Concussion Management Policy
Concussion Management Policy in the School Setting
Name
Institution
Date
Concussion Management Policy in the School Setting
Introduction
Purpose/Specific Aims
Concussion management is not only a duty and role for school nurses to play, it is also part of the law as provided in The Concussion Management and Awareness Act, in Chapter 496 of the 2011 Laws. Thus, it is paramount that nurses working in schools ensure that they follow the provisions of the law of managing concussions and develop a protocol in the school setting to guide them in concussion management. Thus, the goal of this research paper is to come up with a concussion management protocol in schools in order to give nurses the capacity to identify students with potential …show more content…
concussion, and take the necessary and appropriate action to offer proper care to the students. This protocol should be inclusive of all students who have sustained a mild traumatic brain injury regardless of how and where the injury occurred.
As much as the risk of concussions may always be present in schools especially with relation to some certain activities, such as sports, it is paramount that the schools’ management, alongside the medical directors, or nurses or physicians come up with a protocol or policy to be followed in the management of concussions.
This will help minimize the risk of concussions, and insure that the proper equipment, supervision and education is provided to the staff, students and even parents to minimize the risks associated with concussions. This should include the signs and symptoms, how concussions occur, and the long and short-term effects that may result from concussions. The protocol and policy should also include a proper way of reporting any cases of concussions by students at the slightest suspicion no matter how mild they might think it is. Moreover, the protocol should also include the right processes and procedures that should be followed in reviewing student athletes periodically as will be agreed. The main emphasis in the formulation of the protocol should be places on the need for urgent medical evaluation in the case of such injuries to prevent persistent symptoms (The State Education Department , …show more content…
2012).
When developing concussion management protocols, schools should ensure they promote an environment that supports the reporting of any signs and symptoms of a concussion, by all students and members of staff. The protocol will also include a plan for mandatory checkup of the students by the school nurses or medical providers to diagnose concussions. This should be put down in formal writing, with references to the district’s protocols, with the contribution or participation of the district medial director to help in guiding staff members involved in the diagnosis of concussions. The protocol should also follow the provision of the Missouri State Interscholastic Youth Sports Brain Injury Prevention Act of 2011. The parties involved in the formulation of the protocol should also come up with a procedure and treatment plan to be followed in the case of a diagnosis of concussion.
Literature Review
Over the past decade, there have been numerous research studies carried out to enhance the understanding of the clinical implications of concussions, especially in schools.
According to (Tator, 2013) approximately 144,000 of pediatric and adolescent patients are treated for concussions in emergency departments every year. In addition, there are also approximately 3.8 million concussions annually as a result of sports. Majority of these concussions occur in pediatrics and adolescents. For most of these patients, the initial point of care after they have sustained concussions is their primary care medical providers. In schools, these are nurses. Thus, it is essential for the nurses to ensure timely recognition and the earliest possible institution of appropriate management for concussions. This is essential in improving clinical outcomes as a result of the concussions. This is especially vital because to this day, there is no sole diagnostic modality that can be used to detect concussions. On the contrary, school nurses have to rely on their knowledge and experience to uncover the symptoms known to be associated with concussions in medical history. They should also rely on conducting a physical examination that is targeted specifically to identifying the known discrepancies related to
concussions.
The importance of developing a proper concussion management policy and protocol in schools originates from the consequences of inaccurate, untimely and misdiagnosis of concussions or even faulty management. This can result in major disabilities on both the long and short-terms, or even death in extreme cases. It may also result in a second-impact syndrome if a concussed student goes back to playing or any other risky activities and suffers a second concussion before complete recovery. Poor or faulty management of concussions can also end up in brain swelling, and delayed posttraumatic brain degeneration. This may lead to more complicated and serious conditions such as dementia, Parkinson’s disease and Alzheimer’s disease. For this reason, it is imperative to include the current principles of management and recognition of concussions, including the cognitive, physical and emotional effects, as well as the guidelines for return to school or play.
According to (The State Education Department, 2012) one way of developing a concussions management protocol is through the inclusion of extra-class periods for Physical Education. This means that the sessions organized for instruction and practice in the attitudes, knowledge and skills in all organized activities work to supplement the regular physical education instructions offered in class. Moreover, as stipulated in the Education Law Section 902, every school should have a director of school health services, who can be a nurse or a physician. The medical director should be included in the plans and processes of developing school policies and protocols for such health related matters, as concussion management. In addition, schools should also evaluate the design of their physical facilities, as well as, emergency safety plans for the identification of potential risks associated with falls or other injuries. Breaks should include plans for adult supervision, with constant checkups on the condition of playground equipment, ensuring that they are always in good repair and that surfaces are made of approved safety materials.
