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Concussion Treatment & Management

  • Author: David T Bernhardt, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Jul 25, 2016
 

Approach Considerations

In March 2013, the American Academy of Neurology (AAN) updated its 1997 guidelines on the evaluation and management of sports concussion. A major change is the removal of return-to-play recommendations. The current recommendation for athletes who have sustained a concussion is immediate removal from play. Return to play should not be allowed until after assessment by a healthcare professional. Young athletes should be managed even more conservatively; their symptoms and neurocognitive performance take longer to improve after a concussion.

Highlights from the revised recommendations include the following[13, 58] :

  • There is no evidence that medication improves recovery after concussion
  • The risk for concussion is greatest in football and rugby, followed by hockey and soccer; for young women and girls, the risk is greatest in soccer and basketball
  • An athlete who has a history of 1 or more concussions is at greater risk for being diagnosed with another concussion
  • The first 10 days after a concussion appears to be the period of greatest risk for being diagnosed with another concussion
  • Evidence suggests that use of helmets may prevent concussion versus no helmet, but there is no clear evidence that one type of football helmet can better protect against concussion over another kind of helmet
  • Licensed health professionals trained in treating concussion should look for ongoing symptoms, history of concussions, and younger age in the athlete
  • Risk factors linked to chronic neurobehavioral impairment in professional athletes include prior concussion, longer exposure to the sport, and having the ApoE4 gene
  • Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized), and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis
  • Although an athlete should immediately be removed from play after a concussion, there is insufficient evidence to support absolute rest after concussion

A clinical report by the American Academy of Pediatrics (AAP) provided information regarding the diagnosis and management of sports-related concussions in adolescents and children.[11] The recommendations explained that appropriate management is essential in order to reduce the risk of long-term symptoms and complications. The team physician and athletic trainer must maintain a high index of suspicion to detect more mild concussions. The report also noted that cognitive and physical rest is the mainstay of management after diagnosis in these patients, and ongoing neuropsychological testing is a helpful tool during management.

The AAP report notes that a return to sports and physical activity should not occur the same day as a concussion. Return to sports and physical activity requires a progressive exercise program, a complete absence of symptoms, successful completion of a standardized neuropsychological test, and continuing evaluation for any recurring signs or symptoms. The recovery for pediatric and adolescent athletes is generally longer than for older athletes.

Use of standardized tools in ED management of concussion

In a study of 164 patients 5 to 21 years old, use of the CDC’s Acute Concussion Evaluation (ACE) tools modified for use in a pediatric emergency department (ED) increased patient follow-up and improved recall of, and adherence to, ED discharge recommendations.[59, 60] With implementation of the tools, the percentage of patients following up with their primary care provider increased from 23% to 39% in the first week following discharge; from 31% to 55% in the second week; and from 32% to 61% in the fourth week.[59, 60]

Failure on validity tests has been shown to help detect exaggerated or feigned problems in adults with mild traumatic brain injury (TBI), and a study by Kirkwood and colleagues suggests that validity testing may also help identify noninjury effects in children and adolescents.[61] In their study of 191 patients aged 8 to 17 years with mild TBI, the 23 patients (12%) who failed the Medical Symptom Validity Test endorsed significantly more postconcussive symptoms than those who passed the test, with a large effect size (P < .001).[61]

Medical issues/complications

Most of the complications listed below probably already existed when the athlete sustained the initial head injury; in other words, they are not caused by an MTBI. These conditions may be associated with what was thought of as an MTBI. Therefore, the reader should not think of these conditions as a complication of an MTBI but must consider these other conditions when evaluating an athlete with a head injury.

A subdural hematoma is a rare injury in the athlete who presents with a presumed concussion. The classic presentation of a subdural hematoma is an acute and persistent LOC associated with the initial injury.

No association between epidural hematoma and brain injury exists. This condition classically presents with a brief period of unconsciousness, followed by a lucid period, and then a subsequent deterioration over 15-30 minutes. Tearing of the middle meningeal artery secondary to an associated temporal skull fracture is the usual cause of an epidural hematoma.

Subarachnoid bleeding may also occur with a head injury of any type. Worsening headache and other signs of increasing intracranial pressure will gradually grow after the initial event.

Second impact syndrome has been described in many review articles. In this condition, fatal brain swelling occurs after minor head trauma in individuals who still have symptoms from a previous minor head trauma. Thus far, all cases of second impact syndrome have been described in relatively young patients (age < 20 y). Significant controversy exists over the etiology of this condition, although it is thought to be secondary to loss of autoregulation of cerebral blood flow in an already injured brain.

