Research papers that support the present guideline recommendations:
Abbassi, E., & Sirmon-Taylor, B. (2017). Recovery progression and symptom resolution in sport-related mild traumatic brain injury. Brain Injury, 31(12), 1667–1673. https://doi.org/10.1080/02699052.2017.1357834
Babcock, L., Kurowski, B. G., Zhang, N., Dexheimer, J. W., Dyas, J., & Wade, S. L. (2017). Adolescents with Mild Traumatic Brain Injury Get SMART: An Analysis of a Novel Web-Based Intervention. Telemedicine and E-Health, 23(7), 600–607. https://doi.org/10.1089/tmj.2016.0215
Babikian, T., McArthur, D., & Asarnow, R. F. (2013). Predictors of 1-month and 1-year neurocognitive functioning from the UCLA longitudinal mild, uncomplicated, pediatric traumatic brain injury study. Journal of the International Neuropsychological Society, 19(2), 145–154. https://doi.org/10.1017/S135561771200104X
Bellerose, J., Bernier, A., Beaudoin, C., Gravel, J., & Beauchamp, M. H. (2017). Long-term brain-injury-specific effects following preschool mild TBI: A study of theory of mind. Neuropsychology, 31(3), 229–241. https://doi.org/10.1037/neu0000341
Brooks, B. L., Mrazik, M., Barlow, K. M., McKay, C. D., Meeuwisse, W. H., & Emery, C. A. (2014). Absence of differences between male and female adolescents with prior sport concussion. Journal of Head Trauma Rehabilitation, 29(3), 257–264. https://doi.org/10.1097/HTR.0000000000000016
Brown, N. J., Mannix, R. C., O’Brien, M. J., Gostine, D., Collins, M. W., & Meehan, W. P. (2014). Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms. Pediatrics, 133(2), e299–e304. https://doi.org/10.1542/peds.2013-2125
Chrisman, S. P. D., Whitlock, K. B., Somers, E., Burton, M. S., Herring, S. A., Rowhani-Rahbar, A., & Rivara, F. P. (2017). Pilot study of the Sub-Symptom Threshold Exercise Program (SSTEP) for persistent concussion symptoms in youth. NeuroRehabilitation, 40(4), 493–499. https://doi.org/10.3233/NRE-161436
Cordingley, D., Girardin, R., Reimer, K., Ritchie, L., Leiter, J., Russell, K., & Ellis, M. J. (2016). Graded aerobic treadmill testing in pediatric sports-related concussion: safety, clinical use, and patient outcomes. Journal of Neurosurgery: Pediatrics, 18(6), 693–702. https://doi.org/10.3171/2016.5.PEDS16139
Corwin, D. J., Zonfrillo, M. R., Master, C. L., Arbogast, K. B., Grady, M. F., Robinson, R. L., … Wiebe, D. J. (2014). Characteristics of Prolonged Concussion Recovery in a Pediatric Subspecialty Referral Population. The Journal of Pediatrics, 165(6), 1207–1215. https://doi.org/10.1016/j.jpeds.2014.08.034
Covassin, T., Elbin, R. J., Bleecker, A., Lipchik, A., & Kontos, A. P. (2013). Are there differences in neurocognitive function and symptoms between male and female soccer players after concussions? American Journal of Sports Medicine, 41(12), 2890–2895. https://doi.org/10.1177/0363546513509962
Covassin, T., Elbin, R., & Crutcher, B. (2013). The Relationship Between Coping, Neurocognitive Performance, and Concussion Symptoms in High School and Collegiate Athletes. The Sport Psychologist, 27(4), 372–379. https://doi.org/10.1123/tsp.27.4.372
Crowe, L. M., Anderson, V., Barton, S., Babl, F. E., & Catroppa, C. (2014). Verbal ability and language outcome following traumatic brain injury in early childhood. Journal of Head Trauma Rehabilitation, 29(3), 217–223. https://doi.org/10.1097/HTR.0b013e31829babfd
Darling, S. R., Leddy, J. J., Baker, J. G., Williams, A. J., Surace, A., Miecznikowski, J. C., & Willer, B. (2014). Evaluation of the Zurich Guidelines and exercise testing for return to play in adolescents following concussion. Clin J Sport Med, 24(2), 128–133. https://doi.org/10.1097/JSM.0000000000000026
