Gardner, A J; Kohler, R M N; Levi, C R; Iverson, G L
Usefulness of Video Review of Possible Concussions in National Youth Rugby League Journal Article
In: International Journal of Sports Medicine, vol. 38, no. 1, pp. 71–75, 2017.
Abstract | Links | BibTeX | Tags: Concussion, Injury management, Return to Play, Video analysis
@article{Gardner2017,
title = {Usefulness of Video Review of Possible Concussions in National Youth Rugby League},
author = {Gardner, A J and Kohler, R M N and Levi, C R and Iverson, G L},
doi = {10.1055/s-0042-116072},
year = {2017},
date = {2017-01-01},
journal = {International Journal of Sports Medicine},
volume = {38},
number = {1},
pages = {71--75},
abstract = {A new concussion interchange rule (CIR) was introduced in 2014 for the National Rugby League and National Youth Competition (NYC). The CIR allows a player suspected of having sustained a concussion to be removed from play and assessed without an interchange being tallied against the player's team. Participants included all NYC players who used the CIR during the 2014 season. 2 raters completed video analysis of 131 (of a total of 156 reported) uses of the CIR, describing injury characteristics, situational factors, and concussion signs. The incidence rate was 44.9 (95% CI: 38.5-52.3) uses of the CIR per 1 000 NYC player match hours, or approximately one CIR use every 1.3 games. Apparent loss of consciousness/unresponsiveness was observed in 13% of cases, clutching the head in 65%, unsteadiness of gait in 60%, and a vacant stare in 23%. Most incidences occurred from a hit-up (82%). There appeared to be some instances of video evidence of injury but the athlete was cleared to return to play in the same game. Video review appears to be a useful adjunct for identifying players suffering possible concussion. Further research is required on the usefulness of video review for identifying signs of concussive injury.},
keywords = {Concussion, Injury management, Return to Play, Video analysis},
pubstate = {published},
tppubtype = {article}
}
Knight, D; Dewitt, R; Moser, S
Mild traumatic brain injury in a gymnast Journal Article
In: Journal of the American Academy of Physician Assistants, vol. 29, no. 7, pp. 30–34, 2016.
Abstract | Links | BibTeX | Tags: Athletics, Cognitive rest, Concussion, mild traumatic brain injury, Pediatric, Return to Play
@article{Knight2016,
title = {Mild traumatic brain injury in a gymnast},
author = {Knight, D and Dewitt, R and Moser, S},
doi = {10.1097/01.JAA.0000483093.43523.0d},
year = {2016},
date = {2016-01-01},
journal = {Journal of the American Academy of Physician Assistants},
volume = {29},
number = {7},
pages = {30--34},
abstract = {Primary care providers often are responsible for the initial evaluation and management plan of young patients with mild traumatic brain injury (mild TBI, also called concussion), and need to be familiar with new protocols and how to incorporate them into a patient's treatment plan. This article describes a patient who suffered a mild TBI and returned to sports too early, and discusses the appropriate protocols for managing concussion in children. Copyright © 2016 American Academy of Physician Assistants.},
keywords = {Athletics, Cognitive rest, Concussion, mild traumatic brain injury, Pediatric, Return to Play},
pubstate = {published},
tppubtype = {article}
}
Brauge, D; Moulin, B; Lafargue, M; Nogué, E; Rivière, D; Pariente, J
Brain concusion in Midi-Pyrénées amateur rugby Journal Article
In: Science and Sports, vol. 31, no. 5, pp. 297–302, 2016.
Abstract | Links | BibTeX | Tags: brain concussion, mild traumatic brain injury, Return to Play
@article{Brauge2016,
title = {Brain concusion in Midi-Pyr\'{e}n\'{e}es amateur rugby},
author = {Brauge, D and Moulin, B and Lafargue, M and Nogu\'{e}, E and Rivi\`{e}re, D and Pariente, J},
doi = {10.1016/j.scispo.2016.04.009},
year = {2016},
date = {2016-01-01},
journal = {Science and Sports},
volume = {31},
number = {5},
pages = {297--302},
abstract = {Objective Concussion could provide disabling consequences if repetitive. We would like to assess the state of knowledge of this problem in Midi-Pyr\'{e}n\'{e}es amateur rugby. Material and methods Our evaluation was based on questionnaire about diagnosis and management of concussion. For each club, we included at least one player and one staff member (manager, medical team member or coach). Results One hundred and sixty-three subjects (37 players and 126 staff members) of 47 clubs were included. For all subjects, the loss of conscious was a symptom of concussion but only 61% could give 3 others symptoms. The risk of a second accident during days after concussion was known by 95%. About primary care, 50% did not look for cervical spine accident just after brain concussion and 22% thought that concussed athletes could finish the game. A majority of our study population (89%) would not leave alone an injured player after the trauma. This study shows some deficiencies in identification of concussion. The questions about primary care indicate some problems that can cause additional accident. © 2016},
keywords = {brain concussion, mild traumatic brain injury, Return to Play},
pubstate = {published},
tppubtype = {article}
}
Gay, M
Treatment Perspectives Based on Our Current Understanding of Concussion Journal Article
In: Sports Medicine & Arthroscopy Review, vol. 24, no. 3, pp. 134–141, 2016.
Abstract | Links | BibTeX | Tags: Concussion, mild traumatic brain injury, Return to Play, Treatment
@article{Gay2016,
title = {Treatment Perspectives Based on Our Current Understanding of Concussion},
author = {Gay, M},
doi = {10.1097/JSA.0000000000000124},
year = {2016},
date = {2016-01-01},
journal = {Sports Medicine \& Arthroscopy Review},
volume = {24},
number = {3},
pages = {134--141},
abstract = {Sports-related concussion also referred to in the literature as mild traumatic brain injury remains a popular area of study for physicians, neurologists, neuropsychologists, neuroimaging, athletic trainers, and researchers across the other areas of brain sciences. Treatment for concussion is an emerging area of focus with investigators seeking to improve outcomes and protect patients from the deleterious short-term and long-term consequences which have been extensively studied and identified. Broadly, current treatment strategies for athletes recovering from concussion have remained largely unchanged since early 2000s. Knowledge of the complex pathophysiology surrounding injury should improve or advance our ability to identify processes which may serve as targets for therapeutic intervention. Clinicians working with athletes recovering from sports-related concussion should have an advanced understanding of the injury cascade and also be aware of the current efforts within the research to treat concussion. In addition, how clinicians use the word "treatment" should be carefully defined and promoted so the patient is aware of the level of intervention and what stage of recovery or healing is being affected by a specific intervention. The purpose of this review is to bring together efforts across disciplines of brain science into 1 platform where clinicians can assimilate this information before making best practices decisions regarding the treatment of patients and athletes under their care. © 2016 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {Concussion, mild traumatic brain injury, Return to Play, Treatment},
pubstate = {published},
tppubtype = {article}
}
Dematteo, Carol; Volterman, Kimberly A; Breithaupt, Peter G; Claridge, Everett A; Adamich, John; Timmons, Brian W
Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion Journal Article
In: Medicine & Science in Sports & Exercise, vol. 47, no. 11, pp. 2283–2290, 2015, ISBN: 01959131.
Abstract | BibTeX | Tags: *BRAIN -- Concussion, *BRAIN -- Wounds & injuries, *EXERCISE, *EXERCISE tests, *POSTCONCUSSION syndrome, *SPORTS participation, ADOLESCENCE, adolescents, brain concussion, children, DATA analysis, DATA analysis -- Software, DECISION making in clinical medicine, DESCRIPTIVE statistics, head injury, MULTIPLE regression analysis, ONE-way analysis of variance, postconcussion syndrome, RESEARCH -- Finance, Return to Play, SAMPLING (Statistics), STATISTICS
@article{Dematteo2015b,
title = {Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion},
author = {Dematteo, Carol and Volterman, Kimberly A and Breithaupt, Peter G and Claridge, Everett A and Adamich, John and Timmons, Brian W},
isbn = {01959131},
year = {2015},
date = {2015-01-01},
journal = {Medicine \& Science in Sports \& Exercise},
volume = {47},
number = {11},
pages = {2283--2290},
abstract = {Purpose: The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA. Methods: Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion. Results: Participants had a mean T SD symptom duration of 6.3 T 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion. Conclusions: Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth. ABSTRACT FROM AUTHOR},
keywords = {*BRAIN -- Concussion, *BRAIN -- Wounds \& injuries, *EXERCISE, *EXERCISE tests, *POSTCONCUSSION syndrome, *SPORTS participation, ADOLESCENCE, adolescents, brain concussion, children, DATA analysis, DATA analysis -- Software, DECISION making in clinical medicine, DESCRIPTIVE statistics, head injury, MULTIPLE regression analysis, ONE-way analysis of variance, postconcussion syndrome, RESEARCH -- Finance, Return to Play, SAMPLING (Statistics), STATISTICS},
pubstate = {published},
tppubtype = {article}
}
De Matteo, C; Volterman, K A; Breithaupt, P G; Claridge, E A; Adamich, J; Timmons, B W
Exertion testing in youth with mild traumatic brain injury/concussion Journal Article
In: Medicine & Science in Sports & Exercise, vol. 47, no. 11, pp. 2283–2290, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adolescents, brain concussion, Child, children, Cross-Sectional Studies, cross-sectional study, exercise, exercise test, exercise tolerance, Female, head injury, human, Humans, Male, Pathophysiology, Physical Exertion, Post-Concussion Syndrome, postconcussion syndrome, Return to Play, return to sport, time factor, Time Factors
@article{DeMatteo2015,
title = {Exertion testing in youth with mild traumatic brain injury/concussion},
author = {{De Matteo}, C and Volterman, K A and Breithaupt, P G and Claridge, E A and Adamich, J and Timmons, B W},
doi = {10.1249/MSS.0000000000000682},
year = {2015},
date = {2015-01-01},
journal = {Medicine \& Science in Sports \& Exercise},
volume = {47},
number = {11},
pages = {2283--2290},
abstract = {Purpose The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA. Methods Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion. Results Participants had a mean ± SD symptom duration of 6.3 ± 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion. Conclusions Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth. © 2015 by the American College of Sports Medicine.},
keywords = {Adolescent, adolescents, brain concussion, Child, children, Cross-Sectional Studies, cross-sectional study, exercise, exercise test, exercise tolerance, Female, head injury, human, Humans, Male, Pathophysiology, Physical Exertion, Post-Concussion Syndrome, postconcussion syndrome, Return to Play, return to sport, time factor, Time Factors},
pubstate = {published},
tppubtype = {article}
}
Echemendia, R J; Giza, C C; Kutcher, J S
Developing guidelines for return to play: consensus and evidence-based approaches Journal Article
In: Brain Injury, vol. 29, pp. 185–194, 2015.
Abstract | BibTeX | Tags: Return to Play
@article{Echemendia2015,
title = {Developing guidelines for return to play: consensus and evidence-based approaches},
author = {Echemendia, R J and Giza, C C and Kutcher, J S},
year = {2015},
date = {2015-01-01},
journal = {Brain Injury},
volume = {29},
pages = {185--194},
address = {Echemendia,Ruben J. Psychological and Neurobehavioral Associates, Inc., State College, PA , USA .},
abstract = {BACKGROUND: Sports-related concussions are commonplace at all levels of play and across all age groups. The dynamic, evolving nature of this injury coupled with a lack of objective biomarkers creates a challenging management issue for the sports medicine team. Athletes who return to play following a concussion are known to be at higher risk for an additional brain injury, which necessitates a careful, informed return to play (RTP) process. AIM: The goal of this paper is to outline historical attempts at developing RTP guidelines and trace their evolution over time, culminating in a discussion of the process and outcomes of the most recent consensus statements/guidelines published by the international Concussion In Sport Group (CISG), the American Academy of Neurology (AAN), the National Athletic Trainers' Association, and the 2013 Team Physician Consensus Statement Update. METHOD: An evaluation of the pros and cons of these guidelines is presented along with suggestions for future directions. In addition, the Institute of Medicine recently conducted a comprehensive report outlining the current state of evidence regarding youth concussions, which provides specific recommendations for future research. CONCLUSIONS: The different methodologies utilized in the development of consensus statements have distinct advantages and disadvantages, and both approaches add value to the everyday management of sports concussions. Importantly, the overall approach for management of sports concussion is remarkably similar using either consensus-based or formal evidence-based methods, which adds confidence to the current guidelines and allows practitioners to focus on accepted standards of clinical care. Moving forward, careful study designs need to be utilized to avoid bias in selection of research subjects, collection of data, and interpretation of results. Although useful, clinicians must venture beyond consensus statements to examine reviews of the literature that are published in much greater frequency than consensus statements.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Baker, J G; Rieger, B P; McAvoy, K; Leddy, J J; Master, C L; Lana, S J; Willer, B S
Principles for return to learn after concussion Journal Article
In: International Journal of Clinical Practice, vol. 68, pp. 1286–1288, 2014.
BibTeX | Tags: Return to Play
@article{Baker2014b,
title = {Principles for return to learn after concussion},
author = {Baker, J G and Rieger, B P and McAvoy, K and Leddy, J J and Master, C L and Lana, S J and Willer, B S},
year = {2014},
date = {2014-01-01},
journal = {International Journal of Clinical Practice},
volume = {68},
pages = {1286--1288},
address = {Baker,J G. School of Social Work, Nuclear Medicine, Orthopaedics and Sports Medicine, University at Buffalo, Buffalo, NY, USA.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Baker, C S; Cinelli, M E
Visuomotor deficits during locomotion in previously concussed athletes 30 or more days following return to play Journal Article
In: Physiological Reports, vol. 2, pp. 1, 2014.
Abstract | BibTeX | Tags: Return to Play
@article{Baker2014c,
title = {Visuomotor deficits during locomotion in previously concussed athletes 30 or more days following return to play},
author = {Baker, C S and Cinelli, M E},
year = {2014},
date = {2014-01-01},
journal = {Physiological Reports},
volume = {2},
pages = {1},
address = {Baker,Carmen S. Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada. Cinelli,Michael E. Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada.},
abstract = {Current protocols for returning athletes to play (RTP) center around resolution of physical symptoms of concussion. However, recent research has identified that balance and cognitive deficits persist beyond physical symptom recovery. Protocols that involve testing dynamic balance and visuomotor integration have been recommended as potential tools for better understanding of length of impairment following concussion. A dynamic, visuomotor paradigm was undertaken in the current study to assess decision making in athletes who had sustained a concussion \>30 days before study participation and had been cleared to RTP (N = 10). Two obstacles created a gap that varied between 0.6 and 1.8x participants' individual shoulder width in open space. Participants made decisions to navigate through or deviate around the gap created by the two obstacles. The results revealed that previously concussed athletes were highly variable in their decision making and demonstrated variable Medial-Lateral (ML) center of mass (COM) control when approaching the obstacles, when compared with nonconcussed, age-matched controls. As such, they showed poor visuomotor control and decision making, as well as poor dynamic stability compared to controls. Visuomotor deficits were persistent in the sample of previously concussed individuals, well beyond deficits identified by current RTP standards. This study suggests that dynamic, visuomotor integration tasks may be of benefit to increase rigor in RTP protocols and increase safety of athletes returning to sport.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Chermann, J F; Klouche, S; Savigny, A; Lefevre, N; Herman, S; Bohu, Y
Return to rugby after brain concussion: a prospective study in 35 high level rugby players Journal Article
In: Asian Journal of Sports Medicine, vol. 5, pp. e24042, 2014.
Abstract | BibTeX | Tags: Return to Play
@article{Chermann2014,
title = {Return to rugby after brain concussion: a prospective study in 35 high level rugby players},
author = {Chermann, J F and Klouche, S and Savigny, A and Lefevre, N and Herman, S and Bohu, Y},
year = {2014},
date = {2014-01-01},
journal = {Asian Journal of Sports Medicine},
volume = {5},
pages = {e24042},
address = {Chermann,Jean Francois. Department of Neurology, Leopold Bellan Hospital, Paris, France. Klouche,Shahnaz. Department of Orthopedic Surgery, Musculoskeletal Institute of Nollet, Paris, France ; Department of Orthopedic Surgery, Paris Sports Clinic, Paris,},
abstract = {BACKGROUND: Although guidelines based on expert opinions have been developed for the immediate management and return to play of athletes after a concussion, data are lacking on this issue. OBJECTIVES: Evaluate a standardized management of brain concussion among rugby players to prevent the recurrence. PATIENTS AND METHODS: A prospective study was performed from September 2009 to June 2012. All rugby players who had a concussion when playing rugby were included. Patients were managed by a specialized hospital team with a specific protocol developed in collaboration with the medical staff of the rugby clubs included in the study. The series included 35 rugby players, with 23 professionals and 12 high-level players, 30 men and 5 women, mean age 23.1 +/- 5.5 years old. The median number of previous concussions was 2 (0-30) episodes. According to the Cantu concussion severity classification, 3 athletes were grade 1, 12 were grade 2 and 20 were grade 3. None of the injured athletes was lost to follow-up. The primary endpoint was the occurrence of a new concussion within 3 months after the first in patients who returned to rugby. RESULTS: Thirty-three patients returned to rugby after a mean 22.1 +/- 10 days. The recurrence rate within 3 months was 2/33 (6.1%). The median delay before returning to rugby was 21 (7-45) days. Factors associated with a delayed return to play were young age, initial loss of consciousness, severity Cantu grade 3 and post-concussive syndrome of more than 5 days. Analysis of two failures showed that the initial injury was grade 3 and that both were professional athletes and had a history of concussion. CONCLUSIONS: This prospective study validated the study protocol for the management of concussion in rugby players.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Lear, A M; Hoang, M H
Sports concussion: A return-to-play guide Journal Article
In: Journal of Family Practice, vol. 61, pp. 323–328, 2012.
BibTeX | Tags: Return to Play
@article{Lear2012,
title = {Sports concussion: A return-to-play guide},
author = {Lear, A M and Hoang, M H},
year = {2012},
date = {2012-01-01},
journal = {Journal of Family Practice},
volume = {61},
pages = {323--328},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Doolan, Amy W; Day, Daniel D; Maerlender, Arthur C; Goforth, Michael; Gunnar Brolinson, P
A review of return to play issues and sports-related concussion Journal Article
In: Annals of Biomedical Engineering, vol. 40, pp. 106–113, 2012.
