Outpatient Management of Sport-Related Concussion, Return to Learn, Return to Play

2021 ◽  
Vol 40 (1) ◽  
pp. 65-79
Author(s):  
Peter K. Kriz ◽  
James P. MacDonald
Keyword(s):  
Return To Play ◽  
Outpatient Management ◽  
Return To Learn

scholarly journals Preliminary Evidence-Based Recommendations for Return to Learn: a novel pilot study tracking concussion recovery in college students

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S33.3-S34
Author(s):  
Zachary Bevilacqua ◽  
Mary Kerby ◽  
David Fletcher ◽  
Zhongxue Chen ◽  
Becca Merritt ◽  
...  
Keyword(s):  
Physical Activity ◽  
Longitudinal Design ◽  
Text Messages ◽  
Return To Play ◽  
Evidence Based ◽  
Full Time ◽  
Symptom Resolution ◽  
Phone Calls ◽  
Return To Learn ◽  
Concussion Recovery

ObjectiveInvestigate the potential factors influencing resolution of chief concussion symptoms in a longitudinal design. Second, assess subjects’ perception of their concussion recovery and what types of activities and accommodations appeared beneficial.BackgroundAthletes re-entering the academic setting after a concussion is commonly referred as return-to-learn (RTL), which has appeared secondary to the abundantly researched return-to-play protocols implemented ubiquitously. Importantly, every concussed collegiate, adolescent, and pediatric athlete is first and foremost a student-athlete, with “student” holding the emphasis. To date, very few studies have examined the RTL aspect of concussion recovery, and the effects premature classroom attendance may cause.Design/MethodsNine concussed, college aged (18-26 years), full-time students were monitored longitudinally throughout their recovery from diagnosis to full symptom-free academic participation. Symptom severity for five prevalent symptoms were recorded 4 times per day, along with a daily phone call to report participant’s diet, duration of screen-time usage and music listened to, physical activity participation, and types of classes attended.ResultsResponse rates to text messages and phone calls yielded a mean 92% and 93% respectively across the nine subjects. Additionally, five variables were significantly associated with symptom resolution (music, sleep, physical activity, water, and time) (p = 0.0004 to p = 0.036). Lastly, subjects reported math and computer-oriented courses as the most difficult (33% and 44% respectively). Additional time on assignments/exams and reducing screen brightness were the most beneficial accommodations (66% and 56% respectively).ConclusionsOur findings introduce a novel and robust approach to monitoring concussed students throughout their recovery. Furthermore, this methodology is the first to produce holistic evidence-based results concerning re-integrating students to the classroom. Lastly, it appears that dietary and social behaviors can indeed influence symptom resolution.

scholarly journals Management and Treatment of Concussions via Tele-Concussion in a Pediatric Setting: Methodological Approach and Descriptive Analysis

10.2196/19924 ◽  
2020 ◽  
Vol 3 (2) ◽  
pp. e19924
Author(s):  
Todd Caze II ◽  
Gregory P Knell ◽  
John Abt ◽  
Scott O Burkhart
Keyword(s):  
United States ◽  
Clinical Care ◽  
The United States ◽  
Return To Play ◽  
Care Process ◽  
Descriptive Data ◽  
Pediatric Concussion ◽  
Return To Learn ◽  
The Mean

Background Approximately 2 million children in the United States sustain a concussion annually, resulting in an economic impact as high as US $20 billion. Patients who receive treatment at concussion specialty clinics, versus primary care, experience faster recovery, thereby reducing patient burden and subsequent medical-related costs. Accessibility to specialty clinics is typically limited by the availability of in-office visits. This is particularly relevant in light of the severe acute respiratory syndrome coronavirus 2 pandemic and subsequent guidance to eliminate all non–medically necessary in-clinic visits. Telehealth has been used to effectively deliver in-clinic care across several disciplines including psychiatry, psychology, and neuropsychology. However, a model of telehealth delivered concussion assessment, treatment, and management has not been established. Objective The purposes of this paper are to describe a pediatric concussion specialty clinic’s experiences in delivering telehealth concussion services and to provide preliminary descriptive data on a sample of pediatric telehealth patients with concussions. Methods The specialty pediatric concussion clinic described here began providing telehealth services in 2019 and is part of the largest and fastest-growing telehealth hospital network in the United States. The clinical care process will be described, including accessing the telehealth platform, assessment during the initial appointment, injury management including communication with relevant patient stakeholders (eg, parent or guardians, athletic trainers), dissemination of rehabilitation exercises, and nature of follow-up visits. Descriptive data will include patient demographics, the radius of care, the time between the date of injury and initial visit, the average number of follow-up visits, and days until medically cleared for return-to-learn and return-to-play. Results The analytic sample included 18 patients with concussions who were seen for all of their visits via telehealth between August 2019 and April 2020. The mean age of the sample was 14.5 (SD 2.5) years. The radius of care was a median of 17 (IQR 11.0-31.0) miles from the clinic with a median time between injury and the first visit of 21 (IQR 6.0-41.5) days. The mean number of visits was 2.2 (SD 0.8) with a median days between visits of 5.4 (IQR 3.0-9.3) to manage and treat the concussion. Of the 18 patients, 55.6% (n=10) were medically cleared for return-to-learn or -play in a median of 15.5 (IQR 11.0-29.0) days. Conclusions Limited access to health care is a well-understood barrier for receiving quality care. Subsequently, there are increasing demands for flexibility in delivering concussion services remotely and in-clinic. This is the first paper to provide a clinically relevant framework for the assessment, management, and treatment of acute concussion via telehealth in a pediatric population.

