National Athletic Trainers' Association position statement: management of sport concussion.

OBJECTIVE To provide athletic trainers, physicians, and other health care professionals with best-practice guidelines for the management of sport-related concussions. BACKGROUND An estimated 3.8 million concussions occur each year in the United States as a result of sport and physical activity. Athletic trainers are commonly the first medical providers available onsite to identify and evaluate these injuries. RECOMMENDATIONS The recommendations for concussion management provided here are based on the most current research and divided into sections on education and prevention, documentation and legal aspects, evaluation and return to play, and other considerations.

[1]  C Hrysomallis,et al.  Impact energy attentuation of protective football headgear against a yielding surface. , 2004, Journal of science and medicine in sport.

[2]  Tamara C Valovich McLeod,et al.  Sport-Related Concussion Misunderstandings Among Youth Coaches , 2007, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[3]  M. Ebell,et al.  Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. , 2004, The Journal of the American Board of Family Practice.

[4]  J. Bleiberg,et al.  Consistency of within-day and across-day performance after mild brain injury. , 1997, Neuropsychiatry, neuropsychology, and behavioral neurology.

[5]  Steven P Broglio,et al.  Cognitive Decline and Aging: The Role of Concussive and Subconcussive Impacts , 2012, Exercise and sport sciences reviews.

[6]  M. Walker,et al.  Imaging Modalities in Mild Traumatic Brain Injury and Sports Concussion , 2011, PM & R : the journal of injury, function, and rehabilitation.

[7]  T. Hammeke,et al.  Concussion symptom inventory: an empirically derived scale for monitoring resolution of symptoms following sport-related concussion. , 2009, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[8]  Michael McCrea,et al.  Psychometric and measurement properties of concussion assessment tools in youth sports. , 2006, Journal of athletic training.

[9]  C. Randolph Baseline Neuropsychological Testing in Managing Sport-Related Concussion: Does It Modify Risk? , 2011, Current sports medicine reports.

[10]  David H. Perrin,et al.  Repeat Administration Elicits a Practice Effect With the Balance Error Scoring System but Not With the Standardized Assessment of Concussion in High School Athletes. , 2003, Journal of athletic training.

[11]  J. Langlois,et al.  The Epidemiology and Impact of Traumatic Brain Injury: A Brief Overview , 2006, The Journal of head trauma rehabilitation.

[12]  Roald Bahr,et al.  Helmet use and risk of head injuries in alpine skiers and snowboarders. , 2006, JAMA.

[13]  S. Broglio,et al.  The Efficacy of Soccer Headgear. , 2003, Journal of athletic training.

[14]  E. Bigler,et al.  Postconcussive symptoms in children with mild closed head injuries. , 1999, The Journal of head trauma rehabilitation.

[15]  Sébastien Tremblay,et al.  Brain Function Decline in Healthy Retired Athletes who Sustained their Last Sports Concussion in Early Adulthood , 2009, NeuroImage.

[16]  Robert L. Rodnitzky,et al.  Neurobehavioral Consequences of Closed Head Injury , 1982 .

[17]  P. Yarnell,et al.  The ‘ding’ , 1973, Neurology.

[18]  Michael McCrea,et al.  Is neuropsychological testing useful in the management of sport-related concussion? , 2005, Journal of athletic training.

[19]  Stephen W Marshall,et al.  Incidence and risk factors for concussion in high school athletes, North Carolina, 1996-1999. , 2004, American journal of epidemiology.

[20]  Tong Zhu,et al.  Subject-specific changes in brain white matter on diffusion tensor imaging after sports-related concussion. , 2012, Magnetic resonance imaging.

[21]  Jiri Dvorak,et al.  New criteria for female athlete triad syndrome? , 2002, The Physician and sportsmedicine.

[22]  Kurt W. Fischer,et al.  Dynamic growth cycles of brain and cognitive development. , 1996 .

[23]  K. Yeates,et al.  Pediatric Sport-Related Concussion: A Review of the Clinical Management of an Oft-Neglected Population , 2006, Pediatrics.

[24]  Philip Schatz,et al.  Group Versus Individual Administration Affects Baseline Neurocognitive Test Performance , 2011, The American journal of sports medicine.

[25]  K. Guskiewicz,et al.  Incidence of cerebral concussions associated with type of mouthguard used in college football. , 2004, Dental traumatology : official publication of International Association for Dental Traumatology.

[26]  Jason P Mihalik,et al.  Concussion in sports: postconcussive activity levels, symptoms, and neurocognitive performance. , 2008, Journal of athletic training.

[27]  L. Julian,et al.  Neuropsychological Test Performance Prior To and Following Sports-Related Mild Traumatic Brain Injury , 2001, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[28]  W. Barr Methodologic Issues in Neuropsychological Testing. , 2001, Journal of athletic training.

