How to Make Safe Return-to-Play Decisions After Concussion: 5 Quick Wins for Clinicians
Quick Win #1: Track Symptoms Digitally for Immediate Insight
Why it matters: Symptom progression is the strongest predictor of safe RTP (McCrory et al., 2017).
Use the digital SCAT6 to log symptoms at every encounter.
Track trends in headache, dizziness, and fatigue scores over time.
Automated scoring reduces human error and flags subtle changes clinicians might miss (Patricios et al., 2022).
Action: Start every concussion consult by having the athlete complete the digital SCAT6 symptom checklist.
Quick Win #2: Cognitive Screening for Hidden Deficits
Why it matters: Athletes may pass basic tests but still have lingering cognitive impairments.
SCAT6 includes immediate and delayed recall, digits backward, and months-in-reverse tests.
Identify deficits early and delay RTP until cognition is back to baseline.
Keep digital records to support clinical decisions and medico-legal documentation.
Action: Make cognitive testing part of every stage of RTP — not just the initial assessment.
Quick Win #3: Balance and Vestibular Testing
Why it matters: Postural instability predicts slower recovery and higher re-injury risk.
Use tandem gait, BESS, and modified balance tests from SCAT6.
Integrate objective balance scores with symptom data to make informed decisions.
Tip: Digital timers and error counters make scoring faster and more reliable.
Action: Combine balance testing with symptom tracking for a 3D view of recovery.
Quick Win #4: Implement a Stepwise RTP Protocol
Evidence-based progression prevents setbacks (McCrory et al., 2017).
Stage 1: Symptom-limited daily activity
Stage 2: Light aerobic exercise
Stage 3: Sport-specific drills
Stage 4: Non-contact training
Stage 5: Full-contact practice
Stage 6: Return to competition
Only progress if SCAT6 scores remain stable or improve.
Document each stage digitally for accuracy and risk management.
Action: Use SCAT6 at every RTP stage to prevent premature clearance.
Quick Win #5: Integrate SCAT6 with Holistic Clinical Assessment
SCAT6 is a tool, not a diagnosis. Combine it with:
Full patient history & injury mechanism
Neurological and vestibular exams
Age-appropriate considerations (pediatrics vs. adult athletes)
Ongoing symptom monitoring & patient education
Pro Tip: Pair SCAT6 digital tracking with educational handouts for athletes — compliance improves recovery outcomes.
Why Clinicians Should Go Digital
Faster assessments: Automated scoring saves minutes per patient.
Longitudinal tracking: Visual graphs help monitor trends and justify RTP decisions.
Team communication: Share results securely with allied health or sports staff.
Take your SCAT6 skills further
References
Echemendia, R. J., Meeuwisse, W., McCrory, P., Davis, G. A., Putukian, M., Leddy, J. J., ... & Sills, A. (2017). The Sport Concussion Assessment Tool 5th Edition (SCAT5): Background and rationale. British Journal of Sports Medicine, 51(11), 848–850.
McCrory, P., Meeuwisse, W., Dvořák, J., Aubry, M., Bailes, J., Broglio, S., ... & Vos, P. E. (2017). Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838–847.
Patricios, J., Ardern, C. L., Hislop, M. D., Makdissi, M., & Schneider, K. J. (2022). Implementing digital concussion assessment tools in clinical practice: A systematic review. Journal of Neurotrauma, 39(1), 12–22.
