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Middle School
Guidelines for Sports Concussion Management,
Neurocognitive Testing& Return to Play Protocol
____________________________
Athletic Trainer, Lake Travis ISD
____________________________
Registered Nurse, Lake Travis ISD
____________________________
Dr. Michael Shane Reardon
Child Neurology Consultants of Austin
Lake Travis ISD
Guidelines for Middle School Sports Concussion and/or Head Injury
Management, Neurocognitive Testing& Return to Play Protocol
INTRODUCTION
A concussion is a type of traumatic brain injury (TBI) that can occur to any person or any age group.1
Youth athletes are more susceptible to getting a concussion due to their brains still developing as they age.2 It
can be caused by a bump to the head, blow, or jolt that can alter the way your brain normally works.1,3 Signs
and symptoms can occur in a rapid onset or be delayed anywhere from several minutes to a couple hours after
an injury.3 Concussions and/or head injuries can also occur when the body takes a hit that causes the head to
move rapidly back and forth.1 Concussions can occur in any sport or recreational activity.4 All coaches, parents,
and student-athletes need to be aware of concussion signs and symptoms and what to do if a concussion and/or
head injury occur. There is an estimated 1.6-3.8 million concussion that occur every year in sports and
recreational activities.5 Athletes that have sustained at least one concussion in their life are 4-6 times more
likely to sustain another concussion.5 If an athlete is suspected of having a concussion and/or head injury, they
need to be seen by a medical provider.1 In order for the athlete to return to sport or their respected activity, the
student-athlete must undergo a return to play protocol with the LTISD middle school nurse and coaching staff.
Additionally, the LTISD Athletic Trainers and Coaching Staff have the right to pull an athlete from
practice/games and initiate the concussion protocol, based on an athlete’s presentation and observation during
concussion sideline assessment or performing the SCAT5.6,7 To have a standard method of managing
concussions to LTISD athletes, the following guidelines are intended to serve as a written protocol for
concussion management.
WHAT IS A CONCUSSION?
A sports-related concussion (SRC) can be defined as the representation of acute and sudden symptoms
that are comparative with a TBI.3 A SRC can be the result of biomechanical forces that cause the brain to move
rapidly within the skull.3 Due to the impact of the forces placed on the body, it can cause brain function to
change which results in an altered mental state (either temporary or prolonged).3 Student-athletes can have
symptoms that are somatic, cognitive and/or emotional.3 Some of those symptoms include, but are not limited
to: a brief loss of consciousness, headache, amnesia, nausea, dizziness, confusion, blurred vision, ringing in the
ears, loss of balance, moodiness, poor concentration or mentally slow, lethargy, photosensitivity, sensitivity to
noise, and a change in sleeping patterns.3 There is also a concern for the risk of repeated concussions and
second impact syndrome (SIS) to young athletes.6 SIS can occur when an athlete returns to play before they
have fully recovered from a concussion and/or head injury.2,8 These two problems can have long lasting, and
even fatal effects, on the individual.3,8
Lake Travis ISD. ⚫ 3324 RR 620 South ⚫ Austin, TX 78738
Lake Travis ISD
Guidelines for Middle School Sports Concussion and/or Head Injury
Management, Neurocognitive Testing& Return to Play Protocol
HISTORY
The following events played a significant role leading up to the development and implementation of the LTISD
concussion management and return to play protocol:
1) October 2016: the 5th International Conference on Concussion in Sport convened in Berlin, Germany
and published its Consensus Statement on Concussion in Sport
2) January 2015: the NCAA Executive Committee updated its policy statement regarding concussions.
3) April 2019: the National Federation of State High School Associations published Suggested Guidelines
for the Management of Concussion in Sports.
4) June 2011: The Texas’ Legislature’s House Bill 2038, also known as Natasha’s Law, was passed, and
signed into law. This is a law relating to prevention, treatment, and oversight of concussions affecting
public school students’ participation in interscholastic athletics.
5) Summer 2011: Texas Education Code updated Chapter 38, Sub Chapter D regarding concussion
management of student-athletes participating in interscholastic sports in Texas.
6) Summer 2011: The University Interscholastic League updated its requirements for concussion
management in student-athletes participating in activities under the jurisdiction of the UIL, and
published Implementation Guide NFHS Suggested Guidelines for Concussions and Chapter 38, Sub
Chapter D of the Texas Education Code
PURPOSE
Lake Travis Independent School District will continue to keep the health, safety, and welfare of its
student-athletes foremost. In addition, this Protocol complies with HB 2038, the UIL’s concussion management
protocol and TEC Section 38.153.
