Recognizing a Concussion

A concussion can be caused by

  1. A hit to the head
  2. A hit to the body
  3. Any force that causes the brain to move back and forth in the skull
  4. a and c
  5. All the above

Incorrect. Concussions can be caused by any force that causes the brain to move back and forth in the skull including hits to the body.

That’s right all the above are true

Most concussion cases involve a loss of consciousness.

  1. True
  2. False

Correct. Only 10% of concussion cases involve a loss of consciousness

Incorrect. Only 10% of concussion cases involve a loss of consciousness

After a hit or fall that could cause a concussion, a child should be watched closely for signs of a concussion before removing them from play.

  1. True
  2. False

Incorrect. A child may not show signs right away. Remove a player immediately after a potential concussion causing incident.

Correct. A child may not show signs right away. Remove a player immediately after a potential concussion causing incident.

Responding to a Concussion

Scenario 1

One of your players collides with another player, during a game. He falls, is slow to get up and seems a bit unsteady on his feet. You take him out of play away from the other players and spectators. He tells you his head hurts, but has no other symptoms. He does not have a parent or guardian at the game so you ask another adult to monitor him. About 15 minutes later he is complaining of neck pain and vomits. What should you do next?

  1. Call his parents
  2. Call 9-1-1
  3. Send him home immediately with a responsible adult
  4. Continue to monitor him until his parent arrives

Call 9-1-1: That’s right. neck pain is one of the red flags and is a medical emergency, you should call 9-1-1

Actually, neck pain is one of the red flags and is a medical emergency, you should call 9-1-1

Scenario 2

During a game, you notice a player lying on the ice. You did not see the incident. The play is stopped, you follow basic first aid procedure, then assist him to get up and take him to the dressing room. Your player complains of a headache and says he feels dizzy. What should you do next?

  1. Call his parents
  2. Call 9-1-1
  3. Send him home immediately with a responsible adult
  4. Continue to monitor him until his parent arrives

Any of these responses would be appropriate for this scenario. The important thing is that you’ve recognized the player is injured and needs further attention.

Scenario 3

Your player falls and hits her head hard on the ground. The player gets up quickly and wants to continue to play on. What should you do?

  1. Remove her from play and monitor her for signs and symptoms of a concussion
  2. Let her play on and watch her closely for any visual clues of a concussion

That’s right. In the incident you witnessed, her head hit the ground hard. This is enough to consider her as having sustained a concussion and should be removed from play.

Actually, In the incident you witnessed her head hit the ground hard. This is enough to consider her as having sustained a concussion and should be removed from play.

Scenario 4

During soccer practice, while participating in a shooting drill, one of your players collides with another player and falls backwards on the ground. Her head did not appear to move rapidly back and forth and she did not hit her head on the ground when she fell. She immediately jumped up continued on with the drill. What should you do?

  1. Stop her from participating in the drill and call 911
  2. Remove her from the drill and ask her if she knows her name, the date and time of day to determine if she has a concussion.
  3. Let her continue participating in the drill
  4. Contact her parent to have them take her to the doctor

Though if you are unsure it is never wrong to call 911, in this case she does not appear seriously injured nor does she have any red flags, so calling 911 is not required. The incident didn’t appear to result in her head moving back and forth or hitting anything and there are no visual clues of a concussion so you can let her continue to participate in the practice.

Though removing her from the drill is not wrong, asking orientation questions has been shown to be unreliable for determining if someone has a concussion. The incident didn’t appear to result in her head moving back and forth or hitting anything and there are no visual clues of a concussion so you can let her continue to participate in the practice.

Yes, in this case the incident didn’t appear to result in her head moving back and forth or hitting anything and there are no visual clues of a concussion so you can let her continue to participate in the practice.

Though having her seen by a doctor is not wrong, in this case the incident didn’t appear to result in her head moving back and forth or hitting anything and there are no visual clues of a concussion so you can let her continue to participate in the practice.

Scenario 5

During a hockey playoff game, one of your best players is hit hard against the boards. You noticed his head moved rapidly back and forth. He does not fall over and slowly gets back into the game. One of the other adults on the bench yells out ‘That a boy, don’t let them slow you down, you’re better than that”. What should you do:

  1. Let him play on because he doesn’t seem to have any signs of a concussion.
  2. Remove him from play immediately
  3. Wait until he comes off the ice at the end of his shift and ask him how he feels.

