Concussion Management Protocol for FLY Freestyle

Baseline ImPACT testing
 Recommended for all participants
 Mandatory for all winter Elite Team Athletes
- Can be done anytime but ideally recommended before season begins
- Ideally this should be done annually especially for younger athletes under age 13
- If no individual Baseline test completed, should injury occur, athlete WILL BE required to be cleared through
medical/clinical evaluation and ImPACT testing utilizing age/gender normative data
ANY Suspected Head Injury  NO Return to Sport that Day  Action Plan Activated

ACUTE ACTION PLAN

Further Action:
1. REMOVE athlete from sport, observe for signs/symptoms
2. Immediate Medical Triage – EMS and Referral to Medical Facility if indicated
3. Record time of initial incident and Mechanism of injury – communicate to medical personnel if being transported
or to parents these details and the following if observed:
a. Any Loss of Consciousness
b. Memory Loss before or after the incident
c. Any seizures
4. If not transported, athlete should be observed by coach or responsible party until parents arrive
5. NOTIFY PARENTS
6. Parents given home care instructions (CDC ACE Form/thinkheadfirst.com) and advised to contact Think Head
First regarding post injury follow up
7. Coach informs Club Administration of incident
1. Athlete monitored over 24-48 hrs by responsible individual for worsening symptoms or delayed responses.
 Any worsening of symptoms or if any of the 3 details listed above were observed, then transport  Medical
Facility to be evaluated clinically with any additional testing as deemed necessary.
2. If no problems and symptoms improved/resolved, schedule follow up evaluation within 48-72 hours to include:
 Medical evaluation, symptom survey, balance assessment
 ImPACT post injury evaluation if symptom appropriate

