Return to Play Guidelines

  • BasketballEffective July 2012, the Nebraska Concussion Awareness Act requires any athlete 19 years old or yonger reasonably suspected of having a concussion to be evaluated by and have written authorization from an appropriate licensed healthcare provider (i.e. MD, DO, PA-C, APRN, neuropsychologist, athletic trainer), and written permission from a parent/guardian before being allowed to resuming athletic participation following a concussion.
  • Symptoms of a concussion often resolve before neurocognitive brain function (memory, processing speed, reaction time, impulse control). Therefore, a concussed athlete may not be ready to return to play eventhough they may deny having symptoms and admit to feeling absolutely fine.
  • Neurocognitive evaluation is playing a greater role in determining Return to Play.  Increased use of neurocognitive testing is supported by the prevelance of commercial availability of computerized neurocognitive testing and its predecessor, pencil-paper testing.
  • It is the responsibility for a coach or school/organization to disqualify any athlete from playing presenting with a note from anyone clearing them to play that remain symptomatic.


Return to Play Progression (RTP)   (print as handout)

Return to Play protocol following a concussion should follow a stepwise process.  Step 1 represents the timeframe while post-concussion symptoms persist, and then begin to resolve (see Concussion Symptom Inventory Form/Sideline Assessment Tool).  This phase will vary considerably among individuals, and is affected by age, prior history of head injury, injury severity, number of symptoms, and possibly gender among other clinical considerations. 

During Step 1 of the RTP, one should follow Return to Learn Guidelines where the resolution of symptoms generally occur within 10-14 days on average, but may extend longer for others. As symptoms begin to subside, one can gradually become more active, provided the activity does not bring on or worsen symptoms.  Progression to RTP Step 2 and each step thereafter require remaining symptom-free.  Generally, a minimum span of 24-48 hours should transpire between steps (after completing Step 2), with each exercise bout being at least 30 minutes or more in duration unless noted otherwise.  The athlete should be continually monitored for any symptoms worsening during exercise and afterwards.  If at any time an athlete experiences symptoms coming on or worsening, they are to stop and resume the progression at the previous step after being symptom-free at rest for 24-48 hours.

               

1. Symptom-Limited Activities   (Follow Return To Learn Guidelines)

  • Initial 24-48 hrs. of relative rest, including Physical & Cognitive (mental) rest.
  • Thereafter, symptom-limited activity may be encouraged provided the activity does not bring-on or worsen symtoms.


2.  Light, Aerobic Activity, 10-20 minutes (<70% max. heart rate)

  • Must be symptom-free; Completion of Return to Learn protocol and back at school full-time without academic restrictions.
  • Walking, Biking, Swimming
  • No weight lifting or resistance training


3. Sport/Position/Event Specific Exercise & Drills 

  • Individualized, light - moderate conditioning/running drill, agility drills, light weight lifting; throwing, catching, kicking, shooting, passing, mat drills, conducted away from formal practices.
  • Do not allow any head impacts or use of head.

 
4. Non-Contact practice 

  • Prior to advancing to this stage, athlete must have written authorization from an appropriate licensed healthcare provider (i.e. MD/DO, neuropsychologist, athletic trainer), and have written permission from a parent before resuming team practice participation.
  • Athlete is able to participate in non-contact team practice once neurocognitive post-test composite scores are near or return to baseline, or where testing is otherwise considered acceptable by a licensed healthcare provider trained to interpret test scores.

 
5. Full-Contact practice 

  •  The athlete is able to fully participate in practices without restrictions. 

 
6. Competition 

  •  The athlete is able to fully participate in competitions without restrictions.

 

No athlete under the age of 19 should be allowed to return to play while presenting with any SYMPTOMS of a potential head injury (McCrory, 2008).

Athletes themselves, teammates, parents, and coaches, among others, should be relegated to RECOGNIZE signs and symptoms of a concussion head injury, while those responsible for the decision to return to play and managing concussed athletes should be left to appropriate licensed healthcare professionals with both formal training in the evaluation and management of traumatic brain injuries where doing so falls within their scope of practice and state licensure (Nebraska Concussion Awareness Act, 2012, Statue 71-9103(2)).

 

 

 

Return to Play protocol following a concussion should follow a stepwise process.  Step 1 represents the timeframe while post-concussion symptoms persist, and then begin to resolve (see Concussion Symptom Inventory Form/Sideline Assessment Tool).  This phase will vary considerably among individuals, and is affected by age, prior history of head injury, injury severity, number of symptoms, and possibly gender among other clinical considerations.  During Step 1, one should follow Return to Learn Guidelines where the resolution of symptoms generally occur within 10-14 days on average, but may extend longer for others. As symptoms begin to subside, one can gradually become more active, provided the activity does not bring on or worsen symptoms.  Progression to Step 2 and each step thereafter require remaining symptom-free.  Generally, a minimum span of 24-48 hours should transpire between steps (after completing Step 2), with each exercise bout being at least 30 minutes or more in duration unless noted otherwise.  The athlete should be continually monitored for any symptoms worsening during exercise and afterwards.  If at any time an athlete experiences symptoms coming on or worsening, they are to stop and resume the progression at the previous step after being symptom-free at rest for 24-48 hours.

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