Consensus Statement on Concussion in Sport – the 3rd International Conference on Concussion in Sport held in Zurich, November 2008

McCrory, Paul; Meeuwisse, Willem; Johnston, Karen; Dvořák, Jiří; Aubry, Mark; Molloy, Michael G.; Cantu, Robert C.

doi:10.17159/2078-516x/2009/v21i2a296

Cited by 523 publications

(1,170 citation statements)

References 52 publications

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“…[4][5][6][7] Because human data on postinjury exertion is limited, expert consensus recommends 24 to 48 hours of rest before beginning a stepwise return to activity. 8 Many clinicians recommend a longer period of rest, and some clinicians have advocated "cocoon therapy," which restricts patients to several days in a darkened room before slowly returning to activity. 9 To date, the optimal period of rest after concussion remains unknown.…”

Section: What This Study Addsmentioning

confidence: 99%

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

et al. 2015

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OBJECTIVES: To determine if recommending strict rest improved concussion recovery and outcome after discharge from the pediatric emergency department (ED).METHODS: Patients aged 11 to 22 years presenting to a pediatric ED within 24 hours of concussion were recruited. Participants underwent neurocognitive, balance, and symptom assessment in the ED and were randomized to strict rest for 5 days versus usual care (1-2 days rest, followed by stepwise return to activity). Patients completed a diary used to record physical and mental activity level, calculate energy exertion, and record daily postconcussive symptoms. Neurocognitive and balance assessments were performed at 3 and 10 days postinjury. Sample size calculations were powered to detect clinically meaningful differences in postconcussive symptom, neurocognitive, and balance scores between treatment groups. Linear mixed modeling was used to detect contributions of group assignment to individual recovery trajectory.RESULTS: Ninety-nine patients were enrolled; 88 completed all study procedures (45 intervention, 43 control). Postdischarge, both groups reported a 20% decrease in energy exertion and physical activity levels. As expected, the intervention group reported less school and after-school attendance for days 2 to 5 postconcussion (3.8 vs 6.7 hours total, P , .05). There was no clinically significant difference in neurocognitive or balance outcomes. However, the intervention group reported more daily postconcussive symptoms (total symptom score over 10 days, 187.9 vs 131.9, P , .03) and slower symptom resolution.CONCLUSIONS: Recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care. Adolescents' symptom reporting was influenced by recommending strict rest. WHAT'S KNOWN ON THIS SUBJECT:Expert consensus recommends rest after concussion with stepwise return to activity. Animal and retrospective human data suggest that early mental and physical activity may worsen outcome. There are no pediatric studies testing the efficacy of recommending strict rest after concussion. WHAT THIS STUDY ADDS:Recommending strict rest postinjury did not improve outcome and may have contributed to increased symptom reporting. Usual care (rest for 1-2 days with stepwise return to activity) is currently the best discharge strategy for pediatric mild traumatic brain injury/concussion. Dr Thomas developed the study concept and design, obtained funding, supervised the study, acquired data, analyzed and interpreted data, and drafted and revised the manuscript; Dr Apps assisted with study concept and design, supervised the study, provided technical support, analyzed and interpreted data, and critically revised the manuscript; Dr Hoffmann assisted with study design, analyzed data, provided statistical expertise, and critically revised the manuscript; Dr McCrea assisted with study design, analyzed and interpreted data, provided technical support, and critically revised the manuscript; Dr Hammeke assisted with study concept and ...

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Section: What This Study Addsmentioning

confidence: 99%

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

et al. 2015

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“…To progress through these stages, the athlete must remain symptom free. 1,4,5 However, recent research has identified that balance dysfunction and cognitive deficits persist well beyond the physical symptoms of the recovery process. 5 The length of recovery following a concussion varies, lasting anywhere from 1 week to several months.…”

Section: Discussionmentioning

confidence: 99%

“…It is a complex pathophysiological process leading to a wide array of symptoms. 1 It is the common result of a direct blow to the head in contact sports; however, it can be a consequence of collisions and falls. It can also be the result of a whiplash-type injury without a direct blow to the head.…”