Abstract | BibTeX | Tags: Return to Play
@article{Doolan2012,
title = {A review of return to play issues and sports-related concussion},
author = {Doolan, Amy W and Day, Daniel D and Maerlender, Arthur C and Goforth, Michael and {Gunnar Brolinson}, P},
year = {2012},
date = {2012-01-01},
journal = {Annals of Biomedical Engineering},
volume = {40},
pages = {106--113},
address = {Department of Family Medicine, Sports Medicine, Osteopathic Manipulative Medicine, Edward Via College of Osteopathic Medicine, Virginia Campus, 309 N. Knollwood Dr., Blacksburg, VA 24060, USA.},
abstract = {Mild traumatic brain injury in sports has become a significant public health concern which has not only received the general public's attention through multiple news media stories involving athletic concussions, but has also resulted in local, state, and national legislative efforts to improve recognition and management. The purpose of this article is to review the current literature for return to play (RTP) guidelines. State, regional, national, and professional legislation on sport-related concussion RTP management issues will be reviewed. This article will be helpful in developing a generalized systematic approach to concussion management and highlight specific RTP guidelines. The article will also touch upon specific contraindications to RTP, the role of neuropsychological testing in RTP, and other considerations and complications that affect an athlete's ability to return to competition. Finally, considerations for terminating an athlete's competitive season or ending a career after sustaining a concussion resulting in prolonged and protracted symptomatology or repeated concussions will be reviewed. PubMed and Google were searched using the key terms mentioned below. In addition, the author's library of concussion-related articles was reviewed for the relevant literature.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Mayers, Lester
Return-to-Play Interval after Sport-related Concussion: Background Review and Current Issues Journal Article
In: Current Sports Medicine Reports, vol. 11, pp. 277–279, 2012.
BibTeX | Tags: Return to Play
@article{Mayers2012b,
title = {Return-to-Play Interval after Sport-related Concussion: Background Review and Current Issues},
author = {Mayers, Lester},
year = {2012},
date = {2012-01-01},
journal = {Current Sports Medicine Reports},
volume = {11},
pages = {277--279},
address = {Goldstein Fitness Center, Pace University, 861 Bedford Rd., Pleasantville, NY.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
McCrory, Paul
Sports concussion and the risk of chronic neurological impairment Journal Article
In: Clinical Journal of Sport Medicine, vol. 21, pp. 6–12, 2011.
Abstract | BibTeX | Tags: Return to Play
@article{McCrory2011a,
title = {Sports concussion and the risk of chronic neurological impairment},
author = {McCrory, Paul},
year = {2011},
date = {2011-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {21},
pages = {6--12},
address = {From the Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Melbourne, Victoria, Australia.},
abstract = {Intense recent media focus on long-term outcomes from sports concussion has highlighted concerns on both cognitive deterioration and mental health issues, such as depression and suicide. At this time, the scientific evidence to support these views is limited, with only a handful of cases thus far reported. Based on the literature on this topic that extends back over 50 years, it is clear that only a small percentage of athletes suffer such sequelae presumably due to recurrent concussive or subconcussive head impacts. At this stage, determining which athletes are at future risk is not possible; however, following existing concussion guidelines (eg, Zurich guidelines) is likely to be the safest option based on current evidence.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Matheson, Gordon O; Shultz, Rebecca; Bido, Jennifer; Mitten, Matthew J; Meeuwisse, Willem H; Shrier, Ian
Return-to-play decisions: are they the team physician's responsibility? Journal Article
In: Clinical Journal of Sport Medicine, vol. 21, pp. 25–30, 2011.
Abstract | BibTeX | Tags: Return to Play
@article{Matheson2011,
title = {Return-to-play decisions: are they the team physician's responsibility?},
author = {Matheson, Gordon O and Shultz, Rebecca and Bido, Jennifer and Mitten, Matthew J and Meeuwisse, Willem H and Shrier, Ian},
year = {2011},
date = {2011-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {21},
pages = {25--30},
address = {Division of Sports Medicine, Department of Orthopaedic Surgery, Stanford University School of Medicine, 341 Galvez St., Stanford, CA 94305, USA. gord@stanford.edu},
abstract = {OBJECTIVE: Return-to-play (RTP) decisions are a central component of the Team Physician's clinical work, yet there is little more than anecdotal reference to these in the literature. We recently published a 3-step model for return-to-play medical decision making and, in the current paper, undertook a systematic review of the literature to determine the level of evidence in support of this model. DATA SOURCES: PubMed, Web of Science, and CINAHL electronic databases. Any article specifically related to concussion, head injuries, neck injuries, illness, medical conditions (including cardiovascular and renal), and preparticipation in sport or that reported RTP as a clinical outcome was excluded. Any article that contained a discussion on one of the components of the 3-step decision-based RTP model was included. RESULTS: We reviewed 148 articles that met the criteria for inclusion and found 98 review articles, 39 original articles, 6 case reports, and 5 editorials. Of these, 141 articles mentioned Step 1 of the medical decision-making process for RTP (Medical Factors), 26 mentioned Step 2 (Sport Risk Modifiers), and 20 mentioned Step 3 (Decision Modifiers). Of the 148 articles in total, only 13 focused on RTP as the main subject and the remaining 135 mentioned RTP anecdotally. Of these 13 articles, 5 were reviews, 4 were editorials, and 4 were original research. CONCLUSIONS: Although 148 articles we retrieved mention RTP in relation to a specific injury, medical condition, or specific topic, only 13 articles focused specifically on the RTP decision-making process, and 6 of 13 were restricted to Step 1 of the 3-step model (Medical Factors). Return-to-play is a fertile field for research and thought leadership beginning with a focus on the Team Physician's appropriate role in RTP decision making, particularly considering the factors identified in Step 3 (Decision Modification).},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Theriault, Martin; De Beaumont, Louis; Tremblay, Sebastien; Lassonde, Maryse; Jolicoeur, Pierre
Cumulative effects of concussions in athletes revealed by electrophysiological abnormalities on visual working memory Journal Article
In: Journal of Clinical & Experimental Neuropsychology, vol. 33, pp. 30–41, 2011.
Abstract | BibTeX | Tags: Return to Play
@article{Theriault2011,
title = {Cumulative effects of concussions in athletes revealed by electrophysiological abnormalities on visual working memory},
author = {Theriault, Martin and {De Beaumont}, Louis and Tremblay, Sebastien and Lassonde, Maryse and Jolicoeur, Pierre},
year = {2011},
date = {2011-01-01},
journal = {Journal of Clinical \& Experimental Neuropsychology},
volume = {33},
pages = {30--41},
address = {Centre de Recherche en Neuropsychologie et Cognition, Universite de Montreal, Montreal, Quebec, Canada.},
abstract = {Event-related potentials (ERPs) have been useful to detect subtle, pervasive alterations of cognition-related waveforms in athletes with multiple concussions. This study used the sustained posterior contralateral negativity (SPCN) waveform component recorded while participants performed a visual short-term memory task to investigate how working memory (WM) storage capacity was affected among athletes who differed according to their history of sports concussions. Fifty-five university-level football players were assigned to three groups: 1-2 concussion athletes; 3+ concussion athletes; non-concussed athletes. The main finding of the present study was that athletes with a history of three concussions or more exhibited significantly attenuated SPCN amplitude relative to both concussed athletes with only one or two prior concussions and athletes without concussions. The latter finding adds to previous evidence of disproportionately worse outcome in athletes presenting with a history of three or more concussions relative to those with fewer concussions. In addition, SPCN amplitude was found to correlate significantly with a visual memory capacity estimate (K), but this K value did not significantly differ across groups. This suggests that attenuated SPCN amplitude after three or more concussions did not interfere with apparent WM function. Taken together, these findings suggest that the altered neurophysiological index of WM storage might be a more sensitive measure of a latent WM function abnormality which may well worsen with aging, or perhaps additional brain insults.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Clover, Jim; Wall, Jerome
Return-to-play criteria following sports injury Journal Article
In: Clinics in Sports Medicine, vol. 29, pp. 169–175, 2010.
Abstract | BibTeX | Tags: Return to Play
@article{Clover2010,
title = {Return-to-play criteria following sports injury},
author = {Clover, Jim and Wall, Jerome},
year = {2010},
date = {2010-01-01},
journal = {Clinics in Sports Medicine},
volume = {29},
pages = {169--175},
address = {The SPORT Clinic, Riverside, CA 92501, USA. jclover@comgri.com},
abstract = {Determining the criteria for an injured athlete's return to competition can be a confusing scenario when all the individuals involved are brought in. These may include the athlete, parents, guardians, coaches, family physician, the athletic trainer, and others. Providing a foundation from which all can understand the reasoning is key. It must be understood that the primary responsibility is to cause no harm to the athlete, while enabling him or her to participate at the highest level possible. This article discusses the importance of establishing guidelines, athletes' behavioral responses to RTP decisions, testing procedures, and the level of sport and intangible factors related to RTP criteria.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Putukian, M; Aubry, M; McCrory, P
Return to play after sports concussion in elite and non-elite athletes? Journal Article
In: British Journal of Sports Medicine, vol. 43 Suppl 1, pp. i28–31, 2009.
Abstract | BibTeX | Tags: Return to Play
@article{Putukian2009,
title = {Return to play after sports concussion in elite and non-elite athletes?},
author = {Putukian, M and Aubry, M and McCrory, P},
year = {2009},
date = {2009-01-01},
journal = {British Journal of Sports Medicine},
volume = {43 Suppl 1},
pages = {i28--31},
address = {Princeton University, University Health Services, Washington Road, Princeton, NJ 08540, USA. putukian@princeton.edu},
abstract = {OBJECTIVE: To examine the published literature relating to the difference in concussion management strategies between elite and non-elite athletes. DESIGN: Systematic literature review of concussion management. INTERVENTION: Pubmed, Medline, Psych Info, Cochrane Library and Sport Discus databases were reviewed using the MeSH keywords brain concussion and mild traumatic brain injury, combined with athletic injuries. Each were then refined by adding the keyword "return to play" (RTP). English language and human studies only were assessed. RESULTS: For the Medline search, using "brain concussion" as a keyword, 4319 articles were found; this was decreased to 111 when RTP was used to refine the search. When "mild traumatic brain injury" was used, 2509 articles were found; this decreased to 39 when RTP was used to refine the search. Following initial review, these articles form the basis of the discussion below. CONCLUSIONS: The non-elite athlete may not have the same resources available as the elite athlete (such as the presence of trained medical staff during practice and competition, a concussion programme as part of sideline preparedness, the benefit of neuropsychological or postural testing, as well as consultants with expertise in concussion readily available) and as a result will generally be managed more conservatively. Younger athletes often have a greater incidence of concussion with longer recovery time frames; however, they are often managed with less expertise and with limited resources.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Bey, Tareg; Ostick, Brian
Second impact syndrome Journal Article
In: Western Journal of Emergency Medicine, vol. 10, pp. 6–10, 2009.
Abstract | BibTeX | Tags: Return to Play
@article{Bey2009,
title = {Second impact syndrome},
author = {Bey, Tareg and Ostick, Brian},
year = {2009},
date = {2009-01-01},
journal = {Western Journal of Emergency Medicine},
volume = {10},
pages = {6--10},
address = {University of California, Irvine School of Medicine.},
abstract = {A controversial term first described by Saunders and Harbaugh1 in 1984, Second Impact Syndrome (SIS) consists of two events. Typically, it involves an athlete suffering post-concussive symptoms following a head injury.2 If, within several weeks, the athlete returns to play and sustains a second head injury, diffuse cerebral swelling, brain herniation, and death can occur. SIS can occur with any two events involving head trauma. While rare, it is devastating in that young, healthy patients may die within a few minutes. Emergency physicians should be aware of this syndrome and counsel patients and their parents concerning when to allow an athlete to return to play. Furthermore, we present guidelines for appropriate follow up and evaluation by a specialist when necessary.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Miller, Mark D; Arciero, Robert A; Cooper, Daniel E; Johnson, Darren L; Best, Thomas M
Doc, when can he go back in the game? Journal Article
In: Instructional Course Lectures, vol. 58, pp. 437–443, 2009.
Abstract | BibTeX | Tags: Return to Play
@article{Miller2009,
title = {Doc, when can he go back in the game?},
author = {Miller, Mark D and Arciero, Robert A and Cooper, Daniel E and Johnson, Darren L and Best, Thomas M},
year = {2009},
date = {2009-01-01},
journal = {Instructional Course Lectures},
volume = {58},
pages = {437--443},
address = {Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.},
abstract = {In the injured athlete, several criteria must be considered before return to play. There are separate considerations for knee injuries, shoulder injuries, and general upper and lower extremity injuries, as well as concussion, hypertrophic cardiomyopathy, mononucleosis, and spondylolysis. It is important that surgical indications, postoperative rehabilitation, and risk for reinjury are reviewed by the surgeon before the athlete is allowed to resume activity.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Ashare, Alan B
Returning to play after concussion Journal Article
In: Acta Paediatrica, vol. 98, pp. 774–776, 2009.
BibTeX | Tags: Return to Play
@article{Ashare2009,
title = {Returning to play after concussion},
author = {Ashare, Alan B},
year = {2009},
date = {2009-01-01},
journal = {Acta Paediatrica},
volume = {98},
pages = {774--776},
address = {Department of Radiology, St. Elizabeth's Medical Center, Boston, MA 02135, USA. Alan_Ashare_MD@caritaschristi.org},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Purcell, L
What are the most appropriate return-to-play guidelines for concussed child athletes? Journal Article
In: British Journal of Sports Medicine, vol. 43 Suppl 1, pp. i51–5, 2009.
Abstract | BibTeX | Tags: Return to Play
@article{Purcell2009,
title = {What are the most appropriate return-to-play guidelines for concussed child athletes?},
author = {Purcell, L},
year = {2009},
date = {2009-01-01},
journal = {British Journal of Sports Medicine},
volume = {43 Suppl 1},
pages = {i51--5},
address = {Children's Emergency Department, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, Canada. lpurcell1015@rogers.com},
abstract = {OBJECTIVE: To examine concussion literature for specific guidelines regarding return to play (RTP) following sport-related concussion in child athletes. To make recommendations regarding the most appropriate RTP guidelines for child athletes following sport-related concussion. DESIGN: A literature review of concussion literature. INTERVENTION: A literature search was conducted using Medline and Embase databases from 1998 to 2008. More than 60 articles and two websites were reviewed. RESULTS: There is a paucity of research on sport-related concussion in child athletes, particularly younger children (age 5-12 years). In particular, there is no research on RTP guidelines for child athletes following sport-related concussion. Child athletes take longer to recover from concussions than adults. Concussion symptoms may resolve before cognitive function has completely recovered. Concussion assessment and management in children can be confounded by their growth and development, as well as the lack of trained medical personnel involved with youth sports. There are no child-specific assessment tools for concussion. CONCLUSIONS: RTP decisions in children should be made cautiously and should be individualised. No concussed child athlete should be allowed to RTP the same day. Physical and cognitive rest is very important to allow for the resolution of concussion symptoms. Child athletes should remain symptom free for several days before starting a medically supervised stepwise exertion protocol. Further research is needed to elucidate the effects of concussion in children and to determine the most appropriate RTP guidelines. Child-specific concussion assessment tools need to be developed to improve concussion assessment and management in children.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
McCrea, Michael; Guskiewicz, Kevin; Randolph, Christopher; Barr, William B; Hammeke, Thomas A; Marshall, Stephen W; Kelly, James P
Effects of a symptom-free waiting period on clinical outcome and risk of reinjury after sport-related concussion Journal Article
In: Neurosurgery, vol. 65, pp. 873–876, 2009.
Abstract | BibTeX | Tags: Return to Play
@article{McCrea2009a,
title = {Effects of a symptom-free waiting period on clinical outcome and risk of reinjury after sport-related concussion},
author = {McCrea, Michael and Guskiewicz, Kevin and Randolph, Christopher and Barr, William B and Hammeke, Thomas A and Marshall, Stephen W and Kelly, James P},
year = {2009},
date = {2009-01-01},
journal = {Neurosurgery},
volume = {65},
pages = {873--876},
address = {Neuroscience Center, Waukesha Memorial Hospital, Waukesha, Wisconsin 53188, USA. michael.mccrea@phci.org},
abstract = {OBJECTIVE: This study is the first to investigate the influence of a symptom-free waiting period (SFWP) on clinical outcome and risk of repeat injury after sport-related concussion. METHODS: This was a prospective, nonrandomized study of 16 624 player seasons from 1999 to 2004, including a cohort of 635 concussed high school and college athletes grouped on the basis of an SFWP or no SFWP observed after their concussion. Clinical outcome in symptoms, cognitive functioning, and postural stability 45 and 90 days postinjury was compared with preinjury baseline. Data on SFWP and same-season repeat concussion were recorded. RESULTS: An SFWP was observed in 60.3% of cases. There were no significant differences between the SFWP and no SFWP groups in acute injury characteristics or clinical outcome with respect to symptom recovery or postinjury performance on formal neuropsychological and balance testing. Most repeat concussions (79.2%) occurred within 10 days of the initial injury. The rate of repeat concussion was actually higher in the SFWP group (6.49%) than the no SFWP group (0.90%) (P \< 0.005), but the repeat concussion subgroup's SFWP was 2.82 days shorter (95% confidence interval, 0.61-5.03; P \< 0.01) and these athletes resumed participation 3.55 days sooner (95% confidence interval, 0.06-7.04; P \< 0.05) than those in the SFWP group in which there was no repeat concussion. CONCLUSION: Our findings suggest that an SFWP did not intrinsically influence clinical recovery or reduce risk of a repeat concussion. The overall risk of same-season repeat concussion seems to be relatively low, but there may be a period of vulnerability that increases risk of repeat concussion during the first 7 to 10 days postinjury. Further study is required to investigate this preliminary finding and help determine whether this risk can be reduced further with specific injury-management strategies.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Mayers, Lester
Return-to-play criteria after athletic concussion: a need for revision Journal Article
In: Archives of Neurology, vol. 65, pp. 1158–1161, 2008.
