Activity Report 2011

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ACTIVITY REPORTAddressing Concussion Among Kids and Teens:On and Off the Playing FieldActivity Report 2011U.S. Department of Health and Human Services Centers for Disease Control and PreventionNational Center for Injury Prevention and ControlU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCENTERS FOR DISEASE CONTROL AND PREVENTION

THANK YOU!The importance of the current (and future) Heads Up participating organizationsin ensuring the success of these initiatives cannot be overstated. Through yourconsistent and tireless efforts, we are helping to keep young athletes healthy andactive, and for this we THANK YOU!Below is a quick summary of what we have accomplished together: 60 million media impressions through print media and TV public serviceannouncements (PSAs) More than 4 million print resources distributed 300,000 coaches completing online trainings 200% increase in CDC’s concussion and TBI webpage views Over 40 Heads Up products developed 4,000 Facebook fans, and growing More than 85 participating organizations Close to 20 million social-media impressions 2,000 participants in Heads Up webinars 20 radio PSAs and podcasts created

Heads Up Participating OrganizationsAmateur Athletic UnionAmerican Academy of Family PhysiciansAmerican Academy of PediatricsAmerican Academy of Physical Medicine and RehabilitationAmerican Association for Health EducationAmerican Association of Cheerleading Coachesand AdministratorsAmerican Association of Neurological SurgeonsAmerican College of Emergency PhysiciansAmerican College of PhysiciansAmerican College of Sports MedicineAmerican Counseling AssociationAmerican Medical Society for Sports MedicineAmerican School Counselor AssociationAmerican School Health AssociationAmerican Society of Pediatric Neurological SurgeryAmerican Speech-Language-Hearing AssociationAmerican Youth Soccer OrganizationAssociation of State and Territorial Health OfficialsBaltimore RavensBrain Injury Association of AmericaBrain Injury Association of MichiganBrain Injury Association of WashingtonBrain Trauma FoundationCDC FoundationChicago WolvesChildren’s National Medical CenterChildren’s Safety NetworkDetroit LionsEmergency Nurses AssociationEMSC National Resource CenterHealth Resources and Services AdministrationHuskers - University of Nebraska - LincolnInstitute for Preventative Sports MedicineInstitute for the Study of Youth SportsMajor League SoccerMassachusetts Department of Public HealthMichigan High School Athletic AssociationNational Alliance for Youth SportsNational Assembly on School-Based Health CareNational Association for Sport and Physical EducationNational Association of County and City Health OfficialsNational Association of Elementary School PrincipalsNational Association of School NursesNational Association of School PsychologistsNational Association of School Resource OfficersNational Association of Secondary School PrincipalsNational Association of Social WorkersNational Association of State School Nurse ConsultantsNational Athletic Trainers AssociationNational Center for Sports SafetyNational Collegiate Athletic AssociationNational Council for Accreditation of Coaching EducationNational Council of Youth SportsNational Education AssociationNational Education Association Health Information NetworkNational Federation of State High School AssociationsNational Football LeagueNFL Players AssociationNational Interscholastic Athletic Administrators AssociationNational Program for Playground SafetyNational Recreation and Park AssociationNational Operating Committee on Standards forAthletic EquipmentNational Safety CouncilNational School Boards AssociationNational Youth Sports Coaches AssociationNorth American Brain Injury SocietyOakwood HospitalPittsburgh Penguins FoundationPop Warner Little ScholarsPresident’s Council on Physical Fitness and SportsSafe Kids WorldwideSafe States AllianceSeattle SeahawksSpecial Olympics InternationalSports Legacy InstituteState and Territorial Injury Prevent Directors AssociationThe Children’s Hospital of PhiladelphiaUSA BaseballUSA BasketballUSA CheerUSA CyclingUSA DivingUSA FootballUSA Field HockeyUSA HockeyUSA Roller SportsUSA RugbyUSA SkateboardingUSA SoftballUSA VolleyballUS LacrosseUS Ski and Snowboard AssociationUS SoccerUS Youth SoccerWayne State University

Addressing Concussions Among Kids and Teens:On and Off the Playing FieldActivity Report 2011U.S. Department of Health and Human Services Centers for Disease Control and PreventionNational Center for Injury Prevention and Control

