Concussion Management Program

Punahou School has instituted a Concussion Management Program (CMP) to ensure student athletes return to athletic participation safely. CMP aligns Punahou School with national guidelines and recommendations.

What is a Concussion?

A concussion is a traumatic brain injury. Concussions can be caused by a direct blow to the head or body that results in a rapid acceleration or deceleration of the head and neck. This injury changes the way the cells in the brain normally work leading to a variety of physical, cognitive and emotional symptoms.

Concussion Management

The best treatment for a concussion is rest. However, it can take three weeks or longer to fully recover from a concussion. It is imperative that a concussion is managed throughout the entire recovery process.

Concussion management involves creating a support system around the student. Parents, teachers, and coaches need to change and modify the environment around the student to maximize their concussion recovery.

Baseline ImPACT testing for concussion

Punahou School offers baseline ImPACT testing for its student athletes.  ImPACT testing for concussion is a nationally recognized, research based computer test that can be used to assess and manage a concussion.
Learn more about ImPACT testing

Punahou School Return to Play Protocol

Punahou School follows a graduated return to play protocol.  Each step must take a minimum of one day. If your child has any symptoms of a concussion (e.g. headache, feeling sick to his/her stomach) that come back either during activity, or later that day, your child should stop the activity immediately. Report symptoms to the Athletic Training Room.

Step 1: No activity, complete cognitive and physical rest

Athlete should limit or avoid activities that require concentration or physical exertion, including homework, texting, exercise, horseplay, or playing video games if it worsens their symptoms.

Step 2: Return to school

Athlete returns to classes

Step 3: Light aerobic exercises

For example: walking or stationary biking

Step 4: Sport-specific training

For example: running, throwing, serving

Step 5: Non-contact sport-specific drills

For example: dribbling, passing, throwing

Step 6: Full-contact training after cleared from the Punahou Athletic Training Room

Full participation in practice (athlete must participate in a full-contact practice before competing in a game)

Step 7: Game Play

Return to full participation

Remember ... when in doubt, keep ’em out!

Return-to-School Framework

Phase 1: No school

  • Symptoms: In this phase, the student may have a high level of symptoms that prevent him or her from being able to benefit from being in school. Physical symptoms tend to be the most prominent and interfere with even basic tasks.
  • Treatment: The student should rest the brain and body as much as possible.
  • Interventions:
    • No school
    • No activities that exacerbate symptoms, such as television, video games, computer use, texting or loud music
    • Other “triggers” that worsen symptoms – noted and avoided to help promote healing
    • No physical activity, which includes anything that increases the heart rate, such as (but not limited to) weightlifting, sport practices and games, gym class, running, stationary biking, push-ups, sit-ups, etc.

Phase 2: Half-day attendance with accommodations

  • Symptom Severity: In this phase, the student’s symptoms have decreased to manageable levels. Symptoms may be exacerbated by certain mental activities that are complex, difficult and/or have a long duration.
  • Treatment: Balance rest with gradual re-introduction to school. Avoid tasks that produce, worsen or increase symptoms. Avoid symptom triggers.
  • Interventions:
    • Part-day school attendance, with focus on the core subjects; prioritize what classes should be attended and how often
    • Symptoms reported by student addressed with specific accommodations
    • Eliminate busy work or items not essential to learning priority material
    • Emphasis in this phase on in-school learning; rest is necessary once out of school; homework reduced or eliminated
    • No physical activity

Phase 3: Full-day attendance with accommodations

  • Symptom Severity: In this phase, the student’s symptoms have decreased in both number and severity. Symptoms may still be exacerbated by certain activities, but short time spans with known symptom triggers do not have drastic effects on symptom levels.
  • Treatment: As the student improves, gradually increase demands on the brain by increasing the amount of work, length of time spent on the work, and the type or difficulty of work. Gradually re-introduce known symptom triggers for short time periods.
  • Interventions:
    • Continue to prioritize assignments, tests and projects; limit student to one test per day
    • Continue to prioritize in-class learning material; minimize workload and promote best effort on important tasks
    • Gradually increase amount of homework
    • Reported symptoms addressed by specific accommodations; accommodations reduced or eliminated as symptoms wane and resolve
    • No physical activity

Phase 4: Full-day attendance without accommodations

  • Symptom Severity: In this phase, the student may not have any symptoms or may have mild symptoms that are often intermittent.
  • Treatment: Accommodations are removed when student can function fully without them.
  • Interventions:
    • Construct a plan to finish completing missed academic work and keep stress levels low.
    • No physical activity until released by a healthcare professional (such as physician or athletic trainer).