Abstract | BibTeX | Tags: Return to Play
@article{Mayers2008,
title = {Return-to-play criteria after athletic concussion: a need for revision},
author = {Mayers, Lester},
year = {2008},
date = {2008-01-01},
journal = {Archives of Neurology},
volume = {65},
pages = {1158--1161},
address = {Athletics Department, Goldstein Fitness Center, Pace University, 861 Bedford Rd, Pleasantville, NY 10570, USA. lmayers@pace.edu},
abstract = {Management of a sport-related concussion, especially involving return-to-play decisions, is one of the most important challenges confronting sports medicine professionals. Current guidelines result from thoughtful consensus recommendations by expert committees but are chiefly based on the resolution of symptoms and the results of neuropsychological testing, if available. Adherence to this paradigm results in most injured athletes resuming competition in 1 to 2 weeks. [References: 28]},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Putukian, Margot
Repeat mild traumatic brain injury: how to adjust return to play guidelines Journal Article
In: Current Sports Medicine Reports, vol. 5, pp. 15–22, 2006.
Abstract | BibTeX | Tags: Return to Play
@article{Putukian2006,
title = {Repeat mild traumatic brain injury: how to adjust return to play guidelines},
author = {Putukian, Margot},
year = {2006},
date = {2006-01-01},
journal = {Current Sports Medicine Reports},
volume = {5},
pages = {15--22},
address = {Robert-Wood Johnson University of Medicine \& Dentistry of New Jersey, McCosh Health Center, Princeton, NJ 08540, USA. putukian@princeton.edu},
abstract = {Determining when it is safe for an athlete to return to play (RTP) after concussion is one of the most difficult decisions facing the team physician. There is significant variability in the evaluation and management of mild traumatic brain injury (mTBI). In the past decade, a tremendous amount of sport-specific research has improved our understanding of mTBI. The advent of neuro-psychologic (NP) testing batteries designed to assess concussive injury has improved the assessment of cognitive dysfunction that occurs in the absence of structural brain abnormalities. The severity of injury is determined by the nature, burden, and duration of symptoms. Athletes must be asymptomatic and have a normal neurologic and cognitive evaluation prior to RTP. Several factors aid in making the RTP decision, including age, the severity of injury, and history of prior mTBIs. Given the potential complications of mTBI, the RTP decision must be made using a thoughtful, individualized process. [References: 66]},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Kissick, James; Johnston, Karen M
Return to play after concussion: principles and practice Journal Article
In: Clinical Journal of Sport Medicine, vol. 15, pp. 426–431, 2005.
Abstract | BibTeX | Tags: Return to Play
@article{Kissick2005,
title = {Return to play after concussion: principles and practice},
author = {Kissick, James and Johnston, Karen M},
year = {2005},
date = {2005-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {15},
pages = {426--431},
address = {Ottawa Sport Medicine Centre, 39 Goulding Cr., Ottawa, Ontario, Canada K2K 2N9. jkissick@sympatico.ca},
abstract = {OBJECTIVE: The sport medicine team is increasingly being asked to manage concussed athletes and to provide written clearance for return to play postconcussion, making it critical to have a good understanding of concussion recognition, assessment, and management. DATA SOURCES/SYNTHESIS: A handy way to think of concussion management is the four Rs: recognition, response, rehabilitation, and return. RESULTS: Athletes, coaches, parents, therapists, and physicians need a thorough understanding of concussion signs and symptoms. An athlete suspected of having sustained a concussion should be removed from the game or practice and assessed by a member of the sideline medical team. All athletes who sustain a concussion should be evaluated by a medical doctor. Rehabilitation has similarities to but also differs from the traditional orthopedic model in that the first step is rest, both physical and cognitive. Once asymptomatic at rest, a step-wise return to activity is undertaken. CONCLUSIONS: This protocol has been adapted for various sports. It may be used for children, although it is prudent to be more conservative and to progress more slowly than in an older age group. [References: 38]},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Brukner, Peter
Return to play--a personal perspective Journal Article
In: Clinical Journal of Sport Medicine, vol. 15, pp. 459–460, 2005.
BibTeX | Tags: Return to Play
@article{Brukner2005,
title = {Return to play--a personal perspective},
author = {Brukner, Peter},
year = {2005},
date = {2005-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {15},
pages = {459--460},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Best, Thomas M; Brolinson, P Gunnar
Return to play: the sideline dilemma Journal Article
In: Clinical Journal of Sport Medicine, vol. 15, pp. 403–404, 2005.
BibTeX | Tags: Return to Play
@article{Best2005,
title = {Return to play: the sideline dilemma},
author = {Best, Thomas M and Brolinson, P Gunnar},
year = {2005},
date = {2005-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {15},
pages = {403--404},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Lovell, Mark; Collins, Micky; Bradley, James
Return to play following sports-related concussion Journal Article
In: Clinics in Sports Medicine, vol. 23, pp. 421–441, 2004.
Abstract | BibTeX | Tags: Return to Play
@article{Lovell2004a,
title = {Return to play following sports-related concussion},
author = {Lovell, Mark and Collins, Micky and Bradley, James},
year = {2004},
date = {2004-01-01},
journal = {Clinics in Sports Medicine},
volume = {23},
pages = {421--441},
address = {Sports Medicine Concussion Program, Department of Orthopaedic Sugery, University of Pittsburgh Medical Center, 200 Delafield Road, Suite 410, Pittsburgh, PA 15215, USA.},
abstract = {This article provides a review of current important issues in the management of athletes who have sustained a concussion during athletic competition. Recent research in the area of concussion management is reviewed with specific reference to the side line evaluation of concussion and the follow-up of the athlete during the recovery period. The use of neuropsychological testing in sports is also reviewed. A systematic protocol for the management of sports related concussion is presented. [References: 36]},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Brooks, Michael
Coach, I'm OK, can I go in? Journal Article
In: Principal Leadership: Middle Level Edition, vol. 5, no. 1, pp. 63–64, 2004, ISBN: 15298957.
Abstract | BibTeX | Tags: Actions & defenses (Law), brain, Concussion, Education, FOOTBALL coaches, FOOTBALL injuries, FOOTBALL players, Legal & Policy Issues, Nebraska, Public Schools, Return to Play
@article{Brooks2004,
title = {Coach, I'm OK, can I go in?},
author = {Brooks, Michael},
isbn = {15298957},
year = {2004},
date = {2004-01-01},
journal = {Principal Leadership: Middle Level Edition},
volume = {5},
number = {1},
pages = {63--64},
abstract = {Cites the legal case "Cerny v. Cedar Bluffs Junior/Senior Public School," about a student who sued a Nebraska public school alleging that the head coach of the school's football team has failed to examine the student following the initial concussion after the student hit his head on the ground. Familiarity of the head coach about the symptoms of concussions; Measurement of the coach's conduct against a reasonably prudent person holding a Nebraska teaching certificate.},
keywords = {Actions \& defenses (Law), brain, Concussion, Education, FOOTBALL coaches, FOOTBALL injuries, FOOTBALL players, Legal \& Policy Issues, Nebraska, Public Schools, Return to Play},
pubstate = {published},
tppubtype = {article}
}
McFarland, Edward G
Return to play Journal Article
In: Clinics in Sports Medicine, vol. 23, pp. xv–xxiii, 2004.
BibTeX | Tags: Return to Play
@article{McFarland2004,
title = {Return to play},
author = {McFarland, Edward G},
year = {2004},
date = {2004-01-01},
journal = {Clinics in Sports Medicine},
volume = {23},
pages = {xv--xxiii},
address = {Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, 10753 Falls Road, Suite 215, Lutherville, MD 21093, USA.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Asplund, Chad A; McKeag, Douglas B; Olsen, Cara H
Sport-related concussion: factors associated with prolonged return to play Journal Article
In: Clinical Journal of Sport Medicine, vol. 14, pp. 339–343, 2004.
Abstract | BibTeX | Tags: Return to Play
@article{Asplund2004,
title = {Sport-related concussion: factors associated with prolonged return to play},
author = {Asplund, Chad A and McKeag, Douglas B and Olsen, Cara H},
year = {2004},
date = {2004-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {14},
pages = {339--343},
address = {Department of Family Practice, DeWitt Army Community Hospital, Fort Belvoir, VA 22060, USA. chad.asplund@us.army.mil},
abstract = {OBJECTIVE: To assess predictive value of concussion signs and symptoms based on return-to-play timelines. DESIGN: Physician practice study without diagnosis that includes presentation, initial and subsequent treatment, and management of concussion. SETTING: National multisite primary care sports medicine provider locations. PARTICIPANTS: Twenty-two providers at 18 sites; 101 athletes (91 men, 10 women in the following sports: 73 football, 8 basketball, 8 soccer, 3 wrestling, 2 lacrosse, 2 skiing, 5 others; 51 college, 44 high school, 4 professional, and 2 recreational). MAIN OUTCOME MEASUREMENTS: Duration of symptoms, presence of clinical signs, and time to return to play following concussion. RESULTS: One hundred one concussions were analyzed. Pearson chi2 analysis of common early and late concussion symptoms revealed statistical significance (P \< 0.05) of headache \>3 hours, difficulty concentrating \>3 hours, any retrograde amnesia or loss of consciousness, and return to play \>7 days. There appeared to be a trend in patients with posttraumatic amnesia toward poor outcome, but this was not statistically significant. CONCLUSIONS: When evaluating concussion, symptoms of headache \>3 hours, difficulty concentrating \>3 hours, retrograde amnesia, or loss of consciousness may indicate a more severe injury or prolonged recovery; great caution should be exercised before returning these athletes to play.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Stevenson, M
Developing return-to-play guidelines following mild traumatic brain injury Journal Article
In: Journal of Science & Medicine in Sport, vol. 6, pp. 519–520, 2003.
BibTeX | Tags: Return to Play
@article{Stevenson2003,
title = {Developing return-to-play guidelines following mild traumatic brain injury},
author = {Stevenson, M},
year = {2003},
date = {2003-01-01},
journal = {Journal of Science \& Medicine in Sport},
volume = {6},
pages = {519--520},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Echemendia, R J; Cantu, R C
Return to play following sports-related mild traumatic brain injury: The role for neuropsychology Journal Article
In: Applied Neuropsychology, vol. 10, pp. 48–55, 2003, ISSN: 0908-4282.
Abstract | BibTeX | Tags: Return to Play
@article{Echemendia2003,
title = {Return to play following sports-related mild traumatic brain injury: The role for neuropsychology},
author = {Echemendia, R J and Cantu, R C},
issn = {0908-4282},
year = {2003},
date = {2003-01-01},
journal = {Applied Neuropsychology},
volume = {10},
pages = {48--55},
abstract = {Cerebral concussions frequently occur at all levels of athletic competition. The effects from these concussions can be transient or may lead to chronic, debilitating symptoms. A growing literature has established that neuropsychological tests are useful in detecting the subtle neurocognitive changes that occur following concussions. The identification of these deficits and subsequent recovery of function can be important components in making return-to-play (RTP) decisions. This article describes the emergence of neuropsychology in sports medicine, discusses the context in which RTP decisions are made, outlines factors that are important to RTP decisions, and presents a model that views the RTP decision as a dynamic risk-benefit analysis that involves complex interactions among variables. It is argued that neuropsychology has a unique, but not exclusive, role in the decision making process. Implications for future research are discussed.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Putukian, Margot; Echemendia, Ruben J
Psychological aspects of serious head injury in the competitive athlete Journal Article
In: Clinics in Sports Medicine, vol. 22, pp. 617–630, 2003.
Abstract | BibTeX | Tags: Return to Play
@article{Putukian2003,
title = {Psychological aspects of serious head injury in the competitive athlete},
author = {Putukian, Margot and Echemendia, Ruben J},
year = {2003},
date = {2003-01-01},
journal = {Clinics in Sports Medicine},
volume = {22},
pages = {617--630},
address = {Primary Care Sports Medicine, The Pennsylvania State University, 1850 East Park Avenue, Suite 112, University Park, PA 16803, USA. mxp19@psu.edu},
abstract = {In addition to the physical aspects of athletic injury, there are psychological aspects to consider. These are important during all phases of injury management: the acute injury, the rehabilitative process, and the return-to-play progression. Emotional disturbances are often associated with mild traumatic brain injury (mTBI) both directly and indirectly. Evaluating the athlete with mTBI can be made more difficult by the need to distinguish the physical and the emotional effects of injury and to differentiate the emotional factors directly related to the brain injury from those that arise indirectly (eg, reaction to being held out of play). This article discusses some of the psychological issues related to evaluating the head injured athlete. [References: 37]},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Herring, S A; Bergfeld, J A; Boyd, J; Duffey, T; Fields, K B; Grana, W A; Indelicato, P; Ben Kibler, W; Pallay, R; Putukian, M; Sallis, R E
The team physician and return-to-play issues: A consensus statement Journal Article
In: Medicine & Science in Sports & Exercise, vol. 34, pp. 1212–1214, 2002, ISSN: 0195-9131.
Abstract | BibTeX | Tags: Return to Play
@article{Herring2002,
title = {The team physician and return-to-play issues: A consensus statement},
author = {Herring, S A and Bergfeld, J A and Boyd, J and Duffey, T and Fields, K B and Grana, W A and Indelicato, P and {Ben Kibler}, W and Pallay, R and Putukian, M and Sallis, R E},
issn = {0195-9131},
year = {2002},
date = {2002-01-01},
journal = {Medicine \& Science in Sports \& Exercise},
volume = {34},
pages = {1212--1214},
abstract = {The objective of this consensus statement is to provide physicians who are responsible for the healthcare of teams with a decision process for determining when to return an injured or ill athlete to practice or competition. This statement is not intended as a standard of care, and should not be interpreted as such. This statement is only a guide, and as such is of a general nature consistent with the reasonable and objective practice of the healthcare professional. Individual decisions regarding the return of an injured or ill athlete to play will depend on the specific facts and circumstances presented to the physician. Adequate insurance should be in place to help protect the athlete, the sponsoring organization, and the physician. This statement was developed by the collaborative effort of six major professional associations concerned with clinical sports medicine issues they have committed to forming an ongoing project-based alliance to "bring together sports medicine organizations to best serve active people and athletes." The organizations are: American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine. and the American Osteopathic Academy of Sports Medicine.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Goodman, David; Gaetz, Michael
Return-to-play guidelines after concussion: the message is getting through Journal Article
In: Clinical Journal of Sport Medicine, vol. 12, pp. 265, 2002.
BibTeX | Tags: Return to Play
@article{Goodman2002,
title = {Return-to-play guidelines after concussion: the message is getting through},
author = {Goodman, David and Gaetz, Michael},
year = {2002},
date = {2002-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {12},
pages = {265},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Collins, Michael W; Hawn, Kristen L
The clinical management of sports concussion Journal Article
In: Current Sports Medicine Reports, vol. 1, pp. 12–22, 2002.
Abstract | BibTeX | Tags: Return to Play
@article{Collins2002a,
title = {The clinical management of sports concussion},
author = {Collins, Michael W and Hawn, Kristen L},
year = {2002},
date = {2002-01-01},
journal = {Current Sports Medicine Reports},
volume = {1},
pages = {12--22},
address = {University of Pittsburgh Medical Center, Center for Sports Medicine, Sports Concussion Program, 3200 South Water Street, Pittsburgh, PA 15203, USA. collinsmw@msx.upmc.edu},
abstract = {Concussion is among the hottest topics in sports medicine today. It is a highly individualized injury which oftentimes has a subtle presentation that is easily misdiagnosed, and therefore mishandled. When to return a concussed athlete to participation is a highly controversial topic that, to this point, has been primarily based on any one of 17 sets of guidelines. Neuropsychologic and cognitive testing has introduced a quantitative and sensitive measure that allows the clinician to verify an athlete's return to normal functioning levels. It is based on the firm belief that every concussion is a unique event, and must be handled as such. The realization that there is no one formula that can handle an injury this complex and multifaceted is perhaps the greatest breakthrough in mild traumatic brain injury research in the past decade. [References: 53]},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Vaccaro, A R; Watkins, B; Albert, T J; Pfaff, W L; Klein, G R; Silber, J S
Cervical spine injuries in athletes: current return-to-play criteria Journal Article
In: Orthopedics, vol. 24, pp. 695–699, 2001.
BibTeX | Tags: Return to Play
@article{Vaccaro2001,
title = {Cervical spine injuries in athletes: current return-to-play criteria},
author = {Vaccaro, A R and Watkins, B and Albert, T J and Pfaff, W L and Klein, G R and Silber, J S},
year = {2001},
date = {2001-01-01},
journal = {Orthopedics},
volume = {24},
pages = {695--699},
address = {Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute, Philadelphia, PA 19107, USA.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Gaetz, M; Goodman, D; Weinberg, H
Electrophysiological evidence for the cumulative effects of concussion Journal Article
In: Brain Injury, vol. 14, pp. 1077–1088, 2000.
Abstract | BibTeX | Tags: Return to Play
@article{Gaetz2000,
title = {Electrophysiological evidence for the cumulative effects of concussion},
author = {Gaetz, M and Goodman, D and Weinberg, H},
year = {2000},
date = {2000-01-01},
journal = {Brain Injury},
volume = {14},
pages = {1077--1088},
address = {Brain Behaviour Laboratory, School of Kinesiology, Simon Fraser University, Burnaby, BC, Canada. gaetz@sfuica},
abstract = {PURPOSE: A study was initiated with the intent of demonstrating the cumulative effects of concussion in junior hockey players using visual event-related potentials and post-concussion syndrome (PCS) self-reports. METHODS: Players were assessed at the beginning of the season (pre-injury) and at various times post-injury. RESULTS: The results suggest that players with three or more concussions differed significantly on the several cognitive PCS symptoms as well as for the latency of the P3 response compared to those with no concussion history. DISCUSSION: Event-related potentials are useful indices of the cumulative damage that can occur following multiple concussions. These measures correlate significantly with cognitive self-reports of PCS symptoms. CONCLUSIONS: This pattern of results is consistent with the position that each concussion potentially causes brain damage. Cumulative damage can be detected using electrophysiological measures of brain function.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Jackson, P
Concussion in sport Journal Article
In: SportEX Medicine, no. 2, pp. 28–31, 1999, ISBN: 14718138.
