Concussion Management Policy

The Nightingale-Bamford School recognizes that concussions and head injuries are commonly reported injuries in children and adolescents who participate in sports and recreational activity; they can have serious consequences if not managed carefully. The Nightingale-Bamford School has adopted the following policy to support the proper evaluation of head injuries and to follow an established protocol for return to play.

A concussion is a mild traumatic brain injury. Concussions occur when normal brain functioning is disrupted by a blow or jolt to the head. Recovery from concussions will vary. Avoiding re-injury and overexertion until fully recovered is critical to proper concussion management. Physical education teachers, coaches, athletic trainers, and nurses receive training to recognize the signs, symptoms, and behaviors consistent with a concussion. Any student exhibiting the signs, symptoms, or behaviors of concussion while participating in a physical education class, team practice, or interscholastic athletic competition shall be removed from the game or activity and is required to be evaluated as soon as possible by an appropriate health care provider. The school nurse or athletic trainer will notify the student’s parents or guardians and recommend appropriate action if there is a suspected concussion. Students with suspected concussions shall not return to physical activity until authorized by a physician in a written note provided to the school. The athletic trainer will then follow the recommended protocols to guide the athlete through the steps to return to physical activity. Any student returning to physical activity following a diagnosis of concussion must follow the “return to play” protocol below, slowly introducing exercise prior to resuming full activity. As an additional tool to aid the return-to-play protocol, all athletes in Classes VII–XII will take the baseline ImPACT test. In the event of a concussion diagnosed by a health care professional, the athlete will take a post-injury ImPACT test once she is asymptomatic, administered by the athletic trainer. Those results may be shared with the health care provider to help determine if the athlete is ready to begin the return to play protocol. To learn more about ImPACT, click here

New in 2018: Upper School athletes will also be required to take a Sway baseline test using the Sway Medical app. This test is a five-minute balance test. For more information about Sway, visit Sway results may also be shared with the student’s health care provider.

If a student is recommended by a medical professional to receive academic accommodations, the student should not be participating in extracurricular activities during that time. Limiting screen time, reading and study time, or other academic assignments should not be limited to in-school hours; rest is needed to facilitate healing.

If a student sustains a concussion at a time other than when engaged in a school-sponsored activity, the school requires the parent/guardian to report the condition to the school nurse so that the school can support the appropriate management of the condition. 

Return to Play Protocol

Return to play following a concussion involves a stepwise progression once the student is symptom free and has been cleared by a doctor. There are many risks to premature return to play, including: a greater risk for a second concussion because of a lower concussion threshold, second impact syndrome, exacerbation of any current symptoms and possibly increased risk for additional injury due to alteration in balance. The current NYSPHAA return to play recommendations are based on the most recent international expert opinion. No student-athlete should return to play while symptomatic.

Once the student-athlete is symptom free at rest for 24 hours and has a signed release by the treating clinician, she may begin the return to play progression below under supervision of the athletic trainer (provided there are no other mitigating circumstances).

  • Day 1: Take ImPACT post-injury test
  • Day 2: 15-minute stationary bike at 55-65% heart rate maximum
  • Day 3: 20-minute stationary bike at 65-75% heart rate maximum
  • Day 4: Modified practice
  • Day 5: Full practice
  • Day 6: Game/Competition

Each step should take 24 hours. Once the athlete is asymptomatic after introducing all steps of exercise listed above, she can return to play. If any post-concussion symptoms occur while in the stepwise program, then the student should drop back to the previous asymptomatic level and try to progress again after a further 24-hour period of rest has passed. A student who has a second occurrence of post-concussion symptoms during the return to play protocol will be referred to a neurologist for further evaluation and will not continue the protocol until the school receives an update note and recommendation signed by the neurologist.

For further information about concussions, visit the CDC's "HEADS UP" webpage or watch the short video below.