School Health-Concussions » Concussion Management

Concussion Management

Concussion Oversight Team (COT)
According to TEC Section 38.153:
The governing body of each school district and open-enrollment charter school with students enrolled who participate in an interscholastic athletic activity shall appoint or approve a concussion oversight team. The NYOS School Board will approve the members of the concussion oversight team.
The Concussion Oversight Team shall include the following:
1. Physician
Definition of Concussion
There are numerous definitions of concussion available in medical literature as well as in the previously noted “guidelines” developed by the various state organizations. The feature universally expressed across definitions is that concussion
1. is the result of a physical, traumatic force to the head; and
2. that force is sufficient to produce altered brain function which may last for a variable duration of time.
For the purpose of this program the definition presented in Chapter 38, Sub Chapter D of the Texas Education Code is considered appropriate:
“Concussion” means a complex pathophysiological process affecting the brain caused by a traumatic physical force or impact to the head or body, which may:
A. include temporary or prolonged altered brain function resulting in physical, cognitive, or emotional altered sleep patterns; and
B. involve loss of consciousness.
Return to Play (RTP) Protocol
The concussion oversight team has established a return-to-play protocol, based on peer-reviewed scientific evidence, for a student’s return to interscholastic athletics practice or competition following the force or impact believed to have caused a concussion.
1. If at any time during contest or event a student displays signs and symptoms of concussion the student will be held out of play immediately.
2. The individual who removes the student from the contest shall notify the coach immediately. Once the coach is notified, the parent/guardian of the student shall be notified.
3. Parents will be instructed to very carefully monitor the student during the first 24 hours after the initial signs of the concussion. Parents will be provided specific information explaining the signs and symptoms of a worsening condition and encourage parents to take the student to an Emergency Room should any of the signs or symptoms appear during the 24 hour period.
4. Any student who sustains a concussion will be prohibited from athletic participation for at least five days and as many as seven days as determined by the Athletic Director and Assistant Director of Operations.
5. Following the participation prohibition period, the parents should have the student evaluated by their physician of choice. The physician must complete a concussion evaluation instrument which includes the protocol for the students return to participation.
6. The student shall not return to participation until the Athletic Director and Assistant Director of Operations confirms that
  • the student has been evaluated by a treating physician selected by the student’s parent;
  • the student has completed the Return to Play protocol established by the Concussion Oversight Team;
  • the Athletic Director and Assistant Director of Operations has received a written statement from the treating physician indicating, that in the physician’s professional judgment, it is safe for the student to return to play; and
  • the Athletic Director and Assistant Director of Operations has received the required Return to Play form completed and signed by the student’s parent.
Concussion can produce a wide variety of symptoms that should be familiar to those having responsibility for the well being of student-athletes engaged in competitive sports in Texas. Symptoms reported by athletes may include:
  • headache
  • nausea
  • balance problems or dizziness
  • double or fuzzy vision
  • sensitivity to light or noise
  • feeling sluggish
  • feeling foggy or groggy
  • concentration or memory problems
  • confusion
Signs observed by parents, friends, teachers or coaches may include:
  • appears dazed or stunned
  • is confused about what to do
  • forgets plays
  • is unsure of game, score or opponent
  • moves clumsily
  • answers questions slowly
  • loses consciousness
  • shows behavior or personality changes
  • can’t recall events prior to hit
  • can’t recall events after hit
Any one or group of symptoms may appear immediately and be temporary, or delayed and long lasting. The appearance of any one of these symptoms should alert the responsible personnel to the possibility of concussion.

Response to Suspected Concussion (TEC section 38.156)
A student shall be removed from an interscholastic athletics practice or competition immediately if one of the following persons believes the student might have sustained a concussion during the practice or competition:
1. a coach;
2. a physician;
3. a licensed health care professional; or
4. the student’s parent or guardian or another person with legal authority to make medical decisions for the student
If a student-athlete demonstrates signs or symptoms consistent with concussion, the “Heads Up” 4-Step Action Plan shall be followed:
1. The student-athlete shall be immediately removed from game/practice.
2. The student-athlete shall be evaluated by an appropriate health care professional as soon as practicable.
3. The student-athlete’s parent or guardian shall be informed about the possible concussion and given information on concussions.
4. If it is determined that a concussion has occurred, the student-athlete shall not be allowed to return to participation that day regardless of how quickly the signs or symptoms of the concussion resolve and shall be kept from activity until a physician indicates they are symptom free and gives clearance to return to activity. A coach of an interscholastic athletics team shall not authorize a student’s return to play.
Return to Activity/Play Following Concussion 1(TEC section 38.157)
A student removed from an interscholastic athletics practice or competition under suspicion of having a concussion shall not be permitted to practice or compete again following the force or impact believed to have caused the concussion until:
1. the student has been evaluated; using established medical protocols based on peer-reviewed scientific evidence, by a treating physician chosen by the student or the student’s parent or guardian or another person with legal authority to make medical decisions for the student;
2. the student has successfully completed each requirement of the return-to-play protocol established under TEC Section 38.153 necessary for the student to return to play;
3. the treating physician has provided a written statement indicating that, in the physician’s professional judgment, it is safe for the student to return to play; and
4. the student and the student’s parent or guardian or another person with legal authority to make medical decisions for the student:
A. have acknowledged that the student has completed the requirements of the return-to-play protocol necessary for the student to return to play;
B. have provided the treating physician’s written statement to the person responsible for compliance with the return-to-play protocol and the person who has supervisory responsibilities; and
C. have signed a consent form indicating that the person signing:
i. has been informed concerning and consents to the student participating in returning to play in accordance with the return-to-play protocol;
ii. understands the risks associated with the student returning to play and will comply with any ongoing requirements in the return-to-play protocol;
iii. consents to the disclosure to appropriate persons, consistent with the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191), of the treating physician’s written statement and, if any, the return-to-play recommendations of the treating physician; and
iv. understands the immunity provisions under TEC Section 38.159.
NYOS will use the UIL provided Concussion Management Protocol Return to Play Form as the official district form (available on the NYOS website).

