Skip to main content
SpringerLink
Log in

Concussion: Predicting Recovery

  • Chapter
  • First Online:
Return to Play in Football

  • 2745 Accesses

Abstract

Identifying athletes at risk for protracted recovery following a sport-related concussion (SRC) is an important part of concussion management. Consensus statements outline several factors that are purported to contribute to SRC recovery; however, many of these factors lack empirical support and warrant additional research. The purpose of this chapter is to (1) describe best practice for returning an athlete to play following SRC, (2) provide an overview of studies that examine SRC recovery, and (3) present empirical support for factors that predict prolonged recovery following SRC.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Top Five Evidence-Based References

References

  1. Harmon KG, Drezner JA, Gammons M, Guskiewicz KM, Halstead M, Herring SA, Kutcher JS, Pana A, Putukian M, Roberts WO (2013) American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 47(1):15–26

    Article  PubMed  Google Scholar 

  2. McCrory P, Meeuwisse W, Aubry M, Cantu B, Dvorak J, Echemendia RJ, Engebretsen L, Johnston K, Kutcher JS, Raftery M, Sills A (2013) Consensus statement on concussion in sport-the 4th international conference on concussion in sport held in Zurich, November 2012. Clin J Sport Med 23(2):89–117

    Article  PubMed  Google Scholar 

  3. Collins MW, Kontos AP, Okonkwo DO, Almquist J, Bailes J, Barisa M, Bazarian J, Bloom OJ, Brody DL, Cantu R, Cardenas J, Clugston J, Cohen R, Echemendia R, Elbin RJ, Ellenbogen R, Fonseca J, Gioia G, Guskiewicz K, Heyer R, Hotz G, Iverson GL, Jordan B, Manley G, Maroon J, McAllister T, McCrea M, Mucha A, Pieroth E, Podell K, Pombo M, Shetty T, Sills A, Solomon G, Thomas DG, Valovich McLeod TC, Yates T, Zafonte R (2016) Statements of agreement from the targeted evaluation and active management (TEAM) approaches to treating concussion meeting held in Pittsburgh, October 15–16, 2015. J Neurosurg 79(6):912–929

    Article  Google Scholar 

  4. McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, Cantu R (2009) Consensus statement on concussion in sport—the 3rd international conference on concussion in sport held in Zurich, November 2008. J Sci Med Sport 12(3):340–351

    Article  CAS  PubMed  Google Scholar 

  5. Henry LC, Elbin RJ, Collins MW, Marchetti G, Kontos AP (2015) Examining recovery trajectories after sport-related concussion with a multimodal clinical assessment approach. Neurosurgery 78(2):232–241

    Article  Google Scholar 

  6. Collins MW, Lovell MR, Iverson GL, Ide T, Maroon J (2006) Examining concussion rates and return to play in high school football players wearing newer helmet technology: a three-year prospective cohort study. Neurosurgery 58(2):275–286. discussion 275–286

    Article  PubMed  Google Scholar 

  7. McCrea M, Hammeke T, Olsen G, Leo P, Guskiewicz KM (2004) Unreported concussion in high school football players: implications for injury prevention. Clin J Sport Med 14:13–17

    Article  PubMed  Google Scholar 

  8. Asken BM, Snyder AR, Smith MS, Zaremski JL, Bauer RM (2017) Concussion-like symptom reporting in non-concussed adolescent athletes. Clin Neuropsychol 2017:1–16

    Google Scholar 

  9. Iverson GL, Silverberg ND, Mannix R, Maxwell BA, Atkins JE, Zafonte R, Berkner PD (2015) Factors associated with concussion-like symptom reporting in high school athletes. JAMA Pediatr 169(12):1132–1140

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mailer BJ, Valovich-McLeod TC, Bay RC (2008) Healthy youth are reliable in reporting symptoms on a graded symptom scale. J Sport Rehabil 17(1):11–20

    Article  PubMed  Google Scholar 

  11. Alla S, Sullivan SJ, McCrory P (2012) Defining asymptomatic status following sports concussion: fact or fallacy? Br J Sports Med 46(8):562–569

    Article  PubMed  Google Scholar 

  12. McCrea M, Guskiewicz KM, Marshall SW, Barr W, Randolph C, Cantu RC, Onate JA, Yang J, Kelly JP (2003) Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA 290(19):2556–2563

    Article  CAS  PubMed  Google Scholar 

  13. McCrory P, Johnston KM, Meeuwisse W, Aubry M, Cantu RC, Dvorak J, Graf-Baumann T, Kelly J, Lovell MR, Schamasch P (2005) Summary and agreement statement of the 2nd international conference on concussion in sport, Prague 2004. Clin J Sport Med 15(2):48–55

