Sports Concussion

Cognitive and physical rest

The standard of care following a diagnosis of concussion is physical and cognitive rest. During the first few days of recovery, athletes who have sustained concussion should restrict physical AND cognitive activities that require attention and concentration, as they may exacerbate and possibly prolong overall recovery. It is expected that athletes who have sustained concussion who limit relevant physical and cognitive activities will not require further intervention and will recover spontaneously.

What limiting cognitive and physical rest looks like

• Student Athletes should be provided with a return to learn plan and a set of personalized academic accommodations to assist in their recovery. Some athletes may be unable to take tests every day, and homework and classwork can be completed as tolerated. They may be provided the ability to leave class early to avoid noisy areas or crowded hallways.
• Student Athletes should always be provided with documentation to remain out of gym and sports until they are fully cleared.
• Prolonged physical and cognitive rest can exacerbate symptoms and delay recovery! There is no need to try to fully restrict physical and cognitive activities after a concussion. Research indicates that physical exercise promotes recovery and this is especially evident for athletes.
• Once initial symptoms are manageable, light physical activity such as walking is often recommended. It is important to work with a healthcare provider to help athletes taper back into physical activities and usual day to day activities as soon as tolerated.

• Baseline testing measures cognitive functions such as memory, processing speed, and attention, prior to the start of a season.
• Healthcare professionals use baseline measures to compare post injury cognitive functions to baseline pre injury cognitive functions.
• At this time, widespread use of baseline testing is not recommended in children and adolescents given problems with reliability over time and insufficient evidence of their true value.
• Baseline measures may be helpful when administered properly and can add useful information to healthcare providers about making decisions about when it is safe to return to play.
• In some cases, a learning disability, developmental disorder, or psychological disorder may impact or impede computer testing. Students may be referred for neuropsychological paper and pencil testing to address similar measures found on the computerized testing.

Physical, emotional, cognitive, and sleep symptoms that persist beyond several months are often referred to as Post Concussion Syndrome (PCS). While we currently do not know whether persistent symptoms are the result of primarily medical or psychological causes, athletes diagnosed with PCS are referred to specialists with training in concussion such as neuropsychologists, neurologists, physical therapists, neuro-ophthalmologists, and cognitive rehabilitation therapists to help them recover.

Community based youth sports programs are different from interscholastic sports in terms of organizational structure, accountability, and training coaches and staff. Keep in mind that often, the only adult in charge of a community-based sports event is often a volunteer parent.

Is concussion different in younger children compared to teens?

Yes, there are some differences. Younger children:

• may not have the language to describe symptoms.
• are more likely to complain they just “don’t feel good.”
• are more likely to act out behaviorally.
• are more likely to show developmental regression (e.g. potty training regression)
• might misbehave in response to cognitive overload or fatigue
• may not understand what a concussion is- teachers should communicate that a concussion is not contagious or life threatening.

Interscholastic sports are the focus of the NJ Concussion Law, which requires that school districts have a district-wide concussion policy.

Teen student athletes and concussions:

• Cognitive issues seem to take longer to resolve compared to younger children and adults.
• Sometimes student athletes may hide symptoms in order to get back to their sport.
• Student athletes tend to be high achievers and worry about falling behind in their schoolwork.
• Extra-curricular activities and homework keep students very busy, so prioritizing and reducing overall demands is important
• The high school student may be more likely to lose track of assignments or have difficulty planning how to approach school projects
• Good communication among school staff is helpful so that a student’s difficulties do not go unnoticed
• Peer relations are very important, and students can be overly sensitive to being different. They may try to minimize symptoms so as not to stand out
• The demands on executive functioning—such as setting goals and planning ahead—are much greater than in elementary school

Key points in the NJ concussion law:

• When a concussion is suspected the player must be pulled out of practice/competition.
• The player cannot return to sports until a physician states that there is no concussion or the concussion has resolved.
• Prior to beginning the Return to Play Protocol, the player must attend a full day of normal school activities without having any cognitive or physical symptoms.
• The player must complete the Return to Play Protocol.