Navigating the Complexities of NCAA Concussion Management: A Comprehensive Guide

The landscape of collegiate athletics, while fostering athletic achievement and academic growth, also presents inherent risks. Among these, sport-related concussions have emerged as a significant concern, demanding a robust and evolving approach to athlete safety. Ohio Wesleyan University, in alignment with NCAA association-wide policy and a commitment to protecting the health of its participating student-athletes, has implemented a comprehensive concussion management plan. This document aims to elucidate the multifaceted nature of concussions within the NCAA framework, detailing recognition, management, and return-to-play protocols, thereby ensuring a safe environment for all student-athletes.

Understanding the Nature of Sport-Related Concussions

A sport-related concussion is fundamentally a traumatic brain injury. It is instigated by a direct blow to the head, neck, or body, which transmits an impulsive force to the brain. This force triggers a cascade of neurochemical and metabolic changes, potentially affecting axonal integrity, cerebral blood flow, and leading to inflammation within the brain. The onset of symptoms and observable signs can be immediate, or they may manifest and evolve over minutes or hours. While many concussions resolve within days, the recovery period can, at times, be significantly prolonged.

The spectrum of symptoms associated with concussions is broad and not exhaustive. Common presentations include, but are not limited to, headache, nausea, heightened sensitivity to light and noise, fatigue, drowsiness, irritability, and a general feeling of being slowed down or experiencing cognitive fog. It is crucial to understand that concussions are not graded based on the severity of symptoms or the presence or absence of loss of consciousness at the time of injury. Standard structural neuroimaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI) with T1- and T2-weighted images, typically do not reveal abnormalities. However, in research settings, functional imaging studies, including those assessing blood flow or metabolic activity, may detect subtle alterations.

The defining characteristic of a sport-related concussion is its resultant range of clinical symptoms and signs, which may or may not involve a loss of consciousness. This underscores the importance of a thorough evaluation beyond just observable indicators.

The Peril of Second Impact Syndrome

A particularly grave concern in concussion management is Second Impact Syndrome (SIS). This life-threatening condition occurs when an athlete sustains a second head injury before the brain has fully recovered from a previous concussion. A primary driver of SIS is the premature return to participation, often before all symptoms have completely resolved. It is a common misconception that concussion symptoms resolve quickly; in reality, it can take days, weeks, or even longer for full recovery. While SIS most frequently affects younger athletes, particularly those in junior and senior high school, any athlete who returns to play too soon is susceptible. The inherent difficulties in accurately assessing concussion and managing recovery make preventing SIS a paramount objective.

Ohio Wesleyan University's Commitment to Athlete Health and Safety

Ohio Wesleyan University is resolutely committed to safeguarding the health and well-being of every participating NCAA student-athlete, fostering an environment of safety and security. In alignment with this commitment and adhering to NCAA association-wide policy, the university has established a robust concussion management plan. This plan is designed to objectively evaluate an athlete's post-injury condition and meticulously track their recovery, thereby facilitating a safe and informed return to play and crucially preventing the cumulative effects of multiple concussions.

Educational Imperatives and Athlete Acknowledgement

As part of its comprehensive approach, all NCAA student-athletes at Ohio Wesleyan University are provided with and afforded the opportunity to discuss concussion educational material. This includes resources such as the NCAA Concussion Education Fact Sheet or other pertinent documents. Annually, prior to participation, student-athletes are required to sign an acknowledgement form, confirming that they have received, reviewed, and understood the concussion education material. This process is facilitated through digital platforms like Healthy Roster, requiring a signature for submission and approval, and often includes a direct link to the NCAA Concussion Resource page for further information.