Return to Play, School, or Work After Concussion

Neurotrauma ◽  
2018 ◽  
pp. 157-164
Author(s):  
Charles H. Tator
Keyword(s):  
Return To Work ◽  
Clinical Findings ◽  
Return To Play ◽  
Return To Learn ◽  
Exacerbation Of Symptoms ◽  
Made In

Improvements have been made in the management of concussions, and this includes the methods for advising concussed patients about the processes to be followed for return to play (RTP) in sports, return to learn (RTL) in schools, and return to work (RTW) on the job. The aim of management is to facilitate return by a graduated process of steps during which an individual’s thresholds for exacerbation of symptoms are used as a guide, with advice given not to exceed these thresholds. There are no available objective biomarkers to guide these processes and so advice and monitoring are based on clinical findings.

scholarly journals The Value of Speech-Language Pathologists in Concussion Management

2017 ◽  
Vol 04 (01) ◽  
pp. e8-e13 ◽  
Author(s):  
Caroline Ketcham ◽  
Melissa Bowie ◽  
Thomas Buckley ◽  
Martin Baker ◽  
Kirtida Patel ◽  
...  
Keyword(s):  
Cognitive Processing ◽  
Student Athletes ◽  
Management Team ◽  
Return To Play ◽  
Athletic Trainer ◽  
Concussion Management ◽  
Speech Language Pathologist ◽  
Collegiate Level ◽  
Return To Learn ◽  
Learn Process

Abstract Objective The goal of this article is to make a case for the value of a speech-language pathologist (SLP) to be considered for inclusion on a concussion management team in a consultant capacity and resource for student-athletes during the return-to-learn process particularly at the high school or collegiate level where they may already be on staff or affiliated. SLPs have the skills and expertise to address difficulties and provide structured strategies to address symptoms of a concussion that affect cognitive processing, attention, and focus which often are impacted during recovery from a concussion. These skills alongside an athletic trainer/school nurse will provide a mechanism for student-athletes to be monitored and have a resource through the return-to-learn and return-to-play process.

An Evaluation of Post-Concussion Return to School Guidelines: A Survey of Massachusetts School Nurses

2021 ◽  
pp. 105984052110322
Author(s):  
Jonathan Howland ◽  
Julia Campbell ◽  
Rebekah Thomas ◽  
Steven Smyth ◽  
Aynsley Chaneco ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Medical Center ◽  
School Personnel ◽  
School Nurses ◽  
Return To Play ◽  
Return To School ◽  
Care Providers ◽  
Sports Concussion ◽  
Return To Learn ◽  
Prevention Center

Although all states have legislation pertaining to youth sports concussion, most of these laws focus on return-to-play procedures; only a few address return-to-learn (RTL) accommodations for students who have experienced a concussion. To address this gap in the legislation, some states and nongovernmental organizations have developed RTL guidelines to advise school personnel, parents, and health care providers on best practices for accommodating students' postconcussion reintegration into academic activity. In 2018, the Massachusetts Department of Public Health (MDPH) developed RTL guidelines which were disseminated to school nurses (SNs) at all public and nonpublic middle and high schools in the state. In 2020, the MDPH engaged the Injury Prevention Center at Boston Medical Center to survey Massachusetts SNs to assess the usefulness of the guidelines. The response rate was 63%; 92% found the booklet extremely useful or moderately useful; and 70% endorsed that the booklet fostered collaboration among stakeholders.

