This document provides a consensus statement on the definition and management of sports-related concussion by an international panel of experts. It summarizes the key points discussed and recommendations made by the panel regarding the definition of concussion, evaluation of acute injury including symptoms and signs, neurocognitive assessment, neuroimaging, and return to play guidelines. The panel aimed to build upon previous consensus statements to further the understanding of concussion using an evidence-based approach.
This document provides a literature review of neuropsychological and neurocognitive tests used to detect post-concussive abnormalities following a concussion. It discusses common concussion symptoms and sideline assessment tools like the Standardized Assessment of Concussion and Balance Error Scoring System. Popular testing methods reviewed include ImPACT, which assesses cognition, and the Concussion Resolution Index, a computerized neuropsychological test. Return-to-play guidelines are also investigated to help determine when an athlete can safely return to competition following a concussion.
1) A study examined the effect of a comprehensive warm-up program ("The 11+") on injury rates in young female footballers.
2) 1892 players aged 13-17 from 125 football clubs were randomly assigned to an intervention or control group.
3) The intervention group performed the warm-up program before training and matches, focusing on exercises to improve strength, awareness, and neuromuscular control.
4) Compared to the control group, the intervention group had a significantly lower risk of overall injuries, overuse injuries, and severe injuries.
1) The study evaluated the effects of high acceleration forces (9G) on visual performance and ocular responses in 14 men using a human centrifuge.
2) Transient visual acuity reduction and temporary corneal thickening were observed immediately after centrifugation. Prolonged increases in anterior chamber depth and pupillary dilation were also observed up to 30 minutes after.
3) Contrast sensitivity was found to decrease significantly at low and medium spatial frequencies and did not return to baseline levels within 30 minutes of centrifugation.
This document presents recommendations from a task force for the management of knee osteoarthritis. The task force conducted an extensive literature review and analysis to update previous EULAR recommendations from 2000. They identified 497 new relevant publications since 1999 and evaluated evidence for 33 treatment modalities. Based on the literature review and expert opinion, the task force developed 10 recommendations for treating knee osteoarthritis and identified 10 additional important topics for future research. The recommendations support some of the previous propositions but also include modified statements and new propositions based on the recent evidence.
Artigo - Acupuncture on oxygen consumptionRenato Almeida
1) Auricular acupuncture had a significant effect on improving the oxygen consumption and recovery ability of boxing athletes.
2) The study found that VO2max, a key indicator of cardiovascular endurance, was significantly higher after auricular acupuncture stimulation compared to a control group.
3) Auricular acupuncture stimulation may enhance athletic performance by improving aerobic ability as shown by increased VO2max and VEmax, and faster recovery of heart rate and body temperature after exercise.
The effect of various cold‑water immersion protocolsFernando Farias
This study investigated the effects of different cold-water immersion (CWI) protocols on inflammatory response and functional recovery following high-intensity exercise. Eight males completed a high-intensity sprint protocol followed by one of four CWI protocols or passive rest. Blood samples showed CWI of 30 minutes at 10 or 20°C increased some inflammatory markers compared to shorter or colder CWI. Muscle performance decreased immediately after exercise but recovered faster with CWI, though the mechanism is unclear. CWI appears to aid muscle performance recovery but not power, and longer CWI may worsen inflammation without improving recovery.
Effect of Relaxation Therapy on Standing Balance and Mobility among Stroke Pa...ijtsrd
Motor impairment or unilateral weakness of the body, most commonly results from stroke in humans. Stroke is ” ˜Rapidly developing clinical signs of focal or global disturbance of cerebral function, due to ischemic or hemorrhagic injury.The purpose of study is to describe the effect of relaxation therapy on standing balance and mobility among stroke patients.Methods Study included 30 hemiplegic subjects divide in to two groups i.e, Group A Experimental and Group B Control randomly. A baseline assessment was done with outcome measures BBS and TUG test to obtain the pretest score of the subjects. After the pretest, all the subjects were undergone a therapeutic intervention. Participants in the experimental group received relaxation therapy earlier followed with conventional occupational therapy program for one hour of four sessions in a week with duration of total program for 6 weeks. The Participants in control group received only conventional occupational therapy program. After six weeks of intervention outcome measures were administered on both the groups to obtain the post score.Results This study suggests that relaxation Therapy with conventional occupational therapy can improve standing balance and mobility among stroke patients. The mean value of Berg balance scale, pre and post scores are, 42.866 and 49.733 respectively. The mean value of Time up and Go scale are, 27.094 and 15.930. On statistical analysis, the values were determined to be significant at 0.010 level for berg balance and 0.047 for time up and go scale table 5 which supports the alternate hypothesis suggesting relaxation therapy improved standing balance and mobility among stroke patients graph 1 . Conclusion This study concluded that relaxation therapy is effective in improving standing balance and mobility in Stroke patients Ravi Ranjan Kumar | Mr. Subrata Kumar Halder "Effect of Relaxation Therapy on Standing Balance and Mobility among Stroke Patients" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-1 , December 2020, URL: https://www.ijtsrd.com/papers/ijtsrd38210.pdf Paper URL : https://www.ijtsrd.com/medicine/other/38210/effect-of-relaxation-therapy-on-standing-balance-and-mobility-among-stroke-patients/ravi-ranjan-kumar
This document provides a literature review of neuropsychological and neurocognitive tests used to detect post-concussive abnormalities following a concussion. It discusses common concussion symptoms and sideline assessment tools like the Standardized Assessment of Concussion and Balance Error Scoring System. Popular testing methods reviewed include ImPACT, which assesses cognition, and the Concussion Resolution Index, a computerized neuropsychological test. Return-to-play guidelines are also investigated to help determine when an athlete can safely return to competition following a concussion.
1) A study examined the effect of a comprehensive warm-up program ("The 11+") on injury rates in young female footballers.
2) 1892 players aged 13-17 from 125 football clubs were randomly assigned to an intervention or control group.
3) The intervention group performed the warm-up program before training and matches, focusing on exercises to improve strength, awareness, and neuromuscular control.
4) Compared to the control group, the intervention group had a significantly lower risk of overall injuries, overuse injuries, and severe injuries.
1) The study evaluated the effects of high acceleration forces (9G) on visual performance and ocular responses in 14 men using a human centrifuge.
2) Transient visual acuity reduction and temporary corneal thickening were observed immediately after centrifugation. Prolonged increases in anterior chamber depth and pupillary dilation were also observed up to 30 minutes after.
3) Contrast sensitivity was found to decrease significantly at low and medium spatial frequencies and did not return to baseline levels within 30 minutes of centrifugation.
This document presents recommendations from a task force for the management of knee osteoarthritis. The task force conducted an extensive literature review and analysis to update previous EULAR recommendations from 2000. They identified 497 new relevant publications since 1999 and evaluated evidence for 33 treatment modalities. Based on the literature review and expert opinion, the task force developed 10 recommendations for treating knee osteoarthritis and identified 10 additional important topics for future research. The recommendations support some of the previous propositions but also include modified statements and new propositions based on the recent evidence.
Artigo - Acupuncture on oxygen consumptionRenato Almeida
1) Auricular acupuncture had a significant effect on improving the oxygen consumption and recovery ability of boxing athletes.
2) The study found that VO2max, a key indicator of cardiovascular endurance, was significantly higher after auricular acupuncture stimulation compared to a control group.
3) Auricular acupuncture stimulation may enhance athletic performance by improving aerobic ability as shown by increased VO2max and VEmax, and faster recovery of heart rate and body temperature after exercise.
The effect of various cold‑water immersion protocolsFernando Farias
This study investigated the effects of different cold-water immersion (CWI) protocols on inflammatory response and functional recovery following high-intensity exercise. Eight males completed a high-intensity sprint protocol followed by one of four CWI protocols or passive rest. Blood samples showed CWI of 30 minutes at 10 or 20°C increased some inflammatory markers compared to shorter or colder CWI. Muscle performance decreased immediately after exercise but recovered faster with CWI, though the mechanism is unclear. CWI appears to aid muscle performance recovery but not power, and longer CWI may worsen inflammation without improving recovery.
