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World Rugby Concussion Guidance

Introduction

This World Rugby Concussion Guidance document has been developed to provide guidance and information to persons involved in the Game of Rugby (including the general public) regarding concussion and suspected concussion.

Individual member Unions are strongly encouraged to develop their own guidelines and policies, and must use this Concussion Guidance as minimum standards.

These guidelines apply to all male and female Rugby players including adults (over 18 years), adolescents (18 and under) and children (12 and under). Unions can adjust these age levels upwards at their discretion.

脳振盪に関して

  • 脳振盪は、脳の外傷である。
  • 脳振盪はすべて、深刻なものである。
  • 脳振盪は、意識消失を伴わずに起こることもあり得る。
  • must be removed from playing or training
  • must not return to playing or training until symptom free or until all concussion-related symptoms have cleared or have returned to pre-concussion level
  • must complete a Graduated Return To Play programme
  • should be assessed by a medical practitioner
  • Specifically, return to play or training on the day of a concussion or suspected concussion is forbidden.
  • Recognise and Remove to help prevent further injury or even death.
  • Concussion can be fatal - do not return to play if symptoms persist.
  • Most players with concussion recover with physical and mental rest.

World Rugby strongly recommends that all players seek the highest level of medical care available following concussion or suspected concussion (see definition of Advanced Care below).

Concussion information

脳振盪とは何か?

脳振盪とは、脳の機能に障害をもたらす外傷性脳損傷である。脳振盪の症状にはいろいろあるが、一般的なものは、頭痛、めまい、記憶障害、または、バランス障害である。

ノックアウトされた状態の意識消失は、脳振盪の中で10%以下でしかみられない。意識消失は、脳振盪と診断する際の要件ではない。

一般的に、標準的な脳の画像所見は正常である。

脳振盪はどう引き起こされるのか?

脳振盪は、頭部への直接的な衝撃によって生じることがあるが、体の他の部分への衝撃が頭部の急な動きを引き起こして生じることもある。例: 鞭打ちのような怪我。

どのような人に危険があるのか?

脳振盪は、どの年齢にも起こりうる。しかし、小児、および、少年のアスリートの方が:

Recurrent or multiple concussions

1年以内に2回以上の脳振盪の既往のあるアスリートは、さらなる脳の外傷や回復が遅れるリスクがより高まるため、プレーへ復帰する前には、脳振盪の治療経験のある医師の診察を受けるべきである。

In addition, a history of multiple concussions or players with unusual presentations or prolonged recovery should be assessed and managed by health care providers with experience in sports-related concussions.

症状の発症

脳振盪の症状はいつ発症してもおかしくないが、一般的には、頭部外傷受傷後24~48時間に発症するので注意すること。

How to recognise concussion or suspected concussion

Everyone involved in the game (including side-line medical staff, coaches, players, parents and guardians of children and adolescents) should be aware of the signs, symptoms and dangers of concussion. If any of the following signs or symptoms are present following an injury the player should at least be suspected of having concussion and be immediately removed from play or training.

Clear indicators of concussion / suspected concussion – what you see or hear immediately

Any one or more of the following clearly indicate a concussion:

Other signs of concussion / suspected concussion – what you see

Any one or more of the following may suggest a concussion:

Symptoms of concussion / suspected concussion - what you are told

以下のうちの1つ、または、それ以上の兆候や症状があれば、脳振盪の可能性がある:

What questions you ask adults and adolescents

Failure to answer any of these questions correctly is a strong indication of concussion or at least suspected concussion.

What questions you ask children (12 years and under)

Failure to answer any of these questions correctly is a strong indication of concussion or at least suspected concussion.

確認して止めさせる、そして、疑わしければ、退場させる

Managing concussion or suspected concussion

On field management of concussion or suspected concussion at training or during a match

Any player with concussion or suspected concussion should be immediately and permanently removed from training or play. Appropriate emergency management procedures must be followed especially if a neck injury is suspected. In this instance the player should only be removed by emergency healthcare professionals with appropriate spinal care training.

Once safely removed, the injured player must not return to any activity that day and should be medically assessed.

Side-line medical staff, coaches, players or parents and guardians who suspect that a player may have concussion must do their best to ensure that the player is removed from the field of play in a safe manner.

Immediate management of concussion or suspected concussion

If any of the following are reported or noticed then the player should be transported for urgent medical assessment at the nearest hospital:

In all cases of concussion or suspected concussion it is strongly recommended that the player is referred to a medical or healthcare professional for diagnosis and guidance regarding management and return to play, even if the symptoms resolve. It should only be in rare and exceptional circumstances that a player with concussion or suspected concussion is not medically assessed.

Players with concussion or suspected concussion:

Rest the body, rest the brain

Rest is the cornerstone of concussion treatment. This involves resting the body, ‘physical rest’, and resting the brain, ‘cognitive rest’. This means avoidance of:

ADULTS

Physical rest shall be for a minimum of one week for any adult player with concussion or suspected concussion. This physical rest comprises 24 hours of complete physical and cognitive rest followed by relative rest (activity that does not induce or aggravate symptoms) for the rest of the week. Cautious reintroduction of cognitive (“thinking”) activities are allowed following an obligatory 24 hours of complete (physical and cognitive) rest as long as symptoms related to the concussion are not aggravated.

After the one week physical rest period the player:

The only exceptions to the requisite minimum 1 week rest period and the completion of a Graduated Return to Play Programme are set out below (advanced level of concussion care).

