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Return to Play after Concussion

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1. Acute plasma tau relates to prolonged return to play after concussion. Full Text available with Trip Pro

Acute plasma tau relates to prolonged return to play after concussion. To determine whether tau changes after sport-related concussion (SRC) relate to return to play (RTP).Collegiate athletes underwent preseason plasma sampling and cognitive testing and were followed. After a SRC (n = 46), athletes and controls (n = 37) had sampling at 6 hours, and at 24 hours, 72 hours, and 7 days after SRC. A sample of 21 nonathlete controls were compared at baseline. SRC athletes were grouped by long (>10 (...) days, n = 23) and short (≤10 days, n = 18) RTP. Total tau was measured using an ultrasensitive immunoassay.Both SRC and athlete controls had significantly higher mean tau at baseline compared to nonathlete healthy controls (F101,3 = 19.644, p < 0.01). Compared to SRC athletes with short RTP, those with long RTP had higher tau concentrations overall, after controlling for sex (F39,1 = 3.59, p = 0.022), compared to long RTP athletes, at 6 (p < 0.01), 24 (p < 0.01), and 72 hours (p = 0.02). Receiver

2017 Neurology

2. Reconsidering Return-to-Play Times: A Broader Perspective on Concussion Recovery Full Text available with Trip Pro

Reconsidering Return-to-Play Times: A Broader Perspective on Concussion Recovery Return-to-play protocols describe stepwise, graduated recoveries for safe return from concussion; however, studies that comprehensively track return-to-play time are expensive to administer and heavily sampled from elite male contact-sport athletes.To retrospectively assess probable recovery time for collegiate patients to return to play after concussion, especially for understudied populations, such as women (...) and nonelite athletes.Cohort study; Level of evidence, 3.Medical staff at a military academy logged a total of 512 concussion medical records over 38 months. Of these, 414 records included complete return-to-play protocols with return-to-play time, sex, athletic status, cause, and other data.Overall mean return to play was 29.4 days. Sex and athletic status both affected return-to-play time. Men showed significantly shorter return to play than women, taking 24.7 days (SEM, 1.5 days) versus 35.5 days (SEM

2018 Orthopaedic journal of sports medicine

3. Patient, Injury, Assessment, and Treatment Characteristics and Return-to-Play Timelines After Sport-Related Concussion: An Investigation from the Athletic Training Practice-Based Research Network. (Abstract)

Patient, Injury, Assessment, and Treatment Characteristics and Return-to-Play Timelines After Sport-Related Concussion: An Investigation from the Athletic Training Practice-Based Research Network. To describe the patient, injury, assessment and treatment characteristics, as well as return-to-play timelines and clinical findings at discharge for adolescent patients after sport-related concussion.Retrospective analysis of electronic medical records.Athletic training facilities of secondary school (...) members of the Athletic Training Practice-Based Research Network (AT-PBRN).In total, 1886 patient records were reviewed. [1204 (63.8%) male, 682 (36.2%) female, age = 15.3 ± 1.9 years, height = 169.5 ± 13.5 cm, mass = 70.3 ± 17.0 kg]. Patients were diagnosed with a concussion by an athletic trainer or team/directing physician.None.Descriptive analysis of patient, injury, assessment, treatment, and participation status characteristics, as well as discharge information.Injury demographic forms were

2019 Clinical Journal of Sport Medicine

4. Multiple Concussions Increase Odds and Rate of Lower Extremity Injury in National Collegiate Athletic Association Athletes After Return to Play. (Abstract)

Multiple Concussions Increase Odds and Rate of Lower Extremity Injury in National Collegiate Athletic Association Athletes After Return to Play. Concussion in collegiate athletics is one of the most prevalent sport-related injuries in the United States, with recent studies suggesting persistent deficits in neuromuscular control after a concussion and an associated increase in risk of lower extremity injury.To expand on the relationship between concussion and lower extremity injury by examining (...) the effect of multiple concussions (MC) on rate and odds of future lower extremity injury in collegiate athletes after return to play (RTP) compared with matched controls.Cohort study; Level of evidence, 3.From 2001 to 2016, 48 National Collegiate Athletic Association Division I athletes sustaining multiple concussions at a single institution were identified. Athletes with multiple concussions (MC) were matched directly to athletes with a single concussion (SC) and to athletes with no concussion history

