Management of Sports-Related Concussions: Staying Ahead of the Game, 2nd Edition: Summary 32
Return to Play A graduated return to play protocol should be followed, typically including these stages: 1. Symptom-limited activity
Targeted interventions: interventions should be individualized and targeted based on the patient’s symptoms. There is no one-size-fits-all approach to concussions. Specific interventions may include: • Vestibular rehabilitation exercises: ○ Head and eye movements ○ VOR training ○ Balance exercises • Cervical spine treatment • Vision therapy • Cognitive behavioral therapy RETURN TO LEARN AND RETURN TO PLAY Return to Learn LEARNING TIP!
2. Light aerobic exercise 3. Sport-specific exercise 4. Non-contact training drills 5. Full-contact practice 6. Return to sport
Each stage should last at least 24 hours and the athlete should only progress to the next
stage if they remain symptom-free. Buffalo Concussion Treadmill Test
Assessment should be made of activity tolerance for post-concussive patients with symptoms >3 weeks to establish appropriate levels of exercise and identify physiologic variables associated with symptoms. While progressively exercising on a treadmill, heart rate, RPE, and concussion symptoms should be monitored. MEDICAL DISQUALIFICATION In some cases, especially with multiple concussions or prolonged recovery, medical disqualification from a sport may be considered. Key points include: • Decisions are complex, multifaceted, and should be individualized • There is no specific number of concussions that automatically leads to disqualification • Factors to consider include concussion history, severity and duration of symptoms, academic and social impacts, and the athlete's goals and priorities • The decision should be made after full recovery and involve a multidisciplinary team ACCESS THE FULL VIDEO PRESENTATION Scan the QR CODE ► to start video or visit https://uqr.to/sports-concussions
Student athletes should return to the classroom using a gradual, stepwise process to ensure that symptoms are not exacerbated by cognitive activities. The goal is to limit but not eliminate cognitive activity. This process should involve a multidisciplinary team including medical professionals, school staff, and family members. It is important to note that most students will not need academic modification but communication is key.
Stages typically include: 1. No school attendance, cognitive rest 2. Partial day attendance with accommodations 3. Full day attendance with accommodations 4. Full day attendance with minimal accommodations 5. Full school participation
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