PREAMBLE
Canada Basketball and the NLBA understand that having a concussion policy is crucial to the health and wellness of our young athletes. Through the amalgamation of concussion research completed by the Think First Foundation, the Concussion in Sport Group and the National Centre for Injury Prevention and Control, Canada Basketball recommends these return to play protocols before an athlete is allowed to return to both training and competition.
The NLBA has developed a Concussion Protocol to help guide the management of athletes who may have a suspected concussion as a result of participation in any NLBA activities.
PURPOSE
This protocol covers the recognition, medical diagnosis, and management of basketball sport participants (athletes, coaches, officials, etc.,) who may sustain a suspected concussion during a basketball activity. It aims to ensure that persons with a suspected concussion receive timely and appropriate care and proper management to allow them to return back to their sport safely. This protocol may not address every possible clinical scenario that can occur during sport-related activities but includes critical elements based on the latest evidence and current expert consensus.
DEFINITION
A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells. In many cases, a person with a concussion never loses consciousness.
GUIDELINES
1.0 This protocol is intended for use by all individuals who interact with athletes inside the context of NLBA based organized sports activity, including athletes, parents, coaches, officials, and trainers.
2.0 All parents and athletes are required to review and submit a signed copy of the Concussion Education Sheet to their coach prior to the first practice of the season. In addition to reviewing information on concussion, it is also important that all NLBA stake holders have a clear understanding of the NLBA Concussion Protocol.
3.0 The formal diagnosis of concussion should be made following a medical assessment, all sport stakeholders including athletes, parents, coaches, and officials are responsible for the recognition and reporting of athletes who may demonstrate visual signs of a head injury or who report concussion-related symptoms. This is particularly important because many sport and recreation venues will not have access to on-site licensed healthcare professionals.
NLBA CONCUSSION PROTOCOL
1.0 A concussion should be suspected:
1.1 in any athlete who sustains a significant impact to the head, face, neck, or body and demonstrates ANY of the visual signs of a suspected concussion (refer to section on visible signs)
1.2 in any athlete who reports ANY symptoms of a suspected concussion as detailed (refer to section on symptoms)
1.3 if a player reports ANY concussion symptoms to one of their peers, parents, or coaches or if anyone witnesses an athlete exhibiting any of the visual signs of concussion.
2.0 An ambulance should be called immediately to transfer the patient to the nearest emergency department, if:
2.1 an athlete demonstrates signs or symptoms of a more severe head or spine injury including convulsions, worsening headaches, vomiting or neck pain
2.2 an athlete loses consciousness or it is suspected an athlete might have a more severe head or spine injury
2.3 an athlete is suspected of sustaining a more severe head or spine injury during a game or practice
3.0 Coaches, parents, trainers and officials should not make any effort to remove equipment or move the athlete until an ambulance has arrived and the athlete should not be left alone until the ambulance arrives.
3.1 For athletes under 18 years of age, the athlete’s parents MUST be contacted immediately to inform them of the athlete’s injury.
3.2 For athletes over 18 years of age, their emergency contact person should be contacted if one has been provided
4.0 If an athlete is suspected of sustaining a concussion and there is no concern for a more serious head or spine injury, the player should be immediately removed from the field of play.
5.0 Any youth athlete who is suspected of having sustained a concussion must not return to the game or practice and must be referred for Medical Assessment.
6.0 If a youth athlete is removed from play following a significant impact and has undergone assessment by a licensed healthcare professional, but there are NO visual signs of a concussion and the athlete reports NO concussion symptoms then the athlete can be returned to play but should be monitored for delayed symptoms.
6.1 If the athlete develops any delayed symptoms the athlete should be removed from play and undergo medical assessment by a medical doctor or nurse practitioner.
7.0 Medical Assessment and Clearance Letters
7.1 Athletes that are determined to have not sustained a concussion must be provided with a Medical Assessment Letter indicating a concussion has not been diagnosed and the athlete can return to sports activities without restriction.