This Concussion Management (CM) and Return to Play Protocol (RTP) is designed to help the LTISD
Athletic Department treat its student-athletes who are suspected of having sustained a concussion and/or head
injury in a safe, efficient, and objective manner. By following this protocol, LTISD will be able to provide an
efficient treatment plan to keep the student-athlete’s health and well-being a top priority. In addition, this
Protocol complies with the UIL’s Implementation Guide for NFHS Suggested Guidelines for Concussions and
Chapter 38, Sub Chapter D of the Texas Education Code and HB 2038.
Lake Travis ISD. ⚫ 3324 RR 620 South ⚫ Austin, TX 78738
Lake Travis ISD
Guidelines for Middle School Sports Concussion and/or Head Injury
Management, Neurocognitive Testing& Return to Play Protocol
DESCRIPTION
According to this CM & RTP protocol:
A) LTISD Athletic Department will create and implement a Concussion Oversight Team.
“The governing body of each school district and open-enrollment charter school
with students enrolled who participate in an interscholastic athletic activity shall
appoint or approve a concussion oversight team. Each concussion oversight
team shall establish a return-to-play protocol, based on peer reviewed scientific
evidence, for a student’s return to interscholastic athletics practice or
competition following the force or impact believed to have caused a
concussion.” (UIL Concussion Management Protocol Implementation Guide)
The members of the Concussion Oversight Team are made up of the LTISD
Athletic Training staff, Registered Nurse’s, and Dr. Michael Shane Reardon.
B) LTISD Athletic Training staff, middle school nurses and coaching staff will:
1) Complete all UIL-required training regarding concussion management.
2) Educate student-athletes about concussions.
3) Educate the coaching staff about the LTISD CM and RTP protocol and the coaches’ role within
the protocol.
4) Maintain documentation of the incident, evaluation, continued management and clearance of
student-athletes who have suffered a concussion and/or head injury.
5) Maintain documentation of the completed UIL Concussion Management Protocol Return to Play
Form. This form must be completed and signed by the appropriate people prior to a studentathlete’s return to play following a concussion and/or head injury.
6) Communicate with LTISD coaches as to the medical clearance of student-athletes who have
suffered concussions and/or head injury.
C) The coaching staff of LTISD will:
1) Complete all UIL-required training regarding concussions.
2) Educate student-athletes about concussions.
3) Remove a student-athlete from a practice or competition if they show any signs, symptoms, or
behaviors consistent with a concussion and/or head injury, and refer them for evaluation by an
appropriate, licensed health care professional (Medical Doctor, Athletic Trainer, Nurse
Practitioner, etc.).
4) Follow all participation restrictions that are placed on a student-athlete by an appropriate,
licensed healthcare professional that has evaluated the student-athlete.
Lake Travis ISD. ⚫ 3324 RR 620 South ⚫ Austin, TX 78738
Lake Travis ISD
Guidelines for Middle School Sports Concussion and/or Head Injury
Management, Neurocognitive Testing& Return to Play Protocol
D) A student-athlete must be removed from a practice or competition immediately if struck with an object
above the neck region during the practice or competition.
E) A student-athlete must be removed from a practice or competition immediately if one of the following
persons believes the student might have sustained a concussion and/or head injury during practice or
competition:
● Coach
● Athletic Trainer
● Medical Doctor
● Licensed Health Care Professional
● Parent, guardian, or another person with legal authority to make medical decisions for the
student.
F) If a student-athlete shows any signs, symptoms, or behaviors consistent with a concussion and/or head
injury:
1) The student-athlete shall be immediately removed from game/practice.
2) The student-athlete shall be evaluated by an appropriate, licensed health care professional as
soon as it is practical to do so (Medical Doctor, Athletic Trainer, Nurse Practitioner, etc.).
3) Inform the student-athlete’s parent or guardian about the possible concussion and/or head injury
and provide them:
● Educational material on concussions and/or head injuries, including instructions for
monitoring the student-athlete.
● Return to Play Guidelines
4) The student-athlete shall not be allowed to return to participation that day regardless of how
quickly the signs or symptoms of the concussion and/or head injury resolve and shall be kept
from activity until a Medical Doctor indicates they are symptom-free and gives clearance to
return to activity as described below with the LTISD middle school nurse and coaching staff.
5) A coach of an interscholastic athletics team may not authorize a student’s return to play.
EVOLUTION & FUTURE CONSIDERATIONS
This protocol as well as the issue of sports concussion management should be continually updated following
established guidelines and new standards of care as they become available.
