Cognitive and physical symptoms of concussive injury in children: a detailed longitudinal recovery study

Crowe, Louise; Collie, Alex; Hearps, Stephen; Dooley, Julian; Clausen, Helen; Maddocks, David; McCrory, Paul; Anderson, Vicki

doi:10.1136/bjsports-2015-094663

Cited by 43 publications

(28 citation statements)

References 35 publications

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“…First, the sample size is modest and restricted our capacity to explore our findings in more detail and may have led to lack of sensitivity in our analyses. There were also significant variations in time to symptom resolution, although this is in keeping with previous research [12,20]. We do note, however, that our findings were generally consistent and suggest an overall benefit of exercise for participants with concussion compared to healthy controls.…”

Section: Cognitive Performancesupporting

confidence: 91%

“…Concussion, sometimes referred to as mild traumatic brain injury (TBI) accounts for more than 85 % of all TBI [11]. Approximately 1/2 of these concussive injuries are sustained during sports and leisure activities [5,10,12]. While most adults recover completely from a concussive injury within two weeks, there is concern that the developing brain may be more vulnerable, even to very mild injury, resulting in children and adolescents demonstrating more protracted post-concussion recovery [2].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Moderate Exercise on Post-concussive Symptoms and Cognitive Function after Concussion in Children and Adolescents Compared to Healthy Controls

et al. 2018

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Resolution of post-concussive symptoms (PCS) is a marker of recovery. However, it is unclear whether subtle impairments re-emerge in the context of increased demands. This study examined the effect of strenuous exercise on clinical symptoms and cognitive efficiency in children and adolescents after PCS resolution following concussion. We recruited concussed children and adolescents (n=30) on presentation to an Emergency Department (ED), and compared them to community-sourced non-injured controls (n=30), matched for age, and cognitive function. At Day 2 post symptom resolution, concussed participants (and controls) completed an exercise protocol, and pre- and post exercise assessments of PCS and computer-based cognitive efficiency. Findings demonstrated that, compared to controls, participants with recent concussion showed an overall reduction in PCS post-exercise (p=0.048), less impact of exercise on PCS than controls (p=0.021), and faster reaction times on computer-based cognitive tasks, even where cognitive demands were high (ps<0.05). These results provide preliminary support for the use of moderate exercise for the reduction of concussion post-symptom, as suggested in recent clinical guidelines.

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Section: Cognitive Performancesupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Impact of Moderate Exercise on Post-concussive Symptoms and Cognitive Function after Concussion in Children and Adolescents Compared to Healthy Controls

et al. 2018

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“…5 The length of recovery following a concussion varies, lasting anywhere from 1 week to several months. 6,7 Risk factors that can lead to increased recovery time include a history of 1 or multiple concussions and a greater number, severity, and duration of symptoms after the injury. 7 More recent literature suggests that children and adolescents between the ages of 10 and 17 years display a gradual reduction of postconcussive symptoms over a 30-day time span following the injury.…”

Section: Discussionmentioning

confidence: 99%

“…The neurocognitive computerized testing scores returned to baseline levels by day 30. 6 With this being said, simply following the current return-to-play guidelines with only resolution of an athlete's physical symptoms may not be enough to warrant a safe return to play. A previously concussed athlete may be symptom free and returned to a neuropsychological baseline; however, the athlete may continue to have prolonged neurological abnormalities that could have resulted in disqualifying them from being ready to return to such a sport as evident by neurocognitive computerized testing.…”

Section: Discussionmentioning

confidence: 99%

Chiropractic Management of Musculoskeletal Symptoms in a 14-Year-Old Hockey Player With Postconcussion Symptoms: A Case Report

Olson

Tunning

Boesch

2016

Journal of Chiropractic Medicine

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Objective: The purpose of this study is to describe the chiropractic management of a student athlete with postconcussion syndrome. Clinical Features: A 14-year-old male hockey player presented to a chiropractic clinic with postconcussion symptoms 13 days after his initial injury. He experienced an occipital headache with a pain rating of 8/10, upset stomach, blurry vision, nausea, dizziness, balance problems, a "foggy feeling," difficulty with concentration, difficulty with memory, fatigue, confusion, drowsiness, and irritability. Prior to seeing the doctor of chiropractic, the patient was monitored by a medical doctor, and the care he had been receiving was in accordance with current concussion guidelines. At the time of presentation to the chiropractic clinic, he had failed to progress toward return to play, and his computerized neurocognitive testing scores had not improved. Intervention and Outcome: Chiropractic manipulative therapy, myofascial release, instrument-assisted soft tissue technique, and therapeutic exercises were provided over 5 treatments spanning a 20-day period. The patient followed up each treatment with ImPACT testing. At the conclusion of the treatments, the patient's computerized neurocognitive testing scores had improved, and the patient was returned to play. Conclusion: This case demonstrates the improvement of postconcussion syndrome in a 14-year-old male hockey player under chiropractic management. (J Chiropr Med 2016;15:208-213)

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“…Athletes aged 18 years and under may be more susceptible to concussion and take longer to recover, requiring a more conservative approach. [27][28][29][30][31][32] Return to learning should take priority over return to sport. School programs may need to be modified to include more regular breaks, rests and increased time to complete tasks.…”

Section: Children and Adolescentsmentioning

confidence: 99%

Australian Institute of Sport and Australian Medical Association position statement on concussion in sport

Elkington¹,

Hughes²

2017

Medical Journal of Australia

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Sport-related concussion is a growing health concern in Australia. Public concern is focused on the incidence and potential long term consequences of concussion. Children may be more prone to concussion and take longer to recover. The Australian Institute of Sport and the Australian Medical Association have collaborated to present the most contemporary evidence-based information in a format appropriate for all stakeholders. This position statement aims to ensure that participant safety and welfare is paramount when dealing with concussion in sport.First aid principles apply in the management of the athlete with suspected concussion, including protection of the cervical spine. Tools exist for use by members of the community, allowing identification of key symptoms and signs that raise the suspicion of concussion. Medical professionals should use the Sport Concussion Assessment Tool 3, in conjunction with clinical assessment for the diagnosis of concussion. Clinical assessment includes mechanism of injury, symptoms and signs, cognitive functioning, and neurological assessment including balance testing. In any situation where concussion is suspected, the athlete must be immediately removed from sport and not be allowed to return to activity until they have been assessed by a medical practitioner. "If in doubt, sit them out."A diagnosis of concussion requires immediate physical and cognitive rest, followed by a structured, graduated return to physical activity. Children require a longer period of recovery from concussion. Algorithms are provided for use by medical and non-medically trained stakeholders in the recognition and management of concussion.

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Cognitive and physical symptoms of concussive injury in children: a detailed longitudinal recovery study

Abstract: At 5 days postconcussion, the majority of children and adolescents experienced debilitating postconcussive symptoms. However, by 30 days postinjury, 90% demonstrated recovery to normal for both neurocognition and postconcussive symptoms.

Cited by 43 publications

References 35 publications

Impact of Moderate Exercise on Post-concussive Symptoms and Cognitive Function after Concussion in Children and Adolescents Compared to Healthy Controls

Impact of Moderate Exercise on Post-concussive Symptoms and Cognitive Function after Concussion in Children and Adolescents Compared to Healthy Controls

Chiropractic Management of Musculoskeletal Symptoms in a 14-Year-Old Hockey Player With Postconcussion Symptoms: A Case Report

Australian Institute of Sport and Australian Medical Association position statement on concussion in sport

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