    Article  PubMed  Google Scholar 

  14. Pfaller AY, Nelson LD, Apps JN, Walter KD, McCrea MA (2016) Frequency and outcomes of a symptom-free waiting period after sport-related concussion. Am J Sports Med 44(11):2941–2946

    Article  PubMed  Google Scholar 

  15. Nelson LD, Tarima S, LaRoche AA, Hammeke TA, Barr WB, Guskiewicz K, Randolph C, McCrea MA (2016) Preinjury somatization symptoms contribute to clinical recovery after sport-related concussion. Neurology 86(20):1856–1863

    Article  PubMed  PubMed Central  Google Scholar 

  16. Morgan CD, Zuckerman SL, Lee YM, King L, Beaird S, Sills AK, Solomon GS (2015) Predictors of postconcussion syndrome after sports-related concussion in young athletes: a matched case-control study. J Neurosurg Pediatr 15(6):589–598

    Article  PubMed  Google Scholar 

  17. Asken BM, McCrea MA, Clugston JR, Snyder AR, Houck ZM, Bauer RM (2016) “Playing through it”: delayed reporting and removal from athletic activity after concussion predicts prolonged recovery. J Athl Train 51(4):329–335

    Article  PubMed  PubMed Central  Google Scholar 

  18. Elbin RJ, Sufrinko A, Schatz P, French J, Henry L, Burkhart S, Collins MW, Kontos AP (2016) Removal from play after concussion and recovery time. Pediatrics 138(3):10

    Article  Google Scholar 

  19. Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, Gronseth GS, Guskiewicz K, Mandel S, Manley G, McKeag DB, Thurman DJ, Zafonte R (2013) Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the guideline development subcommittee of the American Academy of Neurology. Neurology 80(24):2250–2257

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bell DR, Guskiewicz KM, Clark MA, Padua DA (2011) Systematic review of the balance error scoring system. Sports Health 3(3):287–295

    Article  PubMed  PubMed Central  Google Scholar 

  21. Van Kampen DA, Lovell MR, Pardini JE, Collins MW, FH F (2006) The “value added” of neurocognitive testing after sports-related concussion. Am J Sports Med 34(10):1630–1635

    Article  PubMed  Google Scholar 

  22. Black AM, Sergio LE, Macpherson AK (2017) The epidemiology of concussions: number and nature of concussions and time to recovery among female and male canadian varsity athletes 2008 to 2011. Clin J Sport Med 27(1):52–56

    Article  PubMed  Google Scholar 

  23. Guskiewicz KM, Ross SE, Marshall SW (2001) Postural stability and neuropsychological deficits after concussion in collegiate athletes. J Athl Train 36(3):263–273

    PubMed  PubMed Central  Google Scholar 

  24. Cavanaugh JT, Guskiewicz KM, Giuliani C, Marshall S, Mercer VS, Stergiou N (2006) Recovery of postural control after cerebral concussion: new insights using approximate entropy. J Athl Train 41(3):305–313

    PubMed  PubMed Central  Google Scholar 

  25. Fait P, Swaine B, Cantin JF, Leblond J, BJ MF (2013) Altered integrated locomotor and cognitive function in elite athletes 30 days postconcussion: a preliminary study. J Head Trauma Rehabil 28(4):293–301

    Article  PubMed  Google Scholar 

  26. Howell DR, Osternig LR, Chou LS (2013) Dual-task effect on gait balance control in adolescents with concussion. Arch Phys Med Rehabil 94(8):1513–1520

    Article  PubMed  Google Scholar 

  27. Galetta KM, Brandes LE, Maki K, Dziemianowicz MS, Laudano E, Allen M, Lawler K, Sennett B, Wiebe D, Devick S, Messner LV, Galetta SL, Balcer LJ (2011) The King-Devick test and sports-related concussion: study of a rapid visual screening tool in a collegiate cohort. J Neurol Sci 309(1–2):34–39

    Article  PubMed  Google Scholar 

  28. Mucha A, Collins MW, Elbin RJ, Furman JM, Troutman-Enseki C, DeWolf RM, Marchetti G, Kontos AP (2014) A brief vestibular/ocular motor screening (VOMS) assessment to evaluate concussions: preliminary findings. Am J Sports Med 42(10):2479–2486

    Article  PubMed  PubMed Central  Google Scholar 

  29. Galetta KM, Morganroth J, Moehringer N, Mueller B, Hasanaj L, Webb N, Civitano C, Cardone DA, Silverio A, Galetta SL, Balcer LJ (2015) Adding vision to concussion testing: a prospective study of sideline testing in youth and collegiate athletes. J Neuroophthalmol 35(3):235–241