Lake Travis ISD. ⚫ 3324 RR 620 South ⚫ Austin, TX 78738
Lake Travis ISD
Guidelines for Middle School Sports Concussion and/or Head Injury
Management, Neurocognitive Testing& Return to Play Protocol
Parental Information
What is a concussion?
A sports-related concussion (SRC) can be defined as the representation of acute and sudden symptoms
that are comparative with a TBI.3 A SRC can be the result of biomechanical forces that cause the brain to move
rapidly within the skull.3 Due to the impact of the forces placed on the body, it can cause brain function to
change which results in an altered mental state (either temporary or prolonged).3 Student-athletes can have
symptoms that are somatic, cognitive and/or emotional.3 Some of those symptoms include, but are not limited
to: a brief loss of consciousness, headache, amnesia, nausea, dizziness, confusion, blurred vision, ringing in the
ears, loss of balance, moodiness, poor concentration or mentally slow, lethargy, photosensitivity, sensitivity to
noise, and a change in sleeping patterns.3
What are the symptoms of a concussion?
Due to the impact of the forces placed on the body, it can cause brain function to change which results in
an altered mental state (either temporary or prolonged).3 Student-athletes can have symptoms that are somatic,
cognitive and/or emotional.3 Some of those symptoms include, but are not limited to: a brief loss of
consciousness, headache, amnesia, nausea, dizziness, confusion, blurred vision, ringing in the ears, loss of
balance, moodiness, poor concentration or mentally slow, lethargy, photosensitivity, sensitivity to noise, and a
change in sleeping patterns.3 Signs and symptoms can last anywhere between 7-10 days or be prolonged up to
several weeks or months.2,3,8
What should be done if a concussion is suspected?
1. Immediately remove student from practice or game
2. Seek medical attention right away.
3. Do not allow the student to return to play until proper medical clearance and return to play guidelines
have been followed. The permission for return to play will come from the appropriate health care
professional or professionals.
If you have any questions concerning concussions or the return to play policy, you may contact the LTISD
athletic trainers.
What are risks of returning to activity too soon from or currently with a concussion and/or head injury?
Student-athletes cannot participate in practice/games with a concussion and/or head injury. Rest is key
after a concussion and/or head injury. There is also a concern for the risk of repeated concussions and second
impact syndrome (SIS) to young athletes. SIS can occur when an athlete returns to play before they have fully
recovered from a concussion and/or head injury.2 This condition presents when the brain has not recovered from
the initial concussion—usually within a short time (hours, days, and weeks) and can slow recovery or increase
the chances for long-term problems and be fatal.3 Student-athletes are not allowed to return to play the day of
injury unless cleared by a licensed health care professional. Sometimes athletes, parents, and other school or
league officials wrongfully believe that it shows strength and courage to play while injured. Discourage others
from pressuring injured athletes to play. Don’t let your athlete convince you that they’re “just fine.” Parents
should encourage their student-athlete to be honest when reporting signs and symptoms to the appropriate
health care provider. As a result, education of administrators, coaches, parents, and students is the key for
student-athlete’s safety.
Lake Travis ISD. ⚫ 3324 RR 620 South ⚫ Austin, TX 78738
Lake Travis ISD
Guidelines for Middle School Sports Concussion and/or Head Injury
Management, Neurocognitive Testing& Return to Play Protocol
Liability Provisions
The student and the student’s parent or guardian or another person with legal authority to make medical
decisions for the student understands this policy does not:
1. Waive any immunity from liability of a school district or open-enrollment charter school or of district of
charter school officers or employees.
2. Create any liability for a cause of action against a school district or open-enrollment charter school or
against district or charter school officers or employees.
3. Waive any immunity from liability under Section 74.151, Civil Practice and Remedies Code.
4. Create any liability for a member of a concussion oversight team arising from the injury or death of a
student participating in an interscholastic athletics practice of competition, based only on service on the
concussion oversight team.
Lake Travis ISD. ⚫ 3324 RR 620 South ⚫ Austin, TX 78738
Lake Travis ISD
Guidelines for Middle School Sports Concussion and/or Head Injury
Management, Neurocognitive Testing& Return to Play Protocol
Name: ____________________________________
Sport: ____________________________________
Grade/ Team: _______________________________
Date of Injury: ______________
Date: ______________________
Time: _____________________
How do you feel? You should score yourself on the following symptoms, based on how you feel now.