Effect of Relaxation Therapy on Standing Balance and Mobility among Stroke Pa...ijtsrd
Motor impairment or unilateral weakness of the body, most commonly results from stroke in humans. Stroke is ” ˜Rapidly developing clinical signs of focal or global disturbance of cerebral function, due to ischemic or hemorrhagic injury.The purpose of study is to describe the effect of relaxation therapy on standing balance and mobility among stroke patients.Methods Study included 30 hemiplegic subjects divide in to two groups i.e, Group A Experimental and Group B Control randomly. A baseline assessment was done with outcome measures BBS and TUG test to obtain the pretest score of the subjects. After the pretest, all the subjects were undergone a therapeutic intervention. Participants in the experimental group received relaxation therapy earlier followed with conventional occupational therapy program for one hour of four sessions in a week with duration of total program for 6 weeks. The Participants in control group received only conventional occupational therapy program. After six weeks of intervention outcome measures were administered on both the groups to obtain the post score.Results This study suggests that relaxation Therapy with conventional occupational therapy can improve standing balance and mobility among stroke patients. The mean value of Berg balance scale, pre and post scores are, 42.866 and 49.733 respectively. The mean value of Time up and Go scale are, 27.094 and 15.930. On statistical analysis, the values were determined to be significant at 0.010 level for berg balance and 0.047 for time up and go scale table 5 which supports the alternate hypothesis suggesting relaxation therapy improved standing balance and mobility among stroke patients graph 1 . Conclusion This study concluded that relaxation therapy is effective in improving standing balance and mobility in Stroke patients Ravi Ranjan Kumar | Mr. Subrata Kumar Halder "Effect of Relaxation Therapy on Standing Balance and Mobility among Stroke Patients" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-1 , December 2020, URL: https://www.ijtsrd.com/papers/ijtsrd38210.pdf Paper URL : https://www.ijtsrd.com/medicine/other/38210/effect-of-relaxation-therapy-on-standing-balance-and-mobility-among-stroke-patients/ravi-ranjan-kumar
The document is a research report about creating a device for rehabilitation of whiplash injuries at home. It begins with an introduction describing whiplash and its symptoms. It then details secondary research including literary research on books and publications about neck injuries and patents for similar biofeedback devices. Primary research methods are also listed such as focus groups, observations, interviews and trials. The report provides information on patents for exercise monitoring devices and concludes with appendices including an interview and pictures.
Thomas Souza D.C. Differential Diagnosis 3rd EditionAlex2288
This document provides a summary of chapters in a textbook on musculoskeletal and general medical complaints. The document is divided into 8 parts covering topics such as: musculoskeletal complaints, neurologic complaints, cardiopulmonary complaints, gastrointestinal complaints, genitourinary complaints, head and face complaints, special conditions, and issues related to specific patient populations. Each chapter provides context, relevant anatomy, evaluation techniques, management strategies, and summaries of common disorders addressed within that section. The textbook aims to equip healthcare providers with an evidence-based approach and comprehensive guidance for evaluating and managing a wide range of musculoskeletal and general medical presentations.
Does plyometric training improve vertical jump height a meta‐analytical reviewstrengthcoach71
This meta-analysis reviewed the effects of plyometric training on vertical jump height based on 26 studies. It found that plyometric training provided statistically significant improvements in vertical jump height for squat jumps (4.7% increase), countermovement jumps (8.7% increase), countermovement jumps with arm swing (7.5% increase), and drop jumps (4.7% increase). Effect sizes ranged from moderate (0.44) for squat jumps to large (0.88) for countermovement jumps. Plyometric training can thus effectively enhance vertical jump performance in healthy individuals.
This document provides an abstract for a doctoral thesis that investigated the physiological response to maximal speed training. The thesis included 4 studies. Study 1 examined the reliability of various jump variables commonly used to assess neuromuscular function. Studies 2-4 profiled the neuromuscular, physiological and endocrine responses over 24 hours to a maximal speed training session, the effect of performing additional weight training afterwards, and the impact of training order. The thesis found some jump variables like average rate of force development lacked reliability. It also reported bimodal neuromuscular recovery patterns and differences in metabolic responses depending on training protocol and order. The thesis provided a detailed examination of responses to maximal speed training and factors like additional sessions and session placement
Final Thesis- EMG ANALYSIS OF TRUNK MUSCULATURE DURING PUSH UP EXERCISE ON UN...Dr Nishank Verma
The document is a dissertation submitted to Chaudhary Charan Singh University in partial fulfillment of the requirements for a Masters of Physiotherapy degree. It examines EMG analysis of trunk musculature during push up exercises performed on unstable surfaces in healthy male subjects. The dissertation includes declarations, certificates of approval, acknowledgments, tables of contents, and the first chapter which introduces the study topic.
Hamstring strain prevention in elite soccer playersFernando Farias
Hamstring strains are among the most
common injury in sport and are most
often observed in sports that involve
sprinting, turning, and jumping
(8,38,63). The prevalence of hamstring
strains has been measured between 11
and 16% in studies of soccer, Australian
rules football, and cricket (92). This can
result in an average of 6 players per squad
suffering a hamstring injury (defined as
“preventing player participation in
a match”) each season in professional
soccer and Australian rules football
This document discusses at what age it is too young to start strength and conditioning training programs for youth. The key points are:
1) Participation in youth sports is increasing, leading more children to start strength training at younger ages. However, concerns have been raised about safety.
2) Starting integrative neuromuscular training (INT) programs early can help children develop motor skills and reduce injury risk by increasing their "training age". Training age refers to the duration and consistency of a child's participation in physical activities and training programs.
3) INT programs that incorporate strength, power, agility and other exercises can safely and effectively train children as young as ages 6-8, provided the training is
The document describes the EYE-TRAC Advance study, which is funded by the Department of Defense and conducted by the Brain Trauma Foundation. The study aims to establish a normative database of eye-tracking performance in individuals without concussions and to study abnormal eye-tracking and cognitive performance following a concussion. It will enroll over 5,000 athletes, 5,000 military participants, and several hundred civilians. The study involves baseline eye-tracking and cognitive tests, and follow-up testing including MRI scans for participants who sustain a concussion.
Consensus Statement Version 2.0 D R A F T 12 10Andrew Cannon
The document provides guidance on sport-related concussion management for schools and youth sports leagues. It defines concussion as a complex injury to the brain caused by biomechanical forces that results in short-lived impairment of neurological function. Signs and symptoms of concussion can include headaches, dizziness, fatigue, irritability, difficulty concentrating, and sleep disturbances. The document recommends that any athlete showing signs of concussion should be removed from play and not return until cleared by a medical professional. It also stresses the importance of education for coaches, parents, athletes, and physicians on concussion prevention, identification, and treatment.
Vaihmalan Hovi is a hotel and restaurant located in a manor house with two dining options - Bistro Kynsilaukka serving pizzas, wings, and seafood, and Viikinkikellari, a seasonal à la carte restaurant in the manor cellar. The hotel has 8 rooms in the manor house and 9 country-style rooms in a separate building. Guests can experience golf, horseback riding, spa treatments, shopping, and a sauna by the lake, making it a venue for meetings, weddings, and other celebrations.
Consensus statement on concussion in sportccicalifornia
This document provides a consensus statement on the definition and management of sports-related concussion by an international panel of experts. It summarizes the key points discussed and recommendations made by the panel regarding the definition of concussion, evaluation of acute injury including symptoms and signs, neurocognitive assessment, neuroimaging, and return to play guidelines. The panel aimed to build upon previous consensus statements to further the understanding of concussion using an evidence-based approach.
This document is an amended bill from the California legislature regarding concussions and head injuries in school athletics.
It requires (1) any organization using school facilities for recreational activities to provide a statement of compliance with concussion policies, (2) any school district offering athletics to immediately remove any athlete suspected of a concussion from the activity until cleared by a medical provider, and (3) annual concussion information sheets signed by athletes and parents.
http://eldorado.fgxpress.com/
Making good money while living your life at the fullest with FGXpress , simple like 123- Just open your mouth and share.
Share the product,
Share the plan. http://eldorado.fgxpress.com/
skype kokinatatiana
This document provides information and resources about concussions for schools, coaches, athletes, and parents. It outlines policies requiring annual concussion education, removal from play for any athlete suspected of a concussion, and clearance from a healthcare provider before returning to play. It emphasizes that all head impacts need to be taken seriously, as even mild concussions can have severe consequences if not properly managed. Resources are provided for signs and symptoms, best practices, and online trainings for coaches and clinicians.
Julia Maloney is seeking a position that utilizes her almost 20 years of experience in healthcare and pharmacy benefits. She has extensive knowledge of healthcare industries and Medicare programs from roles managing Medicare Part D data and ensuring compliance. Maloney has a proven track record of strategic problem solving and leadership with clients and PBMs.
This bill amends existing California education code regarding the use of school facilities for supervised recreational activities and athletic programs. It would:
1) Require organizations using school facilities for recreation to provide a statement complying with concussion policies.
2) Require schools offering athletics to immediately remove from play any athlete suspected of a concussion and prohibit return until cleared by a licensed healthcare provider.
3) Require annual concussion information sheets signed by athletes and parents before each season.
This document provides information and resources about concussions for schools, coaches, athletes, and parents. It outlines policies requiring annual concussion education, removal from play for any athlete suspected of a concussion, and clearance from a healthcare provider before returning to play. It emphasizes that all head impacts should be taken seriously, as concussions can have severe consequences if not properly managed. Resources are provided for concussion training and materials covering signs, symptoms, and proper response procedures.
