We are proud that our own Richard Weiler, Vincent Gouttebarge and Evert Verhagen contributed to this position statement that provides guidance to concussion assessment and management for para-athletes. Published recently in the BJSM.
In brief where we are now
Injury surveillance data from the most recent summer and winter Paralympic Games demonstrates high rates of injuries to the head and face.
Despite a paucity of research, the concussion issues faced
by para-athletes and their support staff are of concern and therefore specific recommendations for standards of care are needed.Clinical tools assessing brain function are widely acknowledged to be helpful tools following concussion, but these are neither validated nor applicable in many respects within a para-sport population.
In brief the take-home messages
Medical professionals should continue to use Sports Concussion Assessment Tool 5 (SCAT5) for ‘on’ and ‘off’ field concussion assessment for para-athletes and the Concussion in Para Sport appendices can serve as a guide to interpret these results.
Para athletes may have a concussion even if their SCAT5 is deemed to be ‘normal’. Consequently, SCAT5 should not be used by itself to diagnose concussions in para-athletes.
Given the challenges of diagnosing concussion in para-athletes, periodic baseline pre-participation evaluations are essential as a point of reference.
Concussion in para-sport expert group
A 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 improve concussion care provided to para-athletes, the concussion in para-sport (CIPS) multidisciplinary expert group was formed. 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. The existing Sports 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.
Periodic health examinations
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.
Return to sport
Considering the 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
Additional challenges exist for the evaluation and management of concussions in para-athletes. There is a need for a 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.
The full paper can be found here (open access)
Richard Weiler, Cheri Blauwet, David Clarke, Kristine Dalton, Wayne Derman, Kristina Fagher, Vincent Gouttebarge, James Kissick, Kenneth Lee, Jan Lexell, Peter van de Vliet, Evert Verhagen, Nick Webborn, Osman Hassan Ahmed. Concussion in para-sport: the first position statement of the Concussion in Para Sport (CIPS) Group. British Journal of Sports Medicine Published Online First: 09 April 2021. doi: 10.1136/bjsports-2020-103696