in a concussion protocol you need a certain number of symptom clear days (plus other things) to move forward to the next stage. the clock for that resets with a recurrence of symptoms.
i don't actually know the nhl concussion protocol so i could be mistaken. i am familiar with applying them for teen amateur athletes. those are probably more conservative than the nhl because i imagine nhl teams have quick access to neurologists and more sophisticated testing and assessment.
I think it is unique to each situation but the protocol seemed to imply the Consulting Neuropsychologist is not brought in until
after the patient has gone through the stages and is ready to return to play. Of course nothing would prevent the team from bringing in the CN earlier.
From the
2016/2017 Protocol (latest I could find, not sure how much changed since then):
VI. MANAGEMENT OF CONCUSSION Concussion symptoms might develop immediately after a blow to the head or body; or they might evolve over time (hours or days). Consequently, Players diagnosed with a concussion, and those who are suspected of having a concussion, should be monitored and evaluated over time. Players who are diagnosed with a concussion should undergo an initial period of rest until symptoms have subsided to the point where activity can be gradually introduced without significantly exacerbating symptoms or provoking new symptoms.
Players shall then proceed through a graded progression of activity (see Zurich II Consensus Statement). However, each Player’s concussion shall be managed on an individualized basis; there is no particular program of graded progression, nor is there a minimum period of time for progression from one step to the next in the graded exercise progression.
VII. POST-CONCUSSION NEUROPSYCHOLOGICAL EVALUATION
Once a Player diagnosed with concussion is determined by the Club Physician to be free of concussion-related symptoms at rest and upon exertion, he shall be referred to the Club’s Consulting Neuropsychologist (or, if on the road, a Consulting Neuropsychologist from another team) for a post-concussion evaluation. This evaluation shall occur prior to the Player engaging in an unrestricted practice (wearing a regular colored jersey) or game. The Club’s Consulting Neuropsychologist’s post-injury evaluation shall consist of ImPACT and the NHL Paper and Pencil neuropsychological test battery. In order to facilitate this evaluation, Club Consulting Neuropsychologists should be advised as soon as a Player is diagnosed with a concussion. Club Consulting Neuropsychologists should be provided with baseline and post-injury X2 app data and narratives/reports of the acute medical evaluation, as well as subsequent symptom tracking for review as part of the post-injury assessment. A Club Physician may request a neuropsychological evaluation prior to full symptom resolution only when compelling clinical reasons exist for doing so (e.g., prolonged recovery, complex clinical presentation).
Once complete, the Club Consulting Neuropsychologist shall convey the results of the evaluation to the Club Physician or Club Athletic Trainer (preferably both). Although neuropsychological test data are very useful in assessing the neurocognitive sequelae of concussion, they should not be used in isolation to make the diagnosis of concussion or as the sole determinant for return to play.
VIII. RETURN TO PLAY A Player who is diagnosed with a concussion shall not return to practice or a game on the same day that the event occurred, irrespective of how quickly his symptoms resolve. A Player may return to unrestricted play at a time later than the day the event occurred if the following three circumstances have occurred: (1) there is complete recovery of concussion-related symptoms at rest; (2) there is no emergence of concussion-related symptoms at exertion levels required for competitive play; and (3) the player has been judged by the Club’s Physician to have returned to his neurocognitive baseline following an evaluation by the Club consulting neuropsychologist.
There is no mandatory period of time that a Player must be withheld from play following a concussion, as the return to play decision is based on the individual circumstances of that Player. The Club Physician remains solely responsible for making return to play decisions based on these parameters, including in circumstances where the Player is referred to a consultant for management and treatment. Prior to making the return to play decision, the Club Physician shall ensure that all aspects of the Protocol have been satisfied, including referral for neuropsychological assessment.