Sports Concussion Management: Part II

Abstract

Millions of concussions occur every year in the United States. The public interest in concussion has increased after a number of high-profile deaths in high school athletes from sports-related head trauma and in some professional athletes from chronic traumatic encephalopathy. One of the most active areas of research in sports medicine during the last decade has been the evaluation and management of concussion. In this second article of a two-part series, we provide an overview of the latest scientific advances in concussion research. This overview includes an update on the pathobiological changes that occur during concussion and the results of biomechanical studies. In addition, to aid the practicing clinician, we review the literature on proven and currently studied concussion risk factors, including a history of concussion, fatigue, and age. Genetic polymorphisms and biomarkers may provide risk-prediction capability, but at present the research remains inconclusive. Diffusion tensor imaging and functional magnetic resonance imaging are promising technologies that reveal more sophisticated data about the impact of concussion on the brain. We review the existing literature on the application of these neuroimaging modalities to sports concussion. An update from the Fourth International Conference on Concussion in Sport, with highlights of new recommendations, and the presentation of the third edition of the Sports Concussion Assessment Tool to evaluate acute concussion, concludes our review.

The Timing of Cognitive and Physical Rest and Recovery in Concussion

“…There are no randomized studies evaluating the optimal time for stopping cognitive and physical rest or the effect of having a patient return to school while still symptomatic. 10 –16…”

“…8 Many authors have pointed out that there are no randomized studies to support the different recommendation concerning how long to maintain cognitive and physical rest. 9 –16 There is 1 randomized study looking at the benefit of 5 days of rest versus 1 or 2 days immediately after injury. 17 They found the longer period of cognitive and physical rest was not beneficial.…”

Tintin's travel traumas: Health issues affecting the intrepid globetrotter

“…In the medical literature, concussion is defined as mild traumatic brain injury, mild brain injury or mild head injury, which are all synonymous. Many systems measure the severity, or grade, of concussion but there is little agreement over the best [6,7]. We therefore used an "Hergé'' grading system after considering the clinically evident post-traumatic signs (symbols surrounding Tintin's head after trauma): stars (grade I), whirls or candles (grade II), and LoC (grades III and IV according to duration).…”