Weiler Richard, Blauwet Cheri, Clarke David, Dalton Kristine, Derman Wayne, Fagher Kristina, Gouttebarge Vincent, Kissick James, Lee Kenneth, Lexell Jan, Van de Vliet Peter, Verhagen Evert, Webborn Nick, Ahmed Osman Hassan
Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands.
Sport & Exercise Medicine, Fortius Clinic, London, UK.
Br J Sports Med. 2021 Nov;55(21):1187-1195. doi: 10.1136/bjsports-2020-103696. Epub 2021 Apr 9.
Concussion is a frequent injury in many sports and is also common in para athletes. However, there is a paucity of concussion research related to para sport, and prior International Concussion in Sport (CIS) consensus papers have not substantively addressed this population. To remedy this and to improve concussion care provided to para athletes, the concussion in para sport (CIPS) multidisciplinary expert group was created. This group analysed and discussed in-depth para athlete-specific issues within the established key clinical domains of the current (2017) consensus statement on CIS. Due to the onset of the COVID-19 pandemic, the group held all meetings by video conferencing. The existing Sport Concussion Assessment Tool 5 (SCAT5) for the immediate on-field and office-based off-field assessment of concussion was evaluated as part of this process, to identify any para athlete-specific concerns. Regular preparticipation and periodic health examinations are essential to determine a baseline reference point for concussion symptoms but pose additional challenges for the interpreting clinician. Further considerations for concussion management for the para athlete are required within the remove, rest, reconsider and refer consensus statement framework. Considering return to sport (RTS), the 2017 CIS consensus statement has limitations when considering the RTS of the para athlete. Case-by-case decision making related to RTS following concussion is imperative for para athletes. Additional challenges exist for the evaluation and management of concussion in para athletes. There is a need for greater understanding of existing knowledge gaps and attitudes towards concussion among athlete medical staff, coaches and para athletes. Future research should investigate the use and performance of common assessment tools in the para athlete population to better guide their clinical application and inform potential modifications. Concussion prevention strategies and sport-specific rule changes, such as in Para Alpine Skiing and Cerebral Palsy Football, also should be carefully considered to reduce the occurrence of concussion in para athletes.
脑震荡在许多体育运动中都是常见损伤，在残疾运动员中也很普遍。然而，与残疾运动相关的脑震荡研究较少，之前的国际运动脑震荡（CIS）共识文件并未实质性涉及这一人群。为弥补这一不足并改善为残疾运动员提供的脑震荡护理，成立了残疾运动脑震荡（CIPS）多学科专家组。该小组在当前（2017年）CIS共识声明既定的关键临床领域内，深入分析和讨论了残疾运动员特有的问题。由于新冠疫情的爆发，该小组通过视频会议召开了所有会议。作为这一过程的一部分，对现有的用于脑震荡现场即时和场下办公室评估的运动脑震荡评估工具5（SCAT5）进行了评估，以确定任何与残疾运动员相关的问题。定期的赛前和定期健康检查对于确定脑震荡症状的基线参考点至关重要，但对解读的临床医生提出了额外挑战。在“移除、休息、重新评估和转诊”共识声明框架内，需要对残疾运动员的脑震荡管理进行进一步考虑。考虑到重返运动（RTS），2017年CIS共识声明在考虑残疾运动员的RTS时存在局限性。对于残疾运动员来说，脑震荡后逐案做出与RTS相关的决策至关重要。残疾运动员脑震荡的评估和管理还存在其他挑战。需要更好地了解运动员医务人员、教练和残疾运动员对现有知识差距和脑震荡的态度。未来的研究应调查常用评估工具在残疾运动员群体中的使用和性能，以更好地指导其临床应用并为潜在的改进提供依据。还应仔细考虑脑震荡预防策略和特定运动规则的改变，如在残奥高山滑雪和脑瘫足球中，以减少残疾运动员脑震荡的发生。