Abstract | BibTeX | Tags: *Athletes, *BRAIN -- Concussion, *DIAGNOSIS, *WOUNDS & injuries, METHODOLOGY, Recovery, Return to Play, Second impact syndrome, Testing
@article{Jackson1999,
title = {Concussion in sport},
author = {Jackson, P},
isbn = {14718138},
year = {1999},
date = {1999-01-01},
journal = {SportEX Medicine},
number = {2},
pages = {28--31},
address = {;},
abstract = {Written by one of the UK's top rugby doctors and SportEX Medicine advisor, Dr Paul Jackson, this article reviews the symptoms of concussion, immediate assessment, grading, post-concussion symptoms, guidance for returning to play, second impact syndrome, indications for urgent referral, concusive/impact convulsions, recurrent concussion and briefly outlines the future of tests of brain function. Practical elements such as questions to ask to test recent memory and likely responses from both the concussed and non-concussed individual are also included.},
keywords = {*Athletes, *BRAIN -- Concussion, *DIAGNOSIS, *WOUNDS \& injuries, METHODOLOGY, Recovery, Return to Play, Second impact syndrome, Testing},
pubstate = {published},
tppubtype = {article}
}
Putukian, M
Return to play: Making the tough decisions Journal Article
In: Physician & Sportsmedicine, vol. 26, pp. 25–27, 1998, ISSN: 0091-3847.
BibTeX | Tags: Return to Play
@article{Putukian1998,
title = {Return to play: Making the tough decisions},
author = {Putukian, M},
issn = {0091-3847},
year = {1998},
date = {1998-01-01},
journal = {Physician \& Sportsmedicine},
volume = {26},
pages = {25--27},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Cantu, R C
Stingers, transient quadriplegia, and cervical spinal stenosis: return to play criteria Journal Article
In: Medicine & Science in Sports & Exercise, vol. 29, pp. S233–5, 1997.
Abstract | BibTeX | Tags: Return to Play
@article{Cantu1997,
title = {Stingers, transient quadriplegia, and cervical spinal stenosis: return to play criteria},
author = {Cantu, R C},
year = {1997},
date = {1997-01-01},
journal = {Medicine \& Science in Sports \& Exercise},
volume = {29},
pages = {S233--5},
address = {Neurosurgery Service, Emerson Hospital, Concord, MA, USA.},
abstract = {This article focuses on sports related spinal cord and nerve injuries, ranging from mild "stinger" syndrome to complete quadriplegia. Particular emphasis is placed on recommendations for return to competition after such injuries. Cervical spinal cord symptoms after a spine injury from contact sports require a more precise work up to detect cervical spinal stenosis than radiographic bone measurements alone can provide. Imaging technology such as MRI, contrast positive CT, and myelography more accurately identify true spinal stenosis and allow for safer return to play decisions.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
for Disease Control, Centers; Prevention,
Sports-related recurrent brain injuries--United States Journal Article
In: MMWR - Morbidity & Mortality Weekly Report, vol. 46, no. 10, pp. 224–227, 1997.
Abstract | BibTeX | Tags: Incidence/Epidemiology, Return to Play
@article{CentersforDiseaseControlandPrevention1997,
title = {Sports-related recurrent brain injuries--United States},
author = {{Centers for Disease Control and Prevention}},
year = {1997},
date = {1997-01-01},
journal = {MMWR - Morbidity \& Mortality Weekly Report},
volume = {46},
number = {10},
pages = {224--227},
abstract = {An estimated 300,000 sports-related traumatic brain injuries (TBIs) of mild to moderate severity, most of which can be classified as concussions (i.e., conditions of temporarily altered mental status as a result of head trauma), occur in the United States each year. The proportion of these concussions that are repeat injuries is unknown; however, there is an increased risk for subsequent TBI among persons who have had at least one previous TBI. Repeated mild brain injuries occurring over an extended period (i.e., months or years) can result in cumulative neurologic and cognitive deficits, but repeated mild brain injuries occurring within a short period (i.e., hours, days, or weeks) can be catastrophic or fatal. The latter phenomenon, termed "second impact syndrome", has been reported more frequently since it was first characterized in 1984. This report describes two cases of second impact syndrome and presents recommendations developed by the American Academy of Neurology to prevent recurrent brain injuries in sports and their adverse consequences.},
keywords = {Incidence/Epidemiology, Return to Play},
pubstate = {published},
tppubtype = {article}
}
Gardner, A J; Kohler, R M N; Levi, C R; Iverson, G L
Usefulness of Video Review of Possible Concussions in National Youth Rugby League Journal Article
In: International Journal of Sports Medicine, vol. 38, no. 1, pp. 71–75, 2017.
@article{Gardner2017,
title = {Usefulness of Video Review of Possible Concussions in National Youth Rugby League},
author = {Gardner, A J and Kohler, R M N and Levi, C R and Iverson, G L},
doi = {10.1055/s-0042-116072},
year = {2017},
date = {2017-01-01},
journal = {International Journal of Sports Medicine},
volume = {38},
number = {1},
pages = {71--75},
abstract = {A new concussion interchange rule (CIR) was introduced in 2014 for the National Rugby League and National Youth Competition (NYC). The CIR allows a player suspected of having sustained a concussion to be removed from play and assessed without an interchange being tallied against the player's team. Participants included all NYC players who used the CIR during the 2014 season. 2 raters completed video analysis of 131 (of a total of 156 reported) uses of the CIR, describing injury characteristics, situational factors, and concussion signs. The incidence rate was 44.9 (95% CI: 38.5-52.3) uses of the CIR per 1 000 NYC player match hours, or approximately one CIR use every 1.3 games. Apparent loss of consciousness/unresponsiveness was observed in 13% of cases, clutching the head in 65%, unsteadiness of gait in 60%, and a vacant stare in 23%. Most incidences occurred from a hit-up (82%). There appeared to be some instances of video evidence of injury but the athlete was cleared to return to play in the same game. Video review appears to be a useful adjunct for identifying players suffering possible concussion. Further research is required on the usefulness of video review for identifying signs of concussive injury.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Gay, M
Treatment Perspectives Based on Our Current Understanding of Concussion Journal Article
In: Sports Medicine & Arthroscopy Review, vol. 24, no. 3, pp. 134–141, 2016.
@article{Gay2016,
title = {Treatment Perspectives Based on Our Current Understanding of Concussion},
author = {Gay, M},
doi = {10.1097/JSA.0000000000000124},
year = {2016},
date = {2016-01-01},
journal = {Sports Medicine \& Arthroscopy Review},
volume = {24},
number = {3},
pages = {134--141},
abstract = {Sports-related concussion also referred to in the literature as mild traumatic brain injury remains a popular area of study for physicians, neurologists, neuropsychologists, neuroimaging, athletic trainers, and researchers across the other areas of brain sciences. Treatment for concussion is an emerging area of focus with investigators seeking to improve outcomes and protect patients from the deleterious short-term and long-term consequences which have been extensively studied and identified. Broadly, current treatment strategies for athletes recovering from concussion have remained largely unchanged since early 2000s. Knowledge of the complex pathophysiology surrounding injury should improve or advance our ability to identify processes which may serve as targets for therapeutic intervention. Clinicians working with athletes recovering from sports-related concussion should have an advanced understanding of the injury cascade and also be aware of the current efforts within the research to treat concussion. In addition, how clinicians use the word "treatment" should be carefully defined and promoted so the patient is aware of the level of intervention and what stage of recovery or healing is being affected by a specific intervention. The purpose of this review is to bring together efforts across disciplines of brain science into 1 platform where clinicians can assimilate this information before making best practices decisions regarding the treatment of patients and athletes under their care. © 2016 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Knight, D; Dewitt, R; Moser, S
Mild traumatic brain injury in a gymnast Journal Article
In: Journal of the American Academy of Physician Assistants, vol. 29, no. 7, pp. 30–34, 2016.
@article{Knight2016,
title = {Mild traumatic brain injury in a gymnast},
author = {Knight, D and Dewitt, R and Moser, S},
doi = {10.1097/01.JAA.0000483093.43523.0d},
year = {2016},
date = {2016-01-01},
journal = {Journal of the American Academy of Physician Assistants},
volume = {29},
number = {7},
pages = {30--34},
abstract = {Primary care providers often are responsible for the initial evaluation and management plan of young patients with mild traumatic brain injury (mild TBI, also called concussion), and need to be familiar with new protocols and how to incorporate them into a patient's treatment plan. This article describes a patient who suffered a mild TBI and returned to sports too early, and discusses the appropriate protocols for managing concussion in children. Copyright © 2016 American Academy of Physician Assistants.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Brauge, D; Moulin, B; Lafargue, M; Nogué, E; Rivière, D; Pariente, J
Brain concusion in Midi-Pyrénées amateur rugby Journal Article
In: Science and Sports, vol. 31, no. 5, pp. 297–302, 2016.
@article{Brauge2016,
title = {Brain concusion in Midi-Pyr\'{e}n\'{e}es amateur rugby},
author = {Brauge, D and Moulin, B and Lafargue, M and Nogu\'{e}, E and Rivi\`{e}re, D and Pariente, J},
doi = {10.1016/j.scispo.2016.04.009},
year = {2016},
date = {2016-01-01},
journal = {Science and Sports},
volume = {31},
number = {5},
pages = {297--302},
abstract = {Objective Concussion could provide disabling consequences if repetitive. We would like to assess the state of knowledge of this problem in Midi-Pyr\'{e}n\'{e}es amateur rugby. Material and methods Our evaluation was based on questionnaire about diagnosis and management of concussion. For each club, we included at least one player and one staff member (manager, medical team member or coach). Results One hundred and sixty-three subjects (37 players and 126 staff members) of 47 clubs were included. For all subjects, the loss of conscious was a symptom of concussion but only 61% could give 3 others symptoms. The risk of a second accident during days after concussion was known by 95%. About primary care, 50% did not look for cervical spine accident just after brain concussion and 22% thought that concussed athletes could finish the game. A majority of our study population (89%) would not leave alone an injured player after the trauma. This study shows some deficiencies in identification of concussion. The questions about primary care indicate some problems that can cause additional accident. © 2016},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Dematteo, Carol; Volterman, Kimberly A; Breithaupt, Peter G; Claridge, Everett A; Adamich, John; Timmons, Brian W
Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion Journal Article
In: Medicine & Science in Sports & Exercise, vol. 47, no. 11, pp. 2283–2290, 2015, ISBN: 01959131.
@article{Dematteo2015b,
title = {Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion},
author = {Dematteo, Carol and Volterman, Kimberly A and Breithaupt, Peter G and Claridge, Everett A and Adamich, John and Timmons, Brian W},
isbn = {01959131},
year = {2015},
date = {2015-01-01},
journal = {Medicine \& Science in Sports \& Exercise},
volume = {47},
number = {11},
pages = {2283--2290},
abstract = {Purpose: The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA. Methods: Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion. Results: Participants had a mean T SD symptom duration of 6.3 T 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion. Conclusions: Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth. ABSTRACT FROM AUTHOR},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
De Matteo, C; Volterman, K A; Breithaupt, P G; Claridge, E A; Adamich, J; Timmons, B W
Exertion testing in youth with mild traumatic brain injury/concussion Journal Article
In: Medicine & Science in Sports & Exercise, vol. 47, no. 11, pp. 2283–2290, 2015.
@article{DeMatteo2015,
title = {Exertion testing in youth with mild traumatic brain injury/concussion},
author = {{De Matteo}, C and Volterman, K A and Breithaupt, P G and Claridge, E A and Adamich, J and Timmons, B W},
doi = {10.1249/MSS.0000000000000682},
year = {2015},
date = {2015-01-01},
journal = {Medicine \& Science in Sports \& Exercise},
volume = {47},
number = {11},
pages = {2283--2290},
abstract = {Purpose The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA. Methods Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion. Results Participants had a mean ± SD symptom duration of 6.3 ± 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion. Conclusions Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth. © 2015 by the American College of Sports Medicine.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Echemendia, R J; Giza, C C; Kutcher, J S
Developing guidelines for return to play: consensus and evidence-based approaches Journal Article
In: Brain Injury, vol. 29, pp. 185–194, 2015.
@article{Echemendia2015,
title = {Developing guidelines for return to play: consensus and evidence-based approaches},
author = {Echemendia, R J and Giza, C C and Kutcher, J S},
year = {2015},
date = {2015-01-01},
journal = {Brain Injury},
volume = {29},
pages = {185--194},
address = {Echemendia,Ruben J. Psychological and Neurobehavioral Associates, Inc., State College, PA , USA .},
abstract = {BACKGROUND: Sports-related concussions are commonplace at all levels of play and across all age groups. The dynamic, evolving nature of this injury coupled with a lack of objective biomarkers creates a challenging management issue for the sports medicine team. Athletes who return to play following a concussion are known to be at higher risk for an additional brain injury, which necessitates a careful, informed return to play (RTP) process. AIM: The goal of this paper is to outline historical attempts at developing RTP guidelines and trace their evolution over time, culminating in a discussion of the process and outcomes of the most recent consensus statements/guidelines published by the international Concussion In Sport Group (CISG), the American Academy of Neurology (AAN), the National Athletic Trainers' Association, and the 2013 Team Physician Consensus Statement Update. METHOD: An evaluation of the pros and cons of these guidelines is presented along with suggestions for future directions. In addition, the Institute of Medicine recently conducted a comprehensive report outlining the current state of evidence regarding youth concussions, which provides specific recommendations for future research. CONCLUSIONS: The different methodologies utilized in the development of consensus statements have distinct advantages and disadvantages, and both approaches add value to the everyday management of sports concussions. Importantly, the overall approach for management of sports concussion is remarkably similar using either consensus-based or formal evidence-based methods, which adds confidence to the current guidelines and allows practitioners to focus on accepted standards of clinical care. Moving forward, careful study designs need to be utilized to avoid bias in selection of research subjects, collection of data, and interpretation of results. Although useful, clinicians must venture beyond consensus statements to examine reviews of the literature that are published in much greater frequency than consensus statements.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Baker, C S; Cinelli, M E
Visuomotor deficits during locomotion in previously concussed athletes 30 or more days following return to play Journal Article
In: Physiological Reports, vol. 2, pp. 1, 2014.
@article{Baker2014c,
title = {Visuomotor deficits during locomotion in previously concussed athletes 30 or more days following return to play},
author = {Baker, C S and Cinelli, M E},
year = {2014},
date = {2014-01-01},
journal = {Physiological Reports},
volume = {2},
pages = {1},
address = {Baker,Carmen S. Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada. Cinelli,Michael E. Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada.},
abstract = {Current protocols for returning athletes to play (RTP) center around resolution of physical symptoms of concussion. However, recent research has identified that balance and cognitive deficits persist beyond physical symptom recovery. Protocols that involve testing dynamic balance and visuomotor integration have been recommended as potential tools for better understanding of length of impairment following concussion. A dynamic, visuomotor paradigm was undertaken in the current study to assess decision making in athletes who had sustained a concussion \>30 days before study participation and had been cleared to RTP (N = 10). Two obstacles created a gap that varied between 0.6 and 1.8x participants' individual shoulder width in open space. Participants made decisions to navigate through or deviate around the gap created by the two obstacles. The results revealed that previously concussed athletes were highly variable in their decision making and demonstrated variable Medial-Lateral (ML) center of mass (COM) control when approaching the obstacles, when compared with nonconcussed, age-matched controls. As such, they showed poor visuomotor control and decision making, as well as poor dynamic stability compared to controls. Visuomotor deficits were persistent in the sample of previously concussed individuals, well beyond deficits identified by current RTP standards. This study suggests that dynamic, visuomotor integration tasks may be of benefit to increase rigor in RTP protocols and increase safety of athletes returning to sport.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Chermann, J F; Klouche, S; Savigny, A; Lefevre, N; Herman, S; Bohu, Y
Return to rugby after brain concussion: a prospective study in 35 high level rugby players Journal Article
In: Asian Journal of Sports Medicine, vol. 5, pp. e24042, 2014.
@article{Chermann2014,
title = {Return to rugby after brain concussion: a prospective study in 35 high level rugby players},
author = {Chermann, J F and Klouche, S and Savigny, A and Lefevre, N and Herman, S and Bohu, Y},
year = {2014},
date = {2014-01-01},
journal = {Asian Journal of Sports Medicine},
volume = {5},
pages = {e24042},
address = {Chermann,Jean Francois. Department of Neurology, Leopold Bellan Hospital, Paris, France. Klouche,Shahnaz. Department of Orthopedic Surgery, Musculoskeletal Institute of Nollet, Paris, France ; Department of Orthopedic Surgery, Paris Sports Clinic, Paris,},
abstract = {BACKGROUND: Although guidelines based on expert opinions have been developed for the immediate management and return to play of athletes after a concussion, data are lacking on this issue. OBJECTIVES: Evaluate a standardized management of brain concussion among rugby players to prevent the recurrence. PATIENTS AND METHODS: A prospective study was performed from September 2009 to June 2012. All rugby players who had a concussion when playing rugby were included. Patients were managed by a specialized hospital team with a specific protocol developed in collaboration with the medical staff of the rugby clubs included in the study. The series included 35 rugby players, with 23 professionals and 12 high-level players, 30 men and 5 women, mean age 23.1 +/- 5.5 years old. The median number of previous concussions was 2 (0-30) episodes. According to the Cantu concussion severity classification, 3 athletes were grade 1, 12 were grade 2 and 20 were grade 3. None of the injured athletes was lost to follow-up. The primary endpoint was the occurrence of a new concussion within 3 months after the first in patients who returned to rugby. RESULTS: Thirty-three patients returned to rugby after a mean 22.1 +/- 10 days. The recurrence rate within 3 months was 2/33 (6.1%). The median delay before returning to rugby was 21 (7-45) days. Factors associated with a delayed return to play were young age, initial loss of consciousness, severity Cantu grade 3 and post-concussive syndrome of more than 5 days. Analysis of two failures showed that the initial injury was grade 3 and that both were professional athletes and had a history of concussion. CONCLUSIONS: This prospective study validated the study protocol for the management of concussion in rugby players.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Baker, J G; Rieger, B P; McAvoy, K; Leddy, J J; Master, C L; Lana, S J; Willer, B S
Principles for return to learn after concussion Journal Article
In: International Journal of Clinical Practice, vol. 68, pp. 1286–1288, 2014.
