Here are the steps a Boise State athlete must complete to return from concussion

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For a third straight year, the NCAA has reviewed concussion safety protocols at every Power Five institution and other Division I schools that opt into the program.

Boise State opted in, which means its concussion protocol has been reviewed and approved by the NCAA. The NCAA publishes the protocols for all Power Five schools here.

Boise State’s plan isn’t published by the NCAA but was provided to the Idaho Statesman upon request. The document was last updated July 24.

The concussion protocol is a topic of discussion this week because Boise State starting quarterback Brett Rypien was removed from Saturday’s game at Washington State after a hard hit. Coach Bryan Harsin hasn’t clarified Rypien’s injury or status and will only say that he was hit hard. Rypien’s head hit the turf, and he was seen holding his helmet, but never putting it on, in the first half and was in street clothes in the second half.

If Rypien was diagnosed with a concussion — or any other Bronco, for that matter — here are the required steps before returning to competition:

(read the full plan here)

? The athlete must “present with a low-symptom checklist” and be approved by the team physician or designee before beginning concussion protocol. Post-concussion symptoms are checked through SWAY balance and reaction-time tests. The timeline for returning to play may be condensed only at the direction of the team physician. Two steps can be combined in one day at a physician’s direction as long as symptoms don’t increase.

? Step 0: A SWAY test is administered on the day of the incident. A return-to-learn management plan is created, easing the athlete back into schoolwork depending on symptoms and reactions. Symptoms are checked and recorded daily.

? Step 1: The athlete continues to check symptoms daily until reaching a score of zero. The athlete may begin low-intensity activity (0-50 percent of max heart rate; for example, 15-20 minutes on a stationary bike) prior to reaching a score of zero at the discretion of the physician. In fact, the athlete can progress through step four with low symptoms. Some studies have concluded that low-intensity physical activity can help with recovery.

? Step 2: Activity increases to moderate levels (50-70 percent of maximum heart rate). This could include 15-20 minutes of interval sprints on an exercise bike, 3-5 sets of sport-specific movement and 8-10 striders of 30-60 yards (short speed bursts). After this step, athletes may return to team weightlifting and conditioning.

? Step 3: Begin heavy-intensity activity (70-100 percent of max heart rate). Examples include 10 sprints of 30-60 yards and 15-20 minutes of sport-specific agility drills.

? Step 4: Take ImPact post-concussion assessment test, which must be reviewed by a neuropsychological consultant or their designee. Return to non-contact team practice sessions. To go farther, the symptom checklist score must reach zero.

? Step 5: Return to contact team practice sessions.

? Step 6: Return to team activities without limitations, including competition. A team physician or designee (such as a certified athletic trainer) makes the final decision to allow an athlete to compete. A follow-up SWAY balance and reaction-time test will be administered after the return to full team activities.

All student-athletes go through a per-participation physical exam that includes questions about their concussion history and baseline ImPact and SWAY tests. They also take part in preseason concussion education sessions.

Also of note: If an athlete “displays any signs of symptoms of concussion or complains of symptoms consistent with a concussion, they are to be removed from all activity immediately and may not return to activity for the remainder of the day.”

Chadd Cripe: 208-377-6398, @chaddcripe

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