Authors have questioned the validity of second impact syndrome due to problems with the documentation of the (1) initial event, (2) persistent symptoms, and (3) severity of the second impact. Despite these problems, practitioners should be aware of this possible complication, especially when treating the relatively immature brain of a young athlete. Treatment of second impact syndrome requires immediate recognition and immediate treatment with hyperventilation and osmotic agents. Surgical treatment for this condition is ineffective. The overall prognosis is usually grim.

Postconcussive syndrome consists of prolonged symptoms that are related to the initial head injury. Unfortunately, the severity of the concussion does not necessarily predict who will experience prolonged symptoms. Similarly, the number of concussions is not necessarily predictive of future problems. Symptoms usually consist of persistent recurrent headaches, dizziness, memory impairment, loss of libido, ataxia, sensitivity to light and noise, concentration and attention problems, depression, and anxiety.

A retrospective case-control study indicated that children with a personal or family history of mood disorders who sustain a sports-related concussion have a significantly increased risk for developing postconcussive syndrome.[62]

Most patients with MTBI recover in 48-72 hours, even with detailed neuropsychologic testing, and are headache free within 2-4 weeks of the injury. Obtain a more detailed history of emotional, concentration, and associated symptoms for patients who have persistent symptoms that last longer than 1 week.

A double-blind study by Miller and colleagues indicated that hyperbaric oxygen (HBO) is no better than sham therapy in the treatment of postconcussive syndrome. The study involved 72 persons, 94% of whom were enlisted in military service, with participants experiencing ongoing postconcussion symptoms for a period of at least 4 months after sustaining an MTBI. Patients received HBO treatment, sham air-compression therapy, or routine care alone.[63, 64]

A study of retired professional football players (average age 53.8 +/– 13.4 y) by Guskiewicz et al reported significant memory changes in those players with a history of recurrent concussions.[3] Another report by the same authors of these retired football players suggested a link between recurrent sports-related concussions and an increased risk of clinical depression.[25]

Concussion information from the NFL Players' Association, the American Academy of Neurology, and the American College of Emergency Physicians can be found here.

Consultations

Consultation with a neurologist or primary care sports medicine physician is indicated for patients who have prolonged symptoms. Neuropsychologic consultation may also be considered to document any deficits that may interfere with the athlete's return to sport, school, or work.

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Maintenance Phase

Rehabilitation Program

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Contributor Information and Disclosures
Author

David T Bernhardt, MD Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health

David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Joseph P Garry, MD, FACSM, FAAFP Associate Professor, Department of Family Medicine and Community Health, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American Medical Society for Sports Medicine, Minnesota Medical Association, American College of Sports Medicine

Disclosure: Nothing to disclose.

References
  1. Kelly JP, Nichols JS, Filley CM, et al. Concussion in sports. Guidelines for the prevention of catastrophic outcome. JAMA. 1991 Nov 27. 266(20):2867-9. [Medline].

  2. Moser RS, Iverson GL, Echemendia RJ, et al. Neuropsychological evaluation in the diagnosis and management of sports-related concussion. Arch Clin Neuropsychol. 2007 Dec. 22(8):909-16. [Medline].

  3. Guskiewicz KM, Marshall SW, Bailes J, et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005 Oct. 57(4):719-26; discussion 719-26. [Medline].

  4. Powell JW, Barber-Foss KD. Traumatic brain injury in high school athletes. JAMA. 1999 Sep 8. 282(10):958-63. [Medline]. [Full Text].

  5. Pieter W, Zemper ED. Head and neck injuries in young taekwondo athletes. J Sports Med Phys Fitness. 1999 Jun. 39(2):147-53. [Medline].

  6. Boden BP, Kirkendall DT, Garrett WE Jr. Concussion incidence in elite college soccer players. Am J Sports Med. 1998 Mar-Apr. 26(2):238-41. [Medline].

  7. Cantu RC. Second-impact syndrome. Clin Sports Med. 1998 Jan. 17(1):37-44. [Medline].

  8. Ptito A, Chen JK, Johnston KM. Contributions of functional magnetic resonance imaging (fMRI) to sport concussion evaluation. NeuroRehabilitation. 2007. 22(3):217-27. [Medline].