Post Injury ImPACT Testing:
1. If the Medical Personnel clears athlete medically and athlete essentially symptom free, then the post injury
ImPACT screen can be completed.
2. Think Head First CIC notified to arrange ImPACT post injury evaluation. This testing is possible to accomplish
online from anywhere with an internet connection. Instructions will be given on how to access the post injury
testing if outside of Park City.
3. Once test completed, Think Head First CIC will review ImPACT result and will subsequently and advise athlete,
parent, coach and trainer regarding status for Return to Sport Progression
FY14/15
Return to Sport Progression
Basic Requirements Necessary to BEGIN Return to Sport Progression:
1. Asymptomatic at Rest – Athlete symptoms have resolved at rest
2. Normal medical exam – Normal medical/clinical screen and Balance evaluation
3. ImPACT Normal - post injury ImPACT returned to baseline levels or acceptable compared to normative data
General Return to Sport Guidelines:
- The following represents a generalized progression in activities that can be scheduled once the athlete is symptom free at
rest. Generally, 1 or more levels can be completed daily before progressing to the next level. Ideally, initial RTS conditioning
steps will be monitored by a Therapist or Athletic Trainer.
- If ANY signs/symptoms return with any level of activity, stop and rest until symptoms clear and then resume at level where
symptoms occurred.
Initial Recovery Conditioning Progression: In addition to Initial Recovery Conditioning progression all
athletes must complete the Think Head First “POST CONCUSSION RETURN TO SPORT GRADUATED
PROGRESSION” listed below
1. Activities of Daily Living – rest with light walking around home, short bouts of cognitive challenges, (homework,
reading, computer) etc. Possibly light manual massage, vestibular therapy if indicated
2. Supervised: Light Cognitive activity – reading, limited school work or computer work (short duration/15-20 mins with
plenty of recovery between work intervals. Low levels of physical activity such as hike/walk, stationary bike, etc for
20-30 mins with no return of symptoms – progress to jogging if hike/walk ok. Stretching/light yoga, balance drills,
light strength exercises.
3. Supervised: Increasing cognitive stressors (increased time in school and increased homework loads). Increased
cardio stressors to moderate, increased volume and some interval type. Increased strength challenges, balance
challenges and sport specific drills.
4. Supervised: School full time. Resume full aggressive training without contact and management of risks. Cardio –
interval training, Strength – full training loads, Impact/Agility at full sport loads, Balance training with no deficits.
5. Supervised by coach in program – Sport Specific return to sport training progressions.
Post Concussion Return to Sport Graduated Progression
The following represents recommended initial progression for return to sport physical conditioning stress consistent with
requirements defined in the Utah High School Athletic Association Concussion Return to Play Clearance. Physical Therapists
and Athletic Trainers who have had experience with increasingly stressing athletes physically and
dynamically to assure full recovery from concussive injury have created this program.
General Recommended Process:
 Starting level determined by injury extent and recovery. An athlete may progress through more than one level per day
depending on symptoms/energy level. Assess symptom and energy level prior to and after each session. (scales
attached)
 Typically there will be 3 sessions of exercise progression (Level 2-4) under supervision of physical therapist, coach, or
parent. Coaches supervise the final sport specific sessions.
 Athlete must progress through each stage with no return of symptoms to advance to the next level. If excessive
symptoms occur with current level, recommend rest for 24 hours and restart exercise stress at the level that created
the symptoms
 All stages must be signed off prior to full clearance into sport
 Modify time and intensity of any/all exercises depending on age and fitness level
FY14/15
Progressive Exercise Stress Levels:
Level 1:
Activities of Daily Living: includes regular rest periods
Work
School
Easy Aerobic Stationary Bike or Walk x 15-20 mins
Light Meditative Yoga or Stretching x 15 mins (nothing with head down)
______________________________________________________________________
Level 2:
Cardio: Stationary Bike: 5 minute warm up – easy comfortable spin
WORKOUT*:
2 min at Level 2 HR (65-75% max HR)
2 min at Level 1 HR (< 60% max HR)
Perform above WORKLOAD cycle x 6
Strength:
1 x 20 body wt squat
1 x20 body wt. squat on Dyna disc (1 under each foot)
Wall push up or inclined push up x 10
Plank (prone): 15-30s for younger athlete, 30-60s for high level athlete
Balance: SLS reaching for cones placed in semi-circle in front of pt (4-5 cones) x 3
(Firm surface for younger athlete, Dyna Disc for high level athlete)
Agility:
Tandem gait
Backward Walking
High Knees
Grapevine (walk)
Side Shuffling
______________________________________________________________________
Level 3:
Cardio:
Elliptical: 5 minute Warm Up
WORKOUT*:
2 min Level 2 HR (65-75% max HR)
2 min Level 1 HR (<60% max HR)
2 min Level 2.5 HR (70% max HR)
2 min Level 1 HR (<60% max HR)
2 min Level 3 HR (75-80% max HR)
2 min Level 1 HR (<60% max HR)
Perform above WORKLOAD cycle x 2
Strength:
Double leg squat for younger athlete 2 x15
SL squat for high-level athlete 2 x 15 (Can use dumbbells if needed)
Shoulder Press (can do seated) 2 x 15
Push Ups x 10 (knees for younger athlete)
Side Planks- Knees for younger athlete 15-30 sec each side
Ankles for high level athlete 30- 60 sec each side
Balance:
Hop and Stick on Foam 2 x 15 sec younger athlete
2 x 30 sec high level athlete
Agility:
Ladder Drills- 5 different foot patterns up and back
FY14/15
Side to side cross over box (up and over box laterally)