[29]  J. Winters Commentary: Role of Properly Fitted Mouthguards in Prevention of Sport-Related Concussion. , 2001, Journal of athletic training.

[30]  L. Osternig,et al.  Gait stability following concussion. , 2006, Medicine and science in sports and exercise.

[31]  N Shewchenko,et al.  Effectiveness of headgear in football , 2005, British Journal of Sports Medicine.

[32]  S. Grindel The use, abuse, and future of neuropsychologic testing in mild traumatic brain injury , 2006, Current sports medicine reports.

[33]  P. McCrory What advice should we give to athletes postconcussion? , 2002, British journal of sports medicine.

[34]  Weimo Zhu,et al.  Generalizability theory analysis of balance error scoring system reliability in healthy young adults. , 2009, Journal of athletic training.

[35]  Roberto Sorge,et al.  Assessment of metabolic brain damage and recovery following mild traumatic brain injury: a multicentre, proton magnetic resonance spectroscopic study in concussed patients. , 2010, Brain : a journal of neurology.

[36]  Paul Maruff,et al.  The effects of practice on the cognitive test performance of neurologically normal individuals assessed at brief test-retest intervals. , 2003, Journal of the International Neuropsychological Society : JINS.

[37]  C. Cullum,et al.  Cognitive recovery following concussion in high school athletes , 1999 .

[38]  G. Gioia,et al.  Which symptom assessments and approaches are uniquely appropriate for paediatric concussion? , 2009, British Journal of Sports Medicine.

[39]  J. Gilchrist,et al.  Nonfatal traumatic brain injuries related to sports and recreation activities among persons aged ≤19 years--United States, 2001-2009. , 2011, MMWR. Morbidity and mortality weekly report.

[40]  A. Twijnstra,et al.  Effectiveness of bed rest after mild traumatic brain injury: a randomised trial of no versus six days of bed rest , 2002, Journal of neurology, neurosurgery, and psychiatry.

[41]  L. Bilaniuk,et al.  Diffuse cerebral swelling following head injuries in children: the syndrome of "malignant brain edema". , 1981, Journal of neurosurgery.

[42]  J Dvorak,et al.  Summary and agreement statement of the first International Conference on Concussion in Sport, Vienna 2001* , 2002, British journal of sports medicine.

[43]  J. Jane,et al.  Minor Head Injury in Sports: A New System of Classification and Management , 1984 .

[44]  David H. Perrin,et al.  Performance on the Balance Error Scoring System Decreases After Fatigue. , 2004, Journal of athletic training.

[45]  Kelly Sarmiento,et al.  Evaluation of the Centers for Disease Control and Prevention's concussion initiative for high school coaches: "Heads Up: Concussion in High School Sports". , 2010, The Journal of school health.

[46]  K. Guskiewicz,et al.  Neuropsychological performance, postural stability, and symptoms after dehydration. , 2007, Journal of athletic training.

[47]  S. Marshall,et al.  Postural Stability and Neuropsychological Deficits After Concussion in Collegiate Athletes. , 2001, Journal of athletic training.

[48]  Barbara Osborne Principles of Liability for Athletic Trainers: Managing Sport-Related Concussion. , 2001, Journal of athletic training.

[49]  Craig J. Coghlin,et al.  The ability of parents to accurately report concussion occurrence in their bantam-aged minor hockey league children. , 2009, The Journal of the Canadian Chiropractic Association.

[50]  Council on Sports Medicine and Fitness , 2016, Pediatric Clinical Practice Guidelines & Policies.

[51]  G. Iverson,et al.  Is rest after concussion "the best medicine?": recommendations for activity resumption following concussion in athletes, civilians, and military service members. , 2013, The Journal of head trauma rehabilitation.

[52]  K. Guskiewicz,et al.  Recommendations on management of sport-related concussion: summary of the National Athletic Trainers' Association position statement. , 2004, Neurosurgery.

[53]  P. McCrory New Treatments for Concussion: The Next Millennium Beckons , 2001, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[54]  Steven P Broglio,et al.  Post-concussion cognitive declines and symptomatology are not related to concussion biomechanics in high school football players. , 2011, Journal of neurotrauma.

[55]  Joseph T. Gwin,et al.  HEAD IMPACT SEVERITY MEASURES FOR EVALUATING MILD TRAUMATIC BRAIN INJURY RISK EXPOSURE , 2008, Neurosurgery.

[56]  H. Levin,et al.  Neuroplasticity following non-penetrating traumatic brain injury , 2003, Brain injury.

[57]  R. Thatcher Developmental neuroimaging : mapping the development of brain and behavior , 1996 .

[58]  Cyril H Wecht,et al.  CHRONIC TRAUMATIC ENCEPHALOPATHY IN A NATIONAL FOOTBALL LEAGUE PLAYER: PART II , 2005, Neurosurgery.