@article{Baker2014b,
title = {Principles for return to learn after concussion},
author = {Baker, J G and Rieger, B P and McAvoy, K and Leddy, J J and Master, C L and Lana, S J and Willer, B S},
year = {2014},
date = {2014-01-01},
journal = {International Journal of Clinical Practice},
volume = {68},
pages = {1286--1288},
address = {Baker,J G. School of Social Work, Nuclear Medicine, Orthopaedics and Sports Medicine, University at Buffalo, Buffalo, NY, USA.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Lear, A M; Hoang, M H
Sports concussion: A return-to-play guide Journal Article
In: Journal of Family Practice, vol. 61, pp. 323–328, 2012.
@article{Lear2012,
title = {Sports concussion: A return-to-play guide},
author = {Lear, A M and Hoang, M H},
year = {2012},
date = {2012-01-01},
journal = {Journal of Family Practice},
volume = {61},
pages = {323--328},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Mayers, Lester
Return-to-Play Interval after Sport-related Concussion: Background Review and Current Issues Journal Article
In: Current Sports Medicine Reports, vol. 11, pp. 277–279, 2012.
@article{Mayers2012b,
title = {Return-to-Play Interval after Sport-related Concussion: Background Review and Current Issues},
author = {Mayers, Lester},
year = {2012},
date = {2012-01-01},
journal = {Current Sports Medicine Reports},
volume = {11},
pages = {277--279},
address = {Goldstein Fitness Center, Pace University, 861 Bedford Rd., Pleasantville, NY.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Doolan, Amy W; Day, Daniel D; Maerlender, Arthur C; Goforth, Michael; Gunnar Brolinson, P
A review of return to play issues and sports-related concussion Journal Article
In: Annals of Biomedical Engineering, vol. 40, pp. 106–113, 2012.
@article{Doolan2012,
title = {A review of return to play issues and sports-related concussion},
author = {Doolan, Amy W and Day, Daniel D and Maerlender, Arthur C and Goforth, Michael and {Gunnar Brolinson}, P},
year = {2012},
date = {2012-01-01},
journal = {Annals of Biomedical Engineering},
volume = {40},
pages = {106--113},
address = {Department of Family Medicine, Sports Medicine, Osteopathic Manipulative Medicine, Edward Via College of Osteopathic Medicine, Virginia Campus, 309 N. Knollwood Dr., Blacksburg, VA 24060, USA.},
abstract = {Mild traumatic brain injury in sports has become a significant public health concern which has not only received the general public's attention through multiple news media stories involving athletic concussions, but has also resulted in local, state, and national legislative efforts to improve recognition and management. The purpose of this article is to review the current literature for return to play (RTP) guidelines. State, regional, national, and professional legislation on sport-related concussion RTP management issues will be reviewed. This article will be helpful in developing a generalized systematic approach to concussion management and highlight specific RTP guidelines. The article will also touch upon specific contraindications to RTP, the role of neuropsychological testing in RTP, and other considerations and complications that affect an athlete's ability to return to competition. Finally, considerations for terminating an athlete's competitive season or ending a career after sustaining a concussion resulting in prolonged and protracted symptomatology or repeated concussions will be reviewed. PubMed and Google were searched using the key terms mentioned below. In addition, the author's library of concussion-related articles was reviewed for the relevant literature.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
McCrory, Paul
Sports concussion and the risk of chronic neurological impairment Journal Article
In: Clinical Journal of Sport Medicine, vol. 21, pp. 6–12, 2011.
@article{McCrory2011a,
title = {Sports concussion and the risk of chronic neurological impairment},
author = {McCrory, Paul},
year = {2011},
date = {2011-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {21},
pages = {6--12},
address = {From the Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Melbourne, Victoria, Australia.},
abstract = {Intense recent media focus on long-term outcomes from sports concussion has highlighted concerns on both cognitive deterioration and mental health issues, such as depression and suicide. At this time, the scientific evidence to support these views is limited, with only a handful of cases thus far reported. Based on the literature on this topic that extends back over 50 years, it is clear that only a small percentage of athletes suffer such sequelae presumably due to recurrent concussive or subconcussive head impacts. At this stage, determining which athletes are at future risk is not possible; however, following existing concussion guidelines (eg, Zurich guidelines) is likely to be the safest option based on current evidence.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Theriault, Martin; De Beaumont, Louis; Tremblay, Sebastien; Lassonde, Maryse; Jolicoeur, Pierre
Cumulative effects of concussions in athletes revealed by electrophysiological abnormalities on visual working memory Journal Article
In: Journal of Clinical & Experimental Neuropsychology, vol. 33, pp. 30–41, 2011.
@article{Theriault2011,
title = {Cumulative effects of concussions in athletes revealed by electrophysiological abnormalities on visual working memory},
author = {Theriault, Martin and {De Beaumont}, Louis and Tremblay, Sebastien and Lassonde, Maryse and Jolicoeur, Pierre},
year = {2011},
date = {2011-01-01},
journal = {Journal of Clinical \& Experimental Neuropsychology},
volume = {33},
pages = {30--41},
address = {Centre de Recherche en Neuropsychologie et Cognition, Universite de Montreal, Montreal, Quebec, Canada.},
abstract = {Event-related potentials (ERPs) have been useful to detect subtle, pervasive alterations of cognition-related waveforms in athletes with multiple concussions. This study used the sustained posterior contralateral negativity (SPCN) waveform component recorded while participants performed a visual short-term memory task to investigate how working memory (WM) storage capacity was affected among athletes who differed according to their history of sports concussions. Fifty-five university-level football players were assigned to three groups: 1-2 concussion athletes; 3+ concussion athletes; non-concussed athletes. The main finding of the present study was that athletes with a history of three concussions or more exhibited significantly attenuated SPCN amplitude relative to both concussed athletes with only one or two prior concussions and athletes without concussions. The latter finding adds to previous evidence of disproportionately worse outcome in athletes presenting with a history of three or more concussions relative to those with fewer concussions. In addition, SPCN amplitude was found to correlate significantly with a visual memory capacity estimate (K), but this K value did not significantly differ across groups. This suggests that attenuated SPCN amplitude after three or more concussions did not interfere with apparent WM function. Taken together, these findings suggest that the altered neurophysiological index of WM storage might be a more sensitive measure of a latent WM function abnormality which may well worsen with aging, or perhaps additional brain insults.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Matheson, Gordon O; Shultz, Rebecca; Bido, Jennifer; Mitten, Matthew J; Meeuwisse, Willem H; Shrier, Ian
Return-to-play decisions: are they the team physician's responsibility? Journal Article
In: Clinical Journal of Sport Medicine, vol. 21, pp. 25–30, 2011.
@article{Matheson2011,
title = {Return-to-play decisions: are they the team physician's responsibility?},
author = {Matheson, Gordon O and Shultz, Rebecca and Bido, Jennifer and Mitten, Matthew J and Meeuwisse, Willem H and Shrier, Ian},
year = {2011},
date = {2011-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {21},
pages = {25--30},
address = {Division of Sports Medicine, Department of Orthopaedic Surgery, Stanford University School of Medicine, 341 Galvez St., Stanford, CA 94305, USA. gord@stanford.edu},
abstract = {OBJECTIVE: Return-to-play (RTP) decisions are a central component of the Team Physician's clinical work, yet there is little more than anecdotal reference to these in the literature. We recently published a 3-step model for return-to-play medical decision making and, in the current paper, undertook a systematic review of the literature to determine the level of evidence in support of this model. DATA SOURCES: PubMed, Web of Science, and CINAHL electronic databases. Any article specifically related to concussion, head injuries, neck injuries, illness, medical conditions (including cardiovascular and renal), and preparticipation in sport or that reported RTP as a clinical outcome was excluded. Any article that contained a discussion on one of the components of the 3-step decision-based RTP model was included. RESULTS: We reviewed 148 articles that met the criteria for inclusion and found 98 review articles, 39 original articles, 6 case reports, and 5 editorials. Of these, 141 articles mentioned Step 1 of the medical decision-making process for RTP (Medical Factors), 26 mentioned Step 2 (Sport Risk Modifiers), and 20 mentioned Step 3 (Decision Modifiers). Of the 148 articles in total, only 13 focused on RTP as the main subject and the remaining 135 mentioned RTP anecdotally. Of these 13 articles, 5 were reviews, 4 were editorials, and 4 were original research. CONCLUSIONS: Although 148 articles we retrieved mention RTP in relation to a specific injury, medical condition, or specific topic, only 13 articles focused specifically on the RTP decision-making process, and 6 of 13 were restricted to Step 1 of the 3-step model (Medical Factors). Return-to-play is a fertile field for research and thought leadership beginning with a focus on the Team Physician's appropriate role in RTP decision making, particularly considering the factors identified in Step 3 (Decision Modification).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Clover, Jim; Wall, Jerome
Return-to-play criteria following sports injury Journal Article
In: Clinics in Sports Medicine, vol. 29, pp. 169–175, 2010.
@article{Clover2010,
title = {Return-to-play criteria following sports injury},
author = {Clover, Jim and Wall, Jerome},
year = {2010},
date = {2010-01-01},
journal = {Clinics in Sports Medicine},
volume = {29},
pages = {169--175},
address = {The SPORT Clinic, Riverside, CA 92501, USA. jclover@comgri.com},
abstract = {Determining the criteria for an injured athlete's return to competition can be a confusing scenario when all the individuals involved are brought in. These may include the athlete, parents, guardians, coaches, family physician, the athletic trainer, and others. Providing a foundation from which all can understand the reasoning is key. It must be understood that the primary responsibility is to cause no harm to the athlete, while enabling him or her to participate at the highest level possible. This article discusses the importance of establishing guidelines, athletes' behavioral responses to RTP decisions, testing procedures, and the level of sport and intangible factors related to RTP criteria.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Putukian, M; Aubry, M; McCrory, P
Return to play after sports concussion in elite and non-elite athletes? Journal Article
In: British Journal of Sports Medicine, vol. 43 Suppl 1, pp. i28–31, 2009.
@article{Putukian2009,
title = {Return to play after sports concussion in elite and non-elite athletes?},
author = {Putukian, M and Aubry, M and McCrory, P},
year = {2009},
date = {2009-01-01},
journal = {British Journal of Sports Medicine},
volume = {43 Suppl 1},
pages = {i28--31},
address = {Princeton University, University Health Services, Washington Road, Princeton, NJ 08540, USA. putukian@princeton.edu},
abstract = {OBJECTIVE: To examine the published literature relating to the difference in concussion management strategies between elite and non-elite athletes. DESIGN: Systematic literature review of concussion management. INTERVENTION: Pubmed, Medline, Psych Info, Cochrane Library and Sport Discus databases were reviewed using the MeSH keywords brain concussion and mild traumatic brain injury, combined with athletic injuries. Each were then refined by adding the keyword "return to play" (RTP). English language and human studies only were assessed. RESULTS: For the Medline search, using "brain concussion" as a keyword, 4319 articles were found; this was decreased to 111 when RTP was used to refine the search. When "mild traumatic brain injury" was used, 2509 articles were found; this decreased to 39 when RTP was used to refine the search. Following initial review, these articles form the basis of the discussion below. CONCLUSIONS: The non-elite athlete may not have the same resources available as the elite athlete (such as the presence of trained medical staff during practice and competition, a concussion programme as part of sideline preparedness, the benefit of neuropsychological or postural testing, as well as consultants with expertise in concussion readily available) and as a result will generally be managed more conservatively. Younger athletes often have a greater incidence of concussion with longer recovery time frames; however, they are often managed with less expertise and with limited resources.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Bey, Tareg; Ostick, Brian
Second impact syndrome Journal Article
In: Western Journal of Emergency Medicine, vol. 10, pp. 6–10, 2009.
@article{Bey2009,
title = {Second impact syndrome},
author = {Bey, Tareg and Ostick, Brian},
year = {2009},
date = {2009-01-01},
journal = {Western Journal of Emergency Medicine},
volume = {10},
pages = {6--10},
address = {University of California, Irvine School of Medicine.},
abstract = {A controversial term first described by Saunders and Harbaugh1 in 1984, Second Impact Syndrome (SIS) consists of two events. Typically, it involves an athlete suffering post-concussive symptoms following a head injury.2 If, within several weeks, the athlete returns to play and sustains a second head injury, diffuse cerebral swelling, brain herniation, and death can occur. SIS can occur with any two events involving head trauma. While rare, it is devastating in that young, healthy patients may die within a few minutes. Emergency physicians should be aware of this syndrome and counsel patients and their parents concerning when to allow an athlete to return to play. Furthermore, we present guidelines for appropriate follow up and evaluation by a specialist when necessary.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Purcell, L
What are the most appropriate return-to-play guidelines for concussed child athletes? Journal Article
In: British Journal of Sports Medicine, vol. 43 Suppl 1, pp. i51–5, 2009.
@article{Purcell2009,
title = {What are the most appropriate return-to-play guidelines for concussed child athletes?},
author = {Purcell, L},
year = {2009},
date = {2009-01-01},
journal = {British Journal of Sports Medicine},
volume = {43 Suppl 1},
pages = {i51--5},
address = {Children's Emergency Department, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, Canada. lpurcell1015@rogers.com},
abstract = {OBJECTIVE: To examine concussion literature for specific guidelines regarding return to play (RTP) following sport-related concussion in child athletes. To make recommendations regarding the most appropriate RTP guidelines for child athletes following sport-related concussion. DESIGN: A literature review of concussion literature. INTERVENTION: A literature search was conducted using Medline and Embase databases from 1998 to 2008. More than 60 articles and two websites were reviewed. RESULTS: There is a paucity of research on sport-related concussion in child athletes, particularly younger children (age 5-12 years). In particular, there is no research on RTP guidelines for child athletes following sport-related concussion. Child athletes take longer to recover from concussions than adults. Concussion symptoms may resolve before cognitive function has completely recovered. Concussion assessment and management in children can be confounded by their growth and development, as well as the lack of trained medical personnel involved with youth sports. There are no child-specific assessment tools for concussion. CONCLUSIONS: RTP decisions in children should be made cautiously and should be individualised. No concussed child athlete should be allowed to RTP the same day. Physical and cognitive rest is very important to allow for the resolution of concussion symptoms. Child athletes should remain symptom free for several days before starting a medically supervised stepwise exertion protocol. Further research is needed to elucidate the effects of concussion in children and to determine the most appropriate RTP guidelines. Child-specific concussion assessment tools need to be developed to improve concussion assessment and management in children.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Gardner, A J; Kohler, R M N; Levi, C R; Iverson, G L
Usefulness of Video Review of Possible Concussions in National Youth Rugby League Journal Article
In: International Journal of Sports Medicine, vol. 38, no. 1, pp. 71–75, 2017.
Abstract | Links | BibTeX | Tags: Concussion, Injury management, Return to Play, Video analysis
@article{Gardner2017,
title = {Usefulness of Video Review of Possible Concussions in National Youth Rugby League},
author = {Gardner, A J and Kohler, R M N and Levi, C R and Iverson, G L},
doi = {10.1055/s-0042-116072},
year = {2017},
date = {2017-01-01},
journal = {International Journal of Sports Medicine},
volume = {38},
number = {1},
pages = {71--75},
abstract = {A new concussion interchange rule (CIR) was introduced in 2014 for the National Rugby League and National Youth Competition (NYC). The CIR allows a player suspected of having sustained a concussion to be removed from play and assessed without an interchange being tallied against the player's team. Participants included all NYC players who used the CIR during the 2014 season. 2 raters completed video analysis of 131 (of a total of 156 reported) uses of the CIR, describing injury characteristics, situational factors, and concussion signs. The incidence rate was 44.9 (95% CI: 38.5-52.3) uses of the CIR per 1 000 NYC player match hours, or approximately one CIR use every 1.3 games. Apparent loss of consciousness/unresponsiveness was observed in 13% of cases, clutching the head in 65%, unsteadiness of gait in 60%, and a vacant stare in 23%. Most incidences occurred from a hit-up (82%). There appeared to be some instances of video evidence of injury but the athlete was cleared to return to play in the same game. Video review appears to be a useful adjunct for identifying players suffering possible concussion. Further research is required on the usefulness of video review for identifying signs of concussive injury.},
keywords = {Concussion, Injury management, Return to Play, Video analysis},
pubstate = {published},
tppubtype = {article}
}
Knight, D; Dewitt, R; Moser, S
Mild traumatic brain injury in a gymnast Journal Article
In: Journal of the American Academy of Physician Assistants, vol. 29, no. 7, pp. 30–34, 2016.
Abstract | Links | BibTeX | Tags: Athletics, Cognitive rest, Concussion, mild traumatic brain injury, Pediatric, Return to Play
@article{Knight2016,
title = {Mild traumatic brain injury in a gymnast},
author = {Knight, D and Dewitt, R and Moser, S},
doi = {10.1097/01.JAA.0000483093.43523.0d},
year = {2016},
date = {2016-01-01},
journal = {Journal of the American Academy of Physician Assistants},
volume = {29},
number = {7},
pages = {30--34},
abstract = {Primary care providers often are responsible for the initial evaluation and management plan of young patients with mild traumatic brain injury (mild TBI, also called concussion), and need to be familiar with new protocols and how to incorporate them into a patient's treatment plan. This article describes a patient who suffered a mild TBI and returned to sports too early, and discusses the appropriate protocols for managing concussion in children. Copyright © 2016 American Academy of Physician Assistants.},
keywords = {Athletics, Cognitive rest, Concussion, mild traumatic brain injury, Pediatric, Return to Play},
pubstate = {published},
tppubtype = {article}
}
Brauge, D; Moulin, B; Lafargue, M; Nogué, E; Rivière, D; Pariente, J
Brain concusion in Midi-Pyrénées amateur rugby Journal Article
In: Science and Sports, vol. 31, no. 5, pp. 297–302, 2016.
