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BRAIN HEALTH

iteration of a tool developed by the Concussion in Sport Group, an significant difference in concussion reduction. The exception may be the
international body that has convened multiple times over the last two well-fitted helmet, with padding over the zygoma/mandible, in Amer-
decades to review, update, and summarize the evidence and practice ican football. Several studies have reported a reduced rate or severity of
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surrounding concussion. This tool is a very robust but lengthy exam- concussions with these, and more studies are needed. Although there
ination and may be difficult to perform in a clinical setting with limit- have been well-publicized examples of professional athletes wearing the
ed time. To improve efficient clinical evaluation, Leddy et. al. detailed Guardian cap device over the helmet, to date the evidence is lacking to
an exam that helps the clinician conduct a brief but directed exam- show real-world concussion reduction in high school football.8
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ination in the office setting. If there is still a question, computerized
neurocognitive tests (e.g., ImPACT, Cogstate), exercise testing or Conclusion/Take-Home Points
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formal neuropsychological evaluation may help confirm the diagnosis. • Sport-related concussion is prevalent in all sports, and under-di-
agnosed.
Management • Prompt diagnosis improves outcomes, so the clinician should be
As management of concussion has evolved, the practice of placing familiar with diagnostic tools available.
concussed patients in a dark room (“cocooning”) has been replaced • When in doubt, sit them out.
with early controlled activity and light exercise to tolerance. Recent • Early, controlled physical activity and less daytime sleeping reduce
studies have shown that light exercise and reduction of screen time prolonged post-concussion symptoms.
(not elimination) within 48 hours of concussion can facilitate recov- • Serial examinations are important in determining progress or in
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ery, while sleep disturbances can prolong symptoms. In fact, longer identifying deterioration.
daytime sleep in adolescents in the week following a concussion led to • Most SRCs will resolve within four weeks.
a lower likelihood of symptom resolution in one study. • Return-to-learn should be facilitated with measures to reduce
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Most experts recommend modified activity, adequate nutrition symptoms in the learning environment.
and sleep hygiene, and serial evaluations with symptom scores/physical • Return-to-play strategies should follow the recommended 5-step
exam findings to help guide recovery. The 2022 Amsterdam Interna- graded process of progressive intensity and coordination.
tional Consensus on Concussion in Sport published several tools for • Future tools may include biomarkers and advanced imaging, but
clinicians to aid monitoring of concussion, including the sport concus- are not yet advanced enough to be useful in the clinical setting.
sion office assessment tool (SCOAT6) and one for children aged 7-12
(Child SCOAT6). Although the typical SRC will resolve within
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weeks, up to one-third of pediatric patients may experience symptoms References:
1. Broglio, S.P., Register-Mihalik, J.K., Guskiewicz, K.M., Leddy,
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beyond four weeks. J.J., Merriman, A., Valovich McLeod, T.C. National Athlet-
Once symptoms are beginning to resolve, the focus of the patient ic Trainers’ Association Bridge Statement: Management of
will typically shift to return to activities or return to play. For adoles- Sport-Related Concussion. J Athl Train. 2024 Mar 1;59(3):225-
cents, children and young adults, there should be emphasis on “return 242. doi: 10.4085/1062-6050-0046.22. PMID: 38530653;
PMCID: PMC10976337
to learn” (RTL) before return to play. Recent studies indicate that early 2. Conti, F., McCue, J.J., DiTuro, P., Galpin, A.J., Wood, T.R.
gradual physical and cognitive activity shortens the time to RTL. Aca- Mitigating Traumatic Brain Injury: A Narrative Review of
demic support may be helpful in this setting, and the clinician can Supplementation and Dietary Protocols. Nutrients. 2024 Jul
support this with a school note that recommends temporary academic 26;16(15):2430. doi: 10.3390/nu16152430. PMID: 39125311;
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modifications. Likewise, the return to sport (RTS) should be gradual PMCID: PMC11314487
and follow a 5-step graded return, from relative rest to full contact. 17 3. Cuff, S., Maki, A., Feiss, R., Young, J., Shi, J., Hautmann, A.,
Yang, J. Risk factors for prolonged recovery from concussion in
The Texas Education code (Section 38.157c) requires supervision of a young patients. Br J Sports Med. 2022 Dec;56(23):1345-1352.
return-to-play protocol for all student athletes and uses the example doi: 10.1136/bjsports-2022-105598. Epub 2022 Sep 14. PMID:
protocol provided by the Concussion in Sport Group.7 36104148
4. De Luigi, A.J., Bell, K.R., Bramhall, J.P., Choe, M., Dec, K., Fin-
Future Directions noff, J.T., Halstead, M., Herring, S.A., Matuszak, J., Raksin, P.B.,
Swanson, J., Millett, C. Consensus statement: An evidence-based
Since the Berlin Consensus conference in 2016, there has been review of exercise, rehabilitation, rest, and return to activity
a sharp increase in studies using advanced neuroimaging, blood bio- protocols for the treatment of concussion and mild traumatic
markers, genetic testing and newer technologies to diagnose concus- brain injury. PM R. 2023 Dec;15(12):1605-1642. doi: 10.1002/
sion and follow recovery. While some of these are promising and have pmrj.13070. Epub 2023 Nov 14. PMID: 37794736
potential to improve the care of concussion, at present the body of 5. Eliason, P.H., Galarneau, J.M., Kolstad, A.T., Pankow, M.P.,
West, S.W., Bailey, S., Miutz, L., Black, A.M., Broglio, S.P., Davis,
evidence is judged to be SORT level B (inconsistent or limited-quality G.A., Hagel, B.E., Smirl, J.D., Stokes, K.A., Takagi, M., Tuck-
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patient-oriented evidence). er, R., Webborn, N., Zemek, R., Hayden, A., Schneider, K.J.,
In addition, the prevention of concussion has been targeted as a Emery, C.A. Prevention strategies and modifiable risk factors for
focus of study. There have been quality studies showing the reduction sport-related concussions and head impacts: a systematic review
of concussion by implementation of rule changes and policies in youth and meta-analysis. Br J Sports Med. 2023 Jun;57(12):749-761.
doi: 10.1136/bjsports-2022-106656. PMID: 37316182
sports, use of mouth guards (specifically in ice hockey) and neuromus- 6. Gregory, A., Poddar, S. Diagnosis and Sideline Management of
cular warm-up programs.5 However, due to the anatomy of the brain Sport-Related Concussion. Clin Sports Med. 2021 Jan;40(1):53-
suspended inside the cranium, other external devices don’t often make a 63. doi: 10.1016/j.csm.2020.08.011. PMID: 33187613
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