[59]  Freddie H Fu,et al.  Relationship between Postconcussion Headache and Neuropsychological Test Performance in High School Athletes , 2003, The American journal of sports medicine.

[60]  Grant L Iverson,et al.  On-Field Predictors of Neuropsychological and Symptom Deficit Following Sports-related Concussion , 2003, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[61]  J. Dvořák,et al.  Is protective equipment useful in preventing concussion? A systematic review of the literature , 2009, British Journal of Sports Medicine.

[62]  W. Russell,et al.  Post-traumatic amnesia in closed head injury. , 1961, Archives of neurology.

[63]  Michael S Ferrara,et al.  Evaluation of Neuropsychological Domain Scores and Postural Stability Following Cerebral Concussion in Sports , 2003, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[64]  J. P. Kelly,et al.  Standardized Assessment of Concussion in football players , 1997, Neurology.

[65]  Stephen W Marshall,et al.  Descriptive epidemiology of collegiate men's football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. , 2007, Journal of athletic training.

[66]  K. Guskiewicz,et al.  Identifying Impairments after concussion: normative data versus individualized baselines. , 2012, Medicine and science in sports and exercise.

[67]  Michael McCrea,et al.  Standardized Mental Status Testing on the Sideline After Sport-Related Concussion. , 2001, Journal of athletic training.

[68]  David Halstead Performance Testing Updates in Head, Face, and Eye Protection. , 2001, Journal of athletic training.

[69]  F. Sim,et al.  Ice Hockey Injuries , 1988, The American journal of sports medicine.

[70]  P. Maruff,et al.  Computerised cognitive assessment of athletes with sports related head injury , 2001, British journal of sports medicine.

[71]  M. Saling,et al.  The assessment of orientation following concussion in athletes. , 1995, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[72]  W. Alves,et al.  Neuropsychological functioning and recovery after mild head injury in collegiate athletes. , 1996, Neurosurgery.

[73]  K. Guskiewicz,et al.  Effects of mild head injury on postural stability as measured through clinical balance testing. , 2000, Journal of athletic training.

[74]  D H Perrin,et al.  Alternative approaches to the assessment of mild head injury in athletes. , 1997, Medicine and science in sports and exercise.

[75]  E. Rivera,et al.  Effectiveness of mouthguards in reducing neurocognitive deficits following sports-related cerebral concussion. , 2007, Dental traumatology : official publication of International Association for Dental Traumatology.

[76]  Stephen W Marshall,et al.  Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. , 2003, JAMA.

[77]  B. Jordan,et al.  Prolonged Effects of Concussion in High School Athletes , 2005, Neurosurgery.

[78]  K. Mcfarland,et al.  The Acute Effects of Mild Traumatic Brain Injury on Finger Tapping With and Without Word Repetition , 2005, Journal of clinical and experimental neuropsychology.

[79]  Michael S Ferrara,et al.  Age-related differences in neuropsychological testing among high school athletes. , 2009, Journal of athletic training.

[80]  J. Wilberger,et al.  Minor Head Injuries in American Football , 1993, Sports medicine.

[81]  T. Covassin,et al.  One-Year Test-Retest Reliability of the Online Version of ImPACT in High School Athletes , 2011, The American journal of sports medicine.

[82]  Michael S Ferrara,et al.  National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses. , 2015, Journal of athletic training.

[83]  R. Fields,et al.  White matter in learning, cognition and psychiatric disorders , 2008, Trends in Neurosciences.

[84]  Julian E. Bailes,et al.  Classification of Sport-Related Head Trauma: A Spectrum of Mild to Severe Injury. , 2001, Journal of athletic training.

[85]  J. Linakis,et al.  Emergency Department Visits for Concussion in Young Child Athletes , 2010, Pediatrics.

[86]  A. Collie,et al.  Does history of concussion affect current cognitive status? , 2006, British Journal of Sports Medicine.

[87]  S. Marshall,et al.  Association between Recurrent Concussion and Late-Life Cognitive Impairment in Retired Professional Football Players , 2005, Neurosurgery.

[88]  Exercise-Related Postural Control Deficits in Individuals with Recurrent Low Back Pain , 2011 .

[89]  W. Barr,et al.  Sensitivity and specificity of standardized neurocognitive testing immediately following sports concussion , 2001, Journal of the International Neuropsychological Society.

[90]  M. Lovell,et al.  Post-exertion neurocognitive test failure among student-athletes following concussion , 2013, Brain injury.

[91]  Robert W Platt,et al.  Effectiveness of helmets in skiers and snowboarders: case-control and case crossover study , 2005, BMJ : British Medical Journal.

[92]  B. Gansneder,et al.  Balance Recovers Within 20 Minutes After Exertion as Measured by the Balance Error Scoring System. , 2004, Journal of athletic training.

