Recommendations for diagnosis and therapy of concussion in sports

The Swiss Neurological Society (Schweizerische Neurologische Gesellschaft) has published recommendations for the diagnosis and therapy of sport-related concussions, written by Dr. Nina Feddermann-Demont, and PD Dr. Antonella Palla and leading neurologists of Switzerland.


The diagnosis and treatment of sport-related concussion has changed substantially in recent years. Nevertheless, the affected athletes are often insufficiently diagnosed and not treated – or receive only the recommendation of physical rest. This article provides an overview of diagnostic and therapeutic recommendations for neurologists. The recommendations are based on the latest scientific findings on head injuries, concussions in sports and mild traumatic brain injury. International and national guidelines of the British National Institute for Health and Care, the American Academy of Neurology, the American Medical Society for Sports Medicine, the Concussion in Sport Group and sports associations served as base for the Swiss recommendations.


Feddermann-Demont N, Palla A, Ettlin T, Johannes S, Tettenborn T, Taranutzer AA, Wiest D, Sandor PS, Jung HH, Müller A, Straumann D. Diagnostik und Behandlungsindikation bei Gehirnerschütterung im Sport. Swiss Med Forum. 2020;20(00): Epub adead of print; doi:10.4414/smf.2020.08563.


The publication can be downloaded free of charge from the following link.


Development of the first mobile positioning chair

The first mobile positional chair was developed in close cooperation with the Interdisciplinary Centre for Vertigo and Neurological Visual Disorders (ONO Center) of the University of Zurich and the University Hospital of Zurich and the Prolim Engineering Office (Rotundum). This is primarily used for the diagnosis and therapy of benign paroxysmal positional vertigo (BPPV), which is often observed after head trauma in addition to concussion. The core symptom is a short-term position- or motion-dependent vertigo.

Scientific questions concerning dizziness can also be dealt with.


The SCC is being published in Sportphysio 03/2017

At the invitation of Thieme Verlag, several SCC team members have published two publications in the August 2017 edition of Sportphysio, a journal for sports physiotherapists.

The first article (Brain Surgery in Sports) provides an up-to-date overview of diagnostics and therapy for athletes after concussion (based on last year’s consensus conference in Berlin). The second article (Vestibular and Oculomotor Therapy after Concussion) illustrates an example of individually adapted rehabilitation in the case of a professional ice hockey player with persistent symptoms following a concussion.

The SCC team consists of:
Dr. med. N. Feddermann-Demont, Prof. Dr. phil. A. Junge,
Dr. Phil. M. Bizzini, C. Meier, PT, K. Mani, MSc and A. Ventura, MSc.

Here you can go directly to the 03/2017 edition of Sportphysio.

The SCC at the „The Future of Football Medicine“

The „Football Medicine Strategies Conference“ took place in Barcelona between the 13th and 15th May.

This annual conference has been organized by the Italian Isokinetic Medical Group und FC Barcelona, which hosted the event at the legendary Camp Nou. With more than 2’500 participants from 91 countries, it represents the largest football medicine conference worldwide. A detailed report of the conference is also available on the website of the FC Barcelona.
Prof Jiří Dvořák and Dr. Mario Bizzini, both from the Swiss Concussion Center, were among the invited speakers, with lectures and workshops on concussion in football, sports physiotherapy rehabilitation and prevention of injuries.

Introduction of the Swiss Concussion Centre

On 2 March 2017, the first SCC training course for physicians, physiotherapists and those interested in medicine took place under the theme “Introduction of the Swiss Concussion Centre (SCC)”. The training course was divided into two parts. In the first part, short lectures were held on the SCC as well as on diagnostics and therapy for concussion. The second part consisted of a guided tour of the SCC facilities (SCC tour) followed by a presentation of the devices for vestibular and oculomotor testing (diagnostics) and of the options for therapy and rehabilitation. Subsequently, there was the opportunity for discussion with the physicians and therapists of the SCC.

Swiss Concussion Center at the Zurich BrainFair for the first time

Since 2002, the University Hospital, the University of Zurich and the Swiss Federal Institute of Technology (ETH) have been presenting the latest research results and developments in the field of neurosciences to the public every year at the week-long BrainFair. Laboratories and clinics also open the doors in addition to lectures, exhibitions and discussion forums. This year, the Schulthess Clinic participated for the first time as a cooperation partner of the Swiss Concussion Center (SCC) in this unique event, which attracts up to 4,000 people. Although the SCC was founded less than two years ago, with the focus on diagnostics, treatment and research in sports-associated brain concussion, it was already represented at the BrainFair with two contributions.

Under the key question, “Is concussion harmless?” Dr Nina Feddermann-Demont gave information on the latest diagnostics and adequate treatment methods after concussion in sports in her lecture. The subsequent exchange between doctors, researchers and visitors not only demonstrated the great interest in the topic, but also that further studies are essential for the clarification of certain questions, such as the long-term effects of concussion on brain functions and structures.

On Saturday, the SCC was open to the public and some areas of diagnostics and therapy were demonstrated at the premises. The visitors could see for themselves how well their vestibular organ, oculomotor system and balance were functioning. The therapy methods, which are otherwise available exclusively to our athletes, could also be tried out as part of an SCC tour. Visitors were shown the process from the accident, followed by diagnosis and the therapy, to the step-wise return-to-sport by means of specific patient examples. Visitors were informed about the latest research results with poster presentations.

The Schulthess Clinic and the SCC are pleased to present the new focus on patient care and research at this prestigious event via the invitation, the great interest of the public and a great deal of positive feedback from the participants.

