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of concussions while raising awareness of the severity of the problem. "Now that the summit is over, the real work begins," said Dr. Michael Stuart, USA Hockey's chief medical officer and one of the organizers of the summit. "We need to take this message to all the groups within hockey because each of us is a stakeholder in the safety of our game." The number of reported concussions is on the rise, particularly in youth sports. But according to Lovell and other neurologists who are on the front lines, it's not because there are more concussions but rather the methods of diagnosing and responding to the early warning signs have dramatically improved over the years. No longer do coaches chuckle when they talk about their players "having their bell rung" or "seeing stars" after a big hit. As important as reversing those trends has been, it's equally important to follow established return-to-play guidelines, which start with coaches recognizing the signs and symptoms and keeping players off the ice until they are eventually cleared to play by a physician. The course of treatment depends on the patient's age, concussion history, symptoms, signs and type of sport. It is recommended that all concussed athletes be cleared for return to play only after consulting with a physician. And each case is different. One player may be cleared to play in a week while another is forced to deal with symptoms throughout the season or even longer. "One of the fundamental principles that we all need to understand is that concussion management and return-to-play guidelines are individualized. There is no cookbook approach," said Stuart, who has two sons currently playing pro hockey. "What I tell players, parents and coaches is that return to play after a concussion varies from one week to never. That's because a symptomatic athlete can never return to play." That can be a tough pill to swallow for an athlete in the prime of his or her life. But missing the rest of a game or the rest of the season is a small price to pay compared to the long-term effects of a second concussion. For doctors who have spent their lives dealing with concussions, the time has come to change the mindset that standing on the sidelines is somehow a sign of weakness, or that players are somehow letting their teammates and coaches down as they convalesce. SIGNS AND SYMPTOMS OF CONCUSSIONS SIGNS • Appears dazed or stunned • Is confused about assignment or position • Forgets an instruction • Is unsure of game, score or opponent • Moves clumsily • Answers questions slowly • Loses consciousness (even briefly) • Shows mood, behavior or personality changes • Can't recall events prior to the hit or fall • Can't recall events after hit or fall SYMPTOMS • Headache or 'pressure' in head • Nausea or vomiting • Balance problems or dizziness • Double or blurry vision • Sensitivity to light • Sensitivity to noise • Feeling sluggish, hazy, foggy or groggy • Concentration or memory problems • Confusion • Just not 'feeling right' or is 'feeling down' - Taken from the Centers For Disease Control Concussion Website THIS ARTICLE WAS ORIGINALLY PUBLISHED IN THE DECEMBER 2010 ISSUE OF USA HOCKEY MAGAZINE USAHOCKEYMAGAZINE.COM DIGITAL EDITION HELMET BUYER'S GUIDE 5 "I am happy to say," said Robert Cantu, an expert in the field of brain trauma at Boston University, "that we will never return to the day when a child is knocked out of a game and is brought back in and is cheered for his toughness."