Management Of Concussion In Children Research Articles

Role of nonpharmacological concussion management in children: systematic review of randomized controlled trials.

Concussion is a global public health problem that affects many children worldwide. Most patients present with postconcussion syndrome and normal brain imaging findings. Despite the high incidence of concussion in children, published research on nonpharmacological management is lacking and much more often concerns pharmacological interventions. This systematic review aimed to evaluate the role of nonpharmacological interventions in managing concussion based on randomized controlled trials. The PubMed, Scopus, Web of Science, and Cochrane databases were extensively searched for articles published between January 2013 and July 2023. A modified patient intervention, comparison, and outcome framework was used to construct the search strategy and eligibility criteria. Risk of bias was assessed using the Risk of Bias-2 tool. A total of 16 studies conducted between January 2013 and July 2023 were analyzed. Three studies were conducted in an acute care setting (<24-hour postinjury) involving rest, computer time, and doing nothing, while the other 13 studies were conducted in a chronic care setting (>24-hour postinjury) and included aerobic exercise, collaborative care intervention, cervical spine rehabilitation, education by physiotherapists, a hyperbaric oxygen therapy protocol, family intervention therapy, virtual reality, traditional occupational therapy, virtual rehabilitation, oculomotor control exercises, vestibular rehabilitation, coordination exercises, and balance exercises. This systematic review highlights the importance of nonpharmacological therapy in pediatric concussion cases. Active rehabilitation may yield promising outcomes. Another interesting approach may be useful in pediatric concussion management. However, this systematic review shows a lack of high-quality literature supporting nonpharmacological pediatric concussion treatments.

A Narrative Review of Soccer-Related Concussion Management in Children and Adults Over the Past 10 Years.

Soccer-related concussions (SRC) have increased despite an overall reduction of concussions across all sports activities. Few papers have studied the mechanism of injury, and have been mostly done in high-income countries or focused on small populations, preventing generalization.Our goal was to analyze the available data published about SRC over the past 10 years, independent of the country's income level. A narrative review was performed. The definition of sport-related concussion from the American Academy of Neurology and studies published between 2013 and 2023 were used. Of1210 articles, 45 met the inclusion criteria. The results showed that SRC was more frequent in females (57.6%) than males (44.3%). Player-to-player interaction was the most common mechanism of injury, with midfielders being the most affected position. The first providers to diagnose were certified athletic trainers, within the first 24 hours. Neurological evaluations, including SCAT (SportAssessment Concussion Tool) and ImPact (Immediate Post-concussion Assessment and Cognitive Testing), were included in 42.2% of the studies, with SCAT and ImPact specifically used in 15.5% and11% of cases, respectively. Need for hospitalization was found in 8.9% of participants and one player required surgical intervention. At the time of the concussion, confusion, dizziness, and amnesia were reported frequently. However, after the concussion, headaches and dizziness were prevalent. Follow-up data were included in 35.5% of the studies. On average, children missed 15 practice days and returned to school after 8 days. In conclusion, future research should focus on the circumstances around head-to-head injuries by age, sex, and level of professionalism as well as the importance of early diagnosis and careful follow-up, to protect the players and improve their outcomes.

\u201cWhat is the actual goal of the pathway?\u201d: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

BackgroundMultiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion.MethodsSemi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation.ResultsThe original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes.ConclusionApplication of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

Is There an Optimal Time to Initiate an Active Rehabilitation Protocol for Concussion Management in Children? A Case Series

