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Better concussion protocol announced

Rehabilitation Stage

Functional exercise at each stage of rehabilitation

Objectives of each stage

1. No activity


Symptom limited physical and cognitive rest

Recovery, 100% resolution of symptoms


2. Light aerobic exercise


Walking, swimming, or stationary cycling keeping intensity <70% maximum permitted heart rate.  No resistance training.


Increase heart rate


3. Sport specific exercise


Routes/bear crawl in football, passing/dribbling in basketball, passing/dribbling in soccer; no head impact activities


Add movement


4. Non-contact training drills


Progression to more complex training drills; passing drills in football; may start progressive resistance training


Exercise coordination and cognitive load


5. Full-contact practice


Following medical clearance participate in normal training activities


Restore confidence and assess functional skills by coaching staff


6. Return to Play


Normal Game Play  



The topic of concussions in sports is ever-increasing as the nation moves toward a safer/better environment for athletes.

At the May 20 Board of Education meeting, the Georgia Orthopedics and Sports Medicine (GOSM) announced to the public an expanded partnership with Newton County public high schools for more detailed procedures regarding the Georgia House Bill 284 a.k.a the “Return to Play Act.”

The Return to Play Act, which went into effect Jan. 1, 2014, calls for public and private schools to provide more information to parents on concussions and to establish concussion management and return to play policies and procedures.

The partnership with GOSM provides Newton County School System staff, students and parents with access to medical personnel who are highly trained and experienced in identification of concussions and proper treatment for concussion sufferers. This partnership will also lead to the use of the widely accepted Immediate Post-Concussion Assessment and Cognitive Test (IMPACT) to assist in monitoring concussion symptoms among student-athletes.

The proposed Concussion Management and Return to Play Program includes the following procedures:

Following a diagnosis on or off the field, the student-athlete will be evaluated by a physician.

The physician must be either a licensed MD or DO, a nurse practitioner, a physician’s assistant and/or a certified athletic trainer with concussion evaluation and management training.

No athlete will be allowed to return to a game/practice on the same day that a concussion has been diagnosed or when a concussion can’t be ruled out.

Any athlete diagnosed with a concussion must be cleared medically by an appropriate health care professional. To be cleared, athletes must successfully complete all phases of the proposed Graduated Return to Play Protocol for Concussions.

Athletes will require both mental and physical rest, and for those athletes who do not follow normal recovery patterns, the protocol will provide neuroimaging — new MRI, CT — and neurocognitive testing — computerized, IMPACT.

Every coach in a GHSA sport will participate in a free online course on concussion management prepared by the National Federation of State High Schools Associations (NFHS), which schools will be responsible for monitoring participation.

All athletes participating in high-risk sports – football, basketball, soccer, wrestling and cheerleading – will complete a baseline ImPACT.

Baseline testing is recommended every two years.

“What the procedures will do is outline a process of educating the coaches and even more education for the athletic trainers, who are already certified athletic trainers, but more specific concussion training for them to identify symptoms of possible concussions,” said Darren Berry, student services supervisor. “Once we have either identified a concussion or can’t rule one out, then we would require the students to follow the graduated return to play protocol.”

The proposals are subject to amendment but according to Berry, there will be nothing more than small changes.


The plan is to better screen students who play high-risk sports, because recognition and proper management can help prevent further injury. High-risk sports were determined based off number of concussions and associated sports.

“We’re going to involve our athletes at the high school level taking that IMPACT test which is an anagram for Immediate Post-Concussion Assessment and Positive Test,” Berry said. “It’s the same test that the NFL uses and I believe NCAA is using it now.”

“It outlines at what point the students would be able to go back into activity,” Berry said. “The typical return is no sooner than three days and typically it’s two weeks depending on the concussion and the symptoms that the child is exhibiting.”

The IMPACT is an Internet-based test that takes 25 minutes to complete. The interpretation must be done by a licensed healthcare professional with experience managing concussions.

Regarding the pre-testing, Berry said anyone could administer it.

“Anybody can give the pre-test because it’s computerized and we would have somebody with just minimal training to administer the pre-test,” Berry said. “The people who would be able to look at that and determine from the results whether the child could go back to play or not would be medical personnel.”

“If a kid comes back and says I’m fine after two or three days, the IMPACT test, they would do that test again to compare their results, the post-test to the pre-test results,” Berry said. “A qualified person would have to examine those results to determine whether or not a child is ready to go back.”

The IMPACT is subjective.

“That wouldn’t be done with every concussion,” Berry said. “It would only be done in cases in which we need more information.”

Current Program

Newton County, Newton Medical Center and GOSM’s current athletic trainer program, which began in December 2012, has already placed full-time certified athletic trainers (ATCs) in Alcovy, Eastside and Newton High School. They also provide county-wide physicals at a reduced cost.

ATCs save parents money because they are able to conduct injury evaluations and oversee rehabilitation, according to GOSM’s presentation.

The trainers cover hundreds of hours of practices and games. They are there for over 60 football games, 70+ baseball/softball games, 75+ basketball games, 60+ soccer games and 15+ wrestling matches. Tennis, cross country, swimming and volleyball receive coverage as well.

With an estimated total of 958 high-risk student-athletes, the Newton County School System would need to provide funding for the testing.

“For just our high school kids, to implement the ImPACT program, it would cost the school system about $1,600. That would be to have up to 1,000 pre-tests, and that’s about the number of kids we have participating in high-risk sports,” Berry said.

Newton County will be one of the leading counties in the nation with its use of ImPACT and the Concussion Management and Return to Play Program.

“There aren’t many (counties) doing it,” Berry said. “There are very few in the country and very few in our state who are using this type of return to play and utilizing the ImPACT program.”

GOSM is ready to roll out the program beginning the 2014-2015 school year for all three Newton County public high schools.

The program will also call for the development of a plan for Newton County Middle Schools for student-athletes participating in high-risk sports and conduct in-service concussion awareness training for middle school coaches.