Part of the protocol for concussion management should include assessment of the condition. There should be objective measures to provide a quantifiable means of concussion assessment, as well as, allow for a thorough understanding of the impairments that patients might have. This is not only important in the initial assessment of concussion, but also in the assessment of the progress that should be tracked during recovery. For proper use of these measures, there should be plans for collection of baseline data prior to injury. This will allow for the nurse to determine the normal condition for each student and offer a means for comparison for subsequent testing. However, according to (National Association of School Nurses, 2009), adolescents pose a challenge in the collection of baseline data as a result of their cognitive development. This causes an increase in the retest variability among adolescents. For this reason, the protocol should also include provisions for the frequent testing of the baseline information. This will help account for any potential changes in the initial baseline scores that may result from cognitive growth and maturation.
The school’s management and the medical director should also plan for a variety of testing assessment tools, such as neuropsychological testing, symptom scales, postural stability testing and sideline cognitive testing. There is also the Standard Assessment Concussion, which acts as a means of sideline mental status assessment immediately after injury. It has also been proved to be sensitive to the symptoms or effects of concussion within the first 48 hours of injury. This can be one of the best assessment tests to be included in the protocol as it only takes 5-7 minutes to administer and does not require prior expertise in the administration of neurocognitive tests. Given the ease of its nature of administration and the fact that it does not require any prior experience, this test can be set as the first step in the diagnosis of concussion in the concussion management protocol. Assessment sheets can be provided by the school to be filled by the first person at the site of injury whether it is a student or staff. The information collected in the assessment sheet can also be kept in the school medical records for future reference (National Association of School Nurses, 2009).
Another critical factor to be put into consideration while formulating the concussion management protocol is communication. Concussion is a complex condition that requires support and assistance from a variety of school and health care personnel to ensure the creation of an environment that supports both cognitive and physical rest for quick recovery. For this reason, the concussion management protocol should also include provisions for interactions between the school nurse, other staff members, students and parents. Also of great importance in the list as the school’s athletic trainer who holds the responsibility of ensuring prevention, assessment, treatment, care and rehabilitation of all forms of injuries related to athletic activities, most importantly concussions. Athletic trainers can also provide valuable information with regard to the status of the student-athlete’s history, injury and specific concerns of the student’s condition and scores from the various assessment tests. For this reason, it is imperative to ensure there is a proper plan for a communication channel that can allow open sharing of information among the various concerned individuals or parties.
The school’s management alongside the medical director should also make plans for the implementation of comprehensive programs for the management of concussion injuries. They can design such programs and include them in the concussion management protocol to deal with both educational and athletic concerns. This can also help to ensure safety in offering support to injured students during recovery. According to (McGrath, 2010) there are several steps that can be followed in establishing a comprehensive approach for concussion management protocol formulation. The first step is concussion education, and this involves educating trainers, coaches, parents, and other school personnel to prepare them for their roles in providing support for students recovering from concussions. The second step is preseason baseline testing and this involves the use of baseline individual computerized neurocognitive testing. These tests can be offered by HeadMinder, Automated Neuropsychological Assessment Metrics, and Immediate Post-Concussion Assessment and Cognitive Testing, all of which provide pre-injury measurement of the abilities that can be affected by concussions.
The protocol should also include reasonable accommodations for students in recovery through excused absence from classes, since the students need to rest, especially those with intense symptoms. Prior to the injury, the students may need a few days of complete bed rest, then partial attendance may be allowed as they progress with recovery. In addition, students may also need rest periods during school days, especially if they are taking strong medication, the school policies should include plans to allow for such rests for students who are still under recovery. Apart from breaks, students may also need extensions for assignment deadlines, as they may have difficulty processing information or handling full workloads after the brain injury. There should also be plans for staggering or postponement of tests and excuse from some tests or assignments. This will call for communication between the teachers and medical director to determine how best to support the recovery process while still ensuring that students do not miss out on academic work. Alternatively, teachers can also provide extended testing time to give the students an ample time to focus on tests and classwork without interfering with their recovery. The protocol should also consider accommodation for oversensitivity to noise and light, excuse from gym activities and sports practice and avoidance of physical exertion.