Abstract | Links | BibTeX | Tags: brain concussion, mild traumatic brain injury, Return to Play
@article{Brauge2016,
title = {Brain concusion in Midi-Pyr\'{e}n\'{e}es amateur rugby},
author = {Brauge, D and Moulin, B and Lafargue, M and Nogu\'{e}, E and Rivi\`{e}re, D and Pariente, J},
doi = {10.1016/j.scispo.2016.04.009},
year = {2016},
date = {2016-01-01},
journal = {Science and Sports},
volume = {31},
number = {5},
pages = {297--302},
abstract = {Objective Concussion could provide disabling consequences if repetitive. We would like to assess the state of knowledge of this problem in Midi-Pyr\'{e}n\'{e}es amateur rugby. Material and methods Our evaluation was based on questionnaire about diagnosis and management of concussion. For each club, we included at least one player and one staff member (manager, medical team member or coach). Results One hundred and sixty-three subjects (37 players and 126 staff members) of 47 clubs were included. For all subjects, the loss of conscious was a symptom of concussion but only 61% could give 3 others symptoms. The risk of a second accident during days after concussion was known by 95%. About primary care, 50% did not look for cervical spine accident just after brain concussion and 22% thought that concussed athletes could finish the game. A majority of our study population (89%) would not leave alone an injured player after the trauma. This study shows some deficiencies in identification of concussion. The questions about primary care indicate some problems that can cause additional accident. © 2016},
keywords = {brain concussion, mild traumatic brain injury, Return to Play},
pubstate = {published},
tppubtype = {article}
}
Gay, M
Treatment Perspectives Based on Our Current Understanding of Concussion Journal Article
In: Sports Medicine & Arthroscopy Review, vol. 24, no. 3, pp. 134–141, 2016.
Abstract | Links | BibTeX | Tags: Concussion, mild traumatic brain injury, Return to Play, Treatment
@article{Gay2016,
title = {Treatment Perspectives Based on Our Current Understanding of Concussion},
author = {Gay, M},
doi = {10.1097/JSA.0000000000000124},
year = {2016},
date = {2016-01-01},
journal = {Sports Medicine \& Arthroscopy Review},
volume = {24},
number = {3},
pages = {134--141},
abstract = {Sports-related concussion also referred to in the literature as mild traumatic brain injury remains a popular area of study for physicians, neurologists, neuropsychologists, neuroimaging, athletic trainers, and researchers across the other areas of brain sciences. Treatment for concussion is an emerging area of focus with investigators seeking to improve outcomes and protect patients from the deleterious short-term and long-term consequences which have been extensively studied and identified. Broadly, current treatment strategies for athletes recovering from concussion have remained largely unchanged since early 2000s. Knowledge of the complex pathophysiology surrounding injury should improve or advance our ability to identify processes which may serve as targets for therapeutic intervention. Clinicians working with athletes recovering from sports-related concussion should have an advanced understanding of the injury cascade and also be aware of the current efforts within the research to treat concussion. In addition, how clinicians use the word "treatment" should be carefully defined and promoted so the patient is aware of the level of intervention and what stage of recovery or healing is being affected by a specific intervention. The purpose of this review is to bring together efforts across disciplines of brain science into 1 platform where clinicians can assimilate this information before making best practices decisions regarding the treatment of patients and athletes under their care. © 2016 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {Concussion, mild traumatic brain injury, Return to Play, Treatment},
pubstate = {published},
tppubtype = {article}
}
Dematteo, Carol; Volterman, Kimberly A; Breithaupt, Peter G; Claridge, Everett A; Adamich, John; Timmons, Brian W
Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion Journal Article
In: Medicine & Science in Sports & Exercise, vol. 47, no. 11, pp. 2283–2290, 2015, ISBN: 01959131.
Abstract | BibTeX | Tags: *BRAIN -- Concussion, *BRAIN -- Wounds & injuries, *EXERCISE, *EXERCISE tests, *POSTCONCUSSION syndrome, *SPORTS participation, ADOLESCENCE, adolescents, brain concussion, children, DATA analysis, DATA analysis -- Software, DECISION making in clinical medicine, DESCRIPTIVE statistics, head injury, MULTIPLE regression analysis, ONE-way analysis of variance, postconcussion syndrome, RESEARCH -- Finance, Return to Play, SAMPLING (Statistics), STATISTICS
@article{Dematteo2015b,
title = {Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion},
author = {Dematteo, Carol and Volterman, Kimberly A and Breithaupt, Peter G and Claridge, Everett A and Adamich, John and Timmons, Brian W},
isbn = {01959131},
year = {2015},
date = {2015-01-01},
journal = {Medicine \& Science in Sports \& Exercise},
volume = {47},
number = {11},
pages = {2283--2290},
abstract = {Purpose: The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA. Methods: Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion. Results: Participants had a mean T SD symptom duration of 6.3 T 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion. Conclusions: Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth. ABSTRACT FROM AUTHOR},
keywords = {*BRAIN -- Concussion, *BRAIN -- Wounds \& injuries, *EXERCISE, *EXERCISE tests, *POSTCONCUSSION syndrome, *SPORTS participation, ADOLESCENCE, adolescents, brain concussion, children, DATA analysis, DATA analysis -- Software, DECISION making in clinical medicine, DESCRIPTIVE statistics, head injury, MULTIPLE regression analysis, ONE-way analysis of variance, postconcussion syndrome, RESEARCH -- Finance, Return to Play, SAMPLING (Statistics), STATISTICS},
pubstate = {published},
tppubtype = {article}
}
De Matteo, C; Volterman, K A; Breithaupt, P G; Claridge, E A; Adamich, J; Timmons, B W
Exertion testing in youth with mild traumatic brain injury/concussion Journal Article
In: Medicine & Science in Sports & Exercise, vol. 47, no. 11, pp. 2283–2290, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adolescents, brain concussion, Child, children, Cross-Sectional Studies, cross-sectional study, exercise, exercise test, exercise tolerance, Female, head injury, human, Humans, Male, Pathophysiology, Physical Exertion, Post-Concussion Syndrome, postconcussion syndrome, Return to Play, return to sport, time factor, Time Factors
@article{DeMatteo2015,
title = {Exertion testing in youth with mild traumatic brain injury/concussion},
author = {{De Matteo}, C and Volterman, K A and Breithaupt, P G and Claridge, E A and Adamich, J and Timmons, B W},
doi = {10.1249/MSS.0000000000000682},
year = {2015},
date = {2015-01-01},
journal = {Medicine \& Science in Sports \& Exercise},
volume = {47},
number = {11},
pages = {2283--2290},
abstract = {Purpose The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA. Methods Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion. Results Participants had a mean ± SD symptom duration of 6.3 ± 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion. Conclusions Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth. © 2015 by the American College of Sports Medicine.},
keywords = {Adolescent, adolescents, brain concussion, Child, children, Cross-Sectional Studies, cross-sectional study, exercise, exercise test, exercise tolerance, Female, head injury, human, Humans, Male, Pathophysiology, Physical Exertion, Post-Concussion Syndrome, postconcussion syndrome, Return to Play, return to sport, time factor, Time Factors},
pubstate = {published},
tppubtype = {article}
}
Echemendia, R J; Giza, C C; Kutcher, J S
Developing guidelines for return to play: consensus and evidence-based approaches Journal Article
In: Brain Injury, vol. 29, pp. 185–194, 2015.
Abstract | BibTeX | Tags: Return to Play
@article{Echemendia2015,
title = {Developing guidelines for return to play: consensus and evidence-based approaches},
author = {Echemendia, R J and Giza, C C and Kutcher, J S},
year = {2015},
date = {2015-01-01},
journal = {Brain Injury},
volume = {29},
pages = {185--194},
address = {Echemendia,Ruben J. Psychological and Neurobehavioral Associates, Inc., State College, PA , USA .},
abstract = {BACKGROUND: Sports-related concussions are commonplace at all levels of play and across all age groups. The dynamic, evolving nature of this injury coupled with a lack of objective biomarkers creates a challenging management issue for the sports medicine team. Athletes who return to play following a concussion are known to be at higher risk for an additional brain injury, which necessitates a careful, informed return to play (RTP) process. AIM: The goal of this paper is to outline historical attempts at developing RTP guidelines and trace their evolution over time, culminating in a discussion of the process and outcomes of the most recent consensus statements/guidelines published by the international Concussion In Sport Group (CISG), the American Academy of Neurology (AAN), the National Athletic Trainers' Association, and the 2013 Team Physician Consensus Statement Update. METHOD: An evaluation of the pros and cons of these guidelines is presented along with suggestions for future directions. In addition, the Institute of Medicine recently conducted a comprehensive report outlining the current state of evidence regarding youth concussions, which provides specific recommendations for future research. CONCLUSIONS: The different methodologies utilized in the development of consensus statements have distinct advantages and disadvantages, and both approaches add value to the everyday management of sports concussions. Importantly, the overall approach for management of sports concussion is remarkably similar using either consensus-based or formal evidence-based methods, which adds confidence to the current guidelines and allows practitioners to focus on accepted standards of clinical care. Moving forward, careful study designs need to be utilized to avoid bias in selection of research subjects, collection of data, and interpretation of results. Although useful, clinicians must venture beyond consensus statements to examine reviews of the literature that are published in much greater frequency than consensus statements.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Baker, J G; Rieger, B P; McAvoy, K; Leddy, J J; Master, C L; Lana, S J; Willer, B S
Principles for return to learn after concussion Journal Article
In: International Journal of Clinical Practice, vol. 68, pp. 1286–1288, 2014.
BibTeX | Tags: Return to Play
@article{Baker2014b,
title = {Principles for return to learn after concussion},
author = {Baker, J G and Rieger, B P and McAvoy, K and Leddy, J J and Master, C L and Lana, S J and Willer, B S},
year = {2014},
date = {2014-01-01},
journal = {International Journal of Clinical Practice},
volume = {68},
pages = {1286--1288},
address = {Baker,J G. School of Social Work, Nuclear Medicine, Orthopaedics and Sports Medicine, University at Buffalo, Buffalo, NY, USA.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Baker, C S; Cinelli, M E
Visuomotor deficits during locomotion in previously concussed athletes 30 or more days following return to play Journal Article
In: Physiological Reports, vol. 2, pp. 1, 2014.
Abstract | BibTeX | Tags: Return to Play
@article{Baker2014c,
title = {Visuomotor deficits during locomotion in previously concussed athletes 30 or more days following return to play},
author = {Baker, C S and Cinelli, M E},
year = {2014},
date = {2014-01-01},
journal = {Physiological Reports},
volume = {2},
pages = {1},
address = {Baker,Carmen S. Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada. Cinelli,Michael E. Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada.},
abstract = {Current protocols for returning athletes to play (RTP) center around resolution of physical symptoms of concussion. However, recent research has identified that balance and cognitive deficits persist beyond physical symptom recovery. Protocols that involve testing dynamic balance and visuomotor integration have been recommended as potential tools for better understanding of length of impairment following concussion. A dynamic, visuomotor paradigm was undertaken in the current study to assess decision making in athletes who had sustained a concussion \>30 days before study participation and had been cleared to RTP (N = 10). Two obstacles created a gap that varied between 0.6 and 1.8x participants' individual shoulder width in open space. Participants made decisions to navigate through or deviate around the gap created by the two obstacles. The results revealed that previously concussed athletes were highly variable in their decision making and demonstrated variable Medial-Lateral (ML) center of mass (COM) control when approaching the obstacles, when compared with nonconcussed, age-matched controls. As such, they showed poor visuomotor control and decision making, as well as poor dynamic stability compared to controls. Visuomotor deficits were persistent in the sample of previously concussed individuals, well beyond deficits identified by current RTP standards. This study suggests that dynamic, visuomotor integration tasks may be of benefit to increase rigor in RTP protocols and increase safety of athletes returning to sport.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Chermann, J F; Klouche, S; Savigny, A; Lefevre, N; Herman, S; Bohu, Y
Return to rugby after brain concussion: a prospective study in 35 high level rugby players Journal Article
In: Asian Journal of Sports Medicine, vol. 5, pp. e24042, 2014.
Abstract | BibTeX | Tags: Return to Play
@article{Chermann2014,
title = {Return to rugby after brain concussion: a prospective study in 35 high level rugby players},
author = {Chermann, J F and Klouche, S and Savigny, A and Lefevre, N and Herman, S and Bohu, Y},
year = {2014},
date = {2014-01-01},
journal = {Asian Journal of Sports Medicine},
volume = {5},
pages = {e24042},
address = {Chermann,Jean Francois. Department of Neurology, Leopold Bellan Hospital, Paris, France. Klouche,Shahnaz. Department of Orthopedic Surgery, Musculoskeletal Institute of Nollet, Paris, France ; Department of Orthopedic Surgery, Paris Sports Clinic, Paris,},
abstract = {BACKGROUND: Although guidelines based on expert opinions have been developed for the immediate management and return to play of athletes after a concussion, data are lacking on this issue. OBJECTIVES: Evaluate a standardized management of brain concussion among rugby players to prevent the recurrence. PATIENTS AND METHODS: A prospective study was performed from September 2009 to June 2012. All rugby players who had a concussion when playing rugby were included. Patients were managed by a specialized hospital team with a specific protocol developed in collaboration with the medical staff of the rugby clubs included in the study. The series included 35 rugby players, with 23 professionals and 12 high-level players, 30 men and 5 women, mean age 23.1 +/- 5.5 years old. The median number of previous concussions was 2 (0-30) episodes. According to the Cantu concussion severity classification, 3 athletes were grade 1, 12 were grade 2 and 20 were grade 3. None of the injured athletes was lost to follow-up. The primary endpoint was the occurrence of a new concussion within 3 months after the first in patients who returned to rugby. RESULTS: Thirty-three patients returned to rugby after a mean 22.1 +/- 10 days. The recurrence rate within 3 months was 2/33 (6.1%). The median delay before returning to rugby was 21 (7-45) days. Factors associated with a delayed return to play were young age, initial loss of consciousness, severity Cantu grade 3 and post-concussive syndrome of more than 5 days. Analysis of two failures showed that the initial injury was grade 3 and that both were professional athletes and had a history of concussion. CONCLUSIONS: This prospective study validated the study protocol for the management of concussion in rugby players.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Lear, A M; Hoang, M H
Sports concussion: A return-to-play guide Journal Article
In: Journal of Family Practice, vol. 61, pp. 323–328, 2012.
BibTeX | Tags: Return to Play
@article{Lear2012,
title = {Sports concussion: A return-to-play guide},
author = {Lear, A M and Hoang, M H},
year = {2012},
date = {2012-01-01},
journal = {Journal of Family Practice},
volume = {61},
pages = {323--328},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Doolan, Amy W; Day, Daniel D; Maerlender, Arthur C; Goforth, Michael; Gunnar Brolinson, P
A review of return to play issues and sports-related concussion Journal Article
In: Annals of Biomedical Engineering, vol. 40, pp. 106–113, 2012.
Abstract | BibTeX | Tags: Return to Play
@article{Doolan2012,
title = {A review of return to play issues and sports-related concussion},
author = {Doolan, Amy W and Day, Daniel D and Maerlender, Arthur C and Goforth, Michael and {Gunnar Brolinson}, P},
year = {2012},
date = {2012-01-01},
journal = {Annals of Biomedical Engineering},
volume = {40},
pages = {106--113},
address = {Department of Family Medicine, Sports Medicine, Osteopathic Manipulative Medicine, Edward Via College of Osteopathic Medicine, Virginia Campus, 309 N. Knollwood Dr., Blacksburg, VA 24060, USA.},
abstract = {Mild traumatic brain injury in sports has become a significant public health concern which has not only received the general public's attention through multiple news media stories involving athletic concussions, but has also resulted in local, state, and national legislative efforts to improve recognition and management. The purpose of this article is to review the current literature for return to play (RTP) guidelines. State, regional, national, and professional legislation on sport-related concussion RTP management issues will be reviewed. This article will be helpful in developing a generalized systematic approach to concussion management and highlight specific RTP guidelines. The article will also touch upon specific contraindications to RTP, the role of neuropsychological testing in RTP, and other considerations and complications that affect an athlete's ability to return to competition. Finally, considerations for terminating an athlete's competitive season or ending a career after sustaining a concussion resulting in prolonged and protracted symptomatology or repeated concussions will be reviewed. PubMed and Google were searched using the key terms mentioned below. In addition, the author's library of concussion-related articles was reviewed for the relevant literature.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Mayers, Lester
Return-to-Play Interval after Sport-related Concussion: Background Review and Current Issues Journal Article
In: Current Sports Medicine Reports, vol. 11, pp. 277–279, 2012.
BibTeX | Tags: Return to Play
@article{Mayers2012b,
title = {Return-to-Play Interval after Sport-related Concussion: Background Review and Current Issues},
author = {Mayers, Lester},
year = {2012},
date = {2012-01-01},
journal = {Current Sports Medicine Reports},
volume = {11},
pages = {277--279},
address = {Goldstein Fitness Center, Pace University, 861 Bedford Rd., Pleasantville, NY.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
McCrory, Paul
Sports concussion and the risk of chronic neurological impairment Journal Article
In: Clinical Journal of Sport Medicine, vol. 21, pp. 6–12, 2011.
Abstract | BibTeX | Tags: Return to Play
@article{McCrory2011a,
title = {Sports concussion and the risk of chronic neurological impairment},
author = {McCrory, Paul},
year = {2011},
date = {2011-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {21},
pages = {6--12},
address = {From the Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Melbourne, Victoria, Australia.},
abstract = {Intense recent media focus on long-term outcomes from sports concussion has highlighted concerns on both cognitive deterioration and mental health issues, such as depression and suicide. At this time, the scientific evidence to support these views is limited, with only a handful of cases thus far reported. Based on the literature on this topic that extends back over 50 years, it is clear that only a small percentage of athletes suffer such sequelae presumably due to recurrent concussive or subconcussive head impacts. At this stage, determining which athletes are at future risk is not possible; however, following existing concussion guidelines (eg, Zurich guidelines) is likely to be the safest option based on current evidence.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Matheson, Gordon O; Shultz, Rebecca; Bido, Jennifer; Mitten, Matthew J; Meeuwisse, Willem H; Shrier, Ian
Return-to-play decisions: are they the team physician's responsibility? Journal Article
In: Clinical Journal of Sport Medicine, vol. 21, pp. 25–30, 2011.
