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March 2009

Convolutions of the Silent Sports Concussion: A Neuropsychologist’s Response to the Dark Ages of Rule-Based Return-to-Play Decisions

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Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Neurol. 2009;66(3):416-421. doi:10.1001/archneurol.2009.9

The recent minireview by Dr Mayers1 lends compelling support to similar concerns expressed in the September 2008 edition of Archives of Clinical Neuropsychology.2 At issue in both of these articles1,2 is the hazard of ignoring the possibility that there may be clinically “silent” consequences of a sports concussion with associated return-to-play (RTP) risks. Dr Mayers recommends an extended 4- to 6-week postconcussion RTP interval in place of the commonly used 1- to 2-week interval as an imperative protective measure against this risk. However, it is hardly necessary to point out that such a blanket 4- to 6-week rule may cause some athletes to be kept out of sports longer than necessary, while at the same time there can be no guarantee that every athlete will be recovered after 4 to 6 weeks. In this respect, Dr Mayers actually states that few of the researchers he cites assessed their athletes for periods longer than 1 month and consequently “the total duration of the measured abnormal responses remains unknown.”1 Therefore, Dr Mayers' so-called management revision is unlikely to survive as a viable solution, being merely a sideways move within the discredited rule-based framework of management and not in line with the forward modern move toward fine individualized assessment of the concussed athlete.3,4

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