It is not appropriate for a child or adolescent

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children and adolescents. It is not appropriate for a child or adolescent athlete with concussion to RTP on the same day as the injury regardless of the level of athletic performance. Concussion modi fi ers apply even more to this population than adults and may mandate more cautious RTP advice. Elite Versus Nonelite Athletes All athletes, regardless of level of participation, should be managed using the same treatment and return to play paradigm. The available resources and expertise in concus- sion evaluation are of more importance in determining management than a separation between elite and nonelite athlete management. Although formal NP testing may be beyond the resources of many sports or individuals, it is recommended that in all organized high-risk sports, consid- eration be given to having this cognitive evaluation, regard- less of the age or level of performance. Chronic Traumatic Encephalopathy (CTE) Clinicians need to be mindful of the potential for long- term problems in the management of all athletes. However, it was agreed that CTE represents a distinct tauopathy with an unknown incidence in athletic populations. It was further agreed that a cause and effect relationship has not yet been demon- strated between CTE and concussions or exposure to contact sports. 105 114 At present, the interpretation of causation in the modern CTE case studies should proceed cautiously. It was also recognized that it is important to address the fears of parents/ athletes from media pressure related to the possibility of CTE. INJURY PREVENTION Protective Equipment—Mouthguards and Helmets There is no good clinical evidence that currently avail- able protective equipment will prevent concussion, although mouthguards have a de fi nite role in preventing dental and oro- facial injury. Biomechanical studies have shown a reduction in impact forces to the brain with the use of headgear and helmets, but these fi ndings have not been translated to show a reduction in concussion incidence. For skiing and snowboarding there are a number of studies to suggest that helmets provide protection against head and facial injury and hence should be recom- mended for participants in alpine sports. 115 118 In speci fi c sports such as cycling, motor, and equestrian sports, protective helmets may prevent other forms of head injury (eg, skull fracture) that are related to falling on hard surfaces and may be an important injury prevention issue for those sports. 118 130 Rule Change Consideration of rule changes to reduce the head injury incidence or severity may be appropriate where a clear-cut mechanism is implicated in a particular sport. An example of this is in football (soccer) where research studies demonstrated that upper limb to head contact in heading contests accounted for approximately 50% of concussions. 131 As noted earlier, rule changes also may be needed in some sports to allow an effective off- fi eld medical assessment to occur without compromising the athlete s welfare, affecting the ow of the game or unduly penalizing
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  • Winter '12
  • ChantalComeau
  • Sport Group, sport-related concussion

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Christopher Reinemann
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