ContentsHeads Up Initiatives—An Overview.8Supporting Materials and Resources. 13Heads Up: Concussion in High School Sports. 14Heads Up: Concussion in Youth Sports. 14Heads Up to Schools: Know Your Concussion ABCs. 16Heads Up to Clinicians. 17Partnership and Promotion. 18Impact.22Materials Evaluation. 24Heads Up: Concussion in High School Sports. 24Heads Up: Concussion in Youth Sports. 25Heads Up to Schools: Know Your Concussion ABCs. 26How to Become Involved. 28Get Started . 29Build Momentum. 30Reach the Media. 30Resources.33Ongoing Efforts and Future Plans. 34

ACTIVITY REPORT Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing FieldHeads Up Initiatives—An OverviewHeads Up is a series of educational programs,developed by the Centers for Disease Controland Prevention (CDC), that all have a commongoal: to help protect people of all ages, especiallychildren and teens, from concussions and theirpotentially devastating effects.For nearly 10 years, the Heads Up initiative has provided materials to keyaudiences who play a critical role in helping keep children and teens safefrom concussions. Initially, Heads Up materials addressed health careprofessionals and their important role in diagnosing and managingconcussions. More recent Heads Up initiatives focus on sports programsand schools as key places to share messages that will help improvetraumatic brain injury (TBI) and concussion prevention, recognition, andresponse among children and teens.Parents, coaches, school nurses, teachers, and other schoolprofessionals are frequently the first people in a position to recognizeand respond to concussion symptoms, and thereby potentially helpprevent long-term problems. They are also well-positioned to helpeducate others about concussions and how to respond.8

For nearly 10 years, the Heads Up initiative has providedmaterials to key audiences who play a critical role in helpingkeep children and teens safe from concussions.

?noissucnoCasItahWA concussion is a type of traumatic brain injury (TBI) caused by abump, blow, or jolt to the head—or by a hit to the body—that causesthe head and brain to move rapidly back and forth. This suddenmovement can make the brain bounce around or twist in the skull,stretching and damaging the brain cells and creating chemical changesin the brain. Some researchers believe that children may be morevulnerable to the chemical and metabolic changes that occur in thebrain as a result of a concussion.Why Is It a Special Health Concernfor Children and Teens?Falls account for half of all TBIs among children aged 0-to-14years and, each year, kids and teens aged 5-18 years account foran estimated 65% of emergency department visits for sports andrecreation-related TBIs, including concussions.1,2Concussions can have a serious effect on a young, developing brain,causing short- and long-term problems affecting a child’s thinking,language, learning, behavior, and/or emotions. While most kidsand teens with a concussion recover quickly and fully, some willhave symptoms that last for days, or even weeks. A more seriousconcussion can last for months or longer.1 Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits,hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for InjuryPrevention and Control; 2010.2 Gilchrist J, Thomas KE, Wald M, Langlois J. Nonfatal traumatic brain injuries from sports and recreation activities—United States, 2001-2005. Morbidity and Mortality Weekly Report (MMWR) July 27, 2007; 56(29):733-37.10

The success of Heads Up: Concussion in High School Sports led tothe development of a second sports-related project, Heads Up:Concussion in Youth Sports, with similar objectives but a differenttarget audience.Many coaches in youth sports programs are volunteers—eitherparents or other interested people—who may have minimal or notraining in coaching and safety and are generally juggling manyother commitments.31Yet, these youth sports coaches are also on the front line inthe effort to identify and respond to concussions, and they canplay an important role in sharing this information with theparents of young athletes and with the athletes themselves. TheHeads Up: Concussion in Youth Sports initiative has experiencedgreat success and has helped create a national conversationabout this injury in training rooms and homes, and on sidelinesand benches nationwide. The reach of this initiative is largelyattributed to the participating organizations that have helped putthis information in the hands of coaches, parents, and athletes.ACTIVITY REPORT Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing FieldDeveloped in 2005, Heads Up: Concussion in High School Sportswas the first education and awareness-building effort focusingon children and youth participating in sports and recreationalactivities. Designed for high school athletic coaches, this programaims to 1) educate coaches about concussions and the role thatcoaches can play both to help prevent them and to limit theireffects when they occur, and 2) prepare those coaches to educateathletes and their parents about these same issues.3 Wiersma LD, Sherman CP. Volunteer youth sports coaches’ perspectives of coachingeducation/certification and parental codes of conduct. Res Q Exerc and Sport 2005;76(3):324-38.11

