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Tracey Covassin, Kyle M. Petit, and Morgan Anderson

/symptoms, prevalence), concussion education and awareness, concussion assessment and management, concussion recovery and return to play, concussion treatment, and future research and recommendations for youth sport stakeholders. We also address sex and developmental considerations throughout this review. In reviewing

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Gregory A. Cranmer and Sara LaBelle

Despite advancements in concussion treatment and management, health and sports professionals largely depend on athletes’ self-reporting of symptoms to begin the process of diagnosis. With this in mind, recent scholarly attention has focused on understanding the barriers and processes of athletes’ self-disclosure of symptoms. The current study applied the disclosure decision-making model to understand high school football players’ disclosure decisions after experiencing symptoms of a concussion. Data obtained from 184 high school football players from across the United States demonstrated 2 significant paths by which players’ disclosures of concussion symptoms during a game can be understood. First, the perceived severity of these symptoms predicted athletes’ self-efficacy to disclose concussions, which subsequently predicted their intentions to disclose concussion symptoms during a game. Second, the felt stigma around disclosing concussion symptoms predicted athletes’ anticipated responses from coaches to such disclosures, which subsequently predicted their intentions to disclose concussion symptoms during a game. Furthermore, the effect of perceived stigma on the anticipated responses from coaches was moderated by the quality of athletes’ relationships with their coaches. These results highlight the importance of convincing athletes to take concussion symptoms seriously and the role of athlete–coach relationships in combatting stigma around concussion disclosures. These findings suggest that scholars and practitioners should acknowledge the social contexts surrounding disclosure of concussion symptom and shift educational efforts to focus on the dangers of concussions and the process by which athletes should report potential symptoms.

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Landon Lempke, Abbis Jaffri, and Nicholas Erdman

Clinical Scenario: Currently, rest following concussion serves as the keystone of concussion treatment, but substantial evidence to support it is lacking. Recent literature suggests that early physical activity may be beneficial in reducing concussion symptoms which may influence clinical recovery time. Clinical Question: Does early physical activity decrease postconcussion symptoms compared to physical rest following concussion? Summary of Key Findings: A total of 5 articles were included that examined symptom duration changes at multiple time points. All 5 studies utilized follow-up time points compared to initial examination, but there was variance in the specific time points reported. Two studies employed control groups and compared strict or recommended rest to early activity or limited rest. Three studies were observational studies that directly compared baseline measurements to follow-up assessments. Clinical Bottom Line: Current evidence suggests that early physical activity in the acute phase following a concussion may decrease the time needed for symptom resolution compared to immediate rest. Strength of Recommendation: Using Centre for Evidence-Based Medicine 2011 level 3 evidence and higher, the results suggest that early physical activity during the acute phase of a concussion may decrease symptom duration; however, a lack of high-quality studies and inconsistent interventions are limitations to this recommendation.

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Patricia R. Roby, Robert C. Lynall, Michael J. Cools, Stephen W. Marshall, Janna C. Fonseca, James R. Stevens, and Jason P. Mihalik

Key Points ▸ Consensus statements have recently moved away from strict rest following concussion. ▸ Treatments aimed at reducing initial symptom burden may reduce recovery times. ▸ Hyperbaric oxygen therapy may be an effective treatment in high school athletes. Student-athletes typically experience

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Reid Skeel, Anissa Maffett, Abigail Feder, Cayla Mitzkovitz, and Sofia Lesica

to months, 2 recent studies have found that earlier presentation for concussion treatment in a specialty clinic setting lowers the risk of extended recovery time. 3 , 4 Consequently, the diagnosis, assessment, and management of concussion—particularly sports-related concussion—has received

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Natalie S. Sherry, Abigail Feder, Raymond Pan, Shawn R. Eagle, and Anthony P. Kontos

always clear, especially in chronic cases, but utilizing a biopsychosocial model of care allows us to address all potential contributing factors versus reducing a symptom to a single cause. Individualized Concussion Care Our approach to concussion treatment also functions within the conceptual framework

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Barbara Baker, Eric Koch, Kevin Vicari, and Kyle Walenta

these limitations may be attributed to the changing guidelines for concussion treatment during the postacute phase in recent years. Suggestions for Future Research Considering the shifting guidelines for concussion treatment and the limited number of studies that met the inclusion criteria of this

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Richelle M. Williams, R. Curtis Bay, and Tamara C. Valovich McLeod

need to re-evaluate patients’ symptoms regularly and use this information to drive concussion treatment decisions while using active interventions, academic accommodations, and referrals when necessary. Clinicians should be aware that patients may present with symptoms upward to 3 weeks postinjury and

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Steven Nagib and Shelley W. Linens

continue to explore the correlation between VRT, DHI, and gait. If VRT can normalize disrupted gait and improved gait is correlated with improved DHI scores, then VRT will be further validated and popularized as a form of concussion treatment. There are many variables and confounding factors further

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Carlie K. Elmer and Tamara C. Valovich McLeod

, when used as a treatment technique for reducing concussive symptoms in the child and adolescent population, is more effective than the usual care. Implications for Practice, Education, and Future Research Cognitive behavioral therapy is one approach to concussion treatment that can reduce persisting