[93]  G. Gioia,et al.  School and the concussed youth: recommendations for concussion education and management. , 2011, Physical medicine and rehabilitation clinics of North America.

[94]  J. Kelly,et al.  Standardized Assessment of Concussion (SAC): On-Site Mental Status Evaluation of the Athlete , 1998, The Journal of head trauma rehabilitation.

[95]  B. Romner,et al.  Can Low Serum Levels of S100B Predict Normal CT Findings After Minor Head Injury in Adults?: An Evidence‐Based Review and Meta‐Analysis , 2010, The Journal of head trauma rehabilitation.

[96]  T A Gennarelli,et al.  Mechanisms of brain injury. , 1993, The Journal of emergency medicine.

[97]  B. V. Lunen,et al.  Assessment of High School Coaches’ Knowledge of Sport-Related Concussions , 2009 .

[98]  Kevin M. Guskiewicz,et al.  A Survey of Practice Patterns in Concussion Assessment and Management. , 2001, Journal of athletic training.

[99]  D. Hovda,et al.  Diffuse prolonged depression of cerebral oxidative metabolism following concussive brain injury in the rat: a cytochrome oxidase histochemistry study , 1991, Brain Research.

[100]  Steven P. Broglio,et al.  Previous mild traumatic brain injury and postural-control dynamics. , 2011, Journal of athletic training.

[101]  R. Cantu Clinical Report—Sport-Related Concussion in Children and Adolescents , 2011 .

[102]  Alex Collie Concussion history is not a predictor of computerised neurocognitive performance: Commentary , 2006 .

[103]  K. Guskiewicz Postural Stability Assessment Following Concussion: One Piece of the Puzzle , 2001, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[104]  J Minkoff,et al.  Concussion in Sports , 1999, The American journal of sports medicine.

[105]  Stephen W Marshall,et al.  Recurrent concussion and risk of depression in retired professional football players. , 2007, Medicine and science in sports and exercise.

[106]  P. Schatz Long-Term Test-Retest Reliability of Baseline Cognitive Assessments Using ImPACT , 2010, The American journal of sports medicine.

[107]  S. Berkovic,et al.  The Nature and Duration of Acute Concussive Symptoms in Australian Football , 2000, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[108]  Anita H. Sim,et al.  Prolonged recovery of memory functioning after mild traumatic brain injury in adolescent athletes. , 2008, Journal of neurosurgery.

[109]  C. Hillman,et al.  The persistent effects of concussion on neuroelectric indices of attention. , 2009, Journal of neurotrauma.

[110]  S. Broglio,et al.  Concussion history is not a predictor of computerised neurocognitive performance , 2006, British Journal of Sports Medicine.

[111]  Colin W Fuller,et al.  The Epidemiology of Head Injuries in English Professional Rugby Union , 2008, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[112]  Brandon E Gavett,et al.  Chronic traumatic encephalopathy: a potential late effect of sport-related concussive and subconcussive head trauma. , 2011, Clinics in sports medicine.

[113]  J. Barth,et al.  Outcome after mild head injury. , 1998, Clinics in sports medicine.

[114]  R. Thatcher,et al.  Repeated measures of cognitive processing efficiency in adolescent athletes: implications for monitoring recovery from concussion. , 1999, Neuropsychiatry, neuropsychology, and behavioral neurology.

[115]  T. Covassin,et al.  The Role of Age and Sex in Symptoms, Neurocognitive Performance, and Postural Stability in Athletes After Concussion , 2012, The American journal of sports medicine.

[116]  D. Warden,et al.  Duration of Cognitive Impairment After Sports Concussion , 2004, Neurosurgery.

[117]  Robert C. Cantu,et al.  Posttraumatic Retrograde and Anterograde Amnesia: Pathophysiology and Implications in Grading and Safe Return to Play. , 2001, Journal of athletic training.

[118]  Jay N Giedd,et al.  The teen brain: insights from neuroimaging. , 2008, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[119]  Michael McCrea,et al.  Immediate Neurocognitive Effects of Concussion , 2002, Neurosurgery.

[120]  Tanya Kaushik,et al.  Symptom-based assessment of the severity of a concussion. , 2003, Journal of neurosurgery.

[121]  M. Lovell,et al.  The Assessment of Sport-Related Concussion: The Evidence Behind Neuropsychological Testing and Management , 2001, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[122]  Alain Ptito,et al.  New Frontiers in Diagnostic Imaging in Concussive Head Injury , 2001, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[123]  Early Brain Injury in Children: Development and Reorganization of Cognitive Function , 2003, Developmental neuropsychology.

[124]  J. Kelly Loss of Consciousness: Pathophysiology and Implications in Grading and Safe Return to Play. , 2001, Journal of athletic training.

