1. Vanderbilt Orthopaedic Institute Step-wise Return to Sports Participation Following Concussion JUSTIN WENZEL TRACY CAMPBELL SHANNON GORDON

2. Vanderbilt Orthopaedic Institute Research

3. Vanderbilt Orthopaedic Institute Protocol Guidelines Cognitive rest is an essential component of the recovery process and academic accommodations may be necessary Protocol is based on a step-wise exertional progression that is dependent upon the SA remaining asymptomatic upon completion of each phase ImPACT utilized for baseline and follow-up

4. Vanderbilt Orthopaedic Institute Phase 0 Cognitive Exertion – Student-athletes with symptoms following class will be held from academic requirements until asymptomatic 24 hours – Academic arrangements and documentation will be provided for academic advisors and/or professors – Progression to next phase is dependent on the SA remaining asymptomatic

5. Vanderbilt Orthopaedic Institute Phase 1 Aerobic Exertion – Functional exertion test Bike 20 minutes @ 70 percent of PMHR Rest 15 minutes Monitor symptoms Incremental Treadmill Test 20 minutes (Leddy et al 2010) – Progression to next phase is dependent on the SA remaining asymptomatic

6. Vanderbilt Orthopaedic Institute Phase 2 Functional Exertion – Monitor symptoms – Initial Functional Exertion Scissor step/quick step Jog Lateral shuffle Backpedal Sprints – Advanced Functional Exertion Sit-ups Burpees Push-ups Sprints Sprints w/intermittent push-ups

7. Vanderbilt Orthopaedic Institute Phase 3 Sport Specific Exertion – Parameters Duration approximately 10-15 minutes w/5 minutes rest following session Monitor symptoms Progression depends on the student-athlete remaining asymptomatic – Initial Moderate aerobic exercises specific to sport – Intermediate Progressively difficult exercises specific to sport – Advanced Demanding aerobic exercises specific to sport

8. Vanderbilt Orthopaedic Institute RTP Sport Progression Examples

9. Vanderbilt Orthopaedic Institute RTP Sport Progression Examples

10. Vanderbilt Orthopaedic Institute RTP Sport Progression Examples

11. Vanderbilt Orthopaedic Institute Phase 4 Limited Practice/Non-contact – Monitor Symptoms – Non-contact training drills dependent upon sport – Progression to next phase is dependent on the SA remaining asymptomatic – Consultation w/ team physician for full clearance

12. Vanderbilt Orthopaedic Institute Phase 5 Return to Full Practice Participation with Contact – PCSS – Continue to monitor for recurrent symptoms – Full practice participation without restriction – Completion of Phase 5 without symptoms would result in release to full contact participation without restriction

13. Vanderbilt Orthopaedic Institute RTP Guidelines Recap Symptom monitoring at each phase is critical Progression requires student athlete to be asymptomatic A step-wise progression ensures the safest return to activity Symptom exacerbation during a phase will require rest, reassessment and a repeat of that phase

14. Vanderbilt Orthopaedic Institute Questions? Thank you to all the athletic trainers and physicians that have contributed