  9. Henninger N, Sicard KM, Li Z, et al. Differential recovery of behavioral status and brain function assessed with functional magnetic resonance imaging after mild traumatic brain injury in the rat. Crit Care Med. 2007 Nov. 35(11):2607-14. [Medline].

  10. Kirov I, Fleysher L, Babb JS, et al. Characterizing 'mild' in traumatic brain injury with proton MR spectroscopy in the thalamus: Initial findings. Brain Inj. 2007 Oct. 21(11):1147-54. [Medline].

  11. Halstead ME, Walter KD,. American Academy of Pediatrics. Clinical report--sport-related concussion in children and adolescents. Pediatrics. 2010 Sep. 126(3):597-615. [Medline].

  12. Davis GA, Purcell LK. The evaluation and management of acute concussion differs in young children. Br J Sports Med. 2013 Apr 23. [Medline].

  13. Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013 Mar 18. [Medline].

  14. Slobounov S, Cao C, Sebastianelli W, Slobounov E, Newell K. Residual deficits from concussion as revealed by virtual time-to-contact measures of postural stability. Clin Neurophysiol. 2007 Dec 6. epub ahead of print. [Medline].

  15. Pearce JM. Observations on concussion: a review. Eur Neurol. 2007 Nov 30. 59(3-4):113-9. [Medline].

  16. Lee LK. Controversies in the sequelae of pediatric mild traumatic brain injury. Pediatr Emerg Care. 2007 Aug. 23(8):580-3; quiz 584-6. [Medline].

  17. Capruso DX, Levin HS. Cognitive impairment following closed head injury. Neurol Clin. 1992 Nov. 10(4):879-93. [Medline].

  18. McCrea M, Guskiewicz KM, Marshall SW, et al. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003 Nov 19. 290(19):2556-63. [Medline]. [Full Text].

  19. Bigler ED. Neuropsychology and clinical neuroscience of persistent post-concussive syndrome. J Int Neuropsychol Soc. 2008 Jan. 14(1):1-22. [Medline].

  20. McCrea M, Kelly JP, Kluge J, Ackley B, Randolph C. Standardized assessment of concussion in football players. Neurology. 1997 Mar. 48(3):586-8. [Medline].

  21. Meehan WP 3rd, d'Hemecourt P, Collins CL, Comstock RD. Assessment and management of sport-related concussions in United States high schools. Am J Sports Med. 2011 Nov. 39(11):2304-10. [Medline].

  22. Ruhe A, Gansslen A, Klein W. The incidence of concussion in professional and collegiate ice hockey: are we making progress? A systematic review of the literature. Br J Sports Med. 2013 May 3. [Medline].

  23. Melville NA. Athletes with vestibular symptoms after concussion at risk. Medscape Medical News. June 3, 2013. [Full Text].

  24. De Beaumont L, Lassonde M, Leclerc S, Theoret H. Long-term and cumulative effects of sports concussion on motor cortex inhibition. Neurosurgery. 2007 Aug. 61(2):329-36; discussion 336-7. [Medline].

  25. Guskiewicz KM, Marshall SW, Bailes J, et al. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc. 2007 Jun. 39(6):903-9. [Medline].

  26. Guskiewicz KM, McCrea M, Marshall SW, et al. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003 Nov 19. 290(19):2549-55. [Medline]. [Full Text].

  27. McCrory PR, Berkovic SF. Second impact syndrome. Neurology. 1998 Mar. 50(3):677-83. [Medline].

  28. McCrea M, Kelly JP, Randolph C, et al. Standardized assessment of concussion (SAC): on-site mental status evaluation of the athlete. J Head Trauma Rehabil. 1998 Apr. 13(2):27-35. [Medline].

  29. Young CC, Jacobs BA, Clavette K, Mark DH, Guse CE. Serial sevens: not the most effective test of mental status in high school athletes. Clin J Sport Med. 1997 Jul. 7(3):196-8. [Medline].

  30. Moser RS, Schatz P, Neidzwski K, Ott SD. Group versus individual administration affects baseline neurocognitive test performance. Am J Sports Med. 2011 Nov. 39(11):2325-30. [Medline].

  31. McCrory P, Johnston K, Meeuwisse W, et al. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br J Sports Med. 2005 Apr. 39(4):196-204. [Medline].

  32. Lynall RC, Mauntel TC, Padua DA, Mihalik JP. Acute Lower Extremity Injury Rates Increase following Concussion in College Athletes. Med Sci Sports Exerc. 2015 Jun 8. 16 (1):33-7. [Medline].

