Concussion Management Involves More than Returning to the Playing Field

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Pennsylvania Athletic Trainers’ Society member Jack Foley, LAT, ATC has spearheaded efforts at Lehigh University to assist student-athletes with sport-related concussions from an academic standpoint. These guidelines are intended to increase awareness by educating university administrators and professors how cognitive management following a concussion translates into academic management for student-athletes.

Jack Foley, LAT, ATC

We have learned that physical rest alone fails to address another key component of brain function in young or college age athletes.
Jack Foley, LAT, ATC

Despite a growing body of evidence-based research over the past decade regarding the management of sport-related concussions, the question often raised by many healthcare professionals in the clinical field pertains to return to participation procedures. Science has continued to evolve and multiple evaluation tools are now available, yet return to participation decisions remain largely in the realm of clinical judgment. Therefore, protocols for returning athletes to activity following a concussion can vary from setting to setting.

Regardless of the return to participation process used by Athletic Trainers, one frequently neglected aspect of concussion management is cognitive rest. “We have learned that physical rest alone fails to address another key component of brain function in young or college age athletes,” states Lehigh University Director of Sports Medicine, Jack Foley, LAT, ATC. “This includes mental exertion associated with academic activities.”

“Cognitive activities such as watching television, listening to music, using the computer, text messaging, playing video games, concentrating in the classroom, and completing academic assignments can place additional neurometabolic demand on the brain because they all require mental exertion. So our first therapeutic goal must be to limit concentration, learning, and memorization to a level which is tolerable and does not exacerbate the re-emergence of systems.”

Although the concept of cognitive rest has been utilized by the Sports Medicine staff at Lehigh University for years, it was not until the recently a formal academic support protocol was adopted at the Bethlehem, Pennsylvania campus. Following a presentation he gave to the Patriot League Council of Presidents and Athletic Directors last December entitled “Concussion Management Plan: The Role of the Athletic Trainer”, Jack Foley was formally asked to establish Best Practice Guidelines for Cognitive Rest for students - athlete or not – to be utilized by each league institution. After much discussion and research, the idea was later expanded to include a second educational guide pertaining to Concussion Implications for the Classroom.

“The process of compiling this information took the better part of six weeks to get all parties on board and in agreement as to the content,” shares Foley. “Once completed, the documents written by [Assistant Athletic Trainer] Emily Dunn and myself were reviewed by the Associate Dean of Students, the Assistant Dean of Student for Academic Support Services, the Dean of Athletics, and the University legal counsel offices prior to implementing them at Lehigh. They are also presently on file in the Patriot League office for distribution as requested by the Council of Presidents.”

The process of addressing cognitive rest for student-athletes with a concussion requires synchronized communication between the Athletic Trainer and those responsible for providing academic support services. “These two documents have helped to streamline communication between athletics, academic support, and faculty through the use of consistent information,” indicates Katherine Lavinder, Associate Dean of Student at Lehigh University. “Through the development of this protocol, our response to academic concerns stemming from concussions has become more timely, appropriate, and generally beneficial to students."

Cheryl Ashcroft, Assistant Dean of Students for Academic Support Services, adds, "The protocol for student athletes with concussions has been a valuable tool for our office. Providing the symptoms in writing and a clear model on the concussion management process has given us the guidelines to assist our student-athletes. It is a highly cooperative process that is working well."

While significant progress has been made since the turn of the century, there is still much to be learned. “Concussion management is driven by science,” states Foley. “We are at the end of the beginning rather than the beginning of the end regarding of our understanding of sport-related concussion. Yet we should feel better prepared in what we can control within our concussion management plan, namely cognitive rest.”

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For more information regarding this topic or to schedule an interview with PATS President Yvette Ingram, PhD, LAT, ATC, please contact Tim Doane, MA, LAT, ATC at

The Pennsylvania Athletic Trainers' Society, Inc. is a progressive organization of licensed health care professionals who work under the direction of a licensed physician. Our society continues to increase public awareness and education regarding Athletic Trainers and the Athletic Training profession while serving as the premier source of information for public safety, injury and illness prevention, early intervention, patient care, and healthcare delivery for the physically active in the Commonwealth.

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Tim Doane, MA, LAT, ATC
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