Treatment & Management

The current international consensus statement on concussion in sport  lists a range of factors that may influence the evaluation and management of concussion and in some cases predict the potential for a prolonged recovery .

Baseline and post-concussion neuropsychological (NP) testing is now recommended for all athletes in sports with a high risk of concussion (e.g. football, lacrosse, hockey, soccer, basketball), regardless of age or level of performance, but the timing and type of testing may need to be adjusted for children and adolescents.

Among the things which increase the anxiety level of parents of children playing contact sports is the fact that many high school programs don't employ athletic trainers who have received training in recognizing the often subtle signs of a concussion. Thus, the fourth point in the Parent's Bill of Rights on Concussions is the right to expect that a certified athletic trainer (ATC) be on staff.

Concussions are typically associated with grossly normal structural neuroimaging studies. In other words, unlike other injuries, concussions are usually injuries no one sees and, contrary to popular belief, don't show up on most magnetic resonance imaging (MRI) exams or CAT scans. As a result, conventional CT or MRI scans of the brain are usually not needed where post-concussion symptoms are mild and clear within a week to ten days. A CT or MRI is, however, recommended in some circumstances

A multiple concussion history, especially where concussions occur with progressively less impact force, are considered modifying factors in the investigation and management of concussion under the current international consensus statement on concussions.

The current international consensus of concussion experts recognizes that they lack the ability to predict injury severity or
outcomes at the time of concussion injury, calls for consideration of range of "modifying factors."

The 3rd International Conference on Concussion in Sport held in Zurich in 2008  recommends a four-step return to play process of rest and a stepwise return to game play (light aerobic exercise, sport-specific exercise, non-contact drills, full contact drills, medical clearance and then game play).  Experts say children and adolescents may require a longer rest period and/or extended period of non-contact
exercise than adults because children and teens experience a different
physiological response to concussion than adults, take longer to
recover, and have other unique risk factors.