Wits sports scientist Professor Jon Patricios co-chaired the latest consensus statement updating existing recommendations with the aim of optimizing care for athletes at all levels.
UNIVERSITY OF WITWATERSRAND
The latest consensus statement on concussion in sports includes:
- New and updated age-appropriate tools to help identify and manage the condition.
- New versions of the return to active sports and educational strategies.
- Strongest evidence for the benefits of light intensity exercise within the first 48 hours to aid recovery.
- New specific approach to rehabilitation.
- Call for an interdisciplinary working group to guide research into possible long-term effects.
A group of more than 100 researchers and medical experts from around the world, co-chaired by Professor Jon Patriciosof Wits Sport and Health (WiSH), University of the Witwatersrand (Wits University), has distilled and synthesized new scientific evidence and updated the existing recommendations aimed at optimizing care for athletes at all levels of participation who have, or are at risk for, concussion.
Based on the results of the International Conference on Concussions in Sport, held in Amsterdam in October 2022 and published in the British Journal of Sports Medicine (BJSM), the Statement is based on 10 systematic reviews and a methodology that describes the new consensus process.
In an attempt to be more transparent and inclusive than in previous years, the process adopted anonymous voting, alternative points of view, open declarations of potential conflicts of interest and included athlete opinions, a focus on para-athletes and ethical perspectives.
The Statement includes a series of new (SCOAT6, Child SCOAT6) and updated (CRT6, SCAT6, Child SCAT6) age-appropriate tools for clinicians and sports organizations to help them better identify and manage short- and long-term sports-related concussion. long term.
Presents new evidence-based strategies for returning to active sport and education after a concussion; early exercise and treatment recommendations; approaches to prevention; targeted rehabilitation; and a call for a task force to be established to guide additional research into the potential long-term health effects of concussion.
Among the key recommendations:
Prevention
- Policy or rule changes to minimize collisions, such as banning the body check in ice hockey, a defensive move in which the player attempts to separate the puck from his opponent.
- Neuromuscular training: aerobic, balance, strength and agility exercises +/-specific neck components, in warm-up exercises.
- Use of mouthguard in ice hockey (all ages).
- Implement laws and protocols, such as mandatory removal from play after an actual or suspected concussion; authorization from health professional to return to play; and education of coaches, parents and athletes about the signs and symptoms of concussion.
Early interventions
Strict rest is not recommended. There is now stronger evidence that light-intensity physical activity, such as routine activities of daily living and aerobic exercise, such as walking and stationary cycling, can help recovery, as can limiting screen time during the first 48 hours.
Rehabilitation
For those who experience dizziness, neck pain and/or headaches for more than 10 days, the Statement recommends cervico-vestibular rehabilitation: physical therapy exercises to reduce symptoms and improve function.
Rehabilitation must be directed to the needs of the individual.
Persistent symptoms
Multidisciplinary team evaluation to identify the types, pattern, and severity of symptoms and any other contributing factors is recommended for those with symptoms lasting more than 4 weeks.
Recovery
Advanced neuroimaging, biomarkers (chemical signals from nerves or blood vessels), genetic testing, and other emerging technologies to assess recovery are useful in investigating the diagnosis, prognosis, and recovery from sports-related concussion. But so far, they are far from being used in clinical practice, the Declaration says.
Return to education and sport
- Some athletes may need academic support in the form of a return to learning strategy: this may include modified school attendance, limiting screen time, avoiding contact sports or games, additional time to complete assignments/assignments or tests.
- Light intensity activity is now recommended in the early phases of the return to sport strategy, and full sport participation generally occurs within 1 month of injury.
- But it is best to manage athletes individually, taking into account specific factors that may affect their recovery, such as migraine history, anxiety and social factors.
Potential long-term effects
- The Statement notes the "growing societal concern about possible problems with brain health later in the life of former athletes, such as mental health problems, cognitive impairment and neurological diseases."
- Studies tracking people’s mental health over time (cohort studies) have found that former professional and amateur athletes do not appear to have an increased risk of depression or suicidality later in life.
- Similarly, an increased risk of neurological disease in former amateur athletes has not been reported in this type of study. But some studies of former professional athletes have reported an association between playing professional football and professional soccer and neurological diseases in adulthood.
- But studies to date on the links between early sports participation and dementia and neurological diseases later in life are limited because they have failed to adjust for a variety of potentially highly influential factors, the Statement says.
- Recommends establishing an interdisciplinary working group to guide appropriate research into the potential long-term health effects of concussion.
Evidence gaps yet to be filled
- There is limited evidence on the management of sports-related concussion in children aged 5 to 12 years and in parasport athletes, who are known to be at increased risk of sports-related concussion.
- And there is little research on concussion for certain regions of the world, various cultural contexts, sex and gender.
Commenting on the Statement, Consensus Statement Co-Chair Dr. Kathryn Schneider of the University of Calgary, Canada, says: “This Statement sets out a variety of new evidence-based recommendations, including those for concussion prevention , as well as new versions of the concussion assessment tools and return to sport and school/learning strategies.”
“We encourage physicians and sports organizations around the world to adapt these recommendations to their own geographic and cultural environments to optimize the care of athletes who have suffered a concussion or are at risk of suffering a concussion,” he adds.
"The differentiating aspects of this latest Concussion Consensus are the rigorous methodological process we adopted, the new generation of tools available to clinicians, and the emphasis on the positive impact of exercise and targeted rehabilitation as effective interventions," explains the co-chair of the Consensus Statement, Professor Jon Patricios of Wits University, Johannesburg, South Africa. "These have the potential to positively change the management of sports-related concussion."
Key points
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