Concussion: Determining Safe Return to Activity in
the College Health Setting
Brian Vesci, MA, ATC
Senior Athletic Trainer
Boston University
vesci@bu.edu
Boston University Athletic Training Services
Disclosures
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 Neither I, Brian Vesci, nor any family members, have any
relevant financial relationships to be discussed, directly or
indirectly, referred to or illustrated with or without
recognition within the presentation
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Concussion History1
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Physical and Cognitive Rest2,3
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Graduated Return to Activity3
Rehabilitation
Stage Slideshow Title Goes
Exercise
Boston University
Here Recommendation
Objective
1. No activity
Complete physical and
cognitive rest
Recovery
2. Light aerobic activity
Walking, swimming, stationary Increase heart rate
bike (at 70% max heart rate);
no resistance exercises
3. Activity-specific exercise
Activity related drills but no
head impact
Add movement
4. Noncontact training drills
More complex drills, may start
light resistance training
Exercise, coordination,
increased cognitive load
5. Full-contact participation
After medical clearance,
participate in normal training
Restore confidence,
assessment of functional skills
6. Return to play
Normal game play
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Increased Risk of Injury Post Concussion2,3,4,5
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Higher Level Language Function6,7
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BU Center for the Study of Traumatic
Encephalopathy
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http://www.bu.edu/cste/
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Medial Temporal Lobe8
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65 Year old control
John Grimsley
73 Year old boxer
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Frontal Cortex8
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65 Year old control
John Grimsley
73 Year old boxer
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18 Year Old Frontal Cortex8
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The Future
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 Serum s100b protein levels9,10
 >0.32 μg/L
 <0.10 μg/L
 Docosahexaenoic acid (DHA)11,12
 Silent information regulator 2 (Sir2)
Boston University Athletic Training Services
References
1.
Valovich
McLeod
TC, Title
Bay Goes
RC, Heil
Boston
University
Slideshow
HereJ, McVeigh SD. Identification of Sport and Recreational
Activity Concussion History Through the Pre-Participation Screening and a Symptom
Survey in Young Athletes. Clinical Journal of Sport Medicine. 2008;18(3):235-240.
2. Guskiewicz KM, Bruce SL, Cantu RC, Michael SF, Kelly JP, McCrea M, Putukian M, McLeod
TCV. National Athletic Trainers’ Association position statement: management of sportsrelated concussion. J Athl Train. 2004;39(3):280-297.
3. McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, Cantu R. Consensus
statement on concussion in sport: the 3rd international conference on concussion in sport
held in Zurich, November 2008. Brit J Sports Med. 2009;43:176-184.
4. Faul M, Xu L, Walk MM, Coronado VG. Traumatic brain injury in the United States;
emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for
Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.
5. McCrea M, Guskiewicz K, Randolph C, Barr WB, Hammeke TA, Marshall SW, Kelly JP.
Effects of a symptom-free waiting period on clinical outcome and risk of reinjury after
sport-related concussion. Neurosurgery. 2009;65(5):876-883.
6. Brooks J, Fos LA, Greve KW, Hammond JS. Assessment of executive function in patients
with mild traumatic brain injury. Trauma. 1999;46(1):159-163.
Boston University Athletic Training Services
References
7. Lipton ML, Gulko E, Zimmerman ME, Friedman BW, Kim M, Gellella E, Gold T, Shifteh K,
Boston
University
Title Diffusion-tensor
Goes Here
Ardekani
BA,Slideshow
Branch CA.
imaging implicates prefrontal axonal injury in
executive function impairment following very mild traumatic brain injury. Radiology.
2009;252(3):816-824.
8. Boston University Center for the Study of Traumatic Encephalopathy.
http://www.bu.edu/cste/case-studies/. Updated May 3, 2011. Accessed May 30, 2011.
9. Townend WJ, Guy MJ, Pani MA, Martin B, Yates DW. Head injury outcome prediction in
the emergency department: a role for protein S-100B? J Neurol Neurosurg Pshychiatry.
2002;73:542-546.
10. Biberthaler P, Linsenmeier U, Pfeifer K, Kroetz M, Mussak T, Kanz K, Hoecherl EF, Jonas F,
Marzi I, Leucht P, Jochum M, Mutschler W. Serum S-100B concentration provides
additional information for the idication of computed tomography in patients after minor
head injury: a prospective multicenter study. SHOCK. 2006;25(5):446-453.
11. Wu A, Ying Z, Gomez-Pinilla F. Omega-3 fatty acids supplementation restores
mechanisms that maintain brain homeostasis in traumatic brain injury. J Neurotrauma.
2004;24(10):1587-1595.
12. Conklin SM, Gianaros PJ, Brown SM, Yao JK, Hariri AR, Manuck SB, Muldoon MF. Longchain omega-3 fatty acid intake is associated positively with corticolimbic gray matter
volume in healthy adults. Neuroscience Letters. 2007;421:209-212.