Pre-Participation Baseline Concussion Assessment

A cornerstone of Ohio Wesleyan University's concussion management strategy is the requirement for all NCAA student-athletes to undergo a pre-participation baseline concussion assessment. This assessment is predicated on the principle of individualized medical care, recognizing that each athlete and each injury is unique. Factors such as the severity and number of prior head injuries, alongside other individual health concerns and the evolving scientific understanding of concussions, are carefully considered. The team physician or primary healthcare provider is responsible for reviewing each athlete's history and discussing potential risks and benefits associated with playing sports, especially concerning concussion and repetitive head impacts. The team physician ultimately determines pre-participation clearance and identifies any need for additional consultation or specialized testing. For any student-athlete with a documented concussion, particularly those with a complicated or multiple concussion history, a new baseline concussion assessment may be considered at six months or beyond. It is important to note that while baseline testing can inform post-injury evaluations, student-athletes may perform at or even exceed their baseline scores in post-concussion testing due to factors such as increased motivation.

Immediate Response and Evaluation Protocols

When an Ohio Wesleyan University student-athlete exhibits signs, symptoms, or behaviors consistent with a concussion, they must be immediately removed from practice or competition for evaluation. A return to play on the same day is only permissible if an athletic trainer, team physician, or a designated physician determines, after a thorough evaluation, that a concussion is no longer suspected.

The initial concussion evaluation encompasses several critical components:

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Immediate assessment/neurological screen: This focuses on identifying "red flags" or observable signs that may indicate a more serious injury.
Symptom assessment: A detailed inquiry into the athlete's subjective experiences.
Physical and neurological exam: A clinical assessment of motor function, balance, and reflexes.
Cognitive assessment: Evaluation of memory, concentration, and processing speed.

Following a multi-modal evaluation, the student-athlete receives an educational sheet detailing concussion information, which also includes the date, time, and location for their follow-up appointment with a member of the Medical Staff. This informational sheet is provided for all suspected concussions, acknowledging that symptoms can evolve or manifest over time. For all diagnosed concussions, comprehensive documentation will confirm that a post-concussion plan of care has been communicated to both the student-athlete and another responsible adult, in both oral and written forms. This crucial discussion can occur off-field the same day, or within 72 hours in the Athletic Training Room.

The Role of SCOAT6 and Daily Re-evaluation

In situations where a student-athlete experiences a possible concussion but did not disclose the information to the athletic department's medical team, or if the injury occurred during an extended break from school, the SCOAT6 (Sport Concussion Office Assessment Tool) may be utilized for re-evaluation. This systematic approach ensures that even undisclosed or remotely occurring injuries are addressed with appropriate diagnostic tools.

Re-evaluation of a concussion takes place on a daily basis. Student-athletes are required to complete a Concussion Symptom and Return to Play Progression sheet in conjunction with an Athletic Training (AT) staff member. During this period, the student-athlete can engage in specific steps of the Return to Play protocol, commencing with Steps 1, 2 (A&B), and 3, as outlined later in this document.

Return-to-Learn: Prioritizing Cognitive Recovery

The vast majority of young adults experience a full return to their academic responsibilities, or "return-to-learn," without requiring additional academic support within approximately 10 days post-injury. Complete rest and isolation are generally discouraged, even during the initial 24-48 hours post-injury. Instead, relative rest is considered important during the first 24 hours.

The Return-to-Learn Management Plan is overseen by a designated point person, typically the Ohio Wesleyan University Team Physician managing the injury. This plan follows an individualized, step-wise process to guide the student-athlete through their return to academic activities. In more complex cases involving prolonged recovery, the plan may involve collaboration with a multi-disciplinary team, the composition of which will vary depending on the specific needs of the student-athlete.

A student-athlete recovering from a concussion will gradually return to classroom activities and studying as tolerated. This return will involve modifications to their schedule and academic accommodations as indicated, with assistance from the identified point person (the OWU Team Physician). The management plan may address adjustments to the learning environment, physical demands, curriculum, and testing procedures. For cases that cannot be effectively managed through schedule modifications and academic accommodations alone, campus resources will be engaged. The Accessibility Services Office (ASO) through the Office of Student Success serves as a key on-campus resource. If concussion symptoms persist over a break period, upon returning to campus, the student will have a follow-up appointment with their healthcare provider. Documentation regarding plans for final examinations will be provided by the healthcare provider. Return-to-Learn modifications will be discontinued once the athlete reports no longer experiencing any concussion-related symptoms to the medical team. Crucially, an unrestricted return-to-sport should not occur prior to achieving an unrestricted return-to-learn, particularly for concussions diagnosed while the student-athlete is actively enrolled in classes.