To estimate the time frame during which initiating an active rehabilitation intervention (aerobic exercise, balance, and sport specific skills) after concussion contributed to improvement in symptoms at follow-up in children and adolescents who are slow to recover (symptoms persisting beyond 2 weeks) from concussion. Concussion clinic at a tertiary care pediatric teaching hospital. A total of 677 children and adolescents with concussion aged 7 to 18 years. Case series of participants starting active rehabilitation less than 2, 2, 3, 4, 5, or 6 or more weeks postconcussion. Symptom severity measured by the 22-item Post-Concussion Scale (PCS)-revised. All patients experienced significant improvement of symptoms while participating in active rehabilitation, irrespective of the start time postonset. Patients initiating active rehabilitation at 2 (P < .001) or 3 (P = .039) weeks postinjury demonstrated lower symptom severity at follow-up than those starting at 6 weeks or later. Patients starting at 2 weeks had lower symptom severity than patients starting less than 2 (P = .02), 4 (P = .20), or 5 weeks postinjury (P = .04). Lastly, patients starting less than 2 and 6 weeks or more postinjury yielded equivalent outcomes. The findings support the use of active rehabilitation in children and adolescents who are slow to recover from concussion. Participants starting active rehabilitation less than 2 weeks and up to 6 or more weeks postconcussion demonstrated significant symptom improvements, but improvement was observed in all groups, regardless of the time to start active rehabilitation.

Evaluation of an active rehabilitation program for concussion management in children and adolescents

ABSTRACTObjective: To estimate the extent to which post-concussion symptoms were influenced by participation in an Active Rehabilitation (AR) program (aerobic exercise, coordination drills, visualization and education) for children and adolescents who are slow to recover from concussion. A secondary exploratory objective included examining the influence of sex on symptom evolution.Methods: Analysis of prospectively collected data was performed on 277 youth who initiated an AR program, between three and four weeks post-injury at a Concussion Clinic in a tertiary care paediatric teaching hospital.Main outcome measure: Post-concussion symptom scale (PCSS) from Sport Concussion Assessment Tool-3 (SCAT 3).Results: Children and adolescents participating in an active rehabilitation program displayed improved post-concussion symptom severity at follow-up (median = 9.5) compared to pre-intervention (median = 18) (p < .05). Patients demonstrated improved physical, cognitive, emotional and sleep-related post-concussion symptoms (p < .05). Female sex was associated with an increased post-concussion symptom severity at follow-up.Conclusions: Youth experiencing persisting symptoms three to four weeks post-concussion demonstrated improved post-concussion symptoms scores (physical, cognitive, emotional and sleep related) with participation in an active rehabilitation program.

When is it time to start rehab? exploring the optimal timing to initiate active rehabilitation for concussion management in children and adolescents

ObjectiveEstimate the influence of time to initiation of active rehabilitation on post-concussion symptom (PCS) severity in youth who are slow to recover from concussion.DesignRetrospective analysis of a prospective cohortSettingConcussion clinic of a tertiary care Paediatric Trauma Centre in Canada.Participants569 youth (14.3±2.3 years) with persistent PCS. Clinic patients’ information is entered prospectively in a clinical database and participants were selected for this study if they 1) participated in the active rehabilitation program, and 2) had available PCS assessments at the intake and follow-up visits.InterventionActive rehabilitation consisting of: aerobic exercise, coordination exercises and, education/motivation. The intervention was initiated with a Physical Therapist in the Concussion clinic continued as a daily home program. The independent variable was time to initiation of the active rehabilitation program measured in weeks (2, 3, 4, 5, 6+).Outcome measureSymptom severity measured by the PCS scale of the SCAT3 at follow-up visit, 2 weeks after initiation of intervention.Main results: Patients initiating active rehabilitation 2 weeks post-injury were significantly less symptomatic at follow-up (Mdn PCS score=5) compared to those starting five (Mdn=17) and six weeks or more (Mdn=17.5) (p=0.0002). Those starting at 3 (Mdn=9) and 4 (Mdn=10) weeks also had significantly less severe symptoms compared to those starting 6 weeks or later (p&lt;0.05).ConclusionsThe findings suggest that children benefit more from active rehabilitation if it is initiated between two and four weeks post-injury, and have poorer outcomes if it is delayed beyond 6 weeks post-injury.Competing interestsNone.

