Clinical Scenario: Recent systematic reviews have shown that extended rest may not be beneficial to patients following concussion. Furthermore, recent evidence has shown that patient with postconcussion syndrome benefit from an active rehabilitation program. There is currently a gap between the ability to draw conclusions to the use of aerobic exercise during the early stages of recovery along with the safety of these programs. Clinical Question: Following a concussion, does early controlled aerobic exercise, compared with either usual care or delayed exercise, improve recovery as defined by symptom duration and severity? Summary of Key Findings: After a thorough literature search, 5 studies relevant to the clinical question were selected. Of the 5 studies, 1 study was a randomized control trial, 2 studies were pilot randomized controlled trials, and 2 studies were retrospective. All 5 studies showed that implementing controlled aerobic exercise did not have an adverse effect on recovery. One study showed early aerobic exercise had a quicker return to school, and another showed a 2-day decrease in symptom duration. Clinical Bottom Line: There is sufficient evidence to suggest that early controlled aerobic exercise is safe following a concussion. Although early aerobic exercise may not always result in a decrease in symptom intensity and duration, it may help to improve the psychological state resulting from the social isolation of missing practices and school along with the cessation of exercise. Although treatments continue to be a major area of research following concussion, management should still consist of an interdisciplinary approach to individualized patient care. Strength of Recommendation: There is grade B evidence to support early controlled aerobic exercise may reduce the duration of symptoms following recovery while having little to no adverse events.

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Focused Clinical Question: In a high school, college, and professional athletic population, does individualized baseline tests increase the diagnostic accuracy (e.g., sensitivity and specificity) of identifying cognitive impairments when utilizing neurocognitive testing compared to normative data? Clinical Bottom Line: There was insufficient evidence to definitively suggest the use of individualized baseline data over the use of normative data during a postinjury assessment.

ObjectiveTo compare head kinematics measurements obtained from 6 different head impact sensors utilizing different methods of sensor-to-head fixation. DesignFree-drop impacts (total n = 54) were performed at 3.5 and 5.5 m/s onto to the front, back, side, and top of 2 elderly human cadaveric head-neck specimens: a helmeted (Riddell Revolution Speed) male specimen was dropped onto a NOCSAE testing pad; an un-helmeted female specimen was dropped onto a framed sample of field turf. The specimens were instrumented with an intracranial reference sensor surgically mounted at the approximate head center-of-mass by a rigidly-fixed custom standoff pad, an intra-oral test sensor rigidly fixed to the upper teeth/hard palate by a custom orthodontic appliance, and 4 commercially available head impact sensing systems: X-Patch, Vector mouth guard, HITS (helmeted condition only), and G-Force Tracker (affixed to helmet interior or head band depending on helmet status). Peak linear and rotational head accelerations (PLA and PRA) were compared between each sensor and the intracranial reference sensor using intraclass correlation coefficients (ICC [2, 1]). ResultsAgreement with reference PLA and PRA values differed between sensors, with the greatest agreement observed for the rigidly affixed intraoral sensor (ICC = 0.921, PLA; ICC = 0.810, PRA). Agreement for PLA and PRA, respectively, was: for X-Patch, ICC = 0.638, ICC = 0.155; for Vector mouth guard, ICC = 0.775, ICC = 0.480; for HITS, ICC = 0.662 (PLA only); for G-Force Tracker, ICC = 0.364 (PLA only).