Welcome to the training on Concussion: Diagnosis, Treatment and Prevention provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
The goal of this module is to equip Texas Health Steps providers and others to identify, treat, and reduce the risk of concussions in children and adolescents.
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Apply appropriate methods and tools to diagnose concussion in children and adolescents.
- Determine the appropriate response to and treatment for concussion, including deciding when it is appropriate for a child or adolescent to return to school and to playing sports.
- Recommend key techniques that families can use to help reduce the risk of a concussion.
Note: For purposes of this module, the term “parents” also refers to guardians and caregivers. Also, the terms “return to learning” and “return to school” are used interchangeably.
Please note this module expires on 5/25/2021.
This module was released on 5/25/2018.
Continuing Medical Education (Ethics Accredited)
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This course has been designated by The Texas Department of State Health Services, Continuing Education Service for 1.00 credit(s) of education in medical ethics and/or professional responsibility.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hour(s) of Continuing Nursing Education.
Social Workers (Ethics Accredited)
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hour(s) of Continuing Social Work Education.
This course has been designated by The Texas Department of State Health Services for 1.00 contact hours of education in professional ethics and social work values.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.00 hour(s) for attendance.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.00 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support.
- Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
- Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
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- American Academy of Neurology (AAN). New AAN Evidence-Based Guideline on Sports Concussion, Neurology Today, 2013.
- Centers for Disease Control and Prevention. HEADS UP to providers. Diagnostic and assessment tools, discharge instructions, return to play management, online training, and other resources.
- Cervical spine assessment video for primary care physicians, from the Hospital for Special Surgery in New York.
- Glasgow Coma Scale.
- Standardized Concussion Assessment Tool 5 (SCAT5).
- Texas Education Agency. Guidelines for Educating Students with Traumatic Brain Injury/Concussion.
- Texas Institute for Brain Injury and Repair. Sports concussion videos.
- Texas Sports Concussion Partnership. Videos available under the Multimedia tab.
- Concussion. American Academy of Family Physicians. (available in Spanish)
- Brain Injury Association of America. A variety of resources to help patients and families cope with and understand a brain injury. Texas Division web page with specific news and resources in Texas.
- Centers for Disease Control and Prevention. HEADS UP to Parents and HEADS UP to Youth Sports, including resources for young athletes.
- Texas Sports Concussion Partnership.
- Texas Brain Injury Alliance. TBI Resources for Survivors and Caregivers.
- Texas Health and Human Services Commission’s Office of Acquired Brain Injury. Resources for families, including injury prevention tips, an emergency preparedness guide, and a list of support groups in Texas.
- University of Texas Southwestern Medical Center’s Texas Institute for Brain Injury and Repair (TIBIR) and the Texas State Athletic Trainers’ Association. Educational videos for patients and parents about concussions.
- University Scholastic League. (2014). Cheerleader Safety FAQ.
- American Academy of Pediatrics. (2015). Soccer Safety Tips.
- American Academy of Pediatrics, Policy Statement. (2012). Cheerleading Injuries: Epidemiology and Recommendations for Prevention. Pediatrics, 130(5): 966-971.
- American Academy of Family Physicians. (2017). Concussion.
- Brown, N., Mannix, R., O’Brien, M., Gostine, D., Collins, M., & Meehan, W. (2014). Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms. Pediatrics. Published online January 6, 2014, 2013-2125.
- Centers for Disease Control and Prevention. (2017). Traumatic Brain Injury & Concussion: Signs and Symptoms.
- Centers for Disease Control and Prevention. (2017). Traumatic Brain Injury & Concussion: TBI Get the Facts.
- Centers for Disease Control and Prevention. (2017). CDC Features: TBIs and Injuries.
- Centers for Disease Control and Prevention. (2016). Traumatic Brain Injury & Concussion: National Concussion Surveillance System.
- Echemendia, R. J., Meeuwisse, W., McCrory, P., Putukian, M., Leddy, J., . . . Herring, S. (2017). The Sport Concussion Assessment Tool 5th Edition (SCAT5): Background and rationale. British Journal of Sports Medicine, 51(11): 848-850.
- Giza, C. C., Kutcher, J. S., Ashwal, S., Barth, J., Getchius, T. S. D., Gioia, G. A., . . . Zafonte, R. (2013). Summary of evidence-based guideline update: Evaluation and management of concussion in sports. Neurology, 80(24): 2250-2257.
- Grady, M. F., & Master, C. L. (2017). Return to School and Learning After Concussion: Tips for Pediatricians. Pediatric Annals, 46(3): e93-98.
- Halsted, M. E., McAvoy, K., Devore, C. D., Carl, R., Lee, M., Logan, K., . . . American Academy of Pediatrics Council on School Health, Council on Sports Medicine and Fitness. (2013). Returning to Learning Following a Concussion. Pediatrics, 132(5):. 948 -957.
- Halstead, M. E., McAvoy, K., & Eagan Brown, B. (2016). Expanding Concussion Laws Not Necessary for Return to Learning After Concussion. Pediatrics, 138(6): e20163194.
- Halstead, M. E., & Walter, K. D. (2010, reaffirmed 2014). Sport-Related Concussion in Children and Adolescents. Pediatrics, 126(3): e20163194.
- Makdissi, M., Schneider, K. J., Feddermann-Demont, N., Guskiewicz, K. M., Hinds, S., Leddy, J.J., . . . Johnston, K. M. (2017). Approach to investigation and treatment of persistent symptoms following sport-related concussion: a systematic review. British Journal of Sports Medicine, 51(12):958-968.
- Maroon, J. C., Winkelman, R., Bost, J., Amos, A., Mathyssek, C., & Miele, V. (2015). Chronic Traumatic Encephalopathy in Contact Sports: A Systematic Review of All Reported Pathological Cases. PLoS ONE 10(2): e0117338.
- McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S. . . . Vos, P. E. (2017). Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine, 51: 838-847.
- Meehan, W. P., & Bachur, R. G. (2015). The Recommendation for Rest Following Acute Concussion. Pediatrics, 135(2): 362-363.
- National Academies of Sciences, Engineering, and Medicine. (2014). Sports-Related Concussions in Youth: Improving the Science, Changing the Culture, Chapter 6: Protection and Prevention Strategies.
- Schunk, J., & Schutzman, S. (2012). Pediatric Head Injury. Pediatrics in Review, 33(9):398-411.
- Scorza, K., Raleigh, M., & O’Connor, F. (2012). Current Concepts in Concussion: Evaluation and Management. American Family Physician, 85(2):123-132.
- Stillman, A., Alexander, M., Mannix, R., Madigan, N., Pascual-Leone, A., & Meehan III, W.P. (2017). Concussion: Evaluation and management. Cleveland Clinic Journal of Medicine; 84(8):623-630.
- Tagge, C. A., Fisher, A. M., Minaeva, O. V., Gaudreau-Balderrama, A., Moncaster, J. A., Zhang, X-L., . . . Goldstein, L. E. Concussion, microvascular injury, and early tauopathy in young athletes after impact head injury and an impact concussion mouse model. Brain, 141(2):422-458.
- Taylor, C. A., Bell, J. M., Breiding, M. J., & Xu, L. (2013; updated 2017). Traumatic Brain Injury–Related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2007 and 2013. CDC Surveillance Summaries, 66(9):1–16.
- Texas Brain Injury Alliance. (2017). Brain Injury Statistics.
- Texas Education Agency. (2012). Re-Entry of Students with a TBI to the School Setting.
- Texas Traumatic Brain Injury Advisory Council. (2014). Recommendations for Improving the Lives of Individuals with Traumatic Brain Injury, 2014.
- Thomas, D., Apps, J., Hoffmann, R., McCrea, M., & Hammeke, T. (2015). Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial. Pediatrics, published online January 5, 2015, 2014-0966.
- University Scholastic League. (2014). Cheerleader Safety FAQ.
- U.S. Soccer. (2016). U.S. Soccer Concussion Guidelines.
The medical definitions in this module were obtained or adapted from Australian Family Physician, the Centers for Disease Control and Prevention, Encyclopedia of Clinical Neuropsychology, Fort Worth Star-Telegram, glasgowcomascale.org, humankinetics.com, John Hopkins Medicine, KidsHealth from Nemours, Mayo Clinic, Medicine.net, the National Institutes of Health, Sports Health, USA Hockey, and the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services.
Preventing Unintentional Injury
Learn to identify risk factors for unintentional injury in children and adolescents, provide age-appropriate anticipatory guidance and apply state law and best practices to prevent unintentional injury and death.
Addressing Adverse Childhood Experiences through Trauma-Informed Care
Integrate practices to identify, treat and reduce the effects of trauma and toxic stress among children and adolescents. Includes ethical guidelines for reporting suspected abuse or neglect and for providing culturally effective health-care services.