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Beyond helmets: concussions require proactive, individualized monitoring and rehab

footballNew Con­cus­sion Guide­lines Stress Indi­vid­ual Treat­ment (The New York Times):
“The Amer­i­can Acad­e­my of Neu­rol­o­gy said Mon­day that it had revised its guide­lines for han­dling con­cus­sions to empha­size treat­ing ath­letes case by case rather than accord­ing to a pre­de­ter­mined scale…In not­ing that more than a mil­lion Amer­i­can ath­letes expe­ri­enced con­cus­sions each year, the authors of the study not­ed that the risk of con­cus­sion was great­est in foot­ball and rug­by, fol­lowed by hock­ey and soc­cer, and that the risk of con­cus­sion for young women and girls was great­est in soc­cer and basketball…Critically, the authors found “no clear evi­dence that one type of foot­ball hel­met can bet­ter pro­tect against con­cus­sion over anoth­er kind of hel­met.”

Study: Sum­ma­ry of evi­dence-based guide­line update: Eval­u­a­tion and man­age­ment of con­cus­sion in sports (Neu­rol­o­gy)

  • Objec­tive: To update the 1997 Amer­i­can Acad­e­my of Neu­rol­o­gy (AAN) prac­tice para­me­ter regard­ing sports con­cus­sion, focus­ing on 4 ques­tions: 1) What fac­tors increase/decrease con­cus­sion risk? 2) What diag­nos­tic tools iden­ti­fy those with con­cus­sion and those at increased risk for severe/prolonged ear­ly impair­ments, neu­ro­log­ic cat­a­stro­phe, or chron­ic neu­robe­hav­ioral impair­ment? 3) What clin­i­cal fac­tors iden­ti­fy those at increased risk for severe/prolonged ear­ly post­con­cus­sion impair­ments, neu­ro­log­ic cat­a­stro­phe, recur­rent con­cus­sions, or chron­ic neu­robe­hav­ioral impair­ment? 4) What inter­ven­tions enhance recov­ery, reduce recur­rent con­cus­sion risk, or dimin­ish long-term seque­lae?
  • Results: Spe­cif­ic risk fac­tors can increase or decrease con­cus­sion risk. Diag­nos­tic tools to help iden­ti­fy indi­vid­u­als with con­cus­sion include grad­ed symp­tom check­lists, the Stan­dard­ized Assess­ment of Con­cus­sion, neu­ropsy­cho­log­i­cal assess­ments, and the Bal­ance Error Scor­ing Sys­tem. Ongo­ing clin­i­cal symp­toms, con­cus­sion his­to­ry, and younger age iden­ti­fy those at risk for post­con­cus­sion impair­ments. Risk fac­tors for recur­rent con­cus­sion include his­to­ry of mul­ti­ple con­cus­sions, par­tic­u­lar­ly with­in 10 days after ini­tial concussion…Data are insuf­fi­cient to show that any inter­ven­tion enhances recov­ery or dimin­ish­es long-term seque­lae post­con­cus­sion.

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