How do we know when a player is fully recovered? : A systematic review about return to play

Abstract: Athletes participating in ice hockey are at a high risk of experiencing a concussion which can lead to impairments in cognitive functions. Deciding when a player can be returned to playing ice hockey is part of the concussion management called return to play (RTP). This can bebased on subjective or objective measures. Returning a concussed hockey player too soon can result in devastating consequences. This review aimed to investigate what objective measure could be used to assess a concussed player. It specifically focused on Immediate Post Concussion Assessment and Cognitive Test (ImPACT) and a cognitive motor integration (CMI) performance task. It was hypothesized that by combining the two could contribute to an optimal objective assessment and be used as accurate indicators in the RTP decision. This review involved searches from PubMed, Scopus and Web of Science which resulted in a total of four articles. The amount of articles was a big limitation. Main findings are that concussed participants showed decreased cognitive performance relative to baseline despite subjectively reporting being symptom free. Findings in this review suggest that adding a CMI performance task to the ImPACT test battery could be a way to objectively catch several composites incognitive recovery including tasks that require higher levels of cognitive functioning. Administering an assessment based on two objective measures could add accuracy and contribute to a safe RTP not risking a second impact syndrome or prolonged cognitive impairments.