Welcome to the training on Sports-Related 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 sports-related 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 sports-related concussion in children and adolescents.
- Determine the appropriate response to and treatment for sports-related 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 sports-related 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 5/28/2024.
This module was released on 5/28/2021.
Continuing Medical Education
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.
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.
The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 hours of credit.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.00 hour(s) for attendance.
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 Pediatrics, healthychildren.org. (2019). Soccer-Related Injuries in Kids are Rising – What Can Parents Do?
- American Academy of Pediatrics. (2015). Policy Statement: Cheerleading Injuries: Epidemiology and Recommendations for Prevention. Pediatrics, 130(5): 966-971.
- Arbogast, K. B., Curry, A. E., Pfeiffer, M. R., Zonfrillo, M. R., Haarbauer-Krupa, J., Breiding, M. J., Coronado, V. G., & Master, C. L. (2016). Point of health care entry for youth with concussion within a large pediatric care network. JAMA Pediatrics, 170(7):e160294.
- 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, 133(2), e299-e304. [Abstract].
- Bryan, M. A., Rowhani-Rahbar, A., Comstock, R. D., & Rivara, F. (2016). Seattle Sports Concussion Research Collaborative. Sports- and recreation-related concussions in US youth. Pediatrics, 138(1), e20154635.
- Carney, N., Ghajar, J., Jagoda, A., Bedrick, S., Davis-O’Reilly, du Coudray, H., . . . Riggio, S. (2014). Concussion guidelines step 1: systematic review of prevalent indicators. Neurosurgery, 75(supplement 1):S3–S15. [Abstract].
- Centers for Disease Control and Prevention. (2018). CDC Pediatric mTBI Guideline.
- Centers for Disease Control and Prevention. (2019). Traumatic Brain Injury & Concussion: Symptoms.
- Centers for Disease Control and Prevention. (2019). Traumatic Brain Injury & Concussion: TBI Get the Facts.
- Centers for Disease Control and Prevention. (2019). Traumatic Brain Injury & Concussion: National Concussion Surveillance System.
- Centers for Disease Control and Prevention. What Is A Concussion? (video).
- Cullum, C. M., Bunt, S., Hicks, C., Didehbani, N., Miller, S., Vargas, B., Sabo, T., Bell, K., & Batjer, H. H. (2020). The North Texas Concussion Registry (ConTex). BMJ Open, 10, e032345.
- DePadilla, L., Miller, G. F., Jones, S. E., Peterson, A. B., & Breiding, M. J. Self-Reported Concussions from Playing a Sport or Being Physically Active Among High School Students — United States, 2017. (2018). Centers for Disease Control and Prevention, Morbidity & Mortality Weekly Report (MMWR), 67:682–685.
- 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.
- Grady, M. F., & Master, C. L. (2017). Return to School and Learning After Concussion: Tips for Pediatricians. Pediatric Annals, 46(3): e93-98. [Abstract].
- 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. (2018). Clinical Report: Returning to Learning Following a Concussion. Pediatrics, 132(5), 948 -957.
- Halstead, M. E., McAvoy, K., & Eagan Brown, B. (2016). Commentary: Expanding Concussion Laws Not Necessary for Return to Learning After Concussion. Pediatrics, 138(6): e20163194.
- Halstead, M. E., Walter, K. D., Moffatt, K., & American Academy of Pediatrics Council on Sports Medicine and Fitness. (2018). Clinical Report: Sport-Related Concussion in Children and Adolescents. Pediatrics, 142(6): e20183074.
- 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. [Abstract].
- 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). Commentary: 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. National Center for Biotechnology Information, U.S. National Library of Medicine.
- National Federation of State High School Associations. (2017). Suggested Guidelines for Management of Concussion in Sports.
- 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. (2018). Brain, 141(2):422-458.
- Texas Education Agency. (2016). Guidelines for Educating Students with Traumatic Brain Injury/Concussions.
- Thomas, D., Apps, J., Hoffmann, R., McCrea, M., & Hammeke, T. (2015). Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial. Pediatrics, 135(2), 213-223.
- University Interscholastic League. (n.d.). UIL Spirit Safety FAQs.
- U.S. Soccer. (2019). Assessment & Management of Concussion in Soccer.
- U.S. Club Soccer. (2016). U.S. Soccer Concussion Guidelines.
- UT Southwestern Medical Center. (2019). News release: Largest Texas high schools to report all concussions to statewide registry.
- Concussion. American Academy of Family Physicians.
- Concussion Recognition Tool 5 (CRT5). A tool to provide non-medical personnel with information about the importance of recognition and removal from play of athletes with suspected sports-related concussion.
- 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 Acquired Brain Injury web page. Resources for families, including injury prevention tips, an emergency preparedness guide and a list of support groups in Texas.
- Texas Institute for Brain Injury and Repair at UT Southwestern Medical Center. Sports concussion videos.
- Texas Sports Concussion Partnership. Concussion videos.
- University Interscholastic League. (n.d.). UIL Spirit Safety FAQs.
The medical definitions in this module were obtained or adapted from Columbia University Irving Medical Center, Mayo Clinic and StatPearls.
Recognizing, Reporting and Preventing Child Abuse
Implement best practices to effectively screen for child abuse, comply with legal reporting requirements and promote protective factors that prevent child abuse.
Implement best clinical practices to identify and treat exercise-induced dyspnea, apply an algorithm to clear athletes to return to play, and determine when specialty care is necessary.
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.