Research More Info 26

Return Too Fast AND
Suffer The Consequences






Comment from Dr. Mladenoff


This study does not outline what examination protocols were utilized for ongoing care and Return 2 Play criteria. The SCAT exam protocol is designed for acute on-field evaluations to determine immediate action. However, as  a longer term assessment protocol the SCAT criteria are inadequate whether one considers neurological examination protocol or neuromuscular protocols. 


There is no discussion of did all patients recieve the same examination protocols in addition to the SCAT recommendations.


There is no mention of prenosological  evaluation such as  ANSA Heart rate Variability Assessment, Rapid Eye visual tracking, Vestibular/Cervical Spine Brain Balance Tracking utilized.


Equally there is no discussion of what therapeutic interventions were applied. Did all patients recieve the same treatment protocols? 


There is no discussion if the patients were symptom free before they started any Return 2 Play activity. There is no discussion of what phase of Return 2 Play the patient was in when they experienced exacerbation of symptoms. Were they just starting activity in Stage 1 or were they returning to sports specific drills and skills in Stage 4?


The only criteria used to determine the was aggravation of symptoms.


What I am unclear about is the competence of evaluation by the attending care giver and the thoroughness of examination protocols AND the competence and understanding of the Return 2 Play progression of activity.


When an athlete is recieving and/or seeking care the thou
Premature return to play and return to learn after a sport-related concussion: physician's chart review. Canadian Family Physician 2014, 60 (6): e310, e312-5

OBJECTIVE: To determine what proportion of patients experience an exacerbation of their symptoms as a result of premature return to play (RTP) and return to learn (RTL) following sport-related concussions.

DESIGN:Retrospective study of electronic medical records from the office-based practice of one family and sport medicine physician who had systematically provided recommendations for cognitive and physical rest based on existing consensus recommendations. Two blinded authors independently reviewed each chart, which included Sport Concussion Assessment Tool (SCAT) and SCAT2 symptom self-report forms to determine whether an athlete had returned to play or learn prematurely. If there was a discrepancy between the 2 reviewers then a third author reviewed the charts.

PARTICIPANTS:A total of 170 charts of 159 patients were assessed for sport-related concussion during a 5-year period (April 2006 to March 2011). All participants were students who were participating in sports at the time of injury. There were 41 concussions in elementary students, 95 concussions in high school students, and 34 concussions in college or university students.

MAIN OUTCOME MEASURES:Premature RTP and RTL were defined as chart records documenting the recurrence or worsening of symptoms that accompanied the patients' RTP or RTL. Measures were compared using the earliest available SCAT forms and self-reporting.

RESULTS:In 43.5% of concussion cases, the patient returned to sport too soon and in 44.7% of concussion cases, the patient returned to school too soon. Patients with a history of previous concussion required more days of rest before being permitted to participate in any physical activity than those patients without a previous history of concussion. Elementary school students required fewer days of rest before being permitted to return to any physical activity compared with high school students and college or university students.

CONCLUSION:Currently, physicians recommend restrictions on mental and physical activity following sport-related concussion. This is done without clear guidelines as to what cognitive rest entails for students. Further research is required to determine how to implement a management plan for student athletes to facilitate complete recovery after concussion.
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