Darling, S. R., Leddy, J. J., Baker, J. G., Williams, A. J., Surace, A., Miecznikowski, J. C., & Willer, B. (2014). Evaluation of the zurich guidelines and exercise testing for return to play in adolescents following concussion. Clinical Journal of Sport Medicine, 24(2), 128–133. https://doi.org/10.1097/JSM.0000000000000026
De Matteo, C., Greenspoon, D., Levac, D., Harper, J. A., & Rubinoff, M. (2014). Evaluating the Nintendo Wii for assessing return to activity readiness in youth with mild traumatic brain injury. Physical and Occupational Therapy in Pediatrics, 34(3), 229–244. https://doi.org/10.3109/01942638.2014.885103
De Matteo, C., Volterman, K. A., Breithaupt, P. G., Claridge, E. A., Adamich, J., & Timmons, B. W. (2015). Exertion testing in youth with mild traumatic brain injury/concussion. Medicine and Science in Sports and Exercise, 47(11), 2283–2290. https://doi.org/10.1249/MSS.0000000000000682
DeMatteo, C. A., Randall, S., Lin, C. Y. A., & Claridge, E. A. (2019). What comes first: Return to school or return to activity for youth after concussion? Maybe we don’t have to choose. Frontiers in Neurology, 10(JUL), 1–9. https://doi.org/10.3389/fneur.2019.00792
Dobney, D. M., Grilli, L., Kocilowicz, H., Beaulieu, C., Straub, M., Friedman, D., & Gagnon, I. (2017). Evaluation of an active rehabilitation program for concussion management in children and adolescents. Brain Injury, 31(13–14), 1753–1759. https://doi.org/10.1080/02699052.2017.1346294
Dobney, D. M., Grilli, L., Kocilowicz, H., Beaulieu, C., Straub, M., Friedman, D., & Gagnon, I. J. (2018). Is There an Optimal Time to Initiate an Active Rehabilitation Protocol for Concussion Management in Children? A Case Series. Journal of Head Trauma Rehabilitation, 33(3), E11–E17. https://doi.org/10.1097/HTR.0000000000000339
Gabbe, B. J., Brooks, C., Demmler, J. C., Macey, S., Hyatt, M. A., & Lyons, R. A. (2014). The association between hospitalisation for childhood head injury and academic performance: Evidence from a population e-cohort study. Journal of Epidemiology and Community Health, 68(5), 466–470. https://doi.org/10.1136/jech-2013-203427
Gagnon, I., Grilli, L., Friedman, D., & Iverson, G. L. (2016). A pilot study of active rehabilitation for adolescents who are slow to recover from sport-related concussion. Scandinavian Journal of Medicine and Science in Sports, 26(3), 299–306. https://doi.org/10.1111/sms.12441
Gibson, S., Nigrovic, L. E., O’Brien, M., & Meehan, W. P. (2013). The effect of recommending cognitive rest on recovery from sport-related concussion. Brain Injury, 27(7–8), 839–842. https://doi.org/10.3109/02699052.2013.775494
Grabowski, P., Wilson, J., Walker, A., Enz, D., & Wang, S. (2017). Multimodal impairment-based physical therapy for the treatment of patients with post-concussion syndrome: A retrospective analysis on safety and feasibility. Physical Therapy in Sport, 23, 22–30. https://doi.org/10.1016/j.ptsp.2016.06.001
Green, S. L., Keightley, M. L., Lobaugh, N. J., Dawson, D. R., & Mihailidis, A. (2018). Changes in working memory performance in youth following concussion. Brain Injury, 32(2), 182–190. https://doi.org/10.1080/02699052.2017.1358396
Grool, A. M., Aglipay, M., Momoli, F., Meehan, W. P., Freedman, S. B., Yeates, K. O., … Zemek, R. (2016). Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. Jama, 316(23), 2504. https://doi.org/10.1001/jama.2016.17396
Guo, X., Edmed, S. L., & Anderson, V. (2017). Neurocognitive predictors of posttraumatic stress disorder symptoms in children 6 months after traumatic brain injury: A prospective study. Neuropsychology, 31(1), 84–92. https://doi.org/http://dx.doi.org/10.1037/neu0000305
Heyworth, B. E., Carroll, K. M., Rizza, A. J., McInnis, K. C., & Gill, T. J. (2014). Treatment of Concussion in High School Athletes: A Proposed Protocol for Athletic and Academic Return to Activity. Orthopaedic Journal of Sports Medicine, 2(7), 2015. https://doi.org/10.1177/2325967114S00079
