Evaluation and return-to-play
- Athletes at high risk of concussions (those in collision or contact sports) should undergo baseline examinations before the competitive season.
- Baseline examinations should be completed annually for adolescent athletes, those with recent concussions and, when feasible, all athletes. (this is a departure from other consensus statements, which do not call for annual baseline exams)
- Baseline exam should consist of clinical history, physical and neurologic evaluations, measure of motor control (balance) and neurocognitive functions. (noticeable by its absence is a recommendation for a baseline King-Devick test, a simple vision test that a growing number of experts and studies shows can help identify athletes with possible concussion on the sports sideline in making the all-important "return/no return decision").
- Any athlete suspected of a concussion should be removed from play; not allowed to return to activity on the day of injury; and received a full follow-up evaluation from a physician or AT.
- Once the concussion diagnosis is made, the patient should undergo daily focused examinations to monitor the course of recovery and be cleared by a physician before returning to play. (Note: written RTP clearance is required under the law of 48 states and the District of Columbia, although some state laws allow the written authorization for return to sports to be made by health care professionals other than a physician).
- Those athletes with a history of concussions or who do not show a typical return to normal functioning after injury (usually in about a week to 10 days, according to most studies) may benefit from a referral to a neuropsychologist (as a brand new study in Pediatrics (Kirkwood MW, et al. 2014) recommends,) or additional treatments or therapies. McLeod views as one of the "key aspects" of the statement lies in the fact that it "reiterat[es] the importance of the multifactorial assessment and using an interdisciplinary concussion team."
- The AT should enforce the standard use of certified helmets and educate athletes, coaches and parents that, although helmets can help prevent catastrophic injuries, they do not significantly reduce the risk of concussions.
- Helmet use in high-velocity sports (e.g. skiing, cycling) has been shown to protect against traumatic head and facial injury.
- Consistent evidence demonstrating a reduced concussion risk by wearing a mouthguard is not available, though evidence demonstrates that fitted mouthguards reduce dental injuries.
- Research on the effectiveness of headgear in soccer players is limited; use of headgear is neither encouraged nor discouraged at this time.
- Be aware that recovery among young athletes may take longer than in adults and require a longer return-to-play progression.
- Use age-appropriate, validated concussion-assessment tools with younger athletes; a parent, teacher or responsible adult should also monitor and report symptoms.
- Young athletes undergo continual brain and cognitive development and may require more frequent updates to the baseline assessments.
- ATs, school administrators and teachers should work together to include appropriate academic accommodations in the concussion management plan.
- Implement a standard concussion home instruction form for all patients.
- Instruct a concussed patient to avoid medications other than acetaminophen, and avoid alcohol, drugs or other substances.
- Recommend rest as the best practice for concussion recovery; during the acute stage of injury patients should avoid any physical or mental exertion that exacerbates symptoms, maintain a healthy diet and stay well hydrated.
- Ensure school administrators, counselors and instructors are aware of the patient's injury.
For a comprehensive article about the parents' role in concussion treatment and recovery, click here.