Following clearance and compliance with the above information, supervised progression of activities should be initiated utilizing the following standardized protocol:
  • Student-athlete shall be symptom free for 24 hours prior to initiating the return to play progression.
  • Progress continues at 24-hour intervals as long as student-athlete is symptom free at each level.
  • If the student-athlete experiences any post concussion symptoms during the return to activity progression, activity is discontinued and the student-athlete must be re-evaluated by a licensed health care professional.
  • Phase 1:
    • No exertional physical activity until student-athlete is symptom free for 24 hours and receives written clearance from a physician and submission of the required documentation following the concussion injury.
  • Phase 2:
    • Step 1. When the athlete completes Phase 1, begin light aerobic exercise – 5 – 10 minutes on an exercise bike, or light jog; no weight lifting, resistance training, or any other exercise.
    • Step 2. Moderate aerobic exercise - 15 to 20 minutes of running at moderate intensity in the gym or on the field without a helmet or other equipment.
    • Step 3. Non-contact training drills in full uniform. May begin weight lifting, resistance training, and other exercises.
    • Step 4. Full contact practice or training.
    • Step 5. Full game play.
Subsequent Concussion
Any subsequent concussion requires further medical evaluation, which may include a physical examination prior to return to participation. Written clearance from a physician is required as outlined in TEC Section 38.157 before any participation in practices, games or matches.

Potential Need for School/Academic Adjustments & Accommodations Following Concussion
It may be necessary for individuals with concussion to have both cognitive and physical rest in order to achieve maximum recovery in shortest period of time. In addition to the physical management, the concussion management team may:
  • Notify school receptionist and all classroom teachers regarding the student-athlete’s condition.
  • Advise teachers of post concussion symptoms.
  • Advise teachers and administrators that the student may need (only until asymptomatic) special accommodations regarding academic requirements (such as limited computer work, reading activities, testing, assistance to class, etc.) until concussion symptoms resolve.
  • Advise teachers and administrators that the student may only be able to attend school for half days or may need daily rest periods until symptoms subside. In special circumstances the student may require homebound status for a brief period.
Evaluation Domains
When evaluating an individual who has sustained concussion, the person responsible for the evaluation should always keep in mind that you are evaluating three separate domains of brain function: Physical/Motor, Cognitive, and Behavioral/Emotional. These represent functions of widely different anatomical regions in the brain (although there are cross over/dual function in some areas). Evaluation should focus on each domain separately; the evaluator should never assume that if one domain is symptom free the others will also be without symptoms. Separate evaluation protocols/instruments are employed to assess each domain. Documentation of the method of assessment is always helpful to have for subsequent examiners.


Dazed/stunned Amnesia Irritable
Balance difficulties Confused/Disoriented Emotionally Unstable/Explosive
Weakness Slowed Verbal Responses Depressed
Excessive Fatigue Forgets easily Sleep disturbances
Slowed Reactions Difficulty Concentrating Anxious
Lack of facial expressions Short Attention Span Lack of Interest

1. National Federation of State High School Associations, Suggested Guidelines for the Management of Concussion in Sports; January 2011

Required and Recommended Training
All NYOS coaches of an interscholastic athletic activity shall:

  • complete a two-hour UIL approved training course at least every two years on concussions, including evaluation, prevention, symptoms, risks, and long-term effects.
All licensed health care professionals who serve as a member of the concussion oversight team and is an employee, representative, or agent of the school district, or who serve on a volunteer basis as a member of the concussion oversight team for the school district shall:
  • complete the two-hour UIL approved training course at least every two years on concussions; or
  • complete a training course on concussions approved by the Department of State Health Services Advisory Board or Athletic Trainers; or
  • a course concerning the subject matter of concussions that has been approved for continuing education credit by the appropriate licensing authority for the profession.
All physicians who serves as a member of the concussion oversight team shall, to the greatest extent practicable, periodically take an appropriate continuing medical education course in the subject matter of concussions.

Adapted from Dripping Springs ISD