concussion consensus

Question 1

the panel unanimously support the following recommandation for prevention:

Answer 1

• mouthguard use should be support in ice hockey
  -policy disallowing body checking should be supported for all children and most levels of adolescent ice hockey.
• Strategies limiting contact practice in American football should inform related policies and recommendations for all levels.
• NMT warm-up programmes are recommended, based on research in rugby, and more research is needed for female athletes and in other team sports specifically targeting exer- cise components aimed to reduce concussion rates.
  -Policy supporting optimal concussion management strategies to reduce recurrent concussion rates is recommended.

Question 2

maddox question should be use as a on-field screen tool for athlete of what age

Answer 2

> 12 yrs

Question 3

what are the recommendation made based on the systematic review for the new scat

Answer 3

Create both paper and electronic formats of SCAT6/Child
SCAT6/CRT6.
► Explore the development of alternate tools for serial evalua-
tion in the office setting.
► Improve psychometric properties: longer word list (eg, 12- or
15-word list) and remove the 5-word list.
► Further examine form differences on existing 10-word lists
and consider the use of regression-based norms.
► Create a cognitive composite score to improve test–retest reli-
ability and reduce false positives.
► Add digits (ie, increase the longest string by two digits) to the
digit span backward subtest to reduce ceiling effects.
► Revise months backward to include a component of timed
information processing.
► Add timed dual gait tasks.
► Implement tests and/or procedures to assess the performance
validity of baseline testing.
► Add a more robust set of visible signs to the SCAT6/Child
SCAT6/CRT6, including: Falling with no protective action, tonic posturing, impact seizure, ataxia/motor incoordination, altered mental status and blank/vacant/dazed look.

Question 4

Based on the research on previous iterations, the SCAT has optimum utility in the first

Answer 4

72h and up to a week after the injury

Question 5

The purpose of developing a Sport Concussion Office Assessment Tool (SCOAT6/Child SCOAT6) was to

Answer 5

give HCPs a standardised, expansive and age-appropriate clinical guide to a multidomain evaluation in the subacute phase (72 hours to weeks postinjury), with a view to guide individualised management.25

Question 6

The Child SCOAT6 should be used in patients aged _ years, while the SCOAT6 should be used in patients _ years and older.

Answer 6

8-12 yrs, 13 yrs

Question 7

The following were recommended to be included in an official evaluation of SRC (details included in the SCOAT6):

Answer 7

► Word recall and Digit Backwards tests: The 10-word imme-
diate recall and digit string backwards tests should be used. If the athlete finds the word recall task too easy (eg, exhibits a ceiling effect), a 15-word list may be used.
► Measurement of systolic and diastolic blood pressure as well as heart rate taken in two positions:
– Supine position, rest for 2 min and take measurements.
– Follow with the standing position, measure again after
1 min.
Symptoms brought on by a change in postural position (eg, lightheaded, dizzy or motion sensation) should be noted in the patient’s record.
► Evaluation of cervical spine range of motion, muscle spasm and palpation for segmental or midline tenderness.
► A neurological examination includes the assessment of cranial and spinal nerves, motor function, sensation and deep tendon reflexes.
► Timed tandem gait as a single task and a more complex dual task with the addition of a cognitive task (such as serial 7’s, months backwards or word recall backwards).
► The modified Vestibular-Ocular Motor Screen (VOMS).
► Delayed word recall a minimum of 5 min after completion of
the immediate word recall test.

Question 8

New content discussed at the dedicated Tools workshop (Day
4 of the Amsterdam Conference) led to additional recommended items for the Child SCOAT6 including:

Answer 8

► Additional symptoms for child and parent reports that
capture multiple subacute domains.
► An age-appropriate measure of cognitive reaction time such
as the Symbol Digit Modalities Test.
► Validated paediatric measures of (1) orthostatic tachycardia,
(2) orthostatic intolerance, (3) vestibular and oculomotor
function and (4) child mental health and sleep questionnaires.

Question 9

what does The best available evidence shows that recommending strict rest until the complete resolution of concussion-related symptoms and what is recommanded instead

Answer 9

not recommended
Relative (not strict) rest, which includes activities of daily living and reduced screen time, is indi- cated immediately and for up to the first 2days after injury.

Question 10

when can individual can return to light intensity PA

Answer 10

Individuals can return to light-intensity physical activity (PA), such as walking that does not more than mildly exacerbate symp- toms, during the initial 24–48 hours following a concussion.30

Question 11

when can individual can advanced their exercise intensity

Answer 11

Individuals can systematically advance their exercise inten- sity based on the degree of symptom exacerbation experi- enced during the prior bout of aerobic exercise.
that does not elicit more than mild symptom exacerbation during the exercise test (eg, ‘mild’=testing stops with an increase of more than two points on a 0–10 point and brief <1hour exacerbation of symptom

Question 12

is associated with an increased risk of persisting symptoms and may warrant evalu- ation and treatment.35 36

Answer 12

sleep disturbance in the 10 days

Question 13

The term ‘persisting symptoms’ is used for symptoms that persist

Answer 13

> 4 weeks

Question 14

what are some persisting symptom of concussion

Answer 14

mental health issues; learning or attention difficulties; visual, oculo- motor, cervical and vestibular problems; headache disorders and migraine; sleep disturbance; dysautonomia, including orthostatic intolerance and postural orthostatic tachycardia syndrome; and pain.