Do head injuries in football have long-term consequences?

Repeated head injuries of football players are associated with long-term neurocognitive impairments and abnormal changes in brain structure. Whether these observations are “genuine” is discussed. To improve our understanding of persisting effects of football on brain structures and functions, a systematic review of the existing literature was required.

For this reason, under the leadership of PD Dr. Alexander Tarnutzer, we conducted a systematic literature review and analysed the quality of the studies and summarised information about neurocognitive changes, cerebral imaging, and EEG. A total of 30 studies with 1691 players were included. The 57% (8 of 14) of the case control studies reporting long-term neurocognitive impairments had a higher risk for non-adequate control of type 1 errors (OR = 17.35 [95% CI = 10.61-28.36]) and for inappropriate selection of controls (OR = 1.72 [1.22-2.43]). In the studies that found a link between header frequency and neurocognitive impairment (6/17), quality was significantly lower in the detection of the frequency of headers played (OR = 14.20 [9.01-22.39]). In 7 of 13 studies (54%), the number of head injuries correlated with the degree of neurocognitive impairment. Significant findings in various cerebral imaging techniques (6 of 8 studies) were involved in 3 of 4 studies concerning sub-clinical neurocognitive deficits.

Overall, the analysis led to the conclusion that due to methodological weaknesses, the evidence for persisting effects of football on brain structures and functions is low. Causes of distortions (bias) included the low quality in the survey of the frequency of headers played, the inadequate control of type 1 errors and the inappropriate selection of controls. The evidence for a correlation between the frequency of headers and neurocognitive deficits was weak and distorted by an inaccurate recording of header frequency. The combination of cerebral imaging and neurocognitive testing in prospective combined longitudinal and cross-sectional studies in women’s and men’s football appears essential to further clarify whether there is a link between football and changes in brain structures and functions.

The abstract of the study can be found under this link.

First Concussion Workshop at the SCC in cooperation with the ETH, the Schulthess Clinic, the USZ and the UZH

On 9 December 2016, the first “Concussion Workshop” entitle “What we still do not know about concussion” took place. Scientists and experts with different research areas from ETH, USZ, UZH, SCC and KWS were invited to participate; 46 specialists attended the workshop. After the first clinically oriented part dealing with concussion, five research questions on concussions (biomarkers, prognostic factors, therapeutic options, baseline tests and long-term effects) were discussed in a second part with the goal of developing joint solution strategies. This workshop served as a “kick off” for further interdisciplinary science projects about concussions, and as a motivation for the formation of project groups for further workshops.

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People @ Swiss Concussion Center: Urs Scheifele – Physicist, Research Assistant

In a loose series of short video interviews, we present the people who work at the Swiss Concussion Center and contribute daily to enable athletes to make a safe “return to sport” after concussions.

What is your job at the Swiss Concussion Center?

My primary job here is to assess athletes who have come to us having suffered a concussion or are suffering from balance disorders. I have here two rooms with very complex equipment for this purpose, with many technical devices, with which we carry out the tests. I am also responsible for the technical support of these devices and their further development. I also write other programs. Finally, we want a better understanding of the data and to continue to develop the devices.

What are your goals at the Swiss Concussion Center?

My goal, of course, is to provide the perfect service for the athletes who come to us. Also, to help the physicians to better understand the (collected, editor’s note) data. A part is also research. The more athletes we look after, the better we understand what the measurements tell us and the better the therapy can become. And if I can help with that, I am really happy.

What is your motivation to contribute to the Swiss Concussion Center?

What motivates me here is, of course, the joy of working with the technical equipment, the measuring. For a physicist, this is quite typical. Also, to look after the athletes, to be there for the athletes and then to give this data, which we obtain using these devices, to the physicians and help them to understand the data so that they then are able develop a good therapy from it.


The SCC at the 5th International Consensus Conference on Concussion in Sports in Berlin

From 27th-29th October 2016, the 5th International Consensus Conference on Concussion in Sport took place in Berlin. The conference, which has been held every four years since 2001, is supported by the International Sports Federations, including the International Olympic Committee, and was organized in 2016 by the International Ice Hockey Federation (IIHF). The aim of the conference was to summarise current evidence-based facts as a basis for the development of a consensus concerning “Concussion in Sport”, a document to be used by physicians and other medical staff in dealing with injured athletes, independent of performance level.

In the run-up to the conference, 12 systematic “review papers” were drafted by the members of the scientific committee, including Dr. Nina Feddermann and Prof. Jiri Dvorak; nearly 60,000 publications were analysed and 750 of them were integrated into the process.

“Diagnosis is the key” was the main conclusion of the conference. The diagnosis should be based on the results of clinical neurological and neuropsychological examination, supplemented by examinations of the balance system, eye movements, and the cervical spine. This interdisciplinary approach to diagnosis is the basis for the treatment and return to routine training and competition (“return to play”) and also for children to return to school.

Representatives of the Swiss Concussion Center (alphabetically): Dr. Mario Bizzini, Dr. Christopher Bockisch PD, Prof. Jiri Dvorak (co-founder of the Concussion in Sports Group, member of the Organization and Scientific Committee), Dr. Nina Feddermann (member of the Scientific Committee), Prof. Astrid Junge, Dr. Yann Le Clec`h, Karin Mani, Cornelia Meier, Dr. Alexander Tarnutzer, and Dr. Yulia Valko.

The results of the 12 review papers will be published in May 2017 together with the consensus statement in the British Journal of Sports Medicine. 


The SCC team in Berlin



The Scientific Committee