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Thomas J. Zwimpfer and Mark Bernstein

C erebral concussion is by far the most frequent type of reversible injury of the nervous system. Its clinical features have been extensively reviewed, and reproducible experimental models have allowed investigation into its pathophysiology. 4, 6, 14–17, 19, 26 Spinal cord trauma often results in permanent deficits; however, in a small proportion of cases recovery is rapid and complete. Comparatively little is known about concussion injuries of the spinal cord, due to their infrequency and the lack of an experimental model. The early literature on spinal cord

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Krystal L. Tomei, Christopher Doe, Charles J. Prestigiacomo, and Chirag D. Gandhi

Lystedt Law, requiring immediate removal from play of any young athlete suspected of having sustained a concussion. This law also stipulates clearance from a licensed health care provider trained to evaluate head injuries before an athlete can return to play. 24 Largely driven by professional athletic associations such as the National Football League, awareness of the very important issue of sports-related concussion has increased and served as an impetus for greater regulation among younger athletes. 21 Since the implementation of the Lystedt law, 42 additional

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James Mooney, James Pate, Ian Cummins, M. Chandler McLeod, and Sara Gould

C oncussion is a significant public health concern affecting millions of people worldwide. The number of child and adolescent emergency department visits for concussion has increased dramatically in the United States. 1 Clinically, concussion manifests as a transient disturbance in brain functioning that typically results in self-limiting cognitive, physical, sleep, and emotional symptoms. With appropriate rest and gradual reintegration into school and extracurricular activities, the majority of adolescents make a complete neurological recovery within 1

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Mark R. Lovell, Michael W. Collins, Grant L. Iverson, Melvin Field, Joseph C. Maroon, Robert Cantu, Kenneth Podell, John W. Powell, Mark Belza, and Freddie H. Fu

T he management of sports-related mild traumatic brain injury (for example, concussion) has rightfully received recognition as a public health issue. 1, 6, 7, 10 Of particular concern is competition at the high school level, where a minimum of 1.25 million athletes compete in contact sports. Recent data suggest that an estimated 62,816 concussions occur annually in high school students, with football accounting for approximately 63% of the cases. 22 Currently, neuropsychological testing is mandated within the National Hockey League 15 and the majority of

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Richard Menger, Austin Menger, and Anil Nanda

given match. 4 Across both academic and mainstream publications, medical interest in contact sports has shifted to concussion prevention and long-term neurocognitive decline. 29 Rugby is at the forefront of that discussion. Concussion is a distinct and separate entity from that of mild traumatic brain injury. 21 The current working definition states that concussion is a traumatically induced pathophysiological process affecting the brain. Concussion is distinguished by its rapid onset of impairment, spontaneous resolution of symptoms, and its overarching

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Paul Sean Echlin, Charles H. Tator, Michael D. Cusimano, Robert C. Cantu, Jack E. Taunton, Ross E. G. Upshur, Michael Czarnota, Craig R. Hall, Andrew M. Johnson, Lorie A. Forwell, Molly Driediger, and Elaine N. Skopelja

T he direct independent medical assessment and protocol-guided return to play after an athlete has sustained a medically diagnosed concussion is believed to be essential in the acute concussion care. 19 , 23 This approach may decrease the frequency of short- and long-term sequelae (such as postconcussion syndrome; mild cognitive impairment; chronic traumatic encephalopathy) related to this injury. 4 , 5 , 8 , 9 , 19 , 20 , 22 , 25 , 26 It may also improve the return-to-play data on which individual decisions are determined. Previously published return

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Je Yeong Sone, Douglas Kondziolka, Jason H. Huang, and Uzma Samadani

era for both civilian and military helmets, in which the focus has shifted from protection against lethal, penetrating TBI toward protection against the more frequently incurred blast injury and concussion. 50 , 109 FIG. 4. An ACH worn by US Army Spc. Melissa McIntyre of the 793rd Military Police Battalion, 8th Military Police Brigade, in Basra, Iraq; January 20, 2009. Photography by US Armed Forces. Previous source: US Department of Defense. Public domain. Figure is available in color online only. FIG. 5. Bicycle helmets worn by Olympic cyclists

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Shawn R. Eagle, Lisa Manderino, Michael Collins, Nathan Kegel, Vanessa Fazio-Sumrok, Anne Mucha, and Anthony P. Kontos

C oncussion presentation and recovery is highly individualized, which leads to variability in symptom profiles and recovery times across injured patients. 1 Targeted treatment approaches have been at the center of current discussions to improve clinical assessment and management of this injury. 2–4 An initial approach to identifying an individual’s response to concussion was to characterize symptom clusters using common subjective concussion symptom reports (i.e., Post-Concussion Symptom Scale, Rivermead Postconcussion Symptoms Questionnaire, and Sports

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Matthew Tormenti, Donald Krieger, Ava M. Puccio, Malcolm R. McNeil, Walter Schneider, and David O. Okonkwo

T here is no agreed-upon neuroimaging strategy to diagnose concussion. The diagnosis of concussion, which is also called MTBI, is based on patient symptom self-report and neuropsychological testing as the basis for medical decisions and the treatment paradigms. A significant percentage of patients with concussion have no abnormal findings on CT or MRI studies of the brain. 1 The absence of a formal, objective neuroimaging tool to diagnose concussion reliably is a major impediment in the field. Magnetoencephalography shows promise for the assessment of

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Paul Sean Echlin, Andrew M. Johnson, Suzanne Riverin, Charles H. Tator, Robert C. Cantu, Michael D. Cusimano, Jack E. Taunton, Ross E. G. Upshur, Craig R. Hall, Lorie A. Forwell, and Elaine N. Skopelja

F ailure to recognize and report concussions noted in previous publications in the literature may be the result of a lack of a standardized knowledge base among athletes, coaches, trainers, and parents regarding the signs and symptoms of concussion. 1 , 3 , 6 , 12 , 13 , 16 , 17 , 24 , 25 ,, 27 Such underreporting is likely associated with undertreatment, which may also have very significant immediate and long-term social and health implications. 7 , 8 , 14 , 15 , 18 , 19 , 20 , 22 , 23 The primary goal of this study is to evaluate the effectiveness of