Returning to Sports and Recreational Activities

Since sports and other recreational activities are typi­cally an integral part of the childhood lifestyle, return to the community for children often involves planning for return to these activities.

For the child who has sustained a TBI, counsel­ing the family on the safety of returning them to play­ing sports is challenging. This is partly due to a lack of evidence or guidelines in the rehabilitation litera­ture. In recent years, better guidelines have become available for the management of return to play within sports after a child sustains a concussion during sporting activities (see the section on concussion), but these recommendations do not necessarily translate to appropriate recommendations in the child who sus­tains a TBI unrelated to sport activities. For instance, the grading of non-sports traumatic brain injuries as mild, moderate, and severe is a different rating scale than grading the sports-related concussion as mild, moderate, or severe.

For the child who was injured with a moderate to severe brain injury, the guidelines remain unclear. It is known that in certain sports, such as high school foot­ball, approximately 20% of players incur a concussion each year, though other “collision” sports can result in concussions as well, including boxing, and ice hockey (228). Furthermore, sports such as basketball and soc­cer may result in an inadvertent concussion if players come into contact with each other, though with less force than one would expect in the collision sports. Other high-risk sports, including downhill skiing, snowboarding, and gymnastics, can be as dangerous as contact or collision sports from potential resulting blows to the body (229). For these reasons, it is chal­lenging as a rehabilitation clinician to allow a patient who sustained a TBI to return to these activities. It is known that cognitive impairments will follow multi­ple mild concussions. Mildly concussed athletes dem­onstrate a decline in memory compared with their baseline performance (230), and athletes with a his­tory of multiple concussions score significantly lower on memory testing (60). In the individual with a recent TBI, risking subsequent brain injury or concussion and worsening their clinical outcome is not recommended. Furthermore, the patient may sustain other traumatic injuries in attempting to return to sports as a result of poor performance due to impaired speed, response time, and information processing (30).