Quick Questions in Sport-Related Concussion Expert Advice in Sports Medicine

Acknowledgments

About the Editor

Contributing Authors

Preface

Introduction

Section I Concussion Basics

Question 1 What Is Currently the Most Commonly Accepted Definition of a

Sport-Related Concussion, and How Does This Definition Impact

Clinical Management?

Michelle L. Weber, MS, AT, ATC and

Tamara C. Valovich McLeod, PhD, ATC, FNATA

Question 2 How Common Are Sport-Related Concussions?

Laura Decoster, ATC

Question 3 What Are the Best Educational Materials Available to Help a Coach,

Parent, or Athlete Learn About Concussions?

Johna K. Register-Mihalik, PhD, LAT, ATC

Section II Preseason Planning

Question 4 What Pertinent Questions Should Be Asked During a Preparticipation

Physical Examination to Accurately Determine Prior Concussion

History?

Ian A. McLeod, PA-C, ATC

Question 5 Are There Risk Factors or Behaviors That Can Make Athletes

Prone to Concussion?

Scott C. Livingston, PhD, PT, ATC, SCS

Question 6 Are There Differences Between the Sexes Regarding Concussion

Incidence, Outcomes, and Treatment

Tracey Covassin, PhD, ATC and Erica L. Beidler, MEd, ATC

Question 7 Is It Imperative to Perform Baseline Testing?

Jason P. Mihalik, PhD, CAT(C), ATC and Ashley C. Littleton, MA, ATC

Question 8 Which Medical Professionals Should Be Part of My Concussion

Management Team?

Richelle M. Williams, MS, ATC and

Tamara C. Valovich McLeod, PhD, ATC, FNATA

Question 9 What Are the Most Important Regulations and Policies to Consider Regarding the Management of Sport-Related Concussion?

John T. Parsons, PhD, ATC

Question 10 What Factors Aid in the Prevention of Recurrent Concussion?

Johna K. Register-Mihalik, PhD, LAT, ATC

Question 11 Can Protective Equipment or Strengthening the Neck Decrease

the Risk of Concussion?

Jason P. Mihalik, PhD, CAT(C), ATC and Julianne D. Schmidt, PhD, ATC

Section III Concussion Assessment

Question 12 What Should Be Included in the On-Field or Sideline Examination to Diagnose a Suspected Concussion?

Roger McCoy, MD and Matthew Anastasi, MD

Question 13 What Are the Red Flags During a Sideline Assessment for

Immediate Referral to the Emergency Department?

Kristina Wilson, MD, MPH, CAQSM, FAAP

Question 14 What Constitutes a Failed Postconcussion Test for Athletes

With Baseline Neurocognitive or Balance Tests?

Christina B. Kunec, PsyD; Sheri Fedor, PT, DPT; and Michael W. Collins, PhD

Question 15 Which Self-Report Symptom Scales Are the Best

for Concussion Assessment?

Lindsey Shepherd, MS, ATC, AT, CSCS and

Tamara C. Valovich McLeod, PhD, ATC, FNATA

Question 16 Are Ocular Movements Related to Concussion Assessment,

and if so, How Do I Measure This?

Steven Erickson, MD, FACP and Shelly Massingale, PT, MPT

Question 17 How Common Are Vestibular Deficits Following Sport-Related Concussion, and What Tools Are Best Used to Assess Vestibular Dysfunction?

Shelly Massingale, PT, MPT

Question 18 How Frequently and When Should Postconcussion Assessments

Be Administered?

R.J. Elbin, PhD; Michael W. Collins, PhD; and Anthony P. Kontos, PhD

Question 19 Does Recovery on Clinical Tests Represent True Recovery of the Brain?

Steven P. Broglio, PhD, ATC and Douglas Martini, MS

Question 20 Is Imaging Useful to Determine the Severity of, or the Time to

Recovery From, a Concussion?

Max Zeiger, BS; Meeryo C. Choe, MD; and Christopher C. Giza, MD

Section IV Concussion Management Considerations

Question 21 Should Concussions in Children and Adolescents Be Managed

Differently From Those in Adults?

Richelle M. Williams, MS, ATC and

Tamara C. Valovich McLeod, PhD, ATC, FNATA

Question 22 How Many Concussions Are Too Many Before an Athlete Should Retire?

Amaal J. Starling, MD; Meeryo C. Choe, MD; and Christopher C. Giza, MD

Question 23 What Are the Long-Term Concerns With Concussion?

Steven P. Broglio, PhD, ATC and Douglas Martini, MS

Question 24 How Can We Predict if a Patient Will Have a Protracted Recovery

Following Concussion?

