In October 2022, the 6th International Conference on Concussion in Sport was held in Amsterdam.
Thirty-one (31) expert panelists representing multiple disciplines from nine different countries (Australia, Canada, Finland, Japan, South Africa, USA, UK, Switzerland, Czech Republic) gathered to develop a consensus statement on sports concussion.
Today, the consensus statement was published with open access to the public! This statement includes key recommendations that can be adapted for different sports and a variety of clinical and cultural environments.
Here are 6 key takeaways:
1. Prevention is key!
For children and adolescents playing competitive sports, wearing a mouthguard, reducing body checking, limiting contact practice, and incorporating neuromuscular training (NMT) warm-up programs reduce the risk of concussions. Optimal concussion management strategies should be written into the team policies to help reduce recurrent concussion rates. And, more research is needed!
2. Strict rest is NOT recommended.
Strict rest (also referred to as "cocooning") until symptoms resolve is NOT beneficial. Instead, relative rest is recommended for the first 48 hours post concussion. Light physical activity should begin within 24-48 hours as tolerated. Screen time should be limited within the first 48 hours only.
3. Start physical activity EARLY, with no more than MILD symptoms.
Subsystem threshold aerobic exercise is recommended within 2-10 days after concussion to reduce the incidence of persistent symptoms. Activities such as walking or the stationary bike can be introduced, as long as symptoms remain mild. Consult with your medical providers and rehab team to guide you.
Mild symptom exacerbation is expected when gradually increasing cognitive and physical demands.
MILD symptoms is defined as:
(1) An increase of no more than 2 points on a 0-10 point scale (with 0 representing no symptoms and 10 the worst symptoms imaginable)
(2) for less than an hour
when compared with the baseline value prior to physical or cognitive activity.
4. SLOW the Return to Learn process if there is more than a MILD symptom exacerbation.
The Return to Learn (RTL) process has four main components:
(1) Daily activities with mild symptom exacerbation
(2) School activities AT HOME (e.g. homework or reading)
(3) Return to School Part Time
(4) Return to School Full Time
Progression through the RTL process for students should be slowed if there is more than a MILD symptom exacerbation (see definition above). The majority of students were found to Return to Learn with no additional academic support within the first two weeks. HOWEVER, this process can be prolonged for those with high symptom severity and pre-existing conditions like a prior learning difficulty.
5. Multidisciplinary assessment AND treatment is the gold standard!
Collaborating with an interprofessional concussion team helps assess and treat the student-athlete physically, cognitively, and emotionally. Concussion team members will include parents, medical professionals, rehabilitation providers, coaches, and school professionals. Persistent symptoms (>4 weeks) require referral to clinicians with specialized knowledge and skills in concussion management. Referral to rehabilitation and re-evaluation is especially important if there is a recurrence of symptoms with return-to-learn and return-to-sports.
6. More awareness is needed about the role of the SLP in Concussion Management.
Cognition (or a person's "thinking skills") was mentioned SEVERAL times as being affected following a concussion, and cognitive rehabilitation was stated as having a large impact on a student-athlete's Return-to-Learn. New cognitive and language questions were even added to the SCAT-6 (linked below) to capture more of the cognitive challenges faced post concussion.
YET, SLPs were not mentioned once in this consensus statement.
Speech-Language Pathologists (SLPs) have unique knowledge of the brain, the impact of cognition and communication skills following a brain injury, and school accommodations to support cognitive-communication skills in the learning environment. SLPs are key players on rehabilitation teams for traumatic brain injury survivors providing cognitive rehabilitation therapy. Concussions are a type of mild traumatic brain injury and require a skilled rehabilitation team for optimal recovery.
SLPs are essential members of the Concussion Management Team and Return to Learn process!
Share these takeaways with the parents, coaches, and student-athletes in your life. Let's help each other stay up-to-date on the latest concussion research!
Here are some helpful links to share with your Concussion Management Teams.
Jenny Traver, MS, CCC-SLP, CBIS
Patricios, J. S., Schneider, K. J., Dvorak, J., Ahmed, O. H., Blauwet, C., Cantu, R. C., Davis, G. A., Echemendia, R. J., Makdissi, M., McNamee, M., Broglio, S., Emery, C. A., Feddermann-Demont, N., Fuller, G. W., Giza, C. C., Guskiewicz, K. M., Hainline, B., Iverson, G. L., Kutcher, J. S., Leddy, J. J., … Meeuwisse, W. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. British journal of sports medicine, 57(11), 695–711. https://doi.org/10.1136/bjsports-2023-106898