CCSP - Certified Chiropractic Sports Physician Concussion Evaluation and Management Questions and Answers — Questions and Answers
Question 1: A 16-year-old soccer player is removed from a match after a head-to-head collision. On the sideline, she reports a headache and dizziness but denies loss of consciousness. Which of the following is the most appropriate immediate action for a Certified Chiropractic Sports Physician (CCSP) to take?
- Perform a cervical spine adjustment to alleviate potential cervicogenic headache.
- Administer the Sport Concussion Assessment Tool 6 (SCAT6) and determine return-to-play status based on the score.
- Instruct the athlete to rest and monitor symptoms, with the possibility of returning to play if symptoms resolve within 15-20 minutes.
- Remove the athlete from play for the remainder of the day and advise a follow-up evaluation, regardless of symptom duration. (Correct answer)
Correct answer: Remove the athlete from play for the remainder of the day and advise a follow-up evaluation, regardless of symptom duration.
The consensus from the 6th International Conference on Concussion in Sport is that any athlete suspected of having a concussion must be immediately removed from play and should not be allowed to return on the same day. The CCSP's primary responsibility is to ensure athlete safety. While a SCAT6 is a crucial evaluation tool, the immediate decision is removal from play. Cervical evaluation and treatment may be necessary later, but it is not the first priority, and same-day return to play is contraindicated.
Question 2: Which of the following is a key feature of the graded return-to-play (RTP) protocol following a sport-related concussion?
- Each stage of the protocol must last a minimum of 48 hours.
- The athlete can progress to the next stage if they remain 80% symptom-free.
- The protocol begins with light aerobic exercise to assess symptom provocation.
- The athlete must remain symptom-free at the current stage before advancing to the next, with each stage typically taking at least 24 hours. (Correct answer)
Correct answer: The athlete must remain symptom-free at the current stage before advancing to the next, with each stage typically taking at least 24 hours.
The standard graduated RTP protocol involves a stepwise progression where the athlete must be completely symptom-free at the current level of activity before progressing. Each step should take a minimum of 24 hours. If any symptoms recur during a stage, the athlete should drop back to the previous asymptomatic stage and attempt to progress again after another 24-hour period of rest.
Question 3: A CCSP is managing a patient with persistent post-concussion syndrome (PCS) three months after the initial injury. The patient's primary complaints are chronic headaches, dizziness, and neck pain. Which chiropractic intervention is most directly supported by evidence for managing these specific symptoms?
- High-velocity, low-amplitude (HVLA) adjustments to the thoracic spine.
- Application of therapeutic ultrasound to the suboccipital muscles.
- Manual therapy and low-force adjustments directed at the upper cervical spine. (Correct answer)
- A generalized full-spine mobilization protocol combined with electrical stimulation.
Correct answer: Manual therapy and low-force adjustments directed at the upper cervical spine.
Research suggests a strong correlation between upper cervical spine dysfunction and common post-concussion symptoms like cervicogenic headaches and dizziness. Gentle manual therapy, mobilization, or low-force adjustments to the craniocervical junction can help restore proper mechanics, reduce nerve irritation, and alleviate these specific PCS symptoms.
Question 4: The Sport Concussion Assessment Tool 6 (SCAT6) is a standardized tool for evaluating athletes with a suspected concussion. According to its guidelines, the SCAT6 is most effective when used within what timeframe post-injury?
- Within the first 10 minutes of the injury.
- Within the first hour of the injury.
- Within 72 hours and up to 7 days post-injury. (Correct answer)
- Anytime during the athlete's recovery period.
Correct answer: Within 72 hours and up to 7 days post-injury.
The SCAT6 is designed for use by healthcare professionals in the acute and subacute phases of injury. It is intended to be used ideally within 72 hours (3 days) and up to 7 days following the injury. For assessments conducted more than 7 days post-injury, the Sport Concussion Office Assessment Tool (SCOAT6) is recommended.
Question 5: A 19-year-old collegiate football player, who sustained a concussion 10 days ago, is in Stage 4 of the graduated return-to-play protocol. Which activity is appropriate for him at this stage?
- Full-contact practice with the team.
- Light jogging and stationary cycling for 30 minutes.
- Sport-specific, non-contact training drills (e.g., running plays without opposition). (Correct answer)
- Symptom-limited daily activities and complete cognitive rest.
Correct answer: Sport-specific, non-contact training drills (e.g., running plays without opposition).
The typical graduated return-to-play protocol consists of stages. Stage 1 is symptom-limited activity. Stage 2 is light aerobic exercise. Stage 3 involves sport-specific exercise. Stage 4, the stage in question, involves non-contact training drills. This allows the athlete to return to more complex and cognitively demanding sport-specific movements before being cleared for contact.
Question 6: Which of the following is a primary role of the CCSP within a multidisciplinary team managing a concussed athlete?
- Prescribing medications for headache and sleep disturbances.
- Making the sole and final decision on return-to-play without consulting other providers.
- Exclusively focusing on cognitive rehabilitation and neuropsychological testing.
- Assessing and managing associated neuromusculoskeletal injuries, particularly of the cervical spine, and collaborating on the return-to-play plan. (Correct answer)
Correct answer: Assessing and managing associated neuromusculoskeletal injuries, particularly of the cervical spine, and collaborating on the return-to-play plan.
A CCSP's expertise lies in the neuromusculoskeletal system. In concussion management, they play a crucial role in evaluating and treating associated injuries, especially whiplash and cervical spine dysfunction, which are common sources of post-concussion symptoms. They are integral members of a collaborative team and contribute to the overall management and return-to-play decision-making process alongside physicians, athletic trainers, and other specialists.
CCSP - Certified Chiropractic Sports Physician Concussion Evaluation and Management Questions and Answers
A 16-year-old soccer player is removed from a match after a head-to-head collision.
On the sideline, she reports a headache and dizziness but denies loss of consciousness.
Which of the following is the most appropriate immediate action for a Certified Chiropractic Sports Physician (CCSP) to take?