Consensus_Statement_on_Concussion_in_Sport_the_4th_1

It is recommended that all athletes should have a

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It is recommended that all athletes should have a clinical neurological assessment (including assessment of their cog- nitive function) as part of their overall management. This will normally be done by the treating physician often in conjunc- tion with computerized NP screening tools. Formal NP testing is not required for all athletes, however when this is considered necessary then it should ideally be performed by a trained neuropsychologist. Although neuropsychologists are in the best position to interpret NP tests by virtue of their background and training, the ultimate return to play decision should remain a medical one in which a multidisciplinary approach, when possible, has been taken. In the absence of NP and other (eg, formal balance assessment) testing, a more conservative return to play approach may be appropriate. Neuropsychological testing may be used to assist return to play decisions and is typically performed when an athlete is clinically asymptomatic, however NP assessment may add important information in the early stages following injury. 54,55 There may be particular situations where testing is performed early to assist in determining aspects of management eg, return to school in a pediatric athlete. This will normally be best deter- mined in consultation with a trained neuropsychologist. 56,57 Baseline NP testing was considered by the panel and was not felt to be required as a mandatory aspect of every assessment however may be helpful or add useful information to the overall interpretation of these tests. It also provides an additional educative opportunity for the physician to discuss the signi fi cance of this injury with the athlete. At present, there is insuf fi cient evidence to recommend the widespread routine use of baseline NP testing. Concussion Management The cornerstone of concussion management is physical and cognitive rest until the acute symptoms resolve and then a graded program of exertion prior to medical clearance and return to play. The current published evidence evaluating the effect of rest following a sport-related concussion is sparse. An initial period of rest in the acute symptomatic period following injury (24-48 hours) may be of bene fi t. Further research to evaluate the long-term outcome of rest, and the optimal amount and type of rest, is needed. In the absence of evidence-based recommendations, a sensible approach involves the gradual return to school and social activities (prior to contact sports) in a manner that does not result in a signi fi cant exacerbation of symptoms. Clin J Sport Med ± Volume 23, Number 2, March 2013 Consensus Statement on Concussion Ó 2013 Concussion in Sport Group | 91
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Low-level exercise for those who are slow to recover may be of bene fi t, although the optimal timing following injury for initiation of this treatment is currently unknown.
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  • Winter '12
  • ChantalComeau
  • Sport Group, sport-related concussion

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