Transcript Best Practices in Return to Play After Concussion

Best Practices in Return
to Play After Concussion
Jennifer Volberding, PhD, ATC, LAT
Athletic Training Program Director
Assistant Professor
OSU Center for Health Sciences
Rest and Recovery1
 Grade of concussion
 Severity dependent upon the length of time post-concussive
symptoms last
 Timeline to return
 We can’t answer that at the time of evaluation!!
Risk factors for Concussion and
Implications on Recovery
 Symptoms
 Number
 Duration (longer than 10 days)
 Severity
 Signs
 Prolonged loss of consciousness (greater than 1 minute)
 Sequelae
 Concussion convulsions
Risk factors for Concussion and
Implications on Recovery
 Temporal
 Frequency: repeated concussions over time
 Time: close together
 Recency: recent concussion or TBI
 Threshold
 Repeated concussions occurring with progressively less impact,
force, or slower recovery after each successive event
 Age
 Child or adolescent
Risk factors for Concussion and
Implications on Recovery
 Comorbidities and premorbidities
 Migraine, depression, or other mental health disorders, ADD or
ADHD, learning disabilities, sleep disorders
 Medication
 Psychoactive drugs, anticoagulants
 Behavior
 Dangerous style of play
 Sport
 High risk activity, contact or collision sport, high sporting level
You have a concussion now what?2
 Return to life
 Return to school
 Return to play
Return to Life2
 Rest at home
 Emotional impact
 Physical impact
 Medications
 Sleep aids or anxiety in sub-acute stage
 Diet
 Hydration
 Balanced nutrition
 No alcohol while still experiencing symptoms
Return to School2
 What is cognitive rest
 Reduce but don’t completely remove
 Strict brain rest may have detrimental effects on patients
 Find balance of work with concussion symptoms
Return to Play3
 Baseline Measurements after Patient is Asymptomatic
 Motor Control
 Mental Status
 Neurocognitive Testing
Testing Motor control3
 Gait, posture, hand movement
 Postural control is the recommended and easiest
 BESS, Rhomberg tests
Mental status testing3
 Sport Concussion Assessment Tool (SCAT3)
 Orientation questions
 SAC
 Loss of sensitivity of instrument 24 hours after injury
Neurocognitive testing3
 Used in conjunction with other testing not alone
 ImPACT
 Language and culture can have an impact
Return to play2,3
Did You Know Return to Play After
a Concussion Relates Impacts
More than Head and Neck
Symptoms???2
References
1. Concussion Legacy Foundation
http://concussionfoundation.org/learningcenter/concussion-checklist
2. Cantu, R. How to Best Manage a Concussion, Tulsa OK,
March 2016.
3. Broglio, SP, Cantu, RC, Gioia, GA, Guskiewicz, KM,
Kutcher, J, Palm M, Valovich McLeod TC. National Athletic
Trainers’ Association Position Statement: Management of
Sport Concussion. J Athl Train. 2014; 49: 245-265.
Questions?