The Clinical Assessment for Sports Exertion (CASE) addresses the physical performance of athletes by quantifying physiological and symptomatic responses to dynamic exertion. The CASE is highly sport-specific as it tests multiple body positions that mimic requirements typical of individual and contact sports activities including soccer, gymnastics, cheerleading, swimming, and basketball. It was developed by clinicians at the Baylor Scott and White Sports Concussion Program in an effort to identify specific system impairments in athletes who were unable to successfully demonstrate readiness for return to play protocols. Like the other published forms of concussion exertion testing described above, the CASE is a provocative exercise test that may also prove to be useful in making informed return-to-play decisions based upon the athlete's symptomatology.

Inclusion Criteria:

• 10-22 years of age who have participated in organized sport activities within the past 12 months
• Diagnosed with a concussion according to international concussion in sport group criteria
• Asymptomatic at rest and must be cleared from return-to-play by a qualified healthcare professional no later than 30 days following clearance

Exclusion Criteria:

• Orthopedic or neurologic, or other limitations
• History of seizures
• Previous or current diagnoses for cardiopulmonary conditions
• Medical diagnosis of diabetes and/or currently on medications for diabetes (e.g., insulin)
• Uncontrolled asthma
• Pregnancy
• Currently experiencing symptoms of COVID-19 or < 7 days since last symptoms
• History of moderate or severe traumatic brain injury defined as a brain injury with an associated Glasgow Coma Scale score of 12 or less
• Symptom score >1 point on initial PCSS intake
• A current diagnosis of and treatment with medication for attention-deficit/hyperactivity disorder, learning disorder, depression, anxiety, or a history of more than 3 prior concussions
• Limited English proficiency
• Currently taking prescription medication for concussion related impairments
• Anticoagulant or antiplatelet use
• History of a medical condition that mimics the signs and symptoms of prolonged concussion symptoms (eg, history of chronic headaches, active migraines, cardiovascular conditions)