Development of a Conservative Protocol to Return Children and Youth to Activity Following Concussive Injury

Abstract

Implementation of these new pediatric recommendations is an important addition to prevention of subsequent concussions during vulnerable recovery periods, with potential to facilitate recovery by preventing prolonged symptomatology, and secondary sequelae.

Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature

“…The review of 400 possible articles included information from 10 studies and 3 Web sites; however, none of the guidelines were specific to the younger population. As a result of these findings, follow-up studies using the National Institute of Health and Care Excellence procedures were conducted to develop pediatric-specific return-to-activity 66 and return-toschool 65 protocols. These protocols take a more conservative approach, strive to find a balance between allowing the brain to heal and addressing the need to participate in some activity, and emphasize that different pathways are likely required during the recovery process.…”

“…These protocols take a more conservative approach, strive to find a balance between allowing the brain to heal and addressing the need to participate in some activity, and emphasize that different pathways are likely required during the recovery process. 66 After the development of the protocols, pilot testing was conducted with health care providers, and all strongly agreed that using the protocol changed their clinical practice, increased their knowledge, and enhanced their confidence in treating children with concussion. 66 Similar findings were noted among health care providers who pilot tested the return-toschool protocol: 95% strongly agreed that the protocol gave specific and clear directions for applying the recommenda-tions, 80% indicated that it increased their knowledge, and 85% strongly agreed that their confidence in managing children with concussion improved.…”

“…66 After the development of the protocols, pilot testing was conducted with health care providers, and all strongly agreed that using the protocol changed their clinical practice, increased their knowledge, and enhanced their confidence in treating children with concussion. 66 Similar findings were noted among health care providers who pilot tested the return-toschool protocol: 95% strongly agreed that the protocol gave specific and clear directions for applying the recommenda-tions, 80% indicated that it increased their knowledge, and 85% strongly agreed that their confidence in managing children with concussion improved. 65 These findings are positive and demonstrate a more evidence-based approach to developing return-to-activity progressions, but future authors needs to empirically evaluate how these approaches affect patient outcomes before protocols such as these are used routinely in clinical practice.…”

Post-concussion recovery in children and adolescents: A narrative review

“…2,20 However, the need for a child-specific protocol has previously been established. 52,53 Based on the 2013 Zurich Consensus Statement, 1 a number of organisations throughout the world have developed guidelines to facilitate post-concussion management by medical practitioners (Table 1). [54][55][56][57][58][59][60] They offer different recommendations for the management of adults and children.…”

“…The AIS/AMA position statement errs on the side of caution, given the lack of clear scientific evidence and the need to provide safe advice to the grass-roots sporting community. 53 However, management should be according to the pattern of recovery 53 and individualised clinical judgement will continue to influence management decisions. 2 Concussion research progresses at a fast pace and the synthesis of new studies into clear evidence-based protocols in a timely manner is challenging; however, a major effort is being made to regularly translate research to guidelines for clinical practice.…”