Displaying world-class images, Atlas of Imaging in Sports Medicine, second edition is the essential reference text for accurate diagnosis and imaging in sports medicine today. The second edition of the Atlas summarizes the current state of diagnostic imaging in sports medicine. Both common and uncommon conditions conditions are discussed and illustrated. The book begins with an introductory chapter discussing the basic principles of imaging and pathology in sports related injuries. Followed by chapters providing a comprehensive overview of conditions by individual anatomical areas and a final chapter discussing diagnostic and therapeutic interventions. Unique in its breadth and depth, Atlas of Imaging in Sports Medicine, second edition, is authored by pioneers in the field, Dr Jock Anderson and Dr John Read, in collaboration with colleagues
Prevention of Lower Extremity Stress FracturesJA Larson
This document summarizes a systematic review of the literature on preventing stress fractures in athletes and soldiers. It identifies 176 relevant studies, including 20 diagnostic case series, 66 clinical case series, 52 epidemiological studies, and 9 intervention trials. The review finds that bone scans are more sensitive but less specific than x-rays for diagnosing stress fractures. It also examines the reported incidence of stress fractures in military recruits and trainees. The goal of the review is to evaluate research on causes and risk factors of stress fractures, what is known about prevention, and make recommendations for future research.
This document summarizes Kathy Helmick's presentation on clinical care in neurotrauma from a nursing perspective and Department of Defense programs to support traumatic brain injury care. It discusses the DoD definition of TBI severity, the continuum of care including prevention, screening, diagnosis, case management, treatment and rehabilitation. It also provides an overview of DoD policy and initiatives to improve screening, assessment, and management of concussion and mild TBI in deployed service members.
Head and Neck Injuries in Sports: A Sports Medicine Physician's PerspectiveDr. David Carfagno
Dr. David Carfagno is the principal at Scottsdale Sports Medicine Institute, and a frequent presenter on sports medicine topics around the country.
Concussions and neck injuries are a chronic issue among athletes, particularly in both collegiate and professional football. While their severity is getting more attention today, there are still unique factors that physicians and medical personnel should be aware of.
The document is a research report about creating a device for rehabilitation of whiplash injuries at home. It begins with an introduction describing whiplash and its symptoms. It then details secondary research including literary research on books and publications about neck injuries and patents for similar biofeedback devices. Primary research methods are also listed such as focus groups, observations, interviews and trials. The report provides information on patents for exercise monitoring devices and concludes with appendices including an interview and pictures.
Thomas Souza D.C. Differential Diagnosis 3rd EditionAlex2288
This document provides a summary of chapters in a textbook on musculoskeletal and general medical complaints. The document is divided into 8 parts covering topics such as: musculoskeletal complaints, neurologic complaints, cardiopulmonary complaints, gastrointestinal complaints, genitourinary complaints, head and face complaints, special conditions, and issues related to specific patient populations. Each chapter provides context, relevant anatomy, evaluation techniques, management strategies, and summaries of common disorders addressed within that section. The textbook aims to equip healthcare providers with an evidence-based approach and comprehensive guidance for evaluating and managing a wide range of musculoskeletal and general medical presentations.
Does plyometric training improve vertical jump height a meta‐analytical reviewstrengthcoach71
This meta-analysis reviewed the effects of plyometric training on vertical jump height based on 26 studies. It found that plyometric training provided statistically significant improvements in vertical jump height for squat jumps (4.7% increase), countermovement jumps (8.7% increase), countermovement jumps with arm swing (7.5% increase), and drop jumps (4.7% increase). Effect sizes ranged from moderate (0.44) for squat jumps to large (0.88) for countermovement jumps. Plyometric training can thus effectively enhance vertical jump performance in healthy individuals.
This document provides an abstract for a doctoral thesis that investigated the physiological response to maximal speed training. The thesis included 4 studies. Study 1 examined the reliability of various jump variables commonly used to assess neuromuscular function. Studies 2-4 profiled the neuromuscular, physiological and endocrine responses over 24 hours to a maximal speed training session, the effect of performing additional weight training afterwards, and the impact of training order. The thesis found some jump variables like average rate of force development lacked reliability. It also reported bimodal neuromuscular recovery patterns and differences in metabolic responses depending on training protocol and order. The thesis provided a detailed examination of responses to maximal speed training and factors like additional sessions and session placement
Final Thesis- EMG ANALYSIS OF TRUNK MUSCULATURE DURING PUSH UP EXERCISE ON UN...Dr Nishank Verma
The document is a dissertation submitted to Chaudhary Charan Singh University in partial fulfillment of the requirements for a Masters of Physiotherapy degree. It examines EMG analysis of trunk musculature during push up exercises performed on unstable surfaces in healthy male subjects. The dissertation includes declarations, certificates of approval, acknowledgments, tables of contents, and the first chapter which introduces the study topic.
Hamstring strain prevention in elite soccer playersFernando Farias
Hamstring strains are among the most
common injury in sport and are most
often observed in sports that involve
sprinting, turning, and jumping
(8,38,63). The prevalence of hamstring
strains has been measured between 11
and 16% in studies of soccer, Australian
rules football, and cricket (92). This can
result in an average of 6 players per squad
suffering a hamstring injury (defined as
“preventing player participation in
a match”) each season in professional
soccer and Australian rules football
This document discusses at what age it is too young to start strength and conditioning training programs for youth. The key points are:
1) Participation in youth sports is increasing, leading more children to start strength training at younger ages. However, concerns have been raised about safety.
2) Starting integrative neuromuscular training (INT) programs early can help children develop motor skills and reduce injury risk by increasing their "training age". Training age refers to the duration and consistency of a child's participation in physical activities and training programs.
3) INT programs that incorporate strength, power, agility and other exercises can safely and effectively train children as young as ages 6-8, provided the training is
The document describes the EYE-TRAC Advance study, which is funded by the Department of Defense and conducted by the Brain Trauma Foundation. The study aims to establish a normative database of eye-tracking performance in individuals without concussions and to study abnormal eye-tracking and cognitive performance following a concussion. It will enroll over 5,000 athletes, 5,000 military participants, and several hundred civilians. The study involves baseline eye-tracking and cognitive tests, and follow-up testing including MRI scans for participants who sustain a concussion.
Consensus Statement Version 2.0 D R A F T 12 10Andrew Cannon
The document provides guidance on sport-related concussion management for schools and youth sports leagues. It defines concussion as a complex injury to the brain caused by biomechanical forces that results in short-lived impairment of neurological function. Signs and symptoms of concussion can include headaches, dizziness, fatigue, irritability, difficulty concentrating, and sleep disturbances. The document recommends that any athlete showing signs of concussion should be removed from play and not return until cleared by a medical professional. It also stresses the importance of education for coaches, parents, athletes, and physicians on concussion prevention, identification, and treatment.
Vaihmalan Hovi is a hotel and restaurant located in a manor house with two dining options - Bistro Kynsilaukka serving pizzas, wings, and seafood, and Viikinkikellari, a seasonal à la carte restaurant in the manor cellar. The hotel has 8 rooms in the manor house and 9 country-style rooms in a separate building. Guests can experience golf, horseback riding, spa treatments, shopping, and a sauna by the lake, making it a venue for meetings, weddings, and other celebrations.
Consensus statement on concussion in sportccicalifornia
This document provides a consensus statement on the definition and management of sports-related concussion by an international panel of experts. It summarizes the key points discussed and recommendations made by the panel regarding the definition of concussion, evaluation of acute injury including symptoms and signs, neurocognitive assessment, neuroimaging, and return to play guidelines. The panel aimed to build upon previous consensus statements to further the understanding of concussion using an evidence-based approach.
This document is an amended bill from the California legislature regarding concussions and head injuries in school athletics.
It requires (1) any organization using school facilities for recreational activities to provide a statement of compliance with concussion policies, (2) any school district offering athletics to immediately remove any athlete suspected of a concussion from the activity until cleared by a medical provider, and (3) annual concussion information sheets signed by athletes and parents.
http://eldorado.fgxpress.com/
Making good money while living your life at the fullest with FGXpress , simple like 123- Just open your mouth and share.
Share the product,
Share the plan. http://eldorado.fgxpress.com/
skype kokinatatiana
This document provides information and resources about concussions for schools, coaches, athletes, and parents. It outlines policies requiring annual concussion education, removal from play for any athlete suspected of a concussion, and clearance from a healthcare provider before returning to play. It emphasizes that all head impacts need to be taken seriously, as even mild concussions can have severe consequences if not properly managed. Resources are provided for signs and symptoms, best practices, and online trainings for coaches and clinicians.
