Abstract:
Guidelines for returning a concussed player to sport had been
somewhat controversial and nebulous until the emergence of a
series of international consensus meetings and statements initiated
in 2001. The Vienna (2001), Prague (2004) and Zurich (2009)
statements as well as the American National Athletic Trainers
Association (2004) and the American College of Sports Medicine
(2005) position stands have given all clinicians better guidance
that is more evidence-based than the somewhat subjective
guidelines of the latter 20th century. Some impetus to research
and the re-evaluation of assessment and management guidelines
has been provided by the emergence of computerised neuropsychological
test batteries as a useful barometer of cognitive recovery.
However, the clinical evaluation of a concussed player
remains the cornerstone of management and should incorporate
a thorough symptom analysis, general, cognitive and neurological
examination, and balance testing. The Sports Concussion Assessment
Tool (SCAT) 2 card is a clinical evaluation tool intended
to summarise the most significant aspects of clinical assessment.
In addition, and as an essential ‘final stress’ test, the athlete must
be subjected to a series of graded exercise sessions, increasing
in severity, before being returned to contact or collision sport. A
structured clinical evaluation is particularly important in the South
African context, where computerised testing may not be accessible
to many. This article serves to collate and highlight the evidence-
based and consensus data available for management of
the concussed rugby player in 2010.