Ian A. McLeod, PA-C, ATC

Question 25 Do Subconcussive Blows Place Athletes at Just as Much Risk for

Future Negative Sequelae as Athletes With Diagnosed Concussions?

Steven P. Broglio, PhD, ATC and Douglas Martini, MS

Question 26 How Should I Manage Concussion in Athletes With

Learning Disabilities, Epilepsy, Depression, or Anxiety?

Javier Cárdenas, MD and Tamara C. Valovich McLeod, PhD, ATC, FNATA

Question 27 Are There Any Medications That May Be Useful in the

Management of Concussions?

Javier Cárdenas, MD and Tamara C. Valovich McLeod, PhD, ATC, FNATA

Question 28 Are There Any Rehabilitation Exercises That Help a

Concussed Athlete Heal Faster?

Johna K. Register-Mihalik, PhD, LAT, ATC and

Jason P. Mihalik, PhD, CAT(C), ATC

Question 29 Which Patient Self-Report Measures Are Best for Assessing the Impact

of Concussion on a Patient's Quality of Life?

Michelle L. Weber, MS, AT, ATC and

Tamara C. Valovich McLeod, PhD, ATC, FNATA

Section V Return to Activity

Question 30 Why Can't an Athlete Return to Play on the Same Day

as the Concussion?

Scott C. Livingston, PhD, PT, ATC, SCS

Question 31 Does Recovery Following Concussion Follow a Typical Time Course,

and Does This Really Correspond to Resolution of

Self-Reported Symptoms?

Steven P. Broglio, PhD, ATC

Question 32 How Long Should Patients Be Free of Symptoms Prior to Beginning a Gradual Return to Activity?

Laura Decoster, ATC

Question 33 What Is the Role of the Graded Exertion Protocols for Making

Return-to-Play Decisions?

Tracey Covassin, PhD, ATC and Jessica Wallace, MA, ATC, AT

Question 34 How Should Return to Play Be Managed in Athletes With

Comorbid Factors, Such as Attention Deficit Hyperactivity Disorder or

Prior History of Concussion?

Christopher G. Vaughan, PsyD and Valerie Needham, MS

Question 35 How Do Head Impact Indicators Work, and Is There Value in

Recommending That Patients Purchase Them?

Jason P. Mihalik, PhD, CAT(C), ATC and Robert C. Lynall, MS, ATC

Section VI Return to School

Question 36 What Is Cognitive Rest, and Can It Help Recovery

Following Concussion?

Christopher G. Vaughan, PsyD and Valerie Needham, MS

Question 37 How Can Concussion Negatively Affect School Functioning?

Danielle M.E. Ransom, PsyD and Christopher G. Vaughan, PsyD

Question 38 What School Policies/Procedures Apply to Concussed Student-Athletes

Who Are Attempting to Return to the Classroom?

John T. Parsons, PhD, ATC and Richelle M. Williams, MS, ATC

Question 39 How Are Educational Accommodations Determined, and

Who Should Be Part of the Decision-Making Process?

Richelle M. Williams, MS, ATC and

Tamara C. Valovich McLeod, PhD, ATC, FNATA

Financial Disclosures

Index

Biography

Tamara C. Valovich McLeod, PhD, ATC, FNATA, is the Athletic Training Program Director, Professor of Athletic Training, and the John P. Wood, DO, Endowed Chair for Sports Medicine at A.T. Still University in Mesa, Arizona. Dr. McLeod completed her doctor of philosophy degree in education with an emphasis in sports medicine from the University of Virginia. She is the director of the Athletic Training Practice-Based Research Network, and her research has focused on the pediatric athlete with respect to sport-related concussion. Her current work is investigating the short- and long-term effects of pediatric sports concussion as well as recovery following concussion on traditional concussion assessments and health-related quality of life. Dr. McLeod also has research interests regarding gender differences in lower extremity function, specifically neuromuscular control and postural stability, and studies these areas through an injury prevention approach in younger athletes.

Dr. McLeod was a contributing author for the National Athletic Trainers’ Association (NATA) Position Statement on the Management of Sport-Related Concussion, the lead author on the NATA Position Statement on the Prevention of Pediatric Overuse Injuries, and a consultant and contributing author on the Appropriate Medical Coverage for Secondary School-Aged Athletes. Dr. McLeod serves on numerous editorial boards, publishes frequently in athletic training and sports medicine journals, and is an NATA Fellow.

“As a busy clinician, I find the concept of the Quick Questions series very useful…This will be very helpful for busy sports medicine clinicians. The format makes it very easy to locate information in a timely manner and the content is presented in a way that is easy to understand and put to practical use."

- Janna C. Fonseca, MEd, Carolina Family Practice & Sports Medicine, Doody’s Review Service