  33. Cantu RC. Second impact syndrome. Phys Sports Med. 1992. 20(9):55-66.

  34. Ommaya AK, Gennarelli TA. Cerebral concussion and traumatic unconsciousness. Correlation of experimental and clinical observations of blunt head injuries. Brain. 1974 Dec. 97(4):633-54. [Medline].

  35. Colorado Medical Society School and Sports Medicine Committee. Guidelines for the management of concussion in sports. Colo Med. 1990. 87:4.

  36. American Academy of Neurology. Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee. Neurology. 1997 Mar. 48(3):581-5. [Medline].

  37. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. CDC tool kit on concussion for high school coaches. February 2005. [Full Text].

  38. Sullivan SJ, Schneiders AG, McCrory P, Gray AR. Physiotherapists' use of information in identifying a sports concussion: an extended Delphi approach. Br J Sports Med. 2007 Nov 29. epub ahead of print. [Medline].

  39. Lovell MR, Iverson GL, Collins MW, McKeag D, Maroon JC. Does loss of consciousness predict neuropsychological decrements after concussion?. Clin J Sport Med. 1999 Oct. 9(4):193-8. [Medline].

  40. Aligene K, Lin E. Vestibular and balance treatment of the concussed athlete. NeuroRehabilitation. 2013 Jan 1. 32(3):543-53. [Medline].

  41. Catena RD, van Donkelaar P, Chou LS. Different gait tasks distinguish immediate vs. long-term effects of concussion on balance control. J Neuroeng Rehabil. 2009 Jul 7. 6:25. [Medline]. [Full Text].

  42. Hughes S. Vision Test Improves Concussion Detection. Medscape Medical News. Available at http://www.medscape.com/viewarticle/821495. Accessed: March 10, 2014.

  43. Placeholder.

  44. Delaney JS, Al-Kashmiri A, Drummond R, Correa JA. The effect of protective headgear on head injuries and concussions in adolescent football (soccer) players. Br J Sports Med. 2007 Jul 5. epub ahead of print. [Medline].

  45. McGuine T, Nass S. Football Helmet Fitting Errors in Wisconsin High School Players: Safety in American Football. West Conshohocken, Pa: American Society for Testing and Materials; 1997. 83-8.

  46. Castellani RJ. Chronic traumatic encephalopathy: A paradigm in search of evidence?. Lab Invest. 2015 Jun. 95 (6):576-84. [Medline].

  47. Diseases and conditions: chronic traumatic encephalopathy. Mayo Clinic. Available at http://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/basics/definition/con-20113581. Accessed: Sep 22, 2015.

  48. What is CTE?. BU CTE Center. Available at http://www.bu.edu/cte/about/what-is-cte/. Accessed: Sep 22, 2015.

  49. McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009 Jul. 68 (7):709-35. [Medline].

  50. Hanna J, Goldschmidt D, Flower K. 87 of 91 tested ex-NFL players had brain disease linked to head trauma. CNN. Available at http://www.cnn.com/2015/09/18/health/nfl-brain-study-cte/. Sep 20, 2015;

  51. Breslow JM. 87 Deceased NFL Players Test Positive for Brain Disease. Available at http://www.pbs.org/wgbh/pages/frontline/sports/concussion-watch/new-87-deceased-nfl-players-test-positive-for-brain-disease/. Sep 18, 2015;

  52. Jeret JS, Mandell M, Anziska B, et al. Clinical predictors of abnormality disclosed by computed tomography after mild head trauma. Neurosurgery. 1993 Jan. 32(1):9-15; discussion 15-6. [Medline].

  53. Stein SC, Ross SE. Mild head injury: a plea for routine early CT scanning. J Trauma. 1992 Jul. 33(1):11-3. [Medline].

  54. Strauss SB, Kim N, Branch CA, Kahn ME, Kim M, Lipton RB, et al. Bidirectional Changes in Anisotropy Are Associated with Outcomes in Mild Traumatic Brain Injury. AJNR Am J Neuroradiol. 2016 Jun 9. [Medline].

  55. Anderson P. Neuroimaging May Predict Recovery After Mild TBI. Medscape Medical News. Available at http://www.medscape.com/viewarticle/866419#vp_2. July 21, 2016; Accessed: July 25, 2016.

