Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

Abstract

Background Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. Objective To describe the current landscape of treatment for concussion and provide summary agreements related to treatment in order to assist clinicians in the treatment of concussion. Methods On October 14–16, 2015, the Targeted Evaluation & Active Management (TEAM) Approaches To Treating Concussion meeting was convened in Pittsburgh, Pennsylvania, USA. 37 concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research, and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. Results A total of 16 statements of agreement were supported covering: 1) Summary of the Current Approach to Treating Concussion, 2) Heterogeneity and Evolving Clinical Profiles of Concussion, 3) Targeted Evaluation and Active Management Approach to Concussion Treatment: Specific Strategies, and 4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97–100%. Conclusion Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies based on modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery following concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments.

Anxiety and mood clinical profile following sport-related concussion: From risk factors to treatment.

“…Rather, emerging research suggests that following the acute phase of the injury (i.e., 1 to 7 days of injury), athletes exhibit differing subtypes, or clinical profiles of SRC that are associated with particular patterns of symptoms and deficits (Collins et al, 2016; Henry, Elbin, Collins, Marchetti, & Kontos, 2016a; McCrory et al, 2013b). Researchers have proposed six clinical profiles of SRC including: anxiety/mood, post-traumatic migraine, oculomotor, vestibular, cervical, and cognitive fatigue that are briefly described in Table 1 (Collins et al, 2014a; Henry et al, 2016a; Reynolds, Collins, Mucha, & Troutman-Ensecki, 2014).…”

The Value of Speech-Language Pathologists in Concussion Management

“…Active rehabilitation is currently being assessed in larger clinical studies to determine if actively engaging studentathletes in specific tasks related to their symptoms helps them recover quicker. [5][6][7] What we are suggesting is a similar scaffolded model to follow for targeting cognitive symptoms monitored by an AT or school nurse. One possibility is that can we speed up recovery by providing active management using more targeted support and structured strategies instead of using a passive management model where we reintroduce and remove as needed up to return-to-learn or referred out.…”

“…Research is beginning to assess the importance of active rehabilitation for symptoms management and recovery from a concussion. [5][6][7] Also, recommended concussion management protocols follow a plan where a return-to-learn process occurs before returning to play (►Fig. 1).…”

“…SLPs have the skills and expertise to help provide strategies to address the symptoms of concussions that affect cognitive processing, attention, and focus. Active rehabilitation is being considered to be worthwhile by leaders in the field, [5][6][7] and SLPs may be a logical way to help scaffold active cognitive recovery following a concussive injury. 5 Typical recovery time for concussions is 7 to 10 days with evidence that adolescents may take longer.…”

“…Active rehabilitation is being considered to be worthwhile by leaders in the field, [5][6][7] and SLPs may be a logical way to help scaffold active cognitive recovery following a concussive injury. 5 Typical recovery time for concussions is 7 to 10 days with evidence that adolescents may take longer. 1 In cases where concussion symptoms last more than 10 to 14 days, student-athletes are often referred to neuropsychologists or concussion specialists for comprehensive assessment and care.…”