Howell, D. R., Mannix, R. C., Quinn, B., Taylor, J. A., Tan, C. O., & Meehan, W. P. (2015). Physical Activity Level and Symptom Duration Are Not Associated after Concussion. American Journal of Sports Medicine, 44(4), 1040–1046. https://doi.org/10.1177/0363546515625045
Howell, D., Osternig, L., Van Donkelaar, P., Mayr, U., & Chou, L. S. (2013). Effects of concussion on attention and executive function in adolescents. Medicine and Science in Sports and Exercise, 45(6), 1030–1037. https://doi.org/10.1249/MSS.0b013e3182814595
Kaldoja, M.-L., & Kolk, A. (2015). Does Gender Matter? Differences in Social-Emotional Behavior Among Infants and Toddlers Before and After Mild Traumatic Brain Injury. Journal of Child Neurology, 30(7), 860–867. https://doi.org/10.1177/0883073814544705
Konigs, M., Heij, H. A., van der Sluijs, J. A., Vermeulen, R. J., Goslings, J. C., Luitse, J. S. K., … Oosterlaan, J. (2015). Pediatric Traumatic Brain Injury and Attention Deficit. Pediatrics, 136(3), 534–541. https://doi.org/10.1542/peds.2015-0437
Kurowski, B. G., Hugentobler, J., Quatman-Yates, C., Taylor, J., Gubanich, P. J., Altaye, M., & Wade, S. L. (2017). Aerobic exercise for adolescents with prolonged symptoms after mild traumatic brain injury: An exploratory randomized clinical trial. Journal of Head Trauma Rehabilitation, 32(2), 79–89. https://doi.org/10.1097/HTR.0000000000000238
Lax, I. D., Paniccia, M., Agnihotri, S., Reed, N., Garmaise, E., Azadbakhsh, M., … Keightley, M. (2015). Developmental and gender influences on executive function following concussion in youth hockey players. Brain Injury, 29(12), 1409–1419. https://doi.org/10.3109/02699052.2015.1043344
Manikas, V., Babl, F. E., Hearps, S., Dooley, J., & Anderson, V. (2017). Impact of Exercise on Clinical Symptom Report and Neurocognition after Concussion in Children and Adolescents. Journal of Neurotrauma, 34(11), 1932–1938. https://doi.org/10.1089/neu.2016.4762
McGrath, N., Dinn, W. M., Collins, M. W., Lovell, M. R., Elbin, R. J., & Kontos, A. P. (2013). Post-exertion neurocognitive test failure among student-athletes following concussion. Brain Injury, 27(1), 103–113. https://doi.org/10.3109/02699052.2012.729282
Moser, R. S., Schatz, P., Glenn, M., Kollias, K. E., & Iverson, G. L. (2015). Examining prescribed rest as treatment for adolescents who are slow to recover from concussion. Brain Injury, 29(1), 58–63. https://doi.org/10.3109/02699052.2014.964771
O’Brien, M. J., Howell, D. R., Pepin, M. J., & Meehan, W. P. (2017). Sport-related concussions: Symptom recurrence after return to exercise. Orthopaedic Journal of Sports Medicine, 5(10), 1–6. https://doi.org/10.1177/2325967117732516
Purcell, L. K., Davis, G. A., & Gioia, G. A. (2019). What factors must be considered in “return to school” following concussion and what strategies or accommodations should be followed? A systematic review. British Journal of Sports Medicine, 53(4), 5–18. https://doi.org/10.1136/bjsports-2017-097853
Ransom, D. M., Burns, A. R., Youngstrom, E. A., Vaughan, C. G., Sady, M. D., & Gioia, G. A. (2016). Applying an Evidence-Based Assessment Model to Identify Students at Risk for Perceived Academic Problems following Concussion. Journal of the International Neuropsychological Society, 22(10), 1038–1049. https://doi.org/10.1017/S1355617716000916
Ransom, D. M., Vaughan, C. G., Pratson, L., Sady, M. D., McGill, C. A., & Gioia, G. A. (2015). Academic Effects of Concussion in Children and Adolescents. Pediatrics, 135(6), 1043–1050. https://doi.org/10.1542/peds.2014-3434