1. Headache
2. “Pressure in head”
3. Neck Pain
4. Nausea or vomiting
5. Dizziness
6. Blurred vision
7. Balance problems
8. Sensitivity to light
9. Sensitivity to noise
10. Feeling slowed down
11. Feeling like “in a fog”
12. “Don’t feel right”
13. Difficulty concentrating
14. Difficulty remembering
15. Fatigue or low energy
16. Confusion
17. Drowsiness
18. Trouble falling asleep
19. More emotional
20. Irritable
21. Sadness
22. Nervous or Anxious
None
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Mild
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
Moderate
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
Do symptoms get worse with physical activity?
Yes / No
Do symptoms get worse with mental activity?
Yes / No
Total Number of Symptoms: ______________
Severe
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
5
6
Symptom Severity Score: _________________
Lake Travis ISD. ⚫ 3324 RR 620 South ⚫ Austin, TX 78738
Lake Travis ISD
Guidelines for Middle School Sports Concussion and/or Head Injury
Management, Neurocognitive Testing& Return to Play Protocol
Athlete Name: ______________________________ Date/Time of injury: ____________ Sport: __________
Examiner: ___________ Age: ___ Gender: M / F Current Grade:
Dominant hand: Right / Left
How many concussions have you had in the past?
Most recent concussion: ___________________
How long was your recovery from the most recent concussion? _____________________________________
Have you ever been hospitalized for a head injury?
Yes / No
Have you ever been diagnosed with headaches or migraines? Yes / No
– Have you ever been prescribed medication for
headaches/migraines? Yes / No
– Do you normally take medication for headaches/migraines?
Yes / No
– Have you taken that medication today? Yes / No
Have you been diagnosed by ad doctors with a
learning disability, dyslexia, ADD / ADHD? Yes / No
– Have you been prescribed ADD/ADHD medication?
Yes / No
– Do you normally take your ADD/ADHD medication?
Yes / No
– Have you taken that medication today? Yes / No
Have you been diagnosed with depression, anxiety, or any other
psychiatric disorder? Yes / No
– Have you been prescribed with psychiatric medication?
Yes / No
– Do you normally take medication for a psychiatric disorder?
Yes / No
– Have you taken that medication today? Yes / No
Have you been to the eye doctor in the last year?
Yes / No
– Have you been prescribed glasses or contacts? Yes / No
– Which do you wear while participating in sports?
Contacts / Glasses / None
– Which one are you wearing today?
Contacts / Glasses / None
Are you color-blind?
Yes / No
– What color are you color-blind to? Red / Green/ Unsure
Please list all other medications:
How many hours ago did you last work-out? _____________
What work-out/activity did you perform?
– What was the intensity? Low Moderate Vigorous
How many hours did you sleep last night? _______________
How many hours do you normally sleep? ________
Are you feeling 100% normal today? Yes / No What percent? ___________
Why if not, why?
_____________________________________________________
Cognitive Assessment
What month is it?
What is the date today?
What is the day of the week?
What year is it?
What time is it right now? (w/i hour)
Orientation score
0
1
0
1
0
1
0
1
0
1
___ of 5
NOTES: MOI/ UE&LE Findings/ ROM/ Tenderness
Delayed Recall
Eat Dog Run
Y/N
Concentration months in reverse order Y / N
Dec – Nov – Oct – Sept – Aug – Jul – Jun – May – Apr –
Mar – Feb – Jan
Balance Examination
Footwear: Shoes / Barefoot / Braces Which foot was tested?
Double Leg Stance
Single Leg Stance
Tandem Stance
Errors
Errors
Errors
L /R
Coordination Examination
Upper limb coordination: Which arm was tested: L / R Both
Coordination score: ___of 1
List A
4-9-3
6-2-9
3-8-1-4
3-2-7-9
6-2-9-7-1
1-5-2-8-9
7-1-8-4-6-2
5-3-9-1-4-8
Digits Backwards
List B
List C
5-2-6
1-4-2
Y N
4-1-5
6-5-8
Y N
1-7-9-5
6-8-3-1
Y N
4-9-6-8
3-4-8-1
Y N
4-8-5-2-7
4-9-1-5-3
Y N
6-1-8-4-3
6-8-2-5-1
Y N
8-3-1-9-6-4
3-7-6-5-1-9
Y N
7-2-4-8-5-6
9-2-6-5-1-4
Y N
Digits Score:
Immediate Memory: 5 Word
List
Finger Penny Blanket Lemon
Insect
Candle Paper Sugar Sandwich
Wagon
Baby Monkey Perfume Sunset
Iron
Elbow Apple Carpet Saddle
Bubble
Dollar Honey Mirror Saddle
Anchor
Jacket Arrow Pepper
Cotton Movie
Lake Travis ISD. ⚫ 3324 RR 620 South ⚫ Austin, TX 78738
Trial 1
Total:
0
0
0
0
0
0
0
0
/4
Trial 2 Trial 3
Lake Travis ISD
Guidelines for Middle School Sports Concussion and/or Head Injury
Management, Neurocognitive Testing& Return to Play Protocol
Athlete Name: ____________________________
Date of Injury: ____________________
Sport /Team: _____________________________
Time of Injury: ____________________
Lake Travis ISD has developed a protocol for managing concussions and/or head injuries. This policy includes a
multidiscipline approach involving Athletic Trainer clearance, Medical Doctor referral and clearance, the middle school
nurse and successful completion of activity progressions related to their sport. The following is an outline of this
procedure; the injured athlete must complete and successfully pass all phases (with 0 symptoms) of the protocol to return
to sport activity after having a concussion and/or head injury.
