Ongoing controversy
Despite the strong, unequivocal stance taken by the Zurich consensus statement, significant controversy still exists over whether an athlete should be allowed to return to play on the day of injury:
- Most older (pre-2000) guidelines would permit an athlete to return to the same contest or practice if he has been symptom free for at least 15 to 20 minutes and it is his first concussion of the season (no RTP if second concussion);
- Some disqualify any athlete experiencing LOC or amnesia from returning to play that day and advocate in favor of stricter RTP guidelines for athletes under age 18 years because of the greater risk of catastrophic injury to the maturing brains of youth athletes, and believe that the "safest course of action [is] to hold an athlete out."
- The Zurich consensus statement recommends that an athlete experiencing any post-concussion symptoms not be allowed to return to play that day no matter how quickly the symptoms disappear.
- As recently as 2000, nearly one-third (30%) of all high school and collegiate football players sustaining concussions were allowed to return to competition on the same day of injury, with the remaining 70% average 4 days of rest before RTP.
The evidence supports a 7-day waiting period:
- Two 2003 studies suggest that a 7-day waiting period may minimize the risk of another concussion.
- The evidence show that athletes take, on average, 7 days to fully recover after a concussion,
- Same-season repeat injuries typically take place 7 to 10 days after the first, which supports the idea that the brain may more vulnerable to injury during the first 7 days after injury.
Post-game-day RTP
All concussion management guidelines, old and new, agree that no athlete should be allowed to return to play while continuing to exhibit any post-concussion signs or symptoms and all call for at least one symptom-free week before RTP.
New concussion guidelines, such as the Zurich consensus statement, follow a step-wise RTP approach and take a more individualized approach utilizing progressive aerobic and resistance exercise challenge tests, consideration of so-called modifying factors (e.g. the severity of the current injury, the number, severity, and proximity in time of previous concussions, whether the concussion was a result of a minor blow, age, sport, and the athlete's learning disabilities, such as attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)).
Different guidelines for youth athletes
The Zurich consensus statement continues to emphasize the concept of "cognitive rest" first introduced as an additional concussion management requirement for children four years earlier. Because activities that require concentration and attention might exacerbate the symptoms and delay recovery, the statement recommends that child limit exertion with activities of daily living and limit school-related activities until symptom free (e.g. no homework, no text messaging, videogames and staying home from school).
The statement also recognized (a) that additional research was needed to better clarify the potential differences between adults and children with regard to recovery from concussion injury, and to develop cognitive assessment tools that better evaluate the young athlete, and (b) that it may be appropriate to extend the amount of time of asymptomatic rest and/or the length of the graded exertion in children and adolescents because of the "different physiological response during childhood to head trauma."
1. Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Br. J. Sports Med. 20090: 43:i76-i84.
This happens all the time
This happens all the time with politicians and none of them have to pay back what they stole, they don't have to recant their lies, and if they are convicted in criminal court, they get a slap on the wrist. RUDRAKSHA ASTROLOGY PRAYER BEADS