  56. Papa L, Brophy GM, Welch RD, Lewis LM, Braga CF, Tan CN, et al. Time Course and Diagnostic Accuracy of Glial and Neuronal Blood Biomarkers GFAP and UCH-L1 in a Large Cohort of Trauma Patients With and Without Mild Traumatic Brain Injury. JAMA Neurol. 2016 May 1. 73 (5):551-60. [Medline].

  57. Hughes S. Concussion Biomarker Useful Up to 7 Days After Injury. Medscape Medical News. Available at http://www.medscape.com/viewarticle/862864. May 04, 2016; Accessed: July 25, 2016.

  58. Jeffrey S. AAN Releases New Sports Concussion Guidelines. Available at http://www.medscape.com/viewarticle/780973. Accessed: March 25, 2013.

  59. Boggs W. Acute Concussion Evaluation Tools Improve Adherence to Management Recommendations. Medscape Medical News. Available at http://www.medscape.com/viewarticle/821832. Accessed: March 24, 2014.

  60. Zuckerbraun NS, Atabaki S, Collins MW, Thomas D, Gioia GA. Use of Modified Acute Concussion Evaluation Tools in the Emergency Department. Pediatrics. 2014 Mar 10. [Medline].

  61. Kirkwood MW, Peterson RL, Connery AK, Baker DA, Grubenhoff JA. Postconcussive Symptom Exaggeration After Pediatric Mild Traumatic Brain Injury. Pediatrics. 2014 Mar 10. [Medline].

  62. Osterweil N. Mood Disorders Linked to Lingering Concussion Effect in Kids. Medscape Medical News. Oct 24 2014. [Full Text].

  63. Anderson P. Hyperbaric Oxygen No Better Than Sham After Concussion. Medscape Medical News. Nov 26 2014. [Full Text].

  64. Miller RS, Weaver LK, Bahraini N, et al. Effects of Hyperbaric Oxygen on Symptoms and Quality of Life Among Service Members With Persistent Postconcussion Symptoms: A Randomized Clinical Trial. JAMA Intern Med. 2014 Nov 17. [Medline].

  65. Brooks M. Analgesic Overuse May Fuel Persistent Headache After Concussion. Medscape Medical News. Available at http://www.medscape.com/viewarticle/813762. Accessed: November 12, 2013.

  66. Hughes S. Brain Injury Lingers at Least 4 Months After Concussion. Medscape Medical News. Nov 26 2013. [Full Text].

  67. Ling JM, Klimaj S, Toulouse T, et al. A prospective study of gray matter abnormalities in mild traumatic brain injury. Neurology. 2013 Nov 20. [Medline].

  68. Eisenberg MA, Andrea J, Meehan W, Mannix R. Time interval between concussions and symptom duration. Pediatrics. 2013 Jun 10. [Medline].

  69. MacReady N. Concussion: Kids' Symptoms May Linger and Change Over Time. Medscape Medical News. Available at http://www.medscape.com/viewarticle/824976. Accessed: May 22, 2014.

  70. Eisenberg MA, Meehan WP 3rd, Mannix R. Duration and course of post-concussive symptoms. Pediatrics. 2014 Jun. 133(6):999-1006. [Medline].

  71. American Academy of Neurology. Position Statement On Sports Concussion. October 2010. Accessed November 14, 2010. [Full Text].

  72. Broglio SP, Puetz TW. The effect of sport concussion on neurocognitive function, self-report symptoms and postural control: a meta-analysis. Sports Med. 2008. 38(1):53-67. [Medline].

  73. Brooks M. New Position Statement on Sport-Related Concussion. Medscape Medical News. Jan 17 2013. [Full Text].

  74. Chaput G, Giguere JF, Chauny JM, Denis R, Lavigne G. Relationship among subjective sleep complaints, headaches, and mood alterations following a mild traumatic brain injury. Sleep Med. 2009 Aug. 10(7):713-6. [Medline].

  75. Covassin T, Schatz P, Swanik CB. Sex differences in neuropsychological function and post-concussion symptoms of concussed collegiate athletes. Neurosurgery. 2007 Aug. 61(2):345-50; discussion 350-1. [Medline].

  76. Croall ID, Cowie CJ, He J, et al. White matter correlates of cognitive dysfunction after mild traumatic brain injury. Neurology. 2014 Jul 16. [Medline].

  77. Dave Singh G, Maher GJ, Padilla RR. Customized mandibular orthotics in the prevention of concussion/mild traumatic brain injury in football players: a preliminary study. Dent Traumatol. 2009 Jul 9. epub ahead of print. [Medline].

