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Hunterdon Huskies 2016 Concussion Management Program

As we begin the 2016 football and cheer seasons, your child's safety is out top priority.  The Hunterdon Huskies are pleased to provide our athletes with a premier concussion management program.  Please read the following carefully and be assured that our coaches and athletic trainers are well prepared to handle all sports related injuries as a prerequisite to coaching for our organization.

A concussion is a traumatic brain injury that can occur in sports like football.  Suffering a second concussion prior to fully recovering from the first can have devastating consequences. Thus, in order to protect the well-being and future health of our athletes, the Hunterdon Huskies football and cheer organizations are adopting the following protocol for dealing with concussions suffered by our athletes during the 2016 season. The Concussion Protocol will be monitored by the St. Luke’s Concussion Center at the Warren Campus in Phillipsburg, New Jersey, under the direction of Nick Avallone, M.D.  As a Board Certified Orthopaedic Sports Medicine Specialist and Head Team Physician for 4 local high schools, Dr. Avallone has additional expertise in concussion management and is a Certified ImPACT Consultant.

All Hunterdon Huskies football and cheer athletes aged 10 are to receive a baseline ImPACT test, free of charge, from the St. Luke’s Concussion Center. This is a 30 minute (approximate), computerized neurocognitive test that can be used as a tool in assessing when an athlete has recovered from a concussion. The ImPACT test only is valid for patients aged 10 and up. Unfortunately, no valid computerized neurocognitive test exists to date for those less than 10 years old. For this age group, we will rely on symptom scores and serial neurologic exams to determine when it is safe to allow an athlete to return to play.

For those players or cheerleaders who could not attend the two sessions offered at Voorhees High School, please contact St. Luke’s Warren Concussion Center at 908-859-4381 to arrange testing at a time that is convenient for you.   It is mandatory that Hunterdon Huskies players and cheerleaders participate in this program.

A number of studies have pointed to the notion that stronger neck muscles help reduce the incidence of concussions in athletes by stabilizing the head and restricting its acceleration through space. Thus, the St. Luke’s Concussion Center will also provide the Hunterdon Huskies football and cheer coaches with a neck strengthening exercise program. The exercises will be introduced to the coaches who will then teach their athletes how to help prevent concussions through strengthening their neck muscles.

During the season, if a coach or referee suspects a concussion in a player or cheerleader, the athlete will be removed from practice, game or cheer participation that day and will not be allowed back to play until a full evaluation has been obtained from a physician with expertise in concussion management, a return to play program has been designed and implemented and a Clearance to Return has been obtained from the office of Dr. Avallone and the St. Luke’s Concussion Management Program. If the coach has a question about a certain athlete, they will call Dr. Avallone or one of his associates on their cell phone. These numbers will be provided to the head coach of each team.

When a player is suspected of a concussion, that athlete should be evaluated within a few days of their injury by Dr. Avallone or one of his associates.  If the athlete’s symptoms are more severe or if there is a question regarding the severity of the head injury, the patient should be taken immediately to the closest emergency department. Dr. Avallone and his colleagues at the St. Luke’s Concussion Center in Phillipsburg, NJ, will offer their expertise to evaluate the athlete in the first few days after a concussion.  A full neurologic exam should be performed, a symptom score rendered and a treatment regimen prescribed.  Academic, athletic and lifestyle modifications will be determined based on the severity of the player’s symptoms. A note will be created for the patient to give to his or her school nurse describing the academic modifications and gym restrictions. This note should also be available for the coach to review to keep the athlete out of sports until he or she has successfully completed the Return to Play Protocol.

Return to Play Protocol

The patient will have relative rest during this initial recovery period and will be involved in academics to the level that his or her symptoms allow. The patient will then be seen one week later by Dr. Avallone, or one of his board certified sports medicine associates.  At this visit, the athlete will be given a post-concussion ImPACT test to help determine if the player’s brain has recovered from this injury. Since recent literature has shown that school age individuals tend to take at least 2 weeks to fully recover from a concussion, we will implement a policy whereby the athlete must be symptom-free for 7 days before entering the next phase of the Return to Play Protocol. In addition, for an athlete who is 10 years old or greater and has a valid baseline ImPACT study, he must also pass the post-injury ImPACT test prior to starting the Zurich Return to Play exertional challenges. For an athlete younger than 10 years old or for someone without a valid baseline ImPACT study, that player simply must be free of symptoms for 7 days prior to beginning the Zurich Protocol. A note clearing the athlete to start the Zurich Protocol must be furnished by Dr. Avallone or one of his board certified sports medicine associates.  

If a child fails the ImPACT test or has persistent symptoms of a concussion at his or her follow-up visit, the child may be referred to the cognitive and physical therapists at the St. Luke’s Concussion Center for further treatment. He may also be referred to a neurologist with expertise in concussion management.

The Zurich Return to Play protocol is widely used by NJ high schools as well as high schools, colleges and professional teams throughout the country as a tool to gradually increase an athlete’s level of exertion in a step-wise fashion prior to returning to game competition. 

In its most basic form, the Zurich Protocol is as follows:

  1. Light aerobic exercise at <70% max heart rate
  2. Sport-specific exercise including running drills but no contact
  3. Non-contact training drills and resistance training
  4. Medical clearance must be given to advance to full contact practice
  5. Return to normal game play or cheer activities

At the end of each day of graduated exercises, the parent will hand the athlete a paper with a symptom-score sheet similar to the one given to him by Dr. Avallone or his associates.  The athlete will then fill-out this sheet and hand it back to the parent who will then immediately fax the paper to the doctor for interpretation. Any score greater than zero or their baseline score will be considered a failure, and the physician will have the player repeat the previous, symptom-free step on the following day. Thus, if the athlete’s symptoms recur with the addition of non-contact training during the 3rd day of the protocol, the attending physician or Dr. Avallone will have the patient take a step back to the lower level exercises on the next calendar day. If symptoms cease with the lower level exercises, then the athlete will be allowed to advance once again to the next step in the protocol. Alternatively, if a parent feels uncomfortable administering the exercises for a step in the protocol, the athlete may be seen at the Concussion Center and taken through that day’s exercises under the supervision of one of the physical therapists.

As stated above, once the athlete has successfully navigated the Zurich Protocol through the third step, he must be given a full clearance note by Dr. Avallone.  ONLY DOCTOR AVALLONE or his Associates, CAN CLEAR AN ATHLETE TO RETURN TO PARTICIPATION WITH THE HUSKIES.  This note will also lift the academic guidelines for the athlete. If the athlete experiences symptoms during or after practice in step 4, the athlete will then repeat step 3 on the next calendar day.  Another note from Dr. Avallone would have to be written to clear the athlete for football or cheer participation if he or she fails step 4.

This protocol is intended to help get our athletes back on the field in a safe fashion. While no protocol can guarantee that a child has fully recovered from a concussion, this algorithm has been successfully utilized in many athletes across the region and across the country and is currently used by the students at most local high schools. Neck strengthening, proper tackling and blocking techniques, and appropriately fitting helmets are the best ways to help prevent a concussion. Seminars will be given by Dr. Avallone on concussion prevention, identification and treatment so that parents and children alike can be better educated on how to safely enjoy participating in football or cheer.

Sincerely,

The Hunterdon Huskies Board of Directors