2019 American Journal of Sports Medicine

5. Return to play and risk of repeat concussion in collegiate football players: comparative analysis from the NCAA Concussion Study (1999-2001) and CARE Consortium (2014-2017). (Abstract)

Return to play and risk of repeat concussion in collegiate football players: comparative analysis from the NCAA Concussion Study (1999-2001) and CARE Consortium (2014-2017). We compared data from the National Collegiate Athletic Association (NCAA) Concussion Study (1999-2001) and the NCAA-Department of Defense Concussion Assessment, Research and Education (CARE) Consortium (2014-2017) to examine how clinical management, return to play (RTP) and risk of repeat concussion in collegiate football (...) difference=50.82 days; 95% CI 38.37 to 63.27; p<0.0001).Our findings indicate that concussion in collegiate football is managed more conservatively than 15 years ago. These changes in clinical management appear to have reduced the risk of repetitive concussion during the critical period of cerebral vulnerability after sport-related concussion (SRC). These data support international guidelines recommending additional time for brain recovery before athletes RTP after SRC.© Author(s) (or their employer(s

2019 British Journal of Sports Medicine

6. Return to Play after Concussion

Return to Play after Concussion Return to Play after Concussion Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Return to Play after (...) Concussion Return to Play after Concussion Aka: Return to Play after Concussion , Concussion Return to Play Guidelines , Graded Return to Play after Concussion From Related Chapters II. Precautions See Early return to play (especially for under age 20 years) risks Patient, parents and coaches should be notified of stipulations and concerns regarding return to play Guidelines are best applied to ages 13 years and older Athletes younger than 13 should be evaluated with greater caution III. Evaluation

2018 FP Notebook

7. Concussion in American Versus European Professional Soccer: A Decade-Long Comparative Analysis of Incidence, Return to Play, Performance, and Longevity. (Abstract)

Concussion in American Versus European Professional Soccer: A Decade-Long Comparative Analysis of Incidence, Return to Play, Performance, and Longevity. The incidence and effect of sports-related concussions (SRCs) within the global sport of professional soccer is poorly described.To comparatively examine the effects of SRC on athletes in Major League Soccer (MLS) and the English Premier League (EPL) in terms of incidence, return to play (RTP), performance, and career longevity.Cohort study (...) performance in terms of games started, assists, shots on goal, and total shots after concussion was significantly reduced at all nongoalie positions for players in the EPL; however, MLS nongoalie positions with concussion had no significant decreases in these categories. Goalies in both leagues had no significant change in performance or games started. The probability of playing a full season after concussion was not significantly decreased when compared with the uninjured pool in both leagues.This study

2019 American Journal of Sports Medicine

8. Standards for post-concussion care from diagnosis to the interdisciplinary concussion clinic

, and later providing clearance for return to work/school/play. In some cases a nurse practitioner (NP) will be the available medical provider. Nurse practitioners are primary care providers who can diagnose concussion. There are some limitations to NPs that ONF Standards for Post- Concussion Care 18 preclude them for having all of these responsibilities without an involved physician, namely independently ordering imaging (MRI, CT, cervical spine x-rays) when required, and prescription medications (...) and/or would indicate a diagnosis other than concussion. They can assess for readiness and supports required for return to work/school/play but clearance must be provided by a medical practitioner. Physicians and nurse practitioners will need to have completed the necessary training and educational materials so that they are appropriately prepared to act as the primary care provider coordinating and managing post-concussion care. This training should involve knowledge of Clinical Practice Guidelines

2017 CPG Infobase

9. Sex Differences in Time to Return-to-Play Progression After Sport-Related Concussion Full Text available with Trip Pro

