Written by Heather McCurdy, M.S., CCC-SLP, CBIS
Heather provides in home speech therapy services in Northwest IN, and virtual services for IN residents.
The article "Consensus statement on concussion in sports," published in June 2023, was written by a group of 31 professionals from 9 different countries to update recommendations regarding sports-related concussions (SRCs). This counsel of professionals came up with 11 'R's of SRC which are summarized here.
Recognize: Definition of sports-related concussion
What is a SRC? To summarize the official definition, a SRC is a mild traumatic brain injury caused by a direct blow to the head, neck or body that can occur as a result of sports or exercise activities. Symptoms/signs may present immediately or occur over minutes/hours with varying symptoms present (may/may not include loss of consciousness or LOC). The symptoms/signs are not solely explained by drug, alcohol, medication use or other injuries. No abnormality may appear on a CT/MRI scan; however, abnormalities may be present on functional studies.
Reduce: Prevention of concussion
This may include:
Change to policy/rules for reduced concussions (i.e. no body checking in child/adolescent ice hockey)
PPE (i.e. mouthguards may help)
On-field neuromuscular training reduced concussions (i.e. a warm up program)
Remove: Sideline evaluation
Remove the player from the field if there’s a suspected concussion. An evaluation should be completed away from the field of play
Signs of immediate removal include: tonic posturing, seizure, LOC, ataxia, poor balance, confusion, behavioral changes, amnesia
These players should NOT return to play unless evaluated by a doctor who determines that the signs are non-concussion related
Frequent re-evaluation of the athlete post-concussion should be completed
Re-evaluate: The office assessment
The Sports Concussion Office Assessment 6 (SCOAT6) is a tool that can be used as soon as 72 hrs or several weeks postinjury. It identifies areas for intervention, directing the need for referrals, monitoring recovery & assesses the presentation of the concussion.
A medical professional should note:
Previous concussions
Management & recovery time of previous concussions
Any other symptoms (i.e. mental health change, migraine disorder, etc.)
Rest and Exercise
→ Recommending strict rest until concussion symptoms have gone away is NOT beneficial.
Returning to physical activity within 2-10 days post injury is important in facilitating recovery and reducing the possibility of lasting concussion-related symptoms.
Relative rest IS recommended immediately and up to 2 days post injury. This may include: ADLs & restricted screen time.
Restricted screen time beyond 48 hrs may not be helpful.
Athletes can return to light physical activity (that doesn’t increase symptoms or if it does, mildly only) for 24-48 hours after the concussion. This ‘light activity’ may include walking or stationary cycling, for example. Light activity should be encouraged and activities that could cause a fall or collision should be avoided.
Athletes should be informed of the following information:
Advancement of physical activity can be completed if there is no more than mild increase or exacerbation of symptoms.
If mild symptoms do appear (after cognitive or physical exertion), symptoms should resolve within an hour– this does NOT delay recovery.
Fun fact: Sleep disturbance within 10 days after a SRC is associated with an increased risk of persistent symptoms and should be further evaluated.
Refer
It is imperative to refer to professionals with education of concussion management.
Medical care team may include: sports medicine physicians, athletic trainers/therapists, physiotherapists, occupational therapists (OTs), sports chiropractors, neurologists, neurosurgeons, neuropsychologists, ophthalmologists, optometrists, physiatrists, psychologists and psychiatrists.
Please note that this article did not include "speech language pathologists (SLPs)" as part of the care team, however, SLPs are able to provide cognitive-communication skills for return to learn and return to play more quickly.
Rehabilitation
This can be specific to individual symptoms or target general recovery. This is what SLPs call a "treatment session."
Recovery: Assessment of clinical recovery
Clinical evaluation (when deciding to return to learn/ play) should include:
Assessment of symptom reports (including concussion related symptom resolution at rest, with cognitive activities and following physical exertion)
Other outcomes (related to ongoing symptoms)
Measures of return to activity (like return to learn [RTL] and return to sport [RTS]
Return to Learn (RTL) & Return to Sport (RTS)
Immediate and early postinjury symptoms are the best predictor of recovery
Aspects that make for a longer recovery process
Continuing to play
Delayed time before initial doctor appointment
Return to Learn (RTL)
Most (93% of individuals) RTL within 10 days with no new academic support
Doctors should avoid recommending complete rest and isolation and instead recommend a period of relative rest.
Possible strategies:
Environmental modifications: modified school attendance, frequent rest breaks, limited screen time on electronic devices.
Physical adjustments: avoiding contact sports of game playing during PE and allowing for safe exercises (i.e. walking)
Curriculum adjustments: extra time to complete assignments, preprinted notes
Testing adjustments: delaying tests/quizzes, allowing additional time for test taking
A SLP can provide creative modifications, recommendations and compensatory strategies for successful return to learn.
Return to Sport (RTS)
Clinicians and athletes can expect a minimum of 1 week to complete the full rehabilitation strategy (which is provided in a table in the article), but typical unrestricted RTS can take up to 1 month post-SRC. The time it takes to RTS will vary therefore an individualized approach is necessary.
If symptoms/signs are not improving beyond 2-4 weeks, athletes would benefit from rehabilitation.
Reconsider: Potential Long-term effects
Former amateur athletes (primarily American football players) are not at increased risk for depression or suicidality during early adulthood or as older adults, nor are they at increased risk for cognitive impairment or neurological disorders/neurodegenerative diseases later in life.
Former professional soccer players are not at increased risk for psychiatric hospitalization during their adult life
Former professional football and soccer players are not at increased risk for death associated with having a psychiatric disorder or as a result of suicide.
However, there IS greater mortality from ALS (Amyotrophic Lateral Sclerosis)
There ARE higher mortality rates from neurological disease or dementia
Retire
The conversation of whether to 'retire' or not should include the athlete (with risk tolerance & preferences) and the benefits of participation in the sport.
If school-aged, it’s important to consider successful RTL in their environment
→ If an athlete retires, the benefits of physical activity should be emphasized and encouraged to continue with non-contact or low-contact activity.
Here's the link to the article:
To learn more about how a SLP can help with concussions, click below
To learn more about our services, click below
Heather McCurdy is the owner and speech-language pathologist (SLP) at Mindful Speech Therapy. She is particularly passionate about those who sustain traumatic brain injuries and strives to provide functional, meaningful and relevant treatment.
Comments