may experience. A concussion is an “invisible injury” because its diagnosis is based primarily on reported symptoms. Concussions are not structural injuries and therefore do not show up on diagnostic imaging tests (x-ray, CT scans, MRI’s).

Cognitive / Physical / Behavioral
Disorientation
Memory deficits
Impaired concentration
Decreased attention
Amnesia
Feel “foggy” / Headache
Impaired balance
Impaired coordination
Dizziness
Nausea/Vomiting
Blurred vision
Fatigue
Loss of consciousness / Irritability
Inappropriate emotions
Sleep disturbance
Personality change
Sadness/depression

What should I do if I think I might have a concussion?If you are experiencing any of the signs or symptoms listed above, you should see your athletic trainer, your school nurse, or your physician right away. They can determine how to proceed based on how your injury presents itself.

When do I go to the Emergency Room?If your signs and symptoms are getting progressively worse, you should seek emergency medical care. This may be indicative of a cerebral hemorrhage or “brain bleed”. The hospital will need to do diagnostic imaging (X-ray, MRI, CT Scan) to make this diagnosis. Additionally, if you lose consciousness, you should go to the emergency room.

What can I expect after sustaining a concussion? You may have sleep disturbances, headaches, or difficulty concentrating in school. Any of the symptoms listed above may continue for an unspecified time. Most concussions are healed within 10 days, but some can last for months/years (“post-concussion syndrome”)

When is it safe to return to athletics?When you no longer experience any concussion signs/symptoms, you must complete the return to play protocol to ensure that your concussion is fully healed. This process is important because we must be sure that your initial injury is fully healed which helps reduce risk for additional head injuries. “Second impact syndrome” can occur with multiple concussions and can have devastating effects. The return to play protocol includes multiple exercise stages that increase in intensity. Each stage must be completed without signs/symptoms in order to progress. This test will be administered by the athletic trainer, and overseen by the district physician and your primary care physician.

** Prior to playing sports, the athlete and parent/guardian must complete the attached consent form**

Student-athlete/Parent Concussion Statement

Please initial each statement, confirming that you understand the information presented. Please return completed sheet to the school nurse along with your participation forms. If there are any statements on this sheet that you would like to clarify, please speak to either theathletic trainer,athletic director, coach, or nurse.

Parent/Athlete

_____/_____ I have read and understand the concussion information packet

_____/_____ A concussion is a brain injury, which I am responsible for reporting to my coach,

parents, or medical profession if one is available.

_____/_____ A concussion can affect my ability to perform everyday activities, my ability to

think, my balance, and my classroom performance.

_____/_____ I realize I cannot see a concussion, but I might have some symptoms immediately.

Other symptoms can show up hours or days after the injury.

_____/_____ If I think a teammate has a concussion, I should report it to my coach to protect

them from further injury.

_____/_____ I will not return to play in a practice or a competition if a hit to my head or body

causes any concussion-related symptoms.

_____/_____ I need written permission from a medical professional trained in concussion

management to return to play or practice after having a concussion, and this return to

play clearance process may take time depending on the severity of my injury.

_____/_____ After a concussion, the brain needs time to heal. I understand that I am much

more likely to have another concussion or a more serious brain injury if I return to play

or practice before my symptoms go away.

_____/_____ Sometimes, repeat concussions can cause serious and long lasting problems.

_____/_____ I have read the concussion signs and symptoms in the concussion information

packet.

Student-athlete signatureParent/Guardian signature

Student-athlete printed nameDate