Heading into my 5th fall sports season since moving back to the south, and the 5th fall sports season since passage of Georgia’s “Concussion Law” that mandates concussion education for high-school athletes and coaches, it is admittedly disappointing to realize that there has not been much change in the prevailing local concussion management guidelines distributed to Georgia schools that provide the blueprint for the return-to-learn and to play.
Fortunately, however, we have the recent CDC guidelines – published in the last few weeks – that reflect the changes that have been practiced by sports-concussion experts and sports neuropsychologists for several years, and as a supplement to the Berlin Guidelines and statements from related professional organizations that also contradict much of the current standard practices. Among the highlights:
- Avoid prolonged rest! “Rest” does not mean to sit in a dark room, avoid electronics, tests, and socializing, and staying out of school for more than a couple of days. Rather, it means managing, manipulating, modifying, activities or triggers that lead to a worsening of symptoms. Big difference there!
- Offer symptom-specific school-based supports. These are not “one-size-fits-all” but should be individualized based on each individual’s symptom-profile, context, risk factors, and history.
- Do consider risk factors for prolonged recovery, and refer out to specialists if symptoms are prolonged.
- There is no data to support the utility of widespread, large-scale baseline testing. When it is administered, it should be under structured testing conditions with some guidance or oversight by experts in neurocognitive / neuropsychological testing who can attest to the validity and the reliability of each child’s scores.
There is no medical basis to remove cell phones, limit coloring to child vs. adult coloring books, carbo-load, or to recommend certain fixed portions of school days or no testing, all recommended to students I’ve seen over the last few weeks. Again, management needs to be individualized and symptom-specific, with modifications as needed to avoid activities associated with symptom increase – that is, it’s not black/white, all/nothing, or limited to what’s listed on a pre-printed form, though checklists are always good places to start.