The concussion management protocol plan should also include provisions for the physician to provide guidance to patients during recovery based on an active management plan. Careful management should facilitate recovery and ensure prevention from any further injuries. The protocol should uphold safety ensuring that patients do not go back to high risk activities before full recovery. To ensure full recovery, the school’s management alongside the medical director should also include a procedure and policies to govern retesting and determination of full recovery to ensure that students recover fully before they are allowed to resume any school activities that may interfere with their recovery. In addition, the management planning should also involve all aspects of the student’s home life, social-recreational activities, and work. The concussion management protocol plan should also include guidelines for the nurses to follow before allowing patients to return to activities such as driving. This is because concussion patients may have problems with attention, reaction time and processing speed. Patients should also be encouraged to point out any new or recurrent symptoms whenever they occur (Centers for Disease Control and Prevention , 2012).
The formulation of protocol to guide the concussion management should also include plans for evaluation of the policies to make any necessary changes and ensure that the protocol meets the required safety standards. Evaluation should take into consideration the examination of individual school compliance, and the general effects of the implementation of the program on the rate of head injuries in the school. The protocol should also include provisions for the documentation of the immediate symptoms the patient or student portrays by a school staff member, in the case of head injury. The school staff or nurse should ensure that they document each incident and always keep accurate records. This includes the results of the sideline assessments and any other post-injury test administered to the injured student. They should also keep record of any data surrounding the injury to provide clarity of the issues that led to the injury, for example, equipment failure, incorrect coaching and the state of the environment. In relation to this, the school policies should also take into consideration the risk and nature of concussion requiring the participation of practitioners with informed consent and removal from practice or suspension of certain medical practitioners if deemed necessary.
Increased awareness and an addition to the standard management protocol can help in the subsequent increase in the rate of reporting and responding to injuries related to concussions. The school’s management should work to create and implement a program to provide baseline testing, and record data obtained from clinical reports. The school should also develop a protocol for gradual return to risky or energy-intensive activities, including exertion activities from low, and gradually rising to high according to the tolerance levels of the patient. The management should also take into consideration any possible barriers that may prevent the school’s staff from following or implementing the protocol for concussion management successfully. This may include resistance from members of staff, lack of capacity by the school to support concussion management plans and policies. This is because the school’s management and the medical directors may establish a proper protocol to aid in the management of concussions, but the school may lack the capacity to support the protocol. The other barrier to implementation of concussion management protocol is shortage of funding to put up medical facilities, hire competent and skilled medical personnel and provide other forms of support to the efforts involved in formulating concussion management protocol (Academy, 2014)
Conclusion
Concussions are not only dangerous as they can cause long-term effects in the physical … of students, they can also affect other aspects of the students including academic performance and even mental capacity. In extreme cases, concussions can end in death. This calls for intervention through planning and establishment of policies to govern the management of concussions in schools. It is not only the role of school nurses or medical directors, but it is also the responsibility of all individuals include members of staff, parents and other students to work together to minimize the occurrence and negative effects as a result of injuries leading to concussions. However, this cannot happen effectively if there is no organization on the best way of handling such cases or communication and reporting in the case of injuries that may lead to concussions. Thus, school management boards and medical directors or other practitioners should always work together to come up with the best policies and protocol to govern the management of concussions. The protocols should include guidelines on assessment, reporting, treatment and support of recovery processes in the case of concussions. The protocol should also include provisions for the collection of data including baseline data, as well as, the seasonal update and recording of the same to ensure that there is enough, accurate and timely data to aid in decision making in making plans for proper concussion management.
References
Academy, U. S. (2014). A Countywide Program to Manage Concussions in High School Sports. The Sport Journal.
Centers for Disease Control and Prevention. (2012). Facts fir Physicians About Mild Traumatic Brain Injury (MTBI). New York: U.S. Department of Health and Human Servies.
McGrath, N. (2010). Supporting the Student-Athlete 's Return to the Classroom After a Sport-Related Concussion. Journal of Athletic Training , 492-498. Vol. 45, No. 5. DOI: 10.4085/1062-6050-45.5.492.
National Association of School Nurses. (2009). Caring for Student-Athletes Following a Concussion. The Journal of School Nursing, 270-282. DOI: 10.1177/1059840509339782.
Tator, C. H. (2013). Concussions and their Consequences: Current Diagnosis, Management and Prevention. Canadian Medical Association Journal, 975-979. DOI: 10.1503/cmaj.120039. Retrieved from ProQuest.
The State Education Department. (2012). Guidelines for Concussion Management in the School Setting. New York: The University of the State New York.
