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Return to play

Return to play. Joseph E. Herrera, DO, FABPMR, FACSM Director of Sports Medicine Interventional Spine and Sports Medicine Department of Rehabilitation Medicine Icahn School of Medicine at Mount Sinai. DISCLOSURE. No Conflicts of Interest Parent Coach Athlete Avid Sports Fan

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Return to play

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  1. Return to play Joseph E. Herrera, DO, FABPMR, FACSM Director of Sports Medicine Interventional Spine and Sports Medicine Department of Rehabilitation Medicine Icahn School of Medicine at Mount Sinai

  2. DISCLOSURE No Conflicts of Interest • Parent • Coach • Athlete • Avid Sports Fan • Sports Physician

  3. Goals • Understand the evolution of the return to play criteria for concussion • Be aware of the current return to play algorithm for concussion • Gain an understanding of the challenges with return to play decision making

  4. Return To Play • Why do we care? • Repetitive head trauma • Contact sports • Physical abuse • Epileptic seizures • Head banging • Slowed recovery, cognitive impairment, • Behavioral dysregulation, mood disorders, Neurodegeneration • Gavett et al 2011, McKee et al 2009

  5. In The Classroom • An additive association between multiple episodes of concussion and learning disabilities has been demonstrated Collins MW, Grindel SH, Lovell MR, Dede DE, Moser DJ, Phalin BR, Nogle S, Wasik M, Cordry D, Daugherty MK, Sears SF, Nicolette G, Indelicato P, McKeag DB: Relationship between concussion and neuropsychological performance in college football players. JAMA 282:964-970, 1999].

  6. DECISION MAKERS • Who says its OK to go back to play? • Athlete • Parents • Coach • Agent • ATC • Physician

  7. Return To Play • “Doc I’m OK, • I don’’t want to let the team down” • When do you say OK…………

  8. Return To Play • Chart

  9. IT’S THE LAWConcussion Management and Awareness Act (July 1, 2012) • During school athletic activities schools are required to remove from activity any student suspected of sustaining a mild traumatic injury (“concussion”) • Student is not permitted to return to athletic activity until: • Symptom free for more than 24 hours • Evaluated by and received written signed authorization from a licensed physician • Schools required to follow any guidance from the student’s treating physician in regards to limitations on school attendance and activities

  10. Sports concussion • Rest • Expect gradual resolution in 7-10 days • Start graded exercise rehabilitation when asymptomatic at rest and post-exercise challenge

  11. Sports concussion • How long asymptomatic before exercise? • If rapid and full recovery, then 24-48 hours • One approach is to require that they remain asymptomatic (before starting exertion) for the same amount of time as it took for them to become asymptomatic.

  12. Management • CORNERSTONE =rest until asymptomatic • Rest from activity • No training, playing, exercise, weights • Beware of exertion with activities of daily living • Cognitive rest • No television, extensive reading, video games

  13. Return to Play • 24 hours per step • If there is recurrence of symptoms at any stage, return to previous step

  14. Return To Learn As symptoms improve, a return to learn plan can include • Shorter school days • Rest periods • Extended time for tests/homework/class work • Peer note takers • Audiotapes of class

  15. Persistant Symptoms • What happens if symptoms persist? • Do not return to play • Avoid cognitive stressors such as the videogames, TV, etc. • Adjust the learners classroom environement • Refer for neuropsychological testing

  16. Goals • Understand the evolution of the return to play criteria for concussion • Be aware of the current return to play algorithm for concussion • Gain an understanding of the challenges with return to play decision making

  17. THANK YOU • Any Questions? Joseph E. Herrera, DO, FAAPMR, FACSM Director of Sports Medicine Interventional Spine And Sports Medicine Division Department of Rehabilitation Medicine 5 East 98th Street, Box 1240B New York, NY 10029

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