Table 4 - Cantu return to play after concussion guidelines First Concussion Second Concussion
Grade 1 Return to play if asymptomatic in 1 week
Grade 2 Return to play
Grade 3 1 month off. May return once
asymptomatic for 1 week
2 weeks off. May return only if asymptomatic for 1 week
after asymptomatic once asymptomatic for for 1 week
Terminate season. May resume next season if asymptomatic
The future - Tests of brain function When we rehabilitate an ankle or a knee injury we monitor the ability of the injured joint to perform its function. In recent years more research has been published to show how functional tests of brain func- tion can be used to monitor the return to normality. As we have seen from the PTA questions and the post-concussion syn- drome new learning and concentration is impaired.
Well validated neuropsychological tests already exist for testing these aspects of brain function. These tests together with choice reaction time tests to monitor nor- malisation of brain function have been used in the concussed athlete. Once the athlete has reached his baseline level and is asymptomatic from the post concussion syndrome he is declared fit again. The tests are used to monitor recovery, not to diagnose concussion. One drawback is that there is a need for annual baseline testing and following concussion serial testing may be required. For these reasons this type of testing is likely to be confined to the elite and collision sports.
Dr Paul Jackson is a medical advisor to SportEX Medicine and has a particular interest in collision sports. Since 1993 he has worked with the Rugby Football Union as team doctor to the England 7- side rugby team and England A team. He is involved in sports medicine clinics in Bath and Swindon and practices as a GP in Wiltshire.
Further Reading ● McCrory P.R. Were you knocked out? A team
physician’s approach to initial concussion man- agement. Med & Sci in Sport & Exercise Vol.29(7)Supp:S207-212. ● Schnirring L. Baseline Neurologic Testing Grows – Pro Teams Lead the way. Physician &
Sportsmedicine 1998;26(7):13-15 ● Guskiewicz KM, Reimann BL et al Alternative approaches to the assessment of mild head injury in athletes. Med & Sci in Sport & Exercise Vol.29(7)Supp:S213-221
1 month off. May return 1 week
Third Concussion Terminate season.
May resume next
season if asymptomatic Terminate season. May
resume next season if asymptomatic
● Cantu R.C,
Sports Med 1996;(30):289-296 ● Cantu R.C,
Head Injuries in Sport. Br J Voy R. Second impact syndrome
Physician & Sportsmedicine 1995;23(6):27
References 1. Cantu R.C. Guidelines for return to con- tact sports after a cerebral concussion. Physician & Sportsmedicine 1986;(14)10:75-83 2. Practice parameter: the management of concussion in Sport (Summary Statement). Neurology 1997;48(3):582-585 3. Maddocks D.L, Dicker G.D. The assess- ment of orientation following concussion in athletes.
Clin J Sports Med 1995;5(1):32-35 4. Gerberich S.G, Priest J.D. Concussion incidences and severity in secondary school varsity football players. Am J Public Health 1983;73(12):1370-1375