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Paper Examines Consensus Guidelines for Concussed Youth-Athletes

Three major sets of sports-related concussion guidelines and/or position statements were released this year by the American Medical Society for Sports Medicine, the American Academy of Neurology, and the Zurich Consensus working group. (See here for coverage of the Zurich statement and here for coverage of the AAN's position statement.)

A new paper published online Monday in the Journal of Neurotrauma examines similarities among those three sets of guidelines to determine what consensus exists among medical experts.

All three groups recommended that:

  • Any athlete suspected of having a concussion should not be allowed to play on the day he or she sustained the injury.
  • Concussed athletes should not return to play until having been examined by a licensed medical professional.
  • Even after receiving medical clearance to return to athletic activity, there should be a gradual, stepwise increase in physical activity.

All three groups agreed that a past history of concussions constituted a risk factor for subsequent concussions. Each additionally expressed the belief that no single test can determine whether a concussion has occurred, but preseason baseline neuropsychological tests can aid in the diagnosis of a concussion.

When it comes to a concussed youth-athlete returning to athletic activity or schoolwork, all three groups expressed the belief that each student must be evaluated on a case-by-case basis. Much like how certain people can bounce back from physical injuries more quickly than others (see: Peterson, Adrian), there isn't a specific timeline that all concussed youths will follow.

The Zurich statement, for instance, suggested that as a student-athlete recovers from a concussion, "school attendance and activities may also need to be modified to avoid provocation of symptoms." The AMSSM similarly recommended that while recovering from a concussion, "students will require cognitive rest and may require academic accommodations such as reduced workload and extended time for tests while recovering from concussion."

All three groups did agree that clearance by a licensed medical professional is the first prerequisite for allowing a concussed student-athlete to return to physical activity of any nature. The Zurich panel urged extra caution when allowing student-athletes to return to sports following a concussion because of physiological differences between children and adults.

In terms of concussion prevention, all three groups agreed that there isn't enough research to claim certain helmets or mouth guards prevent or reduce the severity of concussions. That echoes the findings of a study released this summer, which determined the age and brand of a football helmet to be unrelated to a reduced risk of concussion.

While the paper didn't mention any specific areas of disagreement between the three groups, numerous questions remain in terms of youth-athlete concussion research. A handful of examples include the effect of gender and age on concussion risk, sport-specific rules of play that could reduce concussion risk, and further research into the role of baseline neuropsychological testing.

In this nascent field of youth-concussion research, however, it's clear that certain areas of agreement have begun to emerge. And luckily, nearly every state's youth-concussion law follows much of the consensus.

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