Abstract | BibTeX | Tags: Return to Play
@article{Matheson2011,
title = {Return-to-play decisions: are they the team physician's responsibility?},
author = {Matheson, Gordon O and Shultz, Rebecca and Bido, Jennifer and Mitten, Matthew J and Meeuwisse, Willem H and Shrier, Ian},
year = {2011},
date = {2011-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {21},
pages = {25--30},
address = {Division of Sports Medicine, Department of Orthopaedic Surgery, Stanford University School of Medicine, 341 Galvez St., Stanford, CA 94305, USA. gord@stanford.edu},
abstract = {OBJECTIVE: Return-to-play (RTP) decisions are a central component of the Team Physician's clinical work, yet there is little more than anecdotal reference to these in the literature. We recently published a 3-step model for return-to-play medical decision making and, in the current paper, undertook a systematic review of the literature to determine the level of evidence in support of this model. DATA SOURCES: PubMed, Web of Science, and CINAHL electronic databases. Any article specifically related to concussion, head injuries, neck injuries, illness, medical conditions (including cardiovascular and renal), and preparticipation in sport or that reported RTP as a clinical outcome was excluded. Any article that contained a discussion on one of the components of the 3-step decision-based RTP model was included. RESULTS: We reviewed 148 articles that met the criteria for inclusion and found 98 review articles, 39 original articles, 6 case reports, and 5 editorials. Of these, 141 articles mentioned Step 1 of the medical decision-making process for RTP (Medical Factors), 26 mentioned Step 2 (Sport Risk Modifiers), and 20 mentioned Step 3 (Decision Modifiers). Of the 148 articles in total, only 13 focused on RTP as the main subject and the remaining 135 mentioned RTP anecdotally. Of these 13 articles, 5 were reviews, 4 were editorials, and 4 were original research. CONCLUSIONS: Although 148 articles we retrieved mention RTP in relation to a specific injury, medical condition, or specific topic, only 13 articles focused specifically on the RTP decision-making process, and 6 of 13 were restricted to Step 1 of the 3-step model (Medical Factors). Return-to-play is a fertile field for research and thought leadership beginning with a focus on the Team Physician's appropriate role in RTP decision making, particularly considering the factors identified in Step 3 (Decision Modification).},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Theriault, Martin; De Beaumont, Louis; Tremblay, Sebastien; Lassonde, Maryse; Jolicoeur, Pierre
Cumulative effects of concussions in athletes revealed by electrophysiological abnormalities on visual working memory Journal Article
In: Journal of Clinical & Experimental Neuropsychology, vol. 33, pp. 30–41, 2011.
Abstract | BibTeX | Tags: Return to Play
@article{Theriault2011,
title = {Cumulative effects of concussions in athletes revealed by electrophysiological abnormalities on visual working memory},
author = {Theriault, Martin and {De Beaumont}, Louis and Tremblay, Sebastien and Lassonde, Maryse and Jolicoeur, Pierre},
year = {2011},
date = {2011-01-01},
journal = {Journal of Clinical \& Experimental Neuropsychology},
volume = {33},
pages = {30--41},
address = {Centre de Recherche en Neuropsychologie et Cognition, Universite de Montreal, Montreal, Quebec, Canada.},
abstract = {Event-related potentials (ERPs) have been useful to detect subtle, pervasive alterations of cognition-related waveforms in athletes with multiple concussions. This study used the sustained posterior contralateral negativity (SPCN) waveform component recorded while participants performed a visual short-term memory task to investigate how working memory (WM) storage capacity was affected among athletes who differed according to their history of sports concussions. Fifty-five university-level football players were assigned to three groups: 1-2 concussion athletes; 3+ concussion athletes; non-concussed athletes. The main finding of the present study was that athletes with a history of three concussions or more exhibited significantly attenuated SPCN amplitude relative to both concussed athletes with only one or two prior concussions and athletes without concussions. The latter finding adds to previous evidence of disproportionately worse outcome in athletes presenting with a history of three or more concussions relative to those with fewer concussions. In addition, SPCN amplitude was found to correlate significantly with a visual memory capacity estimate (K), but this K value did not significantly differ across groups. This suggests that attenuated SPCN amplitude after three or more concussions did not interfere with apparent WM function. Taken together, these findings suggest that the altered neurophysiological index of WM storage might be a more sensitive measure of a latent WM function abnormality which may well worsen with aging, or perhaps additional brain insults.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Clover, Jim; Wall, Jerome
Return-to-play criteria following sports injury Journal Article
In: Clinics in Sports Medicine, vol. 29, pp. 169–175, 2010.
Abstract | BibTeX | Tags: Return to Play
@article{Clover2010,
title = {Return-to-play criteria following sports injury},
author = {Clover, Jim and Wall, Jerome},
year = {2010},
date = {2010-01-01},
journal = {Clinics in Sports Medicine},
volume = {29},
pages = {169--175},
address = {The SPORT Clinic, Riverside, CA 92501, USA. jclover@comgri.com},
abstract = {Determining the criteria for an injured athlete's return to competition can be a confusing scenario when all the individuals involved are brought in. These may include the athlete, parents, guardians, coaches, family physician, the athletic trainer, and others. Providing a foundation from which all can understand the reasoning is key. It must be understood that the primary responsibility is to cause no harm to the athlete, while enabling him or her to participate at the highest level possible. This article discusses the importance of establishing guidelines, athletes' behavioral responses to RTP decisions, testing procedures, and the level of sport and intangible factors related to RTP criteria.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Putukian, M; Aubry, M; McCrory, P
Return to play after sports concussion in elite and non-elite athletes? Journal Article
In: British Journal of Sports Medicine, vol. 43 Suppl 1, pp. i28–31, 2009.
Abstract | BibTeX | Tags: Return to Play
@article{Putukian2009,
title = {Return to play after sports concussion in elite and non-elite athletes?},
author = {Putukian, M and Aubry, M and McCrory, P},
year = {2009},
date = {2009-01-01},
journal = {British Journal of Sports Medicine},
volume = {43 Suppl 1},
pages = {i28--31},
address = {Princeton University, University Health Services, Washington Road, Princeton, NJ 08540, USA. putukian@princeton.edu},
abstract = {OBJECTIVE: To examine the published literature relating to the difference in concussion management strategies between elite and non-elite athletes. DESIGN: Systematic literature review of concussion management. INTERVENTION: Pubmed, Medline, Psych Info, Cochrane Library and Sport Discus databases were reviewed using the MeSH keywords brain concussion and mild traumatic brain injury, combined with athletic injuries. Each were then refined by adding the keyword "return to play" (RTP). English language and human studies only were assessed. RESULTS: For the Medline search, using "brain concussion" as a keyword, 4319 articles were found; this was decreased to 111 when RTP was used to refine the search. When "mild traumatic brain injury" was used, 2509 articles were found; this decreased to 39 when RTP was used to refine the search. Following initial review, these articles form the basis of the discussion below. CONCLUSIONS: The non-elite athlete may not have the same resources available as the elite athlete (such as the presence of trained medical staff during practice and competition, a concussion programme as part of sideline preparedness, the benefit of neuropsychological or postural testing, as well as consultants with expertise in concussion readily available) and as a result will generally be managed more conservatively. Younger athletes often have a greater incidence of concussion with longer recovery time frames; however, they are often managed with less expertise and with limited resources.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Bey, Tareg; Ostick, Brian
Second impact syndrome Journal Article
In: Western Journal of Emergency Medicine, vol. 10, pp. 6–10, 2009.
Abstract | BibTeX | Tags: Return to Play
@article{Bey2009,
title = {Second impact syndrome},
author = {Bey, Tareg and Ostick, Brian},
year = {2009},
date = {2009-01-01},
journal = {Western Journal of Emergency Medicine},
volume = {10},
pages = {6--10},
address = {University of California, Irvine School of Medicine.},
abstract = {A controversial term first described by Saunders and Harbaugh1 in 1984, Second Impact Syndrome (SIS) consists of two events. Typically, it involves an athlete suffering post-concussive symptoms following a head injury.2 If, within several weeks, the athlete returns to play and sustains a second head injury, diffuse cerebral swelling, brain herniation, and death can occur. SIS can occur with any two events involving head trauma. While rare, it is devastating in that young, healthy patients may die within a few minutes. Emergency physicians should be aware of this syndrome and counsel patients and their parents concerning when to allow an athlete to return to play. Furthermore, we present guidelines for appropriate follow up and evaluation by a specialist when necessary.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Miller, Mark D; Arciero, Robert A; Cooper, Daniel E; Johnson, Darren L; Best, Thomas M
Doc, when can he go back in the game? Journal Article
In: Instructional Course Lectures, vol. 58, pp. 437–443, 2009.
Abstract | BibTeX | Tags: Return to Play
@article{Miller2009,
title = {Doc, when can he go back in the game?},
author = {Miller, Mark D and Arciero, Robert A and Cooper, Daniel E and Johnson, Darren L and Best, Thomas M},
year = {2009},
date = {2009-01-01},
journal = {Instructional Course Lectures},
volume = {58},
pages = {437--443},
address = {Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.},
abstract = {In the injured athlete, several criteria must be considered before return to play. There are separate considerations for knee injuries, shoulder injuries, and general upper and lower extremity injuries, as well as concussion, hypertrophic cardiomyopathy, mononucleosis, and spondylolysis. It is important that surgical indications, postoperative rehabilitation, and risk for reinjury are reviewed by the surgeon before the athlete is allowed to resume activity.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Ashare, Alan B
Returning to play after concussion Journal Article
In: Acta Paediatrica, vol. 98, pp. 774–776, 2009.
BibTeX | Tags: Return to Play
@article{Ashare2009,
title = {Returning to play after concussion},
author = {Ashare, Alan B},
year = {2009},
date = {2009-01-01},
journal = {Acta Paediatrica},
volume = {98},
pages = {774--776},
address = {Department of Radiology, St. Elizabeth's Medical Center, Boston, MA 02135, USA. Alan_Ashare_MD@caritaschristi.org},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Purcell, L
What are the most appropriate return-to-play guidelines for concussed child athletes? Journal Article
In: British Journal of Sports Medicine, vol. 43 Suppl 1, pp. i51–5, 2009.
Abstract | BibTeX | Tags: Return to Play
@article{Purcell2009,
title = {What are the most appropriate return-to-play guidelines for concussed child athletes?},
author = {Purcell, L},
year = {2009},
date = {2009-01-01},
journal = {British Journal of Sports Medicine},
volume = {43 Suppl 1},
pages = {i51--5},
address = {Children's Emergency Department, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, Canada. lpurcell1015@rogers.com},
abstract = {OBJECTIVE: To examine concussion literature for specific guidelines regarding return to play (RTP) following sport-related concussion in child athletes. To make recommendations regarding the most appropriate RTP guidelines for child athletes following sport-related concussion. DESIGN: A literature review of concussion literature. INTERVENTION: A literature search was conducted using Medline and Embase databases from 1998 to 2008. More than 60 articles and two websites were reviewed. RESULTS: There is a paucity of research on sport-related concussion in child athletes, particularly younger children (age 5-12 years). In particular, there is no research on RTP guidelines for child athletes following sport-related concussion. Child athletes take longer to recover from concussions than adults. Concussion symptoms may resolve before cognitive function has completely recovered. Concussion assessment and management in children can be confounded by their growth and development, as well as the lack of trained medical personnel involved with youth sports. There are no child-specific assessment tools for concussion. CONCLUSIONS: RTP decisions in children should be made cautiously and should be individualised. No concussed child athlete should be allowed to RTP the same day. Physical and cognitive rest is very important to allow for the resolution of concussion symptoms. Child athletes should remain symptom free for several days before starting a medically supervised stepwise exertion protocol. Further research is needed to elucidate the effects of concussion in children and to determine the most appropriate RTP guidelines. Child-specific concussion assessment tools need to be developed to improve concussion assessment and management in children.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
McCrea, Michael; Guskiewicz, Kevin; Randolph, Christopher; Barr, William B; Hammeke, Thomas A; Marshall, Stephen W; Kelly, James P
Effects of a symptom-free waiting period on clinical outcome and risk of reinjury after sport-related concussion Journal Article
In: Neurosurgery, vol. 65, pp. 873–876, 2009.
Abstract | BibTeX | Tags: Return to Play
@article{McCrea2009a,
title = {Effects of a symptom-free waiting period on clinical outcome and risk of reinjury after sport-related concussion},
author = {McCrea, Michael and Guskiewicz, Kevin and Randolph, Christopher and Barr, William B and Hammeke, Thomas A and Marshall, Stephen W and Kelly, James P},
year = {2009},
date = {2009-01-01},
journal = {Neurosurgery},
volume = {65},
pages = {873--876},
address = {Neuroscience Center, Waukesha Memorial Hospital, Waukesha, Wisconsin 53188, USA. michael.mccrea@phci.org},
abstract = {OBJECTIVE: This study is the first to investigate the influence of a symptom-free waiting period (SFWP) on clinical outcome and risk of repeat injury after sport-related concussion. METHODS: This was a prospective, nonrandomized study of 16 624 player seasons from 1999 to 2004, including a cohort of 635 concussed high school and college athletes grouped on the basis of an SFWP or no SFWP observed after their concussion. Clinical outcome in symptoms, cognitive functioning, and postural stability 45 and 90 days postinjury was compared with preinjury baseline. Data on SFWP and same-season repeat concussion were recorded. RESULTS: An SFWP was observed in 60.3% of cases. There were no significant differences between the SFWP and no SFWP groups in acute injury characteristics or clinical outcome with respect to symptom recovery or postinjury performance on formal neuropsychological and balance testing. Most repeat concussions (79.2%) occurred within 10 days of the initial injury. The rate of repeat concussion was actually higher in the SFWP group (6.49%) than the no SFWP group (0.90%) (P \< 0.005), but the repeat concussion subgroup's SFWP was 2.82 days shorter (95% confidence interval, 0.61-5.03; P \< 0.01) and these athletes resumed participation 3.55 days sooner (95% confidence interval, 0.06-7.04; P \< 0.05) than those in the SFWP group in which there was no repeat concussion. CONCLUSION: Our findings suggest that an SFWP did not intrinsically influence clinical recovery or reduce risk of a repeat concussion. The overall risk of same-season repeat concussion seems to be relatively low, but there may be a period of vulnerability that increases risk of repeat concussion during the first 7 to 10 days postinjury. Further study is required to investigate this preliminary finding and help determine whether this risk can be reduced further with specific injury-management strategies.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Mayers, Lester
Return-to-play criteria after athletic concussion: a need for revision Journal Article
In: Archives of Neurology, vol. 65, pp. 1158–1161, 2008.
Abstract | BibTeX | Tags: Return to Play
@article{Mayers2008,
title = {Return-to-play criteria after athletic concussion: a need for revision},
author = {Mayers, Lester},
year = {2008},
date = {2008-01-01},
journal = {Archives of Neurology},
volume = {65},
pages = {1158--1161},
address = {Athletics Department, Goldstein Fitness Center, Pace University, 861 Bedford Rd, Pleasantville, NY 10570, USA. lmayers@pace.edu},
abstract = {Management of a sport-related concussion, especially involving return-to-play decisions, is one of the most important challenges confronting sports medicine professionals. Current guidelines result from thoughtful consensus recommendations by expert committees but are chiefly based on the resolution of symptoms and the results of neuropsychological testing, if available. Adherence to this paradigm results in most injured athletes resuming competition in 1 to 2 weeks. [References: 28]},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Putukian, Margot
Repeat mild traumatic brain injury: how to adjust return to play guidelines Journal Article
In: Current Sports Medicine Reports, vol. 5, pp. 15–22, 2006.
Abstract | BibTeX | Tags: Return to Play
@article{Putukian2006,
title = {Repeat mild traumatic brain injury: how to adjust return to play guidelines},
author = {Putukian, Margot},
year = {2006},
date = {2006-01-01},
journal = {Current Sports Medicine Reports},
volume = {5},
pages = {15--22},
address = {Robert-Wood Johnson University of Medicine \& Dentistry of New Jersey, McCosh Health Center, Princeton, NJ 08540, USA. putukian@princeton.edu},
abstract = {Determining when it is safe for an athlete to return to play (RTP) after concussion is one of the most difficult decisions facing the team physician. There is significant variability in the evaluation and management of mild traumatic brain injury (mTBI). In the past decade, a tremendous amount of sport-specific research has improved our understanding of mTBI. The advent of neuro-psychologic (NP) testing batteries designed to assess concussive injury has improved the assessment of cognitive dysfunction that occurs in the absence of structural brain abnormalities. The severity of injury is determined by the nature, burden, and duration of symptoms. Athletes must be asymptomatic and have a normal neurologic and cognitive evaluation prior to RTP. Several factors aid in making the RTP decision, including age, the severity of injury, and history of prior mTBIs. Given the potential complications of mTBI, the RTP decision must be made using a thoughtful, individualized process. [References: 66]},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Kissick, James; Johnston, Karen M
Return to play after concussion: principles and practice Journal Article
In: Clinical Journal of Sport Medicine, vol. 15, pp. 426–431, 2005.
Abstract | BibTeX | Tags: Return to Play
@article{Kissick2005,
title = {Return to play after concussion: principles and practice},
author = {Kissick, James and Johnston, Karen M},
year = {2005},
date = {2005-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {15},
pages = {426--431},
address = {Ottawa Sport Medicine Centre, 39 Goulding Cr., Ottawa, Ontario, Canada K2K 2N9. jkissick@sympatico.ca},
abstract = {OBJECTIVE: The sport medicine team is increasingly being asked to manage concussed athletes and to provide written clearance for return to play postconcussion, making it critical to have a good understanding of concussion recognition, assessment, and management. DATA SOURCES/SYNTHESIS: A handy way to think of concussion management is the four Rs: recognition, response, rehabilitation, and return. RESULTS: Athletes, coaches, parents, therapists, and physicians need a thorough understanding of concussion signs and symptoms. An athlete suspected of having sustained a concussion should be removed from the game or practice and assessed by a member of the sideline medical team. All athletes who sustain a concussion should be evaluated by a medical doctor. Rehabilitation has similarities to but also differs from the traditional orthopedic model in that the first step is rest, both physical and cognitive. Once asymptomatic at rest, a step-wise return to activity is undertaken. CONCLUSIONS: This protocol has been adapted for various sports. It may be used for children, although it is prudent to be more conservative and to progress more slowly than in an older age group. [References: 38]},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Brukner, Peter
Return to play--a personal perspective Journal Article
In: Clinical Journal of Sport Medicine, vol. 15, pp. 459–460, 2005.
BibTeX | Tags: Return to Play
@article{Brukner2005,
title = {Return to play--a personal perspective},
author = {Brukner, Peter},
year = {2005},
date = {2005-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {15},
pages = {459--460},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Best, Thomas M; Brolinson, P Gunnar
Return to play: the sideline dilemma Journal Article
In: Clinical Journal of Sport Medicine, vol. 15, pp. 403–404, 2005.