Julia Maloney is seeking a position that utilizes her almost 20 years of experience in healthcare and pharmacy benefits. She has extensive knowledge of healthcare industries and Medicare programs from roles managing Medicare Part D data and ensuring compliance. Maloney has a proven track record of strategic problem solving and leadership with clients and PBMs.
This bill amends existing California education code regarding the use of school facilities for supervised recreational activities and athletic programs. It would:
1) Require organizations using school facilities for recreation to provide a statement complying with concussion policies.
2) Require schools offering athletics to immediately remove from play any athlete suspected of a concussion and prohibit return until cleared by a licensed healthcare provider.
3) Require annual concussion information sheets signed by athletes and parents before each season.
This document provides information and resources about concussions for schools, coaches, athletes, and parents. It outlines policies requiring annual concussion education, removal from play for any athlete suspected of a concussion, and clearance from a healthcare provider before returning to play. It emphasizes that all head impacts should be taken seriously, as concussions can have severe consequences if not properly managed. Resources are provided for concussion training and materials covering signs, symptoms, and proper response procedures.
Displaying world-class images, Atlas of Imaging in Sports Medicine, second edition is the essential reference text for accurate diagnosis and imaging in sports medicine today. The second edition of the Atlas summarizes the current state of diagnostic imaging in sports medicine. Both common and uncommon conditions conditions are discussed and illustrated. The book begins with an introductory chapter discussing the basic principles of imaging and pathology in sports related injuries. Followed by chapters providing a comprehensive overview of conditions by individual anatomical areas and a final chapter discussing diagnostic and therapeutic interventions. Unique in its breadth and depth, Atlas of Imaging in Sports Medicine, second edition, is authored by pioneers in the field, Dr Jock Anderson and Dr John Read, in collaboration with colleagues
Prevention of Lower Extremity Stress FracturesJA Larson
This document summarizes a systematic review of the literature on preventing stress fractures in athletes and soldiers. It identifies 176 relevant studies, including 20 diagnostic case series, 66 clinical case series, 52 epidemiological studies, and 9 intervention trials. The review finds that bone scans are more sensitive but less specific than x-rays for diagnosing stress fractures. It also examines the reported incidence of stress fractures in military recruits and trainees. The goal of the review is to evaluate research on causes and risk factors of stress fractures, what is known about prevention, and make recommendations for future research.
This document summarizes Kathy Helmick's presentation on clinical care in neurotrauma from a nursing perspective and Department of Defense programs to support traumatic brain injury care. It discusses the DoD definition of TBI severity, the continuum of care including prevention, screening, diagnosis, case management, treatment and rehabilitation. It also provides an overview of DoD policy and initiatives to improve screening, assessment, and management of concussion and mild TBI in deployed service members.
Head and Neck Injuries in Sports: A Sports Medicine Physician's PerspectiveDr. David Carfagno
Dr. David Carfagno is the principal at Scottsdale Sports Medicine Institute, and a frequent presenter on sports medicine topics around the country.
Concussions and neck injuries are a chronic issue among athletes, particularly in both collegiate and professional football. While their severity is getting more attention today, there are still unique factors that physicians and medical personnel should be aware of.
Concussion is a brain injury that results from impacts to the head and has various signs and symptoms. It is most commonly associated with contact sports like football, hockey, and boxing. While historically viewed as only occurring in certain sports, research shows concussions can happen in any sport. Improved prevention and management of concussions requires continued research from different disciplines. Identifying concussions remains challenging due to the variety of possible symptoms, or lack thereof. Once identified, concussions require evaluation by medical professionals and careful management of an athlete's return to play.
This document provides recommendations for implementing a multidisciplinary approach to managing Duchenne muscular dystrophy (DMD). It discusses:
1) Physical therapy interventions like stretching, bracing, and assistive devices to prevent contractures and maintain mobility.
2) Surgical options for contractures depending on the patient's ambulatory stage, including tendon lengthening and transfers.
3) Recommendations for exercise emphasizing submaximum aerobic activity and avoiding high resistance to prevent injury.
Evaluation & treatment of concussions march 2013Satoshi Kajiyama
1) The guideline summarizes evidence on factors that increase or decrease concussion risk in athletes and diagnostic tools to identify concussion. Some factors like age, sex, and sport played can impact risk, but results are inconsistent.
2) Valid diagnostic tools to identify concussion include graded symptom checklists, standardized assessment of concussion tests, neuropsychological assessments, and balance error scoring systems. Ongoing symptoms, concussion history, and younger age indicate increased risks of impairments.
3) Risk factors for more severe or prolonged impairments include multiple prior concussions, particularly within 10 days of the initial injury. Risk factors for long-term issues involve greater concussion exposure and specific genetic factors. No interventions
The document summarizes evidence from a systematic review and expert consensus on clinical practice guidelines for anterior cruciate ligament (ACL) rehabilitation. The rehabilitation should include three phases: (1) an impairment-based phase, (2) a sport-specific training phase, and (3) a return to play phase. A battery of strength, hop, movement quality, and psychological tests should guide progression between phases over 9-12 months. Return to play criteria should incorporate objective measures like strength and hop tests to assess risk of reinjury.
This study examined the effects of manual therapy techniques on 5 former professional football players with histories of concussion. The players underwent cognitive, pain, and mobility tests before and after a 5-day intensive manual therapy program. The therapies aimed to address post-concussion imbalances and included craniosacral, visceral, and neuromeningeal techniques. Results showed improvements in quality of life, depression symptoms, sleep, pain levels, and range of motion. However, the small sample size and lack of controls were limitations; further research with more participants is needed to validate the findings.
Starting from a clinical case where a professional soccer player tear your acl with a concomitant ramp lesion and a detatchment of the lateral meniscus and popliteo fibular ligament we spek about the acl rehab and the not usual knee injury rehabilitation.
from the annual The Battle Sports Medicine Congress helded in Cesena (ITA) Technogym Village
This document describes a project to develop a portable device to detect knee arthritis using acoustic emissions. Microphones will be attached to an elastic knee strap to collect knee sound signals, which will be filtered and analyzed using an Arduino microprocessor. Frequency and amplitude analysis of the signals will be used to determine knee health. Results will be sent via Bluetooth to an Android device for user-friendly display. The goal is to create an inexpensive, easy-to-use tool to help users assess their knee health and determine if a doctor visit is needed for arthritis diagnosis.
This clinical guideline from the North American Spine Society provides recommendations for the diagnosis and treatment of degenerative lumbar spondylolisthesis. It summarizes the methodology used to develop the guideline, compares the current recommendations to the 2008 version, defines degenerative lumbar spondylolisthesis, and provides recommendations on diagnosis/imaging, outcome measures, medical/interventional treatment, surgical treatment, and the value of spine care. The guideline is intended to aid physicians and patients but also allows for clinical judgment based on individual patient circumstances.
Concussions in Sports discusses concussions, which are mild traumatic brain injuries caused by impacts that cause bruising or swelling of the brain. Symptoms include headaches, memory loss, and mood changes. The NFL and NCAA are researching both short and long term effects of concussions on athletes. Rule changes have targeted helmet-to-helmet hits, and equipment is improving with new helmets reducing concussions by 10% annually. Rest is important to properly treat concussions, which usually heal within 7-10 days but can take longer for athletes.
Concussions in Sports discusses concussions, which are mild traumatic brain injuries caused by impacts that cause bruising or swelling of the brain. The document outlines common concussion symptoms like headaches and memory loss. It also discusses how organizations like the NFL and NCAA are researching the short and long term effects of concussions on athletes. New equipment and rules changes have aimed to reduce concussions, like football helmets with more padding and a NCAA rule banning targeting with the crown of the helmet. Rest is very important to properly treat concussions, which usually take 7-10 days to heal in athletes.
1. This document provides summaries of 4 recent studies related to chiropractic care, beginning with a major study published in Annals of Internal Medicine that found spinal manipulative therapy and home exercises were superior to medication for neck pain.
2. The second study summarized was the first randomized controlled trial to examine chiropractic management for patients with chest pain, finding that chiropractic patients improved significantly more than those receiving self-management.
3. References and appendices are provided for each study summarized. The document concludes by commenting on how chiropractic addresses the mechanical cause of problems rather than just symptoms.
1) The study measured the longitudinal excursion and strain in the median and ulnar nerves during different types of nerve gliding exercises commonly used to treat carpal tunnel syndrome and cubital tunnel syndrome.
2) It found that "sliding techniques" which involve alternating movements at two joints resulted in substantially larger nerve excursion with much smaller increases in nerve strain, compared to "tensioning techniques" which simply elongate the nerve bed.
3) The findings demonstrate that different nerve gliding techniques have different mechanical effects on the peripheral nervous system, and may influence neuropathological processes differently. Clinicians should consider these effects when selecting exercises for conservative or post-operative treatment of common neuropathies.
