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Determining Extent Of Injury To Brain Is Difficult
Factors Complicating Concussion Recognition And Management
Concussion Work-Up
Importance Of Prior Concussions
Computerized Neuropsychological Assessment: Replacing Pen And Paper Tests
The Balance Error Scoring System: A Useful Test
When A CT Or MRI Is Recommended
Concussion Management And Return To Play Guidelines
Final Recommendations

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• Any athletic showing signs and symptoms of a concussion should not be allowed to return to play in the current game or practice under any circumstances. "When in doubt, sit them out."

• An athlete experiencing PCSS should not be left alone, but should be monitored regularly until post concussion symptoms and signs have abated.

• If the athlete has not cleared of post concussion symptoms by the time of the end of the practice or game, it is preferable that the athlete be referred for medical evaluation.

The following steps may be used in determining when an athlete can be allowed to return to play following a concussion in which he or she has had post concussion symptoms for several days or more:

1. While symptomatic, complete rest (no physical activity);

2. Once asymptomatic at rest, light aerobic exercise (i.e. walking, stationary cycling) permitted

3. If asymptomatic with light aerobic exercise, allow sports specific training (i.e. skating drills for hockey)

4. Once the athlete has been asymptomatic at rest and with exertion for the appropriate period of time (which will be determined by the grade of concussion and the number of concussion suffered), full contact training allowed

5. If the athlete continues to be asymptomatic, he or she can then be cleared for game play.

Although useful guidelines exist regarding when and if a concussed athlete can return to competition, the final decision should be made on an individual basis and will depend on the athlete's concussion history, the severity of the injury, the duration of signs and symptoms, time between injuries, and the availability of experienced personnel to conduct repeated assessments and monitoring recovery.

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DO NOT return and athlete to collision practice or competition until he or she:

1. Has had a normal neurological assessment

2. Has no post concussion signs/symptoms at rest and exertion

3. Score on neuropsychological tests, if performed, at baseline (normal) or above

4. CT or MRI (if done) shows no lesion placing the athlete at increased risk of head injury (edema, hemorrhage, hydrocephalus, cavum septum pellicidum, arachnoid cyst).

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Article Updated August 15, 2006

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