Results from these tests should be interpreted in light of all other aspects of the injury (physical exam, age, sex, history of previous concussion, etc) to guide the decision on returning to play.11,12 After neurological and balance symptoms have resolved, noncontact exercise may be allowed. When neuropsychological testing has returned to preseason baseline, full contact may be permitted.
Athletes, their families, trainers, and coaches should be educated about concussions so that they are better equipped to both identify and report symptoms. Care for injured athletes should also include education about the long-term effects of multiple concussions.12
Recommendations from others
The 2nd International Conference on Concussion in Sport, Prague 200411 (emphasis added) recommended the following stages of recovery from a concussion:
- No activity, complete rest. Once asymptomatic, proceed to level 2
- Light aerobic exercise such as walking or stationary cycling, no resistance training
- Sport-specific exercise (eg, skating in hockey, running in soccer), progressive addition of resistance training at steps 3 or 4
- Noncontact training drills
- Full contact training after medical clearance
- Game play.
The National Athletic Training Association recommendations are:12
- Increase in education of staff working directly with athletes
- Increase in documentation about events surrounding and subsequent to the concussion
- Initial baseline testing for high-risk sports
- No single test should be use exclusively for return to play, as concussions can present in different ways
- Evaluations by athletic trainers or team physician after concussion Q 5 minutes
- Athletes symptomatic at rest and after exertion for 20 minutes (sprinting, push-ups) should be disqualified for that event
- Pediatric patients should have more strict/prolonged recovery periods.
- Wake athletes from sleep at home only if there has been loss of consciousness, prolonged amnesia, or significant symptoms