Concussion guidelines article. Carney et al. Neurosurgery 2014brwjam004
This document summarizes the methodology and initial findings of a project to develop an evidence-based definition of concussion. The project used a systematic review and quality assessment of published literature from 1980 to 2012 to identify the most prevalent signs, symptoms, and cognitive deficits within 3 months of a potential concussive event. Sixty-two studies of medium or high quality were identified. The findings suggest consistent deficits in reaction time, memory, attention, processing speed and working memory within days of injury. Disorientation or confusion immediately after injury and slower reaction times or impaired verbal learning within 2 days were the most prevalent indicators. The studies mainly examined athletic populations and could not distinguish between evidence of concussion versus just a potential concussive event.
This document outlines topics to be covered in a session on concussions in children, including understanding the pathophysiology and symptoms of concussions, diagnostic tools, signs and symptoms, return to play requirements, and the role of assessment tools like ImPACT testing. It then provides details on concussion rates in various sports, symptoms, management guidelines, and interfacing with schools to support student recovery. The goal is for participants to gain knowledge on evaluating and managing concussions in youth athletes.
This unit focuses on sports injuries, including injury prevention, identification, treatment, and rehabilitation. Key points covered include:
- Identifying intrinsic and extrinsic risk factors for sports injuries and preventative measures that can be taken.
- Explaining the physiological and psychological responses to most sports injuries.
- Describing first aid treatments and common treatment methods for different injury types.
- Being able to plan and construct treatment and rehabilitation programs for two common sports injuries with tutor support.
The unit aims to provide learners with an overview of sports injury prevention, identification, treatment and rehabilitation.
Neurology protesting the brain in sports what do we really know 03-22-13Janet McNichol
(1) Guidelines for diagnosing and treating concussions were last updated 15 years ago, and much has changed in understanding this condition and the role of neurologists in sports.
(2) The authors review literature from 1955 to answer questions about concussion risk factors, diagnostic tools, clinical factors related to outcomes, and interventions to aid recovery.
(3) The guideline provides crucial information to improve concussion management in sports and will serve as a foundation for ongoing work in this important area of public health.
Similar to Consensus statement on concussion in sport (20)
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...
Consensus statement on concussion in sport
1. CONSENSUS STATEMENT
Consensus Statement on Concussion in Sport
rd
3 International Conference on Concussion in Sport
Held in Zurich, November 2008
Paul McCrory, MBBS, PhD,* Willem Meeuwisse, MD, PhD,† Karen Johnston, MD, PhD,‡
Jiri Dvorak, MD,§ Mark Aubry, MD,k Mick Molloy, MB,¶ and Robert Cantu, MA, MD#
(Clin J Sport Med 2009;19:185–200) encouraged to copy and distribute freely the Zurich Consensus
document and/or the Sport Concussion Assessment Tool
(SCAT2) card, and neither is subject to any copyright
Preamble restriction. The authors request, however, that the document
This paper is a revision and update of the recommen- and/or the SCAT2 card be distributed in their full and complete
dations developed following the 1st (Vienna) and 2nd (Prague) format.
International Symposia on Concussion in Sport.1,2 The Zurich The following focus questions formed the foundation for
Consensus statement is designed to build on the principles the Zurich concussion consensus statement:
outlined in the original Vienna and Prague documents and to
develop further conceptual understanding of this problem Acute Simple Concussion
using a formal consensus-based approach. A detailed de- Which symptom scale and which sideline assessment tool is
scription of the consensus process is outlined at the end of this best for diagnosis and/or follow up?
document under the ‘‘Background’’ section (see Section 11). How extensive should the cognitive assessment be in elite
This document is developed for use by physicians, therapists, athletes?
certified athletic trainers, health professionals, coaches and How extensive should clinical and neuropsychological (NP)
other people involved in the care of injured athletes, whether at testing be at non-elite level?
the recreational, elite or professional level. Who should do/interpret the cognitive assessment?
While agreement exists pertaining to principal messages Is there a gender difference in concussion incidence and
conveyed within this document, the authors acknowledge that outcomes?
the science of concussion is evolving and therefore manage-
ment and return to play decisions remain in the realm of
clinical judgment on an individualized basis. Readers are Return to Play (RTP) Issues
Is provocative exercise testing useful in guiding RTP?
What is the best RTP strategy for elite athletes?
What is the best RTP strategy for non-elite athletes?
Submitted for publication January 14, 2009; accepted March 11, 2009.
From the *Centre for Health, Exercise Sports Medicine, University of
Is protective equipment (eg, mouthguards and helmets)
Melbourne, Parkville, Australia; †Sport Medicine Centre, Faculty of useful in reducing concussion incidence and/or severity?
Kinesiology, and Department of Community Health Sciences, Faculty
of Medicine, University of Calgary, Calgary, Alberta, Canada; ‡Sport
Concussion Clinic, Toronto Rehabilitation Institute, Toronto, Ontario, Complex Concussion and Long-term Issues
Canada; §FIFA Medical Assessment and Research Center (F-MARC) and Is the Simple versus Complex classification a valid and
Schulthess Clinic, Zurich, Switzerland; kInternational Ice Hockey useful differentiation?
Federation and Hockey Canada, and Ottawa Sport Medicine Centre,
Ottawa, Ontario, Canada; {International Rugby Board, Dublin, Ireland;
Are there specific patient populations at risk of long-term
and #Department of Neurosurgery and Department of Sport Medicine, problems?
Emerson Hospital, Concord, Massachusetts. Is there a role for additional tests (eg, structural and/or
Consensus panelists (listed in alphabetical order): In addition to the authors functional MR Imaging, balance testing, biomarkers)?
above, the consensus panelists were Steve Broglio, Gavin Davis, Randall Should athletes with persistent symptoms be screened for
Dick, Ruben Echemendia, Gerry Gioia, Kevin Guskiewicz, Stan Herring,
Grant Iverson, Jim Kelly, Jamie Kissick, Michael Makdissi, Michael depression/anxiety?
McCrea, Alain Ptito, Laura Purcell, and Margot Putukian. Also invited but
not in attendance: Roald Bahr, Lars Engebretsen, Peter Hamlyn, Barry
Jordan, and Patrick Schamasch. Paediatric Concussion
Competing Interests: The authors have no competing interests to declare. Which symptoms scale is appropriate for this age group?
Reprints: not available. Which tests are useful and how often should baseline testing
Correspondence: Assoc. Prof. Paul McCrory, MBBS, PhD, Centre for Health,
Exercise Sports Medicine, University of Melbourne, Parkville,
be performed in this age group?
Australia 3010 (e-mail: paulmccr@bigpond.net.au). What is the most appropriate RTP guideline for elite and
Copyright Ó 2009 by Lippincott Williams Wilkins non-elite child and adolescent athletes?
Clin J Sport Med Volume 19, Number 3, May 2009 www.cjsportmed.com | 185
2. McCrory et al Clin J Sport Med Volume 19, Number 3, May 2009
Future Directions 2. CONCUSSION EVALUATION
What is the best method of knowledge transfer and
education? 2.1 Symptoms and Signs of Acute Concussion
Is there evidence that new and novel injury prevention The panel agreed that the diagnosis of acute concussion
strategies work (eg, changes to rules of the game, fair play usually involves the assessment of a range of domains
strategies, etc.)? including clinical symptoms, physical signs, behavior,
The Zurich document additionally examines the balance, sleep and cognition. Furthermore, a detailed concus-
management issues raised in the previous Prague and Vienna sion history is an important part of the evaluation both in the
documents and applies the consensus questions to these areas. injured athlete and when conducting a pre-participation
examination. The detailed clinical assessment of concussion
is outlined in the SCAT2 form, which is an appendix to this
SPECIFIC RESEARCH QUESTIONS AND document.
CONSENSUS DISCUSSION The suspected diagnosis of concussion can include one
or more of the following clinical domains:
1. CONCUSSION (a) Symptoms: somatic (eg, headache), cognitive (eg, feeling
like in a fog) and/or emotional symptoms (eg, lability)
1.1 Definition of Concussion (b) Physical signs (eg, loss of consciousness, amnesia)
Panel discussion regarding the definition of concussion (c) Behavioural changes (eg, irritablity)
and its separation from mild traumatic brain injury (mTBI) (d) Cognitive impairment (eg, slowed reaction times)
was held. Although there was acknowledgement that the (e) Sleep disturbance (eg, drowsiness)
terms refer to different injury constructs and should not be If any one or more of these components is present, a
used interchangeably, it was not felt that the panel would concussion should be suspected and the appropriate manage-
define mTBI for the purpose of this document. There was ment strategy instituted.
unanimous agreement, however, that concussion is defined
as follows:
Concussion is defined as a complex pathophysiological 2.2 On-field or Sideline Evaluation of
process affecting the brain, induced by traumatic biomechan- Acute Concussion
ical forces. Several common features that incorporate clinical, When a player shows ANY features of a concussion:
pathologic and biomechanical injury constructs that may be (a) The player should be medically evaluated onsite using
utilized in defining the nature of a concussive head injury standard emergency management principles, and particular
include: attention should be given to excluding a cervical spine
1. Concussion may be caused either by a direct blow to the injury.
head, face, neck or elsewhere on the body with an (b) The appropriate disposition of the player must be
ÔÔimpulsiveÕÕ force transmitted to the head. determined by the treating healthcare provider in a timely
2. Concussion typically results in the rapid onset of short- manner. If no healthcare provider is available, the player
lived impairment of neurologic function that resolves should be safely removed from practice or play and urgent
spontaneously. referral to a physician arranged.
