Impact of Exercise on Clinical Symptom Report and Neurocognition after Concussion in Children and Adolescents

Abstract

Recovery from concussion in childhood is poorly understood, despite its importance in decisions regarding return to normal activity. Resolution of post-concussive symptoms (PCS) is widely employed as a marker of recovery in clinical practice; however, it is unclear whether subtle impairments persist only to re-emerge in the context of increased physical or cognitive demands. This study aimed to examine the effect of strenuous exercise on clinical symptom report and neurocognition in children and adolescents after PCS resolution after concussion. We recruited children and adolescents with concussion (n = 30) on presentation to an Emergency Department (ED). At Day 2 and Day 10 post-self-reported symptom resolution, participants completed a strenuous exercise protocol, and pre- and post-exercise assessment of PCS and neurocognition. Results demonstrated an overall reduction in PCS from Day 2 to Day 10 post-symptom resolution, with no evidence of symptom increase after strenuous exercise at either time point. Neurocognitive performance was linked to task complexity: on less cognitively demanding tasks, processing speed was slower post-exercise and, unexpectedly, slower on Day 10 than Day 2, while for more demanding tasks (new learning), Day 2 exercise resulted in faster responses, but Day 10 processing speed post-exercise was slower. In summary, we found the expected recovery pattern for PCS, regardless of exercise, while for neurocognition, recovery was dependent on the degree of cognitive demand, and there was an unexpected reduction in performance from Day 2 to Day 10. Findings provide some suggestion that premature return to normal activities (e.g., school) may slow neurocognitive recovery.

Exertional Tolerance Assessments After Mild Traumatic Brain Injury: A Systematic Review

“…Seven studies included samples with a mean age or age range of less than 18 years, 17–22 while the other seven utilized samples with a mean age of 18 years or older. 23–29 Four studies used a sample consisting of only athletes, 23–25, 30 three studies reported using a combination of athletes and non-athletes, 27, 28, 30 and seven studies were unclear in their reporting of athletes versus non-athletes within their samples.…”

“…23–29 Four studies used a sample consisting of only athletes, 23–25, 30 three studies reported using a combination of athletes and non-athletes, 27, 28, 30 and seven studies were unclear in their reporting of athletes versus non-athletes within their samples. 17–20, 22, 26, 29…”

“…Five studies performed exertional assessments with participants who were in the relatively acute post-concussion phases (1–3 weeks post injury). 18, 22–25 Seven studies used a sample of participants who were in a more sub-acute to chronic phase of recovery (3 weeks or more post injury). 17, 26–31 One study was a retrospective chart review that included exertion testing examples in both acute and more chronic patients.…”

“…19, 20, 26–28 Seven of the studies used various forms of a cycle ergometer, or stationary bicycling test. 17, 22–25, 29, 31 One study utilized either a treadmill or cycle, depending on patient presentation and preference. 30 One study evaluated Nintendo Wii games.…”

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

“…This group also completed the same exercise protocol at 10 days post-symptom resolution, with additional test measures (WASI, BRIEF and CHQ) also completed at that time. See Manikas et al) [28]. The HC group were assessed on a single occasion on which they completed all testing.…”