Sex Differences in Time to Return-to-Play Progression After Sport-Related Concussion Recently, female sports participation has increased, and there is a tendency for women to experience more symptoms and variable presentation after sport-related concussion (SRC). The purpose of this study was to determine whether sex differences exist in time to begin a return-to-play (RTP) progression after an initial SRC.After initial SRC, female athletes (11-20 years old) would take longer to begin an RTP (...) of initiation of RTP progression. Participants with a history of more than 1 concussion or injury sustained from non-sport-related activity were excluded.Despite American football having the greatest percentage (49.2%) of sport participation, female athletes took significantly longer to start an RTP progression after an initial SRC (29.1 ± 26.3 days) compared with age-matched male athletes (22.7 ± 18.3 days; P = 0.002).On average, female athletes took approximately 6 days longer to begin an RTP progression

2016 Sports health

10. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Sport-Related Concussion/mTBI

professional using a sideline assessment tool (e.g., SCAT5 - Appendix ). Non-medical professionals should use the Sport Concussion Recognition Tool (Appendix ). (C) The player should not be left alone following the injury, and serial monitoring for increasing symptoms or signs of deterioration is essential over the initial few hours after injury with the aim of detecting an evolving injury. (C) A player with suspected SRC should not be allowed to return-to-play on the day of injury. (C) Taken from McCrory (...) to diagnose, assess and manage. 1 Sport-related concussion/ mTBIs can occur in any population playing sport. A concussion/mTBI injury is more likely to occur when the force or impact suffered is not anticipated by the athlete. Concussion/mTBI’s are more likely to occur in contact sports, with the highest incidences (excluding combat sports) being in soccer, football, ice hockey, rugby and basketball. 2,3 However, nonsport- related concussion/mTBI’s also occur in athletes, and can impact their return

2018 Ontario Neurotrauma Foundation

11. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Diagnosis/Assessment of Concussion/mTBI

into consideration when interpreting the score. Athletes do not have to be at a total score of zero to return to play if they already have had some symptoms prior to their concussion Instructional Video Available? No Ease of Use (By Patient) Very Difficult 1 2 3 4 5 Very Easy Ease of Administration (By Administrator) Very Difficult 1 2 3 4 5 Very Easy Other Comments *** Appendix F Other Links/Resources Table 1.1 Risk Factors Influencing Recovery Post mTBI Table 1.2 Key Features of mTBI Assessment in an Emergency (...) the medical assessment has excluded more severe forms of TBI, these patients should be presumed to have sustained a concussion/mTBI and be managed accordingly. The severity of a person’s symptoms in the initial few days after a TBI is the strongest and most consistent predictor of slower recovery, and demonstrates clinical utility in tracking recovery. 7 Therefore, symptoms should be formally documented at the time of the initial assessment for the purpose of subsequent comparative analysis in the event

2018 Ontario Neurotrauma Foundation

12. Sport-Related Concussions: Symptom Recurrence After Return to Exercise Full Text available with Trip Pro

Sport-Related Concussions: Symptom Recurrence After Return to Exercise Current guidelines dictate a gradual exercise progression after a concussion; however, it is unclear what proportion of athletes experience a recurrence of symptoms once they are symptom free at rest. Estimating the proportion of athletes and predictors of symptom recurrence would help shape return-to-play protocols.To determine the proportion and associated risk factors of athletes who have a recurrence of concussion (...) symptoms with exercise after being symptom free at rest.Case-control study; Level of evidence, 3.Between October 1, 2009 and July 31, 2011, we studied patients from a sport concussion clinic located within a tertiary care regional children's hospital. Patients were queried at every visit using a standardized questionnaire. Our main outcome variable was recurrence of symptoms with exercise after being symptom free at rest at some point in their recovery. Cofactors included age, sex, loss

2017 Orthopaedic journal of sports medicine

13. Premature return to play and return to learn after a sport-related concussion: Physician’s chart review Full Text available with Trip Pro