3. Concussion may result in neuropathological changes, but (c) Once the first aid issues are addressed, then an assessment
the acute clinical symptoms largely reflect a functional of the concussive injury should be made using the SCAT2
disturbance rather than a structural injury. or other similar tool.
4. Concussion results in a graded set of clinical symptoms that (d) The player should not be left alone following the injury,
may or may not involve loss of consciousness. Resolution and serial monitoring for deterioration is essential over the
of the clinical and cognitive symptoms typically follows initial few hours following injury.
a sequential course; however, it is important to note that, in (e) A player with diagnosed concussion should not be allowed
a small percentage of cases, post-concussive symptoms may to return to play on the day of injury. Occasionally, in adult
be prolonged. athletes, there may be return to play on the same day as the
5. No abnormality on standard structural neuroimaging injury. (See section 4.2.)
studies is seen in concussion. It was unanimously agreed that sufficient time for
assessment and adequate facilities should be provided for the
appropriate medical assessment both on and off the field for all
1.2 Classification of Concussion injured athletes. In some sports this may require rule change
There was unanimous agreement to abandon the Simple to allow an off-field medical assessment to occur without
vs. Complex terminology that had been proposed in the Prague affecting the flow of the game or unduly penalizing the injured
agreement statement, as the panel felt that the terminology player’s team.
itself did not fully describe the entities. However, the panel Sideline evaluation of cognitive function is an essential
unanimously retained the concept that the majority (80%- component in the assessment of this injury. Brief neuro-
90%) of concussions resolve in a short (7-10 day) period, psychological test batteries that assess attention and memory
although the recovery time frame may be longer in children function have been shown to be practical and effective. Such
and adolescents.2 tests include the Maddocks questions3,4 and the Standardized
186 | www.cjsportmed.com q 2009 Lippincott Williams Wilkins
3. Clin J Sport Med Volume 19, Number 3, May 2009 Consensus Statement on Concussion
Assessment of Concussion (SAC).5–7 It is worth noting that abnormalities that may be incidentally discovered is not
standard orientation questions (eg, time, place, person) have established at the present time.
been shown to be unreliable in the sporting situation when Other imaging modalities such as fMRI demonstrate
compared with memory assessment.4,8 It is recognized, activation patterns that correlate with symptom severity and
however, that abbreviated testing paradigms are designed for recovery in concussion.9–13 Whilst not part of routine assess-
rapid concussion screening on the sidelines and are not meant ment at the present time, they nevertheless provide additional
to replace comprehensive neuropsychological testing which is insight to pathophysiological mechanisms. Alternative imag-
sensitive to detect subtle deficits that may exist beyond the ing technologies (eg, positron emission tomography, diffusion
acute episode nor should they be used as a stand-alone tool for tensor imaging, magnetic resonance spectroscopy, functional
the ongoing management of sports concussions. connectivity), while demonstrating some compelling findings,
It should also be recognized that the appearance of are still at early stages of development and cannot be recom-
symptoms might be delayed several hours following a con- mended other than in a research setting.
cussive episode.
2.3 Evaluation in Emergency Room or Office by 3.2 Objective Balance Assessment
Medical Personnel Published studies using both sophisticated force plate
An athlete with concussion may be evaluated in the technology, as well as those using less sophisticated clinical
emergency room or doctor’s office as a point of first contact balance tests (eg, Balance Error Scoring System (BESS)),
following injury or may have been referred from another care have identified postural stability deficits lasting approximately
provider. In addition to the points outlined above, the key 72 hours following sport-related concussion. It appears that
features of this exam should encompass: postural stability testing provides a useful tool for objectively
assessing the motor domain of neurologic functioning and
(a) A medical assessment including a comprehensive history
should be considered a reliable and valid addition to the
and detailed neurological examination including a thor-
assessment of athletes suffering from concussion, particularly
ough assessment of mental status, cognitive functioning
where symptoms or signs indicate a balance component.14–20
and gait and balance.
(b) A determination of the clinical status of the patient
including whether there has been improvement or 3.3 Neuropsychological Assessment
deterioration since the time of injury. This may involve
The application of neuropsychological (NP) testing in
seeking additional information from parents, coaches,
concussion has been shown to be of clinical value and
teammates and eyewitness to the injury.
continues to contribute significant information in concussion
(c) A determination of the need for emergent neuroimaging in
evaluation.21–26 Although in most case cognitive recovery
order to exclude a more severe brain injury involving
largely overlaps with the time course of symptom recovery, it
a structural abnormality.
has been demonstrated that cognitive recovery may occasion-
In large part, these points above are included in the
ally precede or more commonly follow clinical symptom
SCAT2 assessment, which forms part of the Zurich consensus
resolution suggesting that the assessment of cognitive function
statement.
should be an important component in any return to play
protocol.27,28 It must be emphasized, however, that NP assess-
ment should not be the sole basis of management decisions;
3. CONCUSSION INVESTIGATIONS rather, it should be seen as an aid to the clinical decision-
A range of additional investigations may be utilized making process in conjunction with a range of clinical
to assist in the diagnosis and/or exclusion of injury. These domains and investigational results.
include: Neuropsychologists are in the best position to interpret
NP tests by virtue of their background and training. However,
3.1 Neuroimaging there may be situations where neuropsychologists are not
It was recognized by the panelists that conventional available and other medical professionals may perform or
structural neuroimaging is normal in concussive injury. Given interpret NP screening tests. The ultimate return to play
that caveat, the following suggestions are made: Brain CT (or, decision should remain a medical one in which a multidisci-
where available, MR brain scan) contributes little to concussion plinary approach, when possible, has been taken. In the
evaluation but should be employed whenever suspicion of an absence of NP and other (eg, formal balance assessment)
intra-cerebral structural lesion exists. Examples of such testing, a more conservative return to play approach may be
situations may include prolonged disturbance of conscious appropriate.
state, focal neurological deficit or worsening symptoms. In the majority of cases, NP testing will be used to assist
Newer structural MRI modalities including gradient return to play decisions and will not be done until the patient
echo, perfusion and diffusion imaging have greater sensitivity is symptom free.29,30 There may be situations (eg, child and
for structural abnormalities. However, the lack of published adolescent athletes) where testing may be performed early
studies, as well as absent pre-injury neuroimaging data, limits whilst the patient is still symptomatic to assist in determining
the usefulness of this approach in clinical management at the management. This will normally be best determined in
present time. In addition, the predictive value of various MR consultation with a trained neuropsychologist.31,32
q 2009 Lippincott Williams Wilkins www.cjsportmed.com | 187
4. McCrory et al Clin J Sport Med Volume 19, Number 3, May 2009
3.4 Genetic Testing recovery, while symptomatically following an injury, it is
The significance of Apolipoprotein (Apo) E4, ApoE important to emphasize to the athlete that physical AND
promotor gene, Tau polymerase and other genetic markers in cognitive rest is required. Activities that require concentration
the management of sports concussion risk or injury outcome is and attention (eg, scholastic work, videogames, text messaging,
unclear at this time.33,34 Evidence from human and animal etc.) may exacerbate symptoms and possibly delay recovery. In
studies in more severe traumatic brain injury demonstrates such cases, apart from limiting relevant physical and cognitive
induction of a variety of genetic and cytokine factors such as: activities (and other risk-taking opportunities for re-injury),
insulin-like growth factor-1 (IGF-1), IGF binding protein-2, while symptomatic, no further intervention is required during
Fibroblast growth factor, Cu-Zn superoxide dismutase, the period of recovery, and the athlete typically resumes sport
superoxide dismutase-1 (SOD-1), nerve growth factor, glial without further problem.
fibrillary acidic protein (GFAP) and S-100. Whether such
factors are affected in sporting concussion is not known at 4.1 Graduated Return to Play Protocol
this stage.35–42 Return to play protocol following a concussion follows
a stepwise process as outlined in Table 1.
