68 (3A) Exploring the impact of ADHD on concussion recovery in adolescent athletes

Methods Head acceleration exposure during 11-weeks of practice was characterized across training events, level, and body region contacted for 18 women's artistic gymnasts, ages 11-15.Gymnasts were later asked to perform skills from common skill progression pathways.Biomechanical data were compared across skills within pathways.Guided by the Intervention Mapping framework, ten stakeholders (i.e., coaches, parents, clinicians, athletes) were engaged to incorporate consensus statements, our biomechanical evidence, and their experience working with gymnasts to co-create a biomechanically-informed, post-concussion return to gymnastics protocol: REBOUND.Results Over six months, we co-created the REBOUND guidelines, which involve progression of activities across four domains (impact, rotation, impact + rotation, and skill connections).A skill bank specifies stage-based recommendations, informed by our biomechanical evidence, for 44 common gymnastics skills.Critical components of REBOUND include tolerance checkpoints, stop signs to indicate advancement decisions, clear indication of when head contact is allowed, and indicators for following up with their provider.Finally, levelspecific guidance is provided via exemplar practice plans.Additional materials were also created to bridge the knowledge and language gaps between athletes, coaches, parents, and clinicians by providing multiple complementary material sets using gymnastics-specific and lay terminology.Conclusion Results of this study demonstrate the value of using biomechanical data to inform skill progressions, and engaging stakeholders in the co-design process to develop sport-specific return to sport strategies.Future research will evaluate the efficacy of REBOUND.