Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

Collins, Michael W. PhD; Kontos, Anthony P. PhD; Okonkwo, David O. MD, PhD; Almquist, Jon ATC, VATL, ITAT; Bailes, Julian MD; Barisa, Mark PhD; Bazarian, Jeffrey MD, MPH; Bloom, O. Josh MD, MPH; Brody, David L. MD, PhD; Cantu, Robert MD; Cardenas, Javier MD; Clugston, Jay MD; Cohen, Randall DPT, ATC; Echemendia, Ruben PhD; Elbin, R.J. PhD; Ellenbogen, Richard MD; Fonseca, Janna ATC; Gioia, Gerard PhD; Guskiewicz, Kevin PhD, ATC; Heyer, Robert MD; Hotz, Gillian PhD; Iverson, Grant L. PhD; Jordan, Barry MD, MPH; Manley, Geoffrey MD; Maroon, Joseph MD; McAllister, Thomas MD; McCrea, Michael PhD; Mucha, Anne DPT; Pieroth, Elizabeth PsyD; Podell, Kenneth PhD; Pombo, Matthew MD; Shetty, Teena MD; Sills, Allen MD; Solomon, Gary PhD; Thomas, Danny G. MD, MPH; Valovich McLeod, Tamara C. PhD; ATC, FNATA; Yates, Tony MD; Zafonte, Ross DO

doi: 10.1227/NEU.0000000000001447
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BACKGROUND: Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment.

OBJECTIVE: To describe the current landscape of treatment for concussion and to provide summary agreements related to treatment to assist clinicians in the treatment of concussion.

METHODS: On October 14 to 16, 2015, the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion meeting was convened in Pittsburgh, Pennsylvania. Thirty-seven concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device.

RESULTS: A total of 16 statements of agreement were supported covering (1) Summary of the Current Approach to Treating Concussion, (2) Heterogeneity and Evolving Clinical Profiles of Concussion, (3) TEAM Approach to Concussion Treatment: Specific Strategies, and (4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97% to 100%.

CONCLUSION: Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies on the basis of modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery after concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments.

ABBREVIATIONS: ARS, audience response system

CDC, Centers for Disease Control and Prevention

DoD, Department of Defense

mTBI, mild traumatic brain injury

NCAA, National Collegiate Athletic Association

NFL, National Football League

NIH, National Institutes of Health

RCT, randomized controlled trial

RTP, return to play

SRC, sport- and recreation-related concussion

TBI, traumatic brain injury

TEAM, Targeted Evaluation and Active Management

*Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program,

Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania;

§Fairfax Family Practice Comprehensive Concussion Center, Fairfax, Virginia;

Department of Neurosurgery, NorthShore University Health System, Chicago, Illinois;

Baylor Institute for Rehabilitation, Frisco, Texas;

#Department of Emergency Medicine, University of Rochester, Rochester, New York;

**Carolina Sports Concussion Clinic, Cary, North Carolina;

‡‡Department of Neurology, Washington University, St. Louis, Missouri;

§§Dr. Robert C. Cantu Concussion Center, Emerson Hospital, Boston University, Concord, Massachusetts;

¶¶Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona;

‖‖Community Health and Family Medicine, University of Florida, Gainesville, Florida;

##Athletics Department, University of Arizona, Tucson, Arizona;

***Psychological and Neurobehavioral Associates, State College, Pennsylvania;

‡‡‡Office for Sports Concussion Research, University of Arkansas, Fayetteville, Arkansas;

§§§Department of Neurological Surgery University of Washington, Seattle, Washington;

¶¶¶Division of Neuropsychology, Children's National Health System, Washington, District of Columbia;

‖‖‖College of Arts and Sciences, University of North Carolina, Chapel Hill, North Carolina;

###Carolinas Medical Center, Charlotte, North Carolina;

****Neuroscience Center, University of Miami Miller School of Medicine, Miami, Florida;

‡‡‡‡Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts;

§§§§Neurorehabilitation, Burke Rehabilitation & Research, White Plains, New York;

¶¶¶¶Department of Neurological Surgery, University of California at San Francisco, San Francisco, California;

‖‖‖‖Department of Psychiatry, Indiana University, Bloomington, Indiana;

####Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin;

*****University of Pittsburgh Medical Center Centers for Rehabilitation Services, Pittsburgh, Pennsylvania;

‡‡‡‡‡Neurological Institute, NorthShore University Health System, Chicago, Illinois;

§§§§§Houston Methodist Concussion Center, Houston Methodist Hospital, Houston, Texas;

¶¶¶¶¶Department of Orthopedics, Emory University Healthcare, Atlanta, Georgia;

‖‖‖‖‖Department of Neurology, Hospital for Special Surgery, Weill Cornell Medical College, New York City, New York;

#####Department of Neurosurgery, Vanderbilt University, Vanderbilt Sports Concussion Center, Nashville, Tennessee;

******Pediatric Emergency Medicine, Children's Hospital of Wisconsin, Wauwatosa, Wisconsin;

‡‡‡‡‡‡Department of Athletic Training, A.T. Still University, Kirksville, Missouri;

§§§§§§Pittsburgh Steelers, Pittsburgh, Pennsylvania

Correspondence: Michael W. Collins, PhD, UPMC Rooney Sports Complex, 3200 S Water St, Pittsburgh, PA 15203. E-mail:

Received December 11, 2015

Accepted July 08, 2016

Copyright © by the Congress of Neurological Surgeons