  78. Deibert E. Concussion and the neurologist: A work in progress. Neurology. 2014 Jul 9. [Medline].

  79. Dhawan P, Starling A, Tapsell L, et al. King-Devick test identifies symptomatic concussion in real-time and asymptomatic concussion over time [abstract S11.003]. Presented at: American Academy of Neurology (AAN) 66th Annual Meeting; April 29, 2014; Philadelphia, Pa. [Full Text].

  80. Fazio VC, Lovell MR, Pardini JE, Collins MW. The relation between post concussion symptoms and neurocognitive performance in concussed athletes. NeuroRehabilitation. 2007. 22(3):207-16. [Medline].

  81. Harmon KG, Drezner J, Gammons M, Guskiewicz K, Halstead M, Herring S, et al. American medical society for sports medicine position statement: concussion in sport. Clin J Sport Med. 2013 Jan. 23(1):1-18. [Medline].

  82. Heegaard W, Biros M. Traumatic brain injury. Emerg Med Clin North Am. 2007 Aug. 25(3):655-78, viii. [Medline].

  83. Hughes S. DTI Shows Brain Changes in Mild Head Injury. Medscape Medical News. Jul 28 2014. [Full Text].

  84. Hughes S. New ethical guidelines on managing sports concussion. Medscape Medical News. July 9, 2014. [Full Text].

  85. Hughes S. Vision test improves concussion detection. Medscape Medical News. April 29, 2014. [Full Text].

  86. Kelly JP, Rosenberg JH. Diagnosis and management of concussion in sports. Neurology. 1997 Mar. 48(3):575-80. [Medline].

  87. Kennedy JE, Jaffee MS, Leskin GA, et al. Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury. J Rehabil Res Dev. 2007. 44(7):895-920. [Medline].

  88. Kiraly M, Kiraly SJ. Traumatic brain injury and delayed sequelae: a review--traumatic brain injury and mild traumatic brain injury (concussion) are precursors to later-onset brain disorders, including early-onset dementia. ScientificWorldJournal. 2007. 7:1768-76. [Medline].

  89. Kirschen MP, Tsou A, Bird Nelson S, Russell JA, Larriviere D. Legal and ethical implications in the evaluation and management of sports-related concussion. Neurology. 2014 Jul 9. [Medline].

  90. Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which On-field Signs/Symptoms Predict Protracted Recovery From Sport-Related Concussion Among High School Football Players?. Am J Sports Med. 2011 Nov. 39(11):2311-8. [Medline].

  91. Lew HL, Thomander D, Chew KT, Bleiberg J. Review of sports-related concussion: Potential for application in military settings. J Rehabil Res Dev. 2007. 44(7):963-74. [Medline].

  92. Lewis R. Repeated concussions may mean slower recovery in adolescents. Medscape Medical News. June 10, 2013. [Full Text].

  93. Lovell MR, Pardini JE, Welling J, et al. Functional brain abnormalities are related to clinical recovery and time to return-to-play in athletes. Neurosurgery. 2007 Aug. 61(2):352-9; discussion 359-60. [Medline].

  94. Ono K, Wada K, Takahara T, Shirotani T. Indications for computed tomography in patients with mild head injury. Neurol Med Chir (Tokyo). 2007 Jul. 47(7):291-7; discussion 297-8. [Medline]. [Full Text].

  95. Piebes SK, Gourley M, Valovich McLeod TC. Caring for student-athletes following a concussion. J Sch Nurs. 2009 Aug. 25(4):270-81. [Medline].

  96. Simpson G, Tate R. Suicidality in people surviving a traumatic brain injury: prevalence, risk factors and implications for clinical management. Brain Inj. 2007 Dec. 21(13):1335-51. [Medline].

  97. Ventura R, Marinides Z, Galetta S, Clugston J, Balcer L. Vision testing is additive to the sideline assessment of sports-related concussion [abstract S19.006]. Presented at: American Academy of Neurology (AAN) 66th Annual Meeting; April 29, 2014; Philadelphia, Pa. [Full Text].

  98. Wojtys EM, Hovda D, Landry G, et al. Current concepts. Concussion in sports. Am J Sports Med. 1999 Sep-Oct. 27(5):676-87. [Medline].

  99. Zemper E. Relative risk of cerebral concussion in football [abstract]. Paper presented at: Annual Meeting of the American College of Sports Medicine; June 1-5, 1999; Seattle, Washington.

 
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