Actually, given you saw his head move rapidly back and forth, you should consider your player to have a concussion. Your player should be removed immediately and the Concussion Response Protocol initiated using the Concussion Response Tool.

You’re right. Just because your player is not showing any obvious signs of a concussion, you saw his head move rapidly back and forth so you should consider him to have a concussion and remove him from play immediately and the Concussion Response Protocol initiated using the Concussion Response Tool.

Though asking a player how they are feeling is one component of monitoring the signs and symptoms of a concussion, using that to determine if a player has a concussion is not reliable. Players will often try to hide how they are feeling because they want to continue playing or they don’t want to be seen as a ‘wimp’ to their coach or other players. In this case, the comments by the other adult could make the player hesitant to report any symptoms. You did see his head move rapidly back and forth so you should consider him to have a concussion and remove him from play immediately.

Recovering from a Concussion

After being diagnosed with a concussion, a child should be monitored but not woken during sleep.

  1. True
  2. False

Correct - Sleep is an important part of recovering from a concussion. Check on your child at least every 2 hours to ensure they are sleeping comfortably and breathing normally. Only wake your child if you are concerned with their breathing or sleeping.

Incorrect - Sleep is an important part of recovering from a concussion. Check on your child at least every 2 hours to ensure they are sleeping comfortably and breathing normally. Only wake your child if you are concerned with their breathing or sleeping.

During the rest stage of a concussion, a child is safe to participate in the following activities:

  1. Video games
  2. Watching TV
  3. Reading a book
  4. None of the above

Correct - A person with a concussion requires cognitive rest. All these activities require concentration and learning and may put them at risk for further complications and delayed recovery

Incorrect - A person with a concussion requires cognitive rest. All these activities require concentration and learning and may put them at risk for further complications and delayed recovery.

A child with a concussion should rest for 24 hours before returning to activities.

  1. True
  2. False

Correct - a child with a concussion should rest until symptom-free for 24 hours before focussing on return to learn activities. This may take several days or weeks.

Incorrect - a child with a concussion should rest until symptom-free for 24 hours before focussing on return to learn activities. This may take several days or weeks.

Returning from a Concussion

A child should focus on returning to learn and returning to sports at the same time.

  1. True
  2. False

Correct. A child should return to learn before returning to sport. This actually results in a quicker return to sports.

Incorrect. A child should return to learn before returning to sport. This actually results in a quicker return to sports.

Returning to learn and activity is a slow, gradual process.

  1. True
  2. False

Correct - A concussed player that returns to activities too soon or does not follow a gradual or stepwise return is more likely to suffer from delayed recovery or serious complications.

Incorrect - A concussed player that returns to activities too soon or does not follow a gradual or stepwise return is more likely to suffer from delayed recovery or serious complications.

Scenario 1

You are the coach of a minor hockey team. One of your players suffered a concussion a week ago during a hockey game. He tells you he has moved through Stage 1 (No Sporting Activity/Rest) and Stage 2 (Light Aerobic Exercise) with no returning symptoms and shows you his signed Return to Play Communication Tool.

Today he has returned to participate in some skating drills. He seems slow and sluggish, and not really himself. You catch him holding his head. You call him over and ask how he’s feeling. He says he’s feeling great. What do you do?

  1. Take him off the ice and have him move back to Stage 2 until free of symptoms for 24 hours.
  2. Take him off the ice. Have him take a break on the bench. Return him to play after he has rested a few minutes.
  3. Keep him on the ice but slow the pace of his drills. He needs some time to get back into it after a week of no exercise.
  4. Keep him on the ice and let him ride it out. He needs to get back into shape quickly and ready for the next game.

A is the best answer. Concussions are serious injuries and we need to err on the side of caution. This player is showing possible symptoms of concussion.

Scenario 2

You are the coach of a girls soccer team. A week ago your player sustained a concussion. She has moved successfully through Stages 1 - 4. She shows up next game ready to play and with clearance from her doctor. Do you let her play?