[125]  J. Bleiberg,et al.  Future Directions for the Neuropsychological Assessment of Sports Concussion , 1998, The Journal of head trauma rehabilitation.

[126]  L. Purcell What are the most appropriate return-to-play guidelines for concussed child athletes? , 2009, British Journal of Sports Medicine.

[127]  J. Powell,et al.  Traumatic brain injury in high school athletes. , 1999, JAMA.

[128]  M. Lovell,et al.  Does loss of consciousness predict neuropsychological decrements after concussion? , 1999, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[129]  G. Iverson,et al.  Interview Versus Questionnaire Symptom Reporting in People With the Postconcussion Syndrome , 2010, The Journal of head trauma rehabilitation.

[130]  G. Gioia,et al.  Improving Identification and Diagnosis of Mild Traumatic Brain Injury With Evidence: Psychometric Support for the Acute Concussion Evaluation , 2008, The Journal of head trauma rehabilitation.

[131]  S. Broglio,et al.  Presence of Headache Does Not Influence Sideline Neurostatus or Balance in High School Football Athletes , 2011, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[132]  F Lepore,et al.  Concussions in athletes produce brain dysfunction as revealed by event‐related potentials , 2000, Neuroreport.

[133]  P. McCrory Head Injuries in Sports , 2015 .

[134]  Eloise E Kaizar,et al.  Reliable change in postconcussive symptoms and its functional consequences among children with mild traumatic brain injury. , 2012, Archives of pediatrics & adolescent medicine.

[135]  M. Lovell,et al.  Sensitivity and specificity of the ImPACT Test Battery for concussion in athletes. , 2006, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[136]  Robert C Cantu,et al.  Second Impact Syndrome. , 1995, The Physician and sportsmedicine.

[137]  T. Talavage,et al.  Functionally-detected cognitive impairment in high school football players without clinically-diagnosed concussion. , 2014, Journal of neurotrauma.

[138]  J. Konin,et al.  Management Strategies In Athletic Training , 1994 .

[139]  Earl R. Cooper,et al.  The influence of ankle support on postural control. , 2009, Journal of science and medicine in sport.

[140]  F. Webbe,et al.  Short-term and long-term outcome of athletic closed head injuries. , 2003, Clinics in sports medicine.

[141]  S. J. Sullivan,et al.  Self-report scales/checklists for the measurement of concussion symptoms: a systematic review , 2009, British Journal of Sports Medicine.

[142]  A. McKee,et al.  Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy After Repetitive Head Injury , 2009, Journal of neuropathology and experimental neurology.

[143]  M. Lovell,et al.  Grade 1 or “Ding” Concussions in High School Athletes , 2004, The American journal of sports medicine.

[144]  M. Schneider Head and Neck Injuries in Football: Mechanisms, Treatment, and Prevention , 1973 .

[145]  Margot Putukian,et al.  Concussion (mild traumatic brain injury) and the team physician: a consensus statement--2011 update. , 2011, Medicine and science in sports and exercise.

[146]  M. Lovell,et al.  Which On-field Signs/Symptoms Predict Protracted Recovery From Sport-Related Concussion Among High School Football Players? , 2011, The American journal of sports medicine.

[147]  Paul J Hewson,et al.  Cycle Helmets and Road Casualties in the UK , 2005, Traffic injury prevention.

[148]  M. Ilyas Kamboh,et al.  Chronic traumatic encephalopathy in a national football league player. Part II. Commentary , 2005 .

[149]  G. Volans,et al.  Delayed deterioration of consciousness after trivial head injury in childhood. , 1984, British medical journal.

[150]  C. Lombard,et al.  Injuries sustained in rugby by wearers and non-wearers of mouthguards. , 1987, British journal of sports medicine.

[151]  Rebecca L. Stearns,et al.  National athletic trainers' association position statement: preventing sudden death in sports. , 2012, Journal of athletic training.

[152]  K Bennell,et al.  Computerised cognitive assessment of concussed Australian Rules footballers , 2001, British journal of sports medicine.

[153]  G. Gioia,et al.  Cognitive Rest: The Often Neglected Aspect of Concussion Management , 2010 .

[154]  K. Guskiewicz,et al.  Sport-related concussion: on-field and sideline assessment. , 2011, Physical medicine and rehabilitation clinics of North America.

[155]  J. Bleiberg,et al.  Factor Analysis of Computerized and Traditional Tests Used in Mild Brain Injury Research , 2000, The Clinical neuropsychologist.

[156]  G. Solomon,et al.  Prevalence of invalid computerized baseline neurocognitive test results in high school and collegiate athletes. , 2012, Journal of athletic training.

[157]  Kevin M. Guskiewicz,et al.  Relationship between clinical and forceplate measures of postural stability , 1999 .