ACTIVITY REPORT Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing FieldRecognizing that concussions don’t just affect students on theplaying field, in 2010 CDC created Heads Up to Schools: KnowYour Concussion ABCs for school nurses, teachers, principals, andother school professionals who work with students ages 5-18(grades K-12) during the school day. Heads Up to Schools: KnowYour Concussion ABCs focuses on prevention and recognition ofconcussion in school settings.Because teachers and other school professionals see theirstudents regularly, they are often among the first to recognizethat a student may be experiencing concussion symptoms. Thus,it is important to educate school professionals about the signsand symptoms of concussion—and the need for cognitive restamong students who are recovering from a concussion—so thatthey can help students return to school and, in partnership withthe student’s parent(s) and health care professional, assist withproper management of a concussion.The reach of this initiative is largely attributed to the participatingorganizations that have helped put this information in the hands ofcoaches, parents, and athletes.12

CDC has developed a set of materials designed to meet theeducational objectives of each of these Heads Up audiences—health care professionals, high school coaches, youth sportscoaches and program administrators, school nurses, teachers,and other school professionals—as well as tools for thoseaudiences to use in reaching secondary audiences such asathletes/students and parents.Representatives from each audience provided feedback to ensurethat the content was relevant and actionable, and that the designand format were appealing and usable. Other research methodsused include literature reviews, interviews with experts, focusgroups, and individual in-depth interviews.ACTIVITY REPOR T Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing FieldSupporting Materialsand Resources13