Question 15

we recommend that clinical evaluation and future research include three components in the determination of recovery:

Answer 15

1.Assessment of symptom reports
2. Other outcomes relevant to ongoing symptoms or a specific research question (eg, response to physical exertion
3. Measures of return to activity such as RTL and RTS

Question 16

The systematic review revealed that the vast majority of athletes (93%) of all ages have a full RTL with no additional academic support by

Answer 16

10 days

Question 16

To improve our clinical recommendations, the following definitions have been adopted by the Amsterdam consensus panel:
- symptom resolution at rest
- complete symptom resolution
- return to learn (RTL)
- return to spot (RTS)

Answer 16

Symptom resolution at rest: resolution of symptoms associ- ated with the current concussion at rest.
► Complete symptom resolution: resolution of symptoms asso- ciated with the current concussion at rest with no return of symptoms during or after maximal physical and cognitive exertion.
► Return-to-learn (RTL): return to preinjury learning activi- ties with no new academic support, including school accom- modations or learning adjustments.
► Return-to-sport (RTS): completion of the RTS strategy with no symptoms and no clinical findings associated with the current concussion at rest and with maximal physical exertion.41

Question 17

when does a multimodal evaluation and referral for rehab is recommended

Answer 17

When symptoms are persisting, worsen or are not progressively resolving 2–4 weeks postinjury,

Question 18

what are the 4 steps for RTL

Answer 18

1. daily activity that do not result in more than a mild exacerbation of symptom
2. school activities
3. return to school part time
4. return to school full time

Question 19

in which step of RTL can you do homework or reading outside the classroom

Answer 19

2

Question 20

what are the 6 steps of RTS

Answer 20

1. symptom-limited activity
2. aerobic exercise
3. individual sport-specific exercise
4. non-contact training drills
5. full contact practice
6. RTS

Question 21

when can you start step 4 of RTS

Answer 21

Steps 4–6 should begin after the resolution of any symptoms, abnormalities in cognitive function and any other clinical findings related to the current concussion, including with and after physical exertion.

Question 22

at which step can you do Daily activities that do not exacerbate symptoms (eg, Gradual reintroduction of work/school walking).

Answer 22

1

Question 23

at which step can you do Stationary cycling or walking at slow to medium pace. May start light resistance training that does not result in
more than mild and brief exacerbation* of concussion
symptoms.

Answer 23

2

Question 24

at which step can you start Sport-specific training away from the team environment .No
activities at risk of head impact.

Answer 24

3

Question 25

at which step can you start exercise to high intensity including more challenging training drill

Answer 25

4

Question 26

at which step can you participate in normal training activity

Answer 26

5

Question 27

the athlete can advanced to step 3 when

Answer 27

The athlete may then advance to Steps 3–6 on a time course dictated by symptoms, cognitive function, exam- ination findings and clinical judgement.

Question 28

each step of rts usually take at least how long

Answer 28

24h

Question 29

Studies that examined mental health as an outcome found that

Answer 29

former amateur athletes (primarily American football players) are not at increased risk for depression or suicidality during early adulthood or as older adults,50–54 (2) former professional soccer players are not at increased risk for psychiatric hospitalisation during their adult life55 and (3) former professional football and soccer players are not at increased risk for death associated with having a psychiatric disorder56 57 or as a result of suicide.5

Question 30

Sport-specific strategies recommended as concussion prevention interventions

Answer 30

include policy or rule changes reducing collisions, neuromuscular training in warm-ups, mouthguard use in ice hockey and implementation of optimal concussion management strategies to reduce recurrent concussion rates.

Question 31

what are the 11 R that the consensus referee to

Answer 31

‘11 Rs’ of SRC (RECOGNISE, REDUCE, REMOVE, REFER, RE-EVAL- UATE, REST, REHABILITATE, RECOVER, RETURN-TO- LEARN/RETURN-TO-SPORT, RECONSIDER and RESIDUAL EFFECTS)

Question 32

what led to a reduction of 64% of concussion in American football

Answer 32

limiting the number and duration of contact practices, intensity of contact in practices and strategies restricting collision time in practices

Question 33

what led to 28% concussion reduction in ice hockey

Answer 33

mouthguard

Question 34

what has been associated with a lower rate of concussion in rugby

Answer 34

Participation in on-field neuromuscular training (NMT) warm-up programmes completed at least three times per week has been associated with a lower rate of concussion in Rugby

Question 35

can we use scat or SCR tool with para athlete

Answer 35

Commonly used SRC tools (eg, SCAT) are not validated in the para athlete population, who require a more individualised approach.

Question 36

what is the recent position statement of the concussion in para sport

Answer 36

1) individuals may benefit from baseline testing given the variable nature of their disability and the poten- tial for atypical presenting signs/symptoms of concussion,
(2) individuals with a history of central nervous system injury (eg, cerebral palsy, stroke) may require an extended period of initial rest,
3). testing for symptoms of concussion through recovery may require modification such as the use of arm ergometry as opposed to a treadmill/stationary bike
4).RTS protocols must be tailored and include the use of the individual’s personal adaptive equipment and, for applicable participants with visual impairment, partnership with their guide.

Question 37

since paediatric athlete are less likely to have trained medical staff on sideline what is recommended

Answer 37

CRT6 be used by all adults supervising child and adolescent sport