  1. Yes
  2. No

Correct. A player must complete Stage 5 (Full-contact practice) and remain symptom-free for 24 hours before playing in a game

Incorrect. A player must complete Stage 5 (Full-contact practice) and remain symptom-free for 24 hours before playing in a game

Preventing and Educating about Concussions

Do helmets prevent concussions?

  1. Yes
  2. No

Correct - Helmets protect from serious skull injuries but do not prevent the brain from moving around in the skull.

Incorrect - Helmets protect from serious skull injuries but do not prevent the brain from moving around in the skull.

Do helmets help in reducing the seriousness of a concussion?

  1. Yes
  2. No

Correct. Helmets absorb the energy from the impact and decrease the speed the brain moves around inside the skull.

Incorrect. Helmets absorb the energy from the impact and decrease the speed the brain moves around inside the skull.

Full contact practices that allow athletes to practice hitting helps to reduce concussions.

  1. True
  2. False

Correct - There are ways to teach the skill of full contact without full contact practices. Less full contact opportunities means less overall concussion incidents.

Incorrect - There are ways to teach the skill of full contact without full contact practices. Less full contact opportunities means less overall concussion incidents.

The most effective way to prevent serious concussion associated risks is to create a positive, receptive environment that allows children to freely report concussion symptoms.

  1. True
  2. False

Correct

Incorrect. Actually, creating a positive, receptive environment that allows children to freely report concussion symptoms is the most effective way to prevent serious concussion associated risks.

Now that you have completed the modules on RECOGNIZE, RESPOND, RECOVERY, RETURN, and PREVENTION, answer the questions that follow to assess your learning.

Final Assessment - Part 1

Now that you are better prepared, here’s another opportunity to answer the questions posed at the beginning of the course.



If you were the coach of this soccer team, would you know what to do next?

  1. Nothing, she got up on her own and didn’t appear seriously injured
  2. Pull her from the field and follow the concussion response protocol
  3. Let her play but watch her closely for any of the signs and symptoms of concussion

Actually the player hit her head hard on the ground, was slow to get up and was holding her head. You should consider her to have sustained a concussion.

That’s the safest action to take as the player hit her head hard on the ground, was slow to get up and was holding her head.

Actually the signs and symptoms of concussion can be delayed for several hours or days. The player hit her head hard on the ground, was slow to get up and was holding her head. You should consider her to have sustained a concussion.

How would you determine if player #8 had sustained a concussion?

  1. When she gets off the field ask her the memory questions. If she gets 3 out of 4 wrong then she has a concussion.
  2. Check to see if she shows any of the red flags or signs and symptoms of concussion. If she has any, she has a concussion.
  3. Player #8 hit her head hard on the ground. That is enough to consider her to have a concussion.

Actually, the fact that she hit her head hard on the ground is enough to consider her to have a concussion. The memory questions are part of the Concussion Response Protocol used to monitor a player’s condition but should not be used to determine if someone has a concussion.

Actually, a person does not have to show any of the signs or symptoms of a concussion to have one. These can be delayed for hours or even days after an incident. The fact that she hit her head hard is enough for you to consider her to have a concussion and follow the Concussion Response Protocol.

You are right. The fact that she hit her head hard on the ground is enough for you to determine that she sustained a concussion and to follow the Concussion Response Protocol.

If you let player #8 continue to play what could be the consequence of this decision?

  1. Puts her at risk for more serious injuries that includes death
  2. She got up on her own, it’s unlikely she has a major concussion, no major consequences
  3. Second impact syndrome
  4. a and c

d is the correct answer. Letting her play after receiving a hard hit to the head puts her at risk for a more serious injury and Second Impact Syndrome, a dangerous and often fatal injury.

Correct. Letting her play after receiving a hard hit to the head puts her at risk for a more serious injury and Second Impact Syndrome, a dangerous and often fatal injury.

Final Assessment - Part 2

What is the first step in responding to a player with a possible concussion?

  1. Remove the player from the field of play
  2. Monitor the player for signs and symptoms
  3. Ask the player the memory questions
  4. Determine if the situation is a medical emergency

Actually, you should first use basic first aid principles to rule out if the situation is a medical emergency. Once a medical emergency is ruled out, remove the player from the game or practice. Then monitor the player for signs and symptoms.