Concussion Return to Learn or Work and Return to Play

2020 ◽  
pp. 111-124
Author(s):  
Suraj Achar ◽  
William Timothy Ward ◽  
Rachel Buehler Van Hollebeke
Keyword(s):  
Return To Play ◽  
Return To Learn

scholarly journals Concussion reporting, return to learn, and return to play experiences in a sample of private preparatory high school students

Brain Injury ◽  
2020 ◽  
Vol 34 (9) ◽  
pp. 1193-1201 ◽  
Author(s):  
Dana Waltzman ◽  
Jill Daugherty ◽  
Katherine Snedaker ◽  
Jason Bouton ◽  
David Wang
Keyword(s):  
High School ◽  
High School Students ◽  
Return To Play ◽  
School Students ◽  
Return To Learn

scholarly journals It is time to rewrite state youth sports concussion laws

2021 ◽  
Vol 7 (1) ◽  
pp. e000959
Author(s):  
Jonathan Howland ◽  
Holly Hackman ◽  
Alcy Torres ◽  
Julia Campbell ◽  
Jonathan Olshaker
Keyword(s):  
Low Income ◽  
Youth Sports ◽  
Return To Play ◽  
Academic Learning ◽  
Academic Accommodations ◽  
Traffic Crashes ◽  
Sports Concussion ◽  
Medical Clearance ◽  
Return To Learn ◽  
And Performance

Between 2009 and 2014, all 50 states and the District of Columbia passed legislation to improve the recognition and management of youth concussed in sports. These laws can include requirements for concussion training for school athletic personnel, concussion education for children and their parents, return-to-play (RTP) procedures, and medical clearance to for RTP. Concussion can impact academic learning and performance in children and adolescents. Postconcussion academic accommodations during recovery can be an important component of secondary prevention for mitigating the sequalae of head injury. Few state youth concussion laws, however, include provision of postconcussion return-to-learn (RTL) accommodations and most of those that do address RTL apply to student athletes only. Concussions may occur in youth who are not participating in organised sports (eg, falls, traffic crashes) and thus may not be subjected to RTL accommodations, even if the state mandates such procedures for athletes. Low income and students of colour may be more likely to have non-sports concussions than their more affluent and white peers, thus potentially creating demographic disparities in the benefits of RTL procedures. State youth sports concussion laws should be revised so that they include RTL provisions that apply to all students, athletes and non-athletes alike.

A Pilot Study Evaluating the Timing of Vestibular Therapy After Sport-Related Concussion: Is Earlier Better?

2021 ◽  
pp. 194173812199868
Author(s):  
Ranbir Ahluwalia ◽  
Scott Miller ◽  
Fakhry M. Dawoud ◽  
Jose O. Malave ◽  
Heidi Tyson ◽  
...  
Keyword(s):  
Pilot Study ◽  
Therapy Group ◽  
Vestibular Dysfunction ◽  
Return To Play ◽  
Additional Time ◽  
Level Of Evidence ◽  
Symptom Resolution ◽  
Kaplan Meier ◽  
Prolonged Recovery ◽  
Return To Learn

Background: Vestibular dysfunction, characterized by nausea, dizziness, imbalance, and/or gait disturbance, represents an important sport-related concussion (SRC) subtype associated with prolonged recovery. Vestibular physical therapy promotes recovery; however, the benefit of earlier therapy is unclear. Hypothesis: Earlier vestibular therapy for young athletes with SRC is associated with earlier return to play (RTP), return to learn (RTL), and symptom resolution. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: Patients aged 5 to 23 years with SRC who initiated vestibular rehabilitation therapy (VRT) from January 2019 to December 2019 were included and patient records were reviewed. Therapy initiation was defined as either early, ≤30 days postinjury, or late (>30 days). Univariate comparisons between groups, Kaplan-Meier plots, and multivariate Cox proportional hazard modeling were performed. Results: Overall, 23 patients (10 early, 13 late) aged 16.14 ± 2.98 years and 43.5% were male patients. There was no difference between group demographics or medical history. Median initial total and vestibular symptom scores were comparable between groups. The late therapy group required additional time to RTP (110 days [61.3, 150.8] vs 31 days [22.5, 74.5], P = 0.03) and to achieve symptom resolution (121.5 days [71, 222.8] vs 54 days [27, 91], P = 0.02), but not to RTL (12 days [3.5, 26.5] vs 17.5 days [8, 20.75], P = 0.09). Adjusting for age and initial total symptom score, earlier therapy was protective against delayed symptom resolution ( P = 0.01). Conclusion: This pilot study suggests that initiating VRT within the first 30 days after SRC is associated with earlier RTP and symptom resolution. Further prospective trials to evaluate if even earlier VRT should be pursued to further improve recovery time. Clinical Relevance: Clinicians should screen for vestibular dysfunction and consider modifying follow-up schedules after SRC to initiate VRT within a month of injury for improved outcomes.

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