ACTIVITY REPORT Heads Up: Addressing Concussions Among Kids and Teens: On and Off the Playing FieldHeads Up: Concussion in High School SportsResources Online training for highschool coaches developedin partnership with theNational Federation of StateHigh School Associations Guide for coaches Fact sheets for parents(in English and Spanish) Fact sheets for athletes(in English and Spanish) DVD of Brandon’s Story Clipboard sticker Coach’s wallet card with tips Poster with concussion signsand symptoms Athlete videos Radio PSAs Podcasts e-Health cards Web buttons and bannersThe initial set of materials was developed in 2005 with thehelp of an expert work group representing health professionals,high school administrators, coaches, and athletic trainers. Thematerials were later updated, and a revised set of materials wasreleased in 2010 with input from an additional expert work group.HCOENCAUSDSIOSN UPare serious.All concussionshave aIf you think youCONCUSSION :A FACT SHEET FOR ATHLETESIN HIGH SCHOOLSPORTSWhat is a concussion?Don’t hide it.Report it.over.Take time to recWhat should I do if I think I have a concussion?A concussion is a brain injury that: Is caused by a bump, blow, or jolt to the heador body. Can change the way your brain normally works. Can occur during practices or games in any sportor recreational activity. Can happen even if you haven’t been knocked out. Can be serious even if you’ve just been “dinged”or “had your bell rung.”All concussions are serious. A concussion can affectyour ability to do schoolwork and other activities (suchas playing video games, working on a computer,studying, driving, or exercising). Most people with aconcussion get better, but it is important to give yourbrain time to heal. Tell your coaches and your parents. Never ignore abump or blow to the head even if you feel fine. Also,tell your coach right away if you think you have aconcussion or if one of your teammates might have aconcussion. Get a medical check-up. A doctor or other healthcare professional can tell if you have a concussionand when it is OK to return to play. Give yourself time to get better. If you have aconcussion, your brain needs time to heal. While yourbrain is still healing, you are much more likely to haveanother concussion. Repeat concussions can increasethe time it takes for you to recover and may causemore damage to your brain. It is important to rest andnot return to play until you get the OK from yourU.S. D EPARTMENT OF H EALTH AND H UMAN S ERVICEShealth care professional that you are symptom-free.HEADS UPCONCUSSIONWhat are the symptoms of a concussion?CENTERS FOR DISEASE CONTROL AND PREVENTIONIN HIGH SCHOOLHow can I prevent a concussion?SPORTSYou can’t see a concussion, but you might noticeEvery sport is different, but there are steps you canone or more of the symptoms listed below or that youtake to protect yourself.“don’t feel right” soon after, a few days after, or even Use the proper sports equipment, including personalACTION PLANSIGNS AND SYMPTOMSweeks after the injury.protective equipment. In order for equipment toIf you suspect that an athlete has a concussion, you should take Headache or “pressure”Athletesin head who experience one or moreprotectyou,it mustof thesignsandbe:symptomsthe following four steps: Nausea or vomitingThe torightthemaygame, position, or activitylisted below after a bump, blow, or-jolttheequipmenthead or forbody Balance problems or dizziness- Worn correctly and the correct size and fit1. Remove the athlete from play.have a concussion. Double or blurry vision- Used every time you play or practice2. Ensure that the athlete is evaluated by a health careSigns Observed byReported Bothered by light or noise FollowSymptomsyour coach’srules for safety and the rulesprofessional experienced in evaluating for concussion.by Athlete Feeling sluggish, hazy, foggy, or Coachinggroggy Staffof the sport.Do not try to judge the seriousness of the injury yourself. Difficulty paying attention Practice good sportsmanship at all times.3. Inform the athlete’s parents or guardians about the possibleAppears dazed or stunnedHeadache or Memory problemsconcussion and give them the fact sheet on concussion.“pressure” in headIs confused about Confusion4.Keepthe athlete out of play the day of the injury and untilIfyouthinkyouhaveaconcussion:assignment or positionNausea or vomitinga health care professional, experienced in evaluating forDon’t hide it. Report it. Take time to recover.concussion, says the athlete is symptom-free and it’s OK toForgets an instructionBalance problemsreturn to play.or dizzinessIs unsure of game,score, or opponentDouble orIt’s better to miss one game than thewholeblurryvision season.For more information andMovesto orderclumsilyadditional materials free-of-charge, visit: www.cdc.gov/Concussion.Answers questions slowlyU.S.D EPARTMENTOF H EALTHLosesconsciousnessEmergency Medical ServicesName:Phone:(even briefly)June 2010Shows mood, behavior,or personality changesCan’t recall eventsprior to hit or fallCan’t recall eventsafter hit or fallFeeling sluggish, hazy,foggy, or groggyConcentration ormemory problemsConfusionJust not “feeling right”or is “feeling down”It’s better to miss one game than the whole season.For more information and to order additional materials free-of-charge, visit:www.cdc.gov/Concussion.For more information and to order additional materialsfree-of-charge, visit: www.cdc.gov/Concussion.U.S. D EPARTMENTOF H EALTH AND H UMAN S ERVICESCENTERS FOR DISEASE CONTROL AND PREVENTIONIMPORTANT PHONE NUMBERSSensitivity to lightSensitivity to noiseAND H UMAN S ERVICESCENTERS FOR DISEASE CONTROL AND PREVENTIONIt’s better to miss one gamethan the whole season.June 2010Health Care ProfessionalName:Phone:School Staff Available During PracticesName:Phone:School Staff Available During GamesName:Phone:June 2010Visit www.cdc.gov/Concussionto download or order allmaterials for free.Heads Up: Concussion in Youth SportsTo develop the Heads Up: Concussion in Youth Sports initiative andmaterials, CDC conducted additional research to understand theunique needs of youth coaches and the types of organized youthsports activities around the country.14

CDC conducted six focus groups with youth sports coaches andadministrators—to test a pilot version of the materials—andformed relationships with dozens of participating organizations togain further input into the creation of the revised materials for thetarget audiences. Participating organizations not only contributedto refining the materials, but also proved critical to accessing thediverse audiences and ma

National Council for Accreditation of Coaching Education. National Council of Youth Sports. National Education Association. National Education Association Health Information Network. National Federation of State High School Associations. National Football League. NFL Players Association. National Interscholastic Athletic Administrators Association

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