Introduction

The Concussion Masterclass, taught by Laura Lallenec and Lauren Fazzari, provides a complete overview of the assessment and management of a Sport-Related Concussion. This position statement provides clinically relevant, actionable information that may be useful to health professionals.

Part 1: Understanding Concussion

A Sport-Related Concussion (SRC) occurs after trauma to the head directly, or alternatively to the body which is then transmitted to the head. It can be a complex and multifactorial injury to manage. Special populations to consider include females, children and para-athletes. Diagnosis is made from clinical judgment, including consideration of history, signs, symptoms and special tests (e.g. SCAT).

• The International Consensus Group is an expert panel which has the most up to date literature on the recommendations of managing SRC.
• A ‘buy-in’ method that can be used to convince an athlete to come off the field for further assessment for suspected SRC is to talk about a decline in their performance if they remained on-field and continued playing. 
• Educating players and staff is the best way to reduce further harm from a SRC. 
  

Part 2: On and Off Field Assessments

The on-field examination of SRC includes basic first aid, spinal precautions, neurological and a cervical spine assessment. The off-field examination involves using the SCAT6 assessment tool which looks at symptoms, orientation/memory, concentration, balance, gait, delayed recall and diagnosis. Other assessment tools include SCOAT6 and CRT6. Medical management includes medication, supplements, lifestyle modification advice and a graded return to play/contact.     

• The Maddock’s questions have high specificity when doing an on-field screening. 
• Current advice states that complete resolution of symptoms is insufficient criteria for return to contact.
• Different methods of cognitive tasks can be used for the assessment, as long as it’s replicable and documented.
  

Part 3: VOMS Assessment

The systems that can be affected from SRC include the neck, autonomic, vestibular and the eyes. Education about SRC is imperative for athletes when re-integrating into sport. The VOMS assessments include smooth pursuits, saccades, convergence and vestibular-ocular reflex (VOR).

• Cognitive load is still a form of load for an athlete rehabbing from a SRC, thus is important to factor in to load management considerations.
• =When testing convergence, it is important to assess reproduction of symptoms, and know what the athlete's baseline measurement is.
  

Part 4: Rehab and Return to Sport

The rehab for SRC consists of a graded return to contact/training. For children, a return to school and learning is a priority. Rehab programs include eye movements, gaze stabilisation, motion sensitivity and neck strengthening. The current guidelines for SRC return to play for youth and non-elite athletes are to allow 21 days minimum. For elite level, the athlete must be 10 days symptom-free prior to returning to contact training.

• During training, symptoms rated at 2/10 that settle with rest is acceptable. However, clinicians should exercise more caution around headache symptoms.
• If the athlete gets genuine vertigo with their eye/head movement drills, assess for BPPV using the Dix Hall-Pike test.
• Make sure to involve psychologists/psychiatrist care for athletes that display signs of stress/anxiety or depressive episodes.