Neuroperiodization After Sport-Related Concussion: A Perspective on Adaptive Load Prescription Within the Amsterdam Return-to-Sport Strategy

Vollständiger Abstract

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Background/Objectives: Contemporary sport-related concussion management has shifted from prolonged rest toward early, symptom-limited activity and a staged return-to-sport strategy. The Amsterdam framework provides an essential safety hierarchy but does not fully operationalize how clinicians should manipulate exercise dose, task complexity, recovery, and interacting rehabilitation domains within each stage. This Perspective proposes neuroperiodization as a constrained, criterion-based load-prescription framework nested within the Amsterdam strategy. Framework Development: The framework distinguishes prescribed external load from internal response, including symptom change and duration, heart rate, rating of perceived exertion, task quality, confidence, and delayed recovery. Clinical decision-making is organized through a repeated cycle of assessment, prescription, monitoring, adaptation, and reassessment. Proposed Framework: Neuroperiodization supports the concurrent but controlled development of aerobic, cervical, vestibular–ocular, neuromotor, cognitive–motor, and sport-specific capacities. Progression remains subordinate to medical clearance, clinical findings, symptom response, and sport-specific risk. Conclusions: Neuroperiodization should be regarded as a conceptual clinical framework rather than a validated rehabilitation protocol or an alternative return-to-sport clearance pathway. It integrates Amsterdam consensus recommendations, evidence-informed extrapolations, and author-proposed elements and requires population-specific adaptation and prospective evaluation.