3.5 Experimental Concussion With this stepwise progression, the athlete should
Assessment Modalities continue to proceed to the next level if asymptomatic at the
Different electrophysiological recording techniques (eg, current level. Generally, each step should take 24 hours so that
evoked response potential (ERP), cortical magnetic stimula- an athlete would take approximately one week to proceed
tion and electroencephalography) have demonstrated repro- through the full rehabilitation protocol once they are
ducible abnormalities in the post concussive state; however, asymptomatic at rest and with provocative exercise. If any
not all studies reliably differentiated concussed athletes from post-concussion symptoms occur while in the stepwise
controls.43–49 The clinical significance of these changes program, then the patient should drop back to the previous
remains to be established. asymptomatic level and try to progress again after a further
In addition, biochemical serum and cerebral spinal fluid 24-hour period of rest has passed.
markers of brain injury (including S-100, neuron specific
enolase (NSE), myelin basic protein (MBP), GFAP, tau, etc.) 4.2 Same Day RTP
have been proposed as means by which cellular damage may With adult athletes, in some settings, where there are
be detected if present.50–56 There is currently insufficient team physicians experienced in concussion management and
evidence, however, to justify the routine use of these sufficient resources (eg, access to neuropsychologists, con-
biomarkers clinically. sultants, neuroimaging, etc.), as well as access to immediate
(ie, sideline) neuro-cognitive assessment, return to play
management may be more rapid. The RTP strategy must still
4. CONCUSSION MANAGEMENT follow the same basic management principles, namely, full
The cornerstone of concussion management is physical clinical and cognitive recovery before consideration of return
and cognitive rest until symptoms resolve and then a graded to play. This approach is supported by published guidelines,
program of exertion prior to medical clearance and return to such as the American Academy of Neurology, US Team
play. The recovery and outcome of this injury may be modified Physician Consensus Statement, and US National Athletic
by a number of factors that may require more sophisticated Trainers’ Association Position Statement.58–60 This issue was
management strategies. These are outlined in the section on extensively discussed by the consensus panelists, and it was
modifiers below. acknowledged that there is evidence that some professional
As described above, the majority of injuries will recover American football players are able to RTP more quickly, with
spontaneously over several days. In these situations, it is even same day RTP supported by NFL studies without a risk of
expected that an athlete will proceed progressively through recurrence or sequelae.61 There is data, however, demonstrat-
a stepwise return to play strategy.57 During this period of ing that, at the collegiate and high school level, athletes
TABLE 1. Graduated Return to Play Protocol
Rehabilitation Stage Functional Exercise at Each Stage of Rehabilitation Objective of Each Stage
1. No activity Complete physical and cognitive rest Recovery
2. Light aerobic exercise Walking, swimming or stationary cycling keeping Increase HR
intensity ,70% MPHR; no resistance training
3. Sport-specific exercise Skating drills in ice hockey, running drills in soccer; Add movement
no head impact activities
4. Non-contact training drills Progression to more complex training drills, eg, Exercise, coordination, and cognitive load
passing drills in football and ice hockey; may
start progressive resistance training
5. Full contact practice Following medical clearance, participate in normal Restore confidence and assess functional skills
training activities by coaching staff
6. Return to play Normal game play
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5. Clin J Sport Med Volume 19, Number 3, May 2009 Consensus Statement on Concussion
allowed to RTP on the same day may demonstrate NP deficits protective equipment employed at time of injury be sought,
post-injury that may not be evident on the sidelines and are both for recent and remote injuries. The benefit a comprehen-
more likely to have delayed onset of symptoms.62–68 It should sive pre-participation concussion evaluation allows for
be emphasized, however, that the young (,18) elite athlete modification and optimization of protective behavior and is
should be treated more conservatively even though the an opportunity for education.
resources may be the same as an older professional athlete.
(See section 6.1.)
5. MODIFYING FACTORS IN
4.3 Psychological Management and Mental CONCUSSION MANAGEMENT
Health Issues The consensus panel agreed that a range of ÔmodifyingÕ
In addition, psychological approaches may have factors may influence the investigation and management of
potential application in this injury, particularly with the concussion and in some cases may predict the potential for
modifiers listed below.69,70 Care givers are also encouraged to prolonged or persistent symptoms. These modifiers would also
evaluate the concussed athlete for affective symptoms such as be important to consider in a detailed concussion history and
depression, as these symptoms may be common in concussed are outlined in Table 2.
athletes.57 In this setting, there may be additional management
considerations beyond simple RTP advice. There may be
4.4 The Role of Pharmacological Therapy a more important role for additional investigations including
Pharmacological therapy in sports concussion may be formal NP testing, balance assessment, and neuroimaging. It is
applied in two distinct situations. The first of these situations is envisioned that athletes with such modifying features would
the management of specific prolonged symptoms (eg, sleep be managed in a multidisciplinary manner coordinated by
disturbance, anxiety, etc.). The second situation is where drug a physician with specific expertise in the management of
therapy is used to modify the underlying pathophysiology concussive injury.
of the condition with the aim of shortening the duration of The role of female gender as a possible modifier in the
the concussion symptoms.71 In broad terms, this approach to management of concussion was discussed at length by the
management should be only considered by clinicians expe- panel. There was not unanimous agreement that the current
rienced in concussion management. published research evidence is conclusive that this should be
An important consideration in RTP is that concussed included as a modifying factor, although it was accepted that
athletes should not only be symptom free but also should gender may be a risk factor for injury and/or influence injury
not be taking any pharmacological agents/medications that severity.76–78
may mask or modify the symptoms of concussion. Where
antidepressant therapy may be commenced during the 5.1 The Significance of Loss of
management of a concussion, the decision to return to play Consciousness (LOC)
while still on such medication must be considered carefully In the overall management of moderate to severe
by the treating clinician. traumatic brain injury, duration of LOC is an acknowledged
4.5 The Role of Pre-participation
Concussion Evaluation TABLE 2. Concussion Modifiers
Recognizing the importance of a concussion history, and Factors Modifier
appreciating the fact that many athletes will not recognize all
Symptoms Number
the concussions they may have suffered in the past, a detailed
Duration (.10 days)
concussion history is of value.72–75 Such a history may pre-
Severity
identify athletes that fit into a high risk category and provides
Signs Prolonged LOC (.1 min), amnesia
an opportunity for the healthcare provider to educate the
Sequelae Concussive convulsions
athlete in regard to the significance of concussive injury. A
Temporal Frequency - repeated concussions over time
structured concussion history should include specific ques-
Timing - injuries close together in time
tions as to previous symptoms of a concussion, not just the
‘‘Recency’’ - recent concussion or TBI
perceived number of past concussions. It is also worth noting
Threshold Repeated concussions occurring with
that dependence upon the recall of concussive injuries by progressively less impact force or slower
teammates or coaches has been demonstrated to be unreli- recovery after each successive concussion
able.72 The clinical history should also include information Age Child and adolescent (,18 years old)
about all previous head, face or cervical spine injuries, as these Co- and Pre-morbidities Migraine, depression or other mental health
may also have clinical relevance. It is worth emphasizing that, disorders, attention deficit hyperactivity
in the setting of maxillofacial and cervical spine injuries, co- disorder (ADHD), learning disabilities (LD),
sleep disorders
existent concussive injuries may be missed unless specifically
Medication Psychoactive drugs, anticoagulants
assessed. Questions pertaining to disproportionate impact
Behaviour Dangerous style of play
versus symptom severity matching may alert the clinician to
Sport High-risk activity, contact and collision sport,
a progressively increasing vulnerability to injury. As part high sporting level
of the clinical history it is advised that details regarding
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6. McCrory et al Clin J Sport Med Volume 19, Number 3, May 2009
predictor of outcome.79 Whilst published findings in concus- ADHD who may need more sophisticated assessment
sion describe LOC associated with specific early cognitive strategies.31,32,101
deficits, it has not been noted as a measure of injury The panel strongly endorsed the view that children
severity.80,81 Consensus discussion determined that prolonged should not be returned to practice or play until clinically
(.1 minute duration) LOC would be considered as a factor completely symptom free, which may require a longer time
that may modify management. frame than for adults. In addition, the concept of Ôcognitive
restÕ was highlighted with special reference to a child’s need
5.2 The Significance of Amnesia and to limit exertion with activities of daily living and to limit
Other Symptoms scholastic and other cognitive stressors (eg, text messaging,
There is renewed interest in the role of post-traumatic videogames, etc.) while symptomatic. School attendance and
amnesia and its role as a surrogate measure of injury activities may also need to be modified to avoid provocation
severity.67,82,83 Published evidence suggests that the nature, of symptoms.
