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Updated: Jul 3, 2026
A Neuroscientific Approach to the Examination of Concussions in Student-Athletes
Published on: December 8, 2014
Evolution of Multifaceted Sport-Related Concussion Management: A 25-Year Narrative Review of Multidomain Assessment
James Stavitz1, Kenneth Swan2, Adam Eckart3
1Department of Athletic Training Education, College of Health Professions and Human Services, Kean University, 1000 Morris Avenue, Union, NJ 07083, USA.
Context:
Sport-related concussion (SRC) management has evolved substantially over the past 25 years. Early paradigms emphasized prolonged physical and cognitive rest; however, growing evidence has demonstrated that recovery following SRC is multidimensional and influenced by interacting neurological, vestibular, autonomic, cervical, cognitive, and psychological systems. Consequently, contemporary clinical practice has shifted toward active, multifaceted rehabilitation approaches.
Objective:
We aimed to synthesize and contextualize the evidence supporting a multifaceted approach to sport-related concussion management from 2000 through 2025, with emphasis on implications for athletic training practice.
Data Sources:
A structured literature search was conducted using PubMed, SPORTDiscus, CINAHL, and Web of Science to identify peer-reviewed publications related to SRC evaluation, management, and rehabilitation.
Study Selection:
Studies published between 1 January 2000, and 31 December 2025 involving human participants with sport-related concussion or sport-like mechanisms of mild traumatic brain injury were included. Evidence from randomized controlled trials, cohort studies, systematic and narrative reviews, and major consensus or position statements was considered.
Data Extraction:
Relevant studies were reviewed and synthesized across key domains of SRC management, including aerobic exercise, vestibular and oculomotor rehabilitation, cervical spine management, multimodal and profile-based rehabilitation, return-to-learn strategies, psychological and behavioral health considerations, and implementation patterns within athletic training settings.
Results:
A total of 182 publications contributed evidence to one or more components of multifaceted SRC management. Across domains, evidence supports early, symptom-limited aerobic exercise; targeted vestibular and cervical rehabilitation; structured return-to-learn planning; and the integration of psychological support. Multimodal rehabilitation and profile-based clinical categorization approaches were associated with shorter recovery timelines and improved functional outcomes compared with rest-only strategies. Despite strong evidence, implementation variability persists across athletic training settings.
Conclusions:
Evidence accumulated over the past 25 years supports a shift toward active, individualized, and multidisciplinary approaches to SRC management. Athletic trainers are uniquely positioned to coordinate multifaceted care addressing the diverse contributors to concussion recovery.