7.2 Athletes with a diagnosed concussion should be provided with a Medical Assessment Letter indicating a concussion has been diagnosed.
7.3 It is the responsibility of the athlete or their parent/legal guardian to provide this documentation to the athlete’s coaches.
8.0 Athletes diagnosed with a concussion are to be managed according to the Return to Play Protocol under the supervision of a medical doctor or nurse practitioner.
8.1 An athlete deemed to be clinically recovered from their concussion must provide a Medical Clearance Letter before beginning to return to practice or play
8.2 If the athlete experiences any new concussion-like symptoms while returning to play, they should be instructed to stop playing immediately, notify their parents, and undergo follow-up Medical Assessment.
8.3 In the event that the athlete sustains a new suspected concussion, the NLBA Concussion Protocol should be followed as outlined here.
RETURN TO PLAY PROTOCOLS
1.0 Step 1: No activity, only complete rest. Once symptoms are gone, a physician, preferably one with experience managing concussions, should be consulted before beginning a step-wise return to play process.
2.0 Step 2: Light aerobic exercise such as walking or stationary cycling while supervised by someone who can monitor for symptoms and signs. No resistance training or weight lifting. The duration and intensity of the aerobic exercise can be gradually increased over time if no symptoms or signs return during the exercise or the next day.
2.1 If the athlete has symptoms: Return to rest until symptoms have resolved. If symptoms persist, consult a physician.
2.2 If the athlete has no symptoms: Proceed to Step 3 the next day.
3.0 Step 3: Sport specific activities. Activities such as stationary passing, dribbling or shooting can begin. There should be no body contact or other jarring motions such as high-speed stops.
3.1 If the athlete has symptoms: Return to rest until symptoms have resolved. If symptoms persist, consult a physician.
3.2 If the athlete has no symptoms: Proceed to Step 4 the next day.
4.0 Step 4: Begin drills without body contact. If the athlete has symptoms: Return to rest until symptoms have resolved.
4.1 If symptoms persist, consult a physician.
4.2 If the athlete has no symptoms: The time needed to progress from non-contact exercise will vary with the severity of the concussion and with the player. Proceed to Step 5 only after medical clearance.
5.0 Step 5: Begin drills with body contact.
5.1 If the athlete has symptoms: Return to rest until symptoms have resolved. If symptoms persist, consult a physician.
5.2 If the athlete has no symptoms: Proceed to Step 6 the next day.
6.0 Step 6: Game play.
VISIBLE SIGNS OF CONCUSSIONS
- Lying motionless on the playing surface
- Slow to get up after a direct or indirect hit to the head
- Disorientation or confusion, or an inability to respond appropriately to questions
- Blank or vacant look
- Balance, gait difficulties, motor incoordination, stumbling, slow laboured movements
- Facial injury after head trauma
SYMPTOMS OF A CONCUSSION
- Headache or “pressure” in head
- Nausea or vomiting
- Balance problems or dizziness
- Double or blurry vision
- Bothered by light and or noise
- Feeling sluggish, hazy, foggy, or groggy
- Difficulty paying attention
- Difficulty remembering
- Memory problems
- Confusion
- Irritability
- Neck Pain
- Nervous or anxious
- Sadness
- Does not “feel right”
- Appears dazed or stunned
- Is confused about assignment or position
- Forgets an instruction
- Is unsure of game, score, or opponent
- Moves clumsily
- Answers questions slowly
- Loses consciousness (even briefly)
- Shows behaviour or personality changes
- Can’t recall events prior to being hit or falling
- Can’t recall events after being hit or falling
- Appears more emotional
Concussion Policy Agreement
I have read the NLBA Concussion Policy above and understand all of the following:
the importance of preventing concussions
the symptoms and signs of concussions
the importance of reporting a concussion or symptoms or signs to parents
the importance of taking the necessary time for the athlete to heal
the return to practice protocol for players
a medical assessment and/or clearance letter is required prior to allowing an athlete to begin the return to play protocol