Depression in youth recovering from concussion: Correlates and predictors

ABSTRACTObjectives: Although depression can be a serious consequence of concussion, little is known about the factors that predict depression and concussion recovery outcomes in children. The purpose of this study was to explore the risk and possible predictors of developing significant depressive symptoms in children recovering from concussion.Methods: A prospective cohort study was conducted in a paediatric tertiary care clinic. Depression data were collected from 92 children using the Children’s Depression Inventory-2 (CDI-2) screening tool. Correlations, t-tests and logistic regression were used to examine the associations between depression scores and demographic as well as injury-related factors.Results: Depressive symptoms were found in 22% of the children (T score on CDI-2 >65). Children with evidence of depressive symptomatology had significantly higher mean post-concussive symptom inventory (PCSI) scores in recovery (p = 0.004) than children who were not depressed. Variables of i) Sex; ii) hospital admission; iii) number of head injuries; iv) post-concussion symptom score and v) experience of prolonged symptoms were predictive of clinically significant CDI T scores, explaining 36% of the variation in the binary logistic model.Conclusion: Depression is commonly reported in this subset of children. High post-concussive symptom scores and hospital admission were strong predictors of depression. Screening for depression should be standard practice in concussion management in children and youth.

Fifteen minute consultation: a structured approach to the recognition and management of concussion in children and adolescents

Concussion is a disturbance in brain function caused by a direct or indirect force, which is transmitted to the head. The incidence of concussion is rising, and poor recognition of...

The evaluation and management of acute concussion differs in young children

BackgroundThere are many reasons why concussion in children needs to be considered different from adults. The Zurich (2008) recommendations on the management of concussion in children are restricted to children...

Sport-Related Concussion in Children and Adolescents

Sport-related concussion is a "hot topic" in the media and in medicine. It is a common injury that is likely underreported by pediatric and adolescent athletes. Football has the highest incidence of concussion, but girls have higher concussion rates than boys do in similar sports. A clear understanding of the definition, signs, and symptoms of concussion is necessary to recognize it and rule out more severe intracranial injury. Concussion can cause symptoms that interfere with school, social and family relationships, and participation in sports. Recognition and education are paramount, because although proper equipment, sport technique, and adherence to rules of the sport may decrease the incidence or severity of concussions, nothing has been shown to prevent them. Appropriate management is essential for reducing the risk of long-term symptoms and complications. Cognitive and physical rest is the mainstay of management after diagnosis, and neuropsychological testing is a helpful tool in the management of concussion. Return to sport should be accomplished by using a progressive exercise program while evaluating for any return of signs or symptoms. This report serves as a basis for understanding the diagnosis and management of concussion in children and adolescent athletes.

Management of Sports-Related Concussion in Children and Adolescents

Management of Sports-Related Concussion in Children and Adolescents

Consensus statement on Concussion in Sport—The 3rd International Conference on Concussion in Sport held in Zurich, November 2008

This paper is a revision and update of the recommendations developed following the 1st (Vienna) and 2nd (Prague) International Symposia on Concussion in Sport.1 2 The Zurich Consensus statement is designed to build on the principles outlined in the original Vienna and Prague documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A detailed description of the consensus process is outlined at the end of this document. This document is developed for use by physicians, therapists, certified athletic trainers, health professionals, coaches and other people involved in the care of injured athletes, whether at the recreational, elite or professional level. While agreement exists pertaining to principal messages conveyed within this document, the authors acknowledge that the science of concussion is evolving and therefore management and return to play decisions remain in the realm of clinical judgement on an individualised basis. Readers are encouraged to copy and distribute freely the Zurich Consensus document and/or the Sports Concussion Assessment Tool (SCAT2) card and neither is subject to any copyright restriction. The authors request, however that the document and/or the SCAT2 card be distributed in their full and complete format. The following focus questions formed the foundation for the Zurich concussion consensus statement: ### Acute simple concussion ### Return to play (RTP) issues

The Role of a School Psychologist in Concussion

School psychologists historically have received little training on topics such as mild traumatic brain injury or concussion, yet they could play a significant role in assessment, consultation, and intervention with students who have sustained a concussion. The purpose of this article is to educate school psychologists with regard to definition, prevalence, characteristics, and management of concussion in children, especially the various services that a school could provide to assist these students with their recovery. The article includes a case study that highlights the personal challenges faced by a student with concussion.