Premature return to play and return to learn after a sport-related concussion: Physician’s chart review To determine what proportion of patients experience an exacerbation of their symptoms as a result of premature return to play (RTP) and return to learn (RTL) following sport-related concussions.Retrospective study of electronic medical records from the office-based practice of one family and sport medicine physician who had systematically provided recommendations for cognitive and physical (...) rest based on existing consensus recommendations. Two blinded authors independently reviewed each chart, which included Sport Concussion Assessment Tool (SCAT) and SCAT2 symptom self-report forms to determine whether an athlete had returned to play or learn prematurely. If there was a discrepancy between the 2 reviewers then a third author reviewed the charts.A sport medicine and family practice in Ontario. The physician assessed sport-related concussions after self-referral or referral from other

2014 Canadian Family Physician

14. Concussion Symptoms and Return to Play Time in Youth, High School, and College American Football Athletes. Full Text available with Trip Pro

levels in the mean number of reported symptoms. Logistic regression models estimated the odds of return to play at less than 24 hours and at least 30 days.Overall, 1429 sports-related concussions were reported among youth, high school, and college-level football athletes with a mean (SD) of 5.48 (3.06) symptoms. Across all levels, 15.3% resulted return to play at least 30 days after the concussion and 3.1% resulted in return to play less than 24 hours after the concussion. Compared with youth (...) , a higher number of concussion symptoms were reported in high school athletes (β = 1.39; 95% CI, 0.55-2.24). Compared with college athletes, the odds of return to play at least 30 days after injury were larger in youth athletes (odds ratio, 2.75; 95% CI, 1.10- 6.85) and high school athletes (odds ratio, 2.89; 95% CI, 1.61-5.19). The odds of return to play less than 24 hours after injury were larger in youth athletes than high school athletes (odds ratio, 6.23; 95% CI, 1.02-37.98).Differences

2016 JAMA pediatrics

15. Use of the stepwise progression return-to-play protocol following concussion among practicing athletic trainers Full Text available with Trip Pro

Use of the stepwise progression return-to-play protocol following concussion among practicing athletic trainers The purpose of this study was to determine whether practicing athletic trainers (ATs) were using the stepwise progression to make return-to-play (RTP) decisions after concussion and to determine what factors influenced their decision to use the stepwise progression.A total of 166 ATs (response rate = 16.6%) completed a 21-item questionnaire that evaluated participant demographics (...) this study are employing the stepwise progression to safely return athletes to play after sustaining a concussion. This demonstrates that ATs are providing a standard of care for concussed athletes across various athletic training settings; however, having a graduate degree and treating more concussions per year are predictors of whether an AT follows all steps of the stepwise progression.

2016 Journal of sport and health science

16. Functional Connectivity Is Altered in Concussed Adolescent Athletes Despite Medical Clearance to Return to Play: A Preliminary Report Full Text available with Trip Pro

be aberrant in recently concussed, asymptomatic athletes who had been cleared to return to play. A seed-based FC analysis measured the FC of the default mode network (DMN) (seeds = anterior cingulate cortex, posterior cingulate cortex (PCC), right lateral parietal cortex, and left lateral parietal cortex) 30 days after SRC in asymptomatic high school athletes cleared to return to play (n = 13) and was compared to the FC of high school athletes with orthopedic injury (OI) (n = 13). The SRC group (...) Functional Connectivity Is Altered in Concussed Adolescent Athletes Despite Medical Clearance to Return to Play: A Preliminary Report Recovery following sports-related concussion (SRC) is slower and often more complicated in young adolescent athletes than in collegiate players. Further, the clinical decision to return to play is currently based on symptoms and cognitive performance without direct knowledge of brain function. We tested the hypothesis that brain functional connectivity (FC) would

