Concussion Management: Early Activity, Return-to-Play Decisions, and Multimodal Assessment

Upon completion of this activity, participants will be able to:

1. Evaluate suspected sport-related concussion using the Amsterdam 2022 definition, time-appropriate multimodal assessment tools, and red-flag criteria within the learner's professional role and authorized scope.

2. Integrate early symptom-limited activity strategies into concussion care, including 24 to 48 hours of relative rest, sub-symptom-threshold aerobic exercise, and appropriately performed heart-rate-threshold testing.

3. Formulate role-appropriate return-to-learn and return-to-sport plans consistent with the Amsterdam graduated strategy, current CDC guidance, and applicable authorization requirements.

4. Design individualized management plans for persisting symptoms that incorporate targeted rehabilitation, interdisciplinary referral, and counseling about recurrent injury and long-term uncertainty.

Concussion care has changed direction. Rest until symptoms clear, the standard advice for two decades, has given way to a brief period of relative rest followed by early activity within a symptom limit, assessment across several domains rather than a single test, and a staged return to learning and to sport that a healthcare provider authorizes.

Most patients are seen off the sideline, in primary care, emergency departments, pediatrics, neurology, physical medicine and rehabilitation, and occupational medicine, which places the decisions that shape recovery with clinicians who may not have encountered the updated guidance. The content is built on the Amsterdam 2022 international consensus statement, the Sport Concussion Assessment Tool 6 (SCAT6) family, and the CDC return-to-sports guidance updated in September 2025, together with the evidence behind each.

Prolonged rest continues to be recommended in some settings, acute sideline tools are sometimes applied in the office days after injury, and clearance decisions are sometimes based on symptom report alone. A United Kingdom scoping review found that roughly one in five general practitioners advised immediate return to play once a patient was asymptomatic, using no return-to-play protocol at all. The gap is not awareness that concussion matters. It is knowing what current guidance directs, which assessment findings carry weight and which do not, how to prescribe activity rather than withhold it, and who holds the authority to authorize return.

Scope and Audience Note: This course is designed for physicians (MD and DO), physician assistants, and APRNs who assess and manage concussion, and for RNs who support recognition, monitoring, patient education, and care coordination. Independent diagnosis, imaging decisions, exercise prescription, rehabilitation referral, and return-to-sport clearance must be performed only by professionals authorized under applicable law, licensure, and organizational policy (American Nurses Association, n.d.; National Council of State Boards of Nursing, 2021, n.d.).