CHILDREN AND ADOLESCENTS

Physical rest shall be for a minimum of two weeks for any child or adolescent (18 years and under) with concussion or suspected concussion. This physical rest comprises a minimum of 24 hours of complete physical and cognitive rest followed by relative rest (activity that does not induce or aggravate symptoms) for the rest of the two weeks. Cautious reintroduction of cognitive (“thinking”) activities are allowed following an obligatory 24 hours of complete (physical and cognitive) rest as long as symptoms related to the concussion are not aggravated.

After the two week physical rest period the player:

Children and adolescents must be managed more conservatively than adults. World Rugby requires any child or adolescent with concussion or suspected concussion to have physical rest for at least two weeks and if symptom free then complete a Graduated Return To Play programme following this minimum two week physical rest period.

Returning to play after concussion or suspected concussion

Any child, adolescent or adult player with a second concussion within 12 months, a history of multiple concussions, players with unusual presentations or prolonged recovery must be assessed and managed by health care professionals (multi-disciplinary) with experience in sports-related concussions and no further participation in Rugby must take place until the player is cleared by a medical practitioner with experience in concussion management. In rare and exceptional circumstances where there is no access to such health care professionals in the country where the player is playing rugby, they must contact their Union for further advice before returning to play.

ADULTS

Exceptions for adults:

CHILDREN AND ADOLESCENTS

Graduated Return To Play (GRTP) programme

The Graduated Return To Play (GRTP) programme incorporates a progressive exercise programme that introduces a player back to sport in a step-wise fashion. This should only be started once the player has completed the requisite physical rest period and is symptom free and off treatments and/or medication that may modify or mask concussion symptoms, for example drugs for headaches or sleeping tablets.

If a player already had symptoms prior to the head injury incident which resulted in the player’s concussion or suspected concussion, the player’s symptoms must have returned to the pre-concussion level prior to commencing a GRTP. However, in these circumstances, extra caution must be exercised and it is recommended that a player specifically seeks medical advice in respect of those pre-existing symptoms.

As a minimum, a GRTP programme must be consistent with World Rugby’s GRTP Protocol below. World Rugby’s GRTP Protocol reflects the Zurich Concussion Consensus Statement GRTP protocol which contains six distinct stages.

World Rugby requires that each stage of the GRTP be a minimum of 24 hours. GRTP stage length may be increased by member Unions at their discretion.

It is critical that all concussion or suspected concussion symptoms have cleared prior to commencing a GRTP programme. The player must only start a GRTP programme or proceed to the next stage if there are no symptoms of concussion during rest and at the level of exercise achieved in the previous GRTP stage.

World Rugby strongly recommends that a medical practitioner or approved healthcare professional confirm that the player can take part in full contact training before entering Stage 5.

GRTP Programme Table

段階
リハビリテーションステ
ージ
運動範囲
目的
1

最低安静期間

症状がない状態での体および脳の絶対安静

リカバリー

2

軽い有酸素運動

10~15分間の軽いジョギング、水泳、または、低
~中度のエアロバイク。筋力トレーニングはしない。24時間ずっと症状がないこと。

心拍数の上昇

3

競技に特化した運動

ランニングドリル。頭部に衝撃を与える活動はし
ない。

動きを加える

4

ノンコンタクト·トレーニングドリル

さらに複雑などトレーニングドリルに進む。例: パ
スドリル。 漸増負荷による筋力トレーニングを始
めてもよい。

運動、協調、認知的負荷

5

フルコンタクトの練習

通常のトレーニング活動

自信を回復させ、コーチングスタッフが機能スキルを評価する

6

競技への復帰

プレーヤーは元の活動に戻る

回復

It is strongly recommended that, in all cases of concussion or suspected concussion, the player is referred to a medical professional for diagnosis and guidance as well as return to play decisions, even if the symptoms resolve.

Advanced level of concussion care

World Rugby strongly recommends that all players seek the highest level of medical care available following concussion or suspected concussion. This highest level of concussion care is supplied in an advanced care setting and shall include at least all of the following:

An adult player with concussion or suspected concussion must have the minimum required one week rest referred to above unless that player accesses an advanced level of concussion care as verified by their Union and has received medical advice that the one week rest period is not required.

Advanced care is generally available within professional Rugby teams and allows for a more individualised management of concussion.

Even if advanced care is available:

There is currently no exception to the requisite minimum rest period which applies to a child or adolescent with concussion or suspected concussion.

NOTES

  1. The minimum standards are set out in this Concussion Guidance. A Union has discretion to introduce more stringent criteria.
  2. The definition of an adolescent for the purposes of this guidance is 18 years and under. The definition of a child for the purposes of this guidance is 12 years and under. Unions are at liberty to increase (but not decrease) this age threshold at their discretion.
  3. If rest periods and GRTP stage lengths are more stringent within a member Union, the player must adhere to their respective Union’s guidelines or policy.
  4. World Rugby strongly recommends that players seek the highest level of medical care available especially when a player’s condition deteriorates, concussions occur repeatedly or more easily in the same player, symptoms fail to resolve or the diagnosis is uncertain.
  5. Only in World Rugby approved elite adult matches is temporary replacement for a head injury assessment (HIA) applicable. The HIA and temporary replacement Law does NOT apply to community rugby at any level or age or to any matches or tournaments which have not been approved by World Rugby.
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