It goes without saying that a proper evaluation to diagnose a concussion is an incredibly critical part of keeping athletes safe. However, it’s how the concussion is managed that is they key to returning athletes back to normal function. Unfortunately, just like assessment, there is no set protocol for concussion management; clinicians must rely on the best practices being published. Keith Scorza and his colleagues outlined the Current Concept in Concussion Evaluation and Management a few years back, and have shared the fundamentals in the proper care for athletes who have suffered a concussion. Today, we’re outlining their results for your reference.

The 6 Elements of Concussion Management

1. Cognitive Rest

Scorza and colleagues (2012) started by encouraging those who have just suffered a concussion to “avoid activities that require attention or concentration.” This includes:

  • Text messaging or video games
  • Television and computer use
  • Schoolwork

 

2. Physical Rest

Next, the researches advised to “avoid any physical activity that exacerbates symptoms” (Scorza K et al. 2012). This includes:

  • Aerobic exercise
  • Lifting weights
  • Household chores
  • Sexual activity

If an athlete is partaking in an activity that causes headache, vomiting or seizures, further neuroimaging may be necessary.

 

3. Medications/Interventions

“There is poor evidence for use of medications for post-concussive symptoms; therefore, medication choices are the same for those without concussion” (Scorza K et al. 2012). The researchers also encourage trainers and clinicians to stay cognizant aware medication may mask post-concussive symptoms. Encourage patients to only:

  • Wear sunglasses for photophobia
  • Wear earplugs or noise canceling headphones for phonophobia
  • Take medications to alleviate specific symptoms
    • Non-steroidal anti-inflammatory drugs (avoid if there is potential for intracranial bleeding)
    • Acetaminophen
    • Amitriptyline
    • Sleep aids
    • Anxiolytics
    • Selective serotonin reuptake inhibitors

 

4. Transition Back to School

Moving the student back into the classroom setting must be treated delicately. While this can usually be accomplished naturally, formal interventions may be necessary. (Scorza K et al. 2012). To make the transition as smooth as possible:

  • Alert school personnel to injury
  • Initiate slow reintegration
  • Consider forgiveness of missed assignments
  • Consider more time to complete tests and schoolwork
  • Consider standard breaks and rest periods as needed
  • Consider decreased schoolwork, distraction-free work areas, and note takers
  • Avoid standardized testing during recovery
  • Monitor carefully for two to three months after concussion for scholastic difficulties

 

5. Graded Return to Play

While the patient will be more than eager to return to their sport, keeping the athlete safe is the number one priority. Scorza and colleagues (2012) suggest the following return-to-play protocol after rest and resolution of symptoms (each of the following steps should take at least 24 hours):

  • Nonimpact aerobic exercise
  • Sport-specific exercise (nonimpact drills)
  • Noncontact training drills
  • Full contact practice
  • Return to normal play
  • Patient must be symptom-free and medication-free before starting return-to- play protocol
  • If any symptoms develop, activity should be stopped immediately; 24 hours after symptoms resolve, protocol may resume at the last step for which the athlete was asymptomatic

 

6. Considerations for Higher-Risk Patients

Finally, the researchers encourage trainers and clinicians to take a multidisciplinary approach with patients that are higher risk, like a referral to a health care professional experienced in concussion management, formal neuropsychological testing and extensive communication with coach and training staff (Scorza K et al. 2012). Higher-risk patients include the following factors:

  • More than three symptoms at presentation
  • Specific symptoms (i.e., fatigue, tiredness, or fogginess)
  • Headache lasting more than 60 hours
  • Loss of consciousness for more than 60 seconds
  • Amnesia
  • History of concussion
  • Age younger than 18 years
  • Comorbid conditions
  • Medication use (psychotropic drugs, anticoagulants)
  • Dangerous style of athletic play
  • High-risk sport (contact, collision)

In addition, catch Performance Health Scientific Advisory Committee member Dr. Greg Stewart’s breakdown of the importance of the brain and the first few days following a concussion!

Scorza K et al. 2012. Current Concepts in Concussion: Evaluation and Management. Am Fam Physician. 85(2):123-132.

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