burden and duration of the clinical post-concussive symptoms Because of the different physiological responses and
may be more important than the presence or duration of longer recovery after concussion and specific risks (eg, diffuse
amnesia alone.80,84,85 Further, it must be noted that retrograde cerebral swelling) related to head impact during childhood and
amnesia varies with the time of measurement post-injury and adolescence, a more conservative return to play approach is
hence is poorly reflective of injury severity.86,87 recommended. It is appropriate to extend the amount of time
of asymptomatic rest and/or the length of the graded exertion
5.3 Motor and Convulsive Phenomena in children and adolescents. It is not appropriate for a child or
A variety of immediate motor phenomena (eg, tonic adolescent athlete with concussion to RTP on the same day as
posturing) or convulsive movements may accompany a con- the injury regardless of the level of athletic performance.
cussion. Although dramatic, these clinical features are Concussion modifiers apply even more to this population than
generally benign and require no specific management beyond adults and may mandate more cautious RTP advice.
the standard treatment of the underlying concussive injury.88,89
6.2 Elite vs. Non-Elite Athletes
5.4 Depression The panel unanimously agreed that all athletes, regard-
Mental health issues (such as depression) have been less of level of participation, should be managed using the
reported as a long-term consequence of traumatic brain injury same treatment and return to play paradigm. A more useful
including sports related concussion. Neuroimaging studies using construct was agreed whereby the available resources and
fMRI suggest that a depressed mood following concussion may expertise in concussion evaluation were of more importance in
reflect an underlying pathophysiological abnormality consistent determining management than a separation between elite and
with a limbic-frontal model of depression.52,90–100 non-elite athlete management. Although formal baseline NP
screening may be beyond the resources of many sports or
individuals, it is recommended that in all organized high-risk
6. SPECIAL POPULATIONS
sports consideration be given to having this cognitive
6.1 The Child and Adolescent Athlete evaluation regardless of the age or level of performance.
There was unanimous agreement by the panel that the
6.3 Chronic Traumatic Brain Injury
evaluation and management recommendations contained
herein could be applied to children and adolescents down to Epidemiological studies have suggested an association
the age of 10 years. Below that age children report concussion between repeated sports concussions during a career and late
symptoms different from adults and would require age- life cognitive impairment. Similarly, case reports have noted
appropriate symptom checklists as a component of assess- anecdotal cases where neuro-pathological evidence of chronic
ment. An additional consideration in assessing the child or traumatic encephalopathy was observed in retired football
adolescent athlete with a concussion is that in the clinical players.108–112 Panel discussion was held, and no consensus
evaluation by the healthcare professional there may be the was reached on the significance of such observations at this
need to include both patient and parent input, as well as teacher stage. Clinicians need to be mindful of the potential for long-
and school input when appropriate.101–107 term problems in the management of all athletes.
The decision to use NP testing is broadly the same as the
adult assessment paradigm. However, timing of testing may 7. INJURY PREVENTION
differ in order to assist planning in school and home
management (and may be performed while the patient is still 7.1 Protective Equipment – Mouthguards
symptomatic). If cognitive testing is performed then it must be and Helmets
developmentally sensitive until late teen years due to the There is no good clinical evidence that currently
ongoing cognitive maturation that occurs during this period available protective equipment will prevent concussion,
which, in turn, makes the utility of comparison to either the although mouthguards have a definite role in preventing
person’s own baseline performance or to population norms dental and oro-facial injury. Biomechanical studies have
limited.20 In this age group it is more important to consider shown a reduction in impact forces to the brain with the use of
the use of trained neuropsychologists to interpret assessment head gear and helmets, but these findings have not been
data, particularly in children with learning disorders and/or translated to show a reduction in concussion incidence. For
190 | www.cjsportmed.com q 2009 Lippincott Williams Wilkins
7. Clin J Sport Med Volume 19, Number 3, May 2009 Consensus Statement on Concussion
skiing and snowboarding, there are a number of studies to managers play an important part in ensuring these values are
suggest that helmets provide protection against head and facial implemented on the field of play.57,136–148
injury and hence should be recommended for participants in
alpine sports.113–116 In specific sports such as cycling, motor 9. FUTURE DIRECTIONS
and equestrian sports, protective helmets may prevent other The consensus panelists recognize that research is
forms of head injury (eg, skull fracture) that are related to needed across a range of areas in order to answer some critical
falling on hard road surfaces, and these may be an important research questions. The key areas for research identified
injury prevention issue for those sports.116–128 include:
Validation of the SCAT2
7.2 Rule Change
Gender effects on injury risk, severity and outcome
Consideration of rule changes to reduce head injury
Paediatric injury and management paradigms
incidence or severity may be appropriate where a clear-cut
Virtual reality tools in the assessment of injury
mechanism is implicated in a particular sport. An example of Rehabilitation strategies (eg, exercise therapy)
this is in football (soccer) where research studies demonstrated
Novel imaging modalities and their role in clinical
that upper limb to head contact in heading contests accounted
assessment
for approximately 50% of concussions.129 As noted earlier, rule Concussion surveillance using consistent definitions and
changes also may be needed in some sports to allow an effective
outcome measures
off-field medical assessment to occur without compromising the
Clinical assessment where no baseline assessment has been
athlete’s welfare, affecting the flow of the game or unduly
performed
penalizing the player’s team. It is important to note that rule ÔBest-practiceÕ neuropsychological testing
enforcement may be a critical aspect of modifying injury risk in
Long-term outcomes
these settings, and referees play an important role in this regard.
On-field injury severity predictors
7.3 Risk Compensation
An important consideration in the use of protective
10. MEDICAL LEGAL CONSIDERATIONS
equipment is the concept of risk compensation.130 This is This consensus document reflects the current state of
where the use of protective equipment results in behavioral knowledge and will need to be modified according to the
change such as the adoption of more dangerous playing development of new knowledge. It provides an overview of
techniques, which can result in a paradoxical increase in injury issues that may be of importance to healthcare providers
rates. This may be a particular concern in child and adolescent involved in the management of sports related concussion. It is
athletes where head injury rates are often higher than in adult not intended as a standard of care and should not be interpreted
athletes.131–133 as such. This document is only a guide and is of a general
nature consistent with the reasonable practice of a healthcare
7.4 Aggression vs. Violence in Sport professional. Individual treatment will depend on the facts and
The competitive/aggressive nature of sport which makes circumstances specific to each individual case.
it fun to play and watch should not be discouraged. However, It is intended that this document will be formally
sporting organizations should be encouraged to address reviewed and updated prior to 1 December 2012.
violence that may increase concussion risk.134,135 Fair play
11. STATEMENT ON BACKGROUND TO
and respect should be supported as key elements of sport.
CONSENSUS PROCESS
In November 2001, the 1st International Conference on
8. KNOWLEDGE TRANSFER Concussion in Sport was held in Vienna, Austria. This meeting
As the ability to treat or reduce the effects of concussive was organized by the IIHF in partnership with FIFA and the
injury after the event is minimal, education of athletes, Medical Commission of the IOC. As part of the resulting mandate
colleagues and the general public is a mainstay of progress in for the future, the need for leadership and future updates were
this field. Athletes, referees, administrators, parents, coaches identified. The 2nd International Conference on Concussion in
and health care providers must be educated regarding the Sport was organized by the same group with the additional
detection of concussion, its clinical features, assessment involvement of the IRB and was held in Prague, Czech Republic,
techniques and principles of safe return to play. Methods to in November 2004. The original aims of the symposia were to
improve education including web-based resources, educational provide recommendations for the improvement of safety and
videos and international outreach programs are important in health of athletes who suffer concussive injuries in ice hockey,
delivering the message. In addition, concussion working rugby, football (soccer) as well as other sports. To this end, a range
groups, plus the support and endorsement of enlightened sport of experts were invited to both meetings to address specific issues
groups such as Federation Internationale de Football Associ-
´ ´ of epidemiology, basic and clinical science, injury grading
ation (FIFA), International Olympic Commission (IOC), systems, cognitive assessment, new research methods, protective
International Rugby Board (IRB) and International Ice Hockey equipment, management, prevention and long-term outcome.1,2
Federation (IIHF) who initiated this endeavor, have enormous The 3rd International Conference on Concussion in Sport
value and must be pursued vigorously. Fair play and respect for was held in Zurich, Switzerland, on 29/30 October 2008 and
opponents are ethical values that should be encouraged in all was designed as a formal consensus meeting following
sports and sporting associations. Similarly, coaches, parents and the organizational guidelines set forth by the US National
q 2009 Lippincott Williams Wilkins www.cjsportmed.com | 191
8. McCrory et al Clin J Sport Med Volume 19, Number 3, May 2009
Institutes of Health. (Details of the consensus methodology 8. McCrea M, Kelly JP, Kluge J, et al. Standardized assessment of
can be obtained at http://consensus.nih.gov/ABOUTCDP. concussion in football players. Neurology. 1997;48:586–588.
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3. A number of specific questions were prepared and posed in Rehabilitation. 2007;22:217–227.
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