Section: Introductionmentioning

confidence: 99%

Chiropractic Management of Musculoskeletal Symptoms in a 14-Year-Old Hockey Player With Postconcussion Symptoms: A Case Report

Olson

Tunning

Boesch

2016

Journal of Chiropractic Medicine

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Objective: The purpose of this study is to describe the chiropractic management of a student athlete with postconcussion syndrome. Clinical Features: A 14-year-old male hockey player presented to a chiropractic clinic with postconcussion symptoms 13 days after his initial injury. He experienced an occipital headache with a pain rating of 8/10, upset stomach, blurry vision, nausea, dizziness, balance problems, a "foggy feeling," difficulty with concentration, difficulty with memory, fatigue, confusion, drowsiness, and irritability. Prior to seeing the doctor of chiropractic, the patient was monitored by a medical doctor, and the care he had been receiving was in accordance with current concussion guidelines. At the time of presentation to the chiropractic clinic, he had failed to progress toward return to play, and his computerized neurocognitive testing scores had not improved. Intervention and Outcome: Chiropractic manipulative therapy, myofascial release, instrument-assisted soft tissue technique, and therapeutic exercises were provided over 5 treatments spanning a 20-day period. The patient followed up each treatment with ImPACT testing. At the conclusion of the treatments, the patient's computerized neurocognitive testing scores had improved, and the patient was returned to play. Conclusion: This case demonstrates the improvement of postconcussion syndrome in a 14-year-old male hockey player under chiropractic management. (J Chiropr Med 2016;15:208-213)

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“…5,[9][10][11][12][13] This treatment method has been shown to decrease symptoms with time and reduce the risk of reinjury in athletes. 1,[10][11][12]16 In this case, the patient's mTBI symptoms interfered with her work duties and daily activities. Often, her daily tasks also increased the intensity and frequency of her symptoms, but she was unable to discontinue aggravating activities due to being unable to be away from work.…”

Section: Discussionmentioning

confidence: 99%

“…8 Consistently, the literature reports rest as the most common treatment method for mTBI symptoms. 5,[9][10][11][12][13] Symptom education and material on future prevention are also commonly given as postconcussive treatment especially in an athletic population where return to play is a major focus. 6,13 Although rest and education have been found to reduce some mTBI symptoms, these can be insufficient as a treatment strategy in an adult, working population where symptoms often can be triggered by occupational duties and can greatly impact daily activities.…”

Section: Introductionmentioning

confidence: 99%

Management of Mild Traumatic Brain Injury Symptoms in a 31-Year-Old Woman Using Cervical Manipulation and Acupuncture: A Case Report

Gergen¹

2015

Journal of Chiropractic Medicine

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Objective: The objective was to describe chiropractic and acupuncture care of a patient with acute mild traumatic brain injury (mTBI) symptoms. Clinical Features: A 31-year-old woman had acute neck pain, headache, dizziness, nausea, tinnitus, difficulty concentrating, and fatigue following a fall. She was diagnosed at an urgent care facility with mTBI immediately following the fall. Pharmaceutical intervention had been ineffective for her symptoms. Intervention and Outcome: The patient was treated with chiropractic adjustments characterized as high velocity, low amplitude thrusts directed to the cervical spine and local acupuncture points in the cervical and cranial regions. The patient received care for a total of 8 visits over 2.5 weeks with resolution of concussive symptoms. Conclusion: This patient with mTBI responded favorably to a conservative treatment protocol with the combination of chiropractic and acupuncture care.

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Consensus Statement on Concussion in Sport – the 3rd International Conference on Concussion in Sport held in Zurich, November 2008

Abstract: No Abstract.

Cited by 523 publications

References 52 publications

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

Chiropractic Management of Musculoskeletal Symptoms in a 14-Year-Old Hockey Player With Postconcussion Symptoms: A Case Report

Management of Mild Traumatic Brain Injury Symptoms in a 31-Year-Old Woman Using Cervical Manipulation and Acupuncture: A Case Report

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