Repeat mild traumatic brain injury: how to adjust return to play guidelines.
ABSTRACT Determining when it is safe for an athlete to return to play (RTP) after concussion is one of the most difficult decisions facing the team physician. There is significant variability in the evaluation and management of mild traumatic brain injury (mTBI). In the past decade, a tremendous amount of sport-specific research has improved our understanding of mTBI. The advent of neuro-psychologic (NP) testing batteries designed to assess concussive injury has improved the assessment of cognitive dysfunction that occurs in the absence of structural brain abnormalities. The severity of injury is determined by the nature, burden, and duration of symptoms. Athletes must be asymptomatic and have a normal neurologic and cognitive evaluation prior to RTP. Several factors aid in making the RTP decision, including age, the severity of injury, and history of prior mTBIs. Given the potential complications of mTBI, the RTP decision must be made using a thoughtful, individualized process.
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ABSTRACT: This chapter has two goals: to provide the reader with a general awareness of traumatic brain injury (TBI), mild in particular, and the multiple complex issues involved in this area, and to offer a detailed understanding of the role of quantitative electroencephalography (qEEG) in the assessment and treatment of the cognitive defi cits of the TBI patient. Sections I–IV address the fi rst goal. Section I discusses defi nitions, sports, vulnerable groups, the concept of spontaneous cure, and roles of loss of consciousness and post-traumatic amnesia criteria. Section II addresses the biomechanics of a TBI. Section III discusses the physical damage to the brain caused by the TBI as measured by modern medical imaging. Section IV reviews the neuropsychological and emotional results of a TBI that may be clinically manifested in a patient. The second goal is addressed in section V, which discusses the scientifi c basics of qEEG technology, development of the technology over the past two decades, and its application in the assessment of the TBI patient. The coordinated allocation of resources (CAR) model of brain functioning, which employs a cognitive challenge or activation method, is discussed in the context of how a TBI specifi cally affects brain and cognitive functioning. An example of the differences between the normative and the TBI response patterns are presented in detail for the cognitive task of auditory memory. We review the results of rehabilitation efforts employing the CAR model, which have proved to be dramatically superior to the minimalHandbook of Integrative Clinical Psychology, Psychiatry and Behavioral Medicine: Perspectives, Practices And Research, 2010 edited by R. Carlstedt (Ed, 01/2010: pages 463-508; Springer, New York.
- Medicine and science in sports and exercise 12/2011; 43(12):2412-22. · 4.48 Impact Factor
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ABSTRACT: Concussion is a challenging injury for the sports medicine team, and neuropsychological testing has been used as an adjunct to other clinical measures for assessment and management, and to guide return-to-play decisions. Understanding the limitations as well as the role of neuropsychological testing in the evaluation and management of sports-related concussion is important for the sports medicine team. This article will review the evidence regarding the utility of neuropsychological testing as it relates to concussion in sports.PM&R 10/2011; 3(10 Suppl 2):S425-32. · 1.37 Impact Factor