Phase 5: Full school and extracurricular involvement

  • Symptom Severity: No symptoms are present.
  • Treatment: No accommodations are needed.
  • Interventions: Before returning to gym class, weightlifting and/or sports, the student should complete the gradual return-to-play progression as indicated by the healthcare professional.

Information for...

Parents

You can’t see a concussion. Signs and symptoms of concussion can show up right after the injury or may not appear or be noticed until days after the injury. If your child reports one or more of the symptoms listed below, or if you notice these symptoms yourself, keep your child out of play and seek medical attention right away.

Download the CDC's Parent Fact Sheet

Signs and Symptoms

Signs observed by parents

  • Appears dazed or stunned
  • Is confused or forgetful
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows behavior or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall

Symptoms reported by children

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration or memory problems
  • Confusion
  • Does not “feel right”

A child should seek immediate medical attention if after a blow to the head or body s/he exhibits any of the following danger signs:

  • Is drowsy or cannot be awakened
  • One pupil is larger than the other
  • Convulsions or seizures
  • Becomes increasingly confused or agitated
  • Slurred speech
  • Repeated vomiting or nausea
  • Weakness, numbness, or decreased coordination

What should you do if your child suffers a concussion?

  1. Immediately remove the child from the activity
  2. Advise the child to report to the Athletic Training Room (ATR) for concussion evaluation
  3. Inform the Athletic Training Room that your child may have been concussed
  4. Allow your child to return to play only with clearance from the Punahou School Athletic Training Room

How can you help your child recover from a concussion?

To maximize your child’s recovery from a concussion, focus on Reduce and Rest! Insist that your child rest, especially for the first few days after being concussed. Some symptoms of a concussion can be so severe on the first day or two that your child may have to stay home from school. It is also helpful to reduce the sensory load at home. Advise your child to:

  • Avoid loud group functions (games, dances)
  • Limit video games and text messaging
  • Limit reading and homework.

A concussion will almost always slow reaction time; therefore, driving should not be allowed until your child is symptom free.

Plenty of sleep and quiet, restful activities after the concussion will maximize your child’s chances for a great recovery!

Students

A concussion can make your game, your grades, and your social life really bad.

Signs and Symptoms

If you have (or one of your teammates has) any of these symptoms, tell your athletic trainer, teacher, coach or parent now:

  • Headache or pressure in your head
  • Double or fuzzy vision
  • Problems with balance
  • Dizziness
  • Problems remembering things
  • Difficulty concentrating
  • A sluggish or foggy feeling
  • Sensitivity to light or noise
  • Nausea
  • Sleep problems
  • Just don’t feel right

Symptoms reported by children

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration or memory problems
  • Confusion
  • Does not “feel right”

You should seek immediate medical attention if after a blow to the head or body you exhibit any of the following danger signs:

  • Is drowsy or cannot be awakened
  • One pupil is larger than the other
  • Convulsions or seizures
  • Becomes increasingly confused or agitated
  • Slurred speech
  • Repeated vomiting or nausea
  • Weakness, numbness, or decreased coordination

What should you do if your teammate suffers a concussion?

  • Immediately remove them from the activity
  • Advise them to report to the Athletic Training Room (ATR) for concussion evaluation
  • Inform the Athletic Training Room that your teammate may have been concussed

How can you help your recovery from a concussion?

To maximize your recovery from a concussion, focus on Reduce and Rest! It is advised that you avoid physical and mental activity, especially for the first few days after being concussed. Some symptoms of a concussion can be so severe on the first day or two that you may have to stay home from school. It is also helpful to reduce the sensory load at home. It is advised that you:

  • Avoid loud group functions (games, dances)
  • Limit video games and text messaging
  • Limit reading and homework. . (Break up your studying into 20 minute sessions with short 2 minute breaks in between)

A concussion will almost always slow reaction time; therefore, driving should be avoided until you are symptom free.

Plenty of sleep and quiet, restful activities after the concussion will maximize your chances for a great recovery!