30 sec younger athlete

60 sec high level athlete
______________________________________________________________________
Level 4:
Cardio:
Strength:
Treadmill: 5 minute easy warm up
WORKOUT*:
1.5 min Level 2 (65-75% max HR)
1.5 min Level 2.5 (70% max HR)
1.5 min Level 3 (75-80% max HR)
5 min easy (HR<110)
Perform above WORKOUT cycle x 2 with very last work interval at Level
4 (80 - 90% max HR)
SL squat on Bosu (flat side up) (foam for younger athlete) 2 x10
Single arm Row 2 x 15 Bilateral
Squat Jump- controlled landing 5 reps
Single leg step up w/ shoulder press and contra lateral LE hip flex 2 x15
Balance/Agility:
Hex Obstacle:
 see attached sheet
Box jump
 15x younger athlete
 30x high athlete
______________________________________________________________________
Level 5:
See sport specific Return to Sport Guidelines
Level 6:
Back to Competition
FY14/15
Workload Intensity Level Description
It is most ideal to have some form of stress testing to obtain work load intensity levels that are specific for each individual’s
cardiovascular capacity and efficiency. However, if this is not an option, relative workload intensity levels can be estimated
based on the following descriptions with typical associated % of maximal heart rate (MHR). If HR is measured utilizing the
descriptors, individual HR work zones may be determined.
Level
Description
Relative %MHR
Example HR level
Age
Level 1
Level 2
Level 3
Easy Aerobic –
 Can maintain conversation easily while
exercising
 Comfortable, relaxed breathing
 Can maintain this for extended time
Aerobic Moderate –
 More difficult to maintain continuous
conversation, can talk intermittently
 Breathing is harder but not
overwhelming
 Think of power walking for 30 mins
continuous – Aerobic Energy System
Threshold Level –
 More difficult – cannot maintain
conversation
 Breathing is heavier
 Using Anaerobic energy systems
primarily
 Able to maintain work for 3-4 mins
Level 4
Anaerobic/Interval –
 Quite difficult – No talking
 Breathing is focus
 Predominantly Anaerobic energy
systems
 Able to maintain work for 60-90 secs
Level 5
Maximal Effort
 All out effort
 Breathing very hard
 Fully anaerobic
 Only able to maintain maybe for 2030 secs maximum
FY14/15
<60% Maximal HR
Generally 65-75% of
maximal heart rate
Individual based on
Cardiovascular system
Generally 75-80% of
Maximal HR
Generally 80-90% of
maximum effort
Greater than 90% of
maximal effort
15
20
30
40
50
HR
<125
<120
<115
<110
<105
15
20
30
40
50
135-155
130-150
120-140
115-135
110-130
15
20
30
40
50
155-165
150-160
145-155
135-145
130-140
15
20
30
40
50
165-180
160-175
155-170
145-160
135-150
15
20
30
40
50
>185
>180
>170
>160
>150
Comment on estimated HR levels:
Example HR levels were calculated based on generic estimate of maximal HR; 220-your age. Realize that this is
GENERIC and your individual level could be higher or lower. Without stress testing to determine your exact Heart
Rates for the various workloads, it is best to use the description and a HR monitor to see where your HR
averages for the description provided.
Sport Specific - Return to Sport Guidelines:
Conditioning with team  progression into full training  competition:
Summer
1. Light warm-up with emphasis on stretching, flexibility and limited core work. Progress to light trampoline bouncing
at low DD (Degree of Difficulty) twists and non inverted moves. Minimum of 4 x :15 minute tramp sessions.
2. Full supervised warm-up with team. Progress to higher DD trampoline routines including inverted moves. Minimum
of 4 x:15 minute tramp sessions.
3. Start on Mini jump: T-sets and twisting moves. Recommended two training sessions
4. Progress to single: T-sets and twisting moves, minimum DD
5. Progress to inverted moves increasing DD
6. Progress into the next DD bracket on all jumps. Athlete can progress to a comfortable degree of difficulty, while
maintain a low level of risk. This will be specific to each individual athlete. However, athletes should not train at full
competition degree of difficulty or speed.
7. Athlete may return to competition at a lower DD.
8. Train at full DD.
9. Return to competition at full DD.
Winter
1. Half day of flats skiing emphasis on skiing at moderate speed limiting terrain difficulty
2. Full day of flat skiing. Emphasis on work rate, not terrain challenges.
3. Full day of flats skiing in on varied terrain including, moguls and terrain park utilizing small jumps under supervision.
4. Return to training in courses, mogul hill, terrain Park and aerial hill. T-sets and twisting moves only, minimum DD.
5. Training in mogul hill and terrain park increasing DD and aerial hill basic inverted moves
6. Return to full training on all terrain increasing DD at coaches discretion
7. Return to full training and competition
FY14/15