[158]  K. Guskiewicz Concussion in Sport: The Grading – System Dilemma , 2001 .

[159]  S. Marshall,et al.  MEASUREMENT OF HEAD IMPACTS IN COLLEGIATE FOOTBALL PLAYERS: RELATIONSHIP BETWEEN HEAD IMPACT BIOMECHANICS AND ACUTE CLINICAL OUTCOME AFTER CONCUSSION , 2007, Neurosurgery.

[160]  M. McCrea Standardized Mental Status Assessment of Sports Concussion , 2001, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[161]  R. Motl,et al.  Evidence for the Factorial and Construct Validity of a Self-Report Concussion Symptoms Scale. , 2003, Journal of athletic training.

[162]  H. Nukada,et al.  Sport and exercise headache: Part 2. Diagnosis and classification. , 1994, British journal of sports medicine.

[163]  J. Vincenten,et al.  Sport and Recreation-Related Head Injuries Treated in the Emergency Department , 2001, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[164]  Albert D. Farrell,et al.  Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion. , 1990, Journal of neurology, neurosurgery, and psychiatry.

[165]  Asgeir Sigurdsson,et al.  Effect of mouthguards on dental injuries and concussions in college basketball. , 2002, Medicine and science in sports and exercise.

[166]  J. Powell,et al.  Injury patterns in selected high school sports: a review of the 1995-1997 seasons. , 1999, Journal of athletic training.

[167]  Michael S Ferrara,et al.  Test-retest reliability of computerized concussion assessment programs. , 2007, Journal of athletic training.

[168]  D. Vane,et al.  Mandatory admission after isolated mild closed head injury in children: is it necessary? , 2001, Journal of pediatric surgery.

[169]  P. McCrory Should we treat concussion pharmacologically? , 2002, British journal of sports medicine.

[170]  S. Marshall,et al.  Standard regression-based methods for measuring recovery after sport-related concussion , 2005, Journal of the International Neuropsychological Society.

[171]  J. Gilger,et al.  Biomechanical correlates of symptomatic and asymptomatic neurophysiological impairment in high school football. , 2012, Journal of biomechanics.

[172]  J. Borg,et al.  Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. , 2004, Journal of rehabilitation medicine.

[173]  Li-Shan Chou,et al.  Cognitive task effects on gait stability following concussion , 2006, Experimental Brain Research.

[174]  J. Sosnoff,et al.  Biomechanical properties of concussions in high school football. , 2010, Medicine and science in sports and exercise.

[175]  Michael McCrea,et al.  Unreported Concussion in High School Football Players: Implications for Prevention , 2004, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[176]  S. Oliaro,et al.  Management of Cerebral Concussion in Sports: The Athletic Trainer's Perspective. , 2001, Journal of athletic training.

[177]  P. Yakovlev,et al.  The myelogenetic cycles of regional maturation of the brain , 1967 .

[178]  Michael W Collins,et al.  The relation between post concussion symptoms and neurocognitive performance in concussed athletes. , 2007, NeuroRehabilitation.

[179]  John A. Jane,et al.  Mild head injury in sports: Neuropsychological sequelae and recovery of function. , 1989 .

[180]  Freddie H Fu,et al.  The “Value Added” of Neurocognitive Testing after Sports-Related Concussion , 2006, The American journal of sports medicine.

[181]  W. Curnow,et al.  Bicycle helmets and public health in Australia. , 2008, Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals.

[182]  Matthew B. Pontifex,et al.  The association between mild traumatic brain injury history and cognitive control , 2009, Neuropsychologia.

[183]  C. Hillman,et al.  The persistent effects of concussion on neuroelectric indices of attention. , 2009, Journal of neurotrauma.

[184]  S. Marshall,et al.  Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. , 2003, JAMA.

[185]  R. Curtis Bay,et al.  Representative Baseline Values on the Sport Concussion Assessment Tool 2 (SCAT2) in Adolescent Athletes Vary by Gender, Grade, and Concussion History , 2012, The American journal of sports medicine.

[186]  Bradley Paras,et al.  Video gaming promotes concussion knowledge acquisition in youth hockey players. , 2006, Journal of adolescence.

[187]  Jason P Mihalik,et al.  Return of postural control to baseline after anaerobic and aerobic exercise protocols. , 2008, Journal of athletic training.

[188]  B. Sennett,et al.  The National Football Head and Neck Injury Registry: 14-Year Report on Cervical Quadriplegia, 1971 Through 1984 , 1985 .

[189]  J. Tracy,et al.  Severity of sports-related concussion and neuropsychological test performance , 2003, Neurology.

