Management of Sports-Related Concussions: Staying Ahead of the Game, 2nd Edition: Summary 23
REHABILITATION TECHNIQUES Modern concussion management emphasizes active rehabilitation rather than prolonged rest. Key principles include: Gradual, progressive activity: in the first 48 hours, athletes should limit their amount of screen time. However, they should be encouraged to engage in light physical and cognitive activity, while staying below symptom thresholds. This approach has been shown to be safe and may facilitate recovery. Subsymptom threshold exercise: closely monitored active rehab programs involving a controlled subsymptom threshold with submaximal exercises have shown benefits in facilitating recovery. Multimodal approach: for athletes with persistent symptoms (>10 days), a multidisciplinary rehabilitation approach may be beneficial, including:
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 Return to Play A graduated return to play protocol should be followed, typically including these stages: 1. Symptom-limited activity
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
• Cognitive therapy • Vestibular therapy • Physical therapy • Psychological therapy • Graded exercise program
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!
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.
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