Postconcussive Syndrome Following Sports-Related Concussion
Postconcussive Syndrome Following Sports-Related Concussion
The ultimate goal of treating PCS is to safely return the athlete to activity. As mentioned earlier, the majority of patients will do so within 1 week; however, patients with prolonged symptoms may struggle to return to athletic and academic activity. In student athletes, return to learn is an important step for which there are no standardized guidelines and which should be individualized to the patient. Successful implementation of academic accommodations require good communication between the provider and the academic institution and include shortened school days, decreased work load, more time to complete tasks, the avoidance of excessive testing or standardized examinations, and a return to the learning environment as tolerated. Furthermore, the CDC has developed educational programs for school administrators/educators as well as the athlete and his or her parents that are available on the CDC Web site (http://www.cdc.gov/headsup/basics/index.html). There is more guidance for returning an athlete to play, with recommendations for complete symptom resolution while off any medications for concussion-related symptoms, normal neurologic examination, normal performance on neurocognitive assessments, and normal academic participation before initiating a return-to-play protocol. Once an athlete has met these criteria, the next step is to initiate a return-to-play protocol that will take place over 5 to 6 days, advancing physical challenges related to his or her respective sport every 24 hours. In general the athlete will progress from no activity to light aerobic activity, sport-specific exercise, noncontact training, and finally full-contact practice with an assessment of normal performance and no return of symptoms immediately and over 24 hours to progress. Incorporating a customized protocol to the athlete's sport is desirable when available and will allow for a more accurate assessment of the athlete's ability to return to full sport without symptoms. Supervision of this protocol by a trained professional (eg, athletic trainer) is ideal but not always available. As with return to learn, there is good-quality information available for athletes, parents, coaches, and trainers on appropriate return-to-play protocols via the CDC Web site.
As of January 2014, concussion laws had been adopted by all 50 states. There is variation regarding what these laws require from state to state; however, education of coaches, students, and parents, as well as the removal of any athlete with suspected concussion from play with no return until medical clearance is completed are pervasive concepts. Beyond these suggestions, there is much more variability regarding specification of ages, requirements to collect concussion data, use of CDC concussion information, and requirements for return-to-learn accommodations. Familiarity with concussion laws in a provider's state is paramount in the management of patients with PCS. Information can be reviewed on the Children's Safety Network Web site (http://www.childrenssafetynetwork.org/publications/state-laws-concerning-sport-related-concussions-among-youth) or state-specific sites dedicated to concussion laws.
Return to Activity
The ultimate goal of treating PCS is to safely return the athlete to activity. As mentioned earlier, the majority of patients will do so within 1 week; however, patients with prolonged symptoms may struggle to return to athletic and academic activity. In student athletes, return to learn is an important step for which there are no standardized guidelines and which should be individualized to the patient. Successful implementation of academic accommodations require good communication between the provider and the academic institution and include shortened school days, decreased work load, more time to complete tasks, the avoidance of excessive testing or standardized examinations, and a return to the learning environment as tolerated. Furthermore, the CDC has developed educational programs for school administrators/educators as well as the athlete and his or her parents that are available on the CDC Web site (http://www.cdc.gov/headsup/basics/index.html). There is more guidance for returning an athlete to play, with recommendations for complete symptom resolution while off any medications for concussion-related symptoms, normal neurologic examination, normal performance on neurocognitive assessments, and normal academic participation before initiating a return-to-play protocol. Once an athlete has met these criteria, the next step is to initiate a return-to-play protocol that will take place over 5 to 6 days, advancing physical challenges related to his or her respective sport every 24 hours. In general the athlete will progress from no activity to light aerobic activity, sport-specific exercise, noncontact training, and finally full-contact practice with an assessment of normal performance and no return of symptoms immediately and over 24 hours to progress. Incorporating a customized protocol to the athlete's sport is desirable when available and will allow for a more accurate assessment of the athlete's ability to return to full sport without symptoms. Supervision of this protocol by a trained professional (eg, athletic trainer) is ideal but not always available. As with return to learn, there is good-quality information available for athletes, parents, coaches, and trainers on appropriate return-to-play protocols via the CDC Web site.
As of January 2014, concussion laws had been adopted by all 50 states. There is variation regarding what these laws require from state to state; however, education of coaches, students, and parents, as well as the removal of any athlete with suspected concussion from play with no return until medical clearance is completed are pervasive concepts. Beyond these suggestions, there is much more variability regarding specification of ages, requirements to collect concussion data, use of CDC concussion information, and requirements for return-to-learn accommodations. Familiarity with concussion laws in a provider's state is paramount in the management of patients with PCS. Information can be reviewed on the Children's Safety Network Web site (http://www.childrenssafetynetwork.org/publications/state-laws-concerning-sport-related-concussions-among-youth) or state-specific sites dedicated to concussion laws.
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