Coaches

As a coach, you play a key role in preventing concussions and responding appropriately when they occur. The information below is intended to help you recognize a possible concussion and respond appropriately.

New HHSAA requirements for coaches

The HHSAA is now requiring all head coaches, assistants and volunteers participating in any HHSAA state championship event to complete the NFHS online concussion education course.

The free 30-min course titled "Concussion in Sports – What You Need To Know" is available on the NFHS learning center website. If a coach fails to complete the course, s/he will not be allowed on the sideline during the event until the course has been successfully completed.

Coach's Guide
Wallet Card
Clipboard Sticker

Signs and Symptoms

Signs observed by coaching staff

  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets sports plays
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows behavior or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall

Symptoms reported by athlete

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration or memory problems
  • ConfusionDoes not “feel right”

An athlete should seek immediate medical attention if after a blow to the head or body s/he exhibits any of the following danger signs:

  • Is drowsy or cannot be awakened
  • One pupil is larger than the other
  • Convulsions or seizures
  • Becomes increasingly confused or agitated
  • Slurred speech
  • Repeated vomiting or nausea
  • Weakness, numbness, or decreased coordination

What should you do if your athlete suffers a concussion?

  1. Immediately remove the child from the activity
  2. Advise the athlete to report to the Athletic Training Room (ATR) for concussion evaluation
  3. Inform the athlete's parents or guardians about the possible concussion
  4. Inform the Athletic Training Room that your athlete may have been concussed
  5. Allow the athlete to return to play only with clearance from the Punahou School Athletic Training Room

Teachers

As a teacher or school counselor, you play a key role in recognizing concussions and responding appropriately when they occur. You may be the first to notice changes in your student. The signs and symptoms can take time to appear and can become evident during concentration and learning activities in the classroom. The information below is intended to help you recognize a possible concussion and respond appropriately.

Fact Sheet for Teachers
Signs and Symptoms Card

Signs and Symptoms

Signs observed by teachers

  • Appears dazed or stunned
  • Is confused about assignment or position
  • Answers questions slowly
  • Repeats questions
  • Loses consciousness (even briefly)
  • Shows behavior or personality changes
  • Can’t recall events prior to hit or fall
  • Can’t recall events after hit or fall

Symptoms reported by student

  • Thinking/Remembering:
    • Difficulty thinking clearly
    • Difficulty concentrating or remembering
    • Feeling more slowed down
    • Feeling sluggish, hazy, foggy, or groggy
  • Physical
    • Headache or “pressure” in head
    • Nausea or vomiting
    • Balance problems or dizziness
    • Fatigue or feeling tired
    • Blurry or double vision
    • Sensitivity to noise
    • Numbness or tingling
    • Does not “feel right"
  • Emotional
    • Irritable
    • Sad
    • More emotional than normal
    • Nervous
  • Sleep*
    • Drowsy
    • Sleeps less or more than usual
    • Has trouble falling asleep

*Ask about sleep symptoms only if the injury occurred on a prior day.

A student should seek immediate medical attention if after a blow to the head or body s/he exhibits any of the following danger signs:

  • Is drowsy or cannot be awakened
  • One pupil is larger than the other
  • Convulsions or seizures
  • Becomes increasingly confused or agitated
  • Slurred speech
  • Repeated vomiting or nausea
  • Weakness, numbness, or decreased coordination

Send a student to the school nurse if you notice or suspect that a student has:

  1. Any kind of forceful blow to the head or body that results in rapid movement of the head
    -and-
  2. Any change in the student’s behavior, thinking, or physical functioning. (See signs and symptoms of concussion)

What do I need to know about my students returning to school after a concussion?

Supporting a student recovering from a concussion requires a collaborative approach among school professionals, health care providers, and parents, as s/he may need accommodations during recovery.

Learn more about helping students return to school safely after a concussion

Students many need to limit activities while they are recovering from a concussion.  Exercising or activities that involve a lot of concentration, such as studying, working on the computer, or playing video games, may cause concussion symptoms (such as headache or tiredness) to reappear or get worse.

Students who return to school may need to:

  • Take rest breaks as needed
  • Spend fewer hours in school
  • Be given more time to take tests or complete assignments
  • Reduce time spent on the computer, reading, or writing

Learn more about accommodations in the classroom