Bret Stetka, MD; Andrew N. Wilner, MD


April 17, 2013

In This Article

Diagnosed Concussion

The Basics

Return to play is prohibited until concussion has resolved

Return to play is prohibited until the player is asymptomatic off medication

High-school age or younger athletes: Take a more conservative approach to return to play

Preteen athletes: Ensure appropriate assessment tools

Consider neurocognitive testing

Consider individual management plans

Consider cognitive restructuring

There is no indication for "absolute rest" after a concussion

The Bottom Line

In athletes with a diagnosed concussion, the AAN recommendations prohibit return to play or to practice until an LHCP is convinced the concussion has resolved and the player is asymptomatic off medication. This caution is intended to diminish the risk for recurrent or additional injury; athletes with residual reflex or cognitive impairment are potentially at higher risk for another concussion. A more conservative return-to-play approach is recommended in athletes of high school age or younger, because younger athletes seem to take longer to recover than older athletes. Ensuring that assessment tools are age-appropriate is encouraged.

In determining whether a concussion has resolved, LHCPs can use supplemental neurocognitive testing, including comparisons with age-matched normal profiles or a patient's baseline profile. Furthermore, LHCPs can consider using individualized management and return-to-play plans with careful monitoring. Cognitive restructuring -- a form of psychological counseling that includes education, reassurance, and reattribution of symptoms -- is also recommended, because data suggest that it may lessen the risk for developing postconcussion syndrome.