Post-concussion Return to Shooting Progression for Military Service Members: A Scoping Review and Conceptual Framework.

ABSTRACT

INTRODUCTION: There are established protocols for staged return to physical activity in sport and military settings following concussion. Currently, there is no evidence-based staged return to shooting protocol in use by the U.S. military despite the unique challenges and stresses shooting places on the vestibular-ocular and cognitive systems often disrupted by a concussion. The primary purpose of this scoping review was to summarize available evidence and current practices on return to shooting post-concussion, with the goal of optimizing an evidence-based return to shooting protocol for military service members. Our secondary aim was to identify individuals who may benefit from a return to shooting progression. MATERIALS AND METHODS: A comprehensive search of PubMed, SPORTDiscus, and Google Scholar was performed from the earliest dates to April 2023. A gray literature (Google) search was also performed. Articles were included if they studied a population with concussion, addressed return to shooting, and were written in English. Articles were excluded if they discussed health conditions other than concussion, focused on non-shooting interventions, did not use human subjects, or were written in a language other than English. RESULTS: Our search strategy yielded 134 articles 1 article met our inclusion and exclusion criteria, whereas the other 133 articles were rejected. The gray literature search yielded one item. CONCLUSIONS: Based on our results, there is insufficient evidence to inform current practices on return to shooting post-concussion. In the absence of a published return to shooting protocol, we offer recommendations for identifying individuals who may benefit from a return to shooting progression and a revised version of a U.S. Army Special Operations Command Return to Range Progression. This protocol follows a conceptual framework for progression for variables such as environment, weapon type/caliber, and shooter position/movement. Further research is needed on identifying individuals who may benefit from a return to shooting protocol and safely and effectively progressing these individuals through a return to shooting protocol post-concussion.