1. Best Practices in Return to Play After Concussion Jennifer Volberding, PhD, ATC, LAT Athletic Training Program Director Assistant Professor OSU Center for Health Sciences

3. Rest and Recovery 1  Grade of concussion  Severity dependent upon the length of time post-concussive symptoms last  Timeline to return  We can’t answer that at the time of evaluation!!

5. Risk factors for Concussion and Implications on Recovery  Symptoms  Number  Duration (longer than 10 days)  Severity  Signs  Prolonged loss of consciousness (greater than 1 minute)  Sequelae  Concussion convulsions

6. Risk factors for Concussion and Implications on Recovery  Temporal  Frequency: repeated concussions over time  Time: close together  Recency: recent concussion or TBI  Threshold  Repeated concussions occurring with progressively less impact, force, or slower recovery after each successive event  Age  Child or adolescent

7. Risk factors for Concussion and Implications on Recovery  Comorbidities and premorbidities  Migraine, depression, or other mental health disorders, ADD or ADHD, learning disabilities, sleep disorders  Medication  Psychoactive drugs, anticoagulants  Behavior  Dangerous style of play  Sport  High risk activity, contact or collision sport, high sporting level

8. You have a concussion now what? 2  Return to life  Return to school  Return to play

9. Return to Life 2  Rest at home  Emotional impact  Physical impact  Medications  Sleep aids or anxiety in sub-acute stage  Diet  Hydration  Balanced nutrition  No alcohol while still experiencing symptoms

10. Return to School 2  What is cognitive rest  Reduce but don’t completely remove  Strict brain rest may have detrimental effects on patients  Find balance of work with concussion symptoms

11. Return to Play 3  Baseline Measurements after Patient is Asymptomatic  Motor Control  Mental Status  Neurocognitive Testing

12. Testing Motor control 3  Gait, posture, hand movement  Postural control is the recommended and easiest  BESS, Rhomberg tests

13. Mental status testing 3  Sport Concussion Assessment Tool (SCAT3)SCAT3  Orientation questions  SAC  Loss of sensitivity of instrument 24 hours after injury

14. Neurocognitive testing 3  Used in conjunction with other testing not alone  ImPACT  Language and culture can have an impact

15. Return to play 2,3

16. Did You Know Return to Play After a Concussion Relates Impacts More than Head and Neck Symptoms??? 2

17. References 1.Concussion Legacy Foundation http://concussionfoundation.org/learning- center/concussion-checklist http://concussionfoundation.org/learning- center/concussion-checklist 2.Cantu, R. How to Best Manage a Concussion, Tulsa OK, March 2016. 3.Broglio, SP, Cantu, RC, Gioia, GA, Guskiewicz, KM, Kutcher, J, Palm M, Valovich McLeod TC. National Athletic Trainers’ Association Position Statement: Management of Sport Concussion. J Athl Train. 2014; 49: 245-265.

18. Questions?