BibTeX | Tags: Return to Play
@article{Best2005,
title = {Return to play: the sideline dilemma},
author = {Best, Thomas M and Brolinson, P Gunnar},
year = {2005},
date = {2005-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {15},
pages = {403--404},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Lovell, Mark; Collins, Micky; Bradley, James
Return to play following sports-related concussion Journal Article
In: Clinics in Sports Medicine, vol. 23, pp. 421–441, 2004.
Abstract | BibTeX | Tags: Return to Play
@article{Lovell2004a,
title = {Return to play following sports-related concussion},
author = {Lovell, Mark and Collins, Micky and Bradley, James},
year = {2004},
date = {2004-01-01},
journal = {Clinics in Sports Medicine},
volume = {23},
pages = {421--441},
address = {Sports Medicine Concussion Program, Department of Orthopaedic Sugery, University of Pittsburgh Medical Center, 200 Delafield Road, Suite 410, Pittsburgh, PA 15215, USA.},
abstract = {This article provides a review of current important issues in the management of athletes who have sustained a concussion during athletic competition. Recent research in the area of concussion management is reviewed with specific reference to the side line evaluation of concussion and the follow-up of the athlete during the recovery period. The use of neuropsychological testing in sports is also reviewed. A systematic protocol for the management of sports related concussion is presented. [References: 36]},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Brooks, Michael
Coach, I'm OK, can I go in? Journal Article
In: Principal Leadership: Middle Level Edition, vol. 5, no. 1, pp. 63–64, 2004, ISBN: 15298957.
Abstract | BibTeX | Tags: Actions & defenses (Law), brain, Concussion, Education, FOOTBALL coaches, FOOTBALL injuries, FOOTBALL players, Legal & Policy Issues, Nebraska, Public Schools, Return to Play
@article{Brooks2004,
title = {Coach, I'm OK, can I go in?},
author = {Brooks, Michael},
isbn = {15298957},
year = {2004},
date = {2004-01-01},
journal = {Principal Leadership: Middle Level Edition},
volume = {5},
number = {1},
pages = {63--64},
abstract = {Cites the legal case "Cerny v. Cedar Bluffs Junior/Senior Public School," about a student who sued a Nebraska public school alleging that the head coach of the school's football team has failed to examine the student following the initial concussion after the student hit his head on the ground. Familiarity of the head coach about the symptoms of concussions; Measurement of the coach's conduct against a reasonably prudent person holding a Nebraska teaching certificate.},
keywords = {Actions \& defenses (Law), brain, Concussion, Education, FOOTBALL coaches, FOOTBALL injuries, FOOTBALL players, Legal \& Policy Issues, Nebraska, Public Schools, Return to Play},
pubstate = {published},
tppubtype = {article}
}
McFarland, Edward G
Return to play Journal Article
In: Clinics in Sports Medicine, vol. 23, pp. xv–xxiii, 2004.
BibTeX | Tags: Return to Play
@article{McFarland2004,
title = {Return to play},
author = {McFarland, Edward G},
year = {2004},
date = {2004-01-01},
journal = {Clinics in Sports Medicine},
volume = {23},
pages = {xv--xxiii},
address = {Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, 10753 Falls Road, Suite 215, Lutherville, MD 21093, USA.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Asplund, Chad A; McKeag, Douglas B; Olsen, Cara H
Sport-related concussion: factors associated with prolonged return to play Journal Article
In: Clinical Journal of Sport Medicine, vol. 14, pp. 339–343, 2004.
Abstract | BibTeX | Tags: Return to Play
@article{Asplund2004,
title = {Sport-related concussion: factors associated with prolonged return to play},
author = {Asplund, Chad A and McKeag, Douglas B and Olsen, Cara H},
year = {2004},
date = {2004-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {14},
pages = {339--343},
address = {Department of Family Practice, DeWitt Army Community Hospital, Fort Belvoir, VA 22060, USA. chad.asplund@us.army.mil},
abstract = {OBJECTIVE: To assess predictive value of concussion signs and symptoms based on return-to-play timelines. DESIGN: Physician practice study without diagnosis that includes presentation, initial and subsequent treatment, and management of concussion. SETTING: National multisite primary care sports medicine provider locations. PARTICIPANTS: Twenty-two providers at 18 sites; 101 athletes (91 men, 10 women in the following sports: 73 football, 8 basketball, 8 soccer, 3 wrestling, 2 lacrosse, 2 skiing, 5 others; 51 college, 44 high school, 4 professional, and 2 recreational). MAIN OUTCOME MEASUREMENTS: Duration of symptoms, presence of clinical signs, and time to return to play following concussion. RESULTS: One hundred one concussions were analyzed. Pearson chi2 analysis of common early and late concussion symptoms revealed statistical significance (P \< 0.05) of headache \>3 hours, difficulty concentrating \>3 hours, any retrograde amnesia or loss of consciousness, and return to play \>7 days. There appeared to be a trend in patients with posttraumatic amnesia toward poor outcome, but this was not statistically significant. CONCLUSIONS: When evaluating concussion, symptoms of headache \>3 hours, difficulty concentrating \>3 hours, retrograde amnesia, or loss of consciousness may indicate a more severe injury or prolonged recovery; great caution should be exercised before returning these athletes to play.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Stevenson, M
Developing return-to-play guidelines following mild traumatic brain injury Journal Article
In: Journal of Science & Medicine in Sport, vol. 6, pp. 519–520, 2003.
BibTeX | Tags: Return to Play
@article{Stevenson2003,
title = {Developing return-to-play guidelines following mild traumatic brain injury},
author = {Stevenson, M},
year = {2003},
date = {2003-01-01},
journal = {Journal of Science \& Medicine in Sport},
volume = {6},
pages = {519--520},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Echemendia, R J; Cantu, R C
Return to play following sports-related mild traumatic brain injury: The role for neuropsychology Journal Article
In: Applied Neuropsychology, vol. 10, pp. 48–55, 2003, ISSN: 0908-4282.
Abstract | BibTeX | Tags: Return to Play
@article{Echemendia2003,
title = {Return to play following sports-related mild traumatic brain injury: The role for neuropsychology},
author = {Echemendia, R J and Cantu, R C},
issn = {0908-4282},
year = {2003},
date = {2003-01-01},
journal = {Applied Neuropsychology},
volume = {10},
pages = {48--55},
abstract = {Cerebral concussions frequently occur at all levels of athletic competition. The effects from these concussions can be transient or may lead to chronic, debilitating symptoms. A growing literature has established that neuropsychological tests are useful in detecting the subtle neurocognitive changes that occur following concussions. The identification of these deficits and subsequent recovery of function can be important components in making return-to-play (RTP) decisions. This article describes the emergence of neuropsychology in sports medicine, discusses the context in which RTP decisions are made, outlines factors that are important to RTP decisions, and presents a model that views the RTP decision as a dynamic risk-benefit analysis that involves complex interactions among variables. It is argued that neuropsychology has a unique, but not exclusive, role in the decision making process. Implications for future research are discussed.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Putukian, Margot; Echemendia, Ruben J
Psychological aspects of serious head injury in the competitive athlete Journal Article
In: Clinics in Sports Medicine, vol. 22, pp. 617–630, 2003.
Abstract | BibTeX | Tags: Return to Play
@article{Putukian2003,
title = {Psychological aspects of serious head injury in the competitive athlete},
author = {Putukian, Margot and Echemendia, Ruben J},
year = {2003},
date = {2003-01-01},
journal = {Clinics in Sports Medicine},
volume = {22},
pages = {617--630},
address = {Primary Care Sports Medicine, The Pennsylvania State University, 1850 East Park Avenue, Suite 112, University Park, PA 16803, USA. mxp19@psu.edu},
abstract = {In addition to the physical aspects of athletic injury, there are psychological aspects to consider. These are important during all phases of injury management: the acute injury, the rehabilitative process, and the return-to-play progression. Emotional disturbances are often associated with mild traumatic brain injury (mTBI) both directly and indirectly. Evaluating the athlete with mTBI can be made more difficult by the need to distinguish the physical and the emotional effects of injury and to differentiate the emotional factors directly related to the brain injury from those that arise indirectly (eg, reaction to being held out of play). This article discusses some of the psychological issues related to evaluating the head injured athlete. [References: 37]},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Herring, S A; Bergfeld, J A; Boyd, J; Duffey, T; Fields, K B; Grana, W A; Indelicato, P; Ben Kibler, W; Pallay, R; Putukian, M; Sallis, R E
The team physician and return-to-play issues: A consensus statement Journal Article
In: Medicine & Science in Sports & Exercise, vol. 34, pp. 1212–1214, 2002, ISSN: 0195-9131.
Abstract | BibTeX | Tags: Return to Play
@article{Herring2002,
title = {The team physician and return-to-play issues: A consensus statement},
author = {Herring, S A and Bergfeld, J A and Boyd, J and Duffey, T and Fields, K B and Grana, W A and Indelicato, P and {Ben Kibler}, W and Pallay, R and Putukian, M and Sallis, R E},
issn = {0195-9131},
year = {2002},
date = {2002-01-01},
journal = {Medicine \& Science in Sports \& Exercise},
volume = {34},
pages = {1212--1214},
abstract = {The objective of this consensus statement is to provide physicians who are responsible for the healthcare of teams with a decision process for determining when to return an injured or ill athlete to practice or competition. This statement is not intended as a standard of care, and should not be interpreted as such. This statement is only a guide, and as such is of a general nature consistent with the reasonable and objective practice of the healthcare professional. Individual decisions regarding the return of an injured or ill athlete to play will depend on the specific facts and circumstances presented to the physician. Adequate insurance should be in place to help protect the athlete, the sponsoring organization, and the physician. This statement was developed by the collaborative effort of six major professional associations concerned with clinical sports medicine issues they have committed to forming an ongoing project-based alliance to "bring together sports medicine organizations to best serve active people and athletes." The organizations are: American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine. and the American Osteopathic Academy of Sports Medicine.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Goodman, David; Gaetz, Michael
Return-to-play guidelines after concussion: the message is getting through Journal Article
In: Clinical Journal of Sport Medicine, vol. 12, pp. 265, 2002.
BibTeX | Tags: Return to Play
@article{Goodman2002,
title = {Return-to-play guidelines after concussion: the message is getting through},
author = {Goodman, David and Gaetz, Michael},
year = {2002},
date = {2002-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {12},
pages = {265},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Collins, Michael W; Hawn, Kristen L
The clinical management of sports concussion Journal Article
In: Current Sports Medicine Reports, vol. 1, pp. 12–22, 2002.
Abstract | BibTeX | Tags: Return to Play
@article{Collins2002a,
title = {The clinical management of sports concussion},
author = {Collins, Michael W and Hawn, Kristen L},
year = {2002},
date = {2002-01-01},
journal = {Current Sports Medicine Reports},
volume = {1},
pages = {12--22},
address = {University of Pittsburgh Medical Center, Center for Sports Medicine, Sports Concussion Program, 3200 South Water Street, Pittsburgh, PA 15203, USA. collinsmw@msx.upmc.edu},
abstract = {Concussion is among the hottest topics in sports medicine today. It is a highly individualized injury which oftentimes has a subtle presentation that is easily misdiagnosed, and therefore mishandled. When to return a concussed athlete to participation is a highly controversial topic that, to this point, has been primarily based on any one of 17 sets of guidelines. Neuropsychologic and cognitive testing has introduced a quantitative and sensitive measure that allows the clinician to verify an athlete's return to normal functioning levels. It is based on the firm belief that every concussion is a unique event, and must be handled as such. The realization that there is no one formula that can handle an injury this complex and multifaceted is perhaps the greatest breakthrough in mild traumatic brain injury research in the past decade. [References: 53]},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Vaccaro, A R; Watkins, B; Albert, T J; Pfaff, W L; Klein, G R; Silber, J S
Cervical spine injuries in athletes: current return-to-play criteria Journal Article
In: Orthopedics, vol. 24, pp. 695–699, 2001.
BibTeX | Tags: Return to Play
@article{Vaccaro2001,
title = {Cervical spine injuries in athletes: current return-to-play criteria},
author = {Vaccaro, A R and Watkins, B and Albert, T J and Pfaff, W L and Klein, G R and Silber, J S},
year = {2001},
date = {2001-01-01},
journal = {Orthopedics},
volume = {24},
pages = {695--699},
address = {Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute, Philadelphia, PA 19107, USA.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Gaetz, M; Goodman, D; Weinberg, H
Electrophysiological evidence for the cumulative effects of concussion Journal Article
In: Brain Injury, vol. 14, pp. 1077–1088, 2000.
Abstract | BibTeX | Tags: Return to Play
@article{Gaetz2000,
title = {Electrophysiological evidence for the cumulative effects of concussion},
author = {Gaetz, M and Goodman, D and Weinberg, H},
year = {2000},
date = {2000-01-01},
journal = {Brain Injury},
volume = {14},
pages = {1077--1088},
address = {Brain Behaviour Laboratory, School of Kinesiology, Simon Fraser University, Burnaby, BC, Canada. gaetz@sfuica},
abstract = {PURPOSE: A study was initiated with the intent of demonstrating the cumulative effects of concussion in junior hockey players using visual event-related potentials and post-concussion syndrome (PCS) self-reports. METHODS: Players were assessed at the beginning of the season (pre-injury) and at various times post-injury. RESULTS: The results suggest that players with three or more concussions differed significantly on the several cognitive PCS symptoms as well as for the latency of the P3 response compared to those with no concussion history. DISCUSSION: Event-related potentials are useful indices of the cumulative damage that can occur following multiple concussions. These measures correlate significantly with cognitive self-reports of PCS symptoms. CONCLUSIONS: This pattern of results is consistent with the position that each concussion potentially causes brain damage. Cumulative damage can be detected using electrophysiological measures of brain function.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Jackson, P
Concussion in sport Journal Article
In: SportEX Medicine, no. 2, pp. 28–31, 1999, ISBN: 14718138.
Abstract | BibTeX | Tags: *Athletes, *BRAIN -- Concussion, *DIAGNOSIS, *WOUNDS & injuries, METHODOLOGY, Recovery, Return to Play, Second impact syndrome, Testing
@article{Jackson1999,
title = {Concussion in sport},
author = {Jackson, P},
isbn = {14718138},
year = {1999},
date = {1999-01-01},
journal = {SportEX Medicine},
number = {2},
pages = {28--31},
address = {;},
abstract = {Written by one of the UK's top rugby doctors and SportEX Medicine advisor, Dr Paul Jackson, this article reviews the symptoms of concussion, immediate assessment, grading, post-concussion symptoms, guidance for returning to play, second impact syndrome, indications for urgent referral, concusive/impact convulsions, recurrent concussion and briefly outlines the future of tests of brain function. Practical elements such as questions to ask to test recent memory and likely responses from both the concussed and non-concussed individual are also included.},
keywords = {*Athletes, *BRAIN -- Concussion, *DIAGNOSIS, *WOUNDS \& injuries, METHODOLOGY, Recovery, Return to Play, Second impact syndrome, Testing},
pubstate = {published},
tppubtype = {article}
}
Putukian, M
Return to play: Making the tough decisions Journal Article
In: Physician & Sportsmedicine, vol. 26, pp. 25–27, 1998, ISSN: 0091-3847.
BibTeX | Tags: Return to Play
@article{Putukian1998,
title = {Return to play: Making the tough decisions},
author = {Putukian, M},
issn = {0091-3847},
year = {1998},
date = {1998-01-01},
journal = {Physician \& Sportsmedicine},
volume = {26},
pages = {25--27},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
Cantu, R C
Stingers, transient quadriplegia, and cervical spinal stenosis: return to play criteria Journal Article
In: Medicine & Science in Sports & Exercise, vol. 29, pp. S233–5, 1997.
Abstract | BibTeX | Tags: Return to Play
@article{Cantu1997,
title = {Stingers, transient quadriplegia, and cervical spinal stenosis: return to play criteria},
author = {Cantu, R C},
year = {1997},
date = {1997-01-01},
journal = {Medicine \& Science in Sports \& Exercise},
volume = {29},
pages = {S233--5},
address = {Neurosurgery Service, Emerson Hospital, Concord, MA, USA.},
abstract = {This article focuses on sports related spinal cord and nerve injuries, ranging from mild "stinger" syndrome to complete quadriplegia. Particular emphasis is placed on recommendations for return to competition after such injuries. Cervical spinal cord symptoms after a spine injury from contact sports require a more precise work up to detect cervical spinal stenosis than radiographic bone measurements alone can provide. Imaging technology such as MRI, contrast positive CT, and myelography more accurately identify true spinal stenosis and allow for safer return to play decisions.},
keywords = {Return to Play},
pubstate = {published},
tppubtype = {article}
}
for Disease Control, Centers; Prevention,
Sports-related recurrent brain injuries--United States Journal Article
In: MMWR - Morbidity & Mortality Weekly Report, vol. 46, no. 10, pp. 224–227, 1997.
Abstract | BibTeX | Tags: Incidence/Epidemiology, Return to Play
@article{CentersforDiseaseControlandPrevention1997,
title = {Sports-related recurrent brain injuries--United States},
author = {{Centers for Disease Control and Prevention}},
year = {1997},
date = {1997-01-01},
journal = {MMWR - Morbidity \& Mortality Weekly Report},
volume = {46},
number = {10},
pages = {224--227},
abstract = {An estimated 300,000 sports-related traumatic brain injuries (TBIs) of mild to moderate severity, most of which can be classified as concussions (i.e., conditions of temporarily altered mental status as a result of head trauma), occur in the United States each year. The proportion of these concussions that are repeat injuries is unknown; however, there is an increased risk for subsequent TBI among persons who have had at least one previous TBI. Repeated mild brain injuries occurring over an extended period (i.e., months or years) can result in cumulative neurologic and cognitive deficits, but repeated mild brain injuries occurring within a short period (i.e., hours, days, or weeks) can be catastrophic or fatal. The latter phenomenon, termed "second impact syndrome", has been reported more frequently since it was first characterized in 1984. This report describes two cases of second impact syndrome and presents recommendations developed by the American Academy of Neurology to prevent recurrent brain injuries in sports and their adverse consequences.},
keywords = {Incidence/Epidemiology, Return to Play},
pubstate = {published},
tppubtype = {article}
}