Exercise and Recovery Time for Youth With Concussions

Chrisman, Sara P D

doi:10.1001/jamapediatrics.2018.5281

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…We suspect that this is because prescribed sub-threshold aerobic exercise treatment reduced recovery time such that a pre-intervention predictor variable of exercise intolerance was no longer valid. There is emerging research to suggest that light to moderate physical activity that does not exacerbate symptoms is beneficial for patients with concussion and reduces recovery time (18, 38, 40–42). In a recent randomized placebo-controlled trial, (24) we showed that sub-threshold aerobic exercise prescribed in the sub-acute phase after SRC safely and significantly reduced recovery time from a median of 17 to 13 days.…”

Section: Discussionmentioning

confidence: 99%

The Predictive Capacity of the Buffalo Concussion Treadmill Test After Sport-Related Concussion in Adolescents

et al. 2019

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The Buffalo Concussion Treadmill Test (BCTT) identifies the heart rate threshold (HRt) of exercise tolerance in concussed patients. A previous study found that an absolute HRt of < 135 bpm was associated with prolonged recovery (>30 days) from sport-related concussion (SRC). In this study, we assessed the relationship of ΔHR (difference between resting HR and HRt) and recovery from SRC. Using a retrospective cohort design, we compared acutely (<10 days since injury) concussed adolescents who were prescribed either (1) relative rest (RG, n = 27, 15.2 ± 1 years, 33% female, median 17 days to recovery, ΔHR = 69.6 ± 28 bpm), (2) a placebo-stretching program (PG, n = 51, 15.4 ± 2 years, 49% female, median 17 days to recovery, ΔHR = 60.9 ± 22 bpm), or (3) sub-threshold aerobic exercise (AG, n = 52, 15.3 ± 2 years, 46% female, median 13 days to recovery, ΔHR = 62.4 ± 26 bpm). Linear regression showed that ΔHR significantly correlated with duration of clinical recovery for RG ( p = 0.012, R 2 = 0.228) and PG ( p = 0.011, R 2 = 0.126) but not for AG ( p = 0.084, R 2 = 0.059). ΔHR values were significantly lower in participants with prolonged recovery (>30 days) in RG ( p = 0.01) and PG ( p = 0.04). A ΔHR of ≤50 bpm on the BCTT is 73% sensitive and 78% specific for predicting prolonged recovery in concussed adolescents who were prescribed the current standard of care (i.e., cognitive and physical rest).

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Section: Discussionmentioning

confidence: 99%

The Predictive Capacity of the Buffalo Concussion Treadmill Test After Sport-Related Concussion in Adolescents

et al. 2019

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C onCussion, and its potential long-term health concerns and complications, remains a public health concern. 1 Often referred to as mild traumatic brain injury, concussion is a brain trauma defined as a complex pathophysiological process resulting from a transient disturbance of brain function. 2 Of particular concern is the effect concussions may have on the developing pediatric brain.

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mentioning

confidence: 99%

“…2 Of particular concern is the effect concussions may have on the developing pediatric brain. 1 The true incidence of pediatric concussion is unknown, as it relies entirely on patient self-report, but it is estimated that 16% of 10-year-olds have required medical attention for a head injury. 3 Further, there are approximately 700,000 emergency department visits for pediatric traumatic brain injury each year in the US, with up to 1.8 million sport-related concussions in children and adoles-ABBREVIATIONS ADHD = attention-deficit hyperactivity disorder; ImPACT = Immediate Post-Concussion Assessment and Cognitive Testing…”

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confidence: 99%

Association of time to initial clinic visit with prolonged recovery in pediatric patients with concussion

Eagle¹,

Puligilla²,

Fazio-Sumrok³

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVENo studies to date have investigated the role of early clinical care in time to recovery from concussion in a pediatric population. The purpose of this study was to investigate the role of clinic presentation timing (≤ 7 days [early] compared to 8–20 days [late] from injury) in concussion assessment performance and risk for prolonged recovery (> 30 days) in pediatric concussion.METHODSThis study is a retrospective cross-sectional study from a concussion clinic between April 2016 and January 2019, including 218 children and adolescents with diagnosed concussion, separated based on clinic presentation timing following injury: early (≤ 7 days) and late (8–20 days). Outcomes were recovery time, Postconcussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Vestibular/Ocular Motor Screen (VOMS), and demographics, medical history, and injury information. A general linear model and chi-square analyses were used to assess differences between early and late presentation, along with logistic regression, to predict prolonged recovery (> 30 days).RESULTSThose with early presentation reported higher symptoms on VOMS subtests (79%–85%) compared to those with late presentation (61%–78%), with the exception of near-point of convergence distance and visual motion sensitivity (VMS). The strongest predictor of prolonged recovery was number of days to first clinic visit (OR 9.8). Positive VMS (OR 5.18), history of headache/migraine (OR 4.02), and PCSS score (OR 1.04) were also predictive of prolonged recovery.CONCLUSIONSDespite patients in the early presentation group presenting with more positive VOMS scores, the early presentation group recovered sooner than patients in the late presentation group. Even after controlling for vestibular dysfunction, history of headache or migraine, and total symptom severity, days to first visit remained the most robust predictor of recovery > 30 days. These findings suggest that early, specialized medical care and intervention for children and adolescents with recent concussion is associated with normal recovery time. Clinicians should educate children and parents on the potential importance of early treatment to improve the odds of positive outcomes following concussion.

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“…A recent randomized controlled trial [107] of over a hundred acutely concussed adolescents showed a significant reduction in recovery time from a median of 17 days in the placebo group to a median of 13 days in the aerobic exercise group (p = 0.006). This study is a turning point and will affect the approach to concussion treatment worldwide [108].…”

Section: Treatment Of Pcsmentioning

confidence: 99%

Post Concussion Syndrome

Haider¹,

Bezherano²

2019

Traumatic Brain Injury - Neurobiology, Diagnosis and Treatment

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Post-concussion syndrome (PCS) is a complex disorder and the complete pathophysiology is still not completely understood. PCS can be subcategorized into physiological PCS, vestibulo-ocular PCS, cervicogenic PCS, and mood-related PCS based on predominant clinical signs and symptoms. Physiological PCS is the most classic type of PCS and is due to global metabolic dysfunction in the brain which affects the autonomic nervous system (ANS) and cerebral blood flow (CBF) autoregulation. This is suspected to be the cause for symptom-limited exercise intolerance which is a characteristic finding in this subtype. In this chapter we discuss the definition of PCS and the main subtypes. We further discuss possible causes for symptoms of PCS based on research that have studied this disorder using advanced imaging, cardiovascular and cerebrovascular metrics, and intracranial pressure. Finally, we discuss the treatment of PCS and the possible long-term effects.

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Exercise and Recovery Time for Youth With Concussions

Cited by 6 publications

References 16 publications

The Predictive Capacity of the Buffalo Concussion Treadmill Test After Sport-Related Concussion in Adolescents

The Predictive Capacity of the Buffalo Concussion Treadmill Test After Sport-Related Concussion in Adolescents

Association of time to initial clinic visit with prolonged recovery in pediatric patients with concussion

Post Concussion Syndrome

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