Russell, K., Hutchison, M. G., Selci, E., Leiter, J., Chateau, D., & Ellis, M. J. (2016). Academic outcomes in high-school students after a concussion: A retrospective population-based analysis. PLoS ONE, 11(10), 1–12. https://doi.org/10.1371/journal.pone.0165116
Russell, K., Selci, E., Black, B., Cochrane, K., & Ellis, M. (2019). Academic outcomes following adolescent sport-related concussion or fracture injury: A prospective cohort study. PLoS ONE, 14(4), 1–14. https://doi.org/10.1371/journal.pone.0215900
Ryan, N. P., Catroppa, C., Beare, R., Coleman, L., Ditchfield, M., Crossley, L., … Anderson, V. A. (2015). Predictors of longitudinal outcome and recovery of pragmatic language and its relation to externalizing behaviour after pediatric traumatic brain injury. Brain and Language, 142, 86–95. https://doi.org/10.1016/j.bandl.2015.01.007
Sarmiento, K., Donnell, Z., Bell, E., & Hoffman, R. (2019). From the CDC: A qualitative study of middle and high school professionals’ experiences and views on concussion: Identifying opportunities to support the return to school process. Journal of Safety Research, 68, 223–229. https://doi.org/10.1016/j.jsr.2018.10.010
Shendell, D. G., Gonzalez, L., Listwan, T. A., Pancella, J., Blackborow, M., & Boyd, J. (2019). Developing and Piloting a School-Based Online Adolescent Student-Athlete Concussion Surveillance System. Journal of School Health, 89(7), 527–535. https://doi.org/10.1111/josh.12775
Silverberg, N. D., Iverson, G. L., McCrea, M., Apps, J. N., Hammeke, T. A., & Thomas, D. G. (2016). Activity-related symptom exacerbations after pediatric concussion. JAMA Pediatrics, 170(10), 946–953. https://doi.org/10.1001/jamapediatrics.2016.1187
Stockbridge, M. D., Doran, A., King, K., & Newman, R. S. (2018). The effects of concussion on rapid picture naming in children. Brain Injury, 32(4), 506–514. https://doi.org/10.1080/02699052.2018.1429660
Sufrinko, A. M., Kontos, A. P., Apps, J. N., McCrea, M., Hickey, R. W., Collins, M. W., & Thomas, D. G. (2017). The Effectiveness of Prescribed Rest Depends on Initial Presentation After Concussion. Journal of Pediatrics, 185, 167–172. https://doi.org/10.1016/j.jpeds.2017.02.072
Teel, E. F., Marshall, S. W., Shankar, V., McCrea, M., & Guskiewicz, K. M. (2017). Predicting Recovery Patterns After Sport-Related Concussion. Journal of Athletic Training, 52(3), 288–298. https://doi.org/10.4085/1062-6050-52.1.12
Thomas, D. G., Apps, J. N., Hoffmann, R. G., McCrea, M., & Hammeke, T. (2015). Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial. Pediatrics, 135(2), 213–223. https://doi.org/10.1542/peds.2014-0966
Van Beek, L., Ghesquière, P., Lagae, L., & De Smedt, B. (2015). Mathematical Difficulties and White Matter Abnormalities in Subacute Pediatric Mild Traumatic Brain Injury. Journal of Neurotrauma, 32(20), 1567–1578. https://doi.org/10.1089/neu.2014.3809
Van Beek, L., Vanderauwera, J., Ghesquière, P., Lagae, L., & De Smedt, B. (2015). Longitudinal changes in mathematical abilities and white matter following paediatric mild traumatic brain injury. Brain Injury, 29(13–14), 1701–1710. https://doi.org/10.3109/02699052.2015.1075172
Wasserman, E. B., Bazarian, J. J., Mapstone, M., Block, R., & Van Wijngaarden, E. (2016). Academic dysfunction after a concussion among US high school and college students. American Journal of Public Health, 106(7), 1247–1253. https://doi.org/10.2105/AJPH.2016.303154
Research papers not associated with a current recommendation:
Rozbacher, A., Selci, E., Leiter, J., Ellis, M., & Russell, K. (2017). The Effect of Concussion or Mild Traumatic Brain Injury on School Grades, National Examination Scores, and School Attendance: A Systematic Review. Journal of Neurotrauma, 34(14), 2195–2203. https://doi.org/10.1089/neu.2016.4765
Last update: November 16, 2019