    Article  PubMed  Google Scholar 

  30. Kontos AP, Sufrinko A, Elbin RJ, Puskar A, Collins MW (2016) Reliability and associated risk factors for performance on the vestibular/ocular motor screening (VOMS) tool in healthy collegiate athletes. Am J Sports Med 44(6):1400–1406

    Article  PubMed  Google Scholar 

  31. McGrath N, Dinn WM, Collins MW, Lovell MR, Elbin RJ, Kontos AP (2013) Post-exertion neurocognitive test failure among student-athletes following concussion. Brain Inj 27(1):103–113

    Article  PubMed  Google Scholar 

  32. Ruff RM, Camenzuli L, Mueller J (1996) Miserable minority: emotional risk factors that influence the outcome of a mild traumatic brain injury. Brain Inj 10(8):551–565

    Article  CAS  PubMed  Google Scholar 

  33. Covassin T, Elbin RJ, Harris W, Parker T, Kontos AP (2012) The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. Am J Sports Med 40(6):1303–1312

    Article  PubMed  Google Scholar 

  34. Field M, Collins MW, Lovell MR, Maroon J (2003) Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J Pediatr 142(5):546–553

    Article  PubMed  Google Scholar 

  35. Giza CC, Hovda DA (2014) The new neurometabolic cascade of concussion. Neurosurgery 75(Suppl 4):S24–S33

    Article  PubMed  PubMed Central  Google Scholar 

  36. Broglio SP, Cantu RC, Gioia GA, Guskiewicz KM, Kutcher J, Palm M, Valovich McLeod TC, National Athletic Trainer's A (2014) National Athletic Trainers’ Association position statement: management of sport concussion. J Athl Train 49(2):245–265

    Article  PubMed  PubMed Central  Google Scholar 

  37. Nelson LD, Guskiewicz KM, Barr WB, Hammeke TA, Randolph C, Ahn KW, Wang Y, McCrea MA (2016) Age differences in recovery after sport-related concussion: a comparison of high school and collegiate athletes. J Athl Train 51(2):142–152

    Article  PubMed  PubMed Central  Google Scholar 

  38. Meehan WP III, Mannix RC, Stracciolini A, Elbin RJ, Collins MW (2013) Symptom severity predicts prolonged recovery after sport-related concussion, but age and amnesia do not. J Pediatr 163(3):721–725

    Article  PubMed  PubMed Central  Google Scholar 

  39. Lee YM, Odom MJ, Zuckerman SL, Solomon GS, Sills AK (2013) Does age affect symptom recovery after sports-related concussion? A study of high school and college athletes. J Neurosurg Pediatr 12(6):537–544

    Article  PubMed  Google Scholar 

  40. Purcell L, Harvey J, Seabrook JA (2015) Patterns of recovery following sport-related concussion in children and adolescents. Clin Pediatr (Phila) 55(5):452–458

    Article  Google Scholar 

  41. Berz K, Divine J, Foss K, Heyl R, Ford K, Myer G (2013) Sex-specific differences in the severity of symptoms and recovery rate following sports-related concussion in young athletes. Phys Sportsmed 41(2):58–63

    Article  PubMed  Google Scholar 

  42. Broshek DK, Kaushik T, Freeman JR, Erlanger D, Webbe F, Barth JT (2005) Sex differences in outcome following sports-related concussion. J Neurosurg 102(5):856–863

    Article  PubMed  Google Scholar 

  43. Colvin A, Mullen J, Lovell M, West R, Collins M, Groh M (2009) The role of concussion history and gender in recovery from soccer-related concussion. Am J Sports Med 37(9):1699–1704

    Article  PubMed  Google Scholar 

  44. Kostyun R, Hafeez I (2015) Protracted recovery from a concussion a focus on gender and treatment interventions in an adolescent population. Sports Health 7(1):52–57

    Article  PubMed  PubMed Central  Google Scholar 

  45. Zuckerman SL, Apple RP, Odom MJ, Lee YM, Solomon GS, Sills AK (2014) Effect of sex on symptoms and return to baseline in sport-related concussion. J Neurosurg Pediatr 13(1):72–81

    Article  PubMed  Google Scholar 

  46. Sufrinko AM, Mucha A, Covassin T, Marchetti G, Elbin RJ, Collins MW, Kontos AP (2016) Sex differences in vestibular/ocular and neurocognitive outcomes after sport-related concussion. Clin J Sport Med 27(2):133–138

    Article  Google Scholar 

  47. Covassin T, Stearne D, Elbin RJ (2008) Concussion history and postconcussion neurocognitive performance and symptoms in collegiate athletes. J Athl Train 43(2):119–124

