Abstract
The previous articles in this compendium reviewed the past, present, and future status
of the diagnosis, prognosis, treatment, and prevention of mild traumatic brain injury
in the adult population. This article will discuss the issue of when an individual
should initiate the return-to-play (or class or work) protocol. The clinical criterion
to initiate the return-to-play protocol consists of neuropsychological performance
that returns to baseline and is stable, with no reported symptoms. Recent functional
magnetic resonance imaging (fMRI) studies raise serious questions about these clinical
criteria. fMRI results in individuals with concussion are different from those of
normal controls. Does this difference represent cortical reorganization and/or cortical
dysfunction? If the imaging results reflect neuroplastic reorganization, then the
initiation of the return-to-play protocol is acceptable. However, if the imaging differences
indicate cortical dysfunction, then initiation of the return-to-play protocol would
not be advised. This article will describe the problem, the data available to address
this problem, and future research needs.
Keywords
Return to play - fMRI - biomarker - neuropsychological test