[190]  Philip Schatz,et al.  Neuropsychological evaluation in the diagnosis and management of sports-related concussion. , 2007, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[191]  D. Ellemberg,et al.  Prolonged Neuropsychological Impairments Following a First Concussion in Female University Soccer Athletes , 2007, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[192]  Steven P. Broglio,et al.  SENSITIVITY OF THE CONCUSSION ASSESSMENT BATTERY , 2007, Neurosurgery.

[193]  R. Cantu,et al.  Considerations for Return‐to‐Play and Retirement Decisions After Concussion , 2011, PM & R : the journal of injury, function, and rehabilitation.

[194]  Steven P Broglio,et al.  The Effect of Sport Concussion on Neurocognitive Function, Self-Report Symptoms and Postural Control , 2008, Sports medicine.

[195]  Paul McCrory,et al.  High school rugby players’ understanding of concussion and return to play guidelines , 2006, British Journal of Sports Medicine.

[196]  W. Roberts,et al.  Who Plays? Who Sits? , 1992, The Physician and sportsmedicine.

[197]  S. Broglio,et al.  Neurocognitive performance of concussed athletes when symptom free. , 2007, Journal of athletic training.

[198]  Kelly Sarmiento,et al.  Educating coaches about concussion in sports: evaluation of the CDC's "Heads Up: concussion in youth sports" initiative. , 2012, The Journal of school health.

[199]  Grant L Iverson,et al.  Cumulative Effects of Concussion in High School Athletes , 2002, Neurosurgery.

[200]  Jason R. Freeman,et al.  Monitoring Resolution of Postconcussion Symptoms in Athletes: Preliminary Results of a Web-Based Neuropsychological Test Protocol. , 2001, Journal of athletic training.

[201]  M. Lovell,et al.  No cumulative effects for one or two previous concussions , 2005, British Journal of Sports Medicine.

[202]  Peter Cummings,et al.  Injuries of the Head, Face, and Neck in Relation to Ski Helmet Use , 2008, Epidemiology.

[203]  Paul McCrory,et al.  Understanding of Sport Concussion by the Parents of Young Rugby Players: A Pilot Study , 2009, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[204]  R. Harbaugh,et al.  The second impact in catastrophic contact-sports head trauma. , 1984, JAMA.

[205]  Assessment of Lower Extremity Posture: Qualitative and Quantitative Clinical Skills , 2007 .

[206]  Tamara C. Valovich-McLeod,et al.  Healthy youth are reliable in reporting symptoms on a graded symptom scale. , 2008, Journal of sport rehabilitation.

[207]  Sandra J Shultz,et al.  Serial Administration of Clinical Concussion Assessments and Learning Effects in Healthy Young Athletes , 2004, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[208]  Robert C. Cantu,et al.  Concussion (mild traumatic brain injury) and the team physician: a consensus statement. , 2006, Medicine and science in sports and exercise.

[209]  Michael Makdissi,et al.  CogSport: Reliability and Correlation with Conventional Cognitive Tests Used in Postconcussion Medical Evaluations , 2003, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[210]  A. Twijnstra,et al.  [Lack of uniformity and low compliance concerning wake-up advice following head trauma]. , 1994, Nederlands tijdschrift voor geneeskunde.

[211]  P. Snyder,et al.  Validity of the CogState brief battery: relationship to standardized tests and sensitivity to cognitive impairment in mild traumatic brain injury, schizophrenia, and AIDS dementia complex. , 2009, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[212]  Luke M Gessel,et al.  Concussions among United States high school and collegiate athletes. , 2007, Journal of athletic training.

[213]  D. Hovda,et al.  The neurophysiology of concussion. , 2014, Progress in neurological surgery.

[214]  J. Powell,et al.  Cerebral Concussion in Athletes: Evaluation and Neuropsychological Testing , 2000, Neurosurgery.

[215]  J. Bailes,et al.  Head Injury in Athletes , 2001, Neurosurgery.

[216]  Michele A. Huitric,et al.  High School Coaches’ Assessments, Intentions to Use, and Use of a Concussion Prevention Toolkit: Centers for Disease Control and Prevention’s Heads Up: Concussion in High School Sports , 2010, Health promotion practice.

[217]  J. Richardson Clinical and Neuropsychological Aspects of Closed Head Injury , 1990 .

[218]  Alan C. Evans,et al.  Brain development during childhood and adolescence: a longitudinal MRI study , 1999, Nature Neuroscience.

[219]  J. Pater,et al.  Comparison of Mouth Guard Designs and Concussion Prevention in Contact Sports: A Multicenter Randomized Controlled Trial , 2005, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[220]  A S McIntosh,et al.  Effectiveness of headgear in a pilot study of under 15 rugby union football , 2001, British journal of sports medicine.

[221]  Freddie H Fu,et al.  Recovery from mild concussion in high school athletes. , 2003, Journal of neurosurgery.