    Article  PubMed  PubMed Central  Google Scholar 

  48. Iverson GL, Gaetz M, Lovell MR, Collins MW (2004) Relation between subjective fogginess and neuropsychological testing following concussion. J Int Neuropsychol Soc 10(6):904–906

    Article  PubMed  Google Scholar 

  49. Gaetz M, Goodman D, Weinberg H (2000) Electrophysiological evidence for the cumulative effects of concussion. Brain Inj 14(12):1077–1088

    Article  CAS  PubMed  Google Scholar 

  50. Kerr ZY, Marshall SW, Harding HP Jr, Guskiewicz KM (2012) Nine-year risk of depression diagnosis increases with increasing self-reported concussions in retired professional football players. Am J Sports Med 40(10):2206–2212

    Article  PubMed  Google Scholar 

  51. Robbins CA, Daneshvar DH, Picano JD, Gavett BE, Baugh CM, Riley DO, Nowinski CJ, McKee AC, Cantu RC, Stern RA (2014) Self-reported concussion history: impact of providing a definition of concussion. Open access. J Sports Med 5:99–103

    Google Scholar 

  52. Kontos AP, Elbin RJ, Schatz P, Covassin T, Henry L, Pardini J, Collins MW (2012) A revised factor structure for the post-concussion symptom scale: baseline and postconcussion factors. Am J Sports Med 40(10):2375–2384

    Article  PubMed  Google Scholar 

  53. Pardini J, Stump JE, Lovell M, Collins MW, Moritz K, FH F (2004) The Post Concussion Symptom Scale (PCSS): a factor analysis [abstract]. Br J Sports Med 38:661–662

    Google Scholar 

  54. Kontos AP, Elbin RJ, Lau B, Simensky S, Freund B, French J, Collins MW (2013) Posttraumatic migraine as a predictor of recovery and cognitive impairment after sport-related concussion. Am J Sports Med 41(7):1497–1504

    Article  PubMed  Google Scholar 

  55. Lau BC, Collins MW, Lovell MR (2012) Cutoff scores in neurocognitive testing and symptom clusters that predict protracted recovery from concussions in high school athletes. Neurosurgery 70(2):371–379

    Article  PubMed  Google Scholar 

  56. Lau BC, Kontos AP, Collins CL, Mucha A, Lovell MR (2011) Which on-field signs and symptoms predict protracted recovery from sport-related concussion among high school football players? Am J Sports Med 39(11):2311–2318

    Article  PubMed  Google Scholar 

  57. Lau BC, Lovell MR, Collins MW, Pardini J (2009) Neurocognitive and symptom predictors of recovery in high school athletes. Clin J Sport Med 19(3):216–221

    Article  PubMed  Google Scholar 

  58. Collins MW, Kontos AP, Reynolds E, Murawski CD, FH F (2014) A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion. Knee Surg Sports Traumatol Arthrosc 22(2):235–246

    Article  PubMed  Google Scholar 

  59. Cantu RC (2001) Posttraumatic retrograde and anterograde amnesia: pathophysiology and implications in grading and safe return to play. J Athl Train 36(3):244–248

    PubMed  PubMed Central  Google Scholar 

  60. Guskiewicz KM, Weaver NL, Padua DA, Garrett WE (2000) Epidemiology of concussion in collegiate and high school football players. Am J Sports Med 28(5):643–650

    Article  CAS  PubMed  Google Scholar 

  61. Aubry M, Cantu RC, Dvorak J, Graf-Baumann T, Johnston KM, Kelly JP, Lovell MR, McCrory PR, Meeuwisse W, Schamasch P (2002) Summary and agreement statement of the 1st international symposium on concussion in sport, Vienna 2001. Clin J Sport Med 12:6–11

    Article  PubMed  Google Scholar 

  62. Pellman EJ, Viano DC, Casson IR, Arfken C, Powell J (2004) Concussion in professional football: injuries involving 7 or more days out—part 5. Neurosurgery 55(5):1100–1119

    Article  PubMed  Google Scholar 

  63. Asplund CA, McKeag DB, Olsen CH (2004) Sport-related concussion: factors associated with prolonged return to play. Clin J Sport Med 14(6):339–343

    Article  PubMed  Google Scholar 

  64. McCrea M, Guskiewicz KM, Randolph C, Barr WB, Hammeke TA, Marshall SW, Powell MR, Woo Ahn K, Wang Y, Kelly JP (2012) Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes. J Int Neuropsychol Soc 2012(18):1–12

