May Keith H, Marshall David L, Burns Thomas G, Popoli David M, Polikandriotis John A
Children's Healthcare of Atlanta, Atlanta, GA, USA.
Int J Sports Phys Ther. 2014 Apr;9(2):242-55.
PURPOSE/BACKGROUND: In 2010, the American Academy of Pediatrics officially adopted the recommended return to play guidelines proposed by the International Conference on Concussion in Sport. The guidelines include a six-step process that provides structure to guide an athlete who is recovering from a concussion in a gradual return to play (RTP) by allowing participation in increasingly difficult physical activities. Unfortunately, the guidelines fail to take into account the variability that occurs within different sports and the resulting challenges medical professionals face in making sure each athlete is able to withstand the rigors of their specific sport, without return of symptoms. Therefore, the purpose of this clinical commentary is to expand upon the current general consensus guidelines for treatment of concussed pediatric athletes and provide sport specific RTP guidelines.
The intention of the sport specific guidelines is to maintain the integrity of the current six-step model, add a moderate activity phase highlighted by resistance training, and to provide contact and limited contact drills specific to the athlete's sport and/or position. The drills and activities in the proposed seven-step programs are designed to simulate sport specific movements; the sports include: football, gymnastics, cheerleading, wrestling, soccer, basketball, lacrosse, baseball, softball, and ice hockey. These activities will provide sports specific challenges to each athlete while simultaneously accomplishing the objectives of each stage of the RTP progression. The final RTP determination should occur with documented medical clearance from a licensed healthcare provider who has been trained in the evaluation and management of concussions.
DISCUSSION/RELATION TO CLINICAL PRACTICE: There have been significant strides in the management and care of concussed athletes. However, there continues to be a lot of confusion among, athletes, parents, and coaches regarding the proper management of an athlete with a concussion, particularly in the pediatric population. In an effort to eliminate ambiguity and help further promote adherence to the RTP guidelines, the authors developed several sports-specific RTP guidelines.
目的/背景：2010年，美国儿科学会正式采用了运动性脑震荡国际会议提出的建议复出比赛指南。该指南包括一个六步骤流程，通过允许运动员参与难度逐渐增加的体育活动，为指导从脑震荡中恢复的运动员逐步重返赛场（RTP）提供了框架。不幸的是，该指南没有考虑到不同运动项目之间存在的差异，以及医疗专业人员在确保每位运动员能够承受其特定运动项目的严苛要求且不出现症状复发方面所面临的挑战。因此，本临床评论的目的是在当前关于脑震荡儿科运动员治疗的普遍共识指南基础上进行扩展，并提供针对特定运动项目的RTP指南。
特定运动项目指南的目的是保持当前六步骤模型的完整性，增加一个以阻力训练为突出特点的中等强度活动阶段，并提供针对运动员所从事运动项目和/或位置的接触性和有限接触性训练。拟议的七步骤计划中的训练和活动旨在模拟特定运动项目的动作；这些运动项目包括：橄榄球、体操、啦啦队、摔跤、足球、篮球、长曲棍球、棒球、垒球和冰球。这些活动将为每位运动员带来特定运动项目的挑战，同时实现RTP进展各阶段的目标。最终的RTP判定应由经过脑震荡评估和管理培训的持牌医疗保健提供者出具书面医疗许可后进行。
讨论/与临床实践的关系：在脑震荡运动员的管理和护理方面已经取得了重大进展。然而，运动员、家长和教练在脑震荡运动员的正确管理方面仍然存在很多困惑，尤其是在儿科人群中。为了消除歧义并进一步促进对RTP指南的遵守，作者制定了几项特定运动项目的RTP指南。
5级。