I.
II.
III.
IV.
V.
All athletes who sustain head injuries are required to be evaluated by a Medical Doctor and will complete
the Return to Play Protocol. This includes athletes who were initially referred to an emergency department.
The student will be monitored daily at school by the middle school nurse and coaching staff. His/her teachers will
be notified of their injury and what to expect. Accommodations may need to be given according to Medical
Doctor recommendations and observations.
The student must be asymptomatic at rest and exertion to move on to the next phase. Additionally, the student
must be asymptomatic for 3 calendar days before starting the Return to Play Protocol.
Once cleared to begin activity, the student will start a progressive step-by-step procedure outlined in the Prague
statement. The progressions will advance at the rate of one step per day (24 hours in between phases). Each phase
of the protocol MUST be completed with the middle school nurse and coaching staff.
Upon completion of the return to play protocol, he/she may return to their sport with no restrictions, with a
DOCTORS CLEARANCE.
Name/Number of Parent Called: _________________________________________________________________
Evaluating Athletic Trainer/ Supervising Coach: _________________Date: _____________
Last date with symptoms: _______________Concussion Checklist Completion Date: _______________
Name of Physician ______________________________ Date of Visit: ________________
Cleared to return to activities: Yes:
No:
Reason: ______________________________________________
Restrictions if needed: __________________________________________________________________________
Phase 0 – Asymptomatic for 3 days – Date: _________
Phase 1 – Stationary Bike (15min) – Date: _________
Phase 2 – Jog on track or field (20min) – Date: _________
Phase 3 – Practice w/ No Contact & Weights (30+ min) – Date: ________
FB – Helmet, Shoulder Pads, Shorts, Girdle
Phase 4 – Full Athletic Practice – Date: _________
Phase 5 – Return to Play
Parent Signature ____________________________ Doctors Signature_______________________________
By signing this form, I (parent/guardian/ person with legal authority) grant permission and understand the risks and dangers related
with returning to play too soon after a concussion. Furthermore, if my son/daughter is diagnosed with a concussion and/or head
injury, I give my consent for my son/daughter to participate in and comply with the Lake Travis ISD return to play protocol.
Lake Travis ISD. ⚫ 3324 RR 620 South ⚫ Austin, TX 78738
Lake Travis ISD
Guidelines for Middle School Sports Concussion and/or Head Injury
Management, Neurocognitive Testing& Return to Play Protocol
REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
Mild tbi and concussion. https://www.cdc.gov/traumaticbraininjury/concussion/index.html#print.
Updated Novemeber 14, 2022. Accessed2023.
Halstead ME, Walter KD. Clincial report-sports- related concussion in children and adolescents. A Aca
Pediatr. 2010;126(6):597-611 doi:10.1542/peds.2010-2005
McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sports- the 5th
international confrence on concussion in sport held in berlin, october 2016. Br J Sports Med.
2018;51:838-847 doi:10.1136/brjsports-2017-097699
Gessel KM, Fields SK, Collins CL, Dick RW, Comstock RD. Concusssions amoung united states high
school and collegiate athletes. J Ath Train. 2007;42(4):495-503.
Brain injury research institute. https://www.protectthebrain.org/. Accessed 2023.
May T, Foris LA, Donnally III CJ. Second impact syndrome. Treasure Island (FL): StatPearls; 2022.
SCAT 5. Br J Sports Med Web site. https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports2017-097506SCAT5.full.pdf. Accessed2023.
Echemendia RJ, Meeuwisse W, McCrory P, et al. The sports concsussion assessment tool 5th edition
(SCAT5): background and rationale. Br J Sports Med. 2017;51:848-850 doi:10.1136/bjsm-2017-097506
Lake Travis ISD. ⚫ 3324 RR 620 South ⚫ Austin, TX 78738
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