Name
Institution
Date
Concussion Management Policy in the School Setting
Introduction
Purpose/Specific Aims
Concussion management is not only a duty and role for school nurses to play, it is also part of the law as provided in The Concussion Management and Awareness Act, in Chapter 496 of the 2011 Laws. Thus, it is paramount that nurses working in schools ensure that they follow the provisions of the law of managing concussions and develop a protocol in the school setting to guide them in concussion management. Thus, the goal of this research paper is to come up with a concussion management protocol in schools in order to give nurses the capacity to identify students with potential …show more content…
concussion, and take the necessary and appropriate action to offer proper care to the students. This protocol should be inclusive of all students who have sustained a mild traumatic brain injury regardless of how and where the injury occurred.
As much as the risk of concussions may always be present in schools especially with relation to some certain activities, such as sports, it is paramount that the schools’ management, alongside the medical directors, or nurses or physicians come up with a protocol or policy to be followed in the management of concussions.
This will help minimize the risk of concussions, and insure that the proper equipment, supervision and education is provided to the staff, students and even parents to minimize the risks associated with concussions. This should include the signs and symptoms, how concussions occur, and the long and short-term effects that may result from concussions. The protocol and policy should also include a proper way of reporting any cases of concussions by students at the slightest suspicion no matter how mild they might think it is. Moreover, the protocol should also include the right processes and procedures that should be followed in reviewing student athletes periodically as will be agreed. The main emphasis in the formulation of the protocol should be places on the need for urgent medical evaluation in the case of such injuries to prevent persistent symptoms (The State Education Department , …show more content…
2012).
When developing concussion management protocols, schools should ensure they promote an environment that supports the reporting of any signs and symptoms of a concussion, by all students and members of staff. The protocol will also include a plan for mandatory checkup of the students by the school nurses or medical providers to diagnose concussions. This should be put down in formal writing, with references to the district’s protocols, with the contribution or participation of the district medial director to help in guiding staff members involved in the diagnosis of concussions. The protocol should also follow the provision of the Missouri State Interscholastic Youth Sports Brain Injury Prevention Act of 2011. The parties involved in the formulation of the protocol should also come up with a procedure and treatment plan to be followed in the case of a diagnosis of concussion.
Literature Review
Over the past decade, there have been numerous research studies carried out to enhance the understanding of the clinical implications of concussions, especially in schools.
According to (Tator, 2013) approximately 144,000 of pediatric and adolescent patients are treated for concussions in emergency departments every year. In addition, there are also approximately 3.8 million concussions annually as a result of sports. Majority of these concussions occur in pediatrics and adolescents. For most of these patients, the initial point of care after they have sustained concussions is their primary care medical providers. In schools, these are nurses. Thus, it is essential for the nurses to ensure timely recognition and the earliest possible institution of appropriate management for concussions. This is essential in improving clinical outcomes as a result of the concussions. This is especially vital because to this day, there is no sole diagnostic modality that can be used to detect concussions. On the contrary, school nurses have to rely on their knowledge and experience to uncover the symptoms known to be associated with concussions in medical history. They should also rely on conducting a physical examination that is targeted specifically to identifying the known discrepancies related to
concussions.
The importance of developing a proper concussion management policy and protocol in schools originates from the consequences of inaccurate, untimely and misdiagnosis of concussions or even faulty management. This can result in major disabilities on both the long and short-terms, or even death in extreme cases. It may also result in a second-impact syndrome if a concussed student goes back to playing or any other risky activities and suffers a second concussion before complete recovery. Poor or faulty management of concussions can also end up in brain swelling, and delayed posttraumatic brain degeneration. This may lead to more complicated and serious conditions such as dementia, Parkinson’s disease and Alzheimer’s disease. For this reason, it is imperative to include the current principles of management and recognition of concussions, including the cognitive, physical and emotional effects, as well as the guidelines for return to school or play.
According to (The State Education Department, 2012) one way of developing a concussions management protocol is through the inclusion of extra-class periods for Physical Education. This means that the sessions organized for instruction and practice in the attitudes, knowledge and skills in all organized activities work to supplement the regular physical education instructions offered in class. Moreover, as stipulated in the Education Law Section 902, every school should have a director of school health services, who can be a nurse or a physician. The medical director should be included in the plans and processes of developing school policies and protocols for such health related matters, as concussion management. In addition, schools should also evaluate the design of their physical facilities, as well as, emergency safety plans for the identification of potential risks associated with falls or other injuries. Breaks should include plans for adult supervision, with constant checkups on the condition of playground equipment, ensuring that they are always in good repair and that surfaces are made of approved safety materials.
