Concussion
Essential Literature
THE ROLL OF THE CERVICAL SPINE IN POST-CONCUSSIVE SYNDROME
Cameron M. et. al. 2015
Conclusion:
The acute symptoms of concussion are widely considered to be the result of functional neuronal disturbance and an altered cerebral environment however; the etiology of chronic postconcussion symptoms remains unclear. The pathophysiological processes involved in the acute neurometabolic cascade of concussion have been shown by the majority of studies to resolve within a 30-day period. As previously discussed, diffusion tensor examinations of PCS patients also provides inconsistent evidence for neuronal dysfunction as a significant underlying cause of chronic symptoms. Studies utilizing SPECT have found hypoperfusion in various brain regions for up to 5 years following concussion, however, these do not seem specific to concussion injuries, as similar findings are present in myriad physical and psychological conditions. The above findings demonstrate that although the underlying pathophysiology of acute concussion is becoming increasingly well understood, the same cannot be said for the symptoms experienced in PCS.
UPDATED GUIDELINES FOR THE MANAGEMENT OF SPORTS-RELATED CONCUSSION IN GENERAL PRACTICE
Makdissi M 2014
Conclusion:
The critical issues in the clinical management of concussion in sport include making a diagnosis, differentiating between concussion and other pathologies (particularly structural head injury), recognising the presence of any modifying factors (which may increase the risk of complications) and determining when the patient can safely return to competition. The key components of safe return-to-play decisions include rest, neuropsychological testing and a graded program of exertion before return to sport.
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SPORTS CONCUSSION MANAGEMENT: PART 1
Terrell TR et. al 2014
Conclusion:
Same-day return to play is outdated, and the relative insensitivity of current neuroimaging modalities to demonstrate structural damage is highlighted. New therapeutic interventions such as amantadine and cognitive rest may improve recovery time. The appropriate management of concussion typically results in a normal functional and neurocognitive outcome. The recommendations in this article may guide clinicians, with varying degrees of prior experience managing concussion, to increase the likelihood of an excellent outcome.
AMERICAN MEDICAL SOCIETY FOR SPORTS MEDICINE POSITION STATEMENT: CONCUSSION IN SPORT
Harmon KG et.al 2013
PURPOSE OF THE STATEMENT:
▸ To provide an evidence-based, best practises summary to assist physicians with the evaluation and management of sports concussion. ▸ To establish the level of evidence, knowledge gaps and areas requiring additional research.
ON FIELD ASSESSMENT OF CONCUSSION IN THE ADULT ATHLETE
Putukian M 2013
Conclusion:
The onfield evaluation of sport-related concussion is often a challenge, given the elusiveness and variability of presentation, difficulty in making a timely diagnosis, specificity and sensitivity of the sideline assessment tools and the reliance on symptoms. Despite these challenges, the sideline evaluation is based on recognition of injury, assessment of symptoms, cognitive and cranial nerve function and balance. Serial assessments are often necessary and, since signs and symptoms may be delayed, erring on the side of caution (keeping an athlete out of participation when there is any suspicion for injury) is important. A standardised assessment of concussion is useful in the assessment of the athlete with suspected concussion but should not take the place of the clinician’s judgement.