Return-to-Sport: A Phased Progression

Similar to the return-to-learn process, complete rest and isolation are to be avoided, even in the initial 24-48 hours post-injury. Relative rest is important during the first 24 hours. A well-structured Return-to-Sport (RTS) management plan is vital to prevent the occurrence of multiple concussions and the potentially devastating Second Impact Syndrome. The RTS progression involves a series of steps, carefully designed to gradually reintroduce the athlete to sport-specific activities while monitoring for any symptom recurrence:

Step 1: Symptom-limited activities of daily living. This involves engaging in normal daily activities as tolerated, without exacerbating symptoms.
Step 2: Introduction to light aerobic exercise. This may involve activities such as walking or stationary cycling.
Step 3: Sport-specific exercise and activity without increased risk of inadvertent head impact exposure. This step introduces drills and movements specific to the athlete's sport but avoids contact or activities that could lead to further head trauma.
Step 4: Progression to more complex drills and increased intensity. This involves gradually increasing the physical demands of training.
Step 5: Simulated game play. This step may involve non-contact scrimmage drills or practice scenarios that mimic game situations.
Step 6: Full return to competition. This is the final step, allowing the athlete to participate in all aspects of their sport without restriction.

Important Note: At any point during this progression, if the student-athlete experiences a return or increase in symptoms (defined as more symptomatic than their baseline, often measured as an increase of more than 2 points on a 0 to 10 point scale compared to their pre-exercise resting value), the team physician or their designee will be notified, and adjustments will be made to the return-to-sport progression. The entire RTS progression is meticulously documented on the Concussion Symptom and Return to Play Progression sheet (Appendix B).

Broader NCAA Initiatives and Ohio House Bill 143

Ohio Wesleyan University's comprehensive concussion management plan is further reinforced by broader NCAA initiatives and state legislation. The NCAA member schools are integral to these efforts, not only through playing rules designed to enhance player safety but also by mandating the implementation of concussion management plans. The NCAA provides a Concussion Safety Protocol template as a resource for member schools, highlighting key components of the updated NCAA Concussion Safety Protocol Checklist. While schools are not obligated to use this template, it serves as a valuable tool for athletic departments in developing their safety protocols. The content within these resources is intended for educational purposes and should be reviewed with applicable campus medical, legal, and risk-management authorities to ensure alignment with institutional requirements and risk mitigation strategies.

Furthermore, in April of 2013, the General Assembly of the State of Ohio enacted Ohio House Bill 143, a significant piece of legislation aimed at enhancing safety in youth sports. This bill mandates that all coaches and referees involved in youth sports receive training in recognizing the signs and symptoms of a concussion or head injury, or possess a current Pupil Activity Permit (PAP) obtained through the Ohio Department of Education. Training programs for concussion recognition are accessible online through the Ohio Department of Health.

The Importance of Data Collection and Research

Data collection, research, and evidence-based decision-making are central to the effective management of concussions. The NCAAâDepartment of Defense CARE Consortium, established in 2014, represents the most comprehensive concussion study ever conducted, underscoring the ongoing commitment to advancing our understanding of sport-related head injuries. Member schools are encouraged to utilize the online reporting tool for submitting annual reports on concussions, with the reporting cycle running from July 1 to June 30, mirroring the academic year.

Coaches' Crucial Role in Concussion Management

Coaches play an indispensable role in both preventing concussions and responding effectively when they occur. This involves proactively educating student-athletes and coaching staff about concussions, clearly communicating concerns about concussion risks, and emphasizing expectations for safe play. By fostering an environment of awareness and vigilance, coaches can significantly contribute to minimizing the incidence and impact of concussions. Preventing long-term problems hinges on diligent adherence to protocols, as a repeat concussion before full recovery can impede healing and increase the risk of lasting issues.

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