2016 Frontiers in neurology

17. Guidelines for diagnosing and managing pediatric concussion

/adolescent return to learn/play?) Number Evidence 4.1 Recommend that the child/adolescent follow a stepwise return-to-learn plan. B/C 4.2 Develop a return-to-learn program after acute symptoms have improved. B/C 4.3 Recommend additional assessment and accommodations if symptoms worsen or fail to improve. B/C 4.4 Develop a return-to-play program only after the child/adolescent has started his/her return-to-learn program. B 4.5 Refer any child/adolescent who has sustained multiple concussions to an expert (...) in sport concussion to help with return-to-play decisions and/or retirement from contact sports. B 3.1 Provide verbal information and written handouts to the child/adolescent and the parents and/or caregivers. A/B On Re-assessment after one month (what do we do next if the child/adolescent still has symptoms?) Number Evidence 5.1 Assess any modifiers that may delay recovery. B 5.2 Make sure the child/adolescent is not taking any medication that might mask or modify the symptoms. B 5.3 Assess, document

2019 CPG Infobase

18. Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury

Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury Clinical Practice Guidelines CATHERINE C. QUATMAN-YATES, PT , DPT , PhD • AIRELLE HUNTER-GIORDANO, PT , DPT KATHY K. SHIMAMURA, PT , DPT , NCS, OCS, CSCS, FAAOMPT • ROB LANDEL, PT , DPT , FAPTA BARA A. ALSALAHEEN, PT , PhD • TIMOTHY A. HANKE, PT , PhD • KAREN L. McCULLOCH, PT , PhD, FAPTA Physical Therapy Evaluation and Treatment After Concussion/ Mild Traumatic Brain Injury Clinical Practice Guidelines (...) , deconditioning, or general fitness may play in symptoms (eg, headache, fatigue, fogginess). F Physical therapists may conduct exertional tests for pa- tients who have experienced a concussive event and do not report symptoms indicative of exertional intolerance in order to rule out subtle autonomic dysfunction in response to exertion, establish initial postconcussion performance level, and identify exertional targets for aerobic exercise training that may be incor- porated to promote brain health and healing

2020 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

19. E-edition: Return to Play

or accommodations should be followed? A systematic review Laura K Purcell, Gavin A Davis, Gerard A Gioia BLOG – Return to Learn (RTL) and Return to Sport (RTS) Protocols for Youth Athletes and Our Proposed Coordinated Return Protocol INFOGRAPHIC – CONSENSUS STATEMENT ON CONCUSSION IN SPORT: GRADUATED RETURN-TO-SPORT STRATEGY @YLMSportScience External – Review – Return to Throwing after Shoulder or Elbow Injury Terrance A. Sgroi, John M. Zajac PODCAST – To risk, or not to risk: the return to play dilemma Prof (...) E-edition: Return to Play E-edition: Return to Play | BJSM blog - social media's leading SEM voice by This was first seen on the BJSM Website. Following the success of our Pain e-journal, the BJSM digital team has curated a special Return to Play edition . This follows on from our July 2016 virtual conference ( ). Our aim is to present quality updates on a host of areas including ACL rehabilitation, Achilles rupture and concussion. Once again we utilise the benefits of going online to link

2019 British Journal of Sports Medicine Blog

20. Living Guideline for Diagnosing and Managing Pediatric Concussion

2.2 Provide verbal information and written (electronic) handouts regarding the course of recovery and when the child/adolescent can return-to-school/activity/sport/work. 2.3 Recommend graduated return to cognitive and physical activity to promote recovery. 2.3a Recommend an initial 24-48 hour period of rest with limited physical and cognitive activity. 2.3b Recommend that low to moderate level physical and cognitive activity be gradually started 24- 48 hours after a concussion at a level that does (...) or has not completed the return-to-school or return-to-sport/activity stages. Recommend an immediate medical follow-up in the presence of any deterioration. Domain 4. Medical Clearance for Full-Contact Sport or High-Risk Activity 4.1 Consider patients for medical clearance to return to full-contact activities and sport/game play if clinical criteria have been met. 7 Guideline for Diagnosing and Managing Pediatric Concussion – Recommendations / Tools 4.2 Provide patients with a letter indicating

2019 Ontario Neurotrauma Foundation

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