RETURN TO PLAY GUIDELINE:
Emerging data suggest exercise, which improves brain function due to brain plasticity after 4-6 weeks of (aerobic) exercise. Aerobic exercise shows improvements of cortical connectivity and activation, in the general populations and patient who suffer concussion specifically. Excessive exercise during the first week after concussion decreases function and recovery. But aerobic exercise 14-21 after concussion upregulates function and decreases symptoms. There should be a differentiation made between
Simple (
Acute Concussion) and the more chronic form
Complex (PCS) and exercise prescribed. Although for both version aerobic exercise is beneficial, the start of exercise and mental activity can be started earlier with the simple version compared to the more complex version of concussion. The post-concussion questionnaire should be used as a monitoring tool to adjust the level of physical and mental activity during the rehabilitation period.
| Step |
Rehabilitation stage |
Objective of Stage |
| 1 |
Acute management: No Activity |
First Aid |
| 2 |
Subacute management: No Activity |
Continued Assessments & Recovery |
| |
|
|
| 3A |
Light aerobic exercise |
Increase heart rate |
| 3B |
Sport specific exercise |
Add movements |
| 3C |
Non-contact training drills/ no race simulation |
Exercise, coordinaton and cognitive load increases |
| 3D |
Full contact practice |
Restore athletes confidence, coaching staff and parents. Assess functional Skills |
| 4 |
Return To Play |
Symptoms free |
- Note: to proceed to the next step, the SCAT 5 and other monitoring protocols need to score lower and reduce while progressing to the next step. If symptoms increase, a step back should be taken.
- Patients that are recovering need scores of 0-1 on the “post concussion symptom scale” before progressing rehabilitation.
Testing and Monitoring:
- The Buffalo Concussion Treadmill Test (BCTT) can be used for aerobic exercise rehabilitation. It is also used as a baseline test post-concussion, in combination of a subjective Visual Analogue Scale to indicate level of concussion symptoms.
- BESS test is a balance test
- Eye Movement Screening Test (clinical test)
- Cogsport – pre-season cognitive test (reaction and memory).
- King-Devick Test for Concussion.
- SCAT 5: http://www.sportphysio.ca/wp-content/uploads/SCAT-5.pdf
- RUGBY Statement NL: https://www.rugby.nl/sites/default/files/20151104%20Rugby%20Nederland%20Sportmedisch%20protocol%20-%20Licht%20Traumatisch%20Hersenletsel%20%28LTHL%29.pdf
