New Guidelines Offer Framework for Safeguarding Athletes' Cognitive Health
Concussion. That word, which used to be taken so lightly, can now strike fear among the burliest of athletes. That’s because increasingly concussions have been linked to risk of neurological conditions, such as Alzheimer’s and other dementias.
Now a new task force made up of top researchers has developed new evidence-based guidelines to guide the evaluation and management of concussions in both professional and amateur sports. In their literature review, the researchers looked at four broad questions related to concussions in sports:
- What factors change the risk of concussions (either positively or negatively) among athletes?
- What diagnostic tools are useful in identifying concussions among athletes who are suspected of incurring this type of brain injury?
- What clinical factors help identify an increased risk for “severe or prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions or late neurobehavioral impairment” among athletes who have a concussion?
- What interventions help with recovery, lower the risk of follow-up concussions or reduce the possibility of late neurobehavioral impairment?
The review led researchers to develop recommendations to help evaluate and manage concussions in sports. These recommendations have been categorized into three areas: counseling recommendations that are made prior to participation in sports; recommendations about assessment, diagnosis and management of suspected concussions; and recommendations related to managing diagnosed concussions.
These recommendations include:
- School-based professionals should be educated on the risks of experiencing a concussion in order to provide accurate information to parents and athletes. These trainings should be conducted by licensed health care providers.
- Inexperienced licensed health care providers should learn about proper administration of validated sideline assessment tools to gauge the possibility of a concussion.
- These assessments should be administered to athletes who are suspected of having a concussion. Furthermore, individual baseline scores on concussions should be considered when assessing younger athletes, athletes who have suffered prior concussions, or athletes who have preexisting learning disabilities, attention deficit disorder or hyperactivity disorder.
- Any athlete who is suspected of sustaining a concussion should be removed from play.
- Athletes who have sustained a concussion should not be allowed to return to play until he or she has undergone an assessment with a licensed health care provider who is experienced in diagnosis and management of concussions as well as identifying more severe traumatic brain injury.
- Athletes who have a concussion should be prohibited from returning to play or practice until a licensed health care provider has decided that the concussion has been resolved.
- Age should be taken into account by coaches and other supervisors of younger athletes (high-school age and younger) who have suffered a concussion. These athletes should be managed more conservatively when making decisions about returning to play.
- Licensed health care providers can use supplemental information to determine concussion resolution. Furthermore, they may develop individualized graded plans to determine when athletes can return to physical activity. This plan should follow a carefully monitored and clinically based approach in order to lower the risk of additional effects due to early postconcussive impairments.
- Professional athletes who have a history of suffering multiple concussions as well as persistent neurobehavioral impairments should be referred for neurologic and neuropsychological assessments by licensed health care providers. The results of these assessments may help determine whether the professional athlete should be counseled to retire from the sport.
- Amateur athletes who have a history of multiple concussions as well as subjective persistent neurobehavioral impairments should be assessed using formal neurologic and cognitive assessments by licensed health care providers in order to guide decisions about retiring from sports.
- Licensed health care providers should counsel athletes who have a history of multiple concussions and persistent neurobehavioral impairment about the risks they face in continuing the sport. These risks include development permanent neurobehavioral or cognitive impairments.
- Professional athletes who participate in contact sports who display objective evidence of chronic, persistent neurologic or cognitive deficits on assessments should be counseled by licensed health care providers to consider retirement from the sport in order to lower the risk for and severity of chronic neuro-behavioral impairments.
These recommendations provide a framework to guide health care providers as well as athletic coaches and trainers at all levels in assessing concussions and making informed decisions about an athlete’s participation in the sport. Considering that as of 1997, neurologists were rarely seen on the sidelines or at ringside, these guidelines represent a big step forward in taking appropriate steps in relation to concussions.
Primary Sources for This Sharepost:
Alessi, A. G., Mayer, T., & Smith. D. (2013). Protecting the brain in sports: What do we really know? Neurology.
Giza, C. C., et al. (2013). Summary of evidence-based guideline update: Evaluation and management of concussion in sports. Neurology.