[222]  C. Randolph,et al.  Returning pediatric athletes to play after concussion: the evidence (or lack thereof) behind baseline neuropsychological testing , 2009, Acta paediatrica.

[223]  Philip Schatz,et al.  Current Issues in the Identification, Assessment, and Management of Concussions in Sports-Related Injuries , 2003, Applied neuropsychology.

[224]  David J Chalmers,et al.  Evaluation of protective equipment for prevention of injuries in rugby union. , 2004, International journal of epidemiology.

[225]  A. Benton,et al.  Mild head injury , 1990 .

[226]  M. Field,et al.  Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. , 2003, The Journal of pediatrics.

[227]  E. Lehman,et al.  High School Soccer Players With Concussion Education Are More Likely to Notify Their Coach of a Suspected Concussion , 2012, Clinical pediatrics.

[228]  W Ritchie Russell The After-Effects of Head Injury. , 1934 .

[229]  M. Lovell,et al.  Measurement of Symptoms Following Sports-Related Concussion: Reliability and Normative Data for the Post-Concussion Scale , 2006, Applied neuropsychology.

[230]  A. Collie,et al.  Sport psychology and concussion: new impacts to explore , 2004, British Journal of Sports Medicine.

[231]  D. Hovda,et al.  The Neurometabolic Cascade of Concussion. , 2001, Journal of athletic training.

[232]  M. Mitten,et al.  Legal Liability in Covering Athletic Events , 2009, Sports health.

[233]  D. Viano,et al.  Concussion in Professional Football: Recovery of NFL and High School Athletes Assessed by Computerized Neuropsychological Testing-Part 12. , 2006, Neurosurgery.

[234]  William P Meehan,et al.  Medical therapies for concussion. , 2011, Clinics in sports medicine.

[235]  B. Ragan,et al.  Measurement Issues in Concussion Testing , 2007 .

[236]  C Finch,et al.  Should football players wear custom fitted mouthguards? Results from a group randomised controlled trial , 2005, Injury Prevention.

[237]  P. McCrory,et al.  Does Second Impact Syndrome Exist? , 2001, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[238]  H S Levin,et al.  The Galveston Orientation and Amnesia Test: A Practical Scale to Assess Cognition after Head Injury , 1979, The Journal of nervous and mental disease.

[239]  R. Cantu,et al.  Guidelines for Return to Contact Sports After a Cerebral Concussion. , 1986, The Physician and sportsmedicine.

[240]  J. Bailes,et al.  Who should conduct and interpret the neuropsychological assessment in sports-related concussion? , 2009, British Journal of Sports Medicine.

[241]  J. Davidson Epidemiology and outcome of bicycle injuries presenting to an emergency department in the United Kingdom , 2005, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[242]  J. Delaney,et al.  The effect of protective headgear on head injuries and concussions in adolescent football (soccer) players , 2007, British Journal of Sports Medicine.

[243]  J Dvorak,et al.  Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. , 2005, British journal of sports medicine.

[244]  Kevin M Guskiewicz,et al.  Sport-related concussion in the young athlete , 2006, Current opinion in pediatrics.

[245]  Alex B Valadka Chronic Traumatic Encephalopathy in a National Football League Player. , 2006, Neurosurgery.

[246]  J. Snoek,et al.  Delayed deterioration following mild head injury in children. , 1984, Brain : a journal of neurology.

[247]  D B McKeag,et al.  Relationship between concussion and neuropsychological performance in college football players. , 1999, JAMA.

[248]  S. Broglio,et al.  Reliable Change of the Sensory Organization Test , 2008, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[249]  R. Cantu Neurologic Athletic Head and Spine Injuries , 2000 .

[250]  R. Wood,et al.  The role of anxiety sensitivity in symptom perception after minor head injury: An exploratory study , 2011, Brain injury.

[251]  J. Maroon,et al.  Head injuries in athletes. , 1989, Clinics in sports medicine.

[252]  Michael Makdissi,et al.  Consensus Statement on Concussion in Sport—The 4th International Conference on Concussion in Sport Held in Zurich, November 2012 , 2013, PM & R : the journal of injury, function, and rehabilitation.

[253]  R. Cantu Athletic head injuries. , 1997, Clinics in sports medicine.

[254]  Lippincott Williams Wilkins,et al.  Practice Parameter , 1997, Neurology.

[255]  K. Guskiewicz,et al.  National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion. , 2004, Journal of athletic training.

[256]  M. Schiff,et al.  Physician Concussion Knowledge and the Effect of Mailing the CDC’s “Heads Up” Toolkit , 2011, Clinical pediatrics.

[257]  M. Gaetz,et al.  Electrophysiological evidence for the cumulative effects of concussion. , 2000, Brain injury.

[258]  A. Glang,et al.  Online Training in Sports Concussion for Youth Sports Coaches , 2010, International journal of sports science & coaching.