Actually, the memory questions are part of monitoring the player off the field of play. You should first use basic first aid principles to rule out if the situation is a medical emergency. Once a medical emergency is ruled out, remove the player from the game or practice. Then monitor the player for signs and symptoms including the memory questions.

You’re right. The first step in responding to an incident that could cause a concussion is to determine if the situation is a medical emergency. Once a medical emergency is ruled out, remove the player from the game or practice. Then monitor the player for signs and symptoms including the memory questions.

A child you suspect has sustained a concussion has vomited three times while being monitored. You should call 911 immediately.

  1. True
  2. False

You’re right. Repeated vomiting is a red flag and considered a medical emergency.

Actually, repeated vomiting is a red flag and considered a medical emergency. You should call 911 immediately.

You witness a concussion causing incident. After ruling out a medical emergency, the player is removed from play. The player shows no signs or symptoms while being monitored and says he feels fine and is ready to return to the game. Your best response is to:

  1. Explain to the player that he cannot go back into the game until he has been seen by a doctor and been cleared to play.
  2. Let him go back into the game but watch closely for signs or symptoms
  3. Tell the player that if he still feels fine in 15 minutes and has no signs or symptoms of a concussion, then he can go back into the game.

This is the correct response. Even when a player who has been involved in an incident that could cause a concussion has no signs or symptoms, the player should not return to play until they’ve been cleared by a medical professional.

Actually, the signs and symptoms of a concussion can be delayed hours or days after the incident. If a player has been involved in an incident that could cause a concussion, the player should not return to play until they’ve been cleared by a medical professional.

Final Assessment - Part 3

The period of rest following a concussion injury includes limiting activities associated with electronic devices such as texting, video games, using a computer and watching television.

  1. True
  2. False

That’s right. Rest means physical and cognitive rest including activities requiring concentration like those required to use electronic devices.

Actually, rest means physical and cognitive rest including activities requiring concentration like those needed to use electronic devices.

A child who has sustained a concussion should be successfully back at school full-time before starting the return to play protocol.

  1. True
  2. False

That’s right. Returning to activities requiring concentrating and learning should be completed before returning to physical activities.

Actually, returning to activities requiring concentrating and learning should be completed before returning to physical activities.

A player who has been away from practices and games for two weeks has shown up to a practice stating that she’s ready to start practicing. What should you do?

  1. Let her practice but watch carefully for signs or symptoms of a concussion.
  2. Confirm she has a note from a doctor allowing her to start practicing.
  3. Confirm that she has returned to school successfully.

Actually, you should confirm she is successfully back at school full days and then follow the return to play protocol to slowly get her back to participating fully.

Though according to the return to play protocol, she doesn’t need a note from her doctor at this point in her recovery, there is nothing wrong with requiring it. Either way, you should confirm she is successfully back at school full days and then follow the return to play protocol to slowly get her back to participating fully.

You’re right. You should confirm she is successfully back at school full days and then follow the return to play protocol to slowly get her back to participating fully.

Final Assessment - Part 4

A good way to reduce the risk of concussion is to:

  1. Model good sportsmanship
  2. Educate your players and children
  3. Stay informed on concussion information
  4. Ensure all your players have the needed safety equipment that is in good condition
  5. All of the above

Though this is a good way to reduce incidents that cause concussions, it takes more than one action to address the risk of concussions. If you also educate children, stay informed and ensure all players have the needed safety equipment that is in good condition you will further support decreasing concussions.

Though this is a good way to reduce incidents that cause concussions, it takes more than one action to address the risk of concussions. If you also model good sportsmanship, stay informed and ensure all players have the needed safety equipment that is in good condition you will further support decreasing concussions.

Though this is a good way to reduce incidents that cause concussions, it takes more than one action to address the risk of concussions. If you also model good sportsmanship, educate players and ensure all players have the needed safety equipment that is in good condition you will further support decreasing concussions.

Though this is a good way to reduce incidents that cause concussions, it takes more than one action to address the risk of concussions. If you also model good sportsmanship and educate players and stay informed you will further support decreasing concussions.

That’s right. It takes more than one action to address the risk of concussions. Modeling good sportsmanship, educating players, staying informed and ensuring all players have the needed safety equipment that is in good condition are good ways to support decreasing concussions.

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