Part of the protocol for concussion management should include assessment of the condition. There should be objective measures to provide a quantifiable means of concussion assessment, as well as, allow for a thorough understanding of the impairments that patients might have. This is not only important in the initial assessment of concussion, but also in the assessment of the progress that should be tracked during recovery. For proper use of these measures, there should be plans for collection of baseline data prior to injury. This will allow for the nurse to determine the normal condition for each student and offer a means for comparison for subsequent testing. However, according to (National Association of School Nurses, 2009), adolescents pose a challenge in the collection of baseline data as a result of their cognitive development. This causes an increase in the retest variability among adolescents. For this reason, the protocol should also include provisions for the frequent testing of the baseline information. This will help account for any potential changes in the initial baseline scores that may result from cognitive growth and maturation.
The school’s management and the medical director should also plan for a variety of testing assessment tools, such as neuropsychological testing, symptom scales, postural stability testing and sideline cognitive testing. There is also the Standard Assessment Concussion, which acts as a means of sideline mental status assessment immediately after injury. It has also been proved to be sensitive to the symptoms or effects of concussion within the first 48 hours of injury. This can be one of the best assessment tests to be included in the protocol as it only takes 5-7 minutes to administer and does not require prior expertise in the administration of neurocognitive tests. Given the ease of its nature of administration and the fact that it does not require any prior experience, this test can be set as the first step in the diagnosis of concussion in the concussion management protocol. Assessment sheets can be provided by the school to be filled by the first person at the site of injury whether it is a student or staff. The information collected in the assessment sheet can also be kept in the school medical records for future reference (National Association of School Nurses, 2009).
Another critical factor to be put into consideration while formulating the concussion management protocol is communication. Concussion is a complex condition that requires support and assistance from a variety of school and health care personnel to ensure the creation of an environment that supports both cognitive and physical rest for quick recovery. For this reason, the concussion management protocol should also include provisions for interactions between the school nurse, other staff members, students and parents. Also of great importance in the list as the school’s athletic trainer who holds the responsibility of ensuring prevention, assessment, treatment, care and rehabilitation of all forms of injuries related to athletic activities, most importantly concussions. Athletic trainers can also provide valuable information with regard to the status of the student-athlete’s history, injury and specific concerns of the student’s condition and scores from the various assessment tests. For this reason, it is imperative to ensure there is a proper plan for a communication channel that can allow open sharing of information among the various concerned individuals or parties.
The school’s management alongside the medical director should also make plans for the implementation of comprehensive programs for the management of concussion injuries. They can design such programs and include them in the concussion management protocol to deal with both educational and athletic concerns. This can also help to ensure safety in offering support to injured students during recovery. According to (McGrath, 2010) there are several steps that can be followed in establishing a comprehensive approach for concussion management protocol formulation. The first step is concussion education, and this involves educating trainers, coaches, parents, and other school personnel to prepare them for their roles in providing support for students recovering from concussions. The second step is preseason baseline testing and this involves the use of baseline individual computerized neurocognitive testing. These tests can be offered by HeadMinder, Automated Neuropsychological Assessment Metrics, and Immediate Post-Concussion Assessment and Cognitive Testing, all of which provide pre-injury measurement of the abilities that can be affected by concussions.
The protocol should also include reasonable accommodations for students in recovery through excused absence from classes, since the students need to rest, especially those with intense symptoms. Prior to the injury, the students may need a few days of complete bed rest, then partial attendance may be allowed as they progress with recovery. In addition, students may also need rest periods during school days, especially if they are taking strong medication, the school policies should include plans to allow for such rests for students who are still under recovery. Apart from breaks, students may also need extensions for assignment deadlines, as they may have difficulty processing information or handling full workloads after the brain injury. There should also be plans for staggering or postponement of tests and excuse from some tests or assignments. This will call for communication between the teachers and medical director to determine how best to support the recovery process while still ensuring that students do not miss out on academic work. Alternatively, teachers can also provide extended testing time to give the students an ample time to focus on tests and classwork without interfering with their recovery. The protocol should also consider accommodation for oversensitivity to noise and light, excuse from gym activities and sports practice and avoidance of physical exertion.
The concussion management protocol plan should also include provisions for the physician to provide guidance to patients during recovery based on an active management plan. Careful management should facilitate recovery and ensure prevention from any further injuries. The protocol should uphold safety ensuring that patients do not go back to high risk activities before full recovery. To ensure full recovery, the school’s management alongside the medical director should also include a procedure and policies to govern retesting and determination of full recovery to ensure that students recover fully before they are allowed to resume any school activities that may interfere with their recovery. In addition, the management planning should also involve all aspects of the student’s home life, social-recreational activities, and work. The concussion management protocol plan should also include guidelines for the nurses to follow before allowing patients to return to activities such as driving. This is because concussion patients may have problems with attention, reaction time and processing speed. Patients should also be encouraged to point out any new or recurrent symptoms whenever they occur (Centers for Disease Control and Prevention , 2012).
The formulation of protocol to guide the concussion management should also include plans for evaluation of the policies to make any necessary changes and ensure that the protocol meets the required safety standards. Evaluation should take into consideration the examination of individual school compliance, and the general effects of the implementation of the program on the rate of head injuries in the school. The protocol should also include provisions for the documentation of the immediate symptoms the patient or student portrays by a school staff member, in the case of head injury. The school staff or nurse should ensure that they document each incident and always keep accurate records. This includes the results of the sideline assessments and any other post-injury test administered to the injured student. They should also keep record of any data surrounding the injury to provide clarity of the issues that led to the injury, for example, equipment failure, incorrect coaching and the state of the environment. In relation to this, the school policies should also take into consideration the risk and nature of concussion requiring the participation of practitioners with informed consent and removal from practice or suspension of certain medical practitioners if deemed necessary.
Increased awareness and an addition to the standard management protocol can help in the subsequent increase in the rate of reporting and responding to injuries related to concussions. The school’s management should work to create and implement a program to provide baseline testing, and record data obtained from clinical reports. The school should also develop a protocol for gradual return to risky or energy-intensive activities, including exertion activities from low, and gradually rising to high according to the tolerance levels of the patient. The management should also take into consideration any possible barriers that may prevent the school’s staff from following or implementing the protocol for concussion management successfully. This may include resistance from members of staff, lack of capacity by the school to support concussion management plans and policies. This is because the school’s management and the medical directors may establish a proper protocol to aid in the management of concussions, but the school may lack the capacity to support the protocol. The other barrier to implementation of concussion management protocol is shortage of funding to put up medical facilities, hire competent and skilled medical personnel and provide other forms of support to the efforts involved in formulating concussion management protocol (Academy, 2014)
Conclusion
Concussions are not only dangerous as they can cause long-term effects in the physical … of students, they can also affect other aspects of the students including academic performance and even mental capacity. In extreme cases, concussions can end in death. This calls for intervention through planning and establishment of policies to govern the management of concussions in schools. It is not only the role of school nurses or medical directors, but it is also the responsibility of all individuals include members of staff, parents and other students to work together to minimize the occurrence and negative effects as a result of injuries leading to concussions. However, this cannot happen effectively if there is no organization on the best way of handling such cases or communication and reporting in the case of injuries that may lead to concussions. Thus, school management boards and medical directors or other practitioners should always work together to come up with the best policies and protocol to govern the management of concussions. The protocols should include guidelines on assessment, reporting, treatment and support of recovery processes in the case of concussions. The protocol should also include provisions for the collection of data including baseline data, as well as, the seasonal update and recording of the same to ensure that there is enough, accurate and timely data to aid in decision making in making plans for proper concussion management.
References
Academy, U. S. (2014). A Countywide Program to Manage Concussions in High School Sports. The Sport Journal.
Centers for Disease Control and Prevention. (2012). Facts fir Physicians About Mild Traumatic Brain Injury (MTBI). New York: U.S. Department of Health and Human Servies.
McGrath, N. (2010). Supporting the Student-Athlete 's Return to the Classroom After a Sport-Related Concussion. Journal of Athletic Training , 492-498. Vol. 45, No. 5. DOI: 10.4085/1062-6050-45.5.492.
National Association of School Nurses. (2009). Caring for Student-Athletes Following a Concussion. The Journal of School Nursing, 270-282. DOI: 10.1177/1059840509339782.
Tator, C. H. (2013). Concussions and their Consequences: Current Diagnosis, Management and Prevention. Canadian Medical Association Journal, 975-979. DOI: 10.1503/cmaj.120039. Retrieved from ProQuest.
The State Education Department. (2012). Guidelines for Concussion Management in the School Setting. New York: The University of the State New York.