    Google Scholar 

  65. Chrisman SP, Rivara FP, Schiff MA, Zhou C, Comstock RD (2013) Risk factors for concussive symptoms 1 week or longer in high school athletes. Brain Inj 27(1):1–9

    Article  PubMed  Google Scholar 

  66. Guskiewicz KM, McCrea M, Marshall SW, Cantu RC, Randolph C, Barr W, Onate JA, Kelly JP (2003) Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA concussion study. JAMA 290(19):2549–2555

    Article  CAS  PubMed  Google Scholar 

  67. Makdissi M, Darby D, Maruff P, Ugoni A, Brukner P, McCrory PR (2010) Natural history of concussion in sport: markers of severity and implications for management. Am J Sports Med 38(3):464–471

    Article  PubMed  Google Scholar 

  68. Collins MW, Field M, Lovell MR, Iverson GL, Johnston KM, Maroon J, FH F (2003) Relationship between postconcussion headache and neuropsychological test performance in high school athletes. Am J Sports Med 31(2):168–173

    Article  PubMed  Google Scholar 

  69. Mihalik JP, Stump JE, Collins MW, Lovell MR, Field M, Maroon JC (2005) Posttraumatic migraine characteristics in athletes following sports-related concussion. J Neurosurg 102(5):850–855

    Article  PubMed  Google Scholar 

  70. Kontos AP, Reches A, Elbin RJ, Dickman D, Laufer I, Geva AB, Shacham G, DeWolf R, Collins MW (2015) Preliminary evidence of reduced brain network activation in patients with post-traumatic migraine following concussion. Brain Imaging Behav 10(2):594–603

    Article  Google Scholar 

  71. Meehan WP III, Mannix R, Monuteaux MC, Stein CJ, Bachur RG (2014) Early symptom burden predicts recovery after sport-related concussion. Neurology 83(24):2204–2210

    Article  PubMed  PubMed Central  Google Scholar 

  72. Meehan WP III, O'Brien MJ, Geminiani E, Mannix R (2016) Initial symptom burden predicts duration of symptoms after concussion. J Sci Med Sport 19(9):722–725

    Article  PubMed  Google Scholar 

  73. Baugh CM, Kroshus E, Daneshvar DH, Filali NA, Hiscox MJ, Glantz LH (2015) Concussion management in United States college sports: compliance with National Collegiate Athletic Association concussion policy and areas for improvement. Am J Sports Med 43(1):47–56

    Article  PubMed  Google Scholar 

  74. Register-Mihalik JK, Guskiewicz KM, McLeod TC, Linnan LA, Mueller FO, Marshall SW (2013) Knowledge, attitude, and concussion-reporting behaviors among high school athletes: a preliminary study. J Athl Train 48(5):645–653

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Health, Human Performance and Recreation, Office for Sport Concussion Research, University of Arkansas, Fayetteville, AR, USA

    Robert J. Elbin Ph.D., Nathan D’Amico M.S., A.T.C. & Morgan Anderson B.S.

  2. Athletic Training Programs, School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ, USA

    Tamara Valovich McLeod Ph.D., A.T.C., F.N.A.T.A.

  3. Department of Kinesiology, Michigan State University, East Lansing, MI, USA

    Tracey Covassin Ph.D., A.T.C., F.N.A.T.A

Authors
  1. Robert J. Elbin Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nathan D’Amico M.S., A.T.C.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tamara Valovich McLeod Ph.D., A.T.C., F.N.A.T.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tracey Covassin Ph.D., A.T.C., F.N.A.T.A
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Morgan Anderson B.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert J. Elbin Ph.D. .

Editor information

Editors and Affiliations

  1. UPMC Rooney Sports Complex, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Volker Musahl

  2. Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden

    Jón Karlsson

  3. Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany

    Werner Krutsch

  4. Santa Monica, California, USA

    Bert R. Mandelbaum

  5. Clínica do Dragão, Espregueira-Mendes Sports Centre, Porto, Portugal

    João Espregueira-Mendes

  6. Orthopaedic Surgery, Aspetar Hospital, Doha, Qatar

    Pieter d'Hooghe

Rights and permissions

Reprints and permissions

Copyright information

© 2018 ESSKA

About this chapter

Cite this chapter

Elbin, R.J., D’Amico, N., McLeod, T.V., Covassin, T., Anderson, M. (2018). Concussion: Predicting Recovery. In: Musahl, V., Karlsson, J., Krutsch, W., Mandelbaum, B., Espregueira-Mendes, J., d'Hooghe, P. (eds) Return to Play in Football. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55713-6_54

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-55713-6_54

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-55712-9

  • Online ISBN: 978-3-662-55713-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation