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Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012

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Podcast: The Concussion Discussion
Two UF Women’s Rugby Players Speak about Concussions
Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012
Podcast: The Concussion Discussion
Two UF Women’s Rugby Players Speak about Concussions
Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012
Preamble
Section 1: sport concussion and its management
Special populations
Injury prevention
Section 2: statement on background to the consensus process
Section 3: Zurich 2012 consensus questions

H3

Definition of concussion
Recovery of concussion
Symptoms and signs of acute concussion
On-field or sideline evaluation of acute concussion
Evaluation in the emergency room or office by medical personnel
Concussion investigations
Neuropsychological assessment
Concussion management
Graduated RTP protocol
Same day RTP
‘Difficult’ or persistently symptomatic concussion patient
Psychological management and mental health issues
Role of pharmacological therapy
Role of preparticipation concussion evaluation
Modifying factors in concussion management
Child and adolescent athlete
Elite versus non-elite athletes
Chronic traumatic encephalopathy
Protective equipment—mouthguards and helmets
Rule change
Risk compensation
Aggression versus violence in sport
Knowledge transfer
Medical legal considerations
When you assess an athlete acutely and they do not have a concussion, what is it? Is a cognitive injury the key component of concussion in making a diagnosis?
Are the existing tools/examination sensitive and reliable enough on the day of injury to make or exclude a diagnosis of concussion?
What is the best practice for evaluating an adult athlete with concussion on the ‘field of play’ in 2012?
How can the SCAT2 be improved?
Advances in neuropsychology: are computerised tests sufficient for concussion diagnosis?
What evidence exists for new strategies/technologies in the diagnosis of concussion and assessment of recovery?

H4

Female gender
Significance of LOC
Significance of amnesia and other symptoms
Motor and convulsive phenomena
Depression

H5

Text Analysis

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concussion injury assessment symptoms clinical athlete sport management sports university concussions consensus athletes cognitive brain medical rtp testing medicine zurich rugby international players recovery injuries conference play evaluation diagnosis healthcare scat3 panel signs neuropsychological tests acute held document pivacek studies concussive evidence traumatic neurological severity statement including balance health sports-related november symptom player child questions additional history calgary perlini include period agreed performed prior centre sideline level tool provider recommended published approach melbourne physician school field detailed outlined considered sporting center reported neuroimaging occur 4th children knowledge cases issues return number mental alberta factor risk institute neuroscience athletic tools amnesia york protective concussed practice examination doctor motor addition features formal loc parents equipment process consideration require impact group baseline professional duration coaches developed neuropsychologists trained deficits assist situations assess component treating rule range prolonged standard structural neurosurgery adolescent prevention demonstrated asymptomatic faculty rehabilitation disturbance nature meeting future treatment evolving discussion view understanding podcast prevent

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competitive florey physical exertion hockey sleep recognised ontario encouraged commission discussed proceed majority data longer activities limited routine stepwise generally decisions snyder strategies required suspected team spine seattle recommendations journalism adult outcome factors science adults major football manner techniques surgery significance injured exists performance order experiences based forms designed principles episode contact decision underlying days effects typically playing imaging exercise involved difficulty assessed functional avoid sophisticated kinesiology multidisciplinary suffered abnormality diagnosed setting insufficient washington paper determining development delayed length programme michael conjunction conflicts domains diagnostic occurs determined professor impairment determination session findings depression complete opportunity experience resources claudia care intended felt elite protocol assessing hospital application hours included toronto ioc department initial organised college suffer interpret vienna authors judgement therapy clinically benefit reflect neurology fifa clinicians modify assessments prague  zurich computerised sensitive evaluating kate modifiers helpful common receiving aliyah recover cervical october term expert comprehensive worth frame women details suffering managed providers general severe protein speak growth incidence pathophysiological variety biomechanical treat loss graded helmets technologies employed review cisg attention basic modifying family safety influence women’ patient categories long-term emergency stage rapid adolescents address

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sophisticated kinesiology multidisciplinary suffered abnormality diagnosed setting insufficient washington paper determining development delayed length programme michael conjunction conflicts domains diagnostic occurs determined professor impairment determination session findings depression complete opportunity experience resources claudia care intended felt elite protocol assessing hospital application hours included toronto ioc department initial organised college suffer interpret vienna authors judgement therapy clinically benefit reflect neurology fifa clinicians modify assessments prague  zurich computerised sensitive evaluating kate modifiers helpful common receiving aliyah recover cervical october term expert comprehensive worth frame women details suffering managed providers general severe protein speak growth incidence pathophysiological variety biomechanical treat loss graded helmets technologies employed review cisg attention basic modifying family safety influence women’ patient categories long-term emergency stage rapid adolescents address spiker irb modified appendix involve deliberations mcmaster physiological reaction experts willem asked preparticipation documents kevin iihf programmes consciousness paradigm paul office contributes mark talks endorsement input jersey meeuwisse2 groups reliable aged individuals sophomore february guskiewicz28 suspicion 3rd hamilton aubry4 mccrory1 genetic 1st values 2nd behavioural tau basis terms mtbi supplement separation echemendia12 context constructs concept literature definition lars violence management the onset karen engebretsen14 consequences magnetic areas involves rates increase demonstrate incorporate face ruben utilised concussion the cantu7 jiří dvořák9 forces fmri referees resolve reduce critical modalities athlete’ complex defined johnston17 meetings pertaining agreement sills21 postural principal identified mainstay spontaneously bob mechanism stability davis25 richard fracture gavin benson22 brian methods soccer population allen organisations shaped subject kutcher19 stages jeffrey updates summary demonstrating martin crt education public remain technology event raftery20 recognition issue ellenbogen26 advance base case beneficial facial unknown timing effective optimal memory needed efficacy expected progressively participation sac 24 h presentation head-on status window in functioning in table weeks table evaluate environment 56  years non-elite aspect interpretation paediatric victoria player’  calgary teammates founder educative club improvement frank symptomatic florida’s diagnose gender recommend widespread women’s making noting points high-risk expertise  check trauma exist distinct applied ideally challenge anxiety pharmacological ongoing continue room didn’t lack trainers clinician received chronic deficit teammate symptom-free open problems levels high postinjury occasionally feeling situation advised collision unreliable progress warning referred claiming sensitivity screening neurocognitive sidelines split vision scat 10 days patterns emotional individual acknowledged north carolina detected neck junior chapel hill excluding scientific departments disposition interviews prepared convulsive response removed vanderbilt task recognize resolution timely austin guide members topic wisconsin instituted on-field association nerve monash superoxide switzerland dismutase strategy gfap s-100 biomarkers objective columbia british english cerebral evaluated national consistent ottawa reduction systematic encephalopathy measure leave neuropsychologist position decision-making 77  missouri off-field flow game massachusetts  boston absence federation conservative featured penalising  ottawa boston articles unduly training city 2012-2013season serial exclude deterioration postconcussive  toronto program mandate identify olympic michigan orthopaedic board chairperson allowed electroencephalography essential

Very Low relevance
 
spiker irb modified appendix involve deliberations mcmaster physiological reaction experts willem asked preparticipation documents kevin iihf programmes consciousness paradigm paul office contributes mark talks endorsement input jersey meeuwisse2 groups reliable aged individuals sophomore february guskiewicz28 suspicion 3rd hamilton aubry4 mccrory1 genetic 1st values 2nd behavioural tau basis terms mtbi supplement separation echemendia12 context constructs concept literature definition lars violence management the onset karen engebretsen14 consequences magnetic areas involves rates increase demonstrate incorporate face ruben utilised concussion the cantu7 jiří dvořák9 forces fmri referees resolve reduce critical modalities athlete’ complex defined johnston17 meetings pertaining agreement sills21 postural principal identified mainstay spontaneously bob mechanism stability davis25 richard fracture gavin benson22 brian methods soccer population allen organisations shaped subject kutcher19 stages jeffrey updates summary demonstrating martin crt education public remain technology event raftery20 recognition issue ellenbogen26 advance base case beneficial facial unknown timing effective optimal memory needed efficacy expected progressively participation sac 24 h presentation head-on status window in functioning in table weeks table evaluate environment 56  years non-elite aspect interpretation paediatric victoria player’  calgary teammates founder educative club improvement frank symptomatic florida’s diagnose gender recommend widespread women’s making noting points high-risk expertise  check trauma exist distinct applied ideally challenge anxiety pharmacological ongoing continue room didn’t lack trainers clinician received chronic deficit teammate symptom-free open problems levels high postinjury occasionally feeling situation advised collision unreliable progress warning referred claiming sensitivity screening neurocognitive sidelines split vision scat 10 days patterns emotional individual acknowledged north carolina detected neck junior chapel hill excluding scientific departments disposition interviews prepared convulsive response removed vanderbilt task recognize resolution timely austin guide members topic wisconsin instituted on-field association nerve monash superoxide switzerland dismutase strategy gfap s-100 biomarkers objective columbia british english cerebral evaluated national consistent ottawa reduction systematic encephalopathy measure leave neuropsychologist position decision-making 77  missouri off-field flow game massachusetts  boston absence federation conservative featured penalising  ottawa boston articles unduly training city 2012-2013season serial exclude deterioration postconcussive  toronto program mandate identify olympic michigan orthopaedic board chairperson allowed electroencephalography essential apply risks diffuse swelling childhood cautious completely extend returned adolescence advice athletes all provocation 13 years female gender the modifier unanimous accepted conclusive modifiers female window table 2 concussion management a behaviour ‘modifying’ investigation persistent predict 75 significance loc in 64  surrogate 79  80 published burden suggests post-traumatic renewed predictor moderate-to-severe 76 although 78 consensus symptoms there 1 min modification concerned category fit educate structured dependence perceived pre-identify 72 such evaluation recognising carefully appreciating reconsider recognise fact recall 69 the vulnerability increasing sought remote pre-participation unrecognised alert matching emphasising relevance maxillofacial coexistent disproportionate missed presence 81  limits turn utility comparison norms person’ maturation developmentally 104 a teacher 12 years broadly planning differences 20 in learning child’ reference limit daily exacerbate living highlighted rest’ adhd disorders 57  98 it ‘cognitive activity checklists age-appropriate tonic phenomena posturing movements dramatic accompany phenomena a 84 motor retrograde 82 further varies measurement 83  reflective benign 85  patients multifactorial populations child athlete the report contained 97although 34  consequence 86 depression mental depressed mood model limbic-frontal attendance welfare questions note december updated question separate covered citations thebjsm  reviewed accessing platforms depend iphone technological facts substitutes formally circumstances reviews acutely milder 154 in as concussion confused identifiable limitation well-validated mri observed existing changing rapidly phase manage perfect transient marker reasonable interpreted panel’ guiding directing panellists quantitative represent academics drawn responsible advocacy serve addressing telemedicine record disseminated robotics—sensory maximum achieve selected outline legal bjsm website phone considerations this smart overview reflects publicly interests icmje abstract speakers disclosure author’ affiliations apps impairments formulation fatigue 15 min minimum arbitrary inclusion uniquely devick qualified conducted steps gcs scale coma observing documenting multifaceted-multimodal sustaining functions 155  156 recent impaired frequently neuropsychology measured rate normalisation 3 weeks scales advances younger variable reinforces ‘cornerstone’ additions impractical youths suitable glasgow battery standardised eager worldwide includes elusiveness specificity variability schools constraint competition play’ ‘field solely recognising logistical performing responsibility challenging reliance challenges ascertained profile measures streamlined multimodal answer validity instrument improved scat2 colleges erring cranial caution keeping clinician’ managing circulated responses adoption 132 this compensation dangerous paradoxical journal phenomenon degree compensation an settings accounted contests heading 50% 131 as enforcement compromising earlier matter higher ability transfer as elements minimal colleagues educated administrators medication supported 137 fair aggressive sport the 135 aggression fun watch 136  discouraged limb upper possibility pressure fears prevention protective equipment—mouthguards mouthguards good helmets there cautiously modern tauopathy represents mindful populations relationship causation 114 at exposure preventing dental falling equestrian cycling surfaces 130 rule implicated clear-cut change consideration 118 in alpine translated gear orofacial skiing snowboarding participants protection detection safe htm aboutcdp gov governing conduct non-government broad-based summarised nih  http systems grading 2 the organisational methodology institutes guidelines non-advocacy assembled advanced posed prepare define scope eye-tracking elucidate direction executive inquiry knowledgeable balanced sensors excluded commercial presented researchers epidemiology invited internationale fédération enlightened initiated endeavour vigorously pursued enormous support working educational web-based improve videos outreach message delivering opponents ethical involvement identified leadership czech republic symposia aims original validated partnership ensuring managers associations implemented 150 section austria process in encephalopathy clinicians suggestions roberts australia 26theodore hospitals endowed chair committee 28matthew usa 27nfl cabrini canada 25department tennessee  nashville ireland 21department usa 22department neurosciences canada 24sport canada 23department gfeller sport-related usa 33burke cornell canada 32weill white plains usa 35department usa 34new vancouver psychiatry orthopaedics usa 29clinical usa 30seattle seahawks usa 31department mariners  dublin usa 20international switzerland 12psychological switzerland 11f-marc clinic neurobehavioral associates pennsylvania  state switzerland 10schulthess usa 9department games switzerland 5ioc canada 6ottawa canada 7department study usa 8center usa 13university kansas edge canada 18concussion switzerland 17division canada 19michigan neurosport arbor  ann  lausanne committee usa 14department  kansas  oslo oslo norway 16international norway 15oslo canada 36canadian men’ australia heidelberg mccrory  paulmccr@bigpond au received 8 2013 preamble this 2013 accepted 8 uk correspondence london canada 52thinkfirst canada 51krembil canada 53parachute canada 54british authority horseracing revision update recreational professionals physicians messages conveyed realm acknowledge description consensus-based 3 the conferences build develop problem conceptual western canada 50toronto australia 41mcintosh wales south consultancy sydney maddocks australia 42perry australia 40transport usa 39australian canada 37national sledge league nflpa committee 38brain mackey-white trollope lawyers wood usa 48robert canada 47princeton johnson dentistry usa 49sport umdnj braley canada 46david campus australia 43the australia 44centre physiotherapy pediatrics australia 45department canada 4international  sport decide reflexes skills diagnoses strenuous reading excessive consult decided causing visible reporting light-headed lethargic stars committed full-time disorientation blurred coordination focusing moodiness  once lethargy teammate’s  pivacek’s physically students headaches dizziness balancing nausea forehead touch sszymanski22 the apr tag lives traumas season played episode-17-the-concussion-discussion thebodycast discussiontwo home articles interviews forums resources about volunteer concussionsconsensus sszymanski22 aliyah http bodycast considers personal couldn’t knew frustrated wasn’t aware incident trainer overwhelmed hurting incurred incidents match ball noticed lip reasoning restlessness kissick6 james jordan32 mccrea38 andrew david mcintosh39 barry iverson31 sszymanski22 consensus carranza tags 2012 paul stanley grant herring29 maddocks42 makdissi43 affiliations 1the author turner54  heidelberg australia 2faculty canada 3faculty hotchkiss tator50 charles purcell45 laura margot putukian47 schneider49 kathryn jackie gibbons resuming excited handle differently agree doctors accurate feel forced trouble months cognitively harder workout difficult practices events strives guards mouth providing optimize carolyn written heavy-duty accidents talk encourage mentioned emphasize technique proper individualised readers 38 there damage cellular justify electrophysiological evoked recording proposed mbp spinal serum biochemical fluid neuron-specific myelin enolase erp cortical 51 although assessment the established overlaps precede suggesting commonly remains 45 the reproducible stimulation abnormalities reliably controls differentiated 31 in acidic apoe apolipoprotein significance promoter gene markers polymerase 21 the valid lasting bess 72 h appears domain objectively unclear 22  fibroblast binding igf cu-zn sod-1 fibrillar glial igf-1 insulin-like human 23 evidence animal demonstrates cytokine induction 52  53 it falls pathologies 15% window psychological approaches issues psychological patient persistent persistently rtp it passed unanimously collegiate 65 ‘difficult’ evident listed 66  experienced 68 in shortening agents medications antidepressant mask aim condition affective 67 physicians 58 role therapy pharmacological pathophysiology drug drop postconcussion mandatory 57 baseline consultation discuss cornerstone sparse clearance aspects 55 there sole emphasised investigational virtue 54  ultimate 48 h type protocol with window table 1 graduated protocol rtp progression step provocative 1 week 58 graduated initiation gradual evidence-based social exacerbation slow low-level scoring error resolves short-lived transmitted evolve minutes sequential neuropathological ‘‘impulsive’ blow revisions minor induced pathologic caused defining 90% short insomnia slowed irritability components concussion when onsite licensed lability fog 2 symptoms 10 day neurobehavioural conducting headache symptoms—somatic countries european distributed accompanying request broken sections a examines lay digital converted distribute copy freely card altered restrictions raised applies pathological ‘shaking’ low-velocity subset tbi cerebri is term commotio representing historical concussion a 3 definition mild acknowledgement refer interchangeably safely urgent lesion intracerebral scan examples conscious deficit focal athletebrain caveat involving emergent investigations a investigations conventional exclusion worsening activation resonance tensor diffusion spectroscopy connectivity plate compelling tomography emission 14 although correlate insight mechanisms positron alternative eyewitnesses seeking practical batteries fitness incorporates maddocks’ 5 and questions4  final facilities arranged referral addressed left adequate monitoring standardized 8 it personnel an appearance stand-alone doctor’ point gait encompass subtle replace compared orientation 9 it paradigms abbreviated commenced

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concussion sport 2012 consensus

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zurich diagnosis management statement athlete evaluation november 4th injury international conference held

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athlete evaluation november 4th injury international conference held assessment rtp symptoms medical acute recovery concussions rugby women’ discussion podcast speak players

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assessment rtp symptoms medical acute recovery concussions rugby women’ discussion podcast speak players sensitive practice reliable existing tools examination evaluating exclude transfer adult knowledge violence aggression legal considerations component cognitive acutely assess making technologies loc significance gender female significance amnesia depression phenomena convulsive motor compensation strategies advances improved scat2 play’ neuropsychology computerised exists evidence tests ‘field factors investigations personnel office room neuropsychological graduated symptomatic persistently ‘difficult’ protocol emergency sideline background prevention populations preamble process questions on-field signs definition patient psychological traumatic chronic athletes non-elite encephalopathy protective rule helmets equipment—mouthguards elite adolescent pharmacological issues health mental therapy preparticipation child athletebrain modifying risk