Because of the lack of valid evidence to support the current recommendations for the management of mild traumatic brain injury (concussion), many physicians, athletic trainers, coaches, and athletes have called into question the way concussions are treated in athletics. This review article discusses the current evidence for the management of concussion in high school, college, and professional sports. A complete review of the epidemiologic and neuropsychological studies to date is presented and critically reviewed, as are other assessment and management tools in concussion. The appropriate use of neuropsychological testing, grading scales, and return-to-play recommendations are discussed in depth based on the current evidence. Additionally, areas requiring further research are identified and future trends are briefly discussed.

This review article presents evidence from the current literature on the epidemiology and pathophysiology of concussion. The recent epidemiologic data for a variety of sports are presented relevant to the general population, and professional, college, and high school athletics. The evidence for the pathophysiology of head injury is presented using a mixture of current animal and human studies. A brief discussion on the benefits and limitations of the evidence is offered for the both the epidemiology and pathophysiology of concussion, and how it relates to current treatment options.

A comparison is made between abbreviated formal neuropsychologic testing programs and computerized neuropsychologic programs such as ImPACT, Headminders, CogSport, and others. Issues of time, cost, need for supervision, liability, and validation are discussed. Specific time and monetary costs per athlete are calculated for each program. The estimated cost is between $22 and $27 per athlete for abbreviated formal testing and between $669 and $677 per athlete for computerized testing. Because of the significant time and monetary costs of neuro-psychologic testing, its lack of validation in deter-mining recovery, limited validation and utility in diagnosing concussion, and its numerous logistic concerns, its widespread use is probably not justified until appropriate data are published and costs contained. Recommendations for alternative evaluation techniques are suggested.

in his poem, To my honoured kinsmen, writes: "The wise for a cure on exercise depend". This is good advice that the NHS is only just beginning to take seriously.Current policy has rightly focused its attention on improving services to treat the big killers: coronary heart disease, stroke, and cancer. The challenge to reduce premature mortality from these diseases is huge-for example, the National Service Framework on Coronary Heart Disease, 1 published earlier this year, has created a blueprint both for improving quality of services (from prevention to palliative care), and for improving access to these services across the country.In the drive to modernise the NHS more emphasis is being placed on the important role that prevention and early intervention can play. Many are aware of the risk to health from smoking, but far fewer realise that the relative risk from physical inactivity is of a similar order. People who are physically inactive carry twice the risk of coronary heart disease and three times the risk of stroke as their more active counterparts. 2If it is to bring continued health benefits, physical activity needs to be embedded in the daily lives of many more people. Six out of ten men and seven out of ten women in England, between the ages of 16-74, are not physically active enough to benefit their health. 3 The recently published National Diet and Nutrition Survey of 4-18 year olds has shown that children are becoming less active. 4 About 40% of boys and 60% of girls spent, on average, less than an hour a day in activities of at least moderate intensity and therefore failed to meet our recommendation for young people's participation in physical activity. 5Moreover, participation in physical activity-such as, sports and walking, is strongly related to household income. However, this association between socioeconomic group and physical activity is partly oVset by the higher levels of occupational activity in manual social classes. As a result, approximately 50% of men in social classes IV and V do not meet current recommendations in levels of physical activity, compared to two thirds of men in classes I and II.Overall, the picture for women is worse. In social classes IV and V, nearly 80% of women fail to achieve the recommended level of physical activity. Although activity levels in class I are not significantly diVerent, levels